Addiction Flashcards
Addiction
a chronic, relapsing brain disease characterized by compulsive drug seeking behavior motivated by cravings, despite harmful consequences; causes long term changes to brain chemistry
Role of Dopamine in Addiction
- Most psychoactive drugs flood the brain with dopamine; produces the high feeling; targets the brains reward system
- activation of the dopamine system leads to learned behaviors and increased likelihood of repeating the behavior
- overstimulation of this hormone leads to an enhanced euphoric effect which causes a strong desire for repeated use of the drug
- with repeated use, the brain adapts to the surges of dopamine by synthesizing less dopamine and reducing the number of receptors; leads to limited ability to experience pleasure without drug, they’re need to feel normal; tolerance
blackouts
amnesia for the events of any part of a drinking episode
intoxication
disturbances in the level of consciousness, cognition, perception, and or behavior after using a substance
cross-tolerance
tolerance of a certain drug produces tolerance to another drug in the same class/category
withdrawal
symptoms that occur after a substance is stopped or reduced after a long term period of use
antagonistic effects
occur when one drug is taken to weaken or inhibit the effects of another drug
codependency
a type of dysfunctional helping relationship where one person supports or enables another person’s addictive behaviors continue
s/s of CNS Depressant Intoxication
“slow”
slurred speech, unsteady gate, drowsiness, decreased vitals, disinhibition, impaired judgement, irritability, impaired attention/memory
CNS Depressant Overdose
cause: cardiovascular and respiratory depression, shock, convulsions, coma, and/or death
tx: clear airway, IV fluids, seizure precautions, activated charcoal, dialysis, flumazenil if barbiturates or benzos
barbiturate and benzo withdrawal
opposite of intoxication, b/c of loss of drug
ex. elevated vitals, n/v, tremors, paroxysmal sweats, insomnia, anxiety and agitation, tactile, auditory or visual disturbances, seizures, disorientation and delirium
alcohol related medical problems
Gasto: gastritis, esophagitis, pancreatitis, hepatitis, cirrhosis of the liver
Neuro: effects cerebral cortex, hippocampus, and cerebellum, Wernicke’s encephalopathy, Korsakoff’s psychosis, peripheral neuropathy
Wernicke’s Encephalopathy
Alcohol related medical problem: (neuro)
caused by thiamine (b1) deficiency
acute/subacute confusion, nystagmus (rapid, repetitive, uncontrolled eye movements), ataxia (poor muscle control)
Korsakoff’s Psychosis
Alcohol related Medical problem (neuro)
difficulty/inability to learn new information and/or remember recent events
also affects thinking and social skills
Four Blood Alcohol concentration levels
0.02-0.06 “buzzed feeling”
0.07-0.14 “drunk”
0.15-0.24 “dangerous intoxication”
>0.24 medical emergency
Measuring alcohol intolerance level;
how and why
blood alcohol concentration level
determines the level of intoxication based on weight and size; assess level of tolerance; verify patients report of recent drinking
Manifestations of alcohol withdrawal; most dangerous?; timeline
autonomic: elevated HR, BP, and temp. diaphoresis, n/v, diarrhea
motor: hand tremor, hyperreflexia, ataxia, seizures, dysarthria (trouble speaking), insomnia, irritability
awareness: disorientation, delirium, agitation
psychiatric: hallucinations, illusions, paranoia, combativeness
most dangerous: delirium tremors- fatal form of alcohol withdrawal
sx peak 24-48 h ours after last drink, can continue 5-7 days
10 Categories of CIWA scale; ranges of scores
- n/v
- tremor
- paroxysmal sweats
- anxiety
- agitation
- tactile disturbances
- auditory disturbances
- visual disturbances
- headache
- orientation/clouding of sensorium
all score from 0-7 except orientation which is 0-4
Medications used for Alcohol Withdrawal
administer meds with a cross tolerance to alcohol and gradually decrease the dose
- most common: benzos
IV ativan for high scores, PO chlordiazepoxide for low scores
can be scheduled or score based
provides sedation, decreases anxiety, and decreases risk of seizures
clonidine for cardiovascular effects
thiamine and vitamin replacement (Rally Pack)
anti-convulsant for seizures and anxiety
Meds used for Sobriety (alcohol)
Disulfiram (anatabuse): helps with impulse drinking d/t long lasting effects, when mixed with alcohol patient will have violent physical reactions; takes 14 days to leave body
Naltrexone (vivitrol): reduces the desired pleasant feelings by blocking the release of endorphins, also blocks cravings; inj. given once a month or daily orally (ReVia)
Acamprosate (campral): reduces unpleasant symptoms of abstinence and decreases cravings
principles of meds for alcohol sobriety
making alcohol unpleasant
reducing psychophysiological symptoms of withdrawal, reducing the reinforced qualities of use
s/s of Opiate intoxication
constricted pupils, drowsiness, slurred speech, psychomotor slowing, initial euphoria followed by dysphoria (sadness, dissatisfied)
Associated Medical Problems with Opiate Use
“super slow”
chronic constipation, respiratory depression and failure, pneumonia, neonatal abstinence syndrome, complications from IV drug use
Possible medical complications of IV drug use
endocarditis, hep c, hiv/aids, tb, infection and abscesses
signs of opiate overdose
“opioid overdose triad”
1. pinpoint pupils
2. respiratory depression
3. decreased LOC
treating opiate overdose
administer narcan, preserve airway, ensure adequate oxygenation
s/s of opiate withdrawal; when does it start
“parasympathetic nervous system “wakes up”- wet, gi, etc.
