1
Q
Substance Use Disorder
- Use of the substance interferes w/ability to fulfill role obligations
- Attempts to cut down or control use fail
- Intense craving for the substance
A
- Excessive amt of time spent trying to procure the substance or recover from its use
- Use causes dysfunctional interpersonal relationships as well as social isolation; impairment results in risky behaviors
- Despite awareness of physical & psychological problems, use continues
2
Q
- Use of the substance causes the person difficulty w/interpersonal relationships or to become socially isolated
A
- The person engages in hazardous activities when impaired by the substance
3
Q
?
Is a primary chronic disease of brain reward, motivation, memory, & related circuitry where a dysfunction in these circuits is connected to an individual pathologically pursuing reward and/or relief by substance use & other behaviors
A
Addiction
4
Q
Addiction: Evident when:
___ occurs - substance-specific sx’s occur upon discontinuation of use
A
Withdrawal
5
Q
___ develops - the amt req’d to achieve the desired effect increases
A
Tolerance
6
Q
Substance-Induced Disorders
- Development of a reversible syndrome of sx’s following excessive use of a substance
- Disruption in physical & psychological functioning
A
- Direct effect on the CNS
- Judgment is disturbed & social & occupational functioning is impaired; disturbed judgment can also result in maladaptive behavior
7
Q
Substance Withdrawal
Occurs upon abrupt reduction or discontinuation of a substance used regularly over a prolonged period of time
A
Substance-specific syndrome includes:
- Clinically significant physical signs & sx’s
- Psychological changes - disturbances in thinking, feeling, & behavior
8
Q
Predisposing Factors
- Biological
- Psychological
- Sociocultural
A
- There’s no single theory that can explain the etiology of substance abuse
9
Q
Biological Factors
- Hereditary factors have been implicated especially in terms of alcoholism; alcohol may produce morphine-like substances in the brain
A
- Evidence supports the idea that changes in brain structure & brain neurochemistry occur in the process of developing addiction
> These pathways are responsible for sensing pleasure and reward. Once activated, they’re believed to be responsible for pleasurable sensations assoc w/drugs as well as creating a memory that triggers desire for repeated use of the drugs
10
Q
Psychological Factors
Developmental influences:
* A punitive superego @ the oral stage of psychosexual development; this is when the individual w/a punitive superego turns to drugs to diminish unconscious anxiety & it increases feelings of power & self-worth
A
Personality factors:
* Certain personality traits have been assoc w/an increased tendency towards addictive behaviors. These include low self-esteem, freq depression, passivity, antisocial personality traits, the inability to relax or to defer gratification & the inability to communicate effectively are common in individuals who abuse substances
11
Q
Cognitive factors:
* Irrational thinking patterns have long been identified as a central problem in addiction
A
12
Q
Sociocultural Factors
Social Learning:
* Modeling & imitation can be observed from an early childhood onward
* The family appears to be an important influence in relation to substance use
A
Conditioning:
* Many substances create a pleasurable experience that encourages the user to repeat it
* The environment can also serve as condition. If the environment is seen as pleasurable, substance use usually increases
13
Q
Cultural and ethnic influences
* We know that factors within an individual’s culture can help establish patterns of substance use by molding attitudes, influencing patterns of consumption based on cultural acceptance, and determining the availability of substances
A
- There’s a high incidence of use within the American Indian & Alaskan Native cultures as well as northern Europeans, esp Ireland (this is esp true for the use of alcohol)
14
Q
Alcohol Use Disorder: Profile of the Substance
- ETOH - CNS depressant
- BAC of ___% is considered legal intoxication
- The body burns alcohol @ a rate of about 0.5 oz per hr
- Other factors that influence the effects of ETOH include an individual’s size, a full or empty stomach, as well as emotional stress or fatigue
A
0.08%
15
Q
Patterns of ETOH use progression
Phase I: pre-alcoholic phase
Phase II: early alcoholic phase
Phase III: crucial phase
Phase IV: chronic phase
A
! Heavy drinking contributes to heart disease, cancer, and stroke
16
Q
?
