Transcript substance abuse - Molloy College

SUBSTANCE ABUSE
Emiliya Mullayeva
Molloy College
Case Description
• Jake is a 15 year old, suspect of recently abusing
prescription drugs. He is brought in his mother for
evaluation. She describes his behavior as erratic and
worse on weekends. He can be very hyperactive or
sluggish. He has consistently completed his school work
in the past and maintained a C + average. His mother
feels he has gotten involved with the “wrong crowed” and
she can no longer reach him. Jake does not see any
problems and is annoyed with his mother. He denies
drug use but acknowledges that his peers are involved
with “some stuff” but can not or will not explain further.
History of present Illness
• 15 year old male presents
hyperactive/sluggish and erratic behavior.
Past Medical History
• Normal vaginal delivery without any
complications
• Birth weight: 8 bls 4 oz. Hight 21”
• Past History: appendectomy age 10
• No serious illnesses
• Up-to-date immunizations and prior health
checkups
Family History
• Father well and alive
History of smoking
Mother no serious medical illnesses
Two siblings 10 yr and 5 yr well and healthy
Mother 40 yr college graduate, works as P/T in
private office, full time
Father 47 yr college graduate, works full-time as
an MRI tech in the hospital
There is no family history of alcohol or drugs
abuse in the family, no mental illnesses.
Physical examination
Pupils 3mm, PERLA
Apical Pulse-88
Respiratory rate-20 breath/min
Blood Pressure-108/60
Weight-145lbs
Height 5 ft 6 inch
BMI 23.4
Temp-97.7 F (tympanic);
No signs of physical abuse noted.
Mental Status examination
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AAO x 3 (time, person and place)
Maintained a good eye contact
Appearance: Well groomed and nourished.
Speech: clear
Mood: Anxious
Affect: congruent
Gate: stable
Thought process: linear
Thought content: appropriate
Impulse control: fair
Insight/Judgment: fair
Sensorium: grossly intact
Is Jake medically stable?
• There is no evidence of acute intoxication
or withdrawals noted at this time.
• No tremors, hallucinations (tactile/visual)
• No diaphoresis, agitation, confusion (DT’s)
• No ataxia, miosis, mydriasis, rinorrhea
• No flash skin, chills, body aches, diarrhea
or piloerrection (hair standing up on arms
or goose bumps).
Screening tools
• COWS - Clinical Opiate Withdrawal Scale
• CIWA – Clinical Institute Withdrawal
• Assessment for Alcohol.
• CAGE – Alcohol and Drug Abuse
assessment
Clinical Decision making
• Jake is medically stable, no ER needed at
this time.
• Refer Jake to the Psychiatrist for the full
evaluation.
• Also refer him to the substance abuse
counselor for the evaluation as well.
Interview the mother
• Behavior patterns of her son: sleeping, taking
showers, school attendance and homework. If
Jake recently changed his friends suddenly?
Any compulsive behavior? Anger or depressive
mood? Any extra curriculum activities?
• Have you ever smell alcohol or cigarettes on
Jake’s breath or cloth?
• Ask the mother to sign consent for Jake’s
interview.
Interviewing Jake
Past/present suicide attempts/ideations or
plans? Do you experiment drugs? If yes/Why?
Do you have trouble with sleeping at night?
Trouble with concentration?
What is your daily routine?
Do you have compulsive behavior, such as
compulsive spending, cutting, internet or
eating disorder?
Do you have a good relationship with your
mother/father?
Do you have a significant other?
Describe your relationship?
Social History
• Jake is lately isolating himself in his room.
• His Growth and Developmental milestones
were WNL according to his mom.
• Jake doing poorly in school this year,
interacts poorly with his family and friends
• Exposed to peer pressure, hanging out
with the “wrong crowed”.
Facts on Substance Abuse in
Teenage
• Teens are making the decision to abuse
prescription medicines based on misinformation.
In fact, many people think that abusing
prescription drugs is safer than abusing illicit
drugs.
• Prescription drugs can have dangerous short –
and long – term health consequences when
used incorrectly or by someone other than for
whom they were intended.
Facts continue
• Teens tend to abuse substances that are
inexpensive and easy to obtain.
