Module 10: Substance Use & Addictive Disorders

addiction

a compulsive or chronic requirement; the need is so strong as to generate distress if left unfulfilled

intoxication

a state of disturbance in cognition, perception, behavior, level of consciousness, judgment, and other functions that is directly attributable to the effects of a psychoactive drug; may be marked by a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor.

withdrawal

the physiological and mental readjustment that accompanies the discontinuation of an addictive substance

predisposing factors

- genetics

- biochemical

- psychological factors

- personality traits

- social learning

- conditioning

- cultural/ethic influences

alcohol use d/o: patterns of use: phase I: prealcoholic phase

characterized by use of alcohol to relieve everyday stress and tensions of life

alcohol use d/o: patterns of use: phase II: early alcoholic phase

begins with blackouts-brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person

alcohol use d/o: patterns of use: phase III: the crucial phase

person has lost control; physiological dependence is clearly evident

alcohol use d/o: patterns of use: phase IV: the chronic phase

characterized by emotional and physical disintegration. the person is usually intoxicated more often than sober

effects of alcohol on the body

ØPeripheral Neuropathy

ØAlcoholic Myopathy

ØWernicke Encephalopathy

ØKorsakoff's Psychosis

ØAlcoholic Cardiomyopathy

ØEsophagitis

ØPancreatitis

ØAlcoholic Hepatitis

ØCirrhosis of the Liver

ØLeukopenia

ØThrombocytopenia

ØSexual Dysfunction

peripheral neuropathy

•Peripheral nerve damage

•Pain

•Burning

•Tingling

•Prickly sensations of the extremities

alcoholic myopathy

•Thought to result from same B vitamin deficiency that contributes to peripheral neuropathy

•Acute: Sudden onset of muscle pain, swelling, and weakness; reddish tinge to the urine; rapid rise in muscle enzymes in the blood

•Chronic: Gradual wasting and weakness in skeletal muscles

wernike's encephalopathy

most serious form of thiamine deficiency in alcoholics; paralysis of ocular muscles, diplopia, ataxia, somnolence, stupor

Korsakoff's psychosis

syndrome of confusion, loss of recent memory, and confabulation in alcoholics

alcoholic cardiomyopathy

effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition

esophagitis

inflammation and pain in the esophagus

gastritis

effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention

pancreatitis

•Acute: Usually occurs 1 or 2 days after a binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain; nausea and vomiting; and abdominal distention.

•Chronic: Leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus

alcohol hepatitis

•Caused by long-term heavy alcohol use

•Symptoms: Enlarged, tender liver; nausea and vomiting; lethargy; anorexia; elevated white blood cell count; fever; and jaundice. Also ascites and weight loss in severe cases.

cirrhosis of the liver

•the end stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue.

- complications: portal hypertension, ascites, esophageal varices, hepatic encephalopathy

leukopenia

impaired production, function, and movement of WBCs

thrombocytopenia

platelet production and survival are impaired as a result of the toxic effects of alcohol

sexual dysfunction

•In the short term, enhanced libido and failure of erection are common.

•Long-term effects include gynecomastia, sterility, impotence, and decreased libido.

alcohol withdrawal

- within 4-12 hrs

- coarse tremor of hands, tongue, eyelids, N, V, malaise or weakness, tachycardia, sweating, elevated BP, anxiety, depressed mood or irritability, transient hallucinations/illusions, headache, insomnia

DTs (delirium tremens)

alcohol withdrawal delirium

fetal alcohol syndrome

problems w/ learning, memory attention span, communication, vision, and hearing

•Alcohol-related neurodevelopmental disorder

•Alcohol-related birth defects

- characteristics: learning difficulties, speech and language delays, intellectual disability, poor reasoning skills, sleep and sucking problems as a baby, vision or hearing problems, problems with heart, kidney, bones, abnormal facial features, small head size, shorter than average height, low body weight, poor coordination, hyperactive behavior, difficulty paying attention, poor memory, difficulty in school

sedative/hypnotic use disorder

•Barbiturates

•Nonbarbiturate hypnotics

•Antianxiety agents

sedative/hypnotic intoxication

•With these central nervous system (CNS) depressants, effects can range from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug).

sedative/hypnotic withdrawal

•Onset of symptoms depends on the half-life of the drug from which the person is withdrawing.