- Characterized by emotional & physical disintegration
- Emotional disintegration is evidenced by profound helplessness & self-pity; impairment may result in psychosis; life-threatening physical manifestations may be evident in virtually every system of the body
- Unmanaged withdrawal from alcohol results in a terrifying syndrome of sx’s that include hallucinations, tremors, convulsions, severe agitation, & panic. Depression & ideas of suicide are not uncommon
- For long-term heavy drinkers, abrupt withdrawal of alcohol can be fatal
A
Phase IV: chronic phase
17
Q
?
- Begins w/blackouts, which are brief periods of amnesia that occur during or immediately following a period of drinking
- Alcohol is now required by the person
A
Phase II: early alcoholic phase
18
Q
?
- Characterized by the use of alcohol to relieve everyday stress & tensions of life
A
Phase I: pre-alcoholic phase
19
Q
?
- Individual has lost the ability to choose whether or not to drink; an addiction is clearly evident
- Binge drinking is common; these episodes are characterized by sickness, loss of consciousness, squalor, or degradation
- Individual is extremely ill; anger & aggression are common manifestations
- By this phase of the illness, it’s not uncommon for the individual to have lost their job, have problems w/their marriage, family, friends, and most especially, self-respect
A
Phase III: crucial phase
20
Q
Effects on the Body
- Peripheral neuropathy
- Alcoholic myopathy
- Wernicke’s encephalopathy
- Korsakoff’s psychosis
A
- At low doses, alcohol produces relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, & sleep
- Chronic abuse results in multi-system physiological impairments
21
Q
?
Results in pain, burning, tingling, or prickly sensations of all extremities
Researchers believe it’s the direct result of deficiencies in the B vitamins, particularly thiamine
This is reversible w/abstinence from alcohol & restoration of nutritional deficiencies but permanent muscle wasting & paralysis can occur w/cont’d use
A
Peripheral neuropathy
22
Q
?
Is identified by a syndrome of confusion, loss of recent memory, & confabulation in alcoholics; is frequently encountered in those w/another assoc sx
A
Korsakoff’s psychosis
23
Q
?
Represents the most serious form of thiamine deficiency in alcoholics
Sx’s include paralysis of the ocular muscle, diplopia, ataxia, somnolence, & stupor
If thiamine replacement therapy is not undertaken quickly, death will ensue
A
Wernicke’s encephalopathy
→ In the US, the 2 disorders are usually considered together & are called Wernicke-Korsakoff’s syndrome
✔ Treatment is w/parenteral or oral thiamine replacement
24
Q
In acute alcoholic myopathy, the individual experiences sudden onset of muscle pain, swelling, & weakness
- These sx’s are usually generalized but pain & swelling may selectively involve calves or other muscle groups
A
Chronic alcoholic myopathy includes gradual wasting & weakness in skeletal muscles
- Neither the pain or tenderness or the elevated muscle enzymes seen in acute myopathy are evident in the chronic condition
25
Alcoholic cardiomyopathy
* Generally, r/t CHF or arrhythmia
* Sx's incl dec exercise tolerance, tachycardia, dyspnea, edema, palpitations, & a non-productive cough
* Changes may be observed by ECG & CHF may be evident on cxr; treatment is total, permanent abstinence from alcohol
* Treatment of CHF may incl rest, oxygen, receiving digoxin, sodium restriction, & diuretics
→ Death rate is high for individuals w/symptomatology
26
Esophagitis
* Inflammation & pain in the esophagus
* Occurs b/c of the toxic effects of alcohol on the esophageal mucosa
* It occurs b/c of freq vomiting assoc w/alcohol use
27
Gastritis
* The effects of alcohol on the stomach incl inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, & distention
