Substance abuse disorders

• substance addiction
• physical dependence
• psychological dependence

Substance use disorder involves repeated use of chemical substance, leading to clinically significant impairment during 12 month period and two of the following criteria is met

• use of substance interferes with ability to fulfill obligations
• attempts to cut down or control use fail
• intense craving for substance
• continued use despite social or intrapersonal problems associated with use

• causes difficulty with interpersonal relationships or becoming socially isolated (state dependent learning)
• engages in hazard activity when on substance ie driving
• tolerance develops and the amt required to achieve the desired effect incr
• - problem can be respiratory center supression- can't tell
• substance-specific symptoms occur upon discontinuation of use
• spend considerable amt time obtaining, using or recovering from the effects of substance and exhibits withdrawal

• development of a reversible syndrome of symptoms following excessive use of substance
• direct effect on the CNS
• disruption in physical and psychological functioning
• judgement is disturbed and social and occupational functioning is impaired

• development of symptoms that occurs upon abrupt reduction or discontinuation of a substance that has been used
• symptoms are specific to whatever you are using
• disruption in physical and psychological functioning with disturbances- thoughts, feelings, behaviors

• alcohol
• caffeine
• cannabis
• hallucinogens
• inhalants
• opioids
• sedatives/hypnotics
• stimulants
• tobacco

• Genetics- alcohol
• biochemical- alchol can produce morphine like
• use before adding ??
• used before 14yrs 44%
• more addictive

• certain personality traits are thought to inc a tendency toward addictive behaviors
• such:
• low self esteem
• depression
• instant gratification
• person w/inability to relax
• peeps cant communicate effectively
• people who love taking risk

• social learning- home parents modeling
• peer group- promoting it
• coping- at times of stress, death of a love one, retirement, socially isolated
• cultural/ethnic influences-more use- like american indian
• behavioral conditioning- peeps who get pleasurable effect using, events, parties, social gatherings

• approx half of college students participate in binge drinking or substance use every month
• the % of college students who use substance is higher than the general population
• anabolic steroid use is growing, called juicing, gym candies, or stackers can be taken orally or by injection to enhance performance & physically appearance. negative effects include liver damage HTN infertility
• older adults are prone to falls, memory loss and reduced ability to care for self. the may show effects of alcohol use earlier and the potential for interaction with rx drugs is high. older adults are at high risk for substance use following retirement

• 1. phase I Pre-alcoholic phase- use of alcohol to relieve everyday stressors of life
• 2. phase II: early alcoholic phase person may blackout. alcohol is now required by the person
• 3. Phase III: the crucial phase- person loss control. physiological dependence. no choice- binge drinking several weeks
• 4. Phase IV: the chronic phase- emotional and physical desinegration. more intoxication than sober

• Effects of alcohol on the body
• - peripheral neuropathy- is characterized by peripheral nerve damage
• s/s
• pain
• burning
• tingling
• prickling sensation of extremities

• Acute: sudden onset of muscle pain, swelling, and weakness, reddish tinge to the urine, rapid rise in muscle enzyme in the blood
• Vita b12 defencies
• myoglobin leaking out of muscle- going to urine- red tinge
• chronic- gradual wasting and weakness in skeletal muscle

• Wernicke's encephalopathy: abnormal brain function- thiamine defencies (b1 vitamine)- serious
• Korsakoff's psychosis: confusion, loss of recent memory (alcohol)

• heart
• too much lipids in myocardial cells
• weakens heart and enlarges it

inflammation and pain in the esophagus occurs bc of the toxic effects of alcohol on the esophageal mucosa

• effects of alcohol on the stomach include inflammation of the stomach lining
• throwing up HCL acid
• engastric distress
• n/v distention

• acute: usually occurs 1 or 2 days after a bine of excessive alcohol consumption
• symptoms:
• - acute epigastric pain- severe
• - n/v
• chronic: leads to pancreatic insufficiency
• resulting in- steatorrhea (mad smelling), malnutrition, wt loss, DM
• - abd distention

• caused by long term heavy alcohol use
• symptoms:
• - enlarged tender liver
• - n/v
• - lethargic
• - anoerexia
• - inc WBC
• - fever
• - jaundice
• - ascites
• - wt loss in severe cases

• cirrhosis end stage of alcohol liver disease and it is believed to be caused by heavy alcoholic use
• there is widespread- damage to liver cells, scar tissue
• portal htn- elevation of bp through the portal circulation
• -results from
• blood can't flow thru

• a condition in which an excessive amt of serous fluid accumulates in abd cavity
• occurs

• distended
• sensitive
• can bleed easily
• aspiration
• medical emergency

cannot excrete ammonia thru the gi tract. not able to go thru liver..ends up in the blood stream and goes to the brain

• leukopenia- dec wbc- impaired production of wbc
• thrombocytopenia- dec platelet production- no clotting factor

• short term- enhance libido, failure of erection
• long term- gynomastia, incr libido, sterile/impotence

• alcohol used during pregnancy can result in fetal alcohol spectrum disorders (FASDs) include following:
• - fetal alcohol syndrome (FAS)
• - alcohol-related neurodevelopment disorder (ARND)
• - alcohol related birth defects (ARBD)
• problems w/learning, memory, attention span, communication, vision/hearing

• no amt of