Substance Abuse and Associated.pdf

Substance Abuse and Associated Problems Dr. Mona Elsheikh Lecturer at department of Physical Therapy for Neurological Disorders and its Surgery Faculty of Physical Therapy, MUST univ...

Substance Abuse and Associated Problems Dr. Mona Elsheikh Lecturer at department of Physical Therapy for Neurological Disorders and its Surgery Faculty of Physical Therapy, MUST univ.  Substance abuse, or chemical dependency, is a newer term used to cover the older concepts of addiction, including alcoholism. The World Health Organization estimates that for every dollar spent in substance abuse treatment, there is a $7 savings in related health care. The World Health Organization has defined it as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Abuse of chemicals, whether prescribed or illicit, leads to changes in behavior, sleep patterns, and interpersonal relationships. Health problems associated with drug abuse  Alcoholism leads to cirrhosis of the liver and brain damage.  Cocaine causes damage to the heart and brain.  Anabolic steroids cause heart disease.  People using intravenous drugs can contract hepatitis or human immunodeficiency virus (HIV).  Children born to substance abusers are directly and indirectly affected as a result of the parent's substance abuse.  Many babies are born addicted and must be supported as they experience withdrawal from the agent.  Family dynamics threaten the physical and mental health of the developing child, and there is a higher incidence of substance abuse among children of drug abusers. Complications that may be easily arise in the health care of substance abusers:- Diagnostic tests may be distorted and general assessment clouded. Unwanted drug interactions may occur, and pathologic processes may be initiated or aggravated by the inappropriate use of drugs. Health care workers themselves may be directly involved in substance abuse.  Terminology Substance abuse, or chemical dependency: Is a broad term that refers to the inappropriate or unnecessary (nonmedical) use of drugs or chemicals that impairs a person’s function in some way to some extent. The individual desires the substance because it may cause euphoria, a sense of pleasure (“high”), or may alter one’s perception of reality or decrease one’s awareness of people and the environment. Essentially the drug interferes with the brain’s reward system, increasing the craving for the drug as well as promoting tolerance and dependence. Substance abuse is not limited to illegal or street drugs but may include prescribed drugs or other readily available substances.  Terminology Habit Means a practice, often involuntary, of using drugs or other substances at regular and frequent intervals. Habit may be associated with either common customs such as constant coffee drinking or cigarette smoking or the use of illegal or street drugs. These terms do not apply to the occasional use on social occasions of a substance such as alcohol when the user feels no need to consume a large amount or to have a drink at regular short intervals. Dependence Includes both physiologic and psychological cravings for the substance. Physiologic dependence Means that the body has adapted to the presence of the drug or chemical so that discontinuing the drug results in withdrawal signs such as tremors or abdominal cramps.  Terminology Psychological dependence Refers to a continuing desire to take the drug to be able to function. Tolerance Implies that because the body adapts to the substance, in time, the amount of the substance taken must be increased to achieve the same effect. The client who has tolerance to a substance will experience withdrawal if use of the substance is discontinued. Addiction Is an older term but is still in common use and is employed for the most serious form of substance abuse—the uncontrollable compulsion to use a substance, often with serious consequences for the individual, the family, and society. Substance abuse at this level often involves increased use of the substance and loss of control over use, leading to multidimensional issues including health, social, psychological, occupational, and legal problems.  Abused substances may be classified in many ways, including Mode of action and Source. Under mode of action,commonly abused psychoactive substances include the following: 1. Central nervous system depressants or tranquilizers, such as alcohol 2. Narcotics or painkillers, which cause euphoria and drowsiness 3. Stimulants, such as coffee or amphetamines 4. Psychedelics or hallucinogens, which alter a person’s perception and awareness and produce illusions. Some chemicals actually manifest both stimulant and depressant effects. For example, alcohol is really a central nervous system (CNS) depressant, although initially it appears to be a stimulant because it first depresses the higher brain centers used for judgment or the inhibitory neurons.  Abused substances may be classified in many ways, including Mode of action and Source. By source. They include legally prescribed medications. These include but are not limited to tranquilizers or sedatives that are prescribed and used long after the need for them has passed, medications shared with another person, prescriptions acquired from several sources, and medications combined with other substances such as alcohol or nonprescription drugs to achieve the desired effect. The surge in drug deaths has recently been fueled by the increased availability and abuse of prescription painkillers (such as OxyContin) and antianxiety drugs. Prescribed drugs that are considered more addictive or dangerous are restricted by government agencies and are available only for research or with a signed written prescription without refill provisions. Illegal or street drugs are widely available and are both costly and more dangerous for the user because their content is unpredictable. For example Common Name (Street Drugs) Medical Or Chemical Names. “speed” or “uppers” amphetamines “angel dust” phencyclidine (PCP) “snow” or “powder” cocaine “crank,” “ice,” or “crystal Methamphetamine “blow Heroin  Predisposing Factors Theories regarding the etiology or cause of substance abuse focus on  psychological imbalances,  personality deficits,  biologic abnormalities,  dysfunctional interpersonal relationships, or a combination of these factors.  