Alcohol and Caffeine Effects Quiz

Substance Use Disorders

• Objectives: Define terminology (referencing DSM-V), discuss common abused substances, presentations of substance abuse patients, and management strategies.

Substance-Related and Addictive Disorders

• Substance-Related Disorders: Categorize substance abuse problems into specific categories, including alcohol-related, caffeine-related, cannabis-related, hallucinogen-related, inhalant-related, opioid-related, sedative-hypnotic/anxiolytic-related, stimulant-related, and tobacco-related disorders.
• Other/Unknown Substance-Related Disorders: Include substance-induced disorders (intoxication and withdrawal) and substance/medication-induced mental disorders, along with gambling disorder (as an addictive disorder).

Diagnostic Criteria for Substance Use Disorders

• Impaired Control: Characterized by using larger amounts or for longer periods than intended, persistent desire to cut down or regulate use, time spent obtaining, using, or recovering from the substance, and experiencing cravings.
• Social Impairment: Involves use causing problems at work, school, or home, despite ongoing social or interpersonal problems, leading to reduced social, occupational, or recreational activities.
• Risky Use: Involves recurrent use in physically hazardous situations and continued use despite significant physical or psychological problems caused by substance use.
• Pharmacological Criteria: Demonstrates tolerance (requiring increased doses to achieve the same effect) and withdrawal symptoms (when blood/tissue levels decline after prolonged use).

Alcohol

• Use Statistics: High rates of use among 15-19, 20-24, and 25+ year-olds are noted, as well as a high percentage of Canadians consuming alcohol in a recent year. Alcohol-related incidents are associated with more regrettable moments, crimes, and traffic fatalities than other drugs.
• Effects (Short-Term): Slowed thinking, reaction time, impaired vision, coordination, and judgment; initial feelings of euphoria are noted.
• Effects (Long-Term): Possible clumsiness, staggering gait, nausea/vomiting, and coma.
• Withdrawal symptoms: Anxiety, insomnia, tremors, and delirium.
• Stages of Alcoholism: Early stage—occasional drinking/increased tolerance; Middle stage—increased frequency/loss of control/denial; Late stage—total obsession/internal organ damage/death.

Alcohol Withdrawal

• Withdrawal Symptoms: Cessation/reduction after heavy use, presenting with symptoms like autonomic hyperactivity (e.g., sweating, high pulse), hand tremor, insomnia, nausea/vomiting, hallucinations, psychomotor agitation, anxiety, and tonic-clonic seizures.
• Symptoms of alcohol intoxication: Characterized by slurred speech, impaired coordination, unsteady gait, nystagmus (involuntary eye movements), attention and memory impairment, stupor (unresponsiveness), or coma.

Caffeine

• Overview: Found in coffee, tea, chocolate, and energy drinks.
• Effects: Generally safe; overdose of 10 g (or 100 cups of coffee) is fatal.
• Caffeine Intoxication: Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, rambling speech, tachycardia, periods of inexhaustibility, and psychomotor agitation.

Cannabis

• Overview: Derived from dried cannabis plant leaves, with active ingredient Delta-9-tetrahydrocannabinol (THC).
• Effects: Euphoria, altered judgment, slowed thinking, impaired reaction time, balance issues, increased appetite, and inappropriate laughter. Long-term use could lead to chronic cough, emphysema, and pulmonary dysplasia.
• Intoxication Signs: Conjunctival injection, increased appetite, dry mouth, tachycardia.
• Withdrawal Symptoms: Irritability, nervousness, sleep disturbances, decreased appetite, and depressed mood.

Hallucinogens

• Examples: PCP, LSD, Ketamine, Mescaline, and Psilocybin.
• Uses and Effects: Recreational use; mood changes, hallucinations, delusions, and potential for high addiction.
• Physical effects: Hallucinations, delusions, self- harm, tachycardia, pupil dilation, sweating, tremors, incoordination, flashbacks.

Inhalants

• Overview: Unstable chemicals found in household products (e.g., glue, gasoline, aerosol paint).
• Effects: Rapid onset; CNS depression; drowsiness, dizziness, slurred speech; incoordination; unsteady gait; decreased reflexes; stupor; coma; apathy or aggression; nystagmus; lethargy; psychomotor retardation; tremors; generalized muscle weakness; blurred vision or double vision (diplopia); euphoria.

Opiates

• Overview: Derived from opium poppy seed; used medically for pain relief, cough suppression, and reducing gastrointestinal motility.
• Commonly abused: By injection, swallowing, or smoking.
• Overdose potential: High risk.
• Effects: Decreased pain perception, sedation, drowsiness, confusion, unsteady gait, slowed thinking, impaired reaction time, slurred speech, and attention/memory impairment. Severe symptoms: respiratory depression, decreased consciousness, hypotension, and pinpoint pupils (miosis).
• Examples: Morphine, Fentanyl, Hydromorphone, Hydrocodone, Meperidine, Heroin, and Carfentanil.
• Withdrawal: Dysphoric mood, nausea/vomiting, muscle aches, lacrimation/rhinorrhea, pupillary dilation, sweating, diarrhea, yawning, fever, or insomnia.

Sedatives, Hypnotics, and Anxiolytics

• Effects: CNS depressants causing slurred speech, incoordination, unsteady gait, nystagmus, cognitive impairment, stupor, coma, lethargy, bradycardia, hypotension, and respiratory depression.
• Withdrawal: Autonomic hyperactivity, hand tremor, insomnia, nausea/vomiting, visual/tactile/auditory hallucinations, psychomotor agitation and potentially grand mal seizures
• Examples: Benzodiazepines, Antipsychotics, and "Z" drugs.

Stimulants

• Effects: Tachycardia/bradycardia, pupil dilation, elevated/lowered blood pressure, perspiration/chills, nausea/vomiting, weight loss, psychomotor agitation/retardation, muscular weakness, respiratory depression, chest pain, cardiac arrhythmias, confusion, seizures, dyskinesias, or dystonias.
• Withdrawal: Fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation
• Examples: Cocaine, Amphetamines

Management Considerations

• General: Monitor ABCs (airway, breathing, and circulation) and consider concurrent substance use. Provide supplemental oxygen, cardiac monitoring, and prepare for possible seizures. Monitor for possible aggression.
• Specific: Consider naloxone for suspected opioid overdose reversal.

Treatment of Substance Abuse

• Recognition: Healthcare providers identify the issue.
• Detoxification: Goal to safely eliminate the substances. Medications may be involved.
• Monitoring/Counseling/Support: Essential element to prevent relapse.

Therapeutic Response to Substance Abusers

• Dos: Be educated, supportive, and encourage treatment; support those struggling.
• Don'ts: Avoid taking behavior personally; do not moralize, criticize, or judge.