Substance abuse Flashcards
Most common substance abuse disorders
Alcohol, tobacco, cannabis,stimulant, hallucinogen, opioid
Psychoactive drug
affect emotion, mind, behavior
Substance Use/Abuse Concepts
Addiction vs substance use disorder Clinical and functional impairment Neurobiology model -binge and intoxication -withdrawal and negative effect -preoccupation and anticipation
Brainstem
controls basic functions ( hear rate, breathing)
Cerebellum
motor control
Limbic system
reward center and feelings of pleasure
hippocampus: storage and retrieval of memory
Amygdala: sensory information and emotions
Diencephalon
Hypothalamus: regulation of basic drives and autonomic nervous system
Thalamus: sensory perception and movement
Cerebral cortex
sensory, motor and association areas
frontal, parietal, occipital and temporal lobes
Synapse
electrical synapse
chemical synapse
Neurotransmitters (can reinforce effects of drugs)
dopamine, opioid peptides, GABA, Glutamate, Serotonin, Acetylcholine
Addiction
Overwhelming compulsion; repetitive drug-taking behavior despite serious health & social consequences
Substance Dependence
Overwhelming desire to take a drug, cannot stop taking drug, 2 categories (physical & psychological)
Physical Dependence
Altered physical condition caused when nervous system adapts to repeated substance use, uncomfortable symptoms result when the agent is discontinued—known as withdrawal
Psychological Dependence
No obvious physical discomfort when substance discontinued, overwhelming desire to continue substance use; may be associated with home or social environment, craving continues for months or years, craving responsible for relapse
Tolerance
Biologic condition; body adapts to repeated administration of a drug, Requires higher doses of drug to produce initial effect, Common in substances that affect nervous system, Does not indicate addiction or substance abuse
Heroin
The most addictive drug, heroin is a very dangerous substance. It is less widely used than some of the other substances, likely because it is typically taken by injection.
Ecstasy
This drug, also known as MDMA (3,4-methylenedioxy-methamphetamine), is most often associated with clubs and raves, especially because the dopamine it helps to release simulates a feeling of connection between users. It is especially risky because the pills are generally less than 30 percent pure and can contain other serious drugs.
Crystal Meth
Crystal meth is almost 3X stronger than cocaine. It provides a much longer high as well as extreme crashes that make the user want to use again.
Cocaine
This white powder is one of the most notorious illicit drugs. It causes bursts of energy and euphoria, which are very tasking on the heart and brain.
Marijuana
The leaves of the cannabis plant are by far the most popular illicit drug among teens and younger people. The THC in the plant causes sensations of relaxation and sometimes mild hallucinations.
LSD
LSD “acid” is one of the most famous drugs of the Woodstock era, becoming mainstream in the 1960s. Trips can last for several hours and include very powerful hallucinations. Made synthetically and processed into strips.
Ventral tegmental area (VTA)
Connects to basal ganglia within limbic system
Basal ganglia function involved in emotions and motivation
Drug activation for VTA
Dopamine
Reward pathway
Median forebrain
Increased levels of Dopamine
Feelings of well-being, exhilaration, and pleasure
Psychologic dependence
Physical dependence
Tolerance
Body held in depressive state (alcohol)
Decreased GABA release
More drug needed for desired effect
Withdrawal
Modulation of dopamine
Serotonin
-Regulates release of dopamine at the VTA of the brain
GABA
-Inhibitory effects on dopamine release onto dopaminergic neuron
Addiction
User-related factors
Genetics, personality, prior experience, disorders
Environmental factors
Societal and community norms, role models, peer influences, educational level
Agent or drug factors
Cost, availability, dose, mode of administration, speed of onset/termination, length of drug use
