Substance-Related Disorders PDF

SUBSTANCE-RELATED DISORDERS Guzman and Tomboc Substance-related Disorders Formerly known as substance abuse or addiction, SUD is a clinical diagnosis characterized by a problematic pattern of substance use leading to significant impairment or distress. Substance-related Disorders Not all drugs cause...

SUBSTANCE-RELATED DISORDERS Guzman and Tomboc Substance-related Disorders Formerly known as substance abuse or addiction, SUD is a clinical diagnosis characterized by a problematic pattern of substance use leading to significant impairment or distress. Substance-related Disorders Not all drugs cause alteration to the mental functioning. However, a psychoactive drug is the one that can. 1. Acute intoxication 2. Withdrawal state 3. Dependence syndrome 4. Harmful use Acute Intoxication Acute intoxication is a transient condition following the administration of alcohol or other psychoactive substances, resulting in the disturbance in the level of consciousness, cognition, perception, affect or behavior, or other psychophysiological functions and responses. This is usually associated with high serum levels of the drug. Withdrawal State Characterized by a cluster of symptoms, often specific to the drug used, which develop on total or partial withdrawal of a drug, usually after repeated and/ or high-dose use. This is a short lasting syndrome with usual duration of few hours to days. Dependence Syndrome Cluster of physiological, behavioral, and cognitive phenomena in which the use of the substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had a greater value. At least three of the following have been experienved or exhibited at sometime during the previous year. Desire or sense of compulsion Difficulties in controlling Withdrawal state Tolerance Progressive neglect of alternative pleasures or interests Persisting with substance use despite clear evidence of harmful consequences TYPES OF SUBSTANCE ABUSE Sedatives, Hypnotics, and Anxiolytic Alcohol Opioid Stimulants Hallucinogens Cannabis Inhalants Statistics (Facility Based) 13 to 72 year old Median: 34 Age 90.06% Males 10:1 Male-to Female ration Sex Single 52.68%, Married 23.91%, c Live-in 19.22% Civil Stat Average monthly income: 13, 200 pesos Economic Stat Mono-drug use inhalation/sniffi ng and oral ingestion Usage Employed 58.4% (Workers, Employed, Businessman, self-employed Employment Most Commonly Abused Drugs Methamphetamine Hydrochloride or “Shabu” 92.06% Cannabis (Marijuana) 27.04% MDMA or Ecstasy 0.65% Dangerous Drug Board (2022) Statistics (Alcohol) Alcoholism In 2021, Department of Health survey showed that an estimated 40 percent of Filipino adults reported drinking alcohol in the previous month (33% engages in heavy drinking sessions) 39,802 Filipinos died from causes attributable to drinking (in 2019) An estimated PHP 200 billion tab picked up by the government for treating alcoholrelated illnesses, policing alcohol-involved crimes, and covering burial expenses for those killed by drinking. Gianna Gayle Amul (2023) Mechanism Mechanism Mesolimbic dopamine system VTA (ventral tegumental area) NAc (nucleus accumbens) Reinforces important behaviors for survival (e.g. eating, sleeping, etc) Natural/ survival needs changed with substance need Mechanism Substances interferes the reuptake of dopamine into the presynaptic cleft, prolonging the action Substances stimulates the VTA to release more action potential triggering more surge of dopamine ETIOLOGIES Genetic Factors Genetic Predisposition: There is evidence that genetic factors play a significant role in susceptibility to substance-related disorders. Individuals with a family history of addiction may have a higher risk due to genetic vulnerability. Identical twins have a higher rate of concordance than fraternal twins Adoption: Alcoholic biologic father = higher probability of alcoholism to the child Biological Factors Neurobiological Factors: Changes in brain structure and function, particularly in areas related to reward, motivation, and impulse control, can contribute to substance-related disorders. Neurotransmitter Imbalance: Dysregulation of neurotransmitters, such as dopamine and serotonin, can influence the rewarding effects of substances and contribute to addiction. Environmental Influences Early Exposure Exposure to substances during critical developmental stages, especially in adolescence, can increase the risk of substance use disorders. Family Environment A family environment that includes substance abuse, poor parental supervision, and inadequate support can contribute to the development of these disorders. Peer Influence Peer pressure and social acceptance of substance use can influence an individual's choices, particularly during adolescence and young adulthood. Psychological Factors Mental Health Disorders: Co-occurring mental health conditions, such as depression, anxiety, or trauma, may contribute to the development of substance-related disorders as individuals may use substances as a form of self-medication. Personality Traits: Certain personality traits, such sensation-seeking, as impulsivity, and a lack of resilience, can increase vulnerability. Children of alcoholics are four times as likely to develop alcoholism compared with the general population. Developmental Factors Early Childhood Trauma: Adverse childhood experiences, including physical, emotional, or sexual abuse, can increase the likelihood of disorders later in life. Critical Developmental Stages: Exposure to substances during key developmental periods may disrupt normal brain development and increase the risk of addiction Sociocultural Factors Cultural Norms: Societal attitudes toward substance use can influence an individual's perception of the acceptability and risks associated with substance use. Economic Factors: Socioeconomic status can impact access to education, employment opportunities, and social support, contributing to substance use as a coping mechanism. Availability and Accessibility Ease of Access: The availability of substances, either legally or illegally, can impact usage patterns. Easy access to substances increases the risk of misuse and addiction Psychosocial Stressors Life Stressors: Significant life events, such as loss, divorce, or financial difficulties, can contribute to substance use as individuals