Substance Abuse Disorders
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Transcript Substance Abuse Disorders
Substance Abuse Disorders
NU124
Criteria: SUBSTANCE ABUSE
Must have one or more in the past 12 months:
Recurrent use in physically dangerous settings
Recurrent drug-related legal problems
Continued use despite recurring interpersonal
problems
Continued:
Failure to fulfill role obligations at home, school, or
work
Criteria: SUBSTANCE DEPENDENCE
Three more in the last 12 months:
Drug intolerance
Drug withdrawal
Use is greater in amount and frequency of use than
intended (loss of control)
Persistent desire and unsuccessful attempts to stop
or control
Continued:
Increasing time and energy to obtain the drug
Lifestyle changes (social, recreational or
occupational)
Use continues despite problems
Intoxication
Reversible substance-specific syndrome
Clinically significant behavioral or psychological
changes
Not due to another mental disorder
Withdrawal
Substance-specific syndrome due to cessation
Clinically significant distress
Not due to another condition
Behaviors
Manipulation
Grandiosity
Denial
Isolation
Decreased occupational functioning
Impaired relationships
Assessment
CAGE:
Cut down?
Annoyed?
Guilty?
Eye-opener?
ALCOHOL INTOXICATION
CNS Impairment – brain function to peripheral NS,
absorbed in stomach, all systems affected. See
Townsend, p. 416+
Acute, Metabolize – gone and symptoms go
Long tem effects with use =
Amounts
Quantities
****CNS depression****
Acute alcohol intoxication
Changes in mood
Poor psychomotor coordination
Impaired memory and judgment
Impaired social functioning
Behavior changes
BAL of 100-200 mg/ml
Remember “Tolerance”
Withdrawal
What is the opposite of CNS depression?
What have you studied in NU 110 that is similar to
this?
***Sympathetic NS Hyperactivity***
Similar to physiological stress response
Symptoms
Tremors
Elevated VS
Anxiety, irritability
Insomnia
Diaphoresis
***Onset: 4-12 hours after last drink
Withdrawal
Peak is 2 – 3 days
GREATEST RISK: Alcohol delirium, DT’s, Delirium
tremens
*** A medical crisis
Occurs on second to third day following last drink
Prevent DT’s. Get pt. past this window.
Alcohol delirium
Autonomic NS hyperactivity: cardiac, smooth
muscles, glands
Hallucinations, illusions, delusions
Fluctuating LOC
Seizures
N and V
Detoxification
Priority #1: Physiological stability, safety
Monitor: BP and P, R and T; q 4 hrs:
Medicate: Use of cross dependent sedatives, titration
based on degree and number of symptoms. What
class of drugs have a sedative/CNS depressant
effect? Use
these_________________________
Continued:
Fluids – replacement and enhance detoxification via
kidney and liver - if functioning normally
Nutrition – alcohol decreases appetite;
Thiamine(Wernick’s encephalopathy), Folic acid and
MVI
Continued:
Reduce risk of seizures: MgSo4, Anticipate
anticonvulsants
Reduce risk of stroke: antihypertensives
Continued:
Priority #2: Address the denial
Around day 3
Matter of fact, no judgment, tell the facts of patient
condition and directly link to alcohol use
“As a result of your body’s dependency on alcohol, it
reacted with the symptoms
of__________________. This indicates damage
to …”
Continued:
“Alcohol use is damaging your body. Examples of
this are____________.”
continued
Priority #3: Plans for sobriety, learning to live
sober. Contingent upon belief that alcohol use has
created problems.
“What would you like to have happen in your life
now?” “What do you wish for?”
