How Substance Use Disorders Affect Physical Health affect Physical Health.pdf · Addiction is...

How Substance Use

Disorders Affect

Physical Health

1

Learning Objectives

• Define the continuum of Substance Use Disorders

• Understand the risk levels associated with various stages of

use

• Examine the general and specific health concerns related to

Substance Use Disorders for users and others

• Identify special problems experienced by substance

using/abusing pregnant women and their babies

• Demonstrate how behavioral and primary healthcare

workers can intervene more effectively to reduce risks

associated with substance use

Stigma

.

3

4

Stereotype

Substance Use Disorders

• Use

• Abuse

• Addiction

Use

7

The Drinkers’

Pyramid

3-7 % alcohol dependent or

harmful users

40% abstainers

35- 40% low-risk

drinkers

10- 15% hazardous,

at-risk users

What is a Low-Risk Limit?

8

What is a Low-Risk Limit?

• No more than two

standard drinks a

day for men, one

per day for women

(for daily drinkers)

• Do not drink at least

two days of the

week

9

10

Definitions: Standard Drink

There are times when even one or two drinks can be too much:

• When operating machinery

• When driving

• When taking certain medicines

• If you have certain medical conditions

• If you cannot control your drinking

• If you are pregnant

11

What is a Low-Risk Limit?

Abuse

13

Substance Abuse vs. Substance

Dependence

Substance Abuse: the misuse of alcohol, an illicit

drug, prescription drug or over-the-counter

medication.

Substance abuse often involves a pattern of

harmful alcohol and/or drug use for mood altering

purposes.

A person diagnosed with substance abuse is not

considered to be addicted or dependent (otherwise

the diagnosis would be substance dependence).

• Substance abuse/dependence is strongly associated with health problems, disability, death, accident, injury, social disruption, crime and violence

• Alcohol abuse/dependence alone generates nearly $185 billion in annual economic costs (NIAAA)

• Drug abuse/dependence generates an estimated $98 billion annually in annual economic costs (NIDA)

14

Scope of the Problem

Addiction

Lincoln on Addiction

“In my judgment such of us who have

never fallen victims (of alcoholism)

have been spared more by the

absence of appetite than from any

mental or moral superiority over those

who have.” (remarks to the Springfield, Illinois

Washingtonian Society, February, 1842)

21

Addiction is Manageable

Recovery Happens

Addiction is Manageable and, with treatment, has good

outcomes.

….all this bad news!

Is there no hope?

Of course there is hope! Recovery is all

around us.

“No known cure” doesn’t mean not “untreatable.” We

don’t cure diabetes, we manage it with proper diet, blood

sugar monitoring and other acts of discipline.

Recovery

• Recovery from alcoholism and drug addiction is a

process of change through which an individual

achieves abstinence and improved health,

wellness, and quality of life. (SAMHSA/CSAT)

General Health Concerns for the

Abuser

• Cardiovascular disease

• Stroke

• Cancer

• HIV/AIDS

• Hepatitis B and C

• Liver disease

• Lung disease

• Mental disorders

• Neurological disorders

According to the American Cancer Society (ACS) the greater a person’s alcohol consumption

is the greater the chances are that he or she will get certain

kinds of cancer

General Health Concerns for Others

• Prenatal exposure

• Negative effects of second-hand smoke

• Increased spread of infectious diseases

• Automobile crashes and other accidents

Alcohol

• Cardiovascular system

– High blood pressure

• Neurological system

– Damage to

• Cerebral cortex

• Hippocampus

• Cerebellum

– Stroke

• Endocrine system

– Cirrhosis

– Liver Cancer

– Diabetes

Alcohol dependence is the leading cause of cirrhosis, which

is the eighth leading cause of death in the U.S. and kills about

25,000 people a year

National Institute of Health, 2000; Stinson, Grant, and Dufour, 2001

• Alcohol is a factor in:

– 60-70% of homicides

– 40% of suicides

– 40-50% of fatal motor vehicle accidents

– 60% of fatal burn injuries

– 60% of drownings

– 40% of fatal falls

29

Scope of the Problem

Alcohol

Prenatal Exposure

• Children with fetal alcohol spectrum disorder may:

– Be born small

– Have problems eating and sleeping

– Have problems seeing and hearing

– Have trouble following directions and learning how to do

simple things

– Have trouble paying attention and learning in school

– Need special teachers and schools

– Have trouble getting along with others and controlling

their behavior

– Need medical care all their lives

Tobacco

• Smoking harms nearly every organ in the body

• Adverse health effects from smoking account for about 443,000 deaths (or nearly one of every 5 deaths) each year in the US

