Flashcards in Substance related disorders Deck (108)
What is substance use, abuse, phsyical dependence?
- sporadic consumption of alcohol/drugs w/ no adverse consequences
- abuse: frequency of alcohol/drug use may vary, there are adverse consequences experienced by the user
- physical dependence: state of adpatation that is manifested by a drug class-specific withdrawal syndrome
What is psychological dependence, addiction?
- psychological dependence: a subjective need for a specific psychoactive substance, either for its positive effect or to avoid negative effects of its abstinence
- addiction: primary, chronic, neurobiologic disease, with genetic, psychosocial, and enviro factors influencing its development and manifestations:
characterized by behaviors that include impaired control over drug use, compulsive use, cont use despite harm and craving, and continuing use despite adverse consequences in the abusers life
Epidemiology of substance abuse?
- 10% of general pop has problems due to substance abuse
- genetic differences
- age differences: prevalence is reduced as age increases
Special populations affected by substance abuse?
- anyone with psych comorbidity
- those who smoke or abuse alcohol
- elderly - alcohol
- health care workers: rx drugs
- pregnant women may fear admitting to drug abuse
How do you recognize the drug abuser?
you won't know unless you ask:
- amt of money spent daily/weekly/monthly
-frequency of use and time of last use
- route of admin
- if hx of use is disclosed ask about prior detox or addiction tx and abstinence periods
Physical changes due to substance abuse?
- drug use is leading cause of impotence in US
- wt loss and sleep disturbance
- evidence of localized or systemic infections
- on abdominal exam may palpate enlarged or shrunken liver
- respiratory or nasal problems (cocaine, smoking - tobacco, marijuana)
- need marks: tracks
- STIs in pts who are trading sex for drugs
CAGE questionnaire? Best in what pop?
- commonly used in medical setting and has been validated as a sensitive and specific tool for detectin problem drinking (esp in men)
- 2 or more positive answers indicate a likely dx of alcohol dependence
- 1. Have you ever felt the need to Cut down on your drinking?
- 2. have you ever felt Annoyed by criticism of your drinking?
- 3. have you ever had Guilty feelings about your drinking?
- 4. do you ever take a morning Eye-opener (steady your nerves or get rid of hangover)
Why does an individual take a substance to start with?
- have to get to the bottom of this with your pts
- is it solely for the high?
- what about over time when there is no longer euphoria? Is it maintain an equilibrium?
- is it to counter something else going on? - does the person have anxiety, depression, are they escaping something?
**you must always seek to determine what fxn a substance is serving for a pt
What is considered risky or hazardous drinking? What is unhealthy alcohol use?
- in men younger than 65 - it is more than 14 drinks a week and in women that are younger than 65 - more than 7 drinks a week
- unhealthy alcohol use: uses that can result in health consequences
Alcohol abuse definition?
assoc with one or more of the following, occurring in a 12 month period:
-failure to fulfill work, school or social obligations
-recurrent substance use in physically hazardous situations
-recurrent legal probs related to substance use
-cont use despite alcohol related social or intrapersonal problems
What is alcohol dependence (alcoholism)?
a maladaptive patterns of use assoc w/ 3 or more of the following, occurrence at any time in the same 12 month period:
-substance taken in larger quantity than intended
-persistent desire to cut down or control use
-time is spent obtaining, using or recovering from the substance
-social, occupational or recreational tasks are sacrificed
- use continues despite physical and psychosocial problems
epidemiology of alcohol?
- over 50% of people 12 and older reported drinking regularly
- over 23% reported binge drinking in last 30 days, 6.9% reported heavy drinking
- 40% of all traffic fatalities are alcohol related
- alcohol related health problems 3rd leading cause of preventable death in the US
- leads all other substances in substance related deaths!!
Medical morbidity of alcohol?
assoc with greater risk of:
- HTN, cardiomyopathy
- hepatitis, cirrhosis (1/2 cases in US secondaray to ETOH), pancreatitis
- TB, pneumonia
- psych probs: anxiety, depression, and eating disorders
- cancers of the stomach, mouth, larynx, breast, and esophagus
Screening tools for alcohol use? Who should be screened?