Research considers the role of gender differences in addiction, particularly with respect to women. Questions center on whether the abuse of substances is related to physiologic or socioeconomic factors facing women. Substance abuse has been attributed to the following:  ~ Heredity or genetics  ~ Family systems and practices  ~ Disease  ~ The ready availability of drugs  ~ Stress and increased medical use of antianxiety agents  ~ Increased acceptance of alcohol or marijuana as a recreational tool in all age groups  Environmental/Behavioral Risk Factors  More common in young adolescents.  Recent developments among teens include “M and M” parties in which the contents of parents’ medicine cabinets are raided and combined at the party.  Surveys have shown that 55% of those age 12 and older who used prescription drugs for nonmedicinal problems obtained them from friends or family.  This risk behavior is particularly challenging for health care workers because the combined affects make treatment difficult.  increase in family breakdown, and economic factors including homelessness and job loss have also contributed to the increase in substance abuse.  People who take narcotic analgesics for prolonged periods of time risk becoming dependent because the drugs are addictive, creating a state of euphoria while relieving pain.  A more recently developed category of abused substances involves the synthetic anabolic steroids, similar to testosterone, taken by some athletes and bodybuilders.  Some individuals with eating disorders ingest anabolic steroids in order to build muscle mass and enhance performance.  Unfortunately, these drugs cause mood disorders, high blood pressure, serious cardiac damage, and liver cancer.  Indications/Recognition of Abuse Recognizing substance abuse is difficult because the pattern of consumption can vary. Some individuals are affected by relatively small amounts, whereas others can function quite well with a high intake. Combinations of chemicals usually exert a more marked effect than one substance, and combinations also tend to cause more toxic effects. The effects of an individual drug depend on the classification of the drug. Depressants usually decrease the level of CNS function, whereas stimulants increase CNS activity. Generally drugs impair neurologic function in some way—for example, by slowing the reflexes, reducing coordination and judgment, or impairing sensitivity and perception. The method of administration may also indicate drug abuse in some people; for example, intravenous use leaves injection marks on the body General indications of substance abuse include o changes in behavior, o appearance (eg, eyes), o personality, o daily living patterns, or work habits. o In adolescents, this may include o a change in friends, o academic achievement, o interest in sports, o or increase in risk-taking behaviors. o Frequently, the person may be defensive, angry, or embarrassed if he or she is questioned about drug intake. o Some individuals may become malnourished or may develop anemia or infection and ignore o normal health needs.  Potential Complications of Substance Abuse Overdose Overdose is a common acute problem. Some drugs have a relatively small safety margin, and an increased dose may cause toxic effects or death. Street drugs may be contaminated by other substances, thereby causing unanticipated effects. A common emergency situation develops when a combination of drugs, often including alcohol, results in a stronger reaction (synergism) than the individual components normally cause. Many hospital emergency rooms list alcohol-drug combinations as their major overdose cases and the primary cause of brain damage and death. Example, the narcotics morphine and heroin depress the CNS and compromise respiratory function. It may depress respiratory effort to a critical level (very slow and shallow respirations), leading to respiratory failure or cardiac arrest. Narcotic overdose, can stimulate the respiratory drive. Although the antianxiety drugs such as diazepam do not cause respiratory depression when used alone, they may cause brain damage and coma when combined with alcohol. Withdrawal Discontinuing a drug on which the body has become physically dependent results in withdrawal symptoms. The signs of withdrawal may be mild or severe depending on the specific drug used and the amount of drug to which the body cells have adapted. Common signs of withdrawal include:-  Irritability,  Tremors,  Nausea,  Vomiting  Stomach Cramps,  High Blood Pressure,  Psychotic Episodes,  Convulsions. It is safer to experience withdrawal under medical supervision in a hospital or detoxification center than on one’s own. Effects on Pregnancy The pattern of neglect of health and nutrition established in the female substance abuser usually continues during pregnancy, creating serious prenatal concerns for both the woman and her fetus. Many women who are abusing substances do not seek prenatal care because of fear of detection or lack of funds. They often are admitted to the hospital in labor with no prior history of care and generally have a higher risk of perinatal complications. Many chemical substances, including alcohol, can affect the fetus, resulting in congenital defects. Fetal alcohol syndrome is a serious example of fetal damage. The incidence of fetal alcohol syndrome increases with the dose of alcohol consumed and with any nutritional deficits. No safe level of alcohol consumption during pregnancy has been determined, and generally pregnant women are encouraged to restrict or avoid consumption. The newborn child of a woman who has abused alcohol during pregnancy has characteristic physical and facial abnormalities and is cognitively delayed. Alcohol consumption late in pregnancy is likely to cause cognitive and behavioral abnormalities more commonly than physical defects in the child.  