Substance Abuse Disorders

Patients with unhealthy alcohol use are frequently seen in the primary care setting for 

insomnia and/or anxiety.

Benzodiazepines (eg, lorazepam, midazolam) are the preferred agents for managing 

PCP-associated agitation; before giving benzos, make sure they’re in a low stimulus environment

calm and cooperative the first day, restless and agitated the second day, and manifestations of sympathetic hyperactivity (eg, elevated blood pressure, tachycardia, diaphoresis, and tremor) all lead to

alcohol withdrawal

Cocaine use disorder can present with 

anxiety, irritability, mood swings, grandiosity, and psychotic symptoms such as paranoia or hallucinations; you will see erythema of nasal mucosa

cocaine withdrawal can cause 

 acute depression with suicidal ideation

Anticholinergic toxicity from doxepin should be considered in patients with 

 altered mental status, tachycardia, and hyperthermia; the main cause of death is arrythmia, so get ECG

Serotonin syndrome is characterized by the triad of 

mental status changes, autonomic dysregulation, and neuromuscular hyperactivity

Inhalant abuse usually occurs in boys age 14-17, can involve one of several common household chemicals, and is characterized by 

rapid onset and short duration of intoxication, euphoria, and loss of consciousness.

When profound CNS depression, respiratory compromise, or vital sign derangements are seen, 

coingestion with other sedative-hypnotics/CNS depressants (eg, alcohol) should be suspected.

If there’s someone who’s in denial about how much they drink, it’s best to see what

third parties like family and friends think

Abrupt cessation of alprazolam, a short-acting benzodiazepine, is associated with risk for

generalized seizures and confusion.