may turn to substances to cope with stress. Expectancies and Beliefs Perceived Benefits: Positive expectations regarding the effects of substances, such as stress relief or enhanced social interactions, can contribute to initial use and subsequent misuse. SEDATIVE-, HYPNOTIC-, OR ANXIOLYTICRELATED Sedatives, Hypnotics, and AnxiolyticDisorders A group of substance use disorders characterized by the misuse of sedatives, hypnotics, and anxiolytics. These substances include medications commonly prescribed for anxiety, insomnia, tension, seizures, panic disorders, sleep disorders, etc.. Overdose Benzodiazepines Rarely fatal, but the person is lethargic and confused Treatment gastric lavage followed by ingestion of activated charcoal and a saline cathartic dialysis can be used if symptoms are severe Barbiturates lethal when taken in overdose - causes coma, respiratory arrest, cardiac failure, and death Treatment Removal of drug through Lavage and or dialysis + system supports STIMULANTS Stimulants Stimulants are drugs that stimulate or excite the central nervous system and have limited clinical use and a high potential for abuse. E.g. Methamphetamine, cocaine, etc. Treatment Chlorpromazine (Thorazine) - an antipsychotic, controls hallucinations, lowers blood pressure, and relieves nausea CANNABIS Cannabis Cannabis sativa is the hemp plant that is widely cultivated for its fiber used to make rope and cloth and for oil from its seeds. Psychoactive resin - resin contains more than 60 substances, called cannabinoids, δ-9tetrahydrocannabinol - psychoactive effects Intoxication and Overdose Effects begins within a minute after inhalation. Peaks at 20 to 30 minutes and last at least 2 to 3 hours. Effects - high feeling similar to that with alcohol, lowered inhibitions, relaxation, euphoria, and increased appetite. Intoxication - impaired motor coordination, inappropriate laughter, impaired judgment and short-term memory, and distortions of time and perception. Anxiety, dysphoria, and social withdrawal may occur Excessive use of cannabis may produce delirium or rarely, cannabisinduced psychotic disorder - both treated symptomatically Overdose does not occur Withdrawal and Detoxification No clinically significant withdrawal syndrome. However, some have experienced symptoms of muscle aches, sweating, anxiety, and tremors OPIOIDS Opioids Include both potent prescription analgesics such as morphine, meperidine (Demerol), codeine, hydromorphone, oxycodone, methadone, oxymorphone, hydrocodone, and propoxyphene as well as illegal substances such as heroin, illicitly produced fentanyl, and normethadone. Treatment Treatment of choice naloxone (Narcan) - an opioid antagonist, which reverses all signs of opioid toxicity Given every few hours until opioid level decreases to nontoxic may take days HALLUCINOGENS Hallucinogens Substances that distort the user’s perception of reality and produce symptoms similar to psychosis, including hallucinations (usually visual) and depersonalization. E.g. mescaline, psilocybin, lysergic acid diethylamide, and “designer drugs” such as ecstasy. Treatment Treatment of toxic reactions is supportive Psychotic reactions are managed best by isolation from external stimuli; physical restraints may be necessary for the safety of the client and others. meds to control seizures and blood pressures Mech vent to support inhalation INHALANTS Inhalants Inhalants are a diverse group of drugs that include anesthetics, nitrates, and organic solvents that are inhaled for their effects. Most common - aliphatic and aromatic hydrocarbons found in gasoline, glue, paint thinner, and spray paint. Inhalants can cause significant brain damage, peripheral nervous system damage, and liver disease Intoxication and Overdose Inhalant intoxication - belligerence, aggression, apathy, impaired judgment, and inability to function. Acute toxicity causes anoxia, respiratory depression, vagal stimulation, and dysrhythmias. Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus Treatment Supporting respiratory and cardiac functioning until the substance is removed from the body. There are no antidotes or specific medications to treat inhalant toxicity ALCOHOL-RELATED DISORDERS (CASE) Alcohol Use Disorders Alcohol A medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.Patterns of alcohol use disorders include alcohol dependence and alcohol abuse. Intoxication and Overdose Serum Ethanol Level Sx Less than 25mg/ dl Warmth and well being 25 - 50 mg/ dl Euphoria and decreased judgement 50 - 100 mg/ dl Incoordination, decreased reaction time/ reflexes 100 - 250 mg/ dl Cerebellar dysfunction (i.e., ataxia, slurred speech, nystagmus) 250 - 400 mg/ dl Coma > 400 mg/ dl Respiratory depression, loss of protective reflexes, and death Withdrawal Syndrome Withdrawal symptoms (begins 4 - 12 h after cessation or reduction) - coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal - results to transient hallucinations, alcohol seizures, or delirium, called delirium tremens. Withdrawal peaks at 2nd day and ends at 5th. However, can vary -may take 1 to 2 weeks Chronic Complications Wernicke's Encephalopathy Korsakoff Psychosis Machiafava - Bignami Disease Other Complications Alcohol dementia Cerebellar degeneration Peripheral neuropathy Central pontine myelinolysis CNS Complications Peripheral neuropathy Delirium tremens Rum fits (alcohol withdrawal syndrome) Alcoholic hallucinosis Alcoholic jelousy Alcoholic dementia Suicide Cerebellar degeneration Central pontine myelinosis Head injury and fractures Social Complications Accidents Marital disharmony Divorce Occupational problems, with loss of productive man-hours Increased incidence of drug dependence Criminality Financial difficulties Treatment The treatment can be broadly divided into two categories, which are: Detoxification Treatment of alcohol dependence Treatment Similar treatment for any CNS depressant overdose and intoxication Gastric lavage or dialysis to remove the drug Support of respiratory and cardiovascular functioning in an intensive care unit. central nervous system stimulants is contraindicated Detoxification Detoxification - to be done with medical supervision at home or admission, depending on the severity of symptoms Accomplished with the use of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the withdrawal symptoms.