MH: week 7 (substance use)

substance use disorders

pathological use of a substance that leads to a disorder of use

symptom groups of substance use disorders

impaired control, social impairment ,risky use, physical affects (tolerance, withdrawl, intoxication)

addiction

chronic medial condition

intoxication

process of using substance to excess

tolerance

takes higher dose to achieve intial level of response

withdrawl

symptoms occur when a person stops using a substance

comorbidities with substance use disorders

psychiatric- any combo of two or more substance use disorders and mental disorders

risk factors for substance use disorders

genetics- runs in fams, twins

neurobiological- neutrotransmitters

environemntal- chronic stress, coping, social support, poverty (main)

theroy pf pvoerh

hard to get out

caffiene

most widely used psychoactive substance in world

result in intoxication, overdose, withdrawl

cannabis 

third most common

hallucinogens

cause a profound disturbance in reality

acid, LSD, ketamines, PCP

inhalants

solvents for glues and adhesives, propellants, thinners, fuels

known for quick high via tolulating

inhalants- sudden sniffing death

rush, sudden cardioac respone with arrythmias and res sitress

opioid use disorder examples

heroin, prescription drugs

opioid intoxication

slow psychomotor, drowsy, poor memory, pin point pupils (myosis), consipation, dec in rr and bp, be aware of alcohol use

brady, hypotension, hypothermia, sedation, hypokinesis, slurred speech, head nod, euphoria, analgesia, calmness

opioid cravings result in

larger amounts of drug with longer periods of use, tolerance cycle

opioid intoxication may inflict (psych)

impairment in life roles, interpersonal conflict, and puts pt in psychically hazzardous situation

opioid overdose usually leads to? treatment? what does treatment do?

death usually due to res arrest, naloxone promotes breathing

opioid withdrawl

tachycardia, hypertn, hyperthermia, insomnia, mydriasis, diaphoresis, inc rr, tearing, rhinorrhea, muscle spams, abd cramps, n/v/d, bone/muscle pain, anxiety

opioid withdrawl drugs

methadone, clonidine, nuprenoprphine/naloxone, lofexidine

opioid maintenance

pharm- methadone or buprenorphine/naloxone reduce cravings, naltrexone prevents high

psychotherapy- Individual, behavioral, CBT, family

sedative, hypnotic, and antianxiety medication use disorder examples

benzodiazepines, benzo-like drugs, carbamates, barbiturates, barbiturate like drugs

treatment to overdose on sedative, hypnotic, and antianxiety medications

gastric lavage (stomach pump)

withdrawl treatment to sedative, hypnotic, and antianxiety medications 

gradual reductoin to prevent seixures

stimulant use disorder examples

anphetamine type, cocaine

stimulant use disorder treatment of withdrawl

group/individual

diazepam for agitation

1-2 week cocaine withdrawl needs NO inpatient care, no drugs to reduce symp

depression treatment AFTER withdrawl is compete (buproprion)

stimulant intoxication

inc energy, decrease appetite, mental alertness, inc hr/bp, dilated pupils

long term= chest pains, panic attacks, depression, delsions/hallucinations

stimulant withdrawl

depression, hypersomnia, fatigue, irritability, poor concentration, psychomotor retardation, inc appetite, paranoia, drug cravings

tobacco withdrawl

distressing, treatment is behavioral therapy, hyponosis, nictoine replacement, buproprion, verniciline

gambling disorder treatment

gamblers anonymous, SSRIs, bupropion, mood stabilizers, anticonvulsants

alcohol use disorder- alcohol

sedatiive w initial euphoria

alcohol use disorder-scale of diagnosis

mild= 2-3 symp

mod=4-5 symp

severe=5 or more symptoms

epidemiology for alcohol use disorder

twice common in men, american indians/alaska natives highest rates

comorbiditiy for alcohol use disorder

bipolar, schizophrenia, antisocial, major depressive disorder

risk factors for alcohol use disorder

genetics- runs in fams

neurobiological- neurotransmitters affect judement

social- inc risk w peer pressure

cultrual- fam norms/values, parental control/guidance

heavy drinking

a lot of. drinking frequently

binge drinking

consuming a large amount of alcohol in a short period of time, typically defined as 5 or more drinks in 2 hours for men and 4 or more drinks for women.

alcohol intoxication- legal

blood concentration of 0.08-0.10 mg/dl

alcohol withdrawl

shakes/jitters 6-8 hrs

mild/mod= aggitation, low appetite, n/v, insomnia, low cognition, perceptual changes, inc bp, hr, temp

severe= seizures (12-24 hrs), delirium (within 72 hes)

ativan is replacement therapy

what is replacement therapy for alcohol use disorder

ativan to taper to zero

Wernicke-Korsakoff Syndrome

pt with heavy use of alcohol for many years may suffer from short-term memory disturbances

Wernicke’s encephalopathy

from alcohol use disorder

altered gait, vestibular dysfunction, confusion, and several ocular motility abnormalities

fetal alcohol syndrome

intellectual disability, low nasal bridge, epithancal folds, shortpalpebral fissure, thin upper lip flat midface

systemic affects of alcohol use disorder

peripheral neuropathy, alcoholic myopathy (cardiaomyopathy=poor heart pumping)

esophagitis, gastritis, pancreatitis, hepatitis, chirrosis

leukopenia, thrombocutopenia

cancer of head/neck

assessment of alcohol use disoder:

SBIRT= screening, brief intervention, and referral to treatment

AUDIT= alcohol use disorders identification test

CAGE 4= questions to identify alcohol abuse

CAGE-AID= same questions as CAGE but adds drug use to alcohol

codependence- alcohol use disorder

cluster of behaviors involving the families of alcoholic patients

overly responsible behaviors, define their self-worth in terms of caring for others to the exclusion of their own needs

alcohol use disorder implemntation

promote safety/sleep (FIRST LINE)

reintroduce god nutrition/hydration and self care

explore harmful thoughts and spiritual distress

health teaching/promotion of alcohol use disorder

prevention against genetic vulnerability

public classes

pharmacotherapy for substance use disorder

disulfiram, maltrexone, benzodiazepines

psychotherapy for sutbance use disoders

CBT and motivational interviewing

what is motivational interviewing

APRN driven, strengthen motivation for change