Week 12: Substance Use-Related Disorders

What is Substance-Related and Addictive Disorders?    

All drugs taken in excess activate the brain’s reward system. Each different class of drugs produces a reward sensation that is different but typically produces feelings of pleasure. Many people become addicted to things they don’t even think of as drugs. Nicotine is considered to be the most addictive drug (and most difficult to quit). Legal substances, when used improperly can become addictive: (Nail polish, Glue, Gasoline). Gambling behaviors activate reward systems in the brain similar to drugs. There is growing evidence suggesting genetic factors contribute between 50% and 60% of vulnerability to alcoholism. A word on DEPENDENCE: In the DSM-5, the APA got rid of the word DEPENDENCE!

What are the DSM substance-related disorders?   

 Alcohol-related: (alcohol use, alcohol intoxication, alcohol withdrawal). Caffeine-related: (caffeine use, caffeine intoxication, caffeine withdrawal). Cannabis related: (cannabis use, cannabis intoxication, cannabis withdrawal). Hallucinogen-related: (phencyclidine use, other hallucinogen use, phencyclidine intoxication, other hallucination intoxication, hallucinogen persisting perception. No withdrawal). Inhalant-related: (inhalant Use, Inhalant Intoxication). Opioid-Related: (Opioid Use, Opioid Intoxication, Opioid Withdrawal). Sedative-, Hypnotic-, or Anxiolytic-Related Disorders: (Sedative-, Hypnotic-,or Anxiolytic-Use Disorders, Sedative-, Hypnotic-, or Anxiolytic Intoxication, Sedative-, Hypnotic-, or Anxiolytic Withdrawal). Stimulant-Related: (Stimulant Use Disorder, Stimulant Intoxication, Stimulant Withdrawal). Tobacco-related: (Tobacco Use Disorder, Tobacco Withdrawal). Other (or Unknown) Substance-Related: (Other (or Unknown) Substance Use Disorder, Other (or Unknown) Substance Intoxication, Other (or Unknown) Substance Withdrawal). Non-Substance-Related - (gambling).

What are the factors related to abuse regarding substance-related disorders?    

All psychoactive drugs provide a pleasurable experience at some point during their use. The social context may encourage use. Alcohol affects people differently at different life stages. Temperament is also a factor in the etiology of substance use disorders. One personality trait is impulsivity – risk taking, lack of planning, chaotic lifestyle, desire for immediate gratification, explosiveness. A person’s intellectual level is also a predictor. Women whose partners have had alcohol problems are more likely to experience victimization, injury, depressive, and anxiety disorders. So far, the biggest predictor of substance use in women is a history of sexual abuse in childhood. - Many have also developed substance use problems through their partner.

What are factors leading to substance use in the elderly?   

 Many elderly develop substance problems due to misuse of alcohol in combination with prescription medications. It can be difficult to determine if physical and cognitive problems in the elderly may be due to the aging process or substance use. Key factors to isolate: female, socially isolated, history of substance use or mental health disorder, and Inappropriate use of prescription drugs are big predictors.

What are factors leading to substance use in LGBT populations?    

Bar-related lifestyles. Grief due to loss of friends because of illness. Fewer supports from family, friends, coworkers, and neighbors.

What are essential features of substance-related disorders?    

Notice that the DSM section for substance-related now consists of substance use disorder, substance-induced disorder accompanied by the criteria for: (Intoxication and withdrawal, Substance/medication-induced mental disorders, Behavioral addictive disorders). The DSM developed criteria that can be applied to all 10 classes (except caffeine). For disorders induced by a substance, there are two categories describing the effect: Intoxication & Withdrawal. We no longer look at categorical differences between substance abuse and substance addiction. Instead, they have been combined into a single disorder: substance use disorder.

What are Non-substance-related disorders?   

 Gambling disorder - A new diagnosis & “Internet gaming disorder” - listed in the area of the DSM reserved for further study.

What are Considerations in prescribed medications?   

 When medication is medically prescribed, the presence of tolerance and withdrawal symptoms are not counted to support the diagnosis of a substance use disorder (Does this mean that prescribing health professionals are absolved of prescribing too much medication (think of opioid use)? Does this mean that prescribing health professionals dodge culpability for prescribing the wrong medication for a particular disorder)? Medications can still be addictive if taking prescriptions as prescribed. As part of the assessment, the practitioner needs to clearly document that the symptoms are occurring in the context of appropriate medical treatment and related prescribed medication.

What is Substance Use Disorder?   