• Smoking causes coronary heart disease, the leading cause of

death in the US

• Smoking causes abdominal aortic aneurysm

• Smoking causes cancers, including acute myeloid leukemia,

bladder cancer, cancer of the cervix, cancer of the esophagus,

kidney cancer, cancer of the larynx, lung cancer

• More deaths are caused each year by tobacco than by all

deaths from HIV, illegal drug use, alcohol use, motor vehicle

injuries, suicides and murders combined (Centers for Disease Control and Prevention)

Tobacco and Pregnancy

• Fetus exposed to dangerous chemicals like nicotine, carbon

monoxide and tar. These chemicals lessen the amount of oxygen

available for the developing fetus

• For the mother, smoking can lead to an ectopic pregnancy,

vaginal bleeding, placental abruption, placenta previa

• Babies can born prematurely, with low birth weight

• Birth defects can occur, such as cleft lip or palate

Second Hand Smoke

• Sidestream v. Mainstream

• 3,400 lung cancer deaths in non-smoking adults (est.)

• 46,000 deaths from heart disease in non-smokers who live

with smokers (est.)

• Increases the number and severity of asthma attacks in

children

• More than 750,000 middle ear infections in children

• Increased risk of low birth weight in babies born to pregnant

women exposed to second hand smoke

(American Cancer Society)

Marijuana

• Cardiovascular

– Increased heart rate

• Respiratory system

– Lung damage

– Cancer

• Reproductive system

– Delay in development

– Possible infertility

Marijuana users have a 4.8-fold increase in the risk of

heart attack in the first hour after smoking the drug

Mittleman, M.A., Lewis, R.A., Maclure, M., Sherwood, J.B., Muller, J.E.

Triggering myocardial infarction by marijuana.

Circulation, 103(23), 2805–2809, 2001.

Marijuana smoke contains 50–70% more carcinogenic hydrocarbons than tobacco smoke.

Hashibe, M., Morgenstern, et al 2006

Heroin (and other opiates)

• Cardiovascular system

– Infection of the heart lining

• Respiratory system

– Chest pains

– Respiratory failure

– pneumonia

• Digestive system

– Abdominal pain

– Nausea

– Constipation

– Weight loss and malnutrition

• Kidney disease

Estimated annual dialysis cost for just one person who has wrecked

his own kidneys by shooting heroin ("heroin nephropathy")

$50,000

AMERICAN JOURNAL OF KIDNEY DISEASES,

40(3):611-622, Lee H © 2002 National Kidney Foundation.

Heroin (and other Opiates)

Prenatal Exposure

• Physical issues

– Low birth weight

– Born physically dependent

– Need to be tapered from opiates

– Need for long-term hospitalization

• Cognitive issues

– Cognitive performance

– Developmental delay

Heroin (and other Opiates)

Route of Use

• Snorting

– Nose bleeds

– Hole in septum

• Injection

– HIV/AIDS

– Hepatitis C

– Allergic reaction to additives

– Collapsed veins.

Injection Drug Use

• Transmission of bloodborne infections

– Human immunodeficiency virus (HIV)

– Hepatitis B (HBV) and hepatitis C (HCV) infections

• Collapsed veins

– Difficult to find veins for medical treatment

• Soft-tissue infections

– Abscesses

– Cellulitis

In the U.S., approximately one third of AIDS cases and one half of

new HCV cases are associated with injection drug use

Cocaine

• Cardiovascular

– Disturbances in heart rate

– Sudden heart attacks

• Respiratory system

– Chest pains

– Respiratory failure

• Digestive system

– Abdominal pain

– Nausea

– Weight loss and malnutrition

• Neurological system

– Strokes

– seizures

Cocaine-related deaths are often a result of cardiac arrest or seizures

followed by respiratory arrest.

NIH Publication Number 99-4342

Cocaine

Prenatal Exposure

• Physical issues

– Low birth weight

– Smaller head circumference

– Shorter length

• Cognitive issues

– Cognitive performance

– Information processing

– Attention to tasks (ADD/ADHD)

Cocaine

Route of Use

• Snorting

– Nose bleeds

– Hole in septum

– Bowel gangrene

• Injection

– HIV/AIDS

– Hepatitis C

– Allergic reaction to additives

• Smoking

– Burns

– Infection

Amphetamines

(including methamphetamine)

• Brain damage

• High body temperature

• Heart problems

• Seizures

• Dental Problems

Ecstasy (MDMA)

• Cardiovascular

– Increased heart rate

– High blood pressure

– Heart wall stress

• Nerve cell toxicity

• Confusion, depression, sleep problems,

severe anxiety

Bath Salts

• Ivory Wave, Bliss, White Lightning, Hurricane Charlie

• Readily available over the Internet and in some convenience

stores

• Effects similar to other stimulants

• Most contain MDPV (methylenedioxypyrovalerone)

