addiction, substance abuse disorders

Substance disorder occurs when

There is an underlying change in brain circuitry that may persist after detoxification

Narcotics

Fentanyl, heroin, hydromophone, methadone, opium, oxycodone

Stimulants

Amphitamines, cocaine, khat, methamphetamine

Depressants

Barbiturates, GHB, rohypnol, benzodiazepines

Hallucinogens

Ecstacy/MDMA, ketamine, LSD, peyote, mescaline, psilocybin

Designer drugs

Bath salts, K2/spice, synthetic opioids

Substance use is higher in

SMI such as schizophrenia, bipolar disorder, etc

Early intervention is key and includes

Initiation occuring before age 21, adolescent focused prevention and screening are essential

Perception influences behavior (if they think its safe, they will do it)

Risk awareness campaigns that target perception can reduce substance use among youth

High rates of ilicit drug use among adolescents with MDE highlight the need for

Integrated mental health and substance use screenings and interventions

Risk factors for substance use

Genes, mental disorders, environment (chaotic homes, abuse, parents use and attitudes, peep influences, poor school achievement, community attitudes)

Cause of substance use

Genetics, personality traits, conduct problems, peer use, environmental, family

Family response to substance use and abuse

loss of jobs and family relationships, legal issues, codependency, poor family relationships, family members in recovery need to distance themselves from users

SUD based on DSM-5

Pattern of substance use leading to impairment or distress as manifested by 2 more sx within 12 months

Recurrent substance use resulting in failure to fulfill life roles

Recurrent use that is dangerous

Use despite having recurrent social problems

Tolerance

Need for markedly increase amounts to reach desired effect bc they don’t achieve same effect with the amount they have been using

Withdrawl

Same substance is taken to releive or avoid withdrawal and in larger amounts or over a longer period than intended

In withdrawal there is

Persistent desire or unsuccessful efforts to cut down or control

Craving or strong desire or urge to use

Great deal of time is spent trying to obtain substance

Alchohol (CNS depressant) effects

Sedative anesthetic, metabolized by liver and excreted through lungs, skin, kidneys

Intoxication level of alcohol

BAL is greater than or equal to 0.08%

Alcohol is

CNS depressant

Binge alcohol use is

5 or more drinks at same location or at least one day in past 30 days

Heavy alcohol use is

5 or more drinks on same occasion on five or more in the past 30 days

Effects of alcohol

Memory loss and dementia due to long term use, esophageal bleeding, lower level of nitric oxide, liver cirrhosis, irregular heart rate, muscle wasting, stomach ulcers, gastritis, hepatitis

Psychological effects of long term use

Tolerance, alcohol induced amnestic disorders

Alcohol withdrawal syndrome

Occurs within 4-12 hrs after person stops drinking. Peaks in intensity during 2nd day and improves by 4th/5th day

Stage 1 MILD AWS

Anxiety, tremor, insomnia, headache, palpitations, GI disturbances

Stage 2 MODERATE AWS

mild symptoms, diaphoresis, increased SBP, tachypnea

Stage 3 AWS (delirum tremens)

Hallucinations, seizures, impaired attention, disorientation

Pts have AWS if they have 2 or more following sx of

Sweating, tachycardia, increased hand tremor, insomnia, N/V, anxiety, seizues (severe), auditory hallucinations or illusions

Delirium tremens

Life threatening, resolves in 3-4 days with tx

Delirium tremens s/sx

Tachycardia, diaphoresis, hypertension, confusion, tremor, disorientation, hallucinations, seizures

Long term use of alochol abuse will cause

Tolerance, cerebellar degeneration, blackouts

Wernickes encephalopathy

Reverisble, degenerative brain disorder caused by thiamine deficiency

Alcohol induced amnestic disorders

Wernickes encephalopathy, korsakoffs amnestic syndrome, wernicke-korsakoff syndrome

Korsakoff amnestic syndrome

Irreversible and follows wernicke, can’t acquire or retrieve memories so confabulation (make up stories), amnesia in an alert and oriented pt

Tx for korsakoff amnestic syndrome

Thiamine 100 mg PO q8-12h for 3-12 months

Med disorders from alcohol abuse long term

Cardiomyopathy, pancreatitis

Alcohol withdrawal can be

Life threatening, monitor vitals and withdrawal sx

Mded tx for acute sx of withdrawal

Valium 5-10 mg q2-4h, librium 25-100mg q4h, ativan 2-10 mg q4-6h and PRNs such as antidepressants, antipsychotics and sleep meds

Benzodiazepines

Valium, librium, ativan

Aside from med tx for acute sx of alcohol withdrawal, can also give

Vitamin B, thiamine, folic acid, magnesium sulfate

Meds for long-term/non-acute withdrawal sx

Disulfiram, naltrexone, acamprosate, topriamate

Disulfiram (antabuse)

Innterferes with degration of alcohol, elevates liver enzymes

SE of disulfiram (antabuse)

Flushing, nausea, and palpitations if pt drinks alcohol

Patient teaching for disulfiram (antabuse)