 Defined as “a cluster of cognitive, behavioral, and physical symptoms indicating that the individual continues using the substances despite significant substance-related problems.” (Note: cognitive, behavioral and physical)! The diagnosis is based on a maladaptive pattern leading to clinically significant impairment or distress for at least 12 months. The diagnosis of substance use is given when a person uses a drug without a legitimate medical need to do so!!

What is the criteria for substance use disorder?    .

Must meet 2 or more of the following 11 symptoms: Impaired control: (Taking the substance in larger amounts and for longer than originally intended. Unsuccessful efforts at cutting down despite a persistent desire to cut down (or discontinue use). Spending time to use/obtain the substance, using the substance, or recovering from its effects. Craving, or a strong desire or urge to use the substance Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home). Social impairment: Failure to fulfill major role obligations (i.e., work, school, or home), Recurrent use despite persistent social/interpersonal problems caused or made worse by the effects of substance, Giving up or reducing other activities because of substance use). Risky Use: (Continued use in situations that are physically hazardous, Continuing to use despite knowing of the problems caused (or made worse by the substance). Pharmacological criteria: (tolerance as defined by needing an increased amount of the substance in order to achieve the desired effect or a significantly reduced effect when the usual amount is consumed. Withdrawal: considered for those who have maintained heavy and prolonged use, stopped using, and developed symptoms; individuals may likely consume the substance (or a related substance) to relieve symptoms)

What are points to consider for substance use disorder and withdrawal?   

 Regarding the Pharmacological criteria: Tolerance and Withdrawal do not include medications taken under medical supervision!!!! Except for caffeine, each of the 10 substance-related classifications follows the same general guidelines except for withdrawal. The DSM-5 considers withdrawal as a syndrome that occurs when “blood or tissue concentrations of a substance decline in the individual who had maintained prolonged heavy use of the substance.” Withdrawal symptoms vary based on the actual substance. While doing an assessment, we need to think about: (The route of administration of the substance: oral, injection, intranasal, The duration of the its effects, and The use of multiple substances)!

What is the Severity for substance use disorder?    

Severity: Mild: The presence of two-three symptoms, Moderate: Four or five symptoms, Severe: Six or more symptoms

What are the specifiers for SUD?    

early and sustained remission

What is the early specifier in SUD?    

Full criteria for substance use were previously met, but none have been met for at least 3 months, but less than 12 months.

What is the Sustained remission specifier in SUD?    

Used after full criteria were previously met, but currently none of the criteria have been met during a 12-month period or longer.

What is Recording in SUD?    

Note the actual substance: e.g., amphetamine-type substance

What are Substance-Induced Disorders?    

Substance Intoxication: the occurrence of a reversible substance-specific syndrome due to recent ingestion or exposure to a substance (Recent ingestion or use, Clinically significant problematic behavioral of psychological changes, Signs or symptoms not attributable to another medical condition). The most common changes are associated with disturbances in: (Perception: vision, hearing, taste, smell, touch; Wakefulness; Attention; Thinking; Judgment; Psychomotor behavior; Interpersonal behavior).

What is substance intoxication?

the occurrence of a reversible substance-specific syndrome due to recent ingestion or exposure to a substance (Recent ingestion or use, Clinically significant problematic behavioral of psychological changes, Signs or symptoms not attributable to another medical condition).

What is substance withdrawal?    

A problematic substance-specific behavior change with both physiological and cognitive elements that are due to stopping or attempting to cut down heavy and prolonged substance use. The diagnostic criteria are ending (or reducing) heavy and prolonged substance use and developing distinctive signs and symptoms particular to the substance within a specific timeframe. These signs and symptoms case significant distress or impairment in social, occupational, or other important area of functioning. First, record the name of the substance (e.g., “methamphetamine intoxication”).

What are Substance/Medication-Induced Mental Disorders?    

These disorders can cause symptoms that are characteristic of other disorders. Certain meds can cause disorders such as those associated with 10 classes of substances: (Psychotic disorders, Bipolar disorders, Depressive disorders, Anxiety disorders, Obsessive-compulsive and related disorders, Sleep disorders, Sexual dysfunctions, Delirium, Neurocognitive disorders. Record the name of the medication: “valium-induced delirium”

Alcohol disorders?    

use, intoxication, withdrawal, other substance/medication-induced disorders

Caffeine disorders?   

 intoxication, withdrawal, other substance/medication-induced disorders

Cannabis disorders?  

use, intoxication, withdrawal, other substance/medication-induced disorders

Hallucinogens disorders?    

use, intoxication, other substance/medication-induced disorders

Inhalants disorders?    use, intoxication, other substance/medication-induced disorders

use, intoxication, other substance/medication-induced disorders

Opioids disorders?   

use, intoxication, withdrawal, other substance/medication-induced disorders

Sedatives, hypnotics, or anxiolytics disorders?    

use, intoxication, withdrawal, other substance/medication-induced disorders

Stimulants disorders?    

use, intoxication, withdrawal, other substance/medication-induced disorders

Tobacco disorders?   

use, withdrawal, other substance/medication-induced disorders

Other or unknown disorders?    

use, intoxication, withdrawal, other substance/medication-induced disorders

What is the prevailing pattern of alcohol use disorder?  