yawning, low energy, irritability, insomnia, agitation, flu like symptoms, runny nose, teary eyes, goose bumps, hot/cold sweats, severe muscle aches and pains, abdominal cramping, diarrhea, n/v
can begin within 1 hour but usually 12 hours after last use; peaks at 3-5 days and lasts 1-4 weeks
Clinical Opiate Withdrawal Scale (COW)
categories, scores
resting pulse, GI upset, Sweating, Tremor, Restlessness, yawning, pupil size, anxiety or irritability, bone or joint aches, goose/flesh skin, runny nose or tearing
mild: 5-12
moderate:13-24
moderately severe: 25-36
severe: >36
Meds used for opiate withdrawal
methadone for staged abstinence
clonidine: can assist with withdrawal effects related to autonomic instability; anxiety, chills, insomnia
symptom management:
- ibuprofen
-dicyclomine
- baclofen (yawning, muscle spasms)
- zofran
- loperamide (diarrhea)
-trazadone
- hydroxyzine (anxiety)
Meds used for opioid sobriety
methadone: long term to decrease cravings and relapses related to urges; does NOT produce a “high”, given once a day usually in a supervised setting
buprenorphine: opioid used to support abstinence that is a partial agonist, longer acting with milder withdrawal sx, only required to take 1-3x week instead of every day
naltrexone: opioid antagonist that blocks the euphoric effects of opiates; will cause withdrawal in pts currently taking opioids
suboxone: combo of buprenorphine and naltrexone
s/s of CNS stimulant intoxication
“fast!”
increased alertness, sexual arousal, behavioral excitement, well-being and energy, diminished fatigue, extreme energy, anorexia, rambling/incoherent speech, increased violence, delusions of grandeur, anxiety/fear, pupil dilation, dryness of nasal cavity, excessive motor activity
s/s of CNS stimulant overdose
exaggerated responses of the drug: respiratory distress, ataxia, hyperpyrexia (temp goes to above 106.7F due to changes in hypothalamus), convulsions. stroke, MI, hypertension, tachycardia, coma, death
tx for CNS Stimulant overdose
supportive:
- benzos to prevent seizure and sedation
- cooling blanket for fever
- IV antihypertensives for tachycardia and hypertension
- supplemental oxygen
- monitor glucose levels (rapid shifts)
s/s CNS stimulant withdrawal
fatigue/lethargy/sleepiness (most common)
OR anxiety/agitation/insomnia
also
apathy, suicidal ideation, depression, cravings, and disorientation
tx for CNS stimulant withdrawal
modafinil (for excessive lethargy)
OR
Diphenhydramine or Trazadone for insomnia and agitation
antidepressants may be needed for depression, apathy, and suicidal ideation
use of modafinil
less intense stimulant that does not produce the high associated with traditional stimulants
narcolepsy or other sleep disturbances
monitor for hyperglycemia
Associated Medical Problems with Nicotine
increased risk for cancer
smoking tobacco can cause pulmonary and cardiac complications (COPD, CAD, stroke, MI)
meds for nicotine withdrawal
nicotine based:
patches, gum, lozenges, nasal sprays, inhalers
- used as substitute for smoking and is gradually tapered
no nicotine
(atypical antidepressants)
verenicline (chantix)
bupropion (zyban)
s/s of marijuana use
euphoria, detachment, relaxation, increased appetite, talkativeness, slowed perception of time, inappropriate laughter, heightened sensitivity to stimuli, anxiety and paranoia
Associated Medical Problems with Marijuana
osteoporosis, respiratory problems, impaired immune system, gynecomastia (increased breast gland tissue), cannabinoid hyperemesis syndrome, increased risk for heart attack and testicular cancer
Psychoactive Drugs- “club drugs” examples; feeling; how do they work
ecstasy, GHB, rohypnol
-produce a euphoric feeling
- increased serotonin and norepi
Psychoactive Drugs-
“dissociative drugs” examples; feeling
ketamine, salvia, pcp
-dissociative feeling
s/s of ecstasy use
hyperthermia, heart failure, kidney failure, hypertensive crisis, serotonin syndrome, and hyponatremia, dehydration, sleep disorders, depression, anxiety
why are rohypnol and ghb used?