• Prescription medications commonly misused:
opioids used for treatment of pain and include
hydrocodone and oxycodone), stimulants
(treatment of attention-deficit/hyperactivity
disorder-ADHD, such as methylphenidate and
amphetamine), tranquilizers (benzodiazepines
and minor tranq. as meprobamate and
carisoprodol), and sedatives (barbiturates and
chloral hydrate). Also steroids: testosterone,
Stanzolol( Winstrol).
Facts continue
Misuse, of drugs can lead to notable risks.
It’s include the potential for physical or
psychological dependence and overdose.
• Physical dependence result from
withdrawal intolerance.
• Addiction: 1 Repeated use of drugs,
compulsive seeking (psychological
depend.) 2. Loss of control. 3. Use despite
negative consequences.
Facts continue
• All of these medications offer pleasant, euphoric
sensations. Stimulants offer improved focus,
decreased need for sleep, and reduced appetite
and can contribute to weight loss. They are
attractive to teens juggling academic and
extracurricular activities.
• Steroids can improve physical appearance and
users may report feelings of invincibility.
Consequences of Prescription
Substance Abuse
Opiate meds may lead to rapid tolerance and if abused consistently
can lead to opiate withdrawal when stopped abruptly. Symptoms of
opioids misuse: resp. depression and death. Drowsiness, miosis,
and constipation. This side effects can be made worse when
prescription drugs are abused in combination with other substances
including alcohol or benzodiazepines, both of which can slow
breathing. When abused, may be taking in inappropriate doses or by
routes of administration that change the way the drugs act in the
body, risking overdose. Example: OxyContin crushed and inhale the
pills, a 12-hour dose hits their central nrvous system all at once –
which increases their risk of addiction and overdose. Opiate
withdrawals: mydriasis, rinorrhea,flash skin, piloerrection, chills,
body aches, GI upset/diarrhea, lethargy.
Consequences continue
• Stimulants such as Adderall-Dextroamphetamine, RitalinMethylphenidate. Increase blood pressure and heart rate, open up
the pathway of the respiratory system, which can increase alertness,
attention and energy. Overdose of stimulants can cause anxiety,
panic, tremors irregular heartbeat, restlessness, dangerously high
body temp, and even heart attack. People who stop taking
stimulants after some time may suffer from fatigue and depression.
Toxic effect of high dose include: seizure, violent behavior, high risk
behavior ( sexual promiscuity, motor vehicle accidents), cardiac
rhythm disturbances, strokes, disease related to IV use (Hep C,
HIV), and lung disease related to the injection of the inert materials
that are components of the Ritalin tablets. Extremely addictive, but
no physical dependency.
Consequences continue
• Benzodiazepines and barbiturates are
CNS depressant medications. Slow down
activity in the brain. People can feel
drowsy or calm , an effect that is helpful
for those suffering from anxiety or sleep
disorders. It can cause confusion and
slowed breathing. Stopping their use
suddenly after long –term use can cause
seizures, because the brain cells become
overactive.
Behavioral Warning Signs
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Loss of enthusiasm and signs of depression
Withdrawal from normal activities
Truancy and unexplained drop in grades
Irritability and overreaction to criticism
Unusual requests for money
Decreased interest in appearance
Unexplained changes in friends
Frequent nasal or sinus infections
Why might teens use drugs?
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To enhance pleasure
To have fun
To vary their conscious experience
To self medicate
As a way to cope with trauma
To relieve anxiety, depression, insomnia
To relieve pain
To Promote and enhance social interaction
To stimulate artistic creativity and performance
To rebel
To improve physical/mental performance
To fend off withdrawal
To lose weight
Consequences continue
• Adolescence is a time of significant growth
and change including the development of
cognitive functioning. The abuse of any
substance during adolescence poses
additional risks to physical, psychological
and cognitive development.
Identifying Abuse
• Peer pressure, depression, a history of
physical, sexual or emotional abuse, and a
history of parental drug abuse.
• Screening parents and teens for potential
substance abuse may help to identify
those at risk.
Rapid Assessment
• Screen tool for assessing teens at risk for substance
abuse. The CAGE questionnaire, usually used for
assessing alcohol abuse, can be use to assess drug
abuse too.
• C=have you ever thought you should Cut down on your
drug use?
• A=have people Annoyed you by being critical about your
drug use?
• G=have you ever felt Guilty about your drug use?
• E=have you ever used drugs first thing in the morning as
an Eye opener or to get the day started?
Rapid Assessment continue
• Any “yes” answer to the questions below should
be investigated.