 In the U.S., the 12-month prevalence of alcohol use disorder is 4.6% among those 12 to 17 years of age and 8.5% among adults 18 years old and older. Fewer women develop alcohol use disorders (2.4% to 4.9%), but when they do, their problems tend to be more severe than men's. Women tend to have more problems with depression and anxiety. Alcohol consumption has declined among white Americans since the mid-1980s, but ethnic and minority groups continue to be disproportionately affected: (Hispanics 6.0%, Native Americans/Alaska Natives 5.7%, African Americans 1.8%, Asian Americans/Pacific Islanders 4.5%).

What is interesting about the effects of alcohol?    

Although it is considered a depressant, the initial effect on the user is stimulation. Low doses (one to two drinks) can lower a person’s inhibitions and make him/her/them feel more comfortable but some individuals become more aggressive. Low dose is influenced by body fat, other disorders, family history of alcoholism

What is the differential assessment of alcohol use disorder?    

The DSM-5 defines alcohol use disorder as a ‘cluster of behavioral and physical symptoms, which can include withdrawal, tolerance and craving.’ Tolerance and withdrawal symptoms reported in early adulthood were associated with a substantial risk for later alcohol use disorder. Someone who struggles with alcohol use tends to engage in a number of other problematic behaviors - abusing people, food. Typically, once a pattern of compulsive use develops, people who struggle with alcohol use may spend substantial periods of time obtaining and consuming alcoholic beverages.

To diagnose alcohol use?

the individual must meet 2 or more of the 11 overall criteria for substance use within a 12-month period. Symptoms of withdrawal after stopping use can look like autonomic hyperactivity (sweating; elevated pulse rate; hand tremors; insomnia; nausea or vomiting, transient visual, tactile, or auditory hallucinations or illusions; agitation; anxiety; and/or grand mal seizures).

What is alcohol intoxication?  

When considering alcohol intoxication, the general rule is that an average person can process about 1 beer or 1 shot of liquor each hour. Binge drinking occurs when a person drinks a large amount in a short period of time to intoxication. For men, this is roughly five or more drinks at a time; for women, the amount is usually four or more. The criteria for alcohol intoxication include recent drinking and significant behavioral or psychological changes that develop during or shortly after ingestion. The person shows one or more of the following: (slurred speech, lack of physical coordination, unsteady gait, nystagmus, impairment in attention or memory, stupor, or coma).

What is Alcohol withdrawal?  

Heavy drinking, especially on a daily basis, disrupts the brain’s neurotransmitters - neurotransmitters are no longer suppressed. When a heavy drinker suddenly stops drinking, the brain’s neurotransmitters are significantly disrupted - The transmitters previously suppressed by alcohol are no longer suppressed. As a result they rebound resulting in brain hyper-excitability - The effects of the withdrawal: anxiety, irritability, agitation, tremors, seizures and DTs are the opposite of those associated with alcohol consumption. Two or more symptoms are required for a diagnosis, which can begin as weekly as several hours to a few days after the last drink and can persist for weeks. The symptoms can range from mild anxiety and shakiness to more severe complications such as DTs. Only about 10 percent or less will develop the more severe withdrawal

What are long-term effects of alcohol use?

Two types of brain damage: Korsakoff psychosis and Wernicke’s encephalopathy. There are of course, other long-term problems: serious liver, heart and stomach problems.

What is Korsakoff psychosis?

a chronic memory disorder of the brain, Characterized by abnormal eye movements, difficulties with muscle coordination, and confusion.

What is Wernicke’s encephalopathy?

results from a thiamine deficiency due to malnutrition. A medical emergency: causes life-threatening disruption, confusion, staggering/stumbling. Almost always accompanied by or followed by Korsakoff’s syndrome.

What are some other points about alcohol use?

About 20% of those with severe alcohol use can have a spontaneous remission or stop drinking on their own, and will not re-experience problems with drinking. Unfortunately, we typically see polysubstance use. So, we do not have a separate diagnosis for polysubstance use - come up with all of the diagnoses. Roughly 40% of people in the US will experience an alcohol-related accident at some time in their lives. We also see absenteeism from work, job-related accidents, and low employee productivity.

