Unit12 substance abuse
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Unit12 substance abuse

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Unit12 substance abuse Unit12 substance abuse Presentation Transcript

  • NUR448 Substance Abuse
  • DSMIV Criteria Substance Abuse
    • 1 or more of following within 12 months
      • Substance abuse resulting in failure of major obligation—work, school, home
      • Substance abuse resulting in physical hazard
      • Substance related legal problems
      • Continued substance use despite social, or interpersonal problems
  • Substance Dependence
    • 3 or more of the following over 12 months
      • Tolerance
      • Withdrawal
      • Larger amounts or longer period of time than intended
      • Persistent desire to control use
      • Reduced important personal, social or work activities
      • Continued use despite problems
  • Substance Intoxication
    • Reversible substance specific syndrome due to ingestion of substance
    • Clinically significant maladaptive behavior
    • Symptoms not due to medical condition
  • Substance Withdrawal
    • Development of substance specific syndrome due to cessation of substance
    • Clinically significant distress or impairment
    • Symptoms not due to medical condition or other mental state
  • Alcohol abuse- two types
    • Type 1
      • relatively mild
      • influenced by environmental factors
      • begins later in life
  • Type 2
    • Severe family Hx
    • Antisocial personality features
    • Strong genetic component
    • Earlier onset (before age 25)
    • Reduced serotonin function
    • Difficulty abstaining from alcohol
    • Loss of control while drinking
  • Etiologic Theories
    • Biological/Genetic-disease model-low levels of dopamine
    • Behavioral-self-doubt and passivity, difficulty with intimacy, narcissistic
    • Sociological-poverty, teen-agers, ETOH western culture- Marijuana-eastern culture
    • Family systems- co-dependent, enabler
  • Family Roles
    • The Addict (center of attention)
    • The Hero (makes the family look good- acts as though the addict is not an addict-fear, guilt, and shame)
    • The Troublemaker or Scapegoat (rebel and act out drawing attention away from real problem- shame and guilt)
    • The Lost Child (quiet and reserved –never make problems-guilt lonliness, neglect)
    • The Mascot (makes jokes about the addict-embarrassment, shame, and anger)
    • The Enabler (tries to make everyone happy-inadequac and unhappiness)
  • Alcohol Withdrawal Syndrome
    • Hangover -tremor, headache, mydriasis, GI symptoms, sweating, tachycardia mild hypertension-6-8 hours post cessation
    • Alcoholic Hallucinosis-above and hallucinations and delusions 8-12 hours post cessation
    • Generalized Seizures- tonic-clonic 12-24 hours post cessation
    • Delirium Tremens- medical emergency seizure occurs in persons with poor health seizures within one week cessation
  • Acute ETOH withdrawal interventions
    • Force fluids and sleep
    • Hallucinations
      • usually disappear
    • Convulsions
      • magnesium sulfate
    • Tremors
      • Librium (chlordiazepoxide) or Ativan (lorazepam)
  • Delirium Tremens
    • High fever
    • Failure of all ego functions
    • Violence
    • Convulsions
    • Death
  • Amnestic disorders associated with ETOH abuse
    • Blackouts—dehydration –can occur early in drinking hx.
    • Korsokoff ’ s psychosis—thiamine deficiency- irreversible brain damage
    • Wernecke ’ s encephalopathy-ataxia damage to 6 th cranial nerve-reversible with thiamine Rx.
  • Physical Effects of Chronic Drinking
    • Peripheral neuropathy
    • Alcoholic cardiomiopathy
    • Esophagitis
    • Gastritis
    • Pancreatitis
    • Hepatitis
    • Cirrhosis
    • Leukopenia
    • Thrombocytopenia
  • ETOH Long term Rx
    • AA, Al Anon
    • Antabuse (Disulfuram)
    • ReVia (Naltrexone)
  • Sedative, hypnotic or anxiolytic Physical effects
    • Interrupt sleep and dreams
    • Respiratory depression
    • Cardiovascular effects
    • Renal function
    • Hepatic effects
    • Sexual function
  • Sedative, hypnotic or anxiolytic abuse and dependence
    • Intoxication
        • Disinhibition
        • Aggression
        • Coma,and or death
    • Withdrawal
        • Depends on ½ life of drug
        • Can be life-threatening
        • Requires hospitalization
  • CNS stimulants
    • Amphetamines
    • Cocaine
    • Caffeine
    • Nicotine
  • CNS Stimulants Physical effects
    • CNS effects
    • Cardiovascular effects
    • Gastrointestinal effects
    • Sexual function
  • CNS stimulant intoxication
    • Euphoria, impaired judgment, anxiety
    • Nausea, vomiting, psychomotor agitation
    • Muscle weakness
    • Confusion, seizures, death
    • Nicotine—restlessness and insomnia
  • CNS withdrawal
    • Dysphoria, fatigue, sleep disturbance
    • Headache, fatigue, anxiety, nausea and vomiting
    • Nicotine- restlessness, increased appetite,
    • irritability
  • Opioid Physical Effects
    • CNS
    • GI effects
    • Cardiovascular
    • Sexual function
  • Opioid Intoxication
    • Consistent with half-life
      • Drowsy, euphoria
      • Respiratory depression- coma-death
  • Opiate/Opioid Withdrawal
    • 6-12 hours after last dose
    • Nausea vomiting diarrhea
    • Lacrimation
    • Rhinorrhea
    • Pupilary dilitation, sweating, fever
      • (no medical emergency involved in opiate/opiod withdrawal)
  • Opiate/Opiod Addiction Long Term Rx
    • Narcotics Anonymous
    • Catapres (Clonidine)
    • Methadone
    • ReVia (Naltrexone)
    • Anti-depressants
  • Cannabis
    • Marijuana
    • Hash-hish
  • Effects
    • Slowed time assessment
    • Impaired motor skills
    • Impaired judgment
  • Questions
    • What are substances typically abused?
    • What is difference between abuse and dependence?
    • What are the names of the short term and long term treatment facilities in the South Florida area?