2. Anti-craving agents such as naltrexone (Revia): Decreases the
desire for alcohol by interfering with neurotransmitter systems
that produce pleasurable effects. 11, 12
3. Acamprosate (Campral): Antagonizes the actions of alcohol
and reduces the desire to drink heavy alcohol. 11, 12 Has been
shown to double the likelihood of successful abstinence. 11
4. Anticonvulsants such as topiramate (Topamax, Qudexy),
carbamazepine (Tegretol, Carbatrol, Equetro), and valproic
acid (Depakote, Depakene, Stavzor): 11, 12 These drugs may be
beneficial for cocaine dependence as well. 11
The dental health professional should be able to provide education and referrals for patients with a suspected chemical dependency problem. Dental local anesthesia with vasoconstrictors
should be used with caution, especially for patients with a known
dependency to stimulants. 11 Larger doses of local anesthesia may
be necessary as they tend to quickly “wear-off” in this population. 5 This is due to the increase in liver enzyme systems that are
common in people who abuse chemical substances, which alters
metabolism. 12 These patients will metabolize and break down the
vasodilators and vasoconstrictors present in dental local anesthesia faster than what is considered normal. 5
Alcohol mouth rinses should be avoided in patients who
are in recovery for fear of relapse. 11 Complete abstinence from
substances is needed for successful long-term recovery. 11 For
patients with infections or altered immune responses, power
instruments (ultrasonics, air polishing, high-speed handpieces)
should be used with caution due to the creation of aerosols. 11 It
is also important for the dental health provider to remember that
this population may have impaired healing due to decreased immune functions. 11 Patient education should consist of nutritional
counseling, abuse risk to overall health status, oral cancer risk,
need for routine oral care, and fetal risk factors. 11
Chemical dependency is a growing public health concern globally. The economic burden of chemical dependency will continue to grow if nothing is done to change current prevalence
and relapse rates. Dental care providers are well positioned in
the health-care community to identify chemical dependency
problems. Appropriate, timely, and compassionate referrals will
increase a patient’s chance for a successful recovery.
1. International Narcotics Control Board. (2014). INCB Report
2013: Economic Consequences of Drug Abuse. Retrieved
Hopkins. (n.d.). Substance Abuse/Chemical Dependency.
3. Temme L, Fenster J, Ream G. Evaluation of meditation
in the treatment of chemical dependency. Journal of
Social Work Practice in the Addictions. 2012; 12:264-81.
doi: 10.1080/1533256. X.2012.70632.
4. Harris JL, Munsell CR. Energy drinks and adolescents:
what’s the harm? Nutrition Reviews. 2015; 73( 4):247-57.
5. Weinberg Pharm Book.
6. James J. Dealing with drug-seeking behavior. Aust Prescr.
2016; 39( 3), 96-100. doi: 10.18773/austpescr.2016.022.
7. Gundersen DC. The legalization of marijuana:
Implications for regulation and practice. Journal of
Nursing Regulation. October 2015; 6( 3): 34-38.
8. Meredith SE, Juliano LM, Hughes JR, Griffiths RR.
Caffeine use disorder: A comprehensive review and
research agenda. Journal of Caffeine Research. September
2013; 3( 3): 114-130. doi: 10.1089/jcr.2013.0016.
10. Mayo Clinic. Nutrition and healthy eating: Caffeine
content for coffee, 9. tea, soda, and more. n.d.;
Retrieved from www.mayoclinic.org/healthy-lifestyle/
11. Zucconi S, Volpato C, Adinolfi F, et al. Gathering
consumption data on specific consumer group of energy
drinks. External Scientific Report for European Food
Safety Authority. 2013; Retrieved from http://www.efsa.
12. Wilkins E. Clinical Practice of the Dental Hygienist. (12th
Ed.), Wolters Kluwer, 2016.
13. Hitner H, Nagle B. Pharmacology: An Introduction. (6th
Ed.). McGraw Hill, 2010.
14. Deneke E, Knepper C, Green BA, Carnes PJ.
Comparative study of three levels of care in a substance
use disorder inpatient facility on risk for sexual addiction.
Sexual Addiction & Compulsivity. 2015. 22:109-125. Doi:
15. Centers for Disease Control and Prevention. Emergency
Department Visits for Drug Poisoning: United States,
2008–2011. 2016; Retrieved from https://www.cdc.gov/
16. Efird LM, Miller DR, Ash AS, Berlowitz DR, Ozonoff A,
Zhao S, Reisman JI, Jasuja GK, Rose AJ. Identifying the
risks of anticoagulation in patients with substance abuse.
J Gen Intern Med. 2013; 28( 10):1333-9. doi: 10.1007/
17. Centers for Disease Control and Prevention. (2016).
Illegal drug use. Retrieved from https://www.cdc.gov/
18. Centers for Disease Control and Prevention. (2016).
Drug-poisoning deaths involving heroin: United States,
2000–2013. Retrieved from https://www.cdc.gov/nchs/
19. Centers for Disease Control and Prevention. (2015). Use
of selected substances in the past month among persons