What are Caffeine-related disorders?

Thisis likely the most commonly used substance and with the least side effects. This is a plant alkaloid that is naturally produced in the leaves, seeds, or fruits of many plants. The primary source of this is the coffee bean. Other sources of this include plants: yerba mate and guarana, which we see in lots of energy-boosting drinks. This is considered a drug because it stimulates the central nervous system. It comes in many types of soda, chocolate, weigh-loss drugs, OTC medications…For whatever reasons, this as a substance, is not associated with a substance use disorder

What is the Caffeine-related disorders Prevailing pattern?

We likely will not see someone with this intoxication. Typically, a cup of coffee is around 150 milligrams of caffeine: not enough for intoxication. Average adult intake of caffeine is about 280 milligrams per day. The need tends not to lead to compulsive drug-seeking behaviors that we see in other substances. But, about 50% of regular caffeine users report difficulties giving up or reducing caffeine use. Approximately 7% of the population may have 5 or more symptoms of caffeine intoxication. Caffeine withdrawal symptoms: HEADACHES!

What is the Caffeine-Related Disorders Differential assessment?

The following symptoms: (headache, fatigue, decreased energy/activity level, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, foggy/not clearheaded, and flu-like symptoms of nausea/vomiting and muscle stiffness). It is absorbed quickly into the bloodstream, but takes a relatively long time to leave our bodies. The effects can last from 12 to 24 hours. Withdrawal symptoms typically occur 12 to 24 hours after abstinence and can last from 2 to 9 days.

What are Cannabis-Related Disorders?

The most routinely used illicit psychoactive substance in the US. Comes from the leaves, buds, flowers, and resin from the cannabis plant.

What are Cannabis-Related Disorders Prevailing pattern?

The 12-month prevalence for this use disorder - 3.4% among 12-17 year olds and 1.5% for adults 18 and older - they might start using other substance at 18. The use increases among adult males (2.2%) and is higher than among adult females (0.8%). In general, the use decreases with age and the lowest use is found among those 65 and older (0.01%). Prevalence of cannabis intoxication is difficult to determine. It is more likely that most users will have at some time met the diagnostic criteria. Among adolescents and adults in treatment, approximately 50% to 95% report withdrawal.

What is Cannabis Use Disorder?

The plants contain a number of psychoactive compounds called cannabinoids (e.g., THC) that are believed to alter mood and behavior. Some users mix marijuana into foods (e.g., brownies) or brew it as tea. Another device is vaporization, where the plant material is heated to release the psychoactive cannabinoids for inhalation. The THC latches onto specific receptors in the brain known to be involved in appetite regulation (munchies) and perception of pain. The disorder develops over time, but is quicker in adolescents, particularly those with conduct problems. The drug is sometimes a gateway to other drugs. Such as alcohol and cigarettes. Synthetic formulations in pill form and are approved for some medical purposes such as for nausea/vomiting (in chemotherapy), or for anorexia (HIV)

What are the effects in cannabis use disorder?

Smoked in moderation, this produces a vague or fuzzy feeling of general wellbeing - Can produce paranoia, hallucinations, and dizziness in larger doses. Others might enter a dreamlike state. For some people it can interfere with memory and increase appetite. Some individuals may experience nausea, anxiety, and paranoia. Coordination can be affected.

What is the Cannabis Use Disorder Differential Assessment?

The criteria follow the same established for substance use disorders. The specific symptoms for withdrawal begin within 1 week after a heavy and prolonged use: (Irritability, anger, or aggression, Nervousness or anxiety, Sleep difficulties - insomnia or disturbing dreams, Decreased appetite, or weight loss, Restlessness, a depressed mood, or Uncomfortable physical symptoms). Due to being fat soluble, cannabinoids stay in the bodily fluids for an extended period of time and are excreted slowly. Urine testing, especially for those who deny use, is helpful to diagnose. When used for medical reasons, it is possible for someone to experience either tolerance or withdrawal reactions.

What is Intoxication in Cannabis Use Disorder?

Cannabis produces euphoria, Detachment, relaxation, altered perception of time and distance - car accidents, intensified sensory experiences, laughter, talkativeness, decreased anxiety, decreased alertness, and depression. The symptoms emerge after recent use and include maladaptive behavioral or psychological changes.

What is withdrawal in Cannabis Use Disorder?

Three or more of the following within about 1 week: Irritability, Anger, Aggression, Nervousness, Sleep difficulties, Decreased appetite or weight loss, Restlessness, Depressed mood, Uncomfortable physical symptoms, Stomach pain, shakiness/tremors, Sweating, Fever and chills, Headache

What are Hallucinogen-Related Disorders?

