Chapter 19 Addiction Flashcards
Substance Abuse
Use of alcohol or drugs for intoxication or beyond intended use
Substance Tolerance
Decrease in the action of a drug at a given dose or concentration
What problems fall under substance abuse versus substance dependencs?
Substance Abuse: Denotes problems in social, vocational, or legal areas of the person’s life
Substance Tolerance: Also includes problems associated with addiction such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance
Dependence
Psychological or physiological dependence on a drug
Substance Use Disorder
Continued use or reward-seeking behavior despite significant adverse consequences
Substance Induced Disorder
Intoxication
Withdrawal
Substance-induced mental disorder
Polysubstance Abuse
Abuse of more than one substance
What is the key symptom of addiction?
Inability to control addictive behavior
What drugs fall under the CNS depressants category?
Alcohol
Sedatives/hypnotics/anxiolytics
Antidepressants
What drugs fall under the CNS stimulants category?
Cocaine
Crack
Amphetamines
Caffeine
Methamphetamine
Nicotine
What drugs fall under the hallucinogens category?
LSD
Peyote
Psilocybin
Ecstasy: MDMA (3,4-Methylenedioxymethamphetamine)
What drugs fall under the dissociative anesthetics category?
PCP (Phencyclidine)
Ketamine (Usually used for pain in clinical practice)
What drugs fall under the narcotic analgesics (AKA opiods)?
Opium
Codeine
Heroin
Demerol (Meperidine)
Darvon (Dextropropxyphene)
Morphine
Methadone
Vicodin (Acetaminophen, Hydrocodone)
Oxycodone
What drugs fall under the inhalants category?
Wide variety of breathable substances that produce mind-altering effects
What drugs fall under the cannabis category?
Cannabis
Cannabinoids
Biologic Risk Factors for Substance Misuse
Genetics: Children of alcoholic parents are at higher risk for developing alcoholism and drug dependence than are children of nonalcoholic parents
- Increased risk is partly the result of environmental factors, but evidence points to the importance of genetic factors as well
- Adoption studies have shown higher rates of alcoholism in sons of biologic fathers with alcoholism than in those of nonalcoholic biologic fathers
->These studies led theorists to describe the genetic component of alcoholism as a genetic vulnerability that is then influenced by various social and environmental factors
Brain’s Reward Center Theory: Addictive substances or behaviors affect the brain’s reward system by flooding the nucleus accumbens with dopamine
- Repeated exposure causes nerve cells in the nucleus accumbens and prefrontal cortex to couple liking something with wanting it
- This motivates someone to seek the pleasure source
Psychosocial Risk Factors for Substance Misuse
Chronic stressors
PTSD
Mood disorders
Anxiety disorders
Abuse
Neglect
Poverty
Lack of parental involvement
Experimentation
Poor academic performance
Home environment that promotes substance abuse
Availability of drugs at school
Poor social skills
Use of drugs to self-medicate if mental or physical illness is present
Designer Drugs
AKA Club Drugs
Synthetic substances made by altering existing medications or formulating new ones not yet controlled by the FDA
- Amphetamine-like effects, some also have hallucinogenic effects
As attempts to make such drugs illegal are formulated, makers of the drugs alter the substance slightly so it once again falls outside the law.
They may also contain unknown compounds as a filler or additive, and the effects are unknown until the drug is ingested.
Some of these substances are known by generic terms such as bath salts or plant food, although the substances are never used for those purposes.
- Others have specific names, such as ecstasy (methylenedioxymethamphetamine), special K (Ketamine), or smiles (2C-1)
Intoxication
Use of a substance that results in maladaptive behavior
Withdrawal Syndrome
Refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases
What two drugs (categories) can cause death from withdrawal syndrome?
Alcohol & Benzodiazepines
Detoxification
The process of safely withdrawing from a substance
What are the initial effects of alcohol intoxication?
