Week 9 - Important concepts Flashcards
Chronic, relapsing medication condition
Addiction
Most prevalent medical condition, cause of preventable death and contributor of excess health spending
Addiction
State of being determined, influenced, or controlled by something else; subordination to someone or something needed or greatly desired
Dependence
When a substance is required for normal physiological or psychological function
Dependence
Risk factors for addiction.
Where?
Where - doesn’t discriminate - in all societies, cultures, classes, genders
Risk factors for addiction
Who is at risk?
- Genetic factors (40-60%)
- Males
- Childhood trauma
- Learning disorders and ADD/ADHD
- Mental illness (depression, bipolar disorder, psychosis, ADH)
What are some reasons people use drugs?
Feels good, relieves boredom, acceptance and peer pressure, escape, relieve pain, etc.
What are the different addiction theories?
Neurobiologic Psychologiacl Social Spiritual Public Health
Describe the neurobiologic theories of addictoin.
Drugs activate the reward pathway (dopamine) when taken in excess
Prolonged use may alter brain structure/chemistry
Use interferes with voluntary control which persists beyond withdrawal - responsible for relapse
Psychological theories of addiction
- Addiction is considered a _______ disorder
- Occurs in a _______ _______,in which an ________ predisposed state determines the ________ that is induced
behavioural
vulnerable phenotype, in which an intrinsic predisposed state determines the neuroplasticity that is induced
Describe the social theories of addiction
All societies have the problem of addiction.
The issue is related to substance availability, legislation and health policies.
Describe a prominent group related to spiritual theories.
Spirituality is an integral component of the 12 step tradition of AA.
However, not necessarily religious, but concept of “something bigger than me”
- doesn’t absolve the person of responsibility, but can guide recovery
Spiritual theories:
- Recovery from addiction is often motivated by or achieved through ________ experiences
spiritual
Describe public health theories.
Considers interactions between host, agent, vector, environment
Host = individual
Agent = substance
Vector = supplier
Environment = cultural, political, economic contexts
Tries to explain the prevalence and existence of substance use
SUD
- New in the DSM-V is the aspect of ________
- Based on the pathological patterns of ___ behaviours
- Mild - ?
- Moderate - ?
Severe - ?
- Level of severity may fluctuate over _____
culture 11 Mild - 2-3 Moderate - 4-5 Severe - 6+ Level of severity may fluctuate with time
There are 4 categories of behaviour related to SUD. What are they?
Impaired control over use
Social impairment
Risky use
Pharmacologic
This isn’t addiction yet, but an earlier intervention can be started.
Impaired control of use
What are different signs of impaired control of use?
Taking larger doses than prescribed Excess amounts of illicit substances Longer duration than recommended Failed attempts at cessatoin Cravings
Telling feature of an impending SUD
Cravings
Social impairment:
- Failure to cope at these locations
- Continued use despite ______/__________ problems as a direct result
- Avoiding/ceasing important _______ activities
home, work, school
social/interpersonal
social
Continued use in hazardous situations
i.e. continued use despite known physical/psychological problems either caused or exarcerbated by substance
Risky use
Pharmacologic - Category of behaviour - describe
Needing to increase dose to achieve same results - i.e. regular dose no longer achieving desired effects
What do we see in the pharmacologic category of behaviour in addiction?
Tolerance - needing a larger dose to achieve the same effect
Withdrawal - non-specific criteria but generally thought to include cravings, tremors, sweating, vomiting, etc.
What is London’s biggest drug problem?
Meth
SUD in nurses
- prevalence in relation to the general population
- reluctance to acknowledge issues as a ________
similar to, or greater than in general population
reluctance to acknowledge issue as a profession
What is the bigger issue related to SUD in nurses?
Impaired nurse - can’t have them caring for individuals
Precipitating factors to SUD development in the psychiatric nursing domain.
Family/social history
Emotional/behavioural complexities
Trauma
Often, in the physical domain, we assess for _______ that may go along with substance abuse.
Screen for these.
Physical signs in drug useage/stoppage.
What are some tests done?
comorbidities
Screen for infection/communicable diseases
Risk for overdose/withdrawal
Lab values - liver function tests, kidney function test (BUN/creatinine), pregnancy, CBC
Nursing interventions - SUD
- Brief intervention - _____
- CBT
- __________ interviewing
- _________ management
FRAME
motivational
withdrawal
Describe an example in reduction of severity in drug use.
What is the ultimate goal of treatment for SUD?
Heroin to methodone
Abstinence is the ultimate goal, but not something we typically start off with
Principles of addictions treatment:
- Recognize addiction as a ________ disease
- Must be readily available to do this
- Focuses on ________ issues within the individual, not just the drug addiction
- ________ therapies effective
chronic
readily available to capitalize on pts willingness to quit/change
individual issues - not just addiction
behavioural
Any ________ addict will always be (same word) ________.
recovering
Addictions treatment principles:
- ________ are important for many patients
- must consider concurrent ________ ________
- involuntary treatments efficacy?
- _________ will happen
medications
mental disorders
involuntary treatments may still be effective
relapses will happen
Alcohol Addiction - the 12 step program:
- Reinforces addiction as a ________, progressive disease that is _________, but not ________
- AA established in the _______
- Only entrance requirement is this
- Acknowledgement of this is a central concept
- ______ is the key to success
- Large _______ component
chronic
managed, not cured
1930s
only entrance requirement is the desire to quit drinking
acknowledgement of higher power is a central component
support is the key to success
Large peer component
AA, as a _______ therapy has been proven to be ___________.
group
effective
Most widely used illicit drug in Canada?
Cannabis
Syndrome related to cannabis use, especially in this population.
High potency strains can produce these symptoms.
___-___% of those involved in MVAs had THC on board.
Cannabinoid hyperemesis syndrome - violent, prolonged vomiting occurring as the result of too much marijuana - prevalent in young HS kids
4-14%
High potency strains can produce psychotic symptoms
Opioids
- CNS ________
- example of a naturally occuring one? semi-synthetic? Synthetic?
- Indication?
- Overdose often leads to?
What is a large contributor to the opioid epidemic?
depressants morphine - natural heroine - semi fentanyl - synthetic Analgesic Respiratory depression Injudicious prescribing (i.e. over-prescribing) is a large contributor
Examples of stimulants?
What is the most deadly 2 drug combo leading to death?
Describe the typical cocaine high and withdrawal pattern.
Cocaine, methamphetamine, methylphenidate (Ritalin)
Cocaine/alcohol compo is the most common 2 drug combo resulting in death
Cocaine high followed by a very intense low
Cocaine withdrawal mostly uncomplicated
Most vulnerable life stage for SUD development.
Peak lifetime alcohol consumption occurs at this age.
Harm reductoin strategies are often used for these individuals with SUD.
Very large issue in this population.
Risk for these diseases as a result of drug use.
Adolescence
Late teens to early 20s
Harm reduction for pregnancy and lactation
Large issue in aboriginal populations
Risk for HIV/AIDS and other communicable illnesses