Impossible to predict accurately if person will become substance abuser
Alcohol
Leading cause of preventable death
Risk factors
Genetic, Psychologic, Environmental
Alcohol intoxication
Physical abnormalities consistent with behavioral changes
Alcohol overdose
Impairments that increase the risk of harm
Alcohol withdrawal
Onset of manifestations 24-72 hours after cessation of drinking
Life-threatening
Goal: cessation of drinking
Treatment Types:
Behavioral treatments, Medications, Mutual support groups
Alcohol Effects
Brain effects Enhances effects of inhibitory GABA Decreases effects of excitatory glutamate Increases dopamine in reward center Acts as a sedative and depressant Interrupts REM sleep Fetal alcohol spectrum disorders Physical problems Behavioral issues Learning difficulties Effects of early alcohol use Impaired growth and development Increased risk for dependency Increased risk taking Liver Failure Hypoglycemia: inhibits glycogenolysis
Alcohol abuse manifestations: Intoxication
Increased risk taking
Cognitive changes
Ataxia
Nausea/vomiting
Alcohol abuse manifestations: Overdose
Unconsciousness
Coma
Respiratory depression
Death
Alcohol abuse manifestations: Withdrawal
Mild: Insomnia, irritability, headache, nausea
Moderate: Tremors, anxiety, insomnia, nausea, confusion, sweating
Severe: Uncontrollable shaking, agitation, vomiting, sweating hallucinations, seizures, death
Alcohol: Heavy Use
Chronic malnutrition
Cancer
Hormonal changes
Brain tissue loss from alcohol toxicity
Organic brain syndrome
Wernicke-Korsakoff syndrome
Chronic alcoholism → thiamine deficiency → brain tissue ischemia & cell death
Wernicke’s: Acute confusion, ataxia, ophthalmoplegia (weakness of eye muscles)
Korsakoff’s: amnesia, psychosis, confabulation (misinterpreted memories)
Delirium tremens (DT) with very long-term consumption
Hallucinations, confusion, disorientation
Medical emergency
Withdrawal can be treated with antiseizure medications
Nursing: CIWA Scale
Clinical Institute Withdrawal Assessment
Assigns a point value for: anxiety agitation headache hallucinations N/V auditory disturbances tactile disturbances visual disturbances altered senses diaphoresis tremors
Tobacco Use (Nicotine)
Characterized by: Persistent tobacco use, Compulsive tobacco use, Physiologic dependence on tobacco Associated with poorer general health Key statistics 42 million Americans continue to smoke Vaping by middle & high school students increased by 50% Comorbidities Psychiatric conditions Decreased immunity Associated diseases/conditions COPD Cardiovascular disorders Cancers Nicotine: Highly carcinogenic (>1000 chemicals)
Tobacco (Nicotine): Effects
Activation of specific areas of brain Visual attention Arousal Motor activation Stimulation and sedation Impaired reproductive health Fertility issues Increased risk of miscarriage Health problems for the mother and baby Immediate physiological effects Tachycardia, Hypertension, Increased respiration Physical assessment Hoarse voice, Stained nails and teeth
Tobacco (Nicotine): Withdrawl
Irritability/frustration/anger Anxiety Difficulty concentrating, headache Increased appetite Restlessness, increased heart rate, increased B/P Depressed mood Insomnia
Tobacco (Nicotine): Cessation treatments
Smoking cessation aids
Nicotine replacement medication
Behavioral therapy
Bupropion (Zyban) & varenicline (Chantix) used to help quit
Cannabis
Third most commonly used drug in United States
Marijuana
Derived from hemp plant
Main psychoactive chemical: tetrahydrocannabinol (THC)
Can be smoked or mixed into foods
Total tissue elimination of a single dose = 30 days
THC: Increases dopamine release
Via binding to CB1 & CB2 receptors
Results in impaired judgment
Increases risk-taking
Cannabis intoxication
≥2 signs or symptoms within two hours of using cannabis
Cannabis withdrawal
Cessation of frequent and prolonged cannabis usage
≥3 signs and symptoms over ~1 week
Irritability & restlessness, Insomnia & tremors, Chills & weight loss
Cannabis use disorder
Significant impairment/distress in multiple areas
