week 5: substance abuse disorder

____________- problematic pattern of use leading to distress/impairment

substance use disorder

_______________: pt has developed a reversible-specific syndrome related to recent ingestion of a substance

Substance use

______________: pt is continuously using a substance without regard to negative consequences including psychological and physiological symptoms

substance use disorder

substance-induced disorder: __________________

-Recent ingestion

-Problematic behavior and psychological effects

-Specific symptoms for each substance

-Symptoms not explained by other condition

intoxication

substance-induced disorder: __________________

-Cessation or reduced in heavy/prolonged use

-The specific symptoms for each substance

-Causes clinically significant stress or impairment

-Symptoms are not explained by other condition

withdrawal

substance-induced disorder: __________________

-Symptoms of a specific mental disorder

-Evidence of BOTH.... Onset within 1 month of intoxication AND withdrawal

-Not explained by other condition

-Not only during delirium

-Significant stress or impairment

Other substance/medication induced mental disorder

Biological etiology (3)

-__________

-Dysfunction in ____________ system

-______

Genetics, reward, pain

Psychological etiology (3)

-_____________

-Psychiatric _____________

-_____________ conditioning

Impulsivity, comorbidity, classical

Sociological etiology (4)

-______ onset of substance use

-_________ hx

-Early __________ to substance use

-______________ strain

Early, trauma, exposure, financial

SUD assessment--- biological domain (9)

Toxicology

Nutrition status

Cardiovascular

GI/liver

Integumentary

Reproductive

Musculoskeletal

Neurologic

Immune

SUD assessment--- psychological domain (4)

Suicidality

Aggression

Mood (depressed, euphoric, anxious, irritable, labile)

Concentration

SUD assessment--- sociological domain: (5)

Relationships and social support

Risk for harm to others

Legal involvement

Access to care

Cultural norms for substance use

Analysis and prioritization-- put these in order:

1. Safety risk withdrawal

2. Safety risk of intoxication

3. Chronic health risks

4. Basic physical needs (food, shelter)

5. Psychiatric comorbidities

6. Suicide risk

2, 1, 6, 4, 5, 3

Non-pharmacologic tx for substance use disorder: GROUP MANAGEMENT INCLUDE:

1

2

3

SBIRT, Peer support, Family support

Non-pharmacologic tx for substance use disorder: INDIVIDUAL MANAGEMENT INCLUDE:

1

2

3

Motivational interviewing, Individual psychotherapy, Contingency management

________________- involves using rewards or incentives as individual reinforcements for positive behaviors, such as abstinence from substance use

type of Individual intervention for SUD

Contingency management

SBIRT= ___________________

is a type of group intervention for SUD

screening, brief intervention, & referral to tx

alcohol withdrawal assessment:

typically begins _________ hrs after last drink and peaks at _________ hrs

6-8, 24-48

these are s/s of ___________ (early or late) alcohol withdrawal:

-Autonomic hyperactivity, tremors, diaphoresis, N/V, headache/fullness, tachycardia, hypertension, piloerection

-Neuropsychiatric (agitation, anxiety, disorientation, confusion, hallucinations-visual or tactile)

Early → 0-48 hr after last drink

these are s/s of ___________ (early or late) alcohol withdrawal:

-Delirium

-Seizures

-Coma

Late → 48-72 hours after last drink- Delirium tremens (DTs)

s/s of Delirium tremens:

1

2

3

Delirium

Seizures

Coma

delirium tremens usually occurs ___________ hr after last drink

48-72

Management: alcohol withdrawal:

1

2

3

4

5

6

VS

Seizure precautions

CIWA assessment

Fall precautions

Re-orientation as needed

Administer medication as ordered: Benzodiazepines

Medication to manage BP/HR

Vitamin infusions

Medications for alcohol use disorder:

___________→ partial opioid agonist, reduces cravings

Naltrexone

Medications for alcohol use disorder:

____________→ MOA unknown but thought modulate GABA

Acamprosate

Medications for alcohol use disorder:

____________→ causes severe N/V if alcohol is ingested

Disulfiram

Medications for alcohol use disorder:

