NUR448

Substance Abuse

DSMIV CriteriaSubstance Abuse

1 or more of following within 12 months Substance abuse resulting in failure of major

obligation—work, school, home Substance abuse resulting in physical hazard Substance related legal problems Continued substance use despite social, or

interpersonal problems

Substance Dependence

3 or more of the following over 12 months Tolerance Withdrawal Larger amounts or longer period of time than

intended Persistent desire to control use Reduced important personal, social or work

activities Continued use despite problems

Substance Intoxication

Reversible substance specific syndrome due to ingestion of substance

Clinically significant maladaptive behaviorSymptoms not due to medical condition

Substance Withdrawal

Development of substance specific syndrome due to cessation of substance

Clinically significant distress or impairmentSymptoms not due to medical condition or

other mental state

Alcohol abuse- two types

Type 1 relatively mild influenced by environmental factors begins later in life

Type 2

Severe family HxAntisocial personality featuresStrong genetic componentEarlier onset (before age 25)Reduced serotonin functionDifficulty abstaining from alcoholLoss of control while drinking

Etiologic Theories

Biological/Genetic-disease model-low levels of dopamine

Behavioral-self-doubt and passivity, difficulty with intimacy, narcissistic

Sociological-poverty, teen-agers, ETOH western culture- Marijuana-eastern culture

Family systems- co-dependent, enabler

Family Roles

The Addict (center of attention)

The Hero (makes the family look good- acts as though the addict is not an addict-fear, guilt, and shame)

The Troublemaker or Scapegoat (rebel and act out drawing attention away from real problem- shame and guilt)

The Lost Child (quiet and reserved –never make problems-guilt lonliness, neglect)

The Mascot (makes jokes about the addict-embarrassment, shame, and anger)

The Enabler (tries to make everyone happy-inadequac and unhappiness)

Alcohol Withdrawal Syndrome

Hangover-tremor, headache, mydriasis, GI symptoms, sweating, tachycardia mildhypertension-6-8 hours post cessation

Alcoholic Hallucinosis-above and hallucinations and delusions 8-12 hours post cessation

Generalized Seizures-tonic-clonic 12-24 hours post cessation

Delirium Tremens-medical emergency seizure occurs in persons with poor health seizures within one week cessation

Acute ETOH withdrawal interventions

Force fluids and sleepHallucinations

usually disappearConvulsions

magnesium sulfateTremors

Librium (chlordiazepoxide) or Ativan (lorazepam)

Delirium Tremens

High feverFailure of all ego functionsViolenceConvulsionsDeath

Amnestic disorders associated with ETOH abuse

Blackouts—dehydration –can occur early in drinking hx.

Korsokoff’s psychosis—thiamine deficiency-irreversible brain damage

Wernecke’s encephalopathy-ataxia damage to 6th cranial nerve-reversible with thiamine Rx.

Physical Effects of Chronic Drinking

Peripheral neuropathyAlcoholic cardiomiopathyEsophagitisGastritisPancreatitisHepatitisCirrhosisLeukopeniaThrombocytopenia

ETOH Long term Rx

AA, Al AnonAntabuse (Disulfuram)ReVia (Naltrexone)

Sedative, hypnotic or anxiolyticPhysical effects

Interrupt sleep and dreamsRespiratory depression Cardiovascular effectsRenal functionHepatic effectsSexual function

Sedative, hypnotic or anxiolytic abuse and dependence

Intoxication Disinhibition Aggression Coma,and or death

Withdrawal Depends on ½ life of drug Can be life-threatening Requires hospitalization

CNS stimulants

AmphetaminesCocaineCaffeineNicotine

CNS Stimulants Physical effects

CNS effectsCardiovascular effectsGastrointestinal effectsSexual function

CNS stimulant intoxication

Euphoria, impaired judgment, anxietyNausea, vomiting, psychomotor agitationMuscle weaknessConfusion, seizures, deathNicotine—restlessness and insomnia

CNS withdrawal

Dysphoria, fatigue, sleep disturbanceHeadache, fatigue, anxiety, nausea and

vomitingNicotine- restlessness, increased appetite,irritability

Opioid Physical Effects

CNSGI effectsCardiovascularSexual function

Opioid Intoxication

Consistent with half-life Drowsy, euphoria Respiratory depression- coma-death

Opiate/Opioid Withdrawal

6-12 hours after last doseNausea vomiting diarrheaLacrimationRhinorrheaPupilary dilitation, \sweating, fever

(no medical emergency involved in opiate/opiod withdrawal)

Opiate/Opiod Addiction Long Term Rx

Narcotics AnonymousCatapres (Clonidine)MethadoneReVia (Naltrexone)Anti-depressants

Cannabis

MarijuanaHash-hish

Effects

Slowed time assessmentImpaired motor skillsImpaired judgment

Questions

What are substances typically abused?What is difference between abuse and

dependence?What are the names of the short term and

long term treatment facilities in the South Florida area?