Psychoactive Substance Use and Addictive Disorders Flashcards
What is a synergistic effect?
When drugs are taken together, effect of either or both is intensified or prolonged
What is a antagonist effect?
When drugs are taken together, effect of one is inhibited or weakened
What is the combination of a psychiatric comorbidity and substance use disorder called?
A concurrent disorder or dual diagnosis
What are medical co-morbidities of substance abuse?
- Wernicke’s (alcoholic) encephalopathy: an acute and reversible condition
- Korsakoff’s syndrome: a chronic condition with a recovery rate of only about 20%
- Fetal Alcohol Spectrum Disorder
- Chronic ETOH use = esophagitis, gastritis, pancreatitis, alcoholic hepatitis and cirrhosis of the liver
- Cancer, accidents, suicide and homicide
- Route of drug administration influences co-morbidities
- Those who use intravenous drugs have a higher incidence of infections
- Hepatitis
- Human immunodeficiency virus (HIV)
- Cellulitis
- Sclerosing of veins
What is the etiology of substance abuse disorder?
Characterized by use, misuse, and physical and psychological dependence, and also by certain behaviours:
- Loss of control of substance consumption
- Continued substance use despite associated problems
- Cravings and a tendency to relapse after efforts to change behaviour
Alcoholism - CAGE assessment
C – Cutting Down
A – Annoyance by Criticism
G – Guilty Feeling
E – Eye-openers
What are the assessment guidelines for acute chemical impairment?
- Assess for severe or major withdrawal syndrome.
- Assess for a drug poisoning that warrants immediate medical attention.
- Assess the patient for suicidal thoughts or other self-harming behaviours.
- Evaluate the patient for any physical complications related to drug use
- Explore the patient’s interest in doing something about their drug problem.
- Assess the patient’s and family’s knowledge of community resources for addiction treatment.
What are the eight steps of motivational interviewing?
- Establishing rapport
- Setting the agenda
- Assessing readiness for change
- Sharpening focus
- Identifying ambivalence
- Eliciting self-motivating statements
- Handling resistance
- Shifting focus and transition
What are important considerations for the treatment of substance use disorders?
- The social determinants of health
- Cultural background
- Trauma
- Involvement of family and other support persons in tx
- Recovery
S/S of an alcohol OD
Excessive intake in short time period
- Vomiting
- Loss of consciousness
- Respiratory depression
- Pneumonia
- Hypotension
- CV shock
- Death
Alcohol withdrawal
- Occurs after reduction or cessation of prolonged heavy drinking
- Symptoms of withdrawal begin 4-12 hours after reduction or cessation of alcohol and peak 1-2 days later and typically resolves in 5-7 days (might be longer)
- Early S/S include: hand tremors, sweating, irritability, elevated pulse (>120 beats/min), insomnia, anxiety, N&V
- If untreated – Delirium Tremens – most serious form of withdrawal. DT’s may occur within 2-4 days (up to 7 days) after last drink
- DT S/S: agitation, confusion, hallucinations, delusions, fever, seizures, can be fatal if untreated.
What are S/S of delirium tremens?
- Agitation
- Confusion
- Hallucinations
- Delusions
- Fever
- Seizures
- Can be fatal if untreated
What medication(s) are given during alcohol detoxification?
- Thiamine (PO) is given (thiamine deficiency develops after long period of drinking and associated with poor nutrition)
- Injections for high risk - Wernicke-Korsakoff Syndrome - Benzodiazepines are given
- Typically diazepam (Valium)
What is the caffeine intoxication criteria?
- Recent Consumption
- Five or more of following symptoms:
- Restlessness
- Nervousness
- Excitement
- Insomnia
- Flushed Face
- Diuresis
- GI Disturbance
- Muscle Twitching
- Rambling
- Tachycardia or Cardiac Arrhythmia
- Periods of inexhaustibility
- Psychomotor agitation
What is the caffeine withdrawal criteria?
