Week 9: Substance-Related and Addictive Disorders

What is Blood alcohol concentration (BAC)?

0.08-0.10 g/dL is considered alcohol intoxication

How do alcohol withdrawal symptoms change over time?

The symptoms get more severe over time (more hrs= worsening s/s)

What are s/s of alcohol withdrawal symptoms (CIWA)?

N/V, tremors, anxiety, agitation, sweats, headache, tactile/visual/auditory disturbance, orientation struggles

What are goals for alcohol withdrawal?

Safety! Control of agitation, decrease risk of seizures

What is counter-transference?

When a healthcare worker unconsciously displaces feelings related to significant figures in their past onto the patient

What is delirium tremens?

Most severe form of alcohol withdrawal that is considered a medical emergency that can result in death

What are some things that increase the likelihood of delirium tremens?

Hepatitis or pancreatitis

What are s/s of delirium tremens?

Agitation, increased anxiety, confusion, disorientation, coarse tremors, seizures, delusions, hallucinations, paranoia, hyperactivity

How do we prevent/treat delirium tremens?

Close monitoring of symptoms, labs, electrolytes, and VS; Hydration, medications, life support/sustaining measures

What is Wernicke encephalopathy?

Acute and reversible condition of decreased thiamine

What is Korsakoff syndrome?

A chronic and debilitating syndrome some may never recover from caused by continued lack of thiamine

What does SBIRT stand for?

Screening, Brief Intervention, and Referral to Treatment

What is dual diagnosis?

Co-occurring mental illness and substance use or addictive disorder

What is the CAGE screening tool?

Assesses the persons feelings about their substance use; A score of 2 or more is significant, although a score of 1 requires further assessment

What is the CAGE-AID Screening tool?

Same as CADE but Adapted to Include Drugs

What is the CRAFFT screening tool?

6 questions about actions and behaviors related to substance use

What is the AUDIT screening tool?

Alcohol Use Disorders Identification Test

What is acamprosate?

Medication that helps reduce alcohol cravings

What is diazepam and lorazepam?

Medications used for a high CIWA score (alcohol withdrawal symptom score); also used for seizures and delirium associated with delirium tremens (severe withdrawal)

What is disulfiram?

Medication that makes people very sick when alcohol is consumed; does not reduce cravings or treat withdrawal symptoms

What is thiamine?

What is naloxone?

Used to quickly reverse an opioid overdose; doesn’t cause any harm if they weren’t actually experiencing OD

What is buprenorphine?

Long-acting medication use to treat opioid use disorder

What is buprenorphine/naloxone?

Combination of a opioid and naloxone helps to reduce cravings, helps with withdrawal s/s, helps avoid overdose

What is methadone?

Not really used anymore but was used for opioid withdrawal; can be used for opioid maintenance for pregnant women to help limit health risks and create a more predictable outcome

How do fetus’ handle substance withdrawal?

They experience s/s of withdrawal that may be 2-3x as intense as the mother’s symptoms

What is naltrexone?

Used for alcohol and opioid use; reduces cravings and feeling of high with use; helps the patient stay sober

What is a substance use disorder?

Chronic but treatable brain disease with craving, seeking, and using regardless of consequences

What is Substance Use Disorder not?

Easy to manage, a personal weakness, a moral failing

What are the symptom groups of substance use disorder?

Impaired control, social impairment, risky use, and physical effects

What are biological aspects of addiction?

genetics, dopamine, brain structure and development, craving and relapse cycle, tolerance and withdrawal g

What is a dopamine surge?

When an individual uses a substance, the substance floods the brain with dopamine; taking it up to as much as 5-10 times the normal level

What does the cycle of alcohol and acetate look like?

Alcohol breaks down into acetate which triggers a craving for more acetate; acetate lingers in the body of alcoholic individuals which intensifies the craving for more acetate

What are environmental risk factors for addiction?

Chronic stressors, socioeconomic factors, anxiety, substance use in family or peers, exposure to abuse/trauma, access to an addictive substance, ineffective coping strategies

What is substance intoxication?

Overuse/excessive use of a substance that impairs judgement, behavior, social functioning, CNS changes, etc.

What is tolerance?

Using increasing amounts of substance over time to achieve the initial level of response

What is substance withdrawal?

Physiological symptoms that occur when a person stops using a substance

What do more intense withdrawal symptoms typically lead to?

More likely to lead to the person starting to use the subtstance again to avoid the symptoms

What are s/s of opioid intoxication?

Bradycardia, hypotension, hypothermia, sedation, pinpoint pupils, slowed movement, slurred speech, euphoria, calmness

What are s/s of opioid overdose?

Difficult to wake up or unconscious, slow/shallow respirations, lips are blue, skin is pale/cool/clammy

What do we do if opioid overdose is suspected?

Call 911 immediately if not at the hospital, administer naloxone (Narcan) if available

What are s/s of opioid withdrawal (COWS)?

Tachycardia, hypertension, increased respiratory rate, hyperthermia, insomnia, enlarged pupils, restlessness, bone or joint aches, anxiety, goosebumps

What medications are used for opioid withdrawal?

Methadone, clonidine, and buprenorphine/naloxone

What is opioid maintenance?

Mimics what dose/amount they had on the outside and then slowly work them down to a smaller dose/amount

What are the types of alcohol use disorder?

Mild, moderate, and severe depending on the amount of symptoms