Session 7: Substance Abuse Disorders

Session 7 Substance Abuse Disorders

 

NIAAA is a group that tracks statistics about alcohol use

 

Chronic alcohol use is a CNS depressant, this can lead to increasing depression symptoms in a patient that is chronically using alcohol

 

AUD – alcohol use disorder. (mild, Moderate, Sever)

  • A cluster of cognitive behavioral, and physiological symptoms indicating that the individual continues use even though there are issues arising in the person’s life related to drinking.
  • Criteria groups:
    • Impaired control
    • Social impairment
    • Risky use
    • Pharmacological
  • Severity is defined by how many criteria that the person is completing
  • If a person starts drinking before 15 there is a 50% higher chance to develope AUD
  • DUI – BAC 0.08 g/dl
  • DWAI – BAC 0.05 g/dl
  • UUD – underage drunk driving
  • Implied consent for breathalyzer in colorado and if you refuze there is a 1 year suspension of licence.

 

Medications to help a person to stop drinking (9% of patients with AUD get one of these meds)

  • Disulfiram, Antabuse – discovered on accident and causes person to feel sick with alcohol. It also has a long half life about 2 weeks but a person can drink after 3 days or so. The patient who is required to take this drug may need to take it in front of a healthcare worker 3 times a week for their probation
    • Disulfiram reaction – flushing increased HR, SOB, Nausea and VOM. Side Effects – drowsiness headache, hepatotoxic.
  • Naltrexone – do not feel the good effects of alcohol
  • Acamprosate (campral)
  • Vivitrol – month long injection of naltrexone
  • Topamax – not yet approved for alcohol. Decreases cravings of alcohol.
    • Now commonly used for seizures and migraines

 

Alcohol withdrawal syndrome

  • N/V, tremors, kindling effect (each time the person goes through withdrawal it get worse.), diaphoresis, high BP HR and temp, seizures,
  • CIWA score
  • Can be deadly!
  • Getting a alcohol history is important and is needed to treat the patient.
  • TREATMENT –
    • CIWA Q4h
    • Vitals – B1 often in a “banana bag”
    • Fluids
    • Pharm: Short acting benzodiazepines (lorazepam Ativan, alprazolam Xanax)

 

Opiates – from poppy plant. morphine, heroin, oxycodone

  • Opioids – synthetic opiates
  • Withdrawal can last 72-96 hours and is not usually deadly.
  • OD s/s: excessive CNS depression, respiratory depression, pinpoint pupils
  • Noxalone (Narcan) – is the opiate overdose med to stop symptoms but the H/L is shorter than the heroine H/L so there may need multiple doses.
  • Methadone clinics are used to take a person off of a street drug and hopefully wean them off of opiates in general.

 

Stimulants

  • Cocaine, and crack cocaine.
    • No pharmacological interventions for cocaine use
  • Methamphetamine
    • Extremely addictive,
    • High may last for days
    • Can have “meth mouth” where teeth fall out

 

Cannabis

  • Smoked
  • Adolescence and cannabis, can affect attention, memory, and IQ. This may not improve after succession of use of the drug
  • “Spice” – called an alternative to cannabis, but there are intense side effects: agitation, vomiting, heart attacks, strokes, brain damage, psychosis.

 

Tobacco

  • The leading preventable cause of disease, disability, and death in the US.
  • Contribute to 443,000 deaths year.
  • Stimulant
  • Higher prevalence in the schizophrenia population.
  • Treatments to stop smoking: nicotine replacement, Bupropion, Varenicline tartrate

 

Gambling disorder

  • AA for gamblers exists

 

Nurses and substances

  • Alcohol use is similar to the general population
  • Prescription drugs is higher in professionals almost 7% of population
  • A nurse is required to report suspected use by other healthcare workers.
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