* Alcohol breaks down the stomach's protective mucosal barrier, allowing hydrochloric acid to erode the stomach wall
* Damage to blood vessels may also result in hemorrhage
28
Pancreatitis
* May be acute or chronic
* Acute pancreatitis usually occurs shortly after binge drinking, & sx's incl constant, severe epigastric pain, nausea, vomiting, & abd distention
* The chronic condition leads to pancreatic insufficiency which results in fatty stools, malnutrition, wt loss, & DM
29
Alcoholic hepatitis
* Inflammation of the liver c/b long term heavy alcohol use
* Sx's incl large or tender liver, n/v, lethargy, anorexia, elevated WBC count, fever, & jaundice
* Ascites & wt loss may be evident in more severe cases
* Treatment incl strict abstinence from alcohol, proper nutrition, & rest
! The individual can experience complete recovery
30
Cirrhosis of the liver or hepatic encephalopathy
* Cirrhosis of the liver may be c/b anything that results in chronic injury to the liver but is also end-stage of alcoholic liver dz & results from chronic long term alcohol use
* Widespread destruction of liver cells which are replaced by fibrous (scar) tissue
* Sx's incl n/v, anorexia, wt loss, abd pain, jaundice, edema, anemia, & blood coag abnormalities
* Treatment is also abstinence from alcohol, correction of malnutrition, & supportive care to prevent complications of dz
31
Effects on the Body cont'd
Complications of cirrhosis of the liver
* Portal hypertension
* Ascites
* Esophageal varices
* Hepatic encephalopathy
* Leukopenia
* Thrombocytopenia
* Sexual dysfunction
32
Use During Pregnancy: Fetal Alcohol Spectrum Disorder (FASD)
* Fetal alcohol syndrome (FAS) includes problems w/learning, memory, attention span, communication, vision, & hearing
* Alcohol-related neurodevelopmental disorder
* Alcohol-related birth defects
33
?
Occurs at blood alcohol levels between 100-200 mg/dL
- Sx's incl disinhibition of sexual & aggressive impulses, mood lability, impaired judgement, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, & flushed face
! Death has been reported at levels ranging from 400-700
Alcohol intoxication
34
?
Incidence of reoccurrence is high, increase risk for seizures
- Occurs in about 1%
Alcohol withdrawal delirium
35
?
Occurs within 4-12 hrs of cessation of or reduction in heavy & prolonged alcohol use
- These incl a coarse tremor of hands, tongue, & eyelids; n/v; malaise; weakness; tachycardia; sweating; elevated BP; anxiety; depressed mood; irritability; transient hallucinations or illusions; headache & insomnia
Alcohol withdrawal
36
Sedative, Hypnotic, or Anxiolytic Use Disorder: Profile of the substance
* Incl barbiturates, non-barbiturate hypnotics, anti-anxiety agents; also, club drugs & date rape drugs
* CNS depressants are additive w/one another & w/the behavioral state of the user
* Physiological & psychological addiction
* Cross-tolerance & cross-dependence may exist between various CNS depressants
37
Effects on the Body
* Effects on sleep & dreaming
* Respiratory depression
* Cardiovascular effects
* Renal function
* Hepatic effects
* Body temperature
* Sexual functioning
38
Sedative, hypnotic, or anxiolytic ___
* Onset of sx's depends on the half-life of the drug
* Severe cessation from CNS depressants can be life-threatening
withdrawal
39
Sedative, hypnotic, or anxiolytic ___
* Effects can range from disinhibition & aggressiveness to coma & death
intoxication
40
Stimulant Use Disorder: Profile of the Substance
* Caffeine & nicotine
* Prescription & illegal
! High abuse potential
e.g., caffeine, nicotine, amphetamines, bath salts, cocaine, crystal meth
41
Effects on the Body
CNS effects
* CNS stimulation results in tremor, restlessness, anorexia, insomnia, agitation, & inc motor activity
