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
- 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”
- 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.
- Cocaine, and crack cocaine.
- No pharmacological interventions for cocaine use
- Extremely addictive,
- High may last for days
- Can have “meth mouth” where teeth fall out
- 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.
- The leading preventable cause of disease, disability, and death in the US.
- Contribute to 443,000 deaths year.
- Higher prevalence in the schizophrenia population.
- Treatments to stop smoking: nicotine replacement, Bupropion, Varenicline tartrate
- 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.