Substance Use and Harm Reduction Flashcards
Continuum of Substance Use
Beneficial: positive health, spiritual and social impact
i.e. medicinal or spiritual use
Non-problematic: recreational, casual or other use that has negligible health or social effects
Problematic: use at an early age, begins to have negative health impacts
i.e. use by minors, impaired driving, binge consumption
SUD/Addiction: habitual and compulsive despite negative health and social effects
Addiction
- a primary, chronic disease of brain reward, motivation, memory and related circuitry
- dysfunction in these circuits lead to characteristic biological, psychological, social and spiritual manifestations
- pathologically pursuing reward and/or relief
Substance Use Disorder
problematic pattern of a substance use leading to clinically significant impairment or distress, occurring within a 12-month period
- large amounts, long periods
- persistent desire, unable to control use
- ++ time spent
- craving
- failure to fulfil major role obligations
- continued use despite social/interpersonal problems
- tolerance
- withdrawal
- important activities given up or reduced
- physically hazardous
Spectrum of Severity for SUD
Mild = 2-3 symptoms Moderate = 4-5 symptoms Severe = 6+ symptoms
Concurrent Disorder
refers to co-occurring addiction and mental health problems
- may be active at the same time or at different times, in present or in the past
- symptoms may vary in intensity and form over time
i.e. alcohol and depression, cannabis and schizophrenia
Why is it so difficult to stop using?
- activation of areas of the brain responsible for feelings of reward, motivation and reinforcement
- increase dopamine in the brain
- disruption of dopamine levels has effect on decision-making, mood and behaviour
- neural and behavioural impairment
Dependence Liability
substance tends to be more addictive according to dependence liability
- an intense, pleasurable effect, fast onset
- short half-life, need to keep using to maintain pleasure and delay withdrawal
Tx tends to have slow onset and long half life
Intoxication
a state in which the level of consciousness, cognition, perception, judgement, affect or behaviour or other functions and responses are changed after administration of a psychoactive substance
Tolerance
the need for an increased amount of the drug to achieve the desired effect, or reduction of the drug’s effectiveness over time
Withdrawal
an unmasking of the body’s adaptation to the drug’s presence, apparent when the drug is abruptly removed
Dependence
need for the drug in order to feel and function “normally”
physical and/or psychological
Principles of Harm Reduction
accepts that some people may not by ready to choose abstinence and works to minimize its harmful effects
low barrier access to healthcare
accepts that people who are substance-dependent have a voice in the creation or programs and policies that serve them
values patient autonomy
Depressants
slows physiological functions, depresses the CNS
- slows heart rate
- slows breathing
- lowers blood pressure
- decreases body temperature
Manifestations:
- sedation
- disinhibition
- motor incoordination
- slurred speech
- confusion
- disorientation
- impaired judgement
- irritability
Alcohol Use Disorder
medical term for alcohol addiction
can be mild to severe
a. problem-drinking: does not fit criteria for alcohol use disorder, but at risk for accidents and problems
b. moderate: no more than 1 (women) or 2 (men) drinks per day
c. heavy: more than 7 (women) or 14 (men) drinks per week
d. binge: more than 4 (women) or 5 (men) drinks per occasion
CAGE
4-item, non-confrontational questionnaire used to screen and detect AUD
- takes less than a minute to administer
C: do you feel the need to CUT down on your drinking?
A: do you feel ANNOYED by others complaining about your drinking?
G: do you ever feel GUILTY about your drinking
E: do you ever drink an EYE-OPENER in the morning to relieve the shakes?
Score: two “yes” for men, one “yes” for women
Alcohol Use Assessment
- number of drinks
- maximum amount consumed on any day in the past month
- how many bottles and what size per week
- previous week’s drinking pattern
- other drug use
- hospitalization or medication
- risk: driving, childcare, violence, med interaction
Effects of Alcohol
Brain: tremors, peripheral neuropathy, seizures
Cancer: ++ risk, throat, mouth, esophageal, breast
Cardiac: cardiomyopathy, arrhythmias, stroke, elevated BP
Liver: fatty liver, alcoholic hepatitis, cirrhosis, fibrosis
Stomach: bloating, gas, ulcers
Pancreas: pancreatitis
Immune system: weakening, ++ susceptibility to infection/illness
Alcohol Withdrawal
- withdrawal begins 6-24 hours after the last drink
- ranges in severity
- severe alcohol withdrawal can be lethal: seizures, delirium tremens (DTs)
6 standard drinks per day for more than 2 weeks»_space; risk for dependence