At discharge
In-patient rehabilitation or, home and AA
Sobriety
Medications – adjunct to learning to cope, re
programming responses
Antabuse – negative reinforcement
Naltrexone – decrease cravings
Campral – decrease distress, improve mood,
contraindicated in liver inpairment
MEMORIZE THESE
Continued:
Continue to address denial and powerlessness over
alcohol – AA
Practice new ways to cope
Counseling on coping and repairing relationships
New relationships, lifestyle changes
Family
Don’t feel
Don’t trust
Don’t expect
Continued:
Deny the problem
Use a substance
Develop a symptom
Kick the user out
Co-dependence (part of denial) – the need to be
needed
Learn to cope with substances
Family treatment
Family therapy to repair relationships, family
structures, re-set family roles
Alanon – adult – learn to give up responsibility for
the user and his/her substance use
Alteen – Adolescents: Leaning to cope, not overfunction, have sx., or use substances
Part II - Other drugs
Why does the brain prefer opium to broccoli?
A shortcut to the brain’s reward system
Floods the nucleus accumbens with dopamine
Hippocampus lays down memories of rapid
satisfaction – Feels GREAT
Continued:
Amygdala creates a condition response to certain
stimuli
Stressors or something associated with substance
use, trips the mental machinery of relapse* Conditioned
response
Very neuophysiologic
*Harvard Mental Health Newsletter, Volume 21, No. 1, 2004, p.1.
OTHER DRUGS
CNS DEPRESSANTS: Opiods
Effects: Suppress sympathetic NS. Load endorphin
receptor sites = euphoria and analgesia
Depletes serotonin which regulates pain perception
and anxiety
Heroin
Name other similar CNS depressants _____
Continued:
Withdrawal: 6 – 8 hrs = nervous and edgy
Runny nose, tearing, pilorection
Muscle, joints and bones ache
N and V, diarrhea
Lasts 4 – 8 days
Not lethal
Continued:
Treatment: No CNS drugs;will cause cross addiction
Systems support - e.g., diarrhea
Fluids and nutrition as tolerated
Emotion support
Replacement therapy/ methadone clinics
Lifestyle change and coping
STIMULANTS: Cocaine/crack
Effects: Stimulates CNS = well-being, energy and
euphoria
Blocks reuptake of norepinephrine, dopamine and
serotonin
Tachycardia, HTN, increased resp. and metabolic
rate
Name other stimulants: ____________
Continued:
Anorexia but craves high-sugar, restlessness
Massive systematic vasoconstriction = MI, CVA,
spontaneous abortion
Who will be at risk? Aged, pregnant f females
Continued:
Withdrawal: Overwhelming fatigue
Dysphoria and anhedonia
Even after drug has been detoxed, neurotransmitter
levels are so unbalanced = clinical depression
Suicide precautions
STIMULANT: Methamphetamine
Coming soon to your neighborhood
Releases high levels of dopamine
Enhances mood
Intense rush or “flash”. Very different from cocaine
MA high lasts 8 – 24 hrs; cocaine lasts 20 - 30
minutes
Continued:
MA effects
Euphoria, increased attention and libido
Increased activity with decreased fatigue and
appetite
Toxicity from binging – visual hallucinations,
violence, elevated BP, R, and Temp.
Tolerance
Continued:
Treatment for toxicity (Intoxication)
Acute ER: IV Haldol for agitation, IV medications for
controlling BP and preventing seizures
Cardiac monitoring, IV hydration
Reducing hyperthermia if present
Continued:
Chronic use at lower dosages:
No physical manifestations of withdrawal
BUT: Depression, anxiety, fatigue, paranoia,
aggression and an intense craving for the drug
HALLUCINOGENS
Mind Altering: PCP, LSD
Low doses – euphoria
Higher - hallucinations, delusions, peripheral
anesthesia, agitation
Risk for trauma due to altered state
Long term: sympathomimetic signs
Continued:
Treatment:
No Withdrawal syndrome but:
When insufficiently metabolized, stored in fat.
Metabolize fat tissue = released into circulation
producing hallucinations later = flashbacks OR brain
damage due to use.
Acute sx. in ER – agitation, ensure pt. safety
Inhalants
Benzene, nitrates: paint, glue, lighter fluid
Very addicting
Affects Cardiac and CNS
Intoxication: euphoria, giddiness, drowsiness
Chronic: Dysrythmias, renal and liver, organic
mental changes
Teens – buy in drugstore or hardware store