The hallucinogens are a broad class of natural and synthetic compounds that alter a person’s perception and consciousness. The most commonly used drugs of this class were LSD (acid), mescaline, and MDMA or ecstasy.

What are the The Phencyclidines?

These drugs are a class of hallucinogenic drugs that produce feelings of depersonalization and detachment from reality - They can be taken orally, intravenously, or smoked & Qualities with great appeal to recreational drug users who value escapism. The drugs were developed as dissociative anesthetics in the late 1950s and became street drugs in the 1960s (Phencyclidine (PCP, Angel Dust, Sernylan), Ketamine (Ketalar, Ketaject), Dizocilpine (DZ, MK-801)).

What are the The Phencyclidines Prevailing pattern?

2.5% of the US population reports having ever used these with rates increasing with age - 0.3% for those 12 to 17, 1.3% for those 18 to 25, 2.9% for those 26 and older.

What is Phencyclidine Use Disorder: PCP?

At least 30 forms of this have been identified. This can be snorted, smoked or eaten. When smoked, this is often applied to tobacco or marijuana or to a leafy herb such as parsley.

What can ow doses of PCP cause?

the user to experience dizziness, ataxia, nystagmus, mild hypertension, abnormal involuntary movements, slurred speech, nausea - flu-like symptoms, weakness, slowed reaction times, euphoria or affective dulling and lack of concern.

What can Medium doses of PCP produce?

reactions of disorganized thinking, changed body image and sensory perception, depersonalization, and feelings of unreality.

What can High doses of produce?

amnesia and coma, seizure and respiratory depression - slowing of breathing

What is Phencyclidine Use Disorder: Ketamine?

Thisis a surgical anesthetic, which, unlike some others does not cause respiratory or cardiac depression. The drug was initially developed to treat TBIs and neurodegenerative disorders such as Huntington's and Alzheimer’s and also ALS. Liquid this was developed in the early 1960s and was used during Vietnam on battlefields. It resurfaced in the 1990s and known as “Special K.” The drug is made by drying this on a stove until it turns from a liquid into a powder. The effects kick in within 30 to 45 minutes and last for 30 minutes to 2 hours. Used as a date-rape drug.

What are symptoms of ketamine?

Users typically take a low dose and experience feelings of euphoria, visual hallucinations, a sense of unreality, depersonalization, and vivid dreams. Some report flashbacks that occur days/weeks after taking the drug. The person describes losing all sense of self and feeling a detachment of the mind and body, leading to a trance-like state. Long-term use at high doses may result in memory problems.

What is Phencyclidine Use Disorder Differential Assessment?

Heavy use is associated with craving - Increased amounts are needed to achieve intoxication or the desired effects - tolerance. Some people may continue to use despite - psychological problems (e.g., anxiety, rage, aggression or flashbacks) or medical problems (e.g., hyperthermia, hypertension, seizures). Due to lack of insight and judgment while intoxicated, a person might also get into situations (such as fighting) that can result in legal problems.

What is Phencyclidine Intoxication?

Look for clinically significant behavior changes (e.g., belligerence, assaultiveness, impulsiveness, unpredictability, agitation, impaired judgment, or impaired social or occupational functioning) that develop during or shortly after use. Within an hour of ingesting the drug, intoxication is seen when the user experiences two or more of the following: (Nystagmus, Hypertension or tachycardia Numbness or diminished responsiveness to pain, Ataxia, Dysarthria - problem forming words, Muscle rigidity - dystonia, Seizures or coma, Sensitivity to sound

What are the Other Hallucinogens?

Diverse group of substances that can cause hallucinations, perceptual anomalies, and other subjective changes. Typically, they include psychedelics such as LSD, mescaline, or ecstasy.

What are the Other Hallucinogens Prevailing Pattern?

This disorder is one of the rarest of the substance use disorders. Overall, rates are higher among males (0.2%) compared to females (0.1%). The rates are the opposite among adolescents where females (0.6%) are higher than for males (0.4%)!!! The prevalence for intoxication is higher for males than females and for younger individuals. The highest rates are in persons younger than 30, peaking in those between 18-29 (0.6%) and decreasing to virtually 0% for those 45 and older. LSD is the most common hallucinogen and can lead to hallucinogen persisting perception disorder.

What is Other Hallucinogen Use Disorder?