Relaxation & loss of inhibitions
Some people become aggressive or display inappropriate sexual behavior when intoxicated
Signs & Symptoms of Alcohol Intoxication
Slurred speech
Memory Impairment
Altered judgement
Decreased motor skills/ unsteady gait
Decreased LOC (stupor, coma)
RESPIRATORY ARREST
Peripheral collapse
Death (w/large doses)
May experience a blackout
Early Onset of Alcohol Misuse
Prognosis: Unclear, only people with alcohol problems seeking treatment have been studied
In the United States, the average age for an initial alcohol intoxication episode is during adolescent years
- The 1st episode of intoxication between 12–14 years of age
- The 1st evidence of minor alcohol-related problems is seen in the late teens
Episodes of “sipping” alcohol may occur at age 8 years or even earlier
“Middle” Clinical Course of Alcohol Use
A pattern of more severe difficulties for people with alcoholism begins to emerge in the mid-20s to the mid-30s
These difficulties can be:
- The alcohol-related breakup of a significant relationship
- An arrest for public intoxication or driving while intoxicated
- Evidence of alcohol withdrawal
- Early alcohol-related health problems, or significant interference w/ functioning at work or school
During this time, the person experiences their 1st blackout
As the person continues to drink, they often develop a tolerance for alcohol
After continued heavy drinking, the person experiences a tolerance break
Blackout
An episode during which the person continues to function but has no conscious awareness of their behavior at the time or any later memory of the behavior
Tolerance Break
Very small amounts of a substance will produce intoxication
Later Course of Alcohol Misuse
The later course of alcoholism, when the person’s functioning is definitely affected, is often characterized by periods of abstinence or temporarily controlled drinking
Abstinence may occur after some legal, social, or interpersonal crisis, and the person may then set up rules about drinking, such as drinking only at certain times or drinking only beer
This period of temporarily controlled drinking soon leads to an escalation of alcohol intake, more problems, and a subsequent crisis
The cycle repeats continuously
Signs & Symptoms of an Alcohol Overdose
Vomiting
Unconsciousness
Respiratory depression
Alcohol-induced hypotension: Can lead to CV shock & death
Combo of symptoms can cause aspiration pneumonia or pulmonary obstruction
Treatment of Alcohol Overdose
Gastric lavage or dialysis to remove the drug and support of respiratory and cardiovascular functioning in an intensive care unit.
The administration of CNS stimulants is contraindicated
What is the relapse range rate?
Range from 60% to 80%, with nearly half of individuals relapsing in the year after treatment
A minority of people remain sober after the first treatment experience
The highest rates for successful recovery are for people who:
- Abstain from substances
- Highly motivated to have a substance-free lifestyle
- Who actively work on relapse prevention
Spontaneous Remission
Natural recovery that occurs without treatment of any kind
Wernicke’s Encephalopathy
Degenerative brain disorder related to vitamin B1 deficiency
Acute & reversible
Signs & Symptoms of Wernicke’s-Korsakoff Syndrome
Abnormal eye movement
Confusion
Confabulation
Hallucinations
Double vision
Memory loss
Inability to form new memories
Loss of muscle coordination
Treatment for Wernicke’s Syndrome
Large doses of thiamine IV 2-3 X daily for 1-2 weeks
May progress into Korsakoff’s syndrome if untreated
Korsakoff Syndrome
CHRONIC!!!
Memory disorder resulting from vitamin B1 deficiency
Treatment: Thiamine for 3-12 months
Recovery rate is 20%
Alcohol Withdrawal
Classic Signs: Tremulousness
Mild to Moderate Withdrawal: Agitation, N/V, insomnia, impaired cognition
- Temp, pulse, & BP increase
Severe Withdrawal: MEDICAL EMERGENCY!!!
