Substance Use & Addictive Disorders (329 E2) Flashcards
substance addiction
a chronic medical condition w/ roots in environment, neurotransmission, genetics & life experiences -> a strong craving of substance & person has desire to cut down w/o success
what is the biggest barrier towards treatment of addiction
stigma
countertransference
unconscious feelings that the healthcare worker has toward the pt
-occurs when the provider unconsciously displaces feelings r/t significant figures in the providers past
-impairs therapeutic relationship
provider needs to examine their own attitudes before treating a person w/ SUD
risk factors for addiction
Biologic: genetic predisposition, inc extracellular dopamine, immature brain dev., function of acetate, having another mental health disorder, being male
neurobio: neurotransmitters associated w/ substance use disorder (dec dopamine)
environment: chronic stressors, anxiety, abuse or trauma, etc
starting alc, nicotine or other drug use at an early age
increased extracellular dopamine in brain leads to
excess of dopamine causing the person to feel high
substances like cocaine, amphetamines, heroin & alc increase extracellular dopamine
front vs back of brain
back: emotion, memory, impulse, psychomotor activity
front: area of executive function, planning, problem solving, judgment, impulse control, organization
if given oxy before front is developed, will develop memory that the drug made me feel good and I don’t have the judgement to not use drugs
alcohol craving & acetate
alcohol breaks down into acetate -> acetate triggers a craving for more acetate -> in normal person acetate moves through system quickly and exits but a person w/ addiction processes alcohol at 1/3 to 1/10 the rate of a normal pancreas and liver -> the slow metabolism from 1 drink causes the acetate to barley be processed out and it makes the body crave more -> loss of control
reasons for continued used (of alc?)
-alcohol craving
-repeated use leads to tolerance & w/draw via fundamental changes in neurotransmitters and decreased D2 receptors and decreased dopamine release
results in compulsive behavior, dec inhibitory control, impulsivity, and impaired regulation of intentional action
what metabolizes down into acetate
alcohol and nicotine
substance intoxication
recent overuse/excessive use of a substance, such as an acute alcohol intoxication, that results in a reversible substance specific syndrome
-judgement is impaired
-CNS changes occur
sx are drug specific
tolerance
occurs when a person no longer responds to the drug or substance in the way that the person initially responded
blackouts
not the same as passing out, caused excessive consumption of alcohol followed by episodes of amnesia. during these periods of time, a person actively engages in behaviors, can perform complicated tasks and appears normal
relapse
the recurrence of alcohol - or drug - dependent behavior in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detox
dual diagnosis
co occurring mental illness and substance use or addictive disorder
substance withdrawal
a set of physiological symptoms that occur when a person stops using a substance
-differ and are specific to each substance
-can be mild to life threatening
-the more intense sx a person has, the more likely the person to start using the substance again to avoid the sx
estimated timing of symptom appearance followign alc intake
6-12: insomnia, tremulousness, mild anxiety, GI upset, headache
12-24: alcoholic hallucinosis, visual, auditory or tactile hallucinations
24-48: w/draw seizures (gen tonic clonic)
48-72: alcohol w/draw delirium, hallucination, disorientation, tachycardia, htn, low grade fever, agitation, diaphoresis
peaks at 48hrs, use CIWA assessment q4
people can die from alc & benzo w/draw
CIWA symptoms of sedative hypnotic / alc withdrawal that need to be asked about
-N/v
-tremors
-anxiety
-agitation
-paroxysmal sweats
-orientation
-headache
-tactile disturbance
-auditory disturbance
-visual disturbance
goal for alc w/draw mgt
to control agitation, decrease the risk of seizures and decrease morbidity and mortality
what drugs can be given for alc w/draw if pt scores 8+ on the CIWA
-chlordiaxepoxide
-diazepam
-lorazepam
what vitamin needs to be given daily during alc w/draw
thiamine -> critical to give and should be given prior to IV dextrose support to prevent precipitation of Wernicke’s syndrome
delirium tremens (DTS)
-most severe form of alc w/draw
-a medical emergency that can result in the death that occurs anytime in the first 72 hours after cessation of heavy drinking