sexual assault due to rapid disinhibition and alteration in voluntary muscle control; lasting anterograde amnesia and is easily mixed with drinks
s/s of dissociate drugs
acute psychosis, aggression, volatile mood swings, bizarre behavior, violence
pcp: makes you impervious to pain and can cause belligerence
s/s of ecstasy overdose
seizures, hypertensive crisis, serotonin syndrome
s/s of GBH and rohypnol overdose
cheyne-stokes respirations (abnormal breathing pattern; fast and shallow, slow and deep, apea), seizures, low body temp
s/s of pcp overdose
stroke, psychosis, hypertensive crisis, hyperthermia, seizures
s/s of ketamine and salvia overdose
amnesia, respiratory failure, hypertension
tx for psychoactive drug overdose; pcp overdose tx
no antidote
can use:
- activated charcoal to prevent further absorption
- treat symptomatically
- quiet environment
pcp
- haldol or benzos
- acidify urine to facilitate excretion of pcp
s/s of psychoactive drug withdrawal; ecstasy, GHB and rohypnol
ecstasy: cravings that last for weeks, profound depression, confusion, anxiety, sleep problems
GHB and rohypnol: tremors, sweating, anxiety and muscle pain
tx of psychoactive drug withdrawal
no specific tx- offer symptomatic support
what are anabolic-androgenic steroids; what do they include; how do they work?
often used in sports to enhance athletic performance
synthetic derivatives related to male sex hormones, testosterone (androgens)
include: DHEA, THG, and Androstenedione
function in a similar way to testosterone by binding with special receptor sites on muscle and tissue to promote protein synthesis in skeletal muscle (anabolic effects) and the development of male sexual characteristics (adrenergic effects)
Associated Medical Problems of Anabolic-Androgenic Steroids; general; male specific; female specific
liver damage, renal failure, elevated cholesterol levels, MI, endocrine dysfunction, depression, stunted growth, paranoia, jealousy, delusions, and violent mood swings
males: infertility, increased risk of prostate cancer, growth of facial hair, breast development
female: male pattern baldness, changes in menstrual cycle, growth of facial hair and deepening of the voice
examples of hallucinogens; feelings produced
LSD, Psilocybin (magic mushrooms) and mescaline (petoye)
dreamlike state of unreality and hallucinations
dissociative sx of salvia
depersonalization, sense of unreality, loss of bodily awareness
s/s of hallucinogen intoxication
pupil dilation, diaphoresis, tremors, incoordination, paranoia, synesthesia (colors are heard and sounds are seen), distorted sense of space and time, hallucinations, delusions of grandeur
s/s of hallucinogen overdose
psychosis, permanent brain damage, death
tx for hallucinogen overdose
low stimuli environment, stay with patient and offer reassurance, speak slowly and softly, give benzos for extreme anxiety or tension
Classes of inhalants
volatile solvents (paint thinner, glue, gasoline)
gases (butane, propane, nitrous oxide)
nitrates (isobutyl, isoamyl)
aerosols (spray paint, etc.)
s/s of inhalant use
slurred speech, lack of inhibition, euphoria, dizziness, drunkenness, sometimes violent behavior
associated medical problems with inhalants
loss of sense of smell, hearing loss, tachycardia, neurotoxic symptoms, nose bleeds, lung, live and kidney problems, muscle wasting and reduced muscle tone, accidental suffocation, cardiac dysrhythmias
two main parts of the assessment of a patient with an addictive disorder
- history of substance abuse:
hx of sobriety, triggers, toxicology screen
2.standardized screenings
types of standardized screenings for clients with an addictive disorder
CAGE (alcohol and/or drug use)
B-DAST (brief drug abuse screening test)
AUDIT (alcohol use disorders identification test)
questions asked during CAGE screening; results
C: cut down
A: annoyed
G: guilty
E: eye opener
- have you ever felt like you should cut down on your drinking or drug problem?
- have people ever annoyed you by criticizing you about your drinking or drug use?
- have you ever felt bad or guilty about your drinking or drug use?
- have you ever had a drink or use a drug the first thing in the morning to steady your nerves or get rid of a hangover? (eye opener)
results: positive responses are given one point and a score of two or more is clinically significant
underreporting
individual doesn’t report full amount of substance abuse
minimizing
individuals belief that the pattern of use is not problematic when compared to others
potential triggers to relapse
people who remind them of using
places that remind them of using
thoughts that lead to use
examples of physical, emotional and mental cues that often precede relapse
physical: stopping counseling/meetings, hanging out with old friends/going old places where substance abuse took place
emotional: increases in anxiety, depression, mood swings, feelings of restlessness and boredom, poor eating and sleeping
mental: glamorizing past drug use, keeping secrets or lying, thinking about using
what is the Recovery Model?
established to define recovery as a process of change through which an individual improves their health and wellness, lives a self-directed life, and strives to reach their full potential
four dimensions of past substance abuse
- health- overcoming or managing ones disease
- home- having a safe and stable place to live
- purpose- conducting meaningful activities
- community- having relationships and social networks that provide support
12 step programs are based on what principles and concepts
individuals with addictive disorders are powerless over their addiction and their lives are unmanageable
although individuals with addictive disorders are not responsible for their disease, they are responsible for their recovery
individuals can no longer blame people, places, and things for their addiction- they must face their problems and their feelings
