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Chapter 49
Substance Abuse
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 49
Lesson 49.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Objectives
• Differentiate among the key terms associated
with substance abuse
• Explore biologic, psychological, and
sociocultural models that influence the
assessment and treatment of substance
abuse
• Describe the different types of screening tools
used to assess alcohol and substance abuse
• Cite the responsibilities of professionals who
suspect substance abuse by a colleague
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 3
Keys Terms of Substance Abuse
• Substance abuse – periodic purposeful use
of a substance that leads to clinically
significant impairment
• Impairment – failure to fulfill major
obligations at work, school, or home
• Dependence/addiction – symptoms of
compulsive use, tolerance, and withdrawal
symptoms on discontinuation
• Illicit substances – any chemical that alters
biologic function and is not required for health
maintenance
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Theories
• Biologic model
 Abuse caused by genetic profile; hereditary
condition
• Psychological theories
 Psychoanalytic theories
 Behavior or learning theories
 Cognitive theories
• Sociocultural factors
 Attitudes, values, norms affect susceptibility to
abuse
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 5
Signs of Impairment
• First manifested in family life
 Violence, separation, divorce, financial
problems
• Disintegration of social life
 Public intoxication, isolation
• Physical and mental changes
 Fatigue, multiple illnesses, injuries, accidents,
emotional crises
• Flagrant evidence of impairment at work
(rare)
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Slide 6
Screening
• Four categories of instruments
 Comprehensive drug abuse screening and
assessment
 Brief drug abuse screening
 Alcohol abuse screening
 Drug and alcohol abuse screening for use with
adolescents (see Table 49-2 for details)
• CAGE
 Used for quick assessment
 C - cut down, A - annoyed, G - guilt, E - eye
opener
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Health Professionals
and Substance Abuse
• Factors leading to substance abuse
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Stress of intense patient care
Managing more patients with same resources
“Zero tolerance” for mistakes
Financial debt
• Signs of abuse
 Behavioral changes: lack of attention to
hygiene, mood swings
 Performance deterioration
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
Substance Abuse
Reporting
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Confidential report to appropriate supervisor
Investigation
Observation and documentation over time
Clinical practice is a privilege
Need to protect patients
Unreported colleague may die as result of
impairment
• Reported colleagues have good chance of
retaining their licenses; legal protections do
exist
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Substances of Abuse
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Alcohol, nicotine, caffeine
Amphetamine
Cannabis (marijuana)
Cocaine
Hallucinogens
Inhalants
Opioids
Phencyclidine (PCP)
Sedatives and hypnotics
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Chapter 49
Lesson 49.2
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Objectives
• Explain the primary long-term goals in the
treatment of substance abuse
• Study the withdrawal symptoms and
approaches to treatment and relapse
prevention for major substances that are
commonly abused
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Long-Term Goals of Treatment
• Reduction or abstinence in the use and
effects of substances
• Reduction in the frequency and severity of
relapse
• Improvement in psychological and social
functioning
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Alcohol
• Withdrawal symptoms
 Visual and auditory hallucinations
 Seizures
• Treatment
 Assess hydration, electrolytes, nutritional
status
 Thiamine and multiple vitamins
 Benzodiazepines for detoxification
• Fixed dose schedule
• Symptom-triggered medication regimen
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
Alcohol Relapse
Prevention
• Social support and lifelong effort required
• Medications used
 Disulfiram (Antabuse) – helps reduce the
desire for alcohol by causing nausea and
vomiting with ingestion of alcohol
 Naltrexone (ReVia) – blocks the effects of the
high
 Acamprosate (Campral) - promotes
abstinence
 Slightly higher success rate of preventing
relapse when naltrexone and acamprosate are
used together
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
Opioids, Cocaine
• Withdrawal symptoms
 Mood swings, impaired memory, slurred
speech
 Anxiety, restlessness, increased blood
pressure and pulse, sweating, nausea,
vomiting, sometimes aches and fever
• Treatment
 May substitute another opioid to reduce
severity of withdrawal symptoms
• Relapse prevention
 Rate of relapse is high for cocaine
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
Amphetamine-Type Stimulants
• Uses
 Treat schizophrenia, depression, radiation
sickness, attention deficit hyperactivity
disorder (ADHD), opiate and nicotine addiction
• Intoxication
 Produce sense of heightened alertness,
attentiveness, self-confidence, powerfulness
and energy; frequently lead to additional dose
and may stay awake for 7-10 days
 Often little water or food is taken when high
 “Meth mouth” occurs from poor oral hygiene
and grinding of teeth
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Amphetamine Treatment
• No antidotes for methamphetamine
• Psychiatric evaluation due to damaged
dopaminergic and serotonergic neurons
• Cognitive behavior therapy
• Contingency management programs
• Support groups
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18