Community SUDs

substance use disorder

• maladaptive pattern of use

• significant impairment or distress

• 2+ sxs within 12 months

• strong genetic basis for dependence

SUDs sxs

• recurrent use and failure to fulfill major obligations

• recurrent use in physically hazardous situations

• craving or strong desire to use

• continued use despite social/interpersonal problems

• tolerance

• withdrawal

• persistent unsuccessful efforts to stop or cut

• great deal of time spent in effort to obtain

epidemiology risk factors

• age: teens/young adults; elderly growing risk

• gender: males > females quicker sicker pattern

• SEC: impoverished/marginalized

• NA, northern Europeans, Irish

• comorbid with psych illness

• polypharm

• medically ill/physically ill for infection

sign of chemically dependent nurse

• looks for opportunity to administer meds

• inadequate pain relief complaints from pt

• high absenteeism

• denial

• increased ‘wasting’ of meds

• poor concentration, memory, recall

SUDs tx settings

• social model detox programs

• therapeutic communities

• sober living or transitional living programs

• harm reduction programs

successful tx of addiction

• detox/withdrawal management

• behavioral therapies

• counseling, 12 step groups, relapse prevention

biological consequences: drug’s direct effects on body

• alcohol: alcoholic hepatitis, pancreatitis

• alcohol locally tears up gut, esophagus, CNS/Resp. depression,

Biological consequences: Route of drug use

• PO (LT alcohol exposure to lining of stomach heightens risk for dz)

• Intranasal, snorting → deviated septum

• SQ, IM, Muscle popping, IDU → skin infections, endocarditis)

• IV → phlebitis, cellulitis, endocarditis, HCV, HIV

• inhaled → respiratory

endocarditis

bacterial infection of innermost layer of heart valves or chambers

pneumonia (PNA)

• common

• fever, cough, dyspnea

• contributing factors:

  • depression of gag reflex

  • aspiration

  • cig smoking

  • malnutrition

  • trauma

TB

• highly contagious communicable dz thru resp. droplets

• highly associated w/ alcoholism

• HIV = major cause

Triple Dx

• alcohol/drugs, MH, HIV

• prevent individual from responding to prev efforts, testing, disclosing status, seeking tx, and addressing necessary related issues

• both substances and infectious dzs affect immune system and vital organs = double body damage

• alcohol/drugs can speed up HIV progression

  • decreased effectiveness of antiretrovirals → poor adherence d/t poor memory & self care from drug use → ARV resistance

• some ARVs have negative reactions when mixed w/ alcohol → Abacavir

1st step in 12 step

Denial

Confabulation

making up stories/lying to fill gaps in memories

Intellectualization

make it sound logical