Use of alcohol in food products, OTC meds, cologne, skin products

Naltrexone

Reduces and suppresses cravings but must be off opioids for 2 weeks prior to starting med

Vivitrol is

Once a month injection fir treating alcoholism

Acomprosate

acts on the gamma-aminobutyric acid (GABA) and glutamate neurotransmitter systems and is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria

Barbituates

Nembutal, amytal sodium

Bnon-barbituate hypnotics

Chloral hydrate, methaqualone

Alcohol is

CNS depressant

Use of cocaine

Powdered form snorted or injected

Crack

Cocaine Processed into rock crystal and smoked

Effects of cocaine

Sudden burst of alertness, energy, self confidence, cocaine rush that lasts for 15-30 mins then become irritatable, tired, depressed, cravings

Long term effect of cocaine

Depletion of dopamine effect on reward system

Short term effect of cocaine

Increases level of dopamine and increase in norepinephrine (so will see tachy, htn, dilated pupils)

Rebound dysphoria

Seen in long term use of cocaine where highs are not as high so they need more cocaine

Intoxication of cocaine

First will see cns stimulation then CNS depression

Cocaine withdrawal tx

Dopamine agonist, cocaine vaccine, antidepressants

Ampetamine and cocaine is

CNS stimulant

Use of amphetamine

Treat obesity, used by students to stay, alert and study, truck drivers to stay awake

Effects of amphetamine

Block reuptake of norepinephrine and dopamine, affect CNS/PNS, release of newly synthesize Norepinephrine. Lesser effect on serotonin

Intoxication of amphetamine

tachycardia, arrhythmia, agitation, aggression, psychosis, impaired judgement, elevated HR/BP, dilated pupils

Withdrawl of amphetamine sx

Anxiety, depression, irritability, cravings, insomnia/hypersomnia, psychosis, SI

Nicotine effects

Mental stimulation, muscle relaxant

Nicotine side effects

Chronic lung disease, cardio disease, stroke, cancer, tolerance, addiction

Withdrawal effects of nicotine

Cravings, irritability, anxiety, difficulty clncentrating, decreased HR

Side effects of nicotine

Chronic lung disease, cardio disease, stroke, cancer, tolerance, addiction

Effects of marijuana

euphoria, relaxation, altered consciousness, increase sociability 

Side effects of marijuana

Memory impairments, slow reaction time, amotivational syndrome (I dont care attitude), increased appetite, paranoia, social withdrawal, visual hallucinations

Withdrawal sx of marijuana

Loss of appetite, depressed mood, restlessness, irritability, insomnia

Opioids is

Substances that binds to opioid receptors in the brain, stimulate release of amounts of dopamine

Withdrawl sx of opioids

Yawning, insomnia, irritability, rhinorrhea, panic diaphoresis, cramps, N/V. Peaks in 2-3 days, lasts up to 2 weeks

Overdose sx of opioids

Clammy skin, shallow respirations, pinpoint pupils, coma, death

Detoxification of opioids

Tapering with methadone or buprenorphine or discontinuing opioids and administering oral clonidine

Buprenorphine/suburex/suboxone is

Partial opioid agonist, supresses withdrawal sx and cravings, no euphoria, blocks effects of other opioids for at least 24 hours

Methadone

Full opioid, suppresses opioid withdrawal, reduces cravings, blocks effects of other problem opioids

Inhalants

Erasex, petrol, glue, paint, thinner solvents

Effects of inhalants

Euphoria

Side effects of inhalants

Dizziness, confusion, nystagmus, ataxia, depression, arrhythmia

Ecstacy/MDMA

increase in serotonin and excess dopamine release which results in hallucinations, confusion, depression, sleep problems, drug craving, severe anxiety

SE OF ecstacy

serotonin syndrome, hyperthermia, confusion, depression, sleep disturbance

Meth effects

Increase activity level, decrease appetite, euphoria bc release of excess dopamine

Opioids

oxycodone, hydrocodone, morphine, fentanyl, codeine

Addiction severity index (ASI)

most universally used instruments for assessment of substance abuse 

Labs in alcohol abuse

GGT, AST, ALT, LC, MCV, urine toxicology and blood screen

GGT is

liver enzyme, will be increased by heavy alcohol intake

MCV is

measures size of RBC,

What does it mean when GGT and MCV is elevated?

 raise suspicion about alcohol abuse 

Medical model

detox, abstinence/meds (antabuse→ prevent breakdown of etoh)

Cognitive model

develop and use positive coping skills. Skill training. Identify and change behaviors associated with addictive behaviors.

Relapse model

 ID situations and factors that = relapse 

Nursing interventions for substance use

• Therapeutic use of self

• Teach pt and family about substance abuse

• Encourage verbalization, expression of feelings

• Stress management and coping skills

• During detoxification monitor VS, admin meds, monitor I/O, fluids, nutritions, seizure precaution

Harm reduction model

policies, programs and practices that aim to reduce harms associated with the use of psychoactive drugs in people unable or unwilling to stop. 

When pt experiences cocaine intoxication first they experience

mental alertness and after 10-20 mins they experience intense let down effect with irritability and depression