substance related NOTES

Mental Health Overview

Substance-Related and Addictive Disorders

  • Substance Use: Refers to the continued use of alcohol or drugs despite negative consequences affecting health, job, or relationships.

  • Related Disorders: Diagnosed based on behavioral patterns, not merely on the act of drinking or using substances.

  • Key Diagnostic Criteria:

    • Must show signs of impairment or distress associated with substance use.

Addiction Severity Levels

  • Severity Categories:

    • Mild: 2-3 symptoms

    • Moderate: 4-5 symptoms

    • Severe: 6+ symptoms

Manifestations of Substance Use Disorders (SUD) Symptoms

  1. Impaired Control: Inability to control substance use.

  2. Social Problems: Issues in relationships or responsibilities due to substance use.

  3. Risky Use: Engaging in dangerous behaviors while using substances, e.g., drunk driving.

  4. Physical Dependence: The body adapts to substances leading to withdrawal symptoms, e.g., headaches without caffeine.

Example of a Social Problem

  • A client continues drinking even after losing custody of their child, demonstrating the negative impact of substance use on relationships.

Motivations for Substance Use

  • Relaxation

  • Pain Reduction

  • Performance enhancement

  • Curiosity

Risk Factors for Substance Use Disorders

  • Mental Illness: Often co-occurs with substance use disorders.

  • Stress: Triggers substance use as a coping mechanism.

  • Genetics: Family history may influence susceptibility to addiction.

  • Peer Pressure: Influence from peers can lead to increased substance use.

  • Environmental Factors: Backgrounds involving abuse history foster higher risks of addiction.

Relationship Between Mental Illness and Substance Use

  • Self-Medication: People may use substances to cope with mental illness.

  • Developing Secondary Conditions: For example, drug use can lead to depression or psychosis.

  • Substance-Induced Psychosis: If someone experiences hallucinations after heavy drug use, it is indicative of this condition.

Common Substances and Their Effects

  • Alcohol: A depressant that slows down the central nervous system.

  • Opioids: Used for pain relief but pose a high risk of addiction.

  • Stimulants: E.g., cocaine, meth; they speed up the central nervous system.

  • Hallucinogens: Cause alterations in perception, mood, and cognitive processes.

  • Sedatives: Depressants that slow down body functions, including alcohol and benzodiazepines.

  • Nicotine: A stimulant found in tobacco that can lead to addiction.

Comorbidities Associated with Substance Use

  • Substance use can lead to or exacerbate various health issues, including:

    • HIV

    • Stroke

    • Depression

    • Heart Disease

    • Cancer

  • Long-term drug users are at a significantly higher risk for contracting HIV.

Warning Signs of Substance Use Disorders

  • Mood Changes: Increased changes in emotional states.

  • Decline in Academic/Job Performance: Noticeable drop in performance.

  • Change in Peer Group: New friends that may be connected to substance use.

  • Weight Changes: Significant fluctuations in body weight.

  • Relationships Strain: Increased conflict or distance with family and friends.

Alcohol Withdrawal Symptoms

  • Decline in performance and shifting peer relationships may indicate possible Substance Use Disorder (SUD).

  • Withdrawal Symptoms:

    • Tremors

    • Seizures

    • Delirium Tremens: Severe confusion and agitation during alcohol withdrawal.

Treatment Considerations for Alcohol Withdrawal

  • Medications Used:

    • Benzodiazepines: Administered to manage withdrawal symptoms.

    • Thiamine (Vitamin B1): Given to prevent Wernicke-Korsakoff Syndrome, which can cause brain damage due to thiamine deficiency.

Why Administer Thiamine Before Glucose?

  • To prevent neurological damage that may occur in patients with reduced thiamine from chronic alcohol abuse.

Medications to Reduce Cravings

  • Naltrexone: Helps reduce the urge to use alcohol.

  • Acamprosate: Aids in maintaining abstinence and reducing relapse rates.