substance abuse

classification of substances

alcohol

caffeine

cannabis

phencyclidine

inhalants

opioids

sedative hypnotics or anxiolytics

stimulants

tobacco

disorders associated with substance and alcohol use

psychosis

bipolar

depression

anxiety

sleep disorders

biggest drug problem in the US

alcohol

alcohol use disorder

major cause of health issues around the world

a leading cause of death and disability in the US: cirrhosis, cardiovascular damage, cancer (breast, mouth, esophageal)

multivariate model- genetic predisposition

withdrawal can be lethal- CNS irritability, delirium tremens; chlordiazepoxide (librium), diazepam (valium)

blood alcohol concentrations

0.05- euphoria, “feels good”, disinhibition

0.08- DUI in MS, LA

0.15- labile mood, talkative

0.2- decreased motor skills, slurred speech

symptoms and effects of alcoholism

cirrhosis, hepatitis

peripheral neuritis

GI irritation

pancreas- pancreatitis

muscles: weakness, wasting

eyes

heart: irregular heart rate, stroke, high blood pressure

reproductive system

withdrawal and detox of alcohol

stage 1: initial s/s including h/a, nausea, anxiety, agitation, hallucination, and even seizures intensify and then diminish

stage 2: delirium tremens (DTS) is one of the most serious symptoms of alcohol withdrawal, sometimes causing death if not treated

stage 3: post acute withdrawal syndrome (PAWS) is a constellation of s/s such as depression, fatigue, and drug cravings

opioids (narcotics)

morphine, codeine, heroin, hydromorphone, methadone

relieve pain by increasing the pain threshold and reducing anxiety

euphoria

heroin- higher abuse potential

CNS- respiratory depression

peripheral nervous system- constipation, urinary retention, hypotension, reduced pupil size

opioids (narcotics) overdose

stupor, unresponsive

skin is wet and warm

coma- respiratory depression

skin is cold and clammy

pupils dilate

death quickly follows

priority- airway, assisted ventilation, admin of naloxone intranasal

CNS stimulants

cocaine

amphetamines

hallucinogens

cocaine

from cocoa plant

blocks dopamine reuptake- immediate high

euphoria, increased alertness, anorexia, tachycardia, intense paranoia, sexual stimulation

snorting causes nasal septal perforation

tachyarrhythmias and coronary artery spasm

death- metabolic and respiratory acidosis, hyperthermia

crack cocaine

processed- less expensive

immediate high followed by an almost immediate crash

immediate withdrawal after using- severe depression, suicide

withdrawal:

• physical- mild

• psychological- severe

• need medical supervision

amphetamines

methamphetamine (meth)

• derived from pseudoephedrine or ephedrine

• prolonged high

• bad crash

• paranoia, hallucinations, violent rage, face is sallow, itchy lesions, tooth rot, stringy hair

ecstasy:

• popular club drug

• promotes lessening of inhibitions, feelings of closeness to others

• heightened sexual feelings

• tachycardia, HTN, anorexia, dry mouth, teeth grinding

releases NE, blocks dopamine reuptake; restlessness, dizziness, agitation, insomnia, palpitations, tachycardia, HTN

overdose: death from cardiac arrhythmias and respiratory collapse; tx induce vomiting, acidification of urine, forced diuresis

physical withdrawal is mild, psychological is severe, the low of withdrawal is in proportion to the high of the drug

hallucinogens

marijuana

sense of well being

altered perceptions

relaxes, increases hunger

antiemetic effects

other: bronchitis, weak heart contraction, anxiety, paranoia, panic, impaired memory

side effects: impaired balance and stability, short term memory and decision making, concentration, dry mouth, tachycardia, dilated pupils, conjunctival irritation, keener sight/hearing

assessment of a chemically dependent pt

absenteeism

increased accidents

looks spaced out

frequent bathroom breaks

flushed face

watery, red eyes

missing meds

drowsy, slurred speech

amount and type of AOD, including prescriptions

med problems associated with AOD in pt and family members

blood and urine screens (prevents AOD minimization)

look for suspicious s/s- tremors might indicate alcohol withdrawal

use screening tests

interview approaches for these pts

use manner that encourages forthrightness- matter of fact, nonjudgmental

be prepared for defensiveness- genuine concern helps overcome this

be aware of own feelings and avoid projecting negative attitudes onto pt

get accurate information- when did you have your last AOD? date and time?

initially focus on legal drug use- caffeine, nicotine

cycle of change

precontemplation- no intention on changing behavior

contemplation- aware a problem exists but with no commitment to action

preparation- intent on taking action to address the problem

action- active modification of behavior

maintenance- sustained change; new behavior replaces old

relapse- fall back into old patterns of behavior

principles of drug addiction tx

addiction is a complex but treatable disease

no single tx is appropriate for everyone

tx must be readily available

effective tx must attend to multiple needs

remaining in tx for adequate time is critical

individual and group counseling

med can be an important element

needs may change

co morbidity mental disorders must be addressed

first stage- medically assisted detox

tx must be voluntary to be effective

drug use during tx must be continually monitored

tx programs should assess for HIV, Hep B and C, and TB

psychopharmacology

naltrexone

acamprosate

disulfiram

milieu management

safety- drug free environment, suicide prevention

structure- active, meaningful schedule

balance- confrontation with support

limit setting- protects pt from self and others

norms

environmental modification

recovery groups in the community

alcohol addiction:

• 12 step program

• AA

• alateen for children/teens of alcoholic parents

drug addiction:

• NA