NUR448 Substance Abuse
DSMIV Criteria Substance Abuse <ul><li>1 or more of following within 12 months </li></ul><ul><ul><li>Substance abuse resul...
Substance Dependence <ul><li>3 or more of the following over 12 months </li></ul><ul><ul><li>Tolerance </li></ul></ul><ul>...
Substance Intoxication <ul><li>Reversible substance specific syndrome due to ingestion of substance </li></ul><ul><li>Clin...
Substance Withdrawal <ul><li>Development of substance specific syndrome due to cessation of substance </li></ul><ul><li>Cl...
Alcohol abuse- two types <ul><li>Type 1 </li></ul><ul><ul><li>relatively mild </li></ul></ul><ul><ul><li>influenced by env...
Type 2 <ul><li>Severe family Hx </li></ul><ul><li>Antisocial personality features </li></ul><ul><li>Strong genetic compone...
Etiologic Theories <ul><li>Biological/Genetic-disease model-low levels of dopamine </li></ul><ul><li>Behavioral-self-doubt...
Family Roles <ul><li>The Addict  (center of attention) </li></ul><ul><li>The Hero  (makes the family look good- acts as th...
Alcohol Withdrawal Syndrome <ul><li>Hangover -tremor, headache, mydriasis, GI  symptoms,  sweating, tachycardia mild hyper...
Acute ETOH withdrawal interventions <ul><li>Force fluids and sleep </li></ul><ul><li>Hallucinations </li></ul><ul><ul><li>...
Delirium Tremens <ul><li>High fever </li></ul><ul><li>Failure of all ego functions </li></ul><ul><li>Violence </li></ul><u...
Amnestic disorders associated with ETOH abuse <ul><li>Blackouts—dehydration –can occur early in drinking  hx.  </li></ul><...
Physical Effects of Chronic Drinking <ul><li>Peripheral neuropathy </li></ul><ul><li>Alcoholic cardiomiopathy </li></ul><u...
ETOH Long term Rx <ul><li>AA, Al Anon </li></ul><ul><li>Antabuse (Disulfuram) </li></ul><ul><li>ReVia   (Naltrexone) </li>...
Sedative, hypnotic or anxiolytic Physical effects <ul><li>Interrupt sleep and dreams </li></ul><ul><li>Respiratory depress...
Sedative, hypnotic or anxiolytic abuse and dependence <ul><li>Intoxication </li></ul><ul><ul><ul><li>Disinhibition </li></...
CNS stimulants <ul><li>Amphetamines </li></ul><ul><li>Cocaine </li></ul><ul><li>Caffeine </li></ul><ul><li>Nicotine </li><...
CNS Stimulants Physical effects <ul><li>CNS effects </li></ul><ul><li>Cardiovascular effects </li></ul><ul><li>Gastrointes...
CNS stimulant intoxication <ul><li>Euphoria, impaired judgment, anxiety </li></ul><ul><li>Nausea, vomiting, psychomotor ag...
CNS withdrawal <ul><li>Dysphoria, fatigue, sleep disturbance </li></ul><ul><li>Headache, fatigue, anxiety, nausea and vomi...
Opioid Physical Effects <ul><li>CNS </li></ul><ul><li>GI effects </li></ul><ul><li>Cardiovascular </li></ul><ul><li>Sexual...
Opioid Intoxication <ul><li>Consistent with half-life </li></ul><ul><ul><li>Drowsy, euphoria </li></ul></ul><ul><ul><li>Re...
Opiate/Opioid Withdrawal <ul><li>6-12 hours after last dose </li></ul><ul><li>Nausea vomiting diarrhea </li></ul><ul><li>L...
Opiate/Opiod Addiction  Long Term Rx <ul><li>Narcotics Anonymous </li></ul><ul><li>Catapres (Clonidine) </li></ul><ul><li>...
Cannabis <ul><li>Marijuana </li></ul><ul><li>Hash-hish </li></ul>
Effects <ul><li>Slowed time assessment </li></ul><ul><li>Impaired motor skills </li></ul><ul><li>Impaired judgment </li></ul>
Questions  <ul><li>What are substances typically abused? </li></ul><ul><li>What is difference between abuse and dependence...
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Unit12 substance abuse

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Unit12 substance abuse

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