Transcript Addiction and its treatment

Addiction and its treatment
Rebecca Sposato MS, RN
Terminology – DSM IV
 Intoxication: reversible syndrome specific to the
induced substance, includes physical and mental changes
 Abuse: maladaptive pattern of use despite adverse
consequences including physical hazard, legal, economic
and social problems
 Synergistic: Combination of substances increases effect
of both (alcohol and sedatives)
 Antagonistic: Drug is taken to inhibit effect of other
drug (alcohol and energy drinks)
Terminology – cont.
 Dependence: cluster of cognitive, behavioral and
physiological symptom resulting from repeated use of
substance, often results in relapse
 Compulsive: intense cravings and use beyond
voluntary control
 Tolerance: diminished effect of substance, requiring
increase in dose amount to maintain baseline effects
 Withdrawal: Psychological and physical disturbance
resulting from lower presence of chemical in body
Drug Enforcement Agency DEA
 Schedule of controlled substances:
 One: High potential for abuse, no accepted safe medical
use, illegal except for approved studies. Ex.- heroin
 Two: High potential for abuse and addiction with limited
accepted and restricted medical use. Ex. – oxycodone
 Three: Potential for abuse with and guarded medical use.
Ex. – anabolic steroids
 Four: low potential for abuse and limited dependence.
Accepted medical use Ex. Valium
 Five: minimal abuse potential, may be prescriptive or
OTC. Ex cough syrup with codeine
 www.justice.gov, 2011)
DSM –IV Criteria for Addiction
 3 of more must be present within 12 months:
 Tolerance
 Withdrawal
 Substance taken in greater amounts then intended
 Unsuccessful efforts to reduce use of substance
 Spending great amount of time in activities to obtain
substance
 Impairment of social, occupational and recreational
activities
 Using substance despite knowing of physical and mental
hazard to self
Physiology of addiction
 Pre-existing low serotonin
levels and euphoric
sensitivity to endorphins
and dopamine
 Most addictive chemicals
and behaviors stimulate
dopamine activity in the
nucleus accumbens
 Even looking at pictures of
drug paraphernalia triggers
the addiction pathway
(Carlson 1998)
Alcohol
 CNS depressant due to effects on GABA receptors, also
NMDA antagonist leading to impaired memory
 High comorbidity rate with depression, anxiety,
personality disorders, systemic medical conditions and
societal problems
 Addiction patterns
 Steady drinkers: anti-social tendencies
 Hereditary influences
 Binge drinkers: emotional, anxiety disorders
 Hereditary and environmental influences
 (Carlson 1998)
Treatment - Physical
 Labs – BAL, chem panel, CBC, liver panel, pancreas enzymes
 Clinical Institute Withdrawal Assessment (CIWA) – items
rated from 0-7
 N/V, tactile disturbance, tremor, auditory disturbance, sweaty,
visual disturbance, anxiety, headache, agitation, orientation
 Pharmacology –Vitamin/fluid/electrolyte replacement,
Ativan, B-blockers
 Naltrexone: opiate receptor blockers
 Disulfiram (antabuse): causes unpleasant physiological reaction
when combined with alcohol
 Acamprosate (Campral): inhibits neuro excitability
 Toprimate (Topamax): Inhibits dopamine in mesolimbic area
Treatment – Alcoholics Anonymous
 Alcoholics helping alcoholics: “A fellowship of men and
women who share their experience, strength and hope with
each other that they may solve their common problem and
other to recover from alcoholism”
 Each chapter is stand alone and self-supporting, will not
endorse any organization or position
 No membership fees or affiliation required for participation
in community meeting
 Open – public availability, discuss progress of 12 steps
 Closed – only those with drinking problem, discuss disruption
of alcohol in life
Twelve Steps of AA
 1. We admitted we were powerless over alcohol—that our
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lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could
restore us to sanity.
3. Made a decision to turn our will and our lives over to the
care of God as we understood Him.
4. Made a searching and fearless moral inventory of
ourselves.
5. Admitted to God, to ourselves, and to another human
being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects
of character.
Twelve Steps of AA
 7. Humbly asked Him to remove our shortcomings.
 8. Made a list of all persons we had harmed, and became
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willing to make amends to them all.