Development of tolerance/withdrawal over 12 months
Cannabis: Treatment
cognitive-behavioral therapy
Stimulants
Most commonly abused stimulants
Amphetamines, Methamphetamine & Cocaine
methylphenidate (Ritalin) ADHD: calms children, opposite for adults
Can be synthetic or plant-based
Can be inhaled or taken orally or intravenously
Cardiovascular consequences of cocaine
Sympathetic nervous system (SNS) effects
Effects on cardiomyocytes
Vasculature effects
Long-term consequences
Treatment:
Medications, Counseling, Inpatient, residential, outpatient treatment, Peer support, 12-step programs
Withdrawal:
Mental depression & anxiety, extreme fatigue & hunger
Amphetamines and synthetic cathiones
Cross blood-brain barrier
Rapid onset of effects when injected or inhaled
Increases synaptic activity of dopamine and norepinephrine
Pharmacologic use: narcolepsy and attention-deficit/hyperactivity disorder
Methamphetamine
Crosses blood-brain barrier
Onset of action within seconds after smoking or injecting
Increases dopamine, norepinephrine, and serotonin
Cocaine
Absorbed through mucous membranes
Onset of action within seconds up to 90 minutes
Blocks reuptake of dopamine and norepinephrine causing euphoria
Hallucinogens
All Schedule I Drugs (cannot be prescribed)
Alter sensory perception, mood, & thought patterns
Types
Psilocybin (mushrooms), Mescaline, Peyote, Lysergic acid diethylamide (LSD), Phencyclidine (PCP) , 3,4-methylenedioxy methamphetamine (MDMA, Ecstasy), Ketamine (date-rape drug)
Appear to involve interaction of:
Serotonin, Dopamine, Glutamate
Treatments
No approved medications
Behavioral therapy and counseling
Withdrawal:
Rarely observed, depends on specific drug
Flashbacks, tolerance, moderate-to-high psychological dependence with little to no physical dependence
Hallucinogen Intoxication:
Cardiovascular
Tachycardia, palpitations, hypertension/hypotension
Hallucinogen Intoxication: Neurologic
Tremors
Hyperreflexia
Hallucinogen Intoxication: Mood, cognition, emotions
Paranoia Suicidal ideation Anxiety Depression Euphoria Intensification of feelings Acute cognitive impairments Megalomania Depersonalization
Opioids
Chemical structure similar to alkaloids, Analgesics, Interact at one of three receptor main opioid receptor systems
Opioid use disorder
Chronic, relapsing illness of a pattern of opioid use, negative health consequences
Naturally occurring
Morphine & codeine
Semisynthetic
Hydromorphone, oxycodone, hydrocodone, and heroin
Synthetic
Meperidine, methadone, tramadol, and fentanyl
Various routes of administration
Potent analgesic & CNS depressive effects
Can produce euphoria, Highly addictive, Rapid progression to physiologic dependence followed by tolerance & subsequent withdrawal
Opioids cont.
Cause substantial morbidity & mortality
Overdose is a life-threatening emergency
General clinical manifestations of opioid toxicity
Decreased or unchanged vital signs, Decreased bowel sounds, Sedation or coma, Seizures, Miosis
Other signs
Track marks, Perforated nasal septum
Treatment for opioid use disorders
Medication-assisted treatment with buprenorphine or methadone
Withdrawal Symptoms: (intense but not life-threatening)
Excessive sweating, restlessness, and pinpointed pupils, Agitation, goose bumps, tremor, and violent yawning ,Increased heart rate, orthostatic hypotension, Nausea/vomiting and abdominal cramps and pain, Muscle spasms with kicking movements and weight loss
Opioid Antagonist
Therapeutic Class: Opioid antagonist Examples: naloxone(Narcan) Mechanism of Action: binds to opiate receptors (competes) Actions & Uses: Reversal of known or suspected opioid overdose, including respiratory and/or CNS depression Adverse Effects: Increased blood pressure, pain, headache, nasal effects (dryness, edema, congestion, inflammation), opioid withdrawal Interactions: Caution with cardiotoxic drugs Pregnancy Category: C
Disulfiram
Examples: disulfiram (Antabuse) Mechanism of Action: Interferes with the hepatic oxidation of acetaldehyde Actions & Uses: Management of ethanol abuse Interactions: Alcohol