- single item screening
- alcohol use disorders identification test (audit)
- CAGE questions (not as reliable for caucasian women)
- screen all adult pts: intervention most likely to succeed in pts who are in risky drinking or hazardous drinking categories
- a large # of pts need to be screened to achieve benefit
- screening essential pts with + family hx, who smoke, have frequent ER visits, or who are on meds that interact with ETOH
CRAFFT screening for adolescents and college students?
- Have you ever ridden in a Car driven by someone (including yourself) who was high or had been using alcohol or drugs?
- do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?
- do you ever use alcohol or drugs while you are Alone?
- Do you ever use alcohol or drugs while you are Alone?
- do you ever Forget things you did while drinking or doing drugs?
- Do your family or Friends ever tell you that you should cut down on your drinking or drug use?
- have you ever gotten into Trouble while you were using alcohol or drugs
- 2 or more positive answers indicate problem use, abuse or dependence
- performs better then CAGE for this age group
What is considered moderate drinking?
- men: 2 drinks or less a day
- women: 1 drink or less a day
What is considered heavy drinking?
- men: drink more than 14 drinks per week, or 4 drinks per occasion
- women: drink more than 7 drinks a week or 3 drinks per occasion
What is considered binge drinking?
- men: 5 or more drinks in a row
- women: 4 or more drinks in a row
1 mixed drink with 1.5 fl oz of 80 proof liquor = 5 oz of wine = 12 oz of beer or wine cooler
Etiology of alcohol related disorders?
- multifaceted including psychosocial, genetic and or behavioral factors
3-4x higher for severe alcohol problems in first degree relatives with alcohol problems
- rate of alcohol problems increases with the number of alcoholic relatives and severity of illness
Absorption of alcohol?
- 10% consumed alcohol is absorbed in the stomach, remainder from the small intestines
- when concentration of alcohol in stomach becomes too high - mucus secretion and pyloric valve closure results in slowed absorption
- pylorospasm results in vomit - rookie drinkers
metabolism of alcohol?
- 90% metabolized in liver through oxidation
- metabolized by 2 enzymes:
ADH catalyzes conversion of alcohol into acetaldehyde, which is toxic
- ALDH catalyzes conversion of acetaldehyde into acetate
Effects of alcohol on the brain? Diff levels and effects?
- CNS depression (like benzodiazepines)
- relatively mild levels: thought, judgement, and restraint are loosened
- increasing levels: voluntary muscle dysfxn and entire motor area of the brain depressed
- yet increasing levels: confusion, stupor, coma, and finally primitive centers that control breathing and HR are affected and can result in death either secondary to direct respiratory depression or aspiration of vomitus
Effects of alcohol on the liver?
- metabolism of alcohol leads to chemical attack on liver (it is unknown if damage is caused by acetaldehyde or other metabolites)
- even after all alcohol intake has stopped and all alcohol has been metabolized, the processes that damage liver cells may continue for weeks to months
- clinical and chemical effects often become worse before disease resolves
3 patterns of hepatocellular injury by alcohol?
- fatty liver
- alcoholic hepatitis
- cirrhosis (rate is 10-15% of all alcoholics)
What is wenicke-korsakoff syndrome?
- occurs in persons who have been drinking heavily for many years - rare to see in persons younger than 35, caused by thiamine deficiency due to poor nutrition/malabsorption
What is wernicke's encephalopathy?
- acute sxs which are completely reversible when tx w/ high dose thiamine: characterized by gait ataxia, vestibular dysfxn, confusion and ocular abnormalities
(remember to give thiamine b/f glucose to prevent encephalopathy)
What is korsakoff's syndrome?
- chronic condition where only 20% of pts recover - can be tx with po thiamine
- characterized by impaired recent memory and anterograde amnesia
- this isn't as well tx with thiamine as wernickes
How is drinking good for the heart?
- several studies have shown that drinking in moderation may have health benefits particularly in regard to CAD and the risk of MI
- meta-analysis of 34 studies found that 1-2 drinks a day in women and 2-4 drinks in men, are inversely related with total mortality while GREATER intake INCreased mortality
- pts will bring this up all the time, pts ofte fail to consider their comorbidities