Chapter 22 Substance-related and Addictive Disorders Flashcards
ADDICTION/Substance Abuse
Define
“Primary, chronic disease of brain reward, motivation, memory and related circuitry.”
“Chronic medical condition with roots in the environment, neurotransmission, genetics and life experiences.”
American Society of Addiction Medicine
A disease of dysregulation in the hedonic or reward pathway of the brain.
ALCOHOL?
Most common abuser
Men
Young people
Whites
Single
ALCOHOL?
What % of US population consumes regularly
2/3
ANTAGONISTIC EFFECTS OF DRUGS
When drugs are taken together and the effect of one is inhibited or weakened
IE cocaine with heroin (speedball)
CNS depressant Heroin softens the withdrawal from cocaine
Narcan (Naloxone) give to OD opiates reverses respiratory and CNS depression
Behavioral Addictions
Do they have clear identifiable intoxication or withdrawal symptoms?
Is Tolerance an ISSUE?
Behavioral addictions NO clear intox or withdrawal symptoms
Tolerance NOT an issue
Behavioral Addictions
How are they assessed?
Patterns of behavior and consequences
Co-occurring disorders. COMORBITIY
Two or more disorders occurring in the same person at the same time with potential interactions and exacerbation of symptoms. Can be SUD or Psychiatric Disorders from DSM-5
Codependence
Cluster of behaviors
client id’s self-worth in terms of caring for others to the exclusion of their own needs
nursing attracts people who are codependent (care for people’s fundamental needs)
COMMORBIDITY
ETOH affects _____
Liver, esophageal varies gastritis CA Whole body nutrition ecteric edema from cirrhosis/ascites
COMORBITITY
name two types
Psychiatric 6/10 that have SUD also affected by mental health d/0
Medical (most common ETOH)
COMORBITIY
Having more than two disorders at the same time.
Drug Schedules
I - high potential for abuse, no acceptable medical use (heroin, LSD)
II - high potential for abuse, dangerous, by RX only, methadone, meperidine (demerol) and methylphenidate (ritalin)
III - low to moderate potential for abuse, by RX only, testosterone, acetaminophen/Codeine/Tylenol with codeine, buprenorphine (Suboxone)
IV - low-risk for abuse, by RX only, alprazolam (Xanax), lorazepam (ativan), propoxyphene/acetaminophen (darvocet)
V - contain limited amount of narcotics for treatment of diarrhea, coughing, and pain. atropine/diphenoxylate (lomotil), guaifenesin and codeine (robitussin AC), and pregabalin (Lyrica), available over the counter.
Substance abuse + Substance disorder =
Substance Use Disorder (SUD). DSM-5
FLASHBACKS
Transitory recurrences of perceptual disturbance caused by a person’s earlier hallucinogenic drug use when they are in a drug free state.
Examples visual time expansions loss of ego boundaries intense emotions mild/pleasant to frightening images or thoughts.
Fragmented Care Began To Change in 20__
2001
with federal initiative to address mental health and SUD treatment systems
-cross training of mental health professionals
-integrated screenings
-early intervention
Fragmented Care Began To Change in 20__
2001
with federal initiative to address mental health and SUD treatment systems
-cross training of mental health professionals
-integrated screenings
-early intervention
INTOXICATION
INTOXICATION
when person using a substance to excess.
-under the influence, intoxicated or high
“STATE OF EXPERIENCING ACUTE EFFECTS OF A SUBSTANCE” -NG
may be different terms -alcohol - drunk. Weed -high, stoned
ADDICTIONS IN USA
what is the most common
ALCOHOL
TOLERANCE
with RX meds
Considered abuse for addiction?
what drugs?
No Antidepressants beta-blockers Analgesics anti-anxiety meds
Substance Use Disorders (SUD’s) are represented by three actions-
CRAVING
SEEKING
USING (regardless of consequences)
Substance Use Disorder
Pathological use of a substance that leads to a disorder of use, intoxication, and often withdrawal if the substance is taken away.
Can be swallowed, injected, rectal, IV, smoke, skin pop, or inhaled.
From caffeine to LSD
SUD - continuous can do what to the brain structure?
Actual change to the Brain structure and to
the function of the limbic (reward and pleasure) system
Mood disorder and self medicated - SUD
Drugs and then mood disorders - SUD
SUD
How long to have brain chemistry revert back with some drugs?
Up to 5 years.
SYNERGISTIC EFFECT of DRUGS
When drugs are taken together, the effect of either or both is intensified or prolonged
IE ETOH with BZO’s
TOLERANCE
SUD experience TOLERANCE to effects of the substance.
They need a higher dose to achieve the same response as initially.
Or the same amount over time is decreased effect
Tolerance
What drug increases tolerance RAPIDLY?
Cocaine
What % of adults in USA during the year will abuse alcohol?
What % will be alcohol dependent>
5% Abuse
4% Dependent
What question do you ask a SUD
What do they use?
How do they use it? This is important. Withdrawal need to know.
What amount?
When did they last use?
TOLERANCE
What drug is a slow tolerance?
prescription pain meds
WITHDRAWAL
Physiological and or psychological symptoms when substance is stopped.
Blood and tissue concentrations decrease after heavy and prolonged use of substance.
Specific to the drug, can be mild or life-threatening.
the more intense the symptoms, more likely to use again
Withdrawal to behavioral addictions
symptoms
cravings sleep disruption anxiety depression ie gambling
Alcohol
Most common drug of abuse in USA
Greatest danger for withdrawal - Seizures Deliriums fatality
NEED to find out when they last drank and how much?
ANTABUSE (Disulfiram)
Used with motivated patients to remain sober. Take daily. Only w patient consent.
RX if have any alcohol Handsanitizer
CNS Stimulants
signs
Pupils dilated oronasal cavity - dry HR - tachycardia N and V insomnia excessive motor activity Cardiac problems prev - ER
Cocaine and crack
how long does it last?
4-6 seconds will feel it
lasts 5-7 minutes
OPIATES
list
Morphine Heroin Codeine Fentanyl Methadone Meperidine (Demerol HCL)
