Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Substance Abuse • Continued use despite related problems • Recurrent use resulting in neglect of role functions • Continued use despite recurrent social/legal problems • Recurrent use in hazardous situations Dependence Criteria 3 of the following At least • Use of amounts greater than intended • Attempts to cut down or control • Excessive time spent in getting, using, recovering • Use despite recurrent problems Dependence (addiction) Criteria • Presence of tolerance (more needed for effect) • Presence of withdrawal symptoms • Substance often taken to relieve or avoid withdrawal Dual Diagnosis • Pts with Schizophrenia more than 4 x likely to have substance use disorder • Pts with Bipolar disorder more than 5 x likely Alcoholism in the U.S. • 14 Million cases & 200,000 deaths/yr • Accounts for: – 50% of auto fatalities – 33% of suicides – 67% of murders • Life expectancy reduced 10-12 years • Economic cost $60 billion yearly CAGE • Cut down (have you tried to cut down) • Annoyed by criticism • Guilty (do you feel guilty for drinking too much) • Eye-opener • (put star by this… good one to remember) • There are number of these to look at in the book Alcoholism • • • • • Vivid memory of first drink Self medication with alcohol Controlled drinking Social crutch Frequent accidents Alcoholism continued • • • • • • Personality change Suicidal attempt Elevated blood pressure Alcohol myopathy (pain or edema in muscles) Denial Family enabling denial (family covers up for person) Predisposing Factors • Biological, Genetic, Biochemical • Psychological links – depression, anxiety, antisocial & dependent personality • Sociocultural Factors – nationality & ethnicity (native american’s, Irish) – religious beliefs – gender differences ( – Male sons of alcoholic fathers are 4X more likely Medical Complications • Hepatic- ascites, wt.loss, cirrhosis • Gastrointestinal-esophagitis; esophageal varices (vessles in esophagus ruptures) • Cardiovascular-cardiomyopathy • Neurological-neuropathy • Nutritional-thiamine (decrease) • Infectious diseases • Obstetrical (fetal alcohol syndrome) • Myopathy: pain, edema in muscles, increased CPK, wasting & weakness. GI: esophagitis, esophageal varices. Cardiovascular: cardiomyopathy. GI: esophagitis, esophageal varices. Cardiovascular: cardiomyopathy. Neurological: neuropathy. Nutritional: thiamine Wernicke-Korsakoff Syndrome • Wernicke encephalopathy (most serious form of Thiamine deficiency) – confusion – ataxia – abnormal eye movements • may be treated with large doses of thiamin, but if it progresses to alcoholic amnestic syndrome (Korsakoff’s) the prognosis for reversal of memory loss is poor Wernicke-Korsakoff syndrome • Korsakoff’s Psychosis – Thiamin dementia • alcohol reduces absorption • Alcohol amnesiac disorder – recent memory impaired – appear apathetic – (need to know what it is & that it is a terrible form of thiamine deficiency) Alcohol Withdrawal Syndrome • 6 hrs after fall in BAC; peaks 24-36 hrs subsides 48 hrs • Tremulousness • Anorexia, N& V • Tachycardia, increased BP • Irritability, hyperreflexia, insomnia • Diaphoresis • Possible seizures (6-48 hours) Alcoholic hallucinosis about 48 hours after last drink • Hallucinations (auditory) • Delirium (visual) • Tactile (feel like things are crawling on them) often they will deny these hallucinations… ask them about nightmares… may admit to the nightmares) Acute Hallucinosis • • • • • Don’t Leave Alone Nonstimulating Environment Sedate Reassure Restrain? (last resort, only to prevent harming self… falling out of bed) • Prevent Injury Delirium Tremens -DTs • Medical emergency; 5% -10% fatal • 3-5 days after last drink • Exaggeration of earlier sx plus – Disorientation – Paranoia, delusions – Visual Hallucinations – Elevated VS, vomiting, diarrhea, diaphoresis Intervention for Alcohol Withdrawal • Benzodiazepines (Librium) Carbamezepine (Tegretol) Thiamine • Seizure precautions • Safety and fall precautions • Maintain nutrition & hydration needs • Decrease environmental stimuli • Reorient when indicated Abstinence • • • • • Antabuse Topamax (anticonvulsant) Naltraxone Revax Campral Alcoholics Anonymous; Women for Sobriety; Rational Recovery • • • • • • • • Education re: alcohol Group support/forgiveness Family involvement Alleviation of loneliness Confession/catharsis Opportunity to help others AA has religious component… (smart, belonging is important) Cocaine • Status seekers-yuppies • Aging marijuana smokers • Medical misinformation (in past thought there weren’t good side effects) • Celebrity endorsements (in movies) • Myths, denial, psychopharmacology • South American Indians stuff a wad of coca leaves