Substance Use Disord

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  • Biochemical factors-role of dopamine and norepnephrine in cocaine, ethanol and opioids
  • Biochemical factors-role of dopamine and norepnephrine in cocaine, ethanol and opioids
  • Biochemical factors-role of dopamine and norepnephrine in cocaine, ethanol and opioids
  • Substance Use Disord

    1. 1. SUBSTANCE USE DISORDER - Mr. Manish Bijalwan M.Sc Nursing 1st yr SCON
    2. 2. TERMINOLOGY  Substance: Any physical matter  Abuse: Wrong or harmful use  Dependence: a compulsive or chronic requirement  Addiction: uncontrolled and compulsive use  Psychoactive substance: one that is capable of altering the mental functions
    3. 3. DSM-V Substance abuse or substance dependence disorders are merged into substance use disorder.
    4. 4. DEFINITIONS:  SUBSTANCE ABUSE: Any use of substances that poses significant hazards to health.  SUBSTANCE DEPENDENCE: A cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues use of the substance despite substance related problems (APA)
    5. 5. DEFINITIONS:  SUBSTANCE USE DISORDER: A disorder in which the use of one or more substances leads to a clinically significant impairment or distress
    6. 6. PSYCHOACTIVE SUBSTANCES 1. Alcohol 2. 3. 4. 5. 7. Sedatives and hypnotics (barbiturates) Opioids (opium, heroin) Cannabinoids (cannabis) 8. Inhalants (volatile solvents) Cocaine 9. Nicotine Amphetamines and 10. Other stimulants other (caffeine) sympathomimetics 6. Hallucinogens (LSD, phencyclidine)
    7. 7. ETIOLOGY 1. BIOLOGICAL FACTORS:  Family history  Co morbid psychiatric disorders  Co morbid medical disorders  Reinforcing effects of drug use  Withdrawal effects of drug use  Biochemical factors
    8. 8. ETIOLOGY 2. PSYCHOLOGICA L FACTORS:      Curiosity Early initiation of alcohol or tobacco Poor impulse control Low self esteem Poor stress management skills      Childhood trauma or loss Relief from boredom/ fatigue Escape from reality Psychological stress Lack of goals
    9. 9. ETIOLOGY 3. SOCIAL FACTORS:      Peer pressure Modeling Ease of availability of alcohol or drugs Intrafamilial conflicts Religious reasons  Poor social/ familial support  Perceived distance within the family  Rapid urbanization
    10. 10. SUBSTANCE ABUSE ADDICTION DEPENDENCY TOLERANCE WITHDRAWAL
    11. 11. CLASSIFICATION: 1. 2. 3. 4. ACUTE INTOXICATION WITHDRAWL STATE DEPENDENCY SYNDROME HARMFUL USE
    12. 12. CLASSIFICATION: 1. ACUTE INTOXICATION Administration of alcohol or other psychoactive substances resulting in disturbances in the level of consciousness, cognition, perception, affect or behavior.    high level in blood Low threshold (CRF) Idiosyncratic sensitivity
    13. 13. CLASSIFICATION: 1. ACUTE INTOXICATION Features       Trauma Delirium Coma Perceptual distortions Convulsions Alcohol intoxification (liver cirrhosis)
    14. 14. CLASSIFICATION: 2. WITHDRAWL STATE Cluster of symptoms often specific to drugs used, develop on total or partial withdrawal of drug    uncomplicated With convulsions With delirium
    15. 15. CLASSIFICATION: 3. DEPENDENCE SYNDROME  Features:        Strong desire Sense of compulsion Difficulty in controlling Physiological withdrawal state Evidence of tolerance Neglect of alternative pleasures Persistant use of substance
    16. 16. CLASSIFICATION: 3. DEPENDENCE SYNDROME  Types: a) Physical dependence b) Psychic dependence c) tolerance
    17. 17. S. N O PSYCHOACTIVE SUBSTANCE ROUTE PHYSICAL PSYCHIC TOLERANC DEPENDENC DEPENDENCE E E 1 Alcohol Oral moderate moderate mild 2 Opioids Oral, parentral, smoking severe severe severe 3 Cannabis Oral, smoking probable moderate Mild 4 Cocaine Oral, parentral, smoking, Inhalation Little moderate nil 5 Amphetamines Oral, parentral moderate moderate severe
    18. 18. S. N O PSYCHOACTIVE SUBSTANCE ROUTE PHYSICAL PSYCHIC TOLERAN DEPENDEN DEPENDENC CE CE E 6 Barbiturates Oral, parentral moderate moderate Severe 7 Benzodiazepine Oral, parentral mild mild Mild 8 Volatile solvents Inhalation little moderate mild 9 caffeine Oral mild moderate mild 10 nicotine Oral, smoking mild moderate mild
    19. 19. CLASSIFICATION: 4. HARMFUL USE continued drug use despite the awareness of harmful medical or social effect of the drug
    20. 20. SIGN & SYMPTOMS 1. Behavioral changes 2. Physical changes 3. Social changes
