Chemical Dependency

When people start using alcohol & drugs development stops. 

• Breathalyzer intoxication- 0.080
• Blood alcohol equivalency = 80. 

25mg/liter/hr. is the average person.

• Maladaptive use of substances with significant impairment in 3 or more of:
• Tolerance develops
• Withdrawal symptoms occur
• Substance taken in larger amounts over a longer time
• Has persistent desire for substances
• Unsuccessful efforts to cut down
• Spend time in procuring substance
• *Social/occupational/recreational interests given up
• *Continues to use despite physical and/or psychological problems

• Impaired consciousness, reduced awareness of environment
• Changes cognition (memory, disorientation, hallucinations, illusions)
• Develops over a short time (hours to days) and fluctuates over day
• Evidence of substance use history

• Low tolerance for frustration & pain
• Lack of success in life
• Lack of affectionate, meaningful relationships
• Low self-esteem
• Takes risks

Forming a relationship with a bottle and not people.

• Less alcohol dehygrogenase, especially in:
• Native Americans
• Japanese
• Women
• Others

• Minor withdrawals:
• Tremors
• Agitation and Anxiety
• Diaphoresis
• Sleep disturbances
• Seizures
• Hallucinations
• Nausea/vomiting
• Insomnia

• Increase in pulse (over 100)
• Increase in BP 
• Sweating
• Hand tremors

• Delirium tremens:
• Anxiety
• Insomnia
• Anorexia:
• Autonomic hyperactivity (elevated BP, pulse, diaphoresis)
• Severely disturbed sensorium (disorientation, clouded consciousness)
• Fluctuating levels of consciousness (hyperexcitability to lethargy)
• Perceptual disturbances (Hallucinations)
• Delusions (paranoid)
• Elevated fever
• Onset occurs around 72 Hours after last drink

• Benzodiazepines, ie
• --Chlordiazepoxide (Librium)
• --Clorazepate (Tranxene)
• --Lorazepam (Ativan)

• Used to discourage drinking. If on disulfiram and then drink-->aldehydre reaction:
• --feels like a heart attack
• Cx if liver enzymes are elevated 5 times normal because affects liver. 

• Naltrexone (Revia and Depade) blocks the pleasure & decreases cravings 
• Contraindicated if liver enzymes are elevated 5 times normal because it affects liver (safer than drinking)
• Vivitrol: Injection of Naltrexone extended release once/month

• euphoria,
• wakefulness,
• talkative,
• rush of energy,
• hyperactive,
• irritable,
• anorexia,
• increased vital signs,
• pressured speech,
• grandiosity,
• slurred speech,
• labile

• depression,
• agitation,
• anxiety,
• drug craving,
• fatigue,
• sleeps,
• insomnia,
• hunger,
• anergia,
• anhedonia

• False
• Need sleep, proper nutrition, and exercise. 

• Severe fatigue, anxiety, depression, and confusion
• Meth craving strong
• Life can feel hopeless; recovery impossible 
• Emotions influenced by a lack of dopamine.
• Recovery:
• Within 2-10 days some recovery of dopamine occurs
• With proper sleep, nutrition, and exercise, brain and body begin to recover.

• euphoria,
• relaxation,
• pain relief,
• apathy,
• detachment,
• impaired judgment,
• drowsiness,
• constricted pupils,
• nausea,
• constipation,
• slurred speech,
• respiratory depression

Lacrimation, rhinorrhea, yawning, diaphoresis, In 12-72 hrs--sleep disturbance, anorexia, dilated pupils, piloerection, irritability, tremor, N/V, diarrhea, chills, fever, muscle spasm, flushing, increased vital signs, abdominal pain

• Methadone (cross addiction occurs) 
• Suboxone (Buprenorphine)
• --both used to ease off opioids.

• Antiemetics
• Naltrexone
• Catapres (muscle cramping)
• --adjuncts to treat symptoms of detox. 

• Depression of brain function (mood, thinking, attention, concentration, judgment, memory, affect, emotions)
• Increased reaction time
• Poor coordination
• Decreased REM sleep-->vivid dreaming.
• *Know alcohol abuse Hx, because body has a hard time distinguishing between benzos and alcohol which may lead a recovering alcoholic back into drinking. 

• Anxiety
• Restlessness
• Vivid dreaming
• Dilated pupils
• Increased pulse and BP
• Insomnia

• Can convulse if untreated 
• Use anticonvulsant such as phenobarbital
• Can taper off medication

• distorted perception & hallucinations
• Time & space distortions
• Depersonalization
• Heightened awareness
• Mood lability
• Paresthesias
• Increased vital signs
• Dizziness
• Tremor
• Increased salivation
• Panic attacks

none

• Psychotic experience
• Confused
• Disoriented
• Paranoid
• Euphoria
• Bizarre perceptions 
• Agitation
• *Enhancement of strength
• *Rage
• --Both are effects of adrenaline dump, not a direct result of the PCP. 
• Dilated pupils
• Red skin
• Ataxia
• Hypertension
• Rigidity
• Seizures

None

belligerence, assaultiveness, apathy, impaired judgement, dizzy, incoordination, slurred speech, unsteady gait, tremor,  blurred vision, euphoria, anorexia

Most commonly used by high school students. 

• Headaches
• Chills
• Abdominal cramping
• Delirium

altered awareness, relaxation, euphoria, reduced inhibition, red eyes, dry mouth, increased appetite, increased pulse, decreased reflexes, panic reactions

No withdrawal effects.

• Reversible brain changes & sex changes (may decrease motivation and v testosterone/estrogen levels)
• Causes emphysema quicker than smoking
• Contains 60 toxins

• Cut down ("have you ever tried?")
• Annoyed with others
• Guilt feelings
• Eye-opener ("Do you need one?")

• **Vital signs-- BP & pulse elevates because of autonomic rebound and CIWA used to track withdrawal symptoms
• Check labs:  CBC, H&H, platelets; K+, Ca+, Mg+, GGT (liver enzyme. If elevated pt has been drinking heavily over time.)
• Assess for DTs (want to know when last drink was) and seizures. Get on Benzos to prevent.

Retains ammonia in colon (decreases blood ammonia concentration) by producing osmotic effects and promotes increased peristalsis and bowel evacuation.--> really bad diarrhea. Prevents ammonia build up in brain which is the cause of confusion for pt with liver damage.

• Benzos
• Vitals at least q4h
• Folic acid
• thiamine
• PRN antacid
• Ecotrin (for headaches)

• Owns substance problem
• Attends aftercare meetings, AA, ALANON for spouse
• *Is alcohol free
• 0.00 breathalyzer
• Plans sober leisure activities
• *Accepts responsibility for own behavior
• Changes faulty thinking
• Deals with feelings
• Uses healthy coping mechanisms

• Establish a 1:1 trusting relationship
• Assess the level of denial
• Assist patient in grieving loss of substances
• Identify triggers to using
• Explore healthy coping skills
• Assist to find alternative  ways to deal with life without substances
• Help patient accept responsibility for own behavior
• Assess guilt and assist with making amends
• Confront unhealthy thoughts and behavior
• Set limits on behavior 
• Help deal with feelings
• Instruct about critical periods
• 3, 6, 9, 12 months, 1.5 and 3 years (may have vivid dreams about using the substance)
• HALT [Hungry, angry, lonely & tired]
• Assist with problem-solving
• Teach social skills as needed
• Learn new and proper ways in dealing with members of the opposite sex
• Discuss consequences of substance use
• Assist with leisure activities
• Refer for aftercare, AA, NA, CA, others