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Substance abuse
Definitions
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Substance abuse: use of a pharmacological
substance for purposes other than medically
defined reasons
Addiction: compulsive and overwhelming
dependence on a drug; an addiction may be a
physiological dependence, a psychological
dependence or both
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Physiological dependence: the resulting condition if
removal of the drug causes adverse physical
reactions. Occurs when, in absence of the drug,
there is observable physiological impact
Psychological dependence: use of the drug is
required to prevent or relieve tension or emotional
stress. The person experiences a strong need to
have the drug repeatedly
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Tolerance: the need to progressively increase the
dose of a drug to reproduce the effect originally
achieved by smaller doses
Withdrawal: referring to alcohol or drug withdrawal
in which the patient’s body reacts severely when
deprived of the abused substance
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Drug overdose: poisoning from pharmacological
substance in excess of the dose the body can
tolerate
Compulsive drug use: the individual is preoccupied
with the use and procurement of the drug
Commonly abused
substances
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Alcohol
Amphetamines
Barbiturates
Benzodiazepines
Cocaine
Methaqualone
opiates
Drug and alcohol abuse is
usually complicated by:
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External reinforcements such as:
- peer acceptance
- peer pressure
- social approval
Internal reinforcements such as:
- relief from pain
- frustration
- boredom
- fatigue
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Drug and alcohol abuse is rarely the primary
problem, rather it is often a sign of other problems
such as medical and/or financial problems or
marital stress
Drugs and alcohol may be used as temporary relief
from these problems. Because temporary relief is
gained, the user is reinforced to continue
Intervention in drug abuse:
General principles
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Protect self, patient and others
Treat medically according to symptoms
Be alert to changes
Preserve evidence
Reduce anxiety and calm the person
Focus on the present
Some specific techniques
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Do not argue
Allow the person to speak freely
Keep the person in contact with reality
Only one person should talk to the patient
Reduce external stimuli
Don’t work alone
Don’t make sudden movements
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Speak in a soft, calm tone
Let the patient know they are safe
Tell them what they are experiencing is caused by
the drugs
You may need to reassure the person that hospital
personnel are safe and will continue to care for
them
Alcohol abuse
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Most abused substance in Canada
Drinking alcohol is a factor in a large number of
assaults, murders, attempted murders, child abuse
and other forms of violence
Factor in many motor vehicle collisions
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1 in 12 adults have alcohol abuse problem
Highest in 18-29 age group
Lowest in 65+ age group
More men than women – 46% vs 34%
Drinking & driving:
- 3% of drunk drivers account for 84% of incidents
- in 2000; 420 pedestrian killed – 38% BAC > 0.08
- 87.5% male
- 56% of drivers killed in single MVC had +ve test
- 20% had +ve test in multiple MVC
- 62% of snowmobile operators killed in collisions
had been drinking
- 49% of off road vehicle operators
Physiological effects of
alcohol
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Depresses the central nervous system
At low doses alcohol has excitatory and stimulating
effects, thus decreasing inhibitions
At higher doses alcohol’s depressive effects are
more obvious
Alcohol is completely absorbed from the stomach
and intestinal tract in 30 – 120 min.
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Once absorbed alcohol is distributed to all body
tissues
Has a diuretic effect
Peripheral vasodilator resulting in flushing and a
feeling of warmth. In cold conditions this results in
increased loss of body heat
Warning signs of alcohol
abuse
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Drinking early in the day
Drinking alone and secretly
Binge drinking – may last for several days
Partial or total memory loss during drinking
episodes
Unexplained GI problems
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“green tongue syndrome” - using chlorophyll
containing breath mints to disguise the odour of
alcohol
Cigarette burns on clothing
Chronically flushed face and palms
Tremors
Odour of alcohol on the breath under inappropriate
conditions
Stages of alcohol
dependency:
Stage 1
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Begins somewhat innocently with social drinking
As the drinker notices a pleasant, euphoric mood he
tends to drink more frequently
The drinking increases, so does the denial, until he
becomes dependent
Stage 2
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Outsiders start to realize a problem exists
Drinker starts to suffer blackouts – they can’t
remember conversations or behaviours
Stage 3
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Loss of control
The drinker still has a choice about whether or not
to take the first drink but once he takes the first
drink, he continues to drink
Can’t control the amount they drink – drinks to
achieve a sense of well-being
Stage 4
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Acute, chronic dependency
Entire life revolves around drinking
Suffers critical deterioration and impairment of
thinking
Can’t think when deprived of alcohol
Values may be affected
Signs of alcohol intoxication
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Odour of alcohol on the breath
Swaying, unsteadiness
Slurred speech
Flushing of the face
Poor coordination
Drowsiness
Inappropriate display of emotions
Tendency towards accidents
Stages of intoxication
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Mild high – reaction time impaired, fine motor
impaired
Intoxication – gross impairment of physical and
mental functions
Stupor – if conscious, presents with a blank stare,
doesn’t respond
Death – respiratory depression, cardiac problems
Be aware of drug-alcohol
interactions
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ASA + alcohol – increases gastric irritation
Sedatives + alcohol – rapid sedation, may lead to
respiratory depression
NTG + alcohol – cardiovascular collapse
Alcohol withdrawal
symptoms
Tremulous stage
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Mildest stage
Characterized by agitation, mild muscle tremors,
headaches, flushed face & nausea
May have nightmares
Starts within several hours of cessation of drinking
Symptoms persist for 5 – 7 days
Acute hallucinosis stage
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2 -3 days after a very heavy drinker stops drinking
Becomes fearful, may be paranoid
Excessive sweating
Marked agitation
May be combative, suicidal
Delirium Tremens
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Within 1 – 7 days after a serious drinker stops
drinking
Most severe stage
Disoriented to time, place and person
Vivid hallucinations, marked agitation, tremors,
pallor, sweating, seizures, fever, tachycardia
May lose consciousness
Signs & symptoms if
withdrawal syndrome
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Coarse tremor of hands, tongue and eyelids
Nausea and vomiting
General weakness
Tachycardia, sweating
Anxiety
Irritability or a depressed mood
hallucinations
Dealing with drug and
alcohol emergencies
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Ask the following:
- what was taken?
- when was it taken?
- how was it taken?
- was anything else taken?
- has anything been done to correct the situation by
the patient or others?
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The biggest impediment to helping is the patient’s
denial of drug and alcohol use
May be because of:
- fear of police
- fear of retaliation from person supplying them
- fear of job loss, fear of losing their driver’s licence
- fear of embarrassment
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Communications skills are very important in dealing
with these emergencies
Be patient
Do not accuse the patient
Be nonjudgmental
Listen