Alcohol Substance Abuse Flashcards
The repeated use of a drug or subs, with or without physical dependence.
Dependence
What indicates an altered physiologic state c/b repeated adm of drug, the cessation of which results in a specific syndrome (e.g. delirium tremens, alc withdraw symptoms)?
Physical dependence
When you suddenly stop, there’ll be certain consequences
Dependence
Use of any drug, usually by self-administration, in a manner that deviates from approved social or medical patterns
Abuse
Similar to abuse, but usually applies to drugs prescribed by physicians that aren’t used properly
Misuse
Example of misuse
Benzodiazepines- keep asking for prescription bcs it makes them feel relaxed
The repeated and increased use of a substance, the deprivation of which gives rise to symptoms of distress and irresistible urge to use agent again and leads to physical and mental deterioration
Addiction
Brain dse
Addiction
Reversible syndrome c/b a specific substance (e.g. alcohol) that affects 1 or more of the following mental fxns: memory, orientation, mood, judgement, behavioral, social and occupational fxninh
Intoxication
Substitute: same physiological and psychological effect
Cross-tolerance (or cross-dependence)
e.g. diazepam, barbiturates
Co-dependence
Enabler
Highest subs of abuse in the PH?
Methamphetamine
Defense against anxious impulses
Relieve tension
Psychodynamic factors
Disturbed ego fxn (inability deal w reality)
Some px use drugs as an escape d/t inability to deal w reality
Psychodynamic factors
Biological aspects
Genetic factors
Biological aspects also
Receptor and receptor systems
- with the exception of alcohol, researchers have identified particular NT or NT receptors involved w most substance abuse
Neurochemiczl factors
NT
Opioid
Cathecolamine (dopamine)
GABA
Dopaminergic neurons in the VTA (part of rewards system of the brain)
○ Projects to the cortical and limbic regions (nucleus accumbens)
○ Pathways is involved in the sensation of rewards
(Amphetamine and cocaine)
largest group of adrenergic neurons-
mediates opiates and opioids
Locus ceruleus
Target of abused drugs
Brain’s pleasure center
What increases in response to natural rewards like food?
Dopamine
When this is taken, dopamine increase are exaggerated and communication is altered.
Cocaine
Mesolimbic system
Mesolimbic tract
Nigrostriatal tract
Mesocortical tract
Tuberoinfundibular tract
Plays a key role in learning and motivation
Mesolimbic system
Activated by all psychoactive substances
Mesolimbic system
Substance use disorder
Maladaptive pattern of substance use leading to clinically significant impairment or distress.
2 or more occurring within a 12-month period:
- Can’t fulfill major role obligations
- Physically hazardous (driving)
- Despite having persistent or recurrent social or interpersonal problems caused or exacerbated by effects of subs
- Tolerance
- Withdrawal
- Larger amounts or over a longer period than was intended
- There’s persistent desire or unsuccessful efforts to cut down or ctrl subs use
- Great time wasted to get, use, and recover from its effects
- Give up important social, occupational, recreational activities
- Continue despite knowledge of having a persistent and recurrent physical or psychological prob
- Crave
A general description of substance withdrawal requires the following criteria to be met:
○ The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged)
○ The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
○ The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
Drinkers male to female ratio
1.3:1
What is the most common co-ingestant in drug overdoses?
Alcohol
In and out of prison, prob with the law
Antisocial personality disorder
What is the most common mood disorder associated with alcohol use?
Depression
Bipolar px go through
Mania and depression
It is used to relieve anxiety and lower inhibitions
Alcohol
Mechanism of Alcohol Abuse
Activates gamma-aminobutyric acid (GABA), dopamine, and serotonin receptors in the central nervous system (CNS)
What is a relaxant because it inhibits the firing of neurons?
GABA
The rewarding feeling of drinking alcohol is the result of
Dopamine and serotonin
Mechanism of Alcohol Abuse
Inhibits glutamate receptor activity and voltage-gated calcium channels
Cause of the See-Saw Effect
GABA receptors- inhibitory
Glutamate receptors- excitatory
Potent CNS depressant
Alcohol
● Recall when you first drank alcohol, what prompted you to continue to drink after that initial drink?