- Prolonged daily Use of Caffeine
- Abrupt cessation followed by 3 or more of the following:
- Headache
- Marked fatigue or drowsiness
- Dysphoric Mood
- Depressed Mood
- Irritability
- Difficulty Concentrating
- Flu like Symptoms
What are the most commonly abused narcotics?
- Morphine, codeine, heroin, fentanyl, methadone, demerol
Induces euphoria, well-being and analgesia
What are intoxication effects of narcotics?
- Apathy
- Lethargy
- Impaired judgment
- Constricted pupils
- Drowsiness
- Slurred speech
- Drowsiness
What are S/S of opioid OD?
- Respiratory depression (sleep apnea)
- Clammy skin
- Coma
- Death (heroin=staggering gait)
Narcan is the medication used stat (antidote for opioid OD). May precipitate withdrawal
Opiate withdrawal symptoms: stage 1
- Craving for drug
- Lacrimation (Tearing)
- Rhinorrhea (Runny nose)
- Yawning
- Diaphoresis (Sweating)
- Dysphoria
- Cramps
Opiate withdrawal symptoms: stage 2
- Mild sleep disturbances
- Dilated pupils
- Loss of appetite
- Piloerection
- Irritability
- Tremor
Opiate withdrawal symptoms: stage 3
- Severe insomnia
- Violent yawning
- Weakness
- Nausea, vomiting, diarrhea
- Chills, fever
- Muscle spasms – lower extremities
- Flushing
- Spontaneous ejaculation
- Abdominal pain
What are pharmacological interventions for the tx of opioid addiction
- Methadone (Dolophine)**
- Synthetic opiate blocks cravings - Suboxone (combo of 2 meds) -Buprenorphine and Naloxone
- Very high affinity for opiate receptors; so can “bump” other opiates off the receptors
- Added to discourage injection - Clonidine (Catapres)
- Effective somatic treatment when combined with naltrexone - Indomycin, Baclofen
- For muscle pain - Trazadone, Seroquel, Atarax (anxiety, runny nose)
- For sleep
What is harm reduction?
Harm reduction is a collection of strategies that are aimed at reducing the negative consequences of an act. It focuses on the behaviour, not the person.
What are the six guiding principles of harm reduction?
- First, do no harm
- Focus on the harms caused by the activity, rather than the activity itself
- Maximize intervention options
- Choose appropriate outcome goals, giving priority to effective programs with practical, realizable goals
- Give priority to new and innovative programming
- Respect the rights of the person you are treating
What are the main components of harm reduction?
- Address and accept the client where he or she is
- Focus on reducing the harm caused by the substance use, not on the use of substance, but may be included
- Client is able to select goals that range from abstinence to safer use
- Treatment is based on the rights of the individuals to make choices
- Health care professionals need to be skilled in therapeutic approaches and the biopsychosocial determinants of addictions
- Based on the ‘do no harm’ concept of medical practice
- Priority of goals depends on the immediate needs of the client
- Methods are based on research in self-efficacy and change
- Clients do not need to be substance free to be in treatment
- Harm reduction is neutral with respect to abstinence; all depends on the goals of the client
- No moral judgments are made regarding the substance use: the benefits of substance use are taken into consideration as a means to understand the use of these substances
- Treatment can be combined with existing treatment strategies and may be most effective in this matter
Opioid substitution therapy
Methadone
- Oral, and liquid form (can be supervised easily)
- Lasts 24 hours, (eliminates peaks)
- Side effects decrease (tolerance)
- Therapeutic dose: withdrawal syndrome management
- Protects against overdose
Suboxone
1) BUPRENORPHINE (BUP)
- Partial mu agonist with ceiling effect
- Very high affinity for opiate receptors so can “bump” other opiates off the receptors
2) NALOXONE (NARCAN)
- mu antagonist with no effect when taken sublingually
- Added to discourage injection
