Week 8: Addiction and Substance Abuse Disorders

general addiction definition

obsession, compulsion, or loss of use with respect of a drug with genetic, psychosocial, environment factors that influence its development.

substance induced disorders examples

intoxication, withdrawal, there’s others I guess.

substance abuse etiology

sociocultural view, psychodynamic view (dependency needs, self - medication), behavioral (classical conditioning), biological view

biological view of substance abuse

limbic system dopamine, basal ganglia motivation, amygdala anxiety and irritability, prefrontal cortex, genetic predisposition, biochemical factors, reward deficiency syndrome

addiction risk factors

mental illness, stress, genetics, peer pressure, abuse

addiction protective factors

positive family support, caregiver involvement, positive relationships, employment, community resources

alcohol biological effects

GABA agonist, legal intoxication 0.08-0.10 g/dL. withdrawal → delirium tremens (DTs). 0.2-confusion, 0.3-stupor, 0.4-coma, 0.5-death

alcohol withdrawal

early as 4-6 hr, peak after 24-48 hr. hyperalertness, jerky movements, irritability, easily startled, “shaking inside”

withdrawal delirium

peaks 2-3 days, lasts 2-3 days. medical emergency. tachycardia, diaphoresis, elevated blood pressure, visual/tactile hallucinations, hyperexcitability/lethargy, paranoid delusions, agitations, fever

alcohol related medical problems

CNS - wernicke’s encephalopathy, korsakoff’s psychosis. GI - esophagitis, gastritis, pancreatitis, hepatitis, cirrhosis. TB, FAS, cancer

alcohol overdose + tx

cardiovascular + resp depression. tx lavage/activated charcoal, vitals, patent airway, IV fluids.

alcohol withdrawal tx

gradual reduction. drugs - thiamine for encephalopathy, magnesium sulfate for seizures, anticonvulsants (topiramate), disulfiram, naltrexone reduces craving, acamprosate, ondansetron 5HT3 antagonist, SSRIs maybe, folic acid + vitamins

antianxiety abuse

enhances GABA, usually used to enhance alcohol or help anxiety in combination with cocaine + stimulants (uppers and downers). overdose tx - gastric lavage. withdrawal tx - gradual reduction

date rape drugs

gamma hyroxybutyrate (GHB - cns depressant), flunitrazepam (benzo), ketamine (anesthetic). rapidly produce disinhibition, rapidly product relaxation of muscles, lasting anterograde amnesia, potentiated by alcohol

CNS stimulants examples

coke, amphetamine, methylphenidate (ritalin), pemoline (cylert), phentermine (anorectic), ephedrine/ma huang, pseudoephedrine (Sudafed)

MDMA

related to dopamine, norepinephrine, and hallucinogenic amphetamines. blocks reuptake and causes release of serotonin.

cocaine

blocks dopamine, norepinephrine, and serotonin reuptake. creates a euphoric rush. cheap forms have increased addiction and dependence. risk of overdose, suicide, heart problems, seizures

amphetamines

blocks reuptake and causes release of dopamine, creates euphoric rush

bath salts

releases a lot of dopamine and inhibits reuptake. meth + coke. causes increased BP, HR, agitation, hallucinations, extreme paranoia, and delusions

CNS stimulant overdose symptoms

aggression, grandiose, paranoia. tachycardia, elevated BP, high fever, convulsions, coma, death.

CNS stimulant side effect treatment

antipsychotics PRN, diazepam for seizures, symptom mgmt (fever)

CNS withdrawal treatments

no good med for withdrawal, antidepressants (desipramine - TCA), bromocriptine (dopamine agonist), diazepam for agitation. mainstay treatment is therapy - group, individual, hospitalization. depression tx when withdrawal is complete.

therapeutic cocaine vaccine

prevents from crossing BBB, stops high feeling but not craving

opioid overdose tx

respiratory arrest → narcan, promote breathing. does not work for tranq/xylazine

opioid withdrawal tx

methadone substitution, LAAM (l-alpha acetylmethadol) - synthetic opiate blocks craving for and effects of heroin. naltrexone - antagonist therapy. buprenorphine substitution - partial antagonist blocks withdrawal symptoms. also lofexidine, clonidine.

hallucinogen examples

LSD (acid), PCP, mescaline, psilocybin (shrooms), toads, DMT (dimethyltryptamine), DXM (dextromethorphan)

hallucinogen side effects

paranoia, anxiety, synesthesia, depersonalization, hallucinations, medical - HTN crisis, fever, desp distress

LSD treatment

low stimuli, talk down

PCP treatment

do not talk down, give valium or haldol, ammonium chloride facilitates drug elimination

effects of chronic weed use

memory impairment, lung disease, reproductive

medical marijuana (dronabinol/marinol//nabilone) uses

antiemetic, appetite stimulant, glaucoma, muscle relaxant, analgesic

inhalant examples

glue solvent, lighter fluid, spray pain, thinners, fuels

tobacco withdrawal tx

nicotine replacement therapy, buproprion, varenicline, behavior therapy/hypnosis

cocaine use side effects

extreme weight loss, malnutrition, MI, stroke

IV drug use side effects

infection/sclerosis of veins, HIV, hep C

intranasal drug use side effects

sinusitis, perforated nasal septum

SBIRT screening tool

screening, beef intervention, referral to tx

AUDIT screening tool

alcohol use disorders identification test

T-ACE screening tool

tolerance, annoyance, cut down, eye-opener

CAGE/CAGE-AID screening tool

should you cut down, are others annoyed, are you guilty, do you drink in the morning as an eye opener

FRAMES health teaching model

feedback of personal risk, responsibility of pt, advice to change, menu of options, empathetic counseling, self efficacy/optimism