Follows the diagnostic criteria for substance use with the exception of the symptoms of withdrawal. The hallucinogens are usually taken orally. Ecstasy is a synthetic drug that acts as both a stimulant and a hallucinogen. Technically known as a hallucinogenic amphetamine (or an empathogen), MDMA produces feelings of energy, empathy, openness, teeth clenching, plus mild visual, and auditory hallucinations. Some users describe a hangover the following day. The drug causes the brain to dump large amounts of serotonin into the synapses and raises dopamine levels. MDMA is not toxic, but it can cause death due to overheating and dehydration.

What is Hallucinogen Intoxication?

The criteria are similar to marijuana intoxication. Marked anxiety or depression, ideas of reference, a fear of losing one’s mind, paranoid ideas, or impaired judgment. The person may experience perceptual changes, depersonalization, derealization, illusions, hallucinations, synthesias - blending of senses (tasting colors), Pupillary dilation, tachycardia, sweating, palpitations, blurred vision tremors, lack of coordination.

What is Hallucinogen Persisting Perception Disorder?

The re-experiencing of perceptual disturbances, typically visual, when the drug experience has ended. Characterized by transient perceptual experiences that are reminiscent of those generated when using hallucinogenic drugs. Flashbacks that occur days, weeks, or months after the last dose!!! The majority of flashbacks consist of visual sensory distortion, also somatic flashbacks that involve feelings of depersonalization and emotional flashbacks involving periods when the person re-experiences distressing emotions felt during the active use of LSD. This seems to be a relatively rare disorder. People who use LSD a lot tend to accept the occurrence of flashbacks.

What are Inhalant-Related Disorders?

A very chemically diverse group of psychoactive substances that include household products. The most common form of ingestion is sniffing the inhalant directly from an open container or “huffing” from a rag soaked in the substance and held up to the face. Various substances such as paint thinner, gasoline, felt-tip markers, nail polish remover, glue, and other household products. Aerosol sprays containing propellants and solvents: Spray paint, deodorant, and hair-care products. Gases, most commonly nitrous oxide (laughing gas) Nitrites, a group of chemicals that are used in room deodorizers, are more often abused by those seeking sexual enhancement rather than a euphoric state. They tend to lower BP.

What are Inhalant-Related Disorders: Differential assessment?

The diagnosis follows the same general guidelines for the substance use disorders except for withdrawal. The behavior resembles alcohol inebriation: Stimulation and loss of inhibition followed by depression, euphoria, lethargy, distortion in perceptions of time and space, headaches, nausea or vomiting, slurred speech, dizziness, reddened nose. Loss of sensation, dulling of pain. Tolerance develops within several hours to a few days after use.

What are the long-term health problems of inhalants?

such as (loss of hearing, brain and nervous system damage, personality changes, blood oxygen depletion, heart, lung, and liver and kidney damag).

What is Inhalant Intoxication?

Usually occurs in brief episodes. The physical symptoms of intoxication that develop during or shortly after use include two or more of the following: Dizziness, Nystagmus, Lack of coordination, unsteady gait, psychomotor retardation, Slurred speech, Lethargy, Depressed reflexes, tremors, generalized muscle weakness, Blurred vision, stupor, coma, and euphoria, Perhaps belligerence, assaultiveness, apathy, or impaired judgment.

What is Opioid Use Disorder?

Sometimes referred to as narcotics. Depress the central nervous system. Used to treat acute pain. Also used in palliative care to alleviate severe, chronic, and disabling pain of terminal conditions such as cancer. They include the naturally occurring alkaloids such as morphine. Derivatives such as heroin and synthetic compounds such as methadone. Prescriptions include morphine, meperdine, methadone, and codeine. The drugs come in a variety of forms including capsules, tablets, syrups, solutions, and suppositories.

What are the Opioids Addictive qualities?

Heroin affects the brain’s pleasure systems and interferes with its ability to perceive pain. Heroin induces feelings of euphoria, a dreamy sense of drowsiness, and a general sense of well-being.

What are other symptoms of opioid use?

It can also cause nausea, constipation, sweating, itchiness, and depressed breathing and heart rate. Heroin users quickly develop tolerance. Heroin injection can cause scarred and/or collapsed veins, bacterial infections of the blood vessels, and heart valves, abscesses and other soft-tissue infections, and liver or kidney disease. Common reactions include nausea and vomiting, drowsiness, dizziness, headaches, orthostatic hypotension, dry mouth, decreased pupil size, urinary retention and constipation.

What are Opioids Prevailing Pattern?

12 month prevalence is approximately 0.37% of those 18 years of age and older. Rates for males (0.49%) are higher than for females (0.26%). Female adolescents are considered more likely to develop opioid use disorders. Overdose can occur with shooting up or snorting opioids. Withdrawal has been reported in 60% of individuals in clinical settings.

What are Opioids Differential Assessment?

