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substance use disorders
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SUBSTANCE USE DISORDER
- Mr. Manish BijalwanM.Sc Nursing 1st yr
SCON
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
DSM-V
Substance abuse or substance
dependence disorders are merged into substance use
disorder.
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)
DEFINITIONS:
SUBSTANCE USE DISORDER:
A disorder in which the use of one or more substances leads to a clinically significant impairment or distress
PSYCHOACTIVE SUBSTANCES
1. Alcohol2. Opioids (opium,
heroin)3. Cannabinoids
(cannabis)4. Cocaine5. Amphetamines
and other sympathomimetics
6. Hallucinogens (LSD,
phencyclidine)7. Sedatives and
hypnotics (barbiturates)
8. Inhalants (volatile solvents)
9. Nicotine10.Other stimulants
(caffeine)
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
ETIOLOGY
2.PSYCHOLOGICAL 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
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
SUBSTANCE ABUSE
ADDICTIONDEPENDENC
Y
TOLERANCE
WITHDRAWAL
CLASSIFICATION:
1.ACUTE INTOXICATION2.WITHDRAWL STATE3.DEPENDENCY SYNDROME4.HARMFUL USE
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
CLASSIFICATION:
1.ACUTE INTOXICATION Features
Trauma Delirium Coma Perceptual distortions Convulsions Alcohol intoxification (liver
cirrhosis)
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
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
CLASSIFICATION:
3.DEPENDENCE SYNDROME Types:
a) Physical dependenceb) Psychic dependencec) tolerance
S.NO
PSYCHOACTIVE SUBSTANCE
ROUTE PHYSICAL DEPENDEN
CE
PSYCHICDEPENDENC
E
TOLERANCE
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
S.NO
PSYCHOACTIVE SUBSTANCE
ROUTE PHYSICAL DEPENDE
NCE
PSYCHICDEPENDEN
CE
TOLERANCE
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
CLASSIFICATION:
4.HARMFUL USE continued drug use
despite the awareness of harmful medical or social effect of the drug
SIGN & SYMPTOMS
1.Behavioral changes2.Physical changes3.Social changes
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
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
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
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
DIFFERENT SUBSTANCE USE DISORDERS
ALCOHOL USE DISORDER
Previously known as alcoholism
Common in males Onset is late second or third decades
May be associated with other drug use
TYPES OF AUDS.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
TYPES OF AUDS.NO ALCOHOL
USE DISORDE
R
FEATURES
4 DELTA •Inability to abstain•Tolerance•Withdrawal symptoms•Amount of consumption can be controlled•Minimal social disruption
5 EPSILON Compulsive drinking-dipsomaniaSpree drinking
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
COMPLICATIONS
1. ACUTE INTOXICATION:
Alcohol consumption
25-100% BAC
CNS depression
Excitation period
Increased reaction time
Slowed thinking,Poor motor control
COMPLICATIONS
2.WITHDRAWAL SYNDROME Common symptoms: Hangover in the next morning,
Mild Tremors, Nausea, vomiting, Weakness, Irriatability
Three types1. Delirium tremens (2-4 days)2. Alcoholic seizures(12-8 hrs)3. Alcoholic hallucinosis
TREATMENT
1. Detoxification (benzodiazepines)2. Behavioral therapy 3. Psychotherapy4. Group therapy5. Deterrent agents (disulfiram,
nitrafezol)6. Anti craving drugs (naltrexone,
SSRIs)7. Psychosocial rehabilitation
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”
OPIOIDS USE DISORDER
ACUTE INTOXICATION: Apathy, bradycardia,
hypotension, respiratory depression, delayed reflexes, thready pulse, coma
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
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)
TREATMENT IN OPIOIDS USE DISORDER
Behavioural therapy Self control strategies Family therapy Group therapy
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
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.
Withdrawal syndrome
Potential for Seizures, delirium and cardiovascular collapse
Insomnia, anxiety, profuse sweating, weakness
Must Be W/d Gradually
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.
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
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 ideationAnxiety, anhedonia, sleep disturbance, increase appetite,
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
Cocaine abuse
INTOXICATION Increased Pulse And B.P. Euphoria and a Sense of Well Being Dilated Pupils Insomnia AnorexiaOVERDOSE Seizures Cardiac Arrest Convulsions & Death
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
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
Nicotine
Route : smoking, chewing, buccalCommon names : cigarettes, cigars, bidis, kreteks, pipe tobacco, snuff, chewing tobaccoIntoxication : 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.
Treatment goals
Abstinence Harm minimization Improvement of health, social &
occupational functions Improvement of quality of life.
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