Substance Abuse Disorders

Addiction

• A state of chronic or recurrent intoxication characterized by psychological dependence.

• The person is emotionally dependent on a drug, is able to obtain a desired effect from the specific dosage, and experiences withdrawal symptoms after he stops taking the drug

Alcoholism

• It is the inability to stop drinking that seriously alters a normal living pattern.

• Cessation of drinking or a reduction in intake results in withdrawal symptoms.

Codependence

Behaviors exhibited by significant others of a substance-abusing individual that serve to enable and protect the abuse at the exclusion or personal fulfillment and self development

Craving

Strong, overpowering urge for drugs felt by an individual who abuses or is dependent on drugs

Drug dependence

Condition occurring when individuals exhibit a set of behaviors associated with inability to control use of a drug

Substance abuse

Maladaptive pattern of use of a drug in situations of real or potential harm

Tolerance

It is an acquired resistance to the effects of a drug and is defined in DSM IV as either needing to increase drug dosage to achieve a given effect or finding decreasing effect from a continued, fixed dosage

Withdrawal

It is a condition occurring when cessation of drug use results in a drug-specific set of symptoms that would be relieved by additional doses of the drug

• Develop tolerance to drug effects

• Manifest withdrawal from a drug

• Use more drug than intended

• Try persistently or unsuccessfully to cut down the use

• Spend significant amount of time using or trying to obtain the drug

• Give up important activities because of the drug

• Continue to use a drug despite knowing it is causing physical or psychological problems

Behaviors associated with drug dependence: TWUT SGC

stimulation of dopamine secretion

All drugs of abuse have one thing in common

Cocaine

blocks the mechanism of which dopamine is reabsorbed into the cells that release dopamine

Amphetamines

provoke the release of dopamine

Nicotine

acts on a receptor for the neurotransmitter acetylcholine and may prevent the enzyme monoamine oxidase from breaking up the dopamine molecule.

Opiates

act as receptor sites for the brain’s own morphine-like substances

Sedatives

hypnotics, alcohol and barbiturates, and benzodiazepines act in various parts of the brain on neurons that release GABA, which direct neurons to quit firing.

stress hormones

Some are predisposed to addiction because of high level of ____ hormones

Learning theory

Behavioral theorists believe that addiction is the result of the positive effect or mood alterations that one experiences using drugs or alcohol

Social theories

• The potential for addiction is affected by economic conditions, formal and informal control, cultural traditions, and the companionship and approval of other drug users.

• Peers and their values are particularly strong influences.

• Experimentation, curiosity, rebellion, and boredom

oral and infantile

Many theories believed that substance abusers are fixed in ___ and _____ level of development.

immediate gratification

Abusers tend to seek ____ _______ of needs

• Low self-esteem

• Feelings of dependency

• Low tolerance for frustration and anxiety

• Antisocial behavior and fear

Characteristics of addictive personality: LFLA

12-14 years old

Age of first drink

14-18 years old

Age first intoxicated

18-25 years old

Age of first minor alcohol problem (Missed school or work due to drinking behavior)

28-30 years old

Usual age of first major problem (lost job because of drinking problem)

40 years

Usual age entering treatment

55 years old

Usual age of death (leading causes: heart disease, cancer, accidents, suicide)

any

Year abstinence alternates with active drinking

10-30 percent

“Spontaneous remission” rate or response to nonspecific interventions

• Phase 1: Pre-alcoholic

• Phase 2: Early alcoholic

• Phase 3: True alcoholic

• Phase 4: Chronic alcoholic

4 Phases of drinking behaviors in alcoholics: PETC

Phase 1: Pre alcoholic

• Drinks because of social motivations

• Finds that alcohol relieves stress

• Over time, needs to increase the amount of alcohol needed for relief

• May be told by others that his drinking is too heavy or too frequent

• Can be described as the “non -addicted heavy drinker”

Phase 2: Early alcoholic

• Begins to drink alone

• Becomes preoccupied with the supply with drinks

• Hides bottles of alcohol at work, home or car

• Wakes up in the morning and needs a drink to control tremors (the eye opener)

• May experience blackouts (memory loss for immediate past events)

• Uses denial s a defense mechanism and does not admit to being dependent on alcohol.

Phase 3: True Alcoholic

• Completely loses control over ability to choose whether or not to drink

• goes out on binge-drinking episodes; stops drinking only when too sick to take another drink

• Experiences the following: isolation from others, aggression, loss of interest in any activity that once brought pleasure, impotence, frigidity, nutritional impairment

• In this phase, most who were gainfully employed have lost their jobs, many have lost their families, and all have lost their self-esteem

Phase 4: Chronic alcoholic

• Over time, the individual’s continuous use of alcohol leads to extensive emotional disorganization.