Follows the general guidelines for the substance use disorders. Tolerance: the person must use ever-increasing doses in order to achieve the same effect. Withdrawal symptoms can be within minutes or up to several days after the last dose. We would see 3 or more of the following in withdrawal: (Severe dysphoria, Nausea/vomiting, Muscle aches or cramps, Tearfulness, Runny nose and eyes, Dilated pupils, Goose bumps, Sweating, Diarrhea, Fever and Insomnia

What is Opioid intoxication?

We would see clinically significant maladaptive behavior or psychological changes that develop during or shortly after opioid use. Pupils constrict or dilate due to deficient oxygen. Drowsiness or coma. Slurred speech. Impairment in attention or memory.

What is Opioid withdrawal?

Develops after stopping or reducing heavy and prolonged substance use. Symptoms can be triggered by administration of an antagonist such as naloxone or naltrexone. Three or more of the following that emerge within minutes to several days: (Pupils constrict or dilate due to deficient oxygen, Drowsiness or coma, Slurred speech, Impairment in attention or memory, Sweating diarrhea, yawning, fever, insomnia)

What are Sedative, Hypnotic, or Anxiolytic-Related Disorders?

These disorders and a group of depressants that include substances that have similar but subtle differences in their outcome. Sedatives (which are calming), hypnotics (which are sleep-inducing), and the anxiolytics (which are anxiety reducing).The benzodiazepines and barbiturates are very addictive and have a high risk of abuse and dependence.

What are Sedative, Hypnotic, or Anxiolytic-Related Disorders Prevailing pattern?

The rates show a decrease with age. Use is greatest among those 18 to 29 years of age (0.5%) and lowest among individuals who are 65 and older (0.4%). Rates are slightly higher for adult males.

What are benzodiazepines?

Benzodiazepines are prescribed for short-term relief of severe, debilitating anxiety and may be abused when not used as directed. The first, Librium, was discovered in 1954. In 1963, the government approved the use of Valium. In 1973, Dalmane was released. These drugs are usually prescribed for short-term relief of severe and debilitating anxiety. There is much potential for abuse and dependence because of the half-life of the drug. Physical dependence develops when the meds are used at high doses and/or for prolonged periods of time.

What are common withdrawal symptoms of benzos?

include (anxiety, insomnia, restlessness, agitation, muscle tension, and irritability. Seizures can sometimes occur.

What are barbituates?

Amytal, Seconal, Nembutal were first prescribed to help people sleep. At low doses they relax muscles and produce a mild feeling of well-being. Larger doses can produce effects that resemble heavy drinking: (Slurred speech, Problems with walking, and Inability to concentrate). Extremely high doses can relax the diaphragm muscles to the point of causing death by suffocation.

What are anxiolytics?

divided into two groups: benzodiazepines and non-benzodiazepines. The category includes herbs such as St. John’s Wort and Kava. The most common antianxiety meds include Xanax, Librium, Klonapin, Valium, Serax., Dalmane, Halcion

What are Sedative, Hypnotic, or Anxiolytic-Related Disorders Differential assessment?

The diagnostic criteria follow the same general guidelines for the substance use disorders. The benzodiazepines are typically divided into three groups: short-acting compounds (for 6 hours or less) and intermediate compounds (lasting for 6 to 10 hours) and long-acting compounds (with sedative effects that persist). Tolerance can lead to iatrogenic syndrome - the cure is worse than the illness.

What is Sedative, Hypnotic, or Anxiolytic-Related Disorders Withdrawal?

Two or more of the following that develop within several hours to a few days: Autonomic hyperactivity – such as sweating or high pulse rate, Increased hand tremors, Insomnia, Nausea/vomiting, visual, tactile or auditory hallucinations or illusions, Psychomotor agitation, Anxiety (or panic attacks) or Grand mal seizures.

What is Sedative, Hypnotic, or Anxiolytic-Related Disorders Intoxication?

The signs and symptoms do not differ substantially from those for other substance use disorders, particularly alcohol intoxication. Maladaptive behavioral changes (e.g., sexual or aggressive behavior). Mood changes or impaired judgment. One or more of the following: (Slurred speech, Incoordination, Unsteady gait, Nystagmus, Impairment in attention or memory, Stupor or coma).

What are Stimulant-Related Disorders Amphetamines?

These disorders include the amphetamines (and methamphetamines) and cocaine. The amphetamines include pep pills/speed are CNS stimulants and are often made in illegal labs. Pilots often used amphetamines (Dexadrine) as stimulants. The drug became popular among truck drivers, construction workers, and factory workers whose jobs required long or irregular shift work or automatic repetitive tasks. Tbey may come in tablet and capsule forms or in powders, off-white crystals, that look like ice.

