Transcript Chapter 10 Substance Abuse

Chapter 10
Substance Abuse
Tolerance: increasing dose day by day to have
the needed effect of substance.
Withdrawal symptoms: If addict stops taking
substance (usually within few hrs.) temporarily,
withdrawal sx will appear (psycho-somatic sx)
which are very painful sx.
-In Nicotine withdrawal sx it is mostly
psychological sx as anxiety & irritability.
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1) Cannabis ‫الحشيش‬
-Marijuana ) ‫ (البانجو‬is one type of it.
-Happy sx of taking Cannabis start after few min. if
taken by smoking, & after 1/2 hr. if taken by mouth
-Its effect (if taken by mouth) continues 5-12 hrs.
-If big amount taken by mouth, respiratory center
may stop & death will result during sleeping.
-Wrongly cannabis is known as sex stimulus (longer
sexual activity) which is not proved scientifically.
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Sx of cannabis Abuse :
-Feeling of well being.
-Talkative with feeling of euphoria when talking.
-Light head.
-Hyperactivity.
-Difficulty in orientation (esp. time).
-If abuser moves up few steps in stair, will
imagine that he is over biggest pyramid.
-By increasing dose, hallucination will result.
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Long-term using effect :
-Respiratory diseases especially Bronchitis.
-Cancer of lung.
-Cardio-vascular diseases.
N.B: Appetite to sweets will increase
-Has negative effect on behavior & ethical
manner as laughing in sad situation.
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2) Opiates)‫(األفيون‬
-Morphine, Heroin, Codeine, Pethedin, Crack.
-Used in medical field as pain killer, cough relief.
-If taken for few months, withdrawal sx will appear (anxiety,
irritability).
-Each time amount will be increased.
-Withdrawal sx will appear after 3 hrs. of taking previous dose
(Withdrawal sx will reach its peak in 1-2 days).
-Usually it is white.
-Used by IV, smoking or sniffing.
-Heroin leads to mush happiness for abuser.
-Abuser health: poor r/s.
-Suffering of chronic constipation.
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Withdrawal sx:
1-Increase urge to get substance, anxiety.
2- Condition like flue (Rhinitis), much sweating,
lacrimation.
3-Pain in joints & muscle.
4-Vomiting, diarrhea, abdominal pain, appetite.
5-Difficulty in breathing.
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Cocaine:
-Cocaine is made from the leaves of the coca plant, which
grows mainly in South America.
-Stimulant drug.
-White powder used by sniffing, or IV.
-Addict may experience grandiosity (exaggerated belief in
importance & abilities). This can lead addict to take risks,
particularly when driving, leading to accidents.
-Usually feeling of anxiety will accompany cocaine use.
-Effect of cocaine is very short.
-Addict of cocaine may become criminal.
-Withdrawal sx of cocaine less severity than opiates.
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Complication of cocaine addiction:
-Sleep disturbance.
-Decrease appetite, decrease wt.
-Skin itching.
-Depression.
-Criminal behavior.
-Impotence.
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Crack:
-Crack is the street name for crystallized freebase
cocaine.
-It is most commonly smoked, which, due to lungs’
rapid absorption rate, means that more of drug gets
into body faster than through injection or inhaling.
-When smoked, it takes about 20 seconds or less for
feelings of euphoria & pleasure to start, but along
with this quick high comes the downside: the happy
feelings fade just a few minutes later & resulting
low can be dramatically dismal.
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-Crack’s main course of action is to alter & work on
autonomic nervous system of human body.
-In normal functions, brain secretes dopamine, a
chemical that, when bound to nerve cells in brain,
produces feelings of pleasure in body.
-Dopamine production normally occurs naturally,
but crack speeds up this natural system by causing
brain to release all of stored dopamine in one quick
burst.
-This produces feelings of intense pleasure &
euphoria, but when settle down, & no dopamine
left, this state means downswing of emotions &
intense desire to get more crack at any cost.
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Rx of addiction (dependence):
Criteria (factors) help in Rx:
1-Short period b/w starting of taking substance
& Rx.
2-Availability of intention of pt. to be treated.
3-Age of pt.'s.
4-Level of education.
4-Type of substance.
5-Acceptance of pt. to follow up Rx at home.
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Stages of Rx:
1-Detoxification: l-2wks (weaning) should be in
specialized hospital.
2-Rehabilitation: Trial to solve problem with cooperation
of family, Reinforcement of positive behavior.
3-Follow up: Very important stage , could be more
important than Rx itself.
-If pt. is relapsed condition worse.
**In some countries they use methadone with small
doses. It is not Rx of addiction, but it is substitution by
another type with less withdrawal sx.
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Alcoholism
-Effects if Alcohol : Alcohol is CNS depressant
Level
Effect on the brain
0.05%
Poor judgment
0.1%
Clumsy motor actions slurred speech
0.2%
Depressed motor area of brain, emotional lability
0.3%
Confusion, stupor
0.4%
Coma
0.5%
Breathing & heart rate centers are affected, Death
due to respiratory paralysis
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-With chronic use: Alcoholic dementia
-Social relation inhibition, marital problems,
occupational problems, violence, legal problems
increased accidents.
-Medical problems.
-Liver cirrhosis , fatty infiltration.
-Gastritis, gastric ulcers.
-Vitamin deficiency, especially Thiamin.
-Peripheral neuropathy.
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Epidemiology :
-In many countries, alcohol is widely used &
abused.
-Some people take alcohol occasionally for social
reasons or to relieve tension.
-Prevalent in early 20-35 years age group.
-Onset is in early 20s.
-Sx of alcoholism start to appear in 30’s.