    21. 21. SIGN & SYMPTOMS 1. Behavioral changes  Drop in attendance and performance at work or school  Frequently getting into trouble (fights, accidents, illegal activities)  Using substances in physically hazardous situations such as while driving or operating a machine  Engaging in secretive or suspicious behaviors
    22. 22. SIGN & SYMPTOMS 1. Behavioral changes  Changes in appetite or sleep patterns  Unexplained change in personality or attitude  Sudden mood swings, irritability, or angry outbursts  Periods of unusual hyperactivity, agitation  Lacking of motivation  Appearing fearful, anxious, or paranoid, with no reason
    23. 23. SIGN & SYMPTOMS 2. Physical changes  Bloodshot eyes and abnormally sized pupils  Sudden weight loss or weight gain  Deterioration of physical appearance  Unusual smells on breath, body, or clothing  Tremors, slurred speech, or impaired coordination
    24. 24. SIGN & SYMPTOMS 3. Social changes  Sudden change in friends, favorite hangouts, and hobbies  Legal problems related to substance use  Unexplained need for money or financial problems  Using substances even though it causes problems in relationships
    25. 25. DIFFERENT SUBSTANCE USE DISORDERS
    26. 26. ALCOHOL USE DISORDER  Previously known as alcoholism  Common in males  Onset is late second or third decades  May be associated with other drug use
    27. 27. TYPES OF AUD S.NO ALCOHOL USE DISORDER FEATURES 1 ALPHA •Excessive and inappropriate drinking •For physical or emotional relief •Control present •Able to abstain 2 BETA •Excessive and inappropriate drinking •Cultural drinking pattern or poor nutrition •Physical complications present •No dependence 3 GAMMA •Malignant disorder •Physical dependency with tolerance and withdrawal symptoms •Psychological dependency with lack of control
    28. 28. TYPES OF AUD S.NO ALCOHOL USE DISORDER FEATURES 4 DELTA •Inability to abstain •Tolerance •Withdrawal symptoms •Amount of consumption can be controlled •Minimal social disruption 5 EPSILON Compulsive drinking-dipsomania Spree drinking
    29. 29. MARKERS OF ALCOHOL DRUG DEPENDENCE 1. Gamma Glutyl transferase (GGT): 40 IU/L 2. Mean corpuscular volume (MCV): more than 92fl (n=80-90fl) 3. Blood alcohol concentration (BAC)- more than 25% 4. Breathe analyser
    30. 30. COMPLICATIONS 1. ACUTE INTOXICATION: Alcohol consumption 25-100% BAC CNS depression Excitation period Increased reaction time Slowed thinking,Poor motor control
    31. 31. COMPLICATIONS 2. WITHDRAWAL SYNDROME  Common symptoms:  1. 2. 3. Hangover in the next morning, Mild Tremors, Nausea, vomiting, Weakness, Irriatability Three types Delirium tremens (2-4 days) Alcoholic seizures(12-8 hrs) Alcoholic hallucinosis
    32. 32. TREATMENT 1. 2. 3. 4. 5. 6. 7. Detoxification (benzodiazepines) Behavioral therapy Psychotherapy Group therapy Deterrent agents (disulfiram, nitrafezol) Anti craving drugs (naltrexone, SSRIs) Psychosocial rehabilitation
    33. 33. OPIOIDS USE DISORDER  Dried exudate obtained from unripe seed capsules of papaver somniferum (morphine, codeine, papaverine, heroin, pethidine)  Heroin commonly called “smack” or “brown sugar”
    34. 34. OPIOIDS USE DISORDER  ACUTE INTOXICATION: Apathy, bradycardia, hypotension, respiratory depression, delayed reflexes, thready pulse, coma
    35. 35. OPIOIDS USE DISORDER  WITHDRAWAL SYMPTOMS:  Appear within 12-24 hrs  Peak 24-72 hrs  Subside after 7-10 days  Pupillary dilation, sweating, lacrimation, yawning, insomnia, generalised bodyache, severe anxiety
    36. 36. TREATMENT IN OPIOIDS USE DISORDER  Naloxone challenge test  Treatment of overdose  Detoxification (methadone)  Maintenance therapy (20-50 mg/day methadone, 100mg naltexone/ 3 day and 150 mg on 5th day)
    37. 37. TREATMENT IN OPIOIDS USE DISORDER  Behavioural therapy  Self control strategies  Family therapy  Group therapy
    38. 38. Cannabis Route : smoking, ingestion Common names : Ganja, charas, bhang, hashish Intoxication : altered state of awareness, relaxation, mild euphoria, reduced inhibition, red eyes, dry mouth, increase appetite, increase pulse, decrease reflexes, panic reaction. Over dose : toxic psychosis Withdrawal symptoms : irritability, difficulty sleeping
    39. 39. Sedatives & Hypnotics Barbiturates & benzodiazepines Depressant drug Route : Ingestion or injection Other names : Barbs, beans, downers, candy, yellow jackets, yellows. Effects : depression of mood, cognition, attention, concentration, insight, judgment, memory, affect; psychomotor impairment, increased reaction time, lack of hand to mouth coordination, motor ataxia, unconsciousness , coma , respiratory depression , death.