• May exhibit impairment of reality testing; regression; and/or loss of a sense of ethics

• Physically the individuals exhibits disorders of the CNS (bilateral, progressive neuritis of the lower extremities; temporary nerve palsies, liver and vascular disease

12-month period

You can diagnose alcohol dependence if there’s at least 3 or more of the stated symptom in ___ month period

one or more

You can diagnose alcohol abuse if the individual exhibits __ or more of the following symptoms in 12-month period

• Recurrent drinking of alcohol resulting in a failure to fulfill major role obligations at work, school or home.

• Recurrent drinking in situations in which it is physically hazardous.

• Recurrent alcohol-related legal problems

• Continued use despite having persistent or recurrent social or interpersonal problems caused by alcoholism

Alcohol abuse

The individual exhibits one or more of the following symptoms in 12-month period: RRRC

Alcohol intoxication

Occurs after the ingestion of alcohol and is evidenced by behavioral changes such as impaired social and occupational functioning, fighting, or impaired judgment

• Mood changes

• Increased verbalization

• Impaired speech

• Irritability

• Slurred speech

• Lack of coordination

• Unsteady gait

• Nystagmus

• Impaired memory

• Stupor

• Coma

Characteristics of Alcohol intoxication: MIII SLUNISC

several hours or days

Client experiences clinical symptoms of alcohol withdrawal within _____ after the cessation or reduction of heavy and prolonged alcohol consumption

Delirium Tremens

it is referred to as alcohol withdrawal delirium

24-72 hrs.

Delirium Tremens occurs ___ hours after the client’s last drink

• Increased VS

• Restlessness

• Tremulousness

• Agitation

• Hyper-alertness

• Incoherent speech

• Sensory misinterpretation

Alcohol withdrawal delirium

Characteristics: IRTAH IS

Alcohol-induced persisting dementia

Chronic alcoholism can develop alcoholic dementia

Permanent brain damage

In alcohol-induced persisting dementia, _______ may occur

• Severe loss of intellectual ability

• Impaired memory, judgment, abstract thinking

Symptoms of alcohol-induced persisting dementia: SIJA

Korsakoff psychosis

Dementia with profound loss of recent memory

• Amnesia

• Dementia

• Psychosis

• Confabulation

• Disorientation

Symptoms of Korsakoff psychosis: ADPCD

Supportive care

Treatment for Korsakoff psychosis

Poor for cognitive recovery

Prognosis of Korsakoff Psychosis:

Wernicke’s encephalopathy

delirium with cranial nerve dysfunction

thiamin deficiency

cause of Wernicke’s encephalopathy

• Ataxia

• Peripheral neuropathy

• Mental status changes

• Paralysis of EOM leading to disconjugate gaze

Symptoms of Wernicke’s encephalopathy: APMP

Thiamin administration

Treatment for Wernicke’s encephalopathy:

excellent with early thiamin administration

Prognosis of Wernicke’s encephalopathy:

Alcoholics Anonymous

• It is a self-help organization of persons who become together to assist each other in dealing with their drinking problems.

• It is nonprofessional, self-supporting, non-denominational, apolitical and multicultural organization

• The AA program is based on the 12 steps that offer the individual a way of living without alcohol.

any time

AA’s 12-Step approach follows a set of guidelines designed as “steps” toward recovery, and members can revisit these steps at ___ ___

• Benzodiazepines

• Carbamates

• Barbituarates

• Barbituarate-like hypnotic

Sedative-hypnotic, or anxiolytic-related disorder includes: BCBSA

• Slurred speech

• Drowsiness

• Drunken appearance

• Stagerring gait

• Quick temper

• Quarrelsome disposition

• Death

Overdose of Sedative-hypnotic or anxiolytics: SDDS QQD

Barbituarates

are use for committing suicide and the most difficult disorder to cure

• Blues

• Rainbows

• Yellow jackets

• Downers

Street names: BRYD

• Morphine

• Demerol

• Dilaudid

• Codeine

• Heroine

Opioid-related disorders include: MDDCH

• Tolerance

• Physical dependence

• Habituation

• Addiction

Chronic abuse results in: TPHA

alcoholics

Psychologically, most opiate addicts show a similarity to ___ in some aspects of their personality; they are emotionally immature, dependent, hostile, and aggressive, and they take drugs to relieve inner tensions

avoidance

Opiate addicts sometimes differ from alcoholics in that the former handle their feelings passively, by _____ rather than by acting out; choosing drugs seems to suppress these inner tensions

Amphetamines and cocaine

has stimulating effect upon the user

When these drugs are chronically and compulsively abused, they result in tolerance and habituation.