9. Made direct amends to such people wherever possible,
except when to do so would injure them or others.
10. Continued to take personal inventory and when we were
wrong promptly admitted it.
11. Sought through prayer and meditation to improve our
conscious contact with God, as we understood Him, praying only
for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these
Steps, we tried to carry this message to alcoholics, and to
practice these principles in all our affairs.
Opiates and Narcotic
 Includes: Heroin, morphine, fentanyl, oxycodone,
hydrocodone, hydromorphone, methadone, and demerol
 Activate receptors for endorphins throughout the brain
 Side Effects: impaired cognition, lethargy, constipation,
 Signs of Overdose: Pinpoint pupils, LOC, bradypnea, and
cool/clammy skin. Treatment:
 Naloxone (Narcan) – blocks recepetors, given IVP or IV drip.
Shorter half-life than most narcotics, requires heart monitor
 Neltrexone: detox/addiction symptom management
 Counseling
Cocaine/Crack
 Stimulant originally derived
from Coca plant can be
formulated for IV, nasal, or
inhalation use
 http://www.youtube.com/
watch?v=4OS2C4NemJI
 Effects: local vasoconstrictor,
dilates pupils, tachypnea,
hyperthermia, hypertension,
delusions, anorexia,
insomnia, injection and nasal
irritation
Hallucinogens and Psychedelics
 Includes: Lysergic Diethylamide Acid, mescaline, psilocybin
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and phenylcyclidine piperidine, salvia.
Distort sense of self and sensory perceptions in low doses,
hallucinatory in higher doses
Most act on serotonin and dopamine receptors. Category
contains both CNS depressants and stimulants
Effects: safety risk, hyperthermia, agitated, delusions, pupil
changes/nystagmus, abnormal vitals
US lifetime prevalence rate: 14% in 2003
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(http://emedicine.medscape.com/article/293752, 2011)
Amphetamines
 Neuro-stimulant on the
dopamine pathways of the
mesolimbic system
 Includes ecstasy and
methamphetamine (longer
lasting)
 Ingredients to meth: cold
tablets, lye, ammonia,
iodine, match heads, ether,
Drano, brake fluid, butane,
hydrochloric acid
Effects: Increase all VS,
polydipsia, delusions,
mucosal irritation, skin
lesions, insomnia, anorexia
http:/http://www.lynnpolice.org/ingredients_of_meth.htm/, 2011)
More on Meth
 Has one of the highest
relapse rates
 Neuro-corrosive causing
structural and functional
changes in brain
 MI and CVA risk
 Annual prevalence 1.2%
Inhalants (Huffing)
 Cleaners, glues, paint etc.
 Call poison control
 Most materials are toxic,
neuro-corrosive and
damaging to lungs, nose and
mouth
 Signs: disoriented dysarthia,
chemical smell on breath,
irritated mucosa, nausea,
dysrythmia, seizures,
hypoxia
17 million Americans at
some point in life. Highest
rate among 12-18 y/o
(www.justive.gov, 2011)
Marijuana/Cannabis
 Tetrahydrocannaibinol
(THC) derived from plant,
can be inhaled or eaten,
acts upon anandamide
neurons
 Marinol: FDA approved
synthetic tablet for appetite
and pain management
 Most used illegal drug in
and most profitable crop in
the United States
Effects: Euphoria, analgesia,
memory impairment, lung
damage, stimulates appetite
Treatment Programs
 Over 50% of addicts will have relapse in disease
 Highest rate in unsupported recovery
 Lowest rate with combination of therapies
 Inpatient: Medical, psych, detox,
 Outpatient: Recovery centers, residential sobriety group
homes, individual/family counseling, support groups
 Treatment Team: Medical MD, psychiatrist, LPC,
SW/CM, nurses, Certified Addiction Counselor (CAC),
BHT
References
 Alcoholics Anonymous (2011) www.aa.org
 Carlson, N. (1998) Physiology of Behavior (6th ed.). Allyn and
Bacon: Boston, MA.
 Department of Justice (2011) www.jusitce.gov
 Lynn Police Department (2011)
http://www.lynnpolice.org/ingredients_of_meth.htm
 MedScape (2011). http://emedicine.medscape.com/article