* Amphetamine & non-amphetamine stimulants as well as cocaine produce inc alertness, dec in fatigue, elation, & euphoria, & subjective feelings of greater mental agility in muscle power
* Amphetamines also induce inc systolic & diastolic BP; inc HR & cardiac arrhythmias
* Also relax bronchial smooth muscle
Gastrointestinal & renal effects
* GI effects are somewhat unpredictable but a dec in the GI tract motility commonly results in constipation
* Contraction of the bladder makes urination difficult
* Nicotine stimulates the hypothalamus to release ADH which results in the excretion of urine
Sexual function
* CNS stimulants appear to inc sexual urges in both men & women
42
Cardiovascular/pulmonary effects
* Cocaine intoxication typ produces a rise in the myocardial demand for oxygen & inc in HR
* Severe vasoconstriction can occur & result in an MI, v-fib, & sudden death
* Inhaled cocaine can produce pulmonary hemorrhage, chronic bronchiolitis, & pneumonia
* Caffeine ingestion can result in increased HR, palpitations, & cardiac arrhythmias
* Caffeine induces dilation of the pulmonary & general systemic blood vessels as well as constriction of the cerebral blood vessels
* Nicotine stimulates the SNS & results in inc HR, BP, & cardiac contractility
43
Stimulant intoxication
* Maladaptive behavioral & psychological changes
Stimulant withdrawal
* Syndrome that develops within a few hrs to a few days >cessation of or reduction in heavy & prolonged use
44
* In severe amphetamine intoxication, sx's can incl memory loss, psychosis, & violent aggression. Physical effects incl tachycardia or bradycardia, pupillary dilation, elevated or lowered BP, perspiration or chills, n/v, wt loss, psychomotor agitation or retardation, muscle weakness, resp depression, CP, cardiac arrhythmias, confusion, seizures, & dystonia; can even result in coma
* Caffeine intoxication usually occurs following consumption in excess of 250 mg. Sx's may incl feeling restless, nervous, excited, insomnia, having a flushed face, diuresis, GI disturbances, muscle twitching, & rambling flow of thoughts & speech
45
* Stimulant withdrawal has been referred to as "crashing" b/c of the sx's of fatigue, cramps, depression, headache, & nightmare. It's a dysphoria that could be intense enough to result in inc risk of suicide. Peak withdrawal sx's usually occur within 2-4 days of abstinence
* Withdrawal syndrome can occur w/an abrupt cessation of caffeine intake after prolonged use & sx's generally begin 24 hrs after last consumption
* Withdrawal from nicotine results in dysphoric or depressed mood, insomnia, irritability, & frustration
46
? : Profile of the Substance
* fuels, solvents, adhesives, aerosol propellants, paint thinners
* huffing & bagging
* readily available, legal, & inexpensive
Inhalant Use Disorder
47
Inhalant Use Disorder: Effects on the Body
CNS effects
* Inhalants generally act as a CNS depressant
* Effects are relatively brief & last from several min to a few hrs & depends on the spec substance and the amt that's consumed
* Include ataxia, damage to the central & peripheral nervous system, speech problems, & tremor. W/heavy use = ototoxicity, encephalopathy, & Parkinsonism
* Damage to the protective sheath around the center nerve fibers have also occurred
Respiratory effects
* Ranges from coughing & wheezing to dyspnea, emphysema, & pna; there's also inc airway resistance
48
Gastrointestinal effects
* Incl abd pain, n/v; there may also be a rash present around the individual's nose & mouth. Unusual breath odors are common. Long term use has also resulted in liver toxicity
Renal system effects
* Incl acute & chronic renal failure; hepatorenal syndrome may occur
* Renal toxicity from exposure to a substance called toluene has been reported & results in renal tubular acidosis, hypokalemia, etc.