Cocaine

is the most addictive drug known to man

general fatigue and depression

Amphetamines and cocaine:

When the drug is withdrawn, _____ and _____ occur, along with changes in sleep EEG pattern

vivid hallucinations; persecutory delusions

Amphetamines and cocaine:

Chronic use can cause toxic psychosis, characterized by ______ and ______

overweight and depressed

Amphetamines and cocaine are used by ____ and ____ individuals

Marijuana

Cannabis-related disorders:

____ is the most widely used illegal drug

18-25

Most users of marijuana are from ____ year age range

cannabis sativa

Marijuana is a common plant with a biologic name of _____ ____

Marijuana (cannabis)

It acts as a stimulant or depressant and is often considered to be a mild hallucinogen with some sedative properties

rolled cigarette

Persons who abused marijuana usually smoke it in pipe or as a ____

15 minutes; 2-4 hours

Marijuana or cannabis:

Quick action about ___ minutes and the effect is about __ hours

psychological dependence

Marijuana/Cannabis:

Not physically addicting but it may lead to

Hallucinogen- and phencyclidine

They are referred to as ‘mind benders’ or psychedelic drugs affecting the mind causing changes in perception and consciousness.

• Lysergic acid diethylamide (LSD)

• Mescaline

• Dimethyl-tryptamine (DMT)

• 2,5 dimethoxy-4- methyl amphetamine (STP)

• Psilocybin

Examples of Hallucinogen and Phencyclidine: LMD2P

• Increased distortion of senses

• Loss of the ability to separate fact from fantasy

• Loss of sense of time

• Ambivalence

• Inability to reason logically

Effects of Hallucinogen and Phencyclidine to CNS: ILLAI

Inhalant-related disorders

These are chemicals that give off fumes or vapors and, when inhaled, produce symptoms similar to intoxication

confusion, excitement or hallucinations

Inhalant related disorders:

When inhaled may produce _____, _____, ____ CEH

• Glue

• Gasoline

• Lighter fluid

• Paint thinner

• Varnish

• Shellac

• Nail polish remover

• Aerosol-packaged products

Commonly abused inhalants: GGLP VSNA

• Coffee

• Soda

• Tea

• OTC analgesics

• Cold remedies

• Stimulants

• Weight loss aids

Caffeine comes in variety of sources such as: CSTOC SW

Nicotine,

___ the active ingredients in tobacco, is a stimulant that elevate one’s blood pressure and increases one’s heartbeat

near the nurses’ station; partially lighted

A safe environment: client safety is given priority especially when he exhibits symptoms of overdose, intoxication, or withdrawal.

• When hospitalized should be placed _____ so that client can be observed closely.

• Reduced stimuli by placing client in a _____ room to prevent injury

IV therapy

Stabilization of medical condition:

• Promote adequate nutrition and hydration because the client is at risk for fluid and electrolyte imbalance.

• Monitor vital signs and measure intake and output

• If the client is vomiting, ____ may be necessary

• Cardiac monitoring is also necessary

staff splitting

Stabilization of behavior:

• Clients who abuse substances are often manipulative and prone to ____.

• They should be placed in secured, and controlled environment

• Methadone

• LAAM

• Naltrexone

Medication management for Heroine: MLN

• Methadone

• LAAM

Medical management

Narcotic drug:

• Disulfiram

• Naltrexone

• Benzodiazepines

Medical management for Alcohol: DNB

• Diazepam

• Haloperidol

Medical management for Hallucinogens: DH

Diazepam

Sedatives:

inpatient unit

Sedatives:

Detoxification should occur on an ____ ___

Haloperidol

Medical management for Inhalants:

• Ammonium chloride

• Antipsychotic

• TCAs

• Diazepam

• Propranolol

Medical management for Amphetamines: AATDP

• hyperpyrexia

• benzodiazepines, haloperidol

Phencyclidine:

• Hospitalization: as death may occur secondary to ___

• IV medications such as _____, _______

• Antihypertensive drugs

• Ammonium chloride, ascorbic acid, cranberry juice

• Anxiolytic

• Antipsychotic

• Antidepressant

Medical management for Cannabis: AAA

Aversion therapy

• It consists of giving a drug such as emetine and then following it with alcohol.

• Nausea and vomiting are induced by emetine, causing and aversion to alcohol based on the reflex association between alcohol and vomiting

Disulfiram (antabuse)

Interferes with the breakdown of alcohol, causing an accumulation of acetaldehyde, a by-product of alcohol in the body