Both cigarette smoking and exposure to second-hand smoke decrease blood flow through the placenta. The consequences of maternal exposure to cigarette smoke include an increase in stillbirths, low birth weight for gestational-age babies, and increased irritability in the infant after birth. Drugs such as cocaine lead to addiction in the newborn, who then must undergo withdrawal therapy after birth. Cocaine causes maternal hypertension, decreasing the placental blood supply to the fetus and resulting in developmental defects or premature birth. Cardiovascular Problems Cocaine and other stimulants such as amphetamines affect the cardiovascular system, causing irregular heartbeat and increased blood pressure. This may lead to heart attacks, strokes, or heart failure at a young age. Infection Systemic infections such as hepatitis B and HIV are common in drug abusers who share needles and other materials when injecting drugs. Local lesions can also form due to local infection of injection sites. These lesions can later become gangrenous, leading to potential systemic infections. Neurologic/Psychological Effects Hallucinogenic or psychedelic drugs such as PCP lead to an increased but unreal and distorted interpretation of sensory input into the brain with little control over the experience. The user hopes for a pleasant, euphoric experience (a “high”) but may have an unpleasant episode with a combination of acute fear, panic, and depression, increasing the risk of suicide. Many hallucinogens also have physical effects, including increased blood pressure, nausea, and tremors. Ecstasy (MDMA) increases basal metabolism and body temperature and is associated with dehydration and electrolyte imbalances that can lead to cardiac arrest. These drugs also impair memory and distort perceptions and judgment, presenting a high risk to those who operate machinery or drive an automobile while under the influence of the drug. Alcohol Cirrhosis (Laënnec Cirrhosis) Alcoholic liver disease, or Laënnec cirrhosis, develops in persons with chronic alcoholism or long-term excessive alcohol intake. Alcohol is a hepatotoxin, an irritant that causes metabolic changes in the liver cells, leading first to lipid accumulation in the cells (fatty liver), then to inflammation and necrosis (alcoholic hepatitis), and finally to fibrosis or scar tissue formation. Destruction of the liver takes place insidiously, with only mild signs and symptoms until the condition is well advanced and irreversible. Nervous System Damage Chronic alcoholism may cause serious nerve damage in the brain owing to a combination of neurotoxicity and malnutrition. A combination of Wernicke syndrome, manifested by confusion, disorientation, loss of motor coordination, and Korsakoff psychosis, which involves altered personality and amnesia, can occur with long-term abuse.  Treatment for Substance Abuse A person suffering an overdose or toxic effect should be treated immediately in an emergency room. Withdrawal from an abused substance should be handled in a medical facility, preferably one with experience in dealing with this problem (eg, a drug detoxification center). Supportive care is required to prevent complications. Clients frequently benefit from psychiatric intervention. Family support services and follow-up are also beneficial. Secondary medical problems such as cirrhosis or pregnancy also require medical supervision. Treatment for any addiction must be individualized and include a holistic approach to all of the individual’s problems. Long-term therapy and support are usually required to maintain abstinence or a significant decrease in use. Therapy may include methadone maintenance programs for heroin dependency. Methadone is a synthetic opioid that Prevents withdrawal symptoms, Improves function, Lessens the craving for narcotics in dependent persons. Methadone is administered in prescribed doses in a controlled situation. Methadone programs have been successful in reducing crimes associated with heroin abuse. Disulfiram (Antabuse) is a deterrent to alcohol use. The drug is taken on a daily basis and causes unpleasant reactions (severe headache, vomiting, difficulty in breathing, and visual problems) when the patient ingests even a small amount of alcohol. Initially observed drug therapy may be employed to establish compliance with the treatment program. In many persons requiring treatment for substance abuse, malnutrition, particularly protein and vitamin B deficits, is a problem that requires treatment. Counseling and behavior modification therapy are ongoing requirements. Some corporations have developed rehabilitation programs to assist employees with drug dependency, and some of the health professions have established self-help groups for their own members. Support groups such as Alcoholics Anonymous and Narcotics Anonymous are available for those with dependency problems, as are groups for families of affected persons (such as Al-Anon). In addition, many community agencies can provide guidance and resources.