Behavior

This is a document discussing substance use disorders and related topics such as addiction, risk factors, and pharmacological therapies. It includes learning outcomes, learning resources, and information on various substances that can lead to use disorders. The document also covers concepts central to addictive use disorder, DEA classes, epidemiology, comorbidity, and specific substances like caffeine, cannabis, and hallucinogens. It outlines the symptoms of intoxication and withdrawal for each substance and provides information on treatment options.Intensification of perceptions

● Hallucinations ● Synesthesia

Physical Symptoms:

● Pupillary Dilation/ Blurred vision ● Tachycardia/ Palpitations ● Sweating ● Tremors ● Incoordination

Treatment:

● Maintain patient and provider SAFETY ○ Restraints ● Talking the patient down ○ Reassurance ○ Symptoms caused by drug and will reside ● Antipsychotic medication ○ Haldol ● Benzodiazepines ○ Valium ○ Ativan

PCP Intoxication

● Medical Emergency!! ● Can have dangerous/violent side effects ○ Belligerent ○ Assaultive ○ Impulsive ○ Unpredictable

● Physical: ○ Nystagmus ○ Hypertension ○ Tachycardia ○ Diminished response to pain ○ Ataxia ○ Dysarthria ○ Muscle rigidity ○ Seizures ○ Coma ○ Hyperacusis ○ Hyperthermia

Treatment:

○ Cannot be talked down ○ May require restraints ○ May need mechanical cooling!

Hallucinogen Withdrawal

● No official diagnosis ● Hallucinogen persisting perception disorder ○ Occurs in 4% ○ Experienced when sober ○ Re-experience symptoms of intoxication ○ Distressing ○ Impair normal functioning ■ Weeks ■ Months ■ Years

Inhalants

Inhalants

● Toxic gases ● Common household products ○ Solvents ○ Propellants ○ Thinners ○ Fuels

● "Sudden sniffing death" ○ Death from cardiac arrhythmias ○ Common with: ■ Butane ■ Propane

● More common in youth

Inhalant Intoxication

Small Doses:

● Disinhibition ● Euphoria ● Apathy ● Diminished social functioning ● Impaired judgment ● Impulsive/ Aggressive Behavior ● Nausea ● Anorexia ● Nystagmus ● Depressed reflexes ● Diplopia

Large Doses/ Lengthy Exposure:

● Fearfulness ● Illusions ● Auditory & Visual Hallucinations ● Distorted Body Image ● Stupor ● Unconsciousness ● Amnesia ● Delirium ● Dementia ● Psychosis

Opioids

Opioids

● Chronic relapsing disorder ● Cravings result in larger amounts ○ Increasing tolerance

● Significant impairment ○ Life roles ○ Interpersonal conflict ○ Physically hazardous situations

Opioid Intoxication

● Psychomotor retardation ● Drowsiness ● Slurred speech ● Altered Mood ○ Withdrawn ○ Elated ● Impaired memory/attention ● Physical symptoms: ○ Miosis (pinpoint pupils) ○ Decreased bowel sounds ○ Reduced respiratory rate ○ Reduced BP and pulse rate ○ Skin disruptions (track marks)

Opioid Overdose

● Key Symptoms:

1. Coma
2. Pinpoint Pupils
3. Respiratory depression

●This is a list of substances and their effects, as well as possible treatments and implications for the therapeutic process. The substances included are: arrhythmia, high or low blood pressure, tachycardia, bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea/vomiting, weight loss, psychomotor agitation or retardation, weakness, confusion, seizures, coma, amphetamines, hyperactivity, agitation, depression, tobacco, cravings, persistent and recurrent usage, dependence, alcohol, sedative, initial feeling of euphoria, decreased inhibitions, severity based on number of symptoms, DSM-5 criteria for alcohol use disorder, tremulousness, mild to moderate symptoms, Librium, medical emergency, death in 20% untreated patients, autonomic hyperactivity, delusion, visual/tactile hallucinations, unpredictable behaviors, alcohol blackouts, Wernicke-Korsakoff Syndrome, fetal-alcohol syndrome, systemic effects of alcohol usage, peripheral neuropathy, alcoholic myopathy, alcoholic cardiomyopathy, esophagitis, gastritis, pancreatitis, leukopenia, thrombocytopenia, cancer, alcoholic hepatitis, cirrhosis of the liver, assessment, mental health symptoms, family history of substance use, physical symptoms, and readiness for help. The possible treatments include cognitive behavioral therapy, motivational interviewing, halfway houses, rehab programs, Alcoholics Anonymous, detox, partial hospitalization programs, intensive outpatient programs, and outpatient treatment. The possible medications include Disulfiram (Antabuse) and Naltrexone (Vivitrol, Depade).After the first month, the patient experienced headaches and sedation. The patient needs to be free of opioids for 10 days before starting medication.

Acamprosate calcium (Campral) is used for relapse prevention. It should be taken on the 5th day of abstinence from alcohol, three times a day. It is contraindicated in patients with renal impairment.

Benzodiazepines are used for withdrawal and can cause sedation, decreased anxiety, and low blood pressure. The CIWA-AR scale should be used to assess the dose according to agency policies. Seizures that could lead to delirium tremens (DTs) should also be monitored.

Anticonvulsants and barbiturates are used for withdrawal, but they are older treatments and other treatments have proven more effective and safer. Clonidine (Catapres) is used for mild to moderate withdrawal and is an alpha-agonist hypertensive agent. It should be given every 4-6 hours as needed.

Gambling disorder is characterized by compulsive activity, economic problems, disturbances in personal, occupational, and social functioning, preoccupation, predisposition to lying to conceal behavior, and financial problems. Treatment options include Gamblers Anonymous (GA), hospitalization, and individual, group, or family therapy.

In clinical judgment, cues should be recognized and assessed through self-assessment, family assessment (codependence), and physical assessment. Clues should be analyzed and hypotheses should be prioritized based on risk for injury, overdose, withdrawal, impaired sleep, impaired coping, risk for suicide, hopelessness, denial, and dysfunctional family processes. Solutions should be generated and actions taken to promote safety and sleep, reintroduce good nutrition and hygiene, support self-care, explore harmful thoughts and spiritual distress, and provide health teaching and promotion.

In the Ticket to Class/Case Study, the priority diagnosis should be identified, and the desired outcome for the patient should be established. One short-term goal, one intervention, one rationale for the intervention, and one way to evaluate the outcome should be listed. The paper should be turned in at the beginning of class.