substance disorder

Alcohol Use Disorder

• Definition:

  • Characterized by:

  • Loss of control over alcohol consumption

  • Continued use despite negative consequences

  • Development of tolerance and withdrawal symptoms

• Withdrawal Symptoms:

  • Can be life-threatening and include:

  • Seizures

  • Delirium

Management of Withdrawal

• Medication Options:

  • Benzodiazepines:

  • Examples:

    • Chlordiazepoxide

    • Diazepam

    • Lorazepam

  • Action: CNS depressants used for substitution therapy

  • Goals:

    • Suppress withdrawal symptoms

    • Reduce risk of seizures

    • Stabilize vital signs

  • Side Effects:

    • Sedation

    • Dizziness

    • Ataxia

    • Risk of respiratory depression when combined with other depressants

  • Monitoring:

    • Vital signs and neurological status

  • Instruct to take as directed and DO NOT STOP ABRUPTLY

  • Avoid alcohol and other CNS depressants

Maintenance of Abstinence

• Medication Options:

  • Disulfiram:

  • Action: Causes unpleasant reaction (acetaldehyde syndrome) when alcohol is consumed

  • Reactions include:

    • Flushing

    • Throbbing

    • Headache

    • Nausea

    • Vomiting

    • Hypotension

    • Tachycardia

  • Can be severe; requires monitoring of liver function tests (LFTs) due to hepatotoxicity

  • Important Instructions:

    • Must completely avoid all forms of alcohol (e.g., mouthwash, sauces, hand sanitizer)

    • Effects can last for 2 weeks after stopping

    • Recommend wearing a medical alert bracelet

  • Naltrexone:

  • Type: Opioid Antagonist

  • Action: Reduces craving and pleasant effects of alcohol by blocking opioid receptors

  • Side Effects:

    • Nausea

    • Headache

    • Dizziness

  • Can induce withdrawal symptoms in individuals with opioid dependence

  • Recommendations: Take with food to mitigate gastrointestinal upset and consider monthly IM injection due to non-adherence.

Opioid Use Disorder

• Definition:

  • Includes substances such as heroin, morphine, and oxycodone

  • Leads to effects including euphoria, sedation, and respiratory depression

  • Withdrawal is intensely uncomfortable but typically not life-threatening

Management of Opioid Withdrawal

• Medication Options:

  • Methadone:

  • Type: Opioid Agonist

  • Action: Long-acting opioid agonist used for substitution therapy to prevent withdrawal and reduce misuse

  • Side Effects:

    • Sedation

    • Respiratory depression

    • Constipation

  • Risks:

    • Risk of overdose, especially at treatment onset

  • Administration must occur through approved treatment centers and the dose must be tapered slowly

• For Abstinence Maintenance:

  • Naltrexone:

  • Type: Opioid Antagonist

  • Action: Blocks euphoric and sedative effects of opioids, preventing relapse

  • Caution: Potential to induce severe withdrawal if opioids have not been completely cleared

  • Must ensure FULL detoxification from opioids before starting

  • Available as monthly IM injection

• For Withdrawal Symptoms:

  • Clonidine:

  • Type: Alpha-2 Agonist

  • Action: Reduces autonomic withdrawal symptoms

  • Side Effects:

    • Hypotension

    • Drowsiness

    • Dry mouth

  • Recommendation: Rise slowly to avoid orthostatic hypotension, drowsiness may impair alertness

Nicotine Use Disorder

• Definition:

  • Highly addictive substance leading to long-term health issues, including cardiovascular and respiratory diseases

Management of Nicotine Withdrawal

• Medication Options:

  • Varenicline:

  • Type: Nicotinic Receptor Partial Agonist

  • Action: Reduces craving and withdrawal symptoms by stimulating nicotine receptors and blocking nicotine from cigarettes

  • Side Effects:

    • Nausea

    • Abnormal dreams

    • Insomnia

  • Recommendations: Take after meals with a full glass of water; report mood or behavior changes to the provider immediately.

• Bupropion:

  • Type: Atypical Antidepressant

  • Action: Reduces nicotine craving and withdrawal symptoms by affecting brain chemistry

  • Side Effects:

    • Dry mouth

    • Insomnia

  • Contraindicated in patients with seizure disorders

  • Recommendations: Avoid caffeine to help with insomnia; do not take at bedtime

• Nicotine Replacement Therapy (NRT):

  • Forms: Patch, gum, lozenges, spray, inhaler

  • Action: Provides a controlled dose of nicotine to relieve withdrawal symptoms without the toxins from tobacco

  • Side Effects:

  • Local skin irritation

  • Recommendations: Do not use tobacco products while on NRT; follow specific instructions for each product type

Opioid Overdose

• Symptoms:

  • Life-threatening respiratory depression

  • Coma

  • Pinpoint pupils

Management of Opioid Overdose

• Naloxone:

  • Type: Opioid Antagonist

  • Action: Competitively binds to opioid receptors, reversing respiratory depression and sedation

  • Considerations:

  • Can precipitate acute withdrawal

  • Short half-life may require repeated doses during management

  • Educate family and caregivers on administration of naloxone

  • Always call Emergency Medical Services (EMS) after administration

Benzodiazepine Overdose

• Symptoms:

  • Severe sedation

  • Respiratory depression

  • Coma

Management of Benzodiazepine Overdose

• Flumazenil:

  • Type: Benzodiazepine Antagonist

  • Action: Reverses sedative effects by competing for benzodiazepine receptor sites

  • Risks:

  • Can precipitate acute withdrawal or seizures in dependent patients

  • Usage:

  • Used in emergency/clinical settings only

  • Monitor for re-sedation as the effects wear off.