NURS 432 psych lec unit 3

Ben Martin

Department of Health and Human Services’ five-point program to address the opioid crisis

•Access: Better prevention, treatment, and recovery services

•Data: Better data on the epidemic

•Pain: Better pain management

•Overdoses: Better targeting of overdose-reversing drugs

•Research: Better research on pain and addiction

*the current crisis may have been triggered by careless over-prescription of opioid analgesics, exacerbated by recreational use of heroin and illicit synthetic opioids

substance abuse treatment

• AA (Alcoholics Anonymous) - a self-help group, includes a 12-step program model for recovery. Says total abstinence is essential, and that alcoholics need the help and support of others to maintain sobriety. Includes sponsors to help each other. Women for Sobriety (exclusively for women) and Rainbow Recovery (for gay and lesbian individuals) do the same thing.

• criticisms- religious-based, confrontational in group setting

• other groups- Narcotics Anonymous (NA); Al-Anon- a support group for spouses, partners, and friends of alcoholics; and AlaTeen, a group for children of parents with substance problems

pharmacologics

• focus

alcohol use

“sipping” at age 8, first intoxication in teens, significant dependency / issues arise in 20s-30s

• blackout = an episode during which the person continues to function but has no conscious awareness of his or her behavior at the time or any later memory of the behavior.

• As the person continues to drink, he or she often develops a tolerance for alcohol; that is, he or she needs more alcohol to produce the same effect. After continued heavy drinking, the person experiences a tolerance break, which means that very small amounts of alcohol intoxicate the person.

• periods of abstinence → the person stops drinking after a significant even like a DUI, and tries to control their drinking, but then they often bounce back & drink more, & the cycle continues

• spontaneous remission / natural recovery = some people with alcohol-related problems can modify or quit drinking on their own without a treatment program

• Poor outcomes: earlier age at onset, longer periods of substance use, and the coexistence of a major psychiatric illness.

• Increases risk of HIV, TB, hepatitis, suicide

alcohol

CNS depressant: relaxation, hypotension, loss of inhibitions

Intoxication: Slurred speech, unsteady gait, lack of coordination, and impaired attention, memory, judgment. Aggressive behavior or display of inappropriate sexual behavior

• May experience a blackout

Overdose: vomiting, unconsciousness, respiratory depression

• Treatment: gastric lavage (stomach pumping) or dialysis to remove the drug, and support of respiratory and cardiovascular functioning in an intensive care unit

Withdrawal: Onset within 4 to 12 hours after cessation or marked reduction of alcohol intake; usually peaks on the second day and complete in about 5 days

• Symptoms: hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety

• Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium (DTs).

• Tx- Benzodiazepines (lorazepam/ Ativan, chlordiazepoxide/ Librium, or diazepam /Valium) based on the CIWA score:

  • <8 = mild withdrawal (may be treated at home)

  • 8 to 15 = moderate withdrawal (marked arousal)

  • >15 = severe withdrawal

etiology of substance / alcohol use

biologic - children with parents who use substances, & twins are more likely

neurochemical - some people have the internal desire to stop after a 1-2 drink buzz, while others just want to keep drinking until intoxicated

psychological - children who grew up with parents who weren’t the best. Can’t cope or form relationships as well

younger ppl- alcohol and cannabis (cheaper & available)

older ppl- cocaine and opioids

cannabis

Used for psychoactive effects. Can be smoked or eaten.

Many people view the social use of cannabis, though still illegal in most states, as not harmful. Many advocate legalizing the use of marijuana for social purposes.

Currently in the United States, there is a federal law that still classifies marijuana as a Schedule 1 drug, but some individual states have or are in the process of legalizing medical use or recreational use or both.

• sx- Lowered inhibitions, relaxation, euphoria, increased appetite, impaired motor control, impaired judgment

• potentially Delirium, cannabis-induced psychotic disorder

• No overdose; No clinically significant withdrawal syndrome- Possible symptoms of insomnia, muscle aches, sweating, anxiety, tremors

cultural considerations of substance use

Muslims do not drink alcohol.

Jews drink wine.

Some Native American tribes use hallucinogens as part of rituals.

Japanese ppl drink alcohol everywhere & it’s normal.

