Substance Abuse Flashcards
Dependency
can be physical or psychological
Physical dependency
refers to the development of a withdrawal syndrome following the abrupt cessation of a drug; is accompanied by tolerance to a substance where increasing dosage is required to sustain the same effects from the drug.
Hallmarks of the diagnostic criterion for substance use disorder
* Two or more of these need to occur over a 12-month period to be considered a substance use disorder.
- Tolerance (need to use more to get same effect).
- Repeated attempts to cut down, control use, or quit
- A significant amount of time spent obtaining and using the drug.
- Cravings
- Continued use despite adverse effects (physical and psychological problems)
- Use interferes with responsibilities at home or work.
- A withdrawal syndrome, or use of a related substance to avoid withdrawal.
Addiction
characterized by the psychological dependence and preoccupation with obtaining or using a substance, loss of control over the use of a substance, and continued use despite adverse consequences.
Patients with mood disorders and anxiety disorders are _________ to have substance abuse problems
Patients with mood disorders and anxiety disorders are twice as likely to have substance abuse problems
List some Drugs of Abuse
- Alcohol
- Cannabis and weed
- Stimulants – amphetamines dextroamphetamines, cocaine, methylphenidates –oral, nasal, IV use
- Prescription drugs
- Sedatives and hypnotics –barbiturates, benzodiazepines
- Opioids – opium, morphine, oxycodone - pain relief
- Nicotine – associated with cancer, heart disease, stroke
- Caffeine – can affect physical health in older adults
- Other substances of abuse – inhalants, steroids, laxatives
CAGE Questionnaire
alcohol related, but some have replaced the word “alcohol” with “drugs” – 4 Questions
1) Have you ever felt you should CUT down on your drinking?
2) Have people ever ANNOUED you by criticizing your drinking
3) Have you felt bad/GUILTY about your dinking
4) Have you ever had an EYE opener drink first think in the morning to steady your nerves?
A complete comprehensive assessment is important. Patient history and medical record contribute to the picture – often overlooked….
Screening and Assessment Tools
- ASSIST screening tool – Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
- CIWA- Assessment of Alcohol Withdrawal (Clinical Institute Withdrawal Assessment of Alcohol Scale)
- CAGE Questionnaire (cut down, annoyed, guility, eye open)
The majority of alcohol abuse is
a) early onset
b) late
The majority of alcohol abuse is early onset as opposed to late onset which occurs after 60 years of age
Top 2 risk factors for Late Onset Alcohol Abuse
Number 1 risk factor is loneliness and isolation
Number 2 factor is chronic pain
Other risk factors for Late Onset Alcohol Abuse
Loss: retiring, deaths, death of a spouse
Geographical and emotional separation from family and friends
Reactive depression
Combined use of OTC drugs, prescriptions and alcohol
Concerns with…financial and health problems
Reduced ability of the aging body to handle alcohol
Remember –older adults have more leisure time, more disposable income, a more positive attitude about alcohol, and higher consumption rates.
How does alcohol effect each system?
Gastrointestinal
Cardiac
Neurological (completion time
Renal and pharmacokinetics
Musculoskeletal
Hematological
Immune
System changes (aging plus alcohol):
Gastrointestinal (gastritis, pancreatitis, cirrhosis)
Cardiac (decreased myocardial contractility, cardiac reserve)
Neurological (exacerbate age related changes of slowed reaction time, memory loss, slowed task completion time
Renal and pharmacokinetics
Musculoskeletal - decreased bone density, muscle atrophy, gout
Hematological (anemia)
Immune (increased infection and decreased lymphocytes ad WBC)
Elderly people have a ______ recovery rate from alcohol abuse
Elderly people have a 75% recovery rate from alcohol abuse
Treating Addiction
Pharmacological agents are best used in conjunction with an overall program of counselling support, self-help groups, and medical monitoring.
Alcohol detoxification
- riskier for older adults
- minor withdrawal 6-12 hours
- major withdrawal symptoms 10-72hrs
– vomiting, diaphoresis, hallucinations, seizures.
–Delirium tremens may occur 24-72hrs up to 10 days after last drink. - Even if older adults drink a moderate amount, but they drink every day, they are high risk for severe withdrawal symptoms (need medical oversight to withdraw