in a cheek or brew them as tea. The leaves are dissolved in hydrochloric acid to produce cocaine hydrochloride. Can be boiled in a solution of baking soda, smoked in a pipe like crack Cocaine • Interacts with dopamine • Animals choice over drug or food • Sexually deprived monkey (in laboratory) – will choose cocaine over a monkey in heat Effects of cocaine • • • • • Euphoria Mental stimulation Sexual stimulation Energy Sociability Crash • • • • • • Rebound dysphoric reaction Restlessness & irritability Craving Depression Sexual disinterest, impotence Fatigue, memory & concentration problems Toxic consequences of Cocaine • • • • • Panic anxiety reaction Agitation & confusion Increased pulse rate Increased pupil size Seizures Toxicity continued • Cardiac Arrest • Violent or suicidal behavior • Paranoid Psychosis – no Haldol or Mellaril when in toxic state Marijuana • • • • Amotivational syndrome Toxic psychosis Gynecomastia (second only to alcohol as most widely abused drug in the US) • • All kinds of side effects (listed in book… read chapter in text) Greater amts of tar than tobacco… abnormal sperm count, CNS on high, tremors, impairment of judgment, cannabis toxication, impaired motor coordination Opiates • • • • • • Opium, heroin Meperidine, morphine Codeine, methadone Oxycontin, lortab, vicoden, (oxycodone in percodan, Hydrocodone: hycodon, vicodin, lortab) Opiate Withdrawal • • • • • • • • Anorexia Stomach cramps and diarrhea Lacrimation, rhinorrhea Muscle aches Mild elevation in V.S Profuse sweating Insomnia, agitation, depression, anxiety Irritability & restlessness Physical Symptoms • • • • • Dilated pupils Diarrhea Rhinorrhea Piloerection (raised hair on arm) Tremors Intervention for narcotic withdrawal • Clonidine (Catapres) • Cyclobenzaprine (Flexeril): muscle relaxant • Suboxone –Sublingual preparation – Part Opiate – Part Anti-Opiate Suboxone • 4 parts Buprenorphine 1 part Narcan • Buprenorphine (a partial agonist) – Gives pt. enough opiate to alleviate sx of withdrawal • Naloxone (Narcan) An antagonist • Prevents abuse from injection Nicotine Dependence • • • • • Most damaging drug to society !!! Classified by FDA as an addictive drug Causes impotence! Pts require larger doses of SSRIs Zyban may decrease craving Agents to Maintain Abstinence • Alcohol – Naltrexone, Disulfiram (Antabuse) topamax is an anticonvulsant… • Cocaine – Bromocriptine (Parlodel), Carbamazepine • Opiates – Methadone, Naltrexone • Nicotine – Zyban (Wellbutrin sr) Hallucinogens • • • • • LSD; PCP; Inhalants (flashback w/ LSD) Reassurance “Talk down” Safe environment, minimal stimulation Do not touch Behaviors of Abuse & Dependence • • • • • • IV Drug use Accidents, violence, self neglect Skin Abscesses, Cellulitis Hepatitis B (HBV) Bacterial Endocarditis HIV (AIDS) Codependent Behaviors • Fulfills Others Needs (ACOA ??) child ends up taking care of the parents • Anxiety Around Intimacy • Boundary Distortions • Enmeshment • Denial • Depression, Anxiety, Addictions • Stress-Related Medical Illness CNS Depressants • Barbiturates – – – – Seconal, nembutal, amytal, phenobarbital drowsiness, tolerance popular street drugs physical and psychological dependence • Benzodiazepines (1960s) – Valium, Xanax, Librium, Dalmane • Withdrawal from CNS Depressants most dangerous Ecstasy • • • • • Methylenedioxymethamphetamine (MDMA) Affects serotonin Euephoria, increased energy & sexual arousal Suppresses need to eat, drink or sleep Fever, muscle breakdown, kidney & heart failure, death Ecstacy • • • • Brain damage worse for women Persistent memory problems Problems with verbal reasoning & attention Amphetamines are cleared more quickly in the presence of testosterone Flunitrazepam Rohypnol “roofies” forget pill • Physiological effects similar to diazepam (Valium) but 10 times more potent! • Adverse: decreased blood pressure, memory impairment, drowsiness, visual disturbances, dizziness, confusion, gastrointestinal and urinary retention • Ingested orally, frequently in conjunction w/ alcohol or other drugs. Effects begin w/in 30 min., peak w/in 2 hours & may persist for up to 8 hours. Rohypnol • Classified as a depressant (benzodiazepine) but can induce excitability or aggressive behavior • Withdrawal: headache, muscle pain, numbness, anxiety, tension, confusion, • Hallucinations, delirium, convulsions, shock and cardiovascular collapse • • W/drawl seizures can occur a week or more after cessation of use AKA date rape drug GHB • • • • • Gamma Hydroxy Butyrate “G” Used by ecstasy users to prolong high Odorless, tasteless and colorless Clear liquid (visine bottle) Causes muscle weakness & amnesia! – Allergic reactions: seizures, coma, death • Detection through urine testing