•Severe withdrawal from CNS depressants can be life-threatening.

stimulant use disorder

•Amphetamines

•Synthetic stimulants

•Nonamphetamine stimulants

•Cocaine

•Caffeine

•Nicotine

stimulant intoxication

•Amphetamine and cocaine intoxication produce euphoria, impaired judgment, confusion, and changes in vital signs (even coma or death, depending on amount consumed).

•Caffeine intoxication usually occurs following consumption in excess of 250 milligrams. Restlessness and insomnia are the most common symptoms.

stimulant withdrawal

•Amphetamine and cocaine withdrawal may result in dysphoria, fatigue, sleep disturbances, and increased appetite.

•Withdrawal from caffeine may include headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting.

•Withdrawal from nicotine may include dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite.

inhalant use disorder

•Aliphatic and aromatic hydrocarbons are found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners.

inhalant intoxication

dizziness, ataxia, euphoria, excitation, disinhibition, nystagmus, blurred vision, double vision, slurred speech, hypoactive reflexes, psychomotor retardation, lethargy, generalized muscle weakness, stupor or coma (at higher doses)

inhalant withdrawal

restlessness, N and V, runny nose and watery eyes, poor attention and concentration, mood changes

opioid use disorder

•Opioids of natural origin

•Opioid derivatives

•Synthetic opiate-like drugs

opioid intoxication

initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment, pupillary constriction, drowsiness, slurred speech, impairment in attention or memory

•Severe intoxication can lead to respiratory depression, coma, and death.

opioid withdrawal

dysphoric mood, N or V, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, insomnia

opioid withdrawal - short acting

-heroin

-symptoms occur within 6-8 hours

-peak within 1-3 days

-gradually subside in 5-10 days

opioid withdrawal - long acting

-methadone

-symptoms occur within 1-3 days

-peak between 4-6 days

-subside in 14-21 days

opioid withdrawal - ultra short acting

- meperidine

-Symptoms begin quickly

-peak in 8 to 12 hours

-subside in 4 to 5 days

hallucinogen use disorder

•Naturally occurring hallucinogens

•Synthetic compounds

hallucinogens physiological effects

•Nausea/vomiting

•Chills

•Pupil dilation

•Increased blood pressure, pulse

•Loss of appetite

•Insomnia

•Elevated blood sugar

•Decreased respirations

hallucinogens psychological effects

•Heightened response to color, sounds

•Distorted vision

•Sense of slowed time

•Magnified feelings

•Paranoia, panic

•Euphoria, peace

•Depersonalization

•Derealization

•Increased libido

hallucinogen intoxication

•Occurs during or shortly after using the drug

•Effects include perceptual alteration, depersonalization, derealization, tachycardia, and palpitations

•Belligerence and assaultiveness, and may proceed to seizures or coma

cannabis use disorder

marijuana, hashish

cannabis intoxication

impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment and memory, social withdrawal, conjunctival injection (red eyes), increased appetite, dry mouth, tachycardia

•Impairment of motor skills lasts for 8 to 12 hours.

cannabis withdrawal

irritability, anger, aggression, nervousness, restlessness, anxiety, sleep difficulty, decreased appetite or weight loss, depressed mood, abdominal pain, tremors, sweating, fever chills, headache

assessment/diagnostic tool for alcohol

CAGE, CIWA

disulfiram (Antabuse)

- used as a deterrent to drinking to individuals who misuse alcohol

- prevent alcohol relapse

- sweating, flushed skin, resp difficulty, N, V, hyperventilation, unconsciousness, convulsions, death

alcohol withdrawal treatment

•Benzodiazepines

•Anticonvulsants

•Multivitamin therapy

•Thiamine

opioid intoxication/withdrawal treatment

Narcotic antagonists

Naloxone (Narcan)

Naltrexone (ReVia)

Nalmefene (Revex)

Buprenorphine

Methadone

Clonidine

depressant intoxication/withdrawal treatment

ØPhenobarbital (Luminal)

ØLong-acting benzodiazepines

stimulant intoxication/withdrawal treatment

ØMinor tranquilizers

ØMajor tranquilizers

ØAnticonvulsants

ØAntidepressants

hallucinogens and cannabinols intoxication/withdrawal treatment

ØBenzodiazepines

ØAntipsychotics