49
Effects on the Body: Inhalant Intoxication
! Dizziness, ataxia, muscle weakness
! Euphoria, excitation, disinhibition
! Nystagmus, blurred or double vision
! Slurred speech, lethargy
! Psychomotor retardation, hypoactive reflexes
! Stupor or coma
These effects develop shortly during or shortly after the exposure to the volatile inhalants
50
Opioid Use Disorder: Profile of the Substance
* Sedative & analgesic effects
* Medical use
* High abuse potential leading to tolerance & addiction
* Oral, snorting, smoking, IM, IV
* Prescription overdose death
* Heroin, with fentanyl or carfentanyl
51
Opioid Use Disorder: Effects on the Body
CNS effects:
* Incl euphoria, mood changes, & mental clouding; drowsiness; pain reduction; suppression of the cough center within the medulla & depression of the resp centers
Gastrointestinal effects:
* Stomach & intestinal tone are increased; peristaltic activity is diminished
* These effects lead to a marked dec in the movement of food through the GI tract & treatment of severe diarrhea
* Morphine is used extensively to treat pulmonary edema & the pain of MI
52
Cardiovascular effects:
* At high doses opioids induce hypotension
Sexual functioning:
* Is decreased w/opiate use & dec libido
! A complete bedside skin check is very important when you assess a pt w/opioid use disorder
53
___ ___
* consistent w/the half-life of most opioid drugs & usually lasts for several hrs
* sx's incl initial euphoria, apathy, dysphoria, psychomotor agitation or retardation, impaired judgment
* severe cases of can lead to resp depression, coma, & death
Opiate intoxication
! Pts who are opioid intoxicated might require admin of naloxone
54
Effects on the Body: Opioid Withdrawal
55
Ultra short-acting (____)
Sx's begin quickly, peak in 8-12 hrs, & subside in 4-5 days
meperidine
56
Short-acting drugs (____)
Sx's occur within 6-8 hrs, peak within 1-3 days, & gradually subside in 5-10 days
heroin
57
Long-acting drugs (____)
Sx's occur within 1-3 days, peak between days 4 & 6, & subside in 14 to 21 days
methadone
58
Hallucinogen Use Disorder: Profile of the Substance
* Naturally occurring hallucinogens
* Synthetic compounds
* Distorts perception of reality, alters sensory perception, & induces hallucinations
→ Use is usually episodic
e.g., mushrooms, molly, ecstasy, LSD, ketamine, & PCP
59
?
Is a spontaneous recurrence of hallucinogenic state w/o drug ingestion, & this can occur mos after last drug was taken
There is no physical addiction that's detectable when the drug is withdrawn; recurrent use can induce a psychological addiction
Flashback
60
Effects on the Body: Physiological
* N/V
* Chills, pupil dilation
* Inc BP, pulse
* Loss of appetite, insomnia
* Sweating, trembling
* Elevated BS, dec resp
Psychological
* Heightened response to color, sounds, body
* Distorted vision
* Sense of slowed time, fear of control loss
* Magnified feelings
* Paranoia, panic
* Euphoria, peace
* Depersonalization
* Derealization
* Inc libido
61
Effects on the body are highly unpredictable; may be r/t dosage, mental state, & use in the environment
2 types of reactions can occur & incl a panic reaction, or bad trip, & flashbacks, the transient, spontaneous repetition of previous hallucinogenic induced state
62
Effects on the Body: Hallucinogen intoxication
Sx's include:
* perceptual alteration
* depersonalization/derealization
* tachycardia/palpitations
Some involved rx's are sympathomimetics
63
?
* Inc HR, BP, temp
* dehydration
* confusion, insomnia, paranoia
MDMA (ecstasy)
64
?
* belligerence & assaultiveness
* may proceed to seizures or coma
Phencyclidine (PCP)
65
Cannabis Use Disorder: Profile of the Substance
* Cannabis is 2nd to alcohol as most widely used drug in US
* THC
* Smoked or orally when prepared in food
Effects on the Body
* Cardiovascular
* Respiratory
* Reproductive
* CNS
* Sexual functioning
66
Cardiovascular
* Tachycardia, orthostatic hypotension
* Dec in BP & myocardial oxygen supply (tachycardia inc oxygen demand)
Respiratory
* **Marijuana produces larger amts of tar which deposit in the lungs**, promoting negative effects
* Initial reaction to smoking marijuana is bronchodilation; chronic use results in obstructed airway disorders; freq users often have cases of laryngitis, bronchitis, cough, & hoarseness
* ***Cannabis smoke contains more carcinogens* than tobacco smoke**
67
Reproductive
* Some studies have shown that there may be a dec in sperm count, motility, & structure
* In women, heavy use can result in the suppression of ovulation, disruption in menstrual cycles, & alteration of hormone levels
CNS
