FINAL Week 9: Substance Use

Concurent disorders

mental health + substance use problem (depression and alc, schizo and weed)

Practical level in harm reduction

pragmatic, realistic, low threshold

Conceptual level in harm reduction

value neutral of drug use and user, focuses on problems, doesnt insist on abstience

Policy level in harm reductionl

middle range, wide spectrum

Programs for harm reduction

needle exchange, methadone maintenance, outreach

Harm reduction strategies for alcohol

minimum drinking age, laws, DD programs, server interventions, LCBO hours

Harm reduction strategies for opioids

supervised injections, naloxone kits, decrimininaliztion

Harm reduction for tobacco

limiting access, nicotine replacement

Toronto drug checking services

offfer people who use drugs information about contents of their drugs

Factors that increase risk of severity

concurrent mental health, self medication, emotional distress, decreased coping, childhood abuse, family historty

Substances that are more addictive have

fast onset and short half life

Intoxication

the direct and immediate effects of taking substances

Tolerance

the need for increased amounts of substance to achieve intoxication

Withdrawal

occurs when reudicng or stopping a substance

Substance use

the ingestion or admin of psuchactive substance that can be beneficial or harmful

Substance use disordr

cluster of cognitive, behavioural, and physiological symptoms indicating the indiial continues the substance despite signficanct substance related problems

Substance use disoder categorization

10 substances

Substance induced categorization

intoxication and withdrawal

Substance use disorder diagnostic criteria

pattern of use with clinically significant impairment by at least 2 during 12 months - larger amounts, persistent desire, great deal of time spent obtaining, craving, interrupts work, continued use despite social issues, rec activies given up, use when hazardous, tolerence, withdrawal

Mild severity

2-3 symptoms

Moderate severity

4-5 symptoms

Severel 6+

Classes of psychoactive susbtances

depressents, stimulants, hallucinogens, anabolic steroids

Depressents phsyological signs

slowed HR, RR, decreased body temp, lowered BP, incoordination, unsteady gait

Depressents psychological signs

disorientation, confusion, irritability, slurred speech, drowsiness

Common depressants

alcohol, benzos, sedatives

Problamatic drinking

more than 14 or 9, no withdrawal, not neglect

Alchohol dependence

more than 40-60, withdrawal, neglect

Neurological presentations of alchohol use

tremors, ataxia, neuropathy, seizures, stroke

Cardiovascular presentations of alchohol use

HTN, cardiomyapthy, CAD

GI/hepatic presentations of alchohol use

gastritis, diarrhea, fatty liver, cirrosis

Reproductive presentations of alchohol use

impotence, menstural irregularities

MSK presentations of alchohol use

trauma, myopathy

Psychological presentations of alchohol use

insomnia, fatigue, depression, anxiety

Behavioural presentations of alchohol use

missed appointments, memory impairment

Social presentations of alchohol use

marital discord, family violence

Minor alcohol withdrawal

N/V, sweating, tremor, tachycardia, HTN

Intermediate alchohol withdrawal

seizures, dysrithmias, hallucinations

Major alchohol withdrawal

severe agitation, confusion, hallucinations, fevers

Primary goal for alcohol withdrawal pharm management

preventing seizures

What benzo given

diazepam unless elderly, opiod use, asthme then give lorazepam

Medications for helpt with cravings/relapse

acamprosate, naltrexone, disulfiram

Acamprosate

restores excitatory neurons, can cause N?V

Naltrexone

option receptor antagonist that reduces rewarding effects of alcohol

Disuldiram

acetaldehyde dehydrogenase inhibitor, causes unpleasant reaction, can cause metallic taste and dermatitis

Short acting benzo withdrawal

onset 24 hours of cessation, peaks at 1-2, lasts 7-21 days

Long acting benzo withdrawal

onset withing 5 days of cessation, peaks 1-9, lasts 10-28 days

Benzo withdrawal vital signs

tachycardia, htn, fever

Benzo withdrawal CNS

agitation, restlessness, anxiety, isnomnia, muscle tension, tremor, hallunicartions

Benzo withdrawal ears

tinnitis

Benzo withdrawal GI

anorezia, n/v

Benzo severe withdrawal

seizures, delirum, death

Opoid Intoxication effects

sedations, slowed breathing, low LOC

Opioid withdrawal flu like effects

muscle aches, cold sweats, cramping, runny nose, yawning

Fentanyl Onset, Peak and Nearly complete

3.5 hours, 8-12 hours, 4-5 days

Heroin onset, peak, and nearly complete

8-12h, 36-72h, 7-10 days

Methadone onset, peak, and nearly complete

24-72h, 5-6days, 14-21days

Opioid withdrawal symptoms management

OTC meds like advil, gravol, immodium

Purprenorphine +Naloxone

partial opiate that relieves opiate withdrawal symptoms for 24 hours and does not causew high

Methadone

full agonist opiate that relieves opiate withdrawal symptoms for full 24 hours, more risk of overdose because full agonist

Stimulants increase

CNS activity

Effects of stimulants

wakefulness, euphoria, decreased appetite, rapid HR, paranoia, delusion

Examples of stimulants include

cocaine, methampethamice, bath salts

Indicators of stimulant use behavioural

using BZD, opoids, or alc to come off, restlessness, euphoria, grandiose, paranoia

Indicators of stimulant use physiological

increased BP, rapid speech, alertness, pupils dilated, wrightloss, insomnia, dental problems

Smoking uppers effect

within 30 seconds

Injecting uppers

effects within 1-2 minutes

Snorting uppers

effects within 3-5 minutes

Stimulant withdrawal symptoms

crash, fatigue, mood swings, craving, paranoia, itching

Hallucinogens examples

marijuana, PCP, mushrooms

Key points for hallucinogens

variable response, first use psycosis

Transtheoretical model of change

readiness to change, precontemplation, contemplation, preparation, action, maintenance

Motivational interviewing OARSI

open ended questions, affirmations, reflect what pt is saying, summarize, informing