Abuse Disorders Flashcards
Smoking Cessation: What is it?
Cigarette smoking (tobacco dependency) is a chronic disease that often requires repeated intervention and multiple attempts to quit. Withdrawal from nicotine produces anxiety, craving, hunger, irritability, drowsiness, tremors, diaphoresis, insomnia, dizziness, and headaches. Smoking cessation is defined as abstaining from cigarette smoking for at least 1 year.
** Although quitting smoking at any age is beneficial, smokers who quit between the ages of 35 and 44 avoid the greatest risk of dying from a smoking-related
Smoking Cessation: Etiology
- Psychosocial stress and nicotine dependence are two primary reasons people smoke
- Reasons for smoking and motivation to quit are age related
Smoking Cessation: Why do teenagers start and quit smoking?
- Teenagers smoke to appear older, due to peer pressure, and are influenced by media and marketing
- Teenagers may be motivated to quit by recognizing the immediate undesirable effects of cigarette smoking (e.g., bad odor, expense, decreased exercise capacity, relationship between smoking a acute respiratory illness)
Smoking Cessation: Why do adults start and quit smoking?
- Adults smoke due to physical dependence
- Adults tend to quit smoking when they are provided with healthy alternatives, if psychosocial issues are addressed, and when they recognize the relationship between smoking and acute illness
- Financial issues can influence adherence to smoking cessation
Smoking Cessation: Why do older adults start and quit smoking?
- Older adults continue to smoke because they feel it is too late to undo damage that is already done
- Older adults tend to quit smoking to receive immediate benefits (e.g., fewer upper respiratory infections, improved taste sensation, less coughing, money savings) and because they believe that quitting can prevent further damage
Smoking Cessation: Assessment Findings
- Use the theoretical model of change to assess a patient’s readiness to act on a new healthier behavior. Consider use of motivational interviewing
- Chronic cough
- Inflammation of oropharynx, sinuses, nose
- Cigarette odor on breath, hair, clothing
- Nicotine-stained teeth and fingers
- Prematurely aged skin
- Frequent upper respiratory infections
- COPD
- Past attempts at quitting
- Smokeless tobacco including vaping/e-cigarettes
- Erythema of isolated areas of intraoral soft tissue
- Leukoplakia (white patches) on gums
- Bronchiolitis obliterans (popcorn lung syndrome)
Smoking Cessation: Non-Pharmacologic Management
Advise all smokers to quit; repeat at every visit
Smoking Cessation: Pharmacologic Management
Focuses on nicotine replacement and non-nicotine-based therapy. Patients should quit smoking before using nicotine replacement (do not use concurrently)
Smoking Cessation: Nicotine Replacement Therapies
- Help relieve withdrawal symptoms while quitting
- Should be used in conjunction with counseling
- Transdermal patch releases a constant dose of nicotine through the skin
- Not recommended for patients <18 years, but recent studies indicate can be used safely in adolescents
- Nicotine gum/lozenge helps reduce urge to smoke
- Nicotine nasal spray highly effective but carries dependence risk due to rapid absorption of nicotine
Smoking Cessation: Non-Nicotine-Based Therapy
- Bupropion theorized to block noradrenergic and dopaminergic pathways (addiction receptors in the brain), resulting in a reduction in urge to smoke and reduction in withdrawal symptoms
- Patients should start taking bupropion before they stop smoking, and should stop smoking during the second week of therapy
- Continue therapy for 7 to 12 weeks
- If used in conjunction with nicotine replacement therapy, nicotine replacement should be started only after patient has stopped smoking
** Varenicline (Chantix)
Alcohol Use Disorder: What is it?
A pattern of alcohol use that results in psychological and physiologic problems. The severity of alcohol use disorder is determined based on the number of symptoms present
* Mild: 2-3 symptoms
* Moderate: 4-5 symptoms
* Severe: greater than 6 symptoms
Alcohol Use Disorder: Etiology
- Combination of social, cultural, biological, and emotional factors
- Probable genetic influence
Alcohol Use Disorder: Incidence
- Men affected at twice the rate of women
- Predominant age 18-25 years
- 88% of people > 18 years old report alcohol use
- 88,000 people (62,000 men/26,000 women) die from alcohol-related causes annually
- Third leading preventable cause of death in U.S.
- Accounts for 31% of all vehicle fatalities
Alcohol Use Disorder: Criteria for Determining Severity
- Consuming alcohol in larger amount or for longer than intended
- Persistent desire or unsuccessful effort to reduce or control use
- Spending significant time getting or using alcohol, or recovering from alcohol use
- Cravings and urges to consume alcohol
- Recurrent use resulting in failure to fulfill obligations at work, school, or home
- Continued alcohol use despite persistent or recurrent social/interpersonal problems caused/exacerbated by consumption
- Giving up/reducing social, occupational, or recreational activities due to alcohol use
- Recurrent use even if physically hazardous
- Continuing use despite knowledge of having problems caused/exacerbated by alcohol
- Tolerance
- Withdrawal
Alcohol Use Disorder: How is tolerance defined?
- Markedly increased amounts to achieve intoxication or desired effect
- Markedly diminished effect with continued use of the same amount