-serious physical illness such as hepatitis or pancreatitis may increase the likelihood of alcohol w/draw delirium
-it is rare to see this syndrome in individuals in good physical health
DTS sx
agitation, inc anxiety, gross confusion & disorientation, coarse tremors, seizures, delusions, hallucinations, paranoia, autonomic hyperactivity (tachycardia, diaphoresis, fever, anxiety, insomnia & htn)
danger of misdiagnosis as psychiatric disorder
best ways to treat DTS
prevent
2) medicate / sedate adequately
3) monitor
4) listen & respond to the pt’s report of sx
5) treat comps
6) give thiamine and other nutrients
-draw labs, hydrate, vitals, meds & life support as needed
DTS medications for treatment
- phenytoin or phenobarbital (for seizures)
-oral diazepam (relief of acute agitation, tremors, impending or acute dts & hallucinosis)
-IV lorazepam (once delirium appears, severe sx)
-haloperidol
-clonidine (elevated BP)
-fluids
sx to assess for opioid w/draw (using COWS)
-resting pulse rate
-sweating
-restlessness
-pupil size
-bone or joint aches
-running nose or tearing
-GI upset
-tremor
-yawning
-anxiety or irritability
-gooseflesh skin
meds for opioid w/draw: N/v
-ondasetron
-promethazine orally or rectal suppository
must see vomiting before giving
meds for opioid w/draw: anxiety, lacrimation, rhinorrhea
-hydroxyzine
-avoid benzodiazepines
meds for opioid w/draw: insomnia
trazodone
meds for opioid w/draw: aches & pain
-acetaminophen
-NSAIDs
meds for opioid w/draw: diarrhea
-kaopectate
-avoid loperamide bc sedation effect
medication assisted treatment
a combination of medication, counseling and behavioral therapies are effective in the treatment of substance use disorders and can help some people to sustain recovery
medications used in medication assisted treatment
naltrexone: blocks the effects of opioids & alc in the body -> helps to reduce cravings & prevents relapse (does not tx w/draw sx)
-cannot use opioids for 10-14 days prior to start of med bc it will make them sick
disulfiram: prevents the breakdown of acetaldehyde -> provides negative affect from drinking (does not reduce alc cravings)
-will make you sick if you drink on it or come into contact w/ anything containing alcohol
clonidine: used to reduce pt’s BP and HR
acamprosate: helps reduce alcohol cravings
medications used to reduce cravings and controls w/draws sx for opioid abuse
methadone: reduces highs & lows of opioids while diminishing w/draw sx -> no ceiling effect, monitor closely
-still an opioid that pt can become addicted to (start and stop slowly)
buprenorphine & naloxone: reduces mortality of opioid use disorder by 50%, helps to relieve cravings and w/draw sx
buprenorphine: reduces craving and w/draw sx and helps prevent relapse -> ceiling effect, limits overdose potential
-replacement of drug they are craving
naloxone kits
can be sent home w/ patients at risk for overdose
psychological treatment for opioid use disorders
-individual therapy
-behavioral therapy
-CBT
-family therapy
-social skills training
-support groups
wernicke - korsakoff syndrome
-neurological disorder caused by lack of thiamine (B1)
-2 stages: wernicke encphalopathy & korsakoff syndrome (the more chronic, long lasting stage)
-develops most often in people w/ alc use and malnut (chronic alc use can dec intestinal absorption of thiamine by 70%)
wernicke’s encephalopathy sx
-confusion
-loss of muscle coordination (ataxia), affecting posture and balance
-vision changes / abnormal eye movements / double vision / eyelid drooping
wernkicke’s encephalopathy
-acute and reversible condition
-may clear up within a few wks or progress into korsakoff’s
-tx: thiamine replacement IV & improve nutritional status
Korsakoff Syndrome
-chronic & debilitating, not reveresible
-sx same as wern. + memory impairments, problems forming and recalling mems, confabulation, hallucinations, repetitious speech and actions, problems w/ decision making
-tx: thiamine for 3 to 5 months
CAGE
-felt you should CUT down
-ANNOYED you with criticism
-felt GUILTY
-had EYE-OPENER drink
goal of SBIRT (screening, brief intervention, and referral to treatment)
reduce and prevent related health consequences, disease, accidents and injuries, reduces costs and healthcare utilization
AUDIT
the alcohol use disorder indentification test
T-ACE
tolerance, annoyance, cut down, eye opener
hazardous
pattern increases risk for adverse consequences
harmful
negative consequences have already occurred
OARS
opened ended questions
affirmation
reflective listening
summarizing