* Feelings of euphoria, relaxed inhibitions, disorientation, depersonalization, & relaxation
* At higher doses, sensory alterations may occur incl impairment in judgement of time & distance, recent memory, & learning ability
* Physiological sx's incl tremor, muscle rigidity, & conjunctival redness
* Toxic effects are generally characterized by panic reactions; very heavy drug use has been shown to participate in acute psychosis that is self-limited & short lived once the drug has been removed from the body
* Heavy use is also assoc w/a condition called amotivational syndrome (is defined as a lack of motivation to persist in or complete a task that requires ongoing attention)
68
Sexual functioning
* Marijuana is reported to increase the sexual experience in both men & women
Cannabis intoxication
* Sx's incl: impaired motor coordination, euphoria, anxiety, sensation of slowed time, & impaired judgment
* Physical sx's incl: conjunctival injection (red eyes), inc appetite, dry mouth, tachycardia
Impairment of motor skills lasts for 8-12 hrs
69
Cannabis withdrawal
* Irritability, anger, aggression
* Nervousness, restlessness, anxiety
* Sleep difficulty, dec appetite or wt loss
* Depressed mood
* Physical sx's: abd pain, tremors, sweating, fever, chills, headache
Sx's can occur within a wk following cessation of use
70
Nursing Assessment
* CIWA-Ar
* Michigan Alcoholism Screening Test; CAGE questionnaire
* COWS
71
?
Determines whether an individual has a problem w/a substance
Michigan Alcoholism Screening Test & CAGE Questionnaire
72
?
Assesses risk & severity of withdrawal from alcohol
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
73
CAGE Questionnaire
* Has also been adapted to screen for drugs as well
* Scoring 2 or 3 a yes, in these questions, suggests a problem
Cut - Annoyed - Guilty - Eye-opener
74
Dual Diagnosis
* Clients w/a coexisting substance disorder & a mental disorder may be assigned to a special program that targets the dual diagnosis
* Program combines special therapies that target both problems
* These programs take a more supportive & less confrontational approach
Nursing Diagnoses
75
Outcomes
✔ Has not experienced physical injury
✔ Has not caused harm to self or others
✔ Accepts responsibility for own behavior
✔ Acknowledges association between personal problems & use of substance(s)
✔ Demonstrates more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances)
✔ Exhibits evidence of increased self-worth by attempting new projects without fear of failure & by demonstrating less defensive behavior toward others
✔ Verbalizes importance of abstaining from use of substances in order to maintain optimal wellness
76
Select Nursing Diagnoses
Risk for injury
→ obtain drug hx
→ observe behaviors & VS
→ freq orient the client to reality surroundings
Ineffective coping
→ establish trust; set limits
→ explore options; explain the effects of substance abuse
→ provide positive reinforcement
Denial
→ convey an attitude of acceptance
→ provide information to correct misconceptions
→ encourage participation in group activities
Dysfunctional family processes
→ review hx
→ provide info
→ involve the family
77
The Chemically Impaired Nurse: *Cues for recognizing substance impairment in nurses*
❐ High absenteeism may be present if the person's source is outside the work area
❐ Or, the person may rarely miss work if the substance source is at work
❐ Inc in "wasting" of drugs, higher incidences of incorrect narcotic counts, & a higher record of signing out drugs for other nurses who may be present
❐ Poor concentration, difficulty meeting deadlines, inappropriate responses, & poor memory or recall
❐ Problems w/relationships
❐ Unkempt appearance, impaired motor coordination, slurred speech, flushed face
❐ Pt complaints of inadequate pain control, discrepancies in documentation
78
State board response
! May deny, suspend, or revoke a license based on a report of chemical abuse by a nurse
! Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment
79
Codependency - Treating Codependence
* Survival stage
* Re-identification stage
* Core issues stage
* Reintegration stage
80
?
Self-acceptance & willingness to change occurs
They relinquish the power over others that was not rightfully theirs to begin with, but they reclaim their own personal powers that they do possess, & control is achieved through self-discipline & self-confidence
(IV) Reintegration stage
81
?
Is when the individual can accept the label of co-dependent & take responsibility for their own dysfunctional behavior
They accept their limitations & are ready to face the issues of co-dependency
(II) Re-identification stage
82
?