Russian men drink alcohol a lot & are likely to become violent or die

Sedatives, Hypnotics, and Anxiolytics

CNS depressants

Intoxication sx: slurred speech, lack of coordination, unsteady gait, labile mood, stupor

• Barbiturate overdose possibly lethal; coma, respiratory arrest, cardiac failure, death

withdrawal: Symptoms opposite of drug’s acute effect. so it causes anxiety & tremors

Detoxification via drug tapering

Stimulants (Amphetamines & Cocaine)

AKA “uppers” - high risk for abuse

Methamphetamine= extremely dangerous due to psychotic behavior & brain damage

Intoxication: High or euphoric feeling, hyperactivity, hypervigilance, talkativeness, grandiosity, hallucinations, stereotypic or repetitive behavior, anger, fighting, and impaired judgment.

• Physiological s/e- tachycardia, elevated blood pressure, dilated pupils, perspiration or chills, nausea, chest pain, confusion, and cardiac dysrhythmias

OD: seizures & coma

tx: Antipsychotics (chlorpromazine/ Thorazine) → controls hallucinations, lowers blood pressure, and relieves nausea

Withdrawal- Onset within hours to several days. Not life-threatening.

• Primary symptom = marked dysphoria (unease or distress).

• fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation.

• “Crashing” → the person may experience depressive symptoms, including suicidal ideation

• Not treated pharmacologically

opioids

popular drugs of abuse because they desensitize the user to both physiological and psychological pain and induce a sense of euphoria and well-being.

Opioid compounds:

• prescription analgesics (morphine, meperidine (Demerol), codeine, hydromorphone, oxycodone, methadone, oxymorphone, hydrocodone, and propoxyphene)

• illegal substances (heroin, illicitly produced fentanyl, and normethadone)

• Fentanyl = a synthetic opioid used in clinical settings for anesthesia. It is 50 to 100 times more potent than morphine. Illicitly produced fentanyl use has skyrocketed in the past decade and is responsible for the dramatic increase in deaths from opioid overdose.

sx of Intoxication: apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech, and impaired attention and memory

Overdose: coma, respiratory depression, pupil constriction, unconsciousness, death

• give IN Naloxone / Narcan → reverses opioid toxicity

Withdrawal:

• Initial symptoms are anxiety, restlessness, aching back and legs, and cravings for more opioids.

• As withdrawal progresses- nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia.

• Methadone may be used for safe withdrawal for 2 weeks.

• ^sx cause significant distress, do not require pharmacologic intervention.

hallucinogens

substances that distort the user’s perception of reality.

ex- mescaline, psilocybin (mushrooms), lysergic acid diethylamide (LSD/ acid), ecstasy (molly), Phencyclidine (PCP), salvia

• Reality distortion; similar to psychosis (visual hallucinations, depersonalization)

• Cause increased pulse, blood pressure, and temperature; dilated pupils, blurred vision, hyperreflexia

• Intoxication: maladaptive behavioral / psychological changes, anxiety, depression, paranoid ideation, ideas of reference, fear of losing one’s mind, and potentially dangerous behaviors

• No overdose; toxic reactions are primarily psychological- not lethal

• *PCP toxicity: seizures, hypertension, hyperthermia, respiratory depression

• Medications to control seizures and blood pressure; Cooling devices

• Mechanical ventilation

no withdrawal from hallucinogens, but flashbacks of the effects can occur for up to 5 years

inhalants

anesthetics, nitrates, and organic solvents that are inhaled for their effects.

• most common: aromatic hydrocarbons found in gasoline, glue, paint thinner, and spray paint

sx of intoxication: dizziness, nystagmus, lack of coordination, slurred speech, unsteady gait, tremor, muscle weakness, and blurred vision. Stupor and coma can occur. Significant behavioral symptoms are belligerence, aggression, apathy, impaired judgment, and inability to function.

Acute toxicity causes anoxia, respiratory depression, vagal stimulation, and dysrhythmias. Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus.

tx- supporting respiratory and cardiac functioning until the substance is removed from the body. There are no antidotes or specific medications to treat inhalant toxicity

• People who abuse inhalants may suffer from persistent dementia or inhalant-induced disorders, such as psychosis, anxiety, or mood disorders even if the inhalant abuse ceases.