○ It depends on social factors such as being with friends
○ Religious Factors ○ Genetics
■ If most family members are drinking, it is much easier to continue drinking
■ Not all become dependent on alcohol
● Reduce tension and stress, but in high doses can incur the
opposite
● There is an increased feeling of “power”
○ You feel that you can do anything because of your lowered inhibitions
○ You become more outgoing and talkative when you consume alcohol when you are typically quiet
● The increased feeling of power and the decreased effects of psychological pain are difficult to evaluate definitively
Psychological theories
- “unconscious”
- not think of or aware but it still affects u
- encompasses large portion of stress when compared w conscious
- help w self-punitive/self-harm behavior
- perfectionist, self super ego
- high moral std
- those easily feel guilt
Alcohol decreases unconscious stress lvls
- stress but unaware thus alcohol
Fixation of the oral stage of development
- freudian hypothesis, fixated
- relieve frustration, subs are taken in by mouth
Psychodynamic theories
● schizophrenia ●
Why do you continue to drink after the first experience with alcohol despite having problems while drinking? Expectations about rewarding effects
○ You know that the good feeling will happen again, so you continue to drink
There’s the cognitive attitude towards the responsibility for one’s behavior. You believe that you can control the drinking and that you can stop yourself at any time Subsequent reinforcement after alcohol intake. It will lower inhibitions, you become more sociable.
Behavioral theories
● Cultural attitudes towards drinking, drunkenness, and personal responsibility for consequences are important contributors to the rates of alcohol related problems in a society.
○ The environment is also part of biopsychosocial.
Sociocultural theories
● It has been proven in research that even twins that are raised from different families and become dependent
● Even within the family, the grandfather who is a drinker, then the father, the son and so on.
● There is the genetic theory but also confounding to that is also what is being observed within the family, especially if living in the same house.
Genetic theories
Peak blood concentration of alcohol is reached in
30 to 90 minutes and usually in 45 to 60 minutes (depends on with/without food)
○ It depends on whether or not you have eaten
○ If you have eaten, it will lower the absorption; if on empty stomach, much is absorbed.
○ Most patients do not eat well during drinking because the focus now is on the alcohol, they don’t crave for
food
Rapid drinking
Reduce time to peak conc
Slow drinking
Increase time to peak conc
Why do you experience nausea and vomiting when drinking?
Pylerospasm
Absorption of alcohol is most rapid w beverages containing
15-30% alcohol (30-60 proof)
When alcohol in stomach becomes
too high, mucus is secreted and the pyloric valve closes
90% of alcohol absorbed is metabolized thru oxidation in the
Liver
The remaining 10% is excreted unchanged by the
Kidneys and lungs
Body can metabolize
15 mg/dL per hour, with, a range of 10 to 34 mg/dL per hour
In persons w hx of excessive alc consumption,
upregulation of the necessary enzymes results in rapid alcohol metabolism
catalyzes the conversion of alcohol into acetoaldehyde (toxic compound)
Alcohol dehydrogenase (ADH)
catalyzes the conversion of acetyldehvde into acetic acid is inhibited by disulferam (Antabuse)
Aldehyde dehydrogenase
Alcohol biochemistry
● About 10% of consumed alcohol is absorbed from the
no single molecular target has been identified as the mediator for the effects of alcohol
● Specifically, studies have found that alcohol ion channel activities associated with the nicotinic acetylcholine, serotonin 5- hydroxytryptamine3 (5-HT3), and GABA type A (GABAa) receptors are enhanced by alcohol
● whereas ion channel activities associated with glutamate receptors and voltage-gated calcium channels are inhibited
Blood alcohol levels
○ 0.05% - thought, judgment and restraint are loosened and sometimes disrupted
○ 0.1% - voluntary motor actions usually become perceptibly clumsy
○ 0.2% - the function of the entire motor area of the brain is measurably depressed, and the parts of the brain that control emotional behavior are affected
○ 0.3% - a person is commonly confused of may become stuporous
○ 0.4% to 0.5% - the person falls into coma
○ At higher levels, the primitive centers of the brain that
control breathing and heart rate are affected, and death ensues secondary to direct respiratory depression or the aspiration of vomitus
Alcohol sleep effects
● Alcohol consumed in the evening usually increases the ease of falling asleep (decreased sleep latency)
● Alcohol also has adverse effects on sleep architecture
● Specifically, alcohol use is associated with a decrease in
REM or dream sleep and deep sleep (stage 4) and more sleep fragmentation with more and longer episodes of awakening.