The individual begins to let go of the denial that problems exist or that their personal capabilities are unlimited
May be a very emotional time in a painful period for the person
(I) Survival stage
83
?
Facing reality that relationships can't be managed by force of will
Each partner must be independent & autonomous
Goal is to detach from control over those things that are beyond the individual's power to control
(III) Core issues stage
84
Treatment Modalities for Substance-Related Disorders
* Alcoholics Anonymous (AA)
* Counseling
* Group therapy
Pharmacotherapy for alcoholism
* Disulfiram (Antabuse)
* Naltrexone (Revia)
* SSRIs (tend to work better in moderate as opposed to heavy drinkers)
* Acamprosate (Campral)
85
Disulfiram (Antabuse)
Is administered as a deterrent to drinking; for those who abuse alcohol
! Is not a cure but a measure to control the impulse to drink
Mild reactions with alcohol levels as low as 5-10 mg/dL
* Liquid cough & cold preparations
* vanilla extract
* aftershave lotions
* colognes, mouthwash
* nail polish removers
* products w/isopropyl alcohol
Pts are to carry a card indicating that they're participating in disulfiram therapy
86
Severe reactions at ___-___ mg/dL
! Resp depression, cardiovascular collapse, arrhythmias
! MI, acute CHF, unconsciousness, convulsions, death
125-150
87
Symptoms at approx ___ mg/dL
! Flushed skin, throbbing in the head & neck, resp difficulty
! Dizziness, n/v, sweating, hyperventilation
! Tachycardia, hypotension, weakness, blurred vision, confusion
50
88
?
Is hypothesized to restore the normal balance between neuronal excitation & inhibition by interacting w/glutamate & gamma-aminobutyric acid (GABA) neurotransmitter systems
Acamprosate
89
?
Lowers overall relapse rates & fewer drinks per drinking day
Naltrexone
90
Psychopharmacology for Substance Intoxication & Substance Withdrawal
* Substitution therapy
Alcohol
* benzodiazepines
* anticonvulsant medication
* multivitamin
* thiamine supplement
91
? these are used for opioid ___ ?
naloxone (Narcan)
naltrexone (Revia)
nalmefene (Revex)
intoxication
92
? this is used for opioid ___ ?
buprenorphine
addiction
93
? these are used for opioid ___ ?
→ rest
→ adequate nutritional support
→ Clonidine (Catapres, methadone substitution)
withdrawal
94
→ Methadone does not produce the high that's assoc w/heroin
→ MAT (Medication-Assisted Treatment); usage of methadone, buprenorphine, & naltrexone to treat opioid use disorder
* These meds reduce cravings assoc w/addiction
→ Suboxone is a combo drug of buprenorphine/naloxone for opioid maintenance & to dec cravings
! Has a potential for abuse & diversion; some may remain on a maintenance dose for some time
95
Depressants - phenobarbital
Stimulants - tranquilizer
Hallucinogens & cannabinols - may use benzo or antipsychotics
* Withdrawal from CNS depressants, particularly barbiturates, is by phenobarbital use & treatment of stimulant intoxication usually begins w/minor tranquilizers like chlordiazepoxide & progresses to major tranquilizers like haloperidol
96
* Antipsychotics have to be given w/caution b/c of their propensity to lower the seizure threshold
* Hallucinogen & cannabis withdrawal don't usually have to be treated but if the pt is experiencing adverse reactions like anxiety or panic, benzodiazepines might be given
→ They might be useful if the client is becoming aggressive & psychotic reactions might require treatment w/an antipsychotic agent
97
Non-Substance Addictions: Gambling Disorder
* The disorder usually runs a chronic course, w/periods of waxing & waning
* Interferes w/interpersonal relationships, social, academic, or occupational functioning
Treatment
✔ Behavior therapy, CBT, motivational interviewing, 12-step programs
✔ Psychopharmacology
✔ SSRIs
✔ Clomipramine
✔ Lithium
✔ Carbamazepine
✔ Naltrexone
✔ Gambler's Anonymous
