Substance Abuse Disorders NU 124 Criteria SUBSTANCE

Substance Abuse Disorders NU 124

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: Mg. So 4, 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