• Answering “yes” to two or more questions
suggests the need for additional assessment
into potential drug and/or alcohol problems.
• These tools can help to start the conversation to
identify potential risky behaviors. Have the teen
complete the questionnaire in the room without
the presence of the parents to begin the
confidentiality process. Let the teen know that
sexual health matters are confidential, lifethreatening behavior may have to be.
Assessment continue
• During a physical exam, several signs and
symptoms may alert you to the possibility
of drug use. Sudden weight loss or gain
and eye signs may provide clues.
• Sedative abuse and hypnotics may cause
nystagmus; opioid abuse causes miosis.
Stimulants and opioid withdrawal can
lead to mydriasis.
Diagnostic lab test
• Urine drug screen may confirm suspected
drug abuse, but accurate results depend
on when the drug was taken and how fast
it’s metabolized.
• Blood test
• Hair analysis is noninvasive and has a
larger window of detection than a urine
drug screen ( up to 6-9 month).
Treatment
• Counseling and detoxification are the first steps
toward treatment. Then, intensive residential
treatment followed by long-term outpatient care
and support (aftercare).
• Encourage teen to begin an open discussion
with parents, school guidance, counselor, or
other trusted adult about sex, drugs, depression,
or other concerns.
• Continue to educate teens about the negatives
of drugs use with each visit in a nonthreatening
manner, and offer information on getting help.
• AA, NA, CA self help meetings.
Family Education
• Educate parents about the proper storage and disposal of
prescription meds and remind them to keep drugs and alcohol out of
reach of all children, regardless of age.
• Medications should not be disposed into water sources. Meds. Can
be harmful to the environment, humans when they enter the water
system via toilets and water drains.
• Advise parents to dispose of meds in the trash by removing them
from their original containers, crushing them , into a kitty litter,
spoiled foods, or coffee grounds. Some communities have the dropof centers. Limit your child exposure to PG-13 movies and avoid Rrated movies. Remove TV from child’s bedroom. Turn off TV during
evening meals.
• Warning signs: depression, low self –esteem.
• Feel like they don’t fit in and are not popular with the mainstream
• Frequently feel sluggish and have difficulty sleeping
• Aggressive and rebellious attitude toward authority figures
Education continue
• Educate Jake about medical aspects of
chemical dependency. Explain the danger
of the combination drugs and drugs with
alcohol. Example: Acetaminophen, a
component of many combination opioid
products, can cause potentially fatal liver
damage in high doses. Nonsteroidal antiinflammatory drugs combined with opioids
can cause gastrointestinal bleeding and
renal damage, etc. Safety standards.
Information and Support
“Smart Moves, Smart Choices: A
prescription Drug Abuse Education
Program”. http://www.nasn.org
“The Current State of Teenage Drug Abuse:
Trend Toward Prescription Drugs”
http://www.nyhealth.gov/publications/1064.p
df
[email protected]
Information and Support
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After School Alliance
Parents-The Anti-Drug
Queens Outreach Program Center
National Suicide Prevention Lifeline
1-800-273-TALK is a crisis hotline that can help with
many problems, not just suicide.
• Treatment referral Helpline 1-800-662-HELP
• Offered by Substance Abuse and Mental Health Services
Administration-refers callers to treatment facilities,
support groups, and other local organizations that can
provide help for their specific needs.
References
Victor C. Strusburger, MD(2010) Policy Statement-Children, Adolescents,
Substance Abuse, and the Media American academy of Pediatrics,
• 126;791 Retrieved from htt://www.pediatrics.aapublications.org on February
10,2012
S. Schepis and k.Suchitra, PhD (2008) Characterizing Adolescent Prescription
Misusers: A Population-Based Study,47:7 J. American Academy Child
Adolesc. Psychiatry. Retrieve from http://www.JAACAP.COM on February
10,2012.
Jennifer R. Havens, PhD, Christoper E. RN,BSN (2011) Nonmedical
Prescription Drug Use in a Nartionally Representative Sample of
Adolescents, vol165(no3). ARCHPediatric Adolesc Medical Association
Retrieve from http://www.ARCHPEdIATRICS.COM on February 10,2012.
Susan Simmons, PhD,RN,ARNP-BC (2010) Teens and Prescription Drugs A
Potentially dangerous combination, vol 42. Nursing, Retrieve from
http://www.NURSING.com on February 10,2012.