● Therefore, the idea that drinking alcohol helps persons fall asleep is a myth
GI system physiological effects of alcohol
● Long-term heavy drinking:
○ Esophagitis
○ Gastritis
○ Achlorhydria
○ Gastric ulcers
● Heavy alcohol abuse
○ Esophageal varices (rupture is a medical emergency)
○ Disorders of the small intestine
○ Pancreatitis, pancreatic insufficiency and pancreatic
CA
○ Interfere with normal processes of food digestion and
absorption
● Alcohol abuse also appears to inhibit the intestine’s
capacity to absorb nutrients, such as vitamins and amino acids . (vitamin deficiencies - B vitamins)
Physiological effects of alcohol on other bodily systems
● Increased blood pressure
● Dysregulation of lipo-protein and triglyceride metabolism
● Increased risk for myocardial infarction and
cerebrovascular disease
● Alcohol has been shown to affect the hearts of nonalcoholic
persons by increasing the cardiac output, heart rate and
myocardial oxygen consumption
● Evidence indicates that alcohol intake can adversely affect
the hematopoietic system, the incidence of cancer, particularly head, neck, esophageal, stomach, hepatic, colon and lung cancer
● Acute intoxication may also be associated with hypoglycemia
● Muscle weakness is another side effect of alcoholism
● Raises the blood concentration of estradiol in women. The increase in estradiol correlates with the blood alcohol level
CAGE qs
○ Cutdown - Have you ever felt you needed to Cut down on your drinking
○ Annoyed - Have people Annoyed you by criticizing your drinking
○ Guilty - Have you ever felt Guilty about drinking
○ Eye-opener - Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your
nerves
● Late onset
● Few childhood risk factors
○ Like in children diagnosed with ADHD or Conduct disorder which is a spectrum towards the Antisocial personality disorder
● Relatively mild dependence
● Few alcohol-related problems
Type A subtypes of alcohol dependence
● Many childhood risk factors
● Strong family history of alcohol abuse
● Frequent polysubstance abuse
● Long history of alcohol treatments
● Lots of severe life stressors
Type B
BAL
some signs: >100
obvious signs: >150mg/dL
Level and likely impairment
20-30: slowed motor and decreased thinking
30-80: increases motor and cogni probs
80-200: inc in incoordination and judgement errors; mood lability; deteriorated cogni
200-300: nystagmus, marked slurring of speech, and blackouts
>300: impaired vital signs and possible death
Alcohol withdrawal
A. Cessation or redxn alc use that’s been heavy and prolonged
B. 2 or more, dev within several hrs or a few days after criterion A
1. Autonomic hyperactivity
2. Inc hand tremor
3. Insomnia
4. Nausea and vom
5. Transient visual, tactile, or auditory hallucinations or illusion
6. Psychomotor agitation
7. Anxiety
8. Generalized tonic-clonic seizures
Alcohol withdrawal facts
If untreated, will progress to psychosis
This will develop within 6-24 hours
This is a life threatening condition
More alarming if there is generalized tonic-clonic seizure but this is temporary
No need to refer to psychiatry, you can treat alcohol withdrawal with Benzodiazepine
○ Even if the patient does not have withdrawal symptoms, you can give Benzodiazepines to prevent this from happening
EtOH withdrawal symptoms usually begin in
6-24 hrs and lasts 2-7 days
Alc withdrawal symptoms
Mild: irritability, tremors, insomnia
Mid: diaphoresis, hpn, tchy, fever, disorientation
Sever: tonic-clonic sei, DTs, hallu
● Most severe form of withdrawal syndrome
● MEDICAL EMERGENCY
● Untreated delirium tremens – mortality rate of 20%
● Prevention
○ Chlordiazepoxide
○ Antipsychotic medications
■ If the patient is already psychotic
● When you detox a patient, it should be in a hospital setting
○ The patient should be in a rehab center, in the detox area, hospital based
Delirium
blocks opioid receptors in the brain
New drug: Nodict 15mg
Tremulousness and mild to mod agitation
Chlordiazepoxide (oral); diazepam (oral)
Hallucinations
Lorazepam (oral)
Extreme agitation
Chlordiazepoxide (IV)
Withdrawal seizures
Diazepam (IV)
Delirium tremens
Lorazepam (IV)
