Drugs and Substance Abuse

Introduction to Substance Use

  • Definition: Mind or mood-altering substances, which can be either legal or illegal.

    • Examples of substances:

    • Alcohol

    • Sedatives

    • Pain medications

    • Stimulants

    • Hallucinogens

    • Cannabis

  • Consequences: All of these substances have the potential to be abused and can become addictive.

Substance Use Disorder

  • Definition: Ongoing use of substances despite the problems it causes.

    • Severity Levels: Can be categorized as mild, moderate, or severe.

  • Mechanism: The brain’s reward system becomes 'hooked' on the substance.

  • Impact on Life: Normal activities and responsibilities are neglected as a result of continued use.

  • Diagnostic Criteria: The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) integrates both "substance abuse" and "substance dependence" into the term "substance use disorder."

Reasons for Substance Use

  1. To Relieve Physical or Emotional Pain

  2. To Relax or Feel Good

  3. To Be More Social

  4. To Improve Focus or Alertness

  5. To Escape Reality

Related Terms in Substance Use

  • Addiction:

    • Definition: Characterized by repeated, compulsive use of a substance even when it causes harm to the individual.

  • Tolerance:

    • Definition: When the body requires increasing amounts of the substance over time to achieve the same effect.

  • Intoxication:

    • Definition: When a drug influences an individual's thinking and behavior, resulting in impaired functioning.

  • Withdrawal:

    • Definition: The body's reaction upon stopping the drug, which may include a variety of physical and psychological symptoms.

Co-occurring Disorder

  • Definition: Many individuals with mental health disorders also engage in substance use, referred to as dual diagnosis or co-occurring disorders.

  • Impact: Substances can exacerbate existing mental health issues, thus requiring simultaneous treatment of both conditions for effective recovery.

Health Care Workers and Substance Use

  • Vulnerability: Nurses and doctors are not immune to substance use disorders.

  • Causes of Substance Use Among Health Care Workers:

    • Stress

    • Easy access to medications

    • Poor coping mechanisms

  • Signs: Indicators of substance use can include errors in duties, absences, and a lack of focus.

  • Reporting Laws: Legal obligations for co-workers to report any suspected substance use.

Indicators of Problematic Substance Use

  • When It Becomes a Problem:

    • Involves interference with daily life activities.

    • Continues despite adverse consequences.

    • Causes harm to others or damages relationships.

Cultural Considerations in Substance Use

  • Demographics: Substance use affects all ethnic groups.

  • Statistics:

    • Higher alcoholism rates among Native Americans.

    • Lower rates among Asians related to adverse physical reactions to alcohol.

  • Influencing Factors: Culture and genetics significantly influence patterns and rates of substance use.

Alcohol Use Disorder

  • Overview: Alcohol is the most commonly abused substance globally and is legal in most cultures, often used in social celebrations.

  • Alcohol Intoxication:

    • Blood Alcohol Level (BAL)

    • Legally considered drunk at a BAL of 0.08.

    • BAL of 0.4 or higher can lead to coma or death.

    • Symptoms of Intoxication: Poor judgment, mood swings, slurred speech, unsteady gait.

Binge Drinking Definition

  • Criteria:

    • Women: 4 or more drinks within a 2-hour time frame.

    • Men: 5 or more drinks within a 2-hour time frame.

  • Consequences:

    • Dangerous risks such as alcohol poisoning and engagement in risky behaviors.

    • Common among teenagers and college students.

Health Effects of Alcohol

  • Physical Health Risks:

    • Heart disease

    • Liver damage

    • Stroke

    • Various forms of cancer

    • Diabetic complications

    • Increased chances of accidents or aggressive behaviors.

  • Effects on Pregnancy:

    • Consumption during pregnancy can lead to Fetal Alcohol Spectrum Disorder (FASD).

  • Effects on Older Adults:

    • Symptoms may be mistaken for dementia or depression, complicating diagnosis and treatment.

Family Effects of Alcohol Abuse

  • Impact on Families:

    • Alcoholism affects all household members, leading to a phenomenon known as codependency, where family members may attempt to conceal or control the behavior of the individual with substance use disorder.

Screening Tools for Alcohol Use

  • CAGE Questionnaire (used for screening alcohol use problems):

    1. Have you ever felt you should cut down on your drinking?

    2. Have you ever been annoyed by criticism of your drinking?

    3. Have you ever felt guilty about your drinking?

    4. Do you ever need a drink first thing in the morning (an eye-opener)?

  • Additional Tools: The Clinical Institute Withdrawal Assessment of Alcohol Scale - Revised (CIWA-Ar) to monitor withdrawal symptoms.

Alcohol Withdrawal Symptoms

  • Occurs 4-12 hours after their last drink.

  • Symptoms May Include:

    • Nausea/Vomiting

    • Elevated Blood Pressure (BP) and Heart Rate (HR)

    • Seizures/Confusion

    • Anxiety

    • Sweating

    • Shaking Hands

Treatment for Alcohol Withdrawal

  1. Detoxification: Safely removing alcohol from the body.

  2. Benzodiazepines: Used for comfort and safety during withdrawal.

  3. Fluids: Replacement of lost fluids.

  4. Vitamins: Addressing vitamin deficiencies caused by alcohol use.

  5. Electrolytes: Replacing electrolyte loss is crucial.

  6. Close Monitoring: Constant supervision during the withdrawal process.

Treatment for Alcohol Use Disorder

  • Rehabilitation Options:

    • Inpatient or outpatient rehab.

  • Support Groups:

    • Alcoholics Anonymous, Al-Anon, and Alateen as community support resources.

  • Therapy:

    • Counseling and therapy for acquiring new coping strategies.

  • Medications: Various medications may assist in reducing cravings associated with alcohol use disorder.

Medications for Alcohol Use Disorder

  • Disulfiram: Causes adverse reactions when alcohol is consumed, discouraging drinking.

  • Naltrexone: Blocks the pleasurable effects (the ‘high’) of alcohol.

  • Acamprosate: Helps reduce cravings for alcohol.

  • Topiramate: May contribute to reduced desire to drink alcohol.