Quiz #3: Substance Disorders Flashcards
Substance abuse
Continued use despite related problems
Substance Dependence
severe condition; a disease - usually physical problems and serious disruptions in the person’s work, family, and social life
Addiction
psychosocial behaviors related to substance dependence
Dual Diagnosis
co-existence of substance abuse and one or more psychiatric disorders in the same person
Withdrawal Symptoms
result from biological need that develops when body becomes adapted to having the drug in the system
tolerance
with continued use, more of the substance is needed to produce same effect
Substances that lead to use disorders
- Alcohol
- Caffeine
- Cannabis
- Hallucinogens
- Inhalant
- Opioid
- Sedative: hypnotic
- Stimulant
- Tobacco
Predisposing Factors/Stressors/Risk Factors for Substance Abuse
- Factors: Familial, psychological, sociocultural
- Stressors: Withdrawal, neurobiology
- Risk Factors: Chronic stress, history of trauma, mood disorder, domestic violence, poverty.
Assessment/Screening for Substance Abuse
- Assesses a patient for substance use problems using standardized tools
- Performed in all health care settings
Tools for Assessing Substance Abuse
- AUDIT-C: 3-item screening tool to identify individuals who are hazardous drinkers
- D-BAST: quickest drug abuse screening tool
- SBIRT: improve early identification of ppl who are overusing, abusing, or dependent on alcohol or other substances
Testing for Substance use
- Breathalyzer: simplest biological measure to obtain BAC
- Blood and urine screening; hair test
CAGE Screening Questions
1) Have you ever felt you should Cut down on your drinking?
2) Have people Annoyed you by criticizing your drinking?
3) Have you ever felt bad or Guilty about your drinking?
4) Have you ever had a drink first thing in the morning to steady your nerves or get risk of the hangover (Eye-opener)?
Alcohol Withdrawal Medications
- Long-acting benzodiazepines are drug of choice (Valium, Ativan)
- Barbituates (also a depressant) also used for withdrawal (Phenobarbital)
- Administration of thiamine is recommended to prevent Wernicke disease
Treatment/Assessment for Alcoholism
- Symptom-triggered dosing regimen preferred over fixed-schedule dosing
- Use a clinically valid withdrawal tool, such as CIWA-AR
Medications for Alcohol Abstinence
- Naltrexone (ReVia): diminishes cravings
- Disulfiram (Antabuse): gives patients who drink alcohol symptoms typical of a hangover (dissuades them from using)
- Acamprosate (Campral): decreases cravings
- Citalopram (Celexa): Decrease desire and sense of liking alcohol
Other Substances: K2-Spice
- Synthetic marijuana
- Contains dried, shredded plant material and chemical additives that are responsible for their psychoactive effects.
Bath Salts
- Designer Drugs - SLE under the disguise of bath salts (purple wave, zoom, cloud nine)
- Banned in July 2012
Inhalants
- Gasoline, paint, paint thinner, nail polish remover, degreaser, dry-cleaning fluid, cement sealer
- Aerosols - spray pain, hair spray, vegetable oil sprays
- Nitrites - mainly to enhance sexual experiences
- Steroids
Early Withdrawal Symptoms
- Anxiety
- Psychomotor agitation
- Tremors
- Diaphoresis
- Restlessness
- N/V
- Increased HR, BP and temperature
- Impaired concentration and memory
- Increased sensitivity to light and sound
- Insomnia
- Headache
Severe Symptoms of Withdrawal include
- Seizures
- Hallucinosis: Auditory, visual, tactile hallucinations (may describe as nightmares or livid dreams) NOT disoriented
- Delusions (usually paranoid type)
What is the onset of early withdrawal symptoms and how long does it last?
- Onset: 6-24 hours; peaks 24-36 hours
- Usually lasts hours to days
- Can last 2 weeks
What is the onset of seizures caused by withdrawals and how long does it last?
- Onset: 8-24 hours; peak 24 hours
- Occurs singly or in a burst of several over 1-6 hours.
What is the onset of hallucinosis caused by withdrawals and how long does it last?
- Onset: ~48 hours
- Usually lasts up to 1 day
- Can last 2 weeks
What is the onset of severe withdrawal symptoms and how long does it last?
- Onset 3-5 days
- Lasts 2-3 days
- Confusion can last up to 50 days