-Alcoholism can coexist with other psychiatric
disorders like: Depression, bipolar, anxiety, &
personality disorders.
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Etiology:
-Alcoholism is not single disorder, it can have many
causes.
-Some alcoholics start to drink in an attempt to treat
psychiatric problems: anxiety, depression, mania, etc.
or physical disorder: pain.
-Some people develop alcoholism & become
dependent.
-The short-term sedative effect of drinking alcohol is
replaced by long term dysphoric mood & withdrawal sx
which push alcoholic to drink more.
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1. Biological Theory:
-Some studies found genetic factor behind
alcoholism.
-In one study it was found that 25% of fathers of
alcoholic pts. were alcoholic.
-Concordance of alcoholism in monozygotic
twins is twice as dizygotic twins.
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2. Psychoanalytic theory :
-Individuals who abuse alcohol (or other
substances) have undeveloped egos r/s, failure
in completing tasks of separation-individuation.
-Person retains highly dependent mature, with
characteristics of poor impulse control, low
frustration tolerance & low self-esteem.
-Superego is weak, resulting in absence of guilt
feelings for their behavior.
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3. Learning theory:
Release of anxiety becomes reinforcement for
further drinking as it results in temporary
reduction of fear & conflict.
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Clinical Picture:
Alcoholic intoxication
-Maladaptive behavior: sexual & aggressive
behavior, labile impaired judgment, impaired social
or occupation functions.
-Somatic sx: slurred speech, in-coordination,
unsteady gait, nystagmus, flushed face.
c) Hematomas & contusions due to falls,
hypothermia in cold weather.
d) Other sx like liver cirrhosis, peripheral
neuropathy & cerebral ataxia.
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Alcohol withdrawal:
-Syndrome observed after cessation or reduction of
alcohol intake after prolonged period of use.
Sx:
-Nausea & vomiting.
-Malaise of weakness, headache, insomnia.
-Autonomic hyperactivity.
- Anxiety, irritability or depression.
- Seizures, especially if past hx of epilepsy.
- Hallucinations or illusions.
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1) Delirium Tremens:
-Occur in 5% of hospitalized alcoholics within 1 week after
cessation or reduction of alcohol intake.
-Withdrawal sx progress to state of delirium.
-Essential features are:
-Delirium: Clouding of consciousness disorientation,
hallucination visual or tactile.
-Autonomic hyperactivity: Tachycardia, sweating,
hypertension.
-Fluctuating level of psychomotor activity: Pt. is sometimes
hyperexcitable & sometimes lethargic.
Rx:
-Benzodiazepines 25 to 50 mg, chlordiazepoxide (librium) 2-4
hrs., adequate nutrition & hydration.
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2) Alcoholic hallucinosis:
-In some pts. visual or auditory hallucinations occur
within 48 hrs. after cessation of alcohol with no sx
of delirium & continue after recovering from
withdrawal sx.
-Course is short, hallucinations disappear within
several weeks or few months.
Rx:
-Like delirium, Benodiazepines, nutrition &
adequate hydration.
-If case is prolonged, anti-psychotics may be used.
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3) Alcohol Amnestic Disorder Encephalopathy:
A) Wernick’s Encephalopathy:
-Acute reversible neurological syndrome that results from
prolonged heavy drinking of alcohol.
-Etiology is due to Thiamin deficiency malnutrition that
accompanies is predisposing factor .
-Essential factors are :
-Ataxia.
-Opthalmoplegia: (cranial nerve paralysis).
-Nystagmus.
-Confusion.
-Spontaneous recovery within few days or weeks.
-It can progress to Alcohol Amnestic Disorder.
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RX:
-High doses of parenteral Thiamin & response is rapid.
-If Rx delayed, irreversible damage occurs & respond to
Rx.
B)Alcohol Amnestic Disorder (Korsakoff’s Syndrome):
-Chronic irreversible disorder resulting from heavy
alcohol intake.
-Irreversible impairment of memory occurs.
Etiology: is also due to Thiamin deficiency.
-Course is short & recovery occurs in only 20% of cases.
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4) Alcoholic Dementia:
-Dementia that persists for longer than 3 weeks
after cessation of alcohol intake.
-Usually occurs in heavy drinkers above 35 y/o who
have been drinking for long period.
Essential features:
-Impairment of intellectual abilities.
-Memory impairment.
-Social & occupational impairment.
-Condition is chronic & irreversible.
-Rx is supportive.
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Rx of Alcohol Dependence:
I. Psychotherapy:
-To explore the desire of alcoholic to be intoxicated
(drinking is treated as a psychological defense).
-Anxiety producing factors are discussed .
-There should be supportive & active periods of
depression are treated by psychotherapy & antidepressants
Behavioral Therapy:
-Teaching alcoholic other ways to relieve anxiety like
relaxation training & assertiveness skills.
-Positive reinforcement is used to reinforce abstinence.
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II. Medications:
Disulfiram: (Antabuse): is drug used to produce
undesirable side effects if alcohol is taken.
-Given in dose of 25 only after last drink.
-If pt. drinks alcohol while on disulfuram, he
experiences nausea, palpitation, dizziness,
hypotension, numbness in extremities.
-These effect are toxic reactions due to
accumulation of acetaldehyde in blood.
Psychotropic medication: Anti-depressants or
anxiolotics to treat depression, anxiety or irritability
that may occur during abstinence.
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III. Support Groups:
-Some alcoholics who have bean treated form
support groups to help other alcoholics.
-These are voluntary organizations that may
help pt. during his Rx.
Ex:
Alcoholics Anonymous (AA).
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