Lecture 9: Substance Use Disorders (Comm)

💊 Lecture 9: Substance use Disorders Week 9 PARA127: Substance Use Disorders Today’s Objectives 1. Terminology: Define (reference required readings from DSM-V). 2. Common Substances Abused: Discuss. 3. Present...

💊 Lecture 9: Substance use Disorders Week 9 PARA127: Substance Use Disorders Today’s Objectives 1. Terminology: Define (reference required readings from DSM-V). 2. Common Substances Abused: Discuss. 3. Presentations of Substance Abuse Patients: Discuss. 4. Management of These Patients: Discuss. Substance Use Disorders Overview Substance-Related and Addictive Disorders Substance-Related Disorders: Alcohol-Related Disorders Caffeine-Related Disorders Cannabis-Related Disorders Hallucinogen-Related Disorders Inhalant-Related Disorders Opioid-Related Disorders Sedative-Hypnotic/Anxiolytic-Related Disorders Stimulant-Related Disorders Tobacco-Related Disorders Lecture 9: Substance use Disorders 1  Other/Unknown Substance-Related Disorders Substance-Induced Disorders: Substance Intoxication and Withdrawal Substance/Medication-Induced Mental Disorders Addictive Disorders: Gambling Disorder Diagnostic Criteria for Substance Use Disorders (At least 2 within a 12-month period): 1. Impaired Control: Larger amounts/longer periods. Persistent desire to cut down/regulate use. Time spent obtaining, using, recovering from the substance. Craving. 2. Social Impairment: Failure at work, school, or home. Continued use despite social/interpersonal problems. Social, occupational, or recreational activities reduced. 3. Risky Use: Recurrent use in hazardous situations. Continued use despite physical/psychological problems caused by the substance. 4. Pharmacological Criteria: Tolerance. Withdrawal. Terminology Tolerance: Lecture 9: Substance use Disorders 2  Markedly increased doses required to achieve effects or markedly reduced effects with usual doses. Withdrawal: Symptoms when blood/tissue levels decline after prolonged use. Alcohol Use Statistics: Use by age: 15–19 years: 59% 20–24 years: 83% 25+ years: 78% 77% of Canadians consumed alcohol in 2015. Involved in more regrettable moments, crimes, and traffic fatalities than all other drugs combined. Effects: Short-Term: Slowed thinking, reaction time; impaired vision, coordination, judgment; initial euphoria. Later Effects: Clumsiness, staggering gait, nausea/vomiting, coma. Withdrawal Symptoms: Anxiety, insomnia, tremors, delirium. Stages of Alcoholism: 1. Early Stage: Occasional drinking, avoiding problems or boosting confidence. Increased tolerance. 2. Middle Stage: Drinking intensifies and begins earlier in the day. Loss of control and denial common. Lecture 9: Substance use Disorders 3  Blackouts and other serious symptoms emerge. 3. Late Stage: Total obsession, internal organ damage, malnutrition, eventual death if untreated. Alcohol Withdrawal: Cessation/reduction after heavy/prolonged use with 2+ symptoms within hours to days: Autonomic hyperactivity (e.g., sweating, pulse >100 bpm). Hand tremor, insomnia, nausea/vomiting. Hallucinations, psychomotor agitation, anxiety. Tonic-clonic seizures. Alcohol Intoxication: Symptoms: Slurred speech, incoordination, unsteady gait, nystagmus, attention/memory impairment, stupor/coma. Management: Consider synergistic effects with other drugs. Frequent monitoring of ABCs. Supplemental oxygen as needed. Caffeine Overview: Found in coffee, tea, chocolate, energy drinks, etc. Legal and generally safe. Overdose of 10 g (100 cups of coffee) can be fatal. Caffeine Intoxication: Lecture 9: Substance use Disorders 4  Symptoms (5+ required): Restlessness, nervousness, excitement, insomnia. Flushed face, diuresis, GI disturbance. Muscle twitching, rambling thoughts/speech, tachycardia, periods of inexhaustibility, psychomotor agitation. Caffeine Withdrawal: Abrupt cessation after prolonged use with 3+ symptoms within 24 hours: Headache, fatigue/drowsiness, dysphoric mood, difficulty concentrating, flu-like symptoms. Cannabis Overview: Derived from dried cannabis plant leaves. Active ingredient: Delta-9-tetrahydrocannabinol (THC). Legalized in Canada (October 2018); edibles in 2019. Effects: Euphoria, altered judgment/perception, slowed thinking, reaction time, impaired balance. Increased appetite, bloodshot eyes, inappropriate laughter, lethargy. Chronic use: Chronic cough, emphysema, pulmonary dysplasia. Intoxication Signs: Conjunctival injection, increased appetite, dry mouth, tachycardia. Withdrawal Symptoms: Irritability, nervousness, sleep difficulty, decreased appetite, restlessness, depressed mood. Lecture 9: Substance use Disorders 5  Physical symptoms: Abdominal pain, tremors, sweating, fever, chills, headache. Management Considerations: Monitor ABCs; consider other substances. Substance Use Part ll Hallucinogens Examples: PCP (phencyclidine) LSD (lysergic acid diethylamide) Ketamine Mescaline (peyote) Psilocybin (magic mushroom) Uses and Effects: Recreational use. Mood changes, hallucinations, delusions. Highly addictive (mostly). Effects: Hallucinations, delusions. Self-harm, tachycardia, pupil