Chapter 6 - Substance Use Assessment

Study Notes

Substance Use Assessment

Alcohol Use and Abuse: Alcohol is the most prevalent psychoactive substance used and abused in the US. Frequently, prescribed and OTC medications interact negatively with alcohol by affecting alcohol metabolism or medication activity, increasing the risk of adverse drug reactions (ADRs), especially with CNS depressants (opioids, heroin, antihistamines, antidepressants). Alcohol is linked to cardiovascular issues including hypertension, ischemic heart disease, stroke, cardiomyopathy, heart failure, and atrial fibrillation.

Illicit Drug Use

Categories of Illicit Drugs: Illicit drug use falls into 7 categories: marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, and psychotherapeutics. All illicit drug use carries significant legal and health consequences, impacting brain development, relationships, academics, and careers.
Opioid Epidemic: This is a significant public health crisis. Many individuals transitioning from prescription opioids to heroin due to the difficulty in obtaining prescriptions, leading to heroin's ready availability and low cost.

Developmental Considerations

Addiction Factors: Addiction is influenced by genetics, environment, and development.
- Adolescents: Adolescents may engage in risky behavior more easily. Alcohol slows brain development and reduces maturity. Marijuana is the most used illicit drug; it negatively impacts adolescent development, potentially affecting academic performance, mental health, focus, learning, problem-solving, and coordination.
- Pregnancy: Alcohol readily crosses the placental barrier, potentially causing fetal alcohol syndrome in the developing fetus. No level of alcohol consumption is safe during pregnancy.
- Aging Adults: Aging adults face increased risks of falls, depression, GI issues, toxic reactions, and fatal alcohol overdoses. Alcohol tolerance decreases with age, and multiple medications may interact adversely with alcohol.

Subjective Data Collection

Alcohol Use: Questions should begin with general alcohol queries, followed by more specific questions based on responses. Examples include:
"Do you sometimes drink beer, wine, or other alcoholic beverages?"
"How many times in the past year have you had 5 or more drinks a day?"(4 for women)
AUDIT Questionnaire: This is a screening tool (Alcohol Use Disorders Identification Test). It assesses alcohol consumption, drinking behavior/dependence, and adverse consequences. Scores range from 0-40. A score of 0-7 indicates low risk, 8-14 = hazardous/harmful, and 15 or more suggests alcohol dependence.
CAGE Questionnaire: This quick screening tool (Cut down, Annoyed, Guilty, Eye-opener) is useful in primary care settings. Answering "yes" to two or more questions suggests potential alcohol abuse requiring further assessment.

Objective Data Collection

Breath Alcohol Analysis: Measures alcohol in exhaled air to correlate with blood alcohol content (BAC). A BAC above 0.08% is often considered legal intoxication in most states.
CIWA Assessment: Clinical Institute Withdrawal Assessment scale is used for individuals experiencing alcohol withdrawal symptoms. It's the most sensitive scale for objective measurement of withdrawal symptoms, which include nausea/vomiting, tremors, sweating, anxiety, agitation, tactile/auditory/visual disturbances, and headache. Also includes orientation and clouding of sensorium.

Description

This quiz explores various aspects of substance use, focusing on alcohol and illicit drugs. You'll learn about the effects of alcohol on health, the categories of illicit drugs, and the implications of drug use on personal and public health. Dive into the complex landscape of substance abuse and its repercussions.