Substance Abuse Flashcards
Use
When one drinks, swallows, smokes, sniffs, inhales or injects a mind altering substance
Abuse
Use of alcohol or drugs for the purpose of intoxication, or, in the case of prescription drugs, for purposes beyond their intended use
Addiction
An irresistible psychological and/or physiological need to continue the substance use or behavior despite the harm it causes
Physical Dependence
Physiological requirement for the substance by the brain, as evidence by development of tolerance and withdrawal when use decreases or stops
Craving
An urgent desire for a substance or behavior to which one is addicted, often in response to triggers, that is very difficult to resist
Tolerance
patient need more of the substance to have the same affect
Cross tolerance
substances that are pharmacologically interchangeable in terms of how the body responds ( Ex: alcohol and most benzodiazepines )
- can use this to treat dependence
Withdrawal
state characterized by adverse physical and psychological symptoms occurring when one ceases using a substance to which the brain is acclimated
Trigger
Anything which cues or prompts a response ex. seeing a bar may trigger a craving for alcohol
Detoxification
Safely withdrawing a person from an addictive substance, usually under medical supervision ( uses cross tolerance and gradually decreasing amounts )
Relapse
The recurrence of alcohol - or drug - dependent behavior in an individual after detoxication
Chemical Hook Theory
Once the brain has been exposed to the substance –> “the brain has to have it”
Alexander experiment
Conclusion, if we have what we need, we will not self medicate with drugs
Impaired response inhibition and salience attribution (iRSA)
With increasing exposure to rewarding activities/substances, the brain starts to focus more on the exposure to activities/substances
- the brain becomes less and less able to control one’s response to cue ( ex: seeking cocaine after seeing white powder- the white powder is the cue)
Alcohol
- CNS Depressant and euphoria
- measure by blood alcohol level
- prenatal use= Fetal alcohol syndrome
Alcohol abuse ( > 1 of the following in a year)
- Recurrent use and hazardous situation’s.
-Recurrent alcohol – related legal problems. - Recurrent use and failure to meet role obligations. - Continue use despite social or interpersonal problems.
Alcohol Dependence ( > 3 of the following in a year)
- Tolerance.
- Withdrawal. Increase time spent in alcohol related activities.
- Important activities given up or reduced.
- Drinking more or longer than desired. Persistent desire or unsuccessful efforts to cut down on alcohol use.
- Continue use despite knowledge of self harm.
Biological response to Alcohol
- Increase GABA activity = causes relaxation and sedation
- Acute CNS, depression, and euphoria
- Long term: physical tolerance independence
- Wernicke’s Encephalopathy
- Korsakoff’s Syndrome
- Wernicke - Korasakoff Syndrome
What is Wernicke’s Encephalopathy
- Alcohol causes gastric irritation, reduce absorption of B vitamins, interferes with conversion of thiamine into thiamine pyrophosphate (bioactive form of thiamine)
- Characterized By: acute onset of ocular motor dysfunction (eyes are misaligned) ataxia (impaired coordination), ptosis (drooping eye) and confusion (may have any or all of the symptoms.)
- REQUIRES EMERGENCY TREATMENT = IV THIAMINE TO PREVENT PERMANENT DAMAGE
what is Korsakoff’s Syndrome
- Gradual onset of retrograde and anterograde amnesia w/sparing of intellectual function and some aspects of memory
- Characteristic features: Apathy (lack of emotion), or increased talkativeness; confabulation ( created fictional stories about past events or present situation )
Alcohol withdrawal ( when does it happen? S/SX?, Alcohol withdrawal syndrome)
- Alcohol withdrawal can begin as soon as two hours after the last drink or dosage of last cross tolerance med
- Early symptoms: tremors, diaphoresis, rapid pulse, elevated blood pressure and headache
- Treatment of early sx
- may feed pt
- B-complex IM: multivitamis
- Best treatment: prevention
ALCOHOL WITHDRAWAL SYNDROME
- early sx above worsen
- hallucination
- grand mal seizures
- changes in cognition
Severe Alcohol Withdrawal : DELIRIUM TREMENS
MEDICAL EMERGENCY
- ANS instability: tachycardia, HTN, pyrexia ( fever)
-MENTAL STATUS CHANGE: disorientation, reduced awareness of environment, delusions hallucinations, marked tremors agitation, and diaphoresis
- Onset: 3-5 days after last drink
- TREATMENT
1. Replace thiamine, niacin, folate and magnesium – all IV
2. Replace electrolytes- all IV
3. Glycogen (D5W) - IV
4. BENZODIAZEPINES - Sedative, increases GABA (used as cross tolerance)
5. BACLOFEN- muscle relaxant, GABA agonist, REDUCES RELAPSE
6. Antipsychotic
Treatment for Alcohol Dependence
THE MEDS ARE USED TO REDUCE CRAVING AND OR REWARD FROM DRINKING
- NALTREXONE- bind to opioid receptors to block euphoric effectes of alcohol
- ACAMPROSATE- increases GABA ( used after detox )
- CITALOPRAM- SSRI
- ODANSTERONE- serotonin antagonist
- BACLOFEN- muscle relaxant, reduces craving, withdrawal
- GABAPENTIN- reduces relapse and amount of EtOH used.
- Assure adequate nutrition and supplemental vitamins ( vitamin B and thiamine )
- Omega 3 may limit neuro damage
Cocaine
- CNS stimulant that produces a euphoric rush of mental alertness and energy feelings of self-confidence,
- Last for 10–20 minutes high followed by intense let down
- Biological effects of cocaine= Paranoia, hallucinations tachycardia, hypertension, dilated pupils in increase temperature.
Intoxication ( Cocaine )
CNS stimulant followed by depression,
-Increasing doses: restlessness –> tremors and agitation –> convulsions –> CNS depression
Withdrawal ( cocaine )
- Norepinephrine depletion causes a person to sleep for 12–18 hours.
Then sleep disturbances with rebound REM lethargy, decreased libido, depression, suicidality, anhedonia, poor concentration and cocaine craving
Toxicity ( Cocaine )
- Mydriasis ( pupils are enlarged), encephalopathy, seizures, decreased responsiveness, hypertension, rapid, and possible, irregular pulse, hyperpyrexia ( very high fever > 41.5 C ) , respiratory and cardiovascular failure.
Meds for cocaine addiction
- METHYLPHENIDATE (ritalin)= may aid i self control and reduce craving ( but is abusable )
- GABAPENTIN (Neurotin)= may reduce tension, cravings
- VIGABATRIN (Sabril)= increases GABA and reduces cravings
- BACLOFEN (Gablofen, Lioresal)= reduces cravings
- N-ACETYLCYSTEINE (NAC)= seems to improve glutamate levels and reduce cravings
- NOCAINE= (experimental) mimics the effects of cocaine but at a weaker level but also blocks the effects of cocaine itself
Amphetamines
- blocks of norepinephrine and dopamine, not as strong effect on serotonin as cocaine has
-Affects the peripheral nervous system
Treatment for Tobacco Addiction
- Is especially important in severe mental illness due to higher rates of smoking greater inhalation in
- Nicotine replacement via e-cigarettes
- BUPROPION (wellbutrin) = reduces cravings and weight gain associated with smoking cessation
- VARENICLINE= block nicotine receptors
Caffeine
- Stimulates cerebral cortex increases mental acuity.
- 300 mg can cause tremors, poor motor performance, and insomnia.
-POTENTIALLY FATAL
Benzodiazepines
- Causes CNS depression
- Decreases the duration of REM Sleep
- Withdrawal sx may begin as long as 8 days after last taken
Withdawal sx
- rebound anxiety and autonomic ( syncope, brain fog, N/V , etc. ), sensory excitement, motor excitement, cognitive excitation
Withdrawal tx = tapering
Molly
Crystalline form of MDMA
- can cause severe dehydration and hyperthermia
MDMA (ecstacy)
Can cause potential hyponatremia and hyperpyrexia
GHB (rupies)
- CNS depressant
- “date rape drug”
- Coma and seizures
Opiate withdrawal sx
HYPEREXCITABILITY
- Autonomic: diarrhea, rhinorrhea, N/V, bradycardia
- CNS: sleeplessness, restlessness, agitation,
-Pain: adb cramping, bone pain, backache, and muscle aching
- Intense craving, erythema
Meds use for Opiate Addiction
- LAAM ( L-alpha acetyl methadol )- every other day
- METHADONE- taken daily
1 & 2.) OPIOID AGONIST- intent is to replace other more disruptive and addictive opioids with meds that reduce craving
3. NALOXONE (narcan)
4. BUPRENORPHINE- ceiling action: blocks further effects of opioids when present in higher in amounts ( partial agonist/ antagonist)
5. BUPRENORPHINE/NALOXONE= naloxone blocks effect in med is crushed or ingested at higher doses in attempt to produce euphoria
6. NALMEFENE= blocks the effects of opioids
Codependency ( signs)
staying in a abusive / unrewarding relationship, focusing on changing the other person while neglecting oneself
