Substance Use Disorder PDF

Chapter 14 - Substance Related and Addictive Disorders **When studying, look @ what each thing does to the CNS, study heavily on alcohol and opioid** Substance Use Disorder Criteria for Dx: Must have 2 or more: ○ More/longer use ○ Hazardous use ○ Interpersona...

Chapter 14 - Substance Related and Addictive Disorders **When studying, look @ what each thing does to the CNS, study heavily on alcohol and opioid** Substance Use Disorder Criteria for Dx: Must have 2 or more: ○ More/longer use ○ Hazardous use ○ Interpersonal problems ○ Neglected responsibilities ○ Abandoned interests ○ Time spent using ○ Cravings ○ Failed attempts to quit ○ Mental and physical health problems ○ Tolerance ○ Withdrawal Important terms r/t substance use disorders: ○ Intoxication, Overdose,Withdrawal, Blackouts, Tolerance, Cross tolerance, Synergistic effects, Cross-dependence, Antagonistic effects, Flashbacks, Co-occurring disease/dual diagnosis, and Codependency ○ Withdrawal can be life-threatening Substance Use Disorder Use of the substance interferes with ability to fulfill role obligations Attempts to cut down or control use fail Intense craving for the substance Excessive amount of time spent trying to procure the substance or recover from its use Use of the substance causes the person difficulty with interpersonal relationships or to become socially isolated Engages in hazardous activities when impaired by the substance Tolerance develops and the amount required to achieve the desired effect increases Substance-specific symptoms occur upon discontinuation of use States of Substance Use Substance intoxication ○ Development of a reversible syndrome of symptoms following excessive use of a substance ○ Direct effect on the central nervous system ○ Disruption in physical and psychological functioning ○ Judgment is disturbed and social and occupational functioning is impaired Substance withdrawal ○ Development of symptoms that occurs upon abrupt reduction or discontinuation of a substance that has been used ○ Symptoms are specific to the substance that has been used. ○ Disruption in physical and psychological functioning Classes of Psychoactive Substances Alcohol, Caffeine, Inhalants, Cannabis, Opioids, Stimulants, Tobacco, and Sedatives/hypnotics/anxiolytics Predisposing Factors of Substance Use Disorder Biological factors [pg. 310] ○ Genetics: Apparent hereditary factor, particularly with alcoholism  ○ Biochemical: Alcohol may produce morphine-like substances in the brain that are responsible for alcohol addiction. Psychological factors ○ Developmental influences Punitive superego Individuals with punitive superegos turn to drugs to diminish unconscious anxiety and increase feelings of power and self-worth. Fixation in the oral stage of psychosexual development ○ Personality factors Certain personality traits are thought to increase a tendency toward addictive behavior. ○ Cognitive factors Irrational thinking patterns have long been identified as a problem that is central in addictions Sociocultural factors ○ Social learning: Children and adolescents are more likely to use substances with parents who provide a model for substance use. ○ Use of substances may also be promoted within a peer group. ○ Conditioning: Pleasurable effects from substance use act as a positive reinforcement for continued use of the substance. ○ Cultural and ethnic influences: Some cultures are more prone to substance abuse than are others. Assessment guidelines: What specific drug(s) have been used? ○ How: much, often, long, & last used? ○ Route ○ UDS, blood toxicology screen, BAC, breathalyzer S/S of intoxication, overdose, & W/D Vitals; Physical & MH assessments & hx Screening Tools Psychosocial hx [coping mech., if they have a job, support system, etc] Insight & interest in additional tx for SUD CNS Depressants & Opioids Alcohol, Benzodiazepines, Barbiturates, & Opioids ○ Intoxication Symptoms: Disinhibition & drowsiness; impaired judgment/functioning Slurred speech; unsteady gait Decreased VS ○ Overdose Symptoms: CV/respiratory depression, shock, convulsions, coma, & death ○ Withdrawal Symptoms: Elevated VS, tremors, N/V, muscle aches, sweats, anxiety/agitation, & insomnia Disorientation, hallucinations, delirium, & seizures (not with opioids) Alcohol Use Disorder [pg. 305] Patterns of Use ○ Phase I: Pre Alcoholic phase: Characterized by use of alcohol to relieve everyday stress and tensions of life  ○ Phase II: Early alcoholic phase: Begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person. ○ Phase III: The crucial phase: Person has lost control; physiological dependence is clearly evident. ○ Phase IV:The chronic phase: Characterized by emotional and physical disintegration. The person is usually intoxicated more often than sober. Effects of Alcohol on the Body ○ Wernicke’s encephalopathy: Most serious form of thiamine deficiency in alcoholic patients ○ Korsakoff’s psychosis: Syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients ○ Peripheral neuropathy ○ Alcoholic myopathy Acute ○ Leukopenia ○ Thrombocytopenia ○ Sexual dysfunction [in males & females] ○ Esophagitis ○ Gastritis ○ Alcoholic Cardiomyopathy ○ Pancreatitis ○ Alcoholic hepatitis ○ Cirrhosis of the liver Portal hypertension Ascites Esophageal varices Hepatic encephalopathy Fetal Alcohol Syndrome s/s [pg. 307] Learning difficulties Small head size Speech and language delays Shorter-than-average height Sleep and sucking problems as a baby Low body weight Vision or hearing problems Poor coordination Problems with the heart, kidneys, or bones Hyperactive behavior ADD/ADHD Difficulty paying attention Abnormal facial features Poor memory Difficulty in school Alcohol Intoxication and Withdrawal Alcohol intoxication: Occurs at blood alcohol levels between 100 and 200 milligrams per deciliter Alcohol withdrawal: Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use Severe s/s shows that they’ve built a tolerance to alcohol Withdrawal Delirium Medical emergency = DEATH Peaks around 48-72 hours after last/reduced intake Additional symptoms of WD Severe autonomic hyperactivity, changes in LOC, delusions, hallucinations, severe mood changes Alcohol withdrawal & withdrawal delirium tx (KNOW acute treatment vs chronic tx for alcohol withdrawal) FIND IN BOOK BC NOT EVERYTHING WASN’T THERE Prevent harm related to mental health manifestations Med mana. For W/D from alcohol, benzos, & barbiturates ○ Slow taper using benzo or barbiturate CIWA ○ Clonidine ○ Beta blockers ○ Anticonvulsants ○ B-vitamin replacement Thiamine [B1] Folic acid Cyanocobalamin [B12] Meds to help maintain sobriety from alcohol Disulfiram (Antabuse) Naltrexone ○ Daily pill (Revia) ○ Extended release-Monthly injection (Vivitrol) Acamprosate Opioid [pg. 350]: Most commonly misused: ○ heroin, oxycodone, hydrocodone, morphine, fentanyl, & codeine Overdose requires medical tx: ○ Naloxone (Narcan) or Nalmefene (Revex) ○ Supportive care Withdrawal tx: ○ Begins hours after last use ○ Not life-threatening; however usually unpleasant ○ COWS; Substitution & eventual taper ○ MAT ○ Methadone ○ Buprenorphine or Buprenorphine/Naloxone ○ Naltrexone ○ Clonidine CNS stimulants [pg. 312] Profile of the substance ○ Amphetamines/Methamphetamines ○ Synthetic stimulants ○ Non-amphetamine stimulants ○ Cocaine/Crack ○ Caffeine ○ Nicotine ○ Cocaine & Crack ○ Amphetamines & Methamphetamines Intoxication symptoms: ○ Cause imbalance of NTs ○ Dilated pupils  ○ Increased VS & alertness ○ Insomnia ○ Mood changes/instability with potential for violence ○ Paranoia & hallucinations Caffeine intoxication: ○ Usually occurs after consumption in excess of 250 mg ○ Restlessness and insomnia are the most common symptoms ○ Caffeine Withdrawal Symptoms: Headache Fatigue and drowsiness Irritability Muscle pain and stiffness Nausea and vomiting Overdose Symptoms: ○ Respiratory distress/arrest ○ Stroke; MI ○ Ataxia ○ Hyperpyrexia ○ Seizures; Coma; Death Overdose Management: ○ Supportive care ○ Maintain ABCs ○ Benzodiazepines ○ Cooling measures Withdrawal Symptoms: ○ Range from fatigue/lethargy to anxiety/agitation/insomnia ○ Disorientation ○ Depression; SI ○ Cravings Withdrawal Treatments: ○ Based on Symptoms ○ Modafinil ○ Diphenhydramine or Trazodone ○ Antidepressants Nicotine Withdrawal Symptoms: ○ Dysphoria, anxiety, irritability ○ Difficulty focusing ○ Increased appetite ○ Pharmacological aids for smoking suppression Inhalants [pg. 319]: Spray paint, glue, lighter fluid, aerosols, paint thinners Abused by sniffing/snorting, bagging, & huffing Intoxication Symptoms: ○ Drunkenness ○ Slurred speech ○ Dizziness ○ Euphoria; lack of inhibitions ○ Vision changes  ○ Psychomotor retardation ○ Violent behaviors Overdose Effects & Tx: ○ Severe liver, brain, & heart damage ○ Respiratory arrest ○ Fatal dysrhythmias ○ Sudden Sniffing Death ○ Coma & Death ○ Support affected body systems ○ Neuro symptoms- vitamin B12 & folate Withdrawal Symptoms: ○ Mood changes, panic attacks ○ Restlessness ○ Body aches, tremors ○ N/V ○ Runny nose, watery eyes ○ Seizure ○