    40. 40. Withdrawal syndrome  Potential for Seizures, delirium and cardiovascular collapse  Insomnia, anxiety, profuse sweating, weakness  Must Be W/d Gradually
    41. 41. Stimulants Amphetamines  Route :-Ingestion  Common names:-AMT, bam, bennies, crystal, diet pills, dolls, eye openers, lid openers, Purple hearts, wake ups  Effects :-Euphoria, abrupt awakening, increased energy, talkativeness, elation, agitation, hyperactivity, irritability, grandiosity, pressured speech.
    42. 42.  Cocaine Route :-Inhalation, Smoking, injection, Topical Common names:-Bernice, big C, blow C, coke, dust, girl, sugar, white lady, crack. Effects :-Increase temperature, blood pressure & pulse, Tachycardia, ectopic heartbeats, chest pain, urinary retention, constipation, dry mouth
    43. 43. Stimulants  Over dose : seizure, cardiac arrhythmias coronary artery spasm, myocardial infarction, marked increase in B.P.& temperature that may lead to cardiovascular shock, convulsions, cardiac arrest & death.  Withdrawal Symptoms : intense & pleasant feelings of depression & fatigue & sometimes suicidal ideation Anxiety, anhedonia, sleep disturbance, increase appetite,
    44. 44. Cocaine abuse  It is a potent form of cocaine hydrochloride mixed with baking soda and water, heated (cooked), allowed to harden and then is broken or “cracked”into little pieces and smoked in cigarettes or glass water pipes.  Cardiac dysrhythmias, respiratory paralysis and seizures are some of the dangers associated with crack abuse
    45. 45. Cocaine abuse INTOXICATION Increased Pulse And B.P. Euphoria and a Sense of Well Being Dilated Pupils Insomnia Anorexia OVERDOSE Seizures Cardiac Arrest Convulsions & Death
    46. 46. Hallucinogens  LSD, Mescaline, peyote,psilocybin  Route : ingestion, smoking  Intoxication : distorted perceptions, hallucinations (in presence of a clear sensorium) ; distortion of time space, illusions, depersonalizations, mystical experiences, heightened sense of awareness; extreme mood liability, tremor, dizziness, nausea & vomiting; increase temperature, pulse, B.P. & salivation ; panic reaction
    47. 47. Inhalants  Gasoline, glue, aerosol sprays, paint thinner  Route : Inhalation  Intoxication : assaultive, apathy, impaired judgment ; dizziness, nystagmus, incoordination, slurred speech, unsteady gait, depressed reflex, tremor, blurred vision, euphoria, anorexia.  Overdose : lethargy, stupor/coma, respiratory arrest, cardiac arrhythmia
    48. 48. Nicotine Route : smoking, chewing, buccal Common names : cigarettes, cigars, bidis, kreteks, pipe tobacco, snuff, chewing tobacco Intoxication : feeling of pleasure, increased alertness, enhanced mental performance, increased heart rate & B.P. Withdrawal : anger, anxiety, depressed mood, difficulty in concentration, increased appetite & craving for nicotine.
    49. 49. Treatment goals  Abstinence  Harm minimization  Improvement of health, social & occupational functions  Improvement of quality of life.
    50. 50. Role of Nurse Monitor vital sign, observe the patient care fully  Decrease stimulation , provide care Evaluate the patient hydration  and serum electrolytes  Maintain intake output chart  Care fully evaluate the patient – medcal/ surgical problem- head trauma,GI bleeding , hepatic disease, withdrawal from other drug. Institute high calorie and high carbohydrate diet  Add vit.thiamine 100 mg im than oral Folic 1 mg PO daily for 7- 10 day  Initiate pharmacotherapy
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