____________ (off-label) → multimodal, exact MOA unknown but thought to increase GABA activity

Topiramate

Management of alcohol intoxication (5):

VS

Resp support as needed

Positioning to prevent aspiration

Fall precautions (risk for injury from falls)

Hydration

ACUTE adverse effects of opioids: _____________

resp depression and sedation

Assessment: opioid intoxication or withdrawal? ________________

VS, Analgesia, Euphoria, Constricted pupils, Sedation, Psychomotor retardation, Urinary retention, Constipation, Pruritus cyanosis

intoxication

Management: Opioid intoxication

1

2

3

1. VS - RR and SpO2

2. Airway management- oxygenation, aspiration risk

3. Administer reversal agent as needed- narcan

Assessment: opioid intoxication or withdrawal? ________________

VS→ high HR, high BP

Dilated pupils

Yawning

Diaphoresis

Lacrimation

Diarrhea

Stomach cramping, N/V

Myalgia

Insomnia

Anxiety

Psychomotor agitation

withdrawal

Management: Opioid withdrawal

1. __________ assessment protocol

2. Maintain ___________

3. __________ care

4. Supportive __________

Cows, hydration, Perianal, meds

ACUTE adverse effects of stimulant pharmacology:

1

2

3

4

5

hyperthermia, cardiac arrhythmia, MI, seizure

Stimulant use----- intoxication or withdrawal? ________________

-high HR, BP, RR

- Pupil dilation, blurred vision, nystagmus

-diaphoresis

-insomnia

-psychosis(paranoia, tactile and visual hallucinations)

-mood lability

-agression

-Reduced appetite

-Increased energy

intoxication

Stimulant use----- intoxication or withdrawal? ________________

-Fatigue

-Anxiety

-Impaired cognition

-Mood swings confusion

-Insomnia

-Vivid dreams

withdrawal

Management of stimulant intoxication (6)

CV monitoring

Maintain safety of pt and others

Maintain hydration and nutrition

Reduce environment stimuli

Encourage rest

Therapeutic communication (validate emotions, do not argue with delusions, reassure physical safety)

ACUTE adverse effects of PCP:

1

2

3

4

cardiac arrhythmia, seizure, coma, rhabdomyolysis

PCP intoxication or withdrawal? ________________

-no clinical manifestations

withdrawal

PCP intoxication or withdrawal? ________________

High HR and BP

Pupil dilation, nystagmus

Insomnia

Psychosis (paranoia, tactile & visual hallucinations)

Mood lability

Aggression

Increased energy

Analgesia

Impulsivity

Muscle rigidity

intoxication

Management of PCP intoxication (6)

Monitor CV status, maintain safety of pt and others, monitor creatine kinase, hydration, reduce environment stimuli, encourage rest

Medications for opioid use disorder (MOUD) (3):

Methadone, buprenorphine, naltrexone

Pharmacologic tx for nicotine withdrawal (2):

Bupropion, Varenicline

Management of nicotine withdrawal (5):

Nicotine replacement therapy (patch, gum, nasal spray)

Offer candy/gum/mints

Relaxation techniques

Dirstractio

Pharmacologic tx

Assessment for moderate alcohol intoxication (8):

Disinhibition

Lack of coordination

Unsteady gait

Slurred speech

Slowed reaction time

Impaired attention

Blurred vision

Nystagmus

Assessment for severe alcohol intoxication (3)

N/V, resp depression, coma

Substances that have medically serious withdrawal:

Stimulants, steroids, inhalants (nicotine), sedatives/hypnotics

SUD Harm reduction:

- always carry ___________

- utilize __________

-Use only ___________

-Never use ___________

-Start with small amount and go slow

-Use less after period of ___________

-Supervised consumption sites

-co-prescribe___________ with opiates

-_________ screening, tx, and education

Narcan, Test strips, one substance at a time, alone, abstinence or reduced tolerance, narcan, STI

Harm reduction: inhalation---Smoking

-Use mouthpiece and filter with pipe

-Don't share mouthpiece or pipe

-Avoid use of homemade pipes

Harm reduction: inhalation---snorting

-Rotate nostrils

-Use sterile straw

-Grind substance

-Use water or nasal spray