Exam 18: Substance Abuse
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| Addiction | Substance dependence that is serious enough to call a disease.
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| 4 Elements of substance abuse | Excessive use or abuse.
Display of psychological dependence.
↓ of social and economic function.
Uncontrollable consumption indicating dependence.
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| Alcoholism | Primary chronic disease with genetic, pyschosocial and environmental factors influencing development and manifestations.
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| Dependence | Physiological state of adaptation to the specific psychoactive substance
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| Withdrawal | Physiological state that occurs when the substance of which a person is dependent upon ti achieve the desired effect.
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| Tolerance | Characteristic of drug addiction that refer to a progressive need for more of the abused substance to achieve the desired effect.
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| CAGE | Cut.
Annoyed.
Guilty.
Eye Opener.
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| Benzodiazepines: Street names | Vitamin K
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| Barbituates: Street names | Reds, blues, yellow jackets
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| Chloral hydrate: Street name | Mickey Finn, "Club drug"
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| Cocaine: Street name | Coke, blow, snow
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| GHB: strret name | Soap, liquid X, Georgia Home Boy.
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| Heroin: Street name | H, smack, junk
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| Ketamine: Street names | Vitamin K, Special K
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| LSD: Street name | Acid
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| Marijuana: Street name | Weed, grass, chronic, dank, pot, bammer, jee-zoint, budda, "smell-it-through-the-bag-baby", Sir Smoke-a-lot, Dat Blunt, that fire, Mary-Jane, "Off-the-heezie", etc.
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| Methamphetamine: Street names | Speed, crystal, ice (form that may be smoked)
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| MDMA: Street names | Ecstacy, E, X (Club drug)
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| Nitrous Oxide: Street names | Nitrous, whippets
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| PCP: Street names | Angel dust (may be in a club-drug setting)
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| Psilocybin: Street names | Shrooms, magic mushrooms
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| Pohypnol: Street names | Roofies, rough, rope, roach (club drug)
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| Inhalants: types | glues, spray paint, etc.
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| Alcoholism is believed to result from a complex combination of | environment, behavior and genetic predisposition.
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| Alcohol is a central nervous system (CNS) | depressant (initially stimulating effect occurs because higher areas of brain are affected; frontal cortex which governs self-control)
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| As the pattern of drinking continues, the _____ ______ (most primitive part of brain) is affected which impacts hunger, thirst and sexual desire | limbic system
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| Repeated exposure affects the _____ _____ of the brain where compulsion controls are unbalanced. | basal ganglia
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| 3 Steps of Chemical/Substance Abuse | Early stages.
Middle Stages.
Late stages.
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| Early stages of Chemical/Substance Abuse | Amount and frequency ↑.
Physiological Changes (anxiety, cramping, heart palpitations, etc.).
Denial (defensive, social groups, legal problems, good prognosis).
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| Middle Stages of Chemical/Substance Abuse | Moderate impairment.
Might see signs & symptoms of withdrawal.
*A multi-drug user, progression through this stage is faster.
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| Signs and symptoms of withdrawal. | Self-medicates for "normalcy".
Use pattern.
Estrangement from family/others.
negative behaviors.
Physical health ↓.
Blacksouts.
$/legal problems.
Job problems.
Poor prognosis w/o Tx.
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| Late Stages of Chemical/Substance abuse. | Functioning severely impaired.
Habitual use, cannot achieve "normal".
Worsened medical problems.
Malnutrition.
Impaired judgement.
Denial.
Manipulative behavior. Occupational problems.
Possible homeless.
Appropriate Tx is key to survival.
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| Alcohol Withdrawal Syndrome | Usually occurs 6-48 hours after the last drink.
May last 3-5 days.
Diaphoresis, tachycardia, hypertension, tremors, nausea/vomiting, anorexia, restlessness, disorientation, hallucinations.
Negative behaviors (lying stealing, broad mood swings).
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| Delirium Tremens (DT) | Acute psychotic reaction to withdrawal of alcohol.
Occurs 1-4 days after cessation, 2 days to 1 week.
D/T excessive use.
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| Signs and Symptoms of DT | ↑ activity to extreme agitation.
Disorientation; fear/panic.
Hallucinations; elevated temperature.
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| Fetal Alcohol Syndrome | Frequently seen in newborns whose mothers drank heavily during
pregnancy.
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| Congenital anomalies seen in Fetal Alcohol Syndrome. | Mental retardation.
Growth disorders.
Wide-set eyes.
Malformed body part.
Spontaneous abortion or stillborn.
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| Two brain disorders that sometimes occur in chronic alcoholics. | Korsakoff’s Psychosis and Wernicke’s Encephalopathy
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| Korsakoff’s characteristics | Short-term memory loss.
Disorientation.
Muttering delirium.
Insomnia.
Hallucinations.
Polyneuritis.
Painful extremities with foot drop affecting the gait.
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| Wernicke’s Encephalopathy occurs in association | thiamine deficiency. this causes brain damage in the temporal lobe of the brain.
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| Wernicke’s Encephalopathy characteristics | Memory loss.
Aphasia.
Involuntary eye movement and double vision.
Lack of muscle coordination.
Disorientation with confabulation i.e. the patient fills in memory gaps with inappropriate words.
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| Subjective Data of alcohol or substance abuse | Normal using or drinking pattern.
Time of the last drink or use of a drug.
Complaints of nausea, indigestion, sleep disturbance or pain.
Presence of any disease requiring treatment with prescribed medications.
Regular use of over-the-counter drugs.
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| Objective Data of alcohol or substance abuse | Malnutrition usually seen with ETOH.
Tremors.
Skin conditions.
Frequent sniffing, stuffy nose or harsh nonproductive cough.
Tachycardia, hypertension, petechiae and neuropathies.
Ascites, urine or blood sample positive for drugs or alcohol.
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| Diagnostic tests for alcohol or substance abuse | Blood and urine tests, screen for toxins.
Some foods can cause a false-positive reading in a urine screen (poppy seeds).
Alcoholism: Liver enzymes, hypoglycemia, blood protein levels and magnesium Hepatitis and HIV.
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| Medications for alcohol/ subtance are used as an adjunct to other therapeutic methods. | Includes the SSRI antidepressants, Naltrexone, which is an opiate/ETOH. antagonist and competes for binding sites, thereby negating the effects of alcohol or opiates
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| Medication to reduce withdrawal symptoms | Chlordiazepoxide (Librium).
Naltrexone (ReVia).
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| Detoxification | Removal of poisonous effects of a substance from a patient.
A controlled setting where the patient can be closely observed and treated for complications.
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