- Psychosis which can lead to unconsciousness, seizure (grand-mal = deadly), & delirium
- Alcohol w/drawal delirium or DT’s (Delirium Tremens) (Usually see bugs crawling around)
If the client’s withdrawal symptoms are mild & they can abstain from alcohol…
…they can be treated safely at home (pg. 360)
If the client’s withdrawal symptoms are severe or they cannot abstain during detoxification…
…short admission of 3-5 days is the more common setting
Treatment for Alcohol Withdrawal
Treat w/ benzodiazepine PO or IM
When does alcohol withdrawal start?
Between 3 hrs- 3 days after last drink
Why is it important to obtain the client’s VS before each dose of benzodiazepine for alcohol withdrawal?
To watch for the response to treatment & signs of impending respiratory distress
Pay close attention to the patient’s respirations!!!
Tapering
Administering decreasing doses of a medication, leading to discontinuation of the drug
Symptom-Triggered Dosing
The presence and severity of withdrawal symptoms determine the amount of medication needed & the frequency of admin
Alcohol Assessment Tools: CAGE
Have you ever…
Attempted to CUT back on your alcohol?
Been ANNOYED by comments made about your drinking?
Feel GUILTY about your drinking?
Had an EYE-OPENER in the morning to calm your nerves?
Alcohol Assessment Tools: CIWA-Ar
More often used versus CAGE assessment tool
10-item scale to assess and manage alcohol withdrawal
- Sum indicates severity of withdrawal
Mild ≤ 15
Moderate = 16-20
Severe > 20
Score ranges prompt protocol decisions
- e.g., administration of benzodiazepines
Which two types of CNS depressants are the most frequently abused?
Benzodiazepines & barbiturates
Sedatives, Hypnotics, and Anxiolytics Intoxication Signs & Symptoms
Slurred speech
Lack of coordination
Unsteady gait
Labile mood
Impaired attention & memory
Stupor & coma
Disorientation
N/V
Treatment for Benzodiazepine Toxicity
IV flumazenil
Signs & Symptoms of Sedative, Hypnotic, & Anxiolytic Withdrawal
Anxiety
Insomnia
Diaphoresis, HTN
Possible psychotic reactions
Hand tremors
N/V
Hallucinations/ illusions
Psychomotor agitation, possible seizures
Psychological Signs & Symptoms of Stimulant Intoxication
Develops rapidly!
High or euphoric feeling
Hyperactivity, hypervigilance, talkativeness
Anxiety
Grandiosity
Hallucinations
Stereotypic or repetitive behavior
Anger, fighting, and impaired judgment
Physiological Signs & Symptoms of Stimulant Intoxication
Tachycardia
Elevated BP
Dilated pupils
Perspiration or chills
Nausea
Chest pain
Confusion
Cardiac dysrhythmias
Stimulant Withdrawal Signs & Symptoms
Occurs w/in a few hours to several days after cessation of the drug and is NOT life-threatening
Marked dysphoria is the primary symptom and is accompanied by:
- Fatigue
- Vivid and unpleasant dreams
- Insomnia or hypersomnia,
- Increased appetite
- Psychomotor retardation or agitation
Marked withdrawal symptoms are referred to as “crashing”
- Person may experience depressive symptoms, including suicidal ideation, for several days
Nicotine Intoxication
Highly toxic
Acute toxicity only in children or when exposure is to nicotine in pesticides
Contains other harmful highly toxic chemicals w/ long-term effects
Long-term Effects of Nicotine
Cardiovascular disease (HTN, stroke)
Respiratory disease (emphysema, lung cancer)
Cancer and irritation to oral mucous membranes with smokeless tobacco (snuff)
Signs & Symptoms of Caffeine Intoxication
With ingestion of > 250 mg
Tachycardia and arrhythmias
Flushed face
Muscle twitching
Restlessness
Diuresis
GI disturbances
Anxiety
Insomnia
Signs & Symptoms of Caffeine Withdrawal
Can occur w/in 24 hrs of last consumption
Headache
N/V
Muscle pain
Irritability
Inability to focus
Drowsiness
