Substance Use Disorders: Definitions, Symptoms, and Treatment Strategies

Tolerance

The body gets used to the drug, so more is needed.

Withdrawal

The body depends on the drug and reacts when it's stopped.

Hazardous use

Strong cravings lead to risky use.

Social/interpersonal problems

Substance use starts affecting relationships.

Neglected roles

Responsibilities (school, work, home) are ignored.

Genetics

Some people are biologically more likely to become addicted.

Environment

Exposure (family, peers, stress, access to drugs).

Psychological factors

Mental health issues (anxiety, depression, trauma).

Wernicke's Encephalopathy

Caused by thiamine (B1) deficiency + symptoms: confusion, trouble walking, eye problems.

Korsakoff's Psychosis

Long-term damage from thiamine deficiency + severe memory problems.

Delirium Tremens (DTs)

Severe alcohol withdrawal + causes confusion, hallucinations, unstable vitals + life-threatening + occurs 48-96 hours after last drink.

CIWA-Ar

Tool used to measure how severe alcohol withdrawal is.

Naloxone (Narcan)

Reverses opioid overdose by blocking opioid receptors.

Benzodiazepines (alcohol withdrawal)

Calm the brain and prevent seizures.

Thiamine (B1)

Prevents brain damage (Wernicke/Korsakoff) + must be given before glucose.

Lorazepam

Often the benzodiazepine of choice in alcohol withdrawal for clients with liver disease.

Opioid toxicity

Slow breathing + pinpoint pupils + decreased consciousness.

Cirrhosis

A systemic effect of chronic alcohol use + long-term liver damage.

MAT (Medication-Assisted Treatment)

Includes methadone, buprenorphine, and naltrexone to support recovery.

Alcohol Intoxication

SLOW DRUNK: On-set: minutes to hours after consuming.

Alcohol Withdrawal

WERID + SHADE: Treatment: Benzodiazepines (e.g., lorazepam), thiamine, CIWA monitoring.

Opioid Intoxication

DOWN OPID: Time of onset: After use of opioids.

Opioid Withdrawal

WIDE FLU: Time of onset: Within 6-24 hours after last dose (depending on opioid type).

Librium

A long-acting benzodiazepine used for moderate alcohol withdrawal + Prevents seizures + DTs.

Phenobarbital

Role: GABA enhancement + anti-seizure. Best for: Severe/refractory withdrawal.

Gabapentin

Role: Symptom relief, cravings. Best for: Mild/moderate withdrawal, PAWS.

Carbamazepine

Role: Anti-seizure + mood stabilizer. Best for: Outpatient detox.

Clonidine

Role: Autonomic symptom control. Best for: Adjunct for mild to moderate cases.

Dexmedetomidine (Precedex)

Role: ICU sedation. Best for: Benzo-refractory ICU-level withdrawal.