Transcript Chapter 49
Chapter 49 Substance Abuse Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 49 Lesson 49.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2 Objectives • Differentiate among the key terms associated with substance abuse • Explore biologic, psychological, and sociocultural models that influence the assessment and treatment of substance abuse • Describe the different types of screening tools used to assess alcohol and substance abuse • Cite the responsibilities of professionals who suspect substance abuse by a colleague Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3 Keys Terms of Substance Abuse • Substance abuse – periodic purposeful use of a substance that leads to clinically significant impairment • Impairment – failure to fulfill major obligations at work, school, or home • Dependence/addiction – symptoms of compulsive use, tolerance, and withdrawal symptoms on discontinuation • Illicit substances – any chemical that alters biologic function and is not required for health maintenance Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4 Theories • Biologic model Abuse caused by genetic profile; hereditary condition • Psychological theories Psychoanalytic theories Behavior or learning theories Cognitive theories • Sociocultural factors Attitudes, values, norms affect susceptibility to abuse Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5 Signs of Impairment • First manifested in family life Violence, separation, divorce, financial problems • Disintegration of social life Public intoxication, isolation • Physical and mental changes Fatigue, multiple illnesses, injuries, accidents, emotional crises • Flagrant evidence of impairment at work (rare) Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6 Screening • Four categories of instruments Comprehensive drug abuse screening and assessment Brief drug abuse screening Alcohol abuse screening Drug and alcohol abuse screening for use with adolescents (see Table 49-2 for details) • CAGE Used for quick assessment C - cut down, A - annoyed, G - guilt, E - eye opener Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7 Health Professionals and Substance Abuse • Factors leading to substance abuse Stress of intense patient care Managing more patients with same resources “Zero tolerance” for mistakes Financial debt • Signs of abuse Behavioral changes: lack of attention to hygiene, mood swings Performance deterioration Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Substance Abuse Reporting • • • • • • Confidential report to appropriate supervisor Investigation Observation and documentation over time Clinical practice is a privilege Need to protect patients Unreported colleague may die as result of impairment • Reported colleagues have good chance of retaining their licenses; legal protections do exist Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Substances of Abuse • • • • • • • • • Alcohol, nicotine, caffeine Amphetamine Cannabis (marijuana) Cocaine Hallucinogens Inhalants Opioids Phencyclidine (PCP) Sedatives and hypnotics Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Chapter 49 Lesson 49.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11 Objectives • Explain the primary long-term goals in the treatment of substance abuse • Study the withdrawal symptoms and approaches to treatment and relapse prevention for major substances that are commonly abused Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12 Long-Term Goals of Treatment • Reduction or abstinence in the use and effects of substances • Reduction in the frequency and severity of relapse • Improvement in psychological and social functioning Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13 Alcohol • Withdrawal symptoms Visual and auditory hallucinations Seizures • Treatment Assess hydration, electrolytes, nutritional status Thiamine and multiple vitamins Benzodiazepines for detoxification • Fixed dose schedule • Symptom-triggered medication regimen Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14 Alcohol Relapse Prevention • Social support and lifelong effort required • Medications used Disulfiram (Antabuse) – helps reduce the desire for alcohol by causing nausea and vomiting with ingestion of alcohol Naltrexone (ReVia) – blocks the effects of the high Acamprosate (Campral) - promotes abstinence Slightly higher success rate of preventing relapse when naltrexone and acamprosate are used together Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15 Opioids, Cocaine • Withdrawal symptoms Mood swings, impaired memory, slurred speech Anxiety, restlessness, increased blood pressure and pulse, sweating, nausea, vomiting, sometimes aches and fever • Treatment May substitute another opioid to reduce severity of withdrawal symptoms • Relapse prevention Rate of relapse is high for cocaine Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16 Amphetamine-Type Stimulants • Uses Treat schizophrenia, depression, radiation sickness, attention deficit hyperactivity disorder (ADHD), opiate and nicotine addiction • Intoxication Produce sense of heightened alertness, attentiveness, self-confidence, powerfulness and energy; frequently lead to additional dose and may stay awake for 7-10 days Often little water or food is taken when high “Meth mouth” occurs from poor oral hygiene and grinding of teeth Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17 Amphetamine Treatment • No antidotes for methamphetamine • Psychiatric evaluation due to damaged dopaminergic and serotonergic neurons • Cognitive behavior therapy • Contingency management programs • Support groups Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18