• Physical effects include: tachycardia, hypertension, stomach

cramps and digestive problems, bruxism, kidney pain, tinnitus,

dizziness, difficulty breathing

• Prolonged panic attacks, possible psychosis

• Users have reported a compulsive desire to continuously re-dose

• Routes of use include: oral, smoking, snorting, intravenous use

Inhalants

• Neurological system

– Effect the myelin sheath around the neuron

– Personality change, memory loss, hallucinations, tremors

– Vision problems

• Cardiovascular system

– Disturbances in heart rate

– Sudden heart attacks

• Respiratory system

– Lung damage

– Difficulty breathing (due to lack of oxygen in the blood)

• Kidneys

– Kidney stones

Inhalants

• More 12 and 13 year olds use inhalants than marijuana

• 1.1 million adults (over 18) used inhalants in the past year-

more than the number of adults who used crack cocaine,

LSD, heroin or PCP

• 54% of the 3,273 people treated for inhalants in 2008 were

18 or older; 1 in 3 adults were between 30-44; 1 in 6 were

45 or older; 72% were non-Hispanic whites

(NSDUH)

LSD (and other Hallucinogens)

• Cardiovascular system

– Increased heart rate

– High blood pressure

• Neurological system

– Tremors

– sleeplessness

• Digestive system

– Loss of appetite

• Mental health

– Traumatic experiences

– Emotional instability

Mescaline has been associated to fetal abnormalities

Gilmore HT. Peyote use during pregnancy.

S D J Med 54(1):27–29, 2001.

Steroids

• Cardiovascular

• Liver problems

• Stroke

• Infectious disease

• Depression and suicide

Drug combinations

• Cocaine and alcohol

– Greater risk of sudden death

• Alcohol and depressants

– Loss of coordination

– Coma

– Slowing of CNS

• Fentanyl and heroin or cocaine

– Irregular heartbeat

– Breathing difficulties

Researchers have found that the human liver combines

cocaine and alcohol to produce Cocaethylene which is associated with a greater risk of sudden death than

cocaine alone. Harris DS, et al

1. Identification of use, misuse, and problematic use; screen with simple direct methods

2. Connection of use/misuse to health related issues

3. Consumption reduction

4. Brief Intervention

5. Referral for formal assessment

63

Role of Behavioral and Primary Healthcare

Workers in Drug and Alcohol Use–

What Can We Do To Help?

64

SBIRT

An Effective Approach

»Screening

»Brief

Intervention

»Referral

»Treatment

65

SBIRT

• “alcohol screening and counseling (is)

one of the highest-ranking preventive

services among the 25 effective services

evaluated using standardized methods.

Since current levels of delivery are the

lowest of comparably ranked services,

this service deserves special attention by

clinicians and care delivery systems. --

American Journal of Preventive Medicine

66

Screening

• Involves the use of …

• Alcohol and/or drug abuse screening tools,

like the Alcohol Use Disorders

Identification Test (AUDIT) or the Drug

Abuse Screening Test (DAST)

Screening vs.

Assessment

• Screening: determining the possibility

that a condition exists

• Assessment: confirming the existence

of a condition and its severity.

68

Early and Brief Intervention

• For those not ready to change, may

increase their motivation

• For those ready to change

– Provides advice on appropriate goals and

strategies

– Provides support

69

The Brief Intervention:

• Short dialogues between the healthcare provider and the patient that typically involve:

– Feedback

– Client engagement

– Simple advice or brief counseling

– Goal-setting

– Follow-up

Spirit of Motivational Interviewing

• Collaboration (vs. Confrontation)

– Meeting of aspirations

– Neither exhortation nor persuasion

• Evocation (vs. Education)

– Drawing out

– Neither instilling nor installing

• Autonomy (vs. Authority)

– Personal responsibility

– Neither imposition nor coercion

71

A Good Outcome from BI

• Reduction or cessation of

use (even temporary)

• Starting to think about

reducing

• Agreeing to accept referral

“A cross-national trial of brief interventions with heavy drinkers”

• Multinational study in 10 countries (n=1,260)

• Interventions included simple advice, brief and extended counseling compared to control group

• Results: Consumption decreased

–21% with 5 minutes advice, 27% with 15 minutes

compared to 7% controls

–Significant effect for all interventions

72

World Health Organization (Am J Pub Health 1996)

Video of a Brief Intervention

73

Thank you for your time and attention!

References

• www.drug abuse.gov

• www.niaaa.nih.gov

• www.cdc.gov/ncbddd/fasd/training.html

• www.nida.nih.gov/infofacts

• NIDA Research Report Series: Cocaine Abuse and Addiction, NIH

Publication Number 99-4342, May, 1999, Revised November

2004

• NIDA Monograph 44. Marijuana Effects on the Endocrine and

Reproductive Systems

• Drinking and Your Pregnancy, NIH Publication No. 05–5610

Revised 2009

• www.sbirtoregon.org

• http://sbirt.ireta.org/sbirt/