What are methamphetamines?

These look like shaved glass slivers or clear rock salt that can be swallowed, sniffed or snorted or injected. When smoked or injected, these produce an intense sense of euphoria, a “rush” or a “flash” that lasts only a few minutes. Crystal this can easily be produced in small labs (in a kitchen) by mixing a cocktail of about 15 substances, including (ammonia, paint thinner, ether, Drano, and lithium from batteries).

What is cocaine?

Developed in the 19th century in response to a decision to prohibit the use of alcohol. The product contained 60 milligrams of cocaine per 8- ounce serving and later became known as Coca-Cola. Became a recreational drug in the 70s and 80s. This comes from the leaves of the coca plant, native of the Andes. VERY addictive. The effect is a rapidly induced feeling of self-confidence, exhilaration, and energy that can last for about 15 to 45 minutes before giving way to fatigue and melancholy. Comes in two main forms: Hydrochloride and crack.

What does heavy use of cocaine lead to?

can lead to hallucinations, paranoia, aggression, insomnia, and depression. Crack condenses the effects into a shorter and more intense high. Very high doses can lead to cardiac arrest.

What is Hydrochloride?

a white crystalline powder that can be snorted into the nostrils or dissolved in water and injected.

What is Crack cocaine?

that has been processed with ammonia or baking soda and water into a freebase which makes it smokable.

What can cocaine use lead to in small amounts?

(Boosts a person’s sense of self-esteem and optimism, Increases mental and physical abilities, and Conveys feelings of power).

What can extended use of cocaine lead to?

(negative symptoms such as anxiety, depression, suicidal ideations, weight loss, aggressiveness, sexual dysfunction, sleeping problems, and paranoid delusions and hallucinations). Roughly 2/3 or more of those who are chronic cocaine abusers will develop a drug-induced psychosis that looks like paranoid schizophrenia.

What are the Stimulant-Related Disorders Prevailing Pattern?

12-month prevalence for use in the US is 0.2%. The male-to-female ratio is 3:1. The highest prevalence rates occur for persons. 18-29 years of age (0.6%) and lowest. 45 to 64 years of age (0.1%).

What is the Stimulant Use Disorder Differential Assessment?

Use affects all demographic groups. We would see social problems such as being arrested, suspended from school, job loss, engaging in illegal activities. Tolerance develops rapidly. Withdrawal develop within a few hours to several days after stopping use. Symptoms include: (Dysphoria, Fatigue, Vivid and unpleasant dreams, insomnia or hypersomnia, Increased appetite, Psychomotor retardation or agitation, Cravings, Restless, anxiety, depression, and Suicidal behavior).

What is stimulant intoxication?

Usually begins with a “high” feeling followed by problematic psychological behaviors such as euphoria with enhanced energy or affective blunting, changes in sociability – becoming extremely gregarious, hypervigilant, anxiety, tension, anger, stereotypical and repetitive behaviors and impaired judgment. We would see two of more of the following: (Tachycardia or bradycardia, Dilated pupils, Elevated or lowered blood pressure, Perspiration or chills, Nausea or vomiting, Weight loss, Psychomotor agitation/retardation, Muscular weakness, Confusion, Seizures

What is stimulant withdrawal?

The withdrawal symptoms are generally the opposite of those seen during intoxication. - Dysphoric mood instead of the euphoria. Crashing often follows an episode of intense high. Anhedonia. Drug craving. Bradycardia. Increased stamina and energy. Nystagmus, Perspiration, Increased sexual drive/response, Involuntary bodily movements, jitteriness, nausea, Itchy, blotchy, greasy skin, Irregular heart rate, HTN, Sleep disturbance, Headaches. Anhedonia

What are Tobacco-Related Disorders?

Nicotine is a poisonous oily liquid that comes from the nightshade family of plants called “Nicotiana tobacum.” Small amounts of nicotine are found in foods in the nightshade family (e.g., tomatoes and eggplants). Cigarette smoking is the most popular form of nicotine ingestion – and nicotine is the substance in tobacco that causes dependence. Teens are generally resistant to antismoking messages.

What are the dependence statistics of tobacco?

Only about 4% to 7% of people are able to quit on any given attempt without medicine or other help. About 90% of smokers are persistent daily users and 55% become dependent. A small percentage (5%-10%) are not dependent. The nicotine in tobacco smoke rides on small particles of tar. About 90% of all inhaled nicotine is actually absorbed. Neuro-chemical changes occur in the brain just after a few cigarettes, suggesting that a limited exposure to nicotine can initiate dependence.