dilation, sweating, tremors, incoordination, flashbacks. Physical Signs: Lecture 9: Substance use Disorders 6  Pupillary dilation, tachycardia, sweating, palpitations, blurring of vision, tremors, incoordination. Behavioral/Psychological Signs: Anxiety, depression, ideas of reference, fear of “losing one’s mind,” paranoid ideation, impaired judgment. Perceptual Changes: Subjective intensification of perceptions. Depersonalization/derealization, illusions, hallucinations, synesthesia. Management Considerations: Similar to phencyclidine intoxication. Inhalants Overview: Unstable, unpredictable chemicals found in household products (e.g., glue, gasoline, aerosol paint, thinner). Rapid onset due to bloodstream absorption. Effects vary by chemical type. Effects: CNS Depression: Drowsiness, dizziness, slurred speech, incoordination, unsteady gait, decreased reflexes, stupor, coma. Apathy or aggression, nystagmus, lethargy, psychomotor retardation, tremor. Generalized muscle weakness, blurred vision or diplopia, euphoria. Prehospital Management: Ensure safety—patient may be aggressive. Prevent substance exposure to paramedics or the patient. Provide supplemental oxygen (PRN if safe). Cardiac monitoring. Lecture 9: Substance use Disorders 7  Opiates Overview: Derived from the opium poppy seed. Primary uses: Analgesia, cough suppression, reduced GI motility. Commonly abused: Injected, swallowed, smoked. Dangerous overdose potential. Effects: Decreased pain perception. Sedation, drowsiness, confusion, unsteady gait, slowed thinking, reaction time. Slurred speech, attention/memory impairment. Severe Symptoms: Respiratory depression, decreased consciousness, hypotension, pinpoint pupils, hypothermia. Examples: Morphine (MS Contin) Fentanyl (Duragesic) Hydromorphone (Dilaudid) Hydrocodone (Hycodan) Meperidine (Demerol) Heroin, Carfentanil. Withdrawal Symptoms: Dysphoric mood, nausea/vomiting, muscle aches, lacrimation/rhinorrhea, pupillary dilation, sweating, diarrhea, yawning, fever, insomnia. Management Considerations: PPE to avoid exposure (risk of hepatitis, HIV). Lecture 9: Substance use Disorders 8  Manage ABCs closely. Expect vomiting and respiratory depression. Consider naloxone for reversal (possible ACP). Sedative, Hypnotic, and Anxiolytics Examples: Benzodiazepines: Valium (diazepam), Ativan (lorazepam), clonazepam, midazolam. Antipsychotics: Haldol (haloperidol), Zyprexa (olanzapine). “Z” Drugs: Imovane (zopiclone), Lunesta (eszopiclone), Ambien (zolpidem). Effects: CNS depressants causing: Slurred speech, incoordination, unsteady gait, nystagmus, cognitive impairment. Stupor, coma, lethargy, bradycardia, hypotension, respiratory depression, death. Withdrawal Symptoms: Autonomic hyperactivity (e.g., sweating or pulse rate >100 bpm), hand tremor, insomnia, nausea/vomiting. Visual/tactile/auditory hallucinations, psychomotor agitation, anxiety, grand mal seizures. Management Considerations: Manage ABCs (monitor apnea). Provide supplemental oxygen. Cardiac monitoring. Anticipate withdrawal complications: hypotension, seizures, bradycardia. Lecture 9: Substance use Disorders 9  Stimulants Effects: General: Tachycardia/bradycardia, pupil dilation, elevated/lowered BP, perspiration/chills, nausea/vomiting. Weight loss, psychomotor agitation/retardation, muscular weakness, respiratory depression, chest pain, cardiac arrhythmias. Confusion, seizures, dyskinesias, dystonias, coma. Withdrawal Symptoms: 1. Fatigue. 2. Vivid, unpleasant dreams. 3. Insomnia or hypersomnia. 4. Increased appetite. 5. Psychomotor retardation/agitation. Cocaine Overview: Derived from coca plant; sometimes lab-manufactured. Strong CNS stimulant, sympathomimetic. Legitimate uses: Local anesthetic, vasoconstrictor. Methods of use: Snorting, injecting, smoking (crack cocaine), buccal administration. Highly addictive and expensive. Effects: Tachycardia, arrhythmias, seizures, respiratory arrest. 24x increased risk of heart attack within an hour of use. Lecture 9: Substance use Disorders 10  Management Considerations: Manage ABCs, provide supplemental oxygen PRN. Cardiac monitoring (12-lead ECG). Prepare for seizures. Amphetamines Effects: Increased mental alertness/energy, sweating, tachycardia, nervousness, jittery movements, pupil dilation, weight loss. Aggression, paranoia, hallucinations, psychotic behavior. Examples: Amphetamine (speed), Methamphetamine (ice, crank), Ritalin (methylphenidate). Designer drugs like bath salts. Management Considerations: Safety precautions: Patient may be irritable/violent. Manage ABCs, cardiac monitoring. Treatment of Substance Abuse 1. Recognition: Healthcare providers identify the issue. 2. Detoxification: Goal to safely eliminate substances, may involve medications. 3. Monitoring/Counseling/Support: Essential to prevent relapse. Therapeutic Response to Substance Abusers Dos: Be educated and supportive. Lecture 9: Substance use Disorders 11  Encourage seeking treatment. Support relapsing patients. Don’ts: Avoid taking behavior personally. Do not moralize, criticize, or judge. Lecture 9: Substance use Disorders 12