Substance Abuse Flashcards
Risks of alcohol use/abuse
accidents, trauma
cirrhosis, alcoholism
cancers of the mouth, esophagus, liver, breast
cardiomyopathy, HTN, arrhythmias
Binge drinking numbers
Men: 5 drinks in 2 hrs
Women: 4 drinks in 2 hrs
Risks of drinking while pregnant
-Fetal alcohol syndrome
What amount of alcohol is safe for pregnant women?
No amount of alcohol is safe for pregnant women
Pocket Guide for Alcohol Screening and Brief Intervention
Step 1 - ask about alcohol use
Step 2 - assess for use disorders
Step 3 - advise and assist
Step 4 - follow-up and continued support
Step 1 questions
-Do you sometimes consume beer, wine, beverages?
-How many times in the past year have you had 5 or 4 or more drinks/day?
On average, how many days a week do you have an alcoholic drink?
-On a typical day, how many drinks do you have?
calculate WEEKLY AVERAGE
How to calculate weekly average of drinks
day/week x drink/day
Step 2 questions
In the past year, has you drinking repeatedly caused risk of harm, relationship trouble, role failure, run-ins with the law
How do you indicate alcohol abuse in step 2?
If yes to one or more of the questions
How do you indicate alcohol dependence?
3 or more of:
- not been able to cut down/stop
- not been able to stick to drinking limits
- show tolerance (need more to have same effect)
- shown signs of withdrawal
- kept drinking despite problems
- spent a lot of time drinking
- spent less time on other matters
If the patient is not alcohol dependent or alcohol abuser, what are they?
At risk drinking
In step 3, what should you do for the at-risk drinkers?
State conclusions and recommendations
-Gauge readiness to change
What model do you use to assess readiness to change?
Transtheoretical model
What do you do if the patient is ready for change?
Help set a goal, agree on a plan, provide educational materials
What do you do if the patient is not ready for change?
Restate concerns, address barriers to change, encourage reflection, reaffirm willingness to help them
In step 3, what do you do for the alcohol-use disorders?
- State conclusions
- Negotiate a drinking goal
- Consider evaluation by an addiction specialist
- Recommend a mutual help group
- Arrange follow up
For those who are alcohol dependent, what should you consider for them?
Medication
Medically managed withdrawal (detoxification)
What do you check in step 4?
Was the patient able to meet and sustain their goal?
If YES - reinforce and support continued adherence
If NO - acknowledge that change is difficult, address coexisting problems, continue to support the patient
Uncomplicated alcohol withdrawal
Shortly after cessation, peaks at 2nd day, improves by 4th or 5th day
- coarse tremors of hands, tongue, eyelids
- anorexia, malaise
- autonomic hyperactivity (tachycardia, sweating, elevated BP)
- headache, hallucinations, insomnia, anxiety, irritability
Withdrawal delirium
Delirium Tremens - occurs within a week of cessation
- coarse irregular tremors
- marked autonomic hyperactivity
- vivid hallucinations and elusions, agitated behavior
- fever
CIWA scale for Alcohol rates what on a range from 0-7?
Rate nausea, vomit, tremors, anxiety, paroxysmal sweats, tactile disturbances, auditory disturbances, visual disturbances, headache from 0-7
CIWA scale for Alcohol rates what on a range of 0-4?
Orientation and clouding of sensorium
What is the max score for the CIWA scale?
67
At what score is the patient at a severe withdrawal?
Over 20
At what score is the patient at mild withdrawal?
Less than 15
What sort of abuse often occurs in conjunction with other substance use and abuse?
Tobacco abuse
Smoking history questions
Current or past? How many packs/day? How many years? Calculate pack years When did you quit smoking?
What is the most commonly used drug/abused
Marijuana
Subjective questions for drug abuse
- which of the following substances have you used in your life time?
- in the past 3 months, how often have you used this substance? How often do you have a strong desire to use it? How often has your use led to health, legal, social, or financial problems? How often have you failed to do what was normally expected from you?
- has a friend or relative or anyone else ever expressed concern about your use?
- have you ever tried and failed to control, cutdown, or stop using?
What scale is used to assess drug withdrawal?
COWS
In COWS, what do you rate on a scale of 0-4?
Resting pulse, sweating, bone/join ache, runny nose, tremors, yawning, anxiety, irritability
In COWS, what do you rate on a scale of 0-5?
Restlessness, pupil size, GI upset, gooseflesh skin
Max COWS score
48
Mild withdrawal COWS score
less than 5 -12
Moderate withdrawal COWS score
13-24
Moderately severe withdrawal COWS score
25-36
Severe withdrawal COWS score
greater than 36
the 4 A’s of recommendations for drug abuse
Assist - provide medical advice
Assess - determine readiness to change
Assist - offer help based on level of readiness
Arrange - refer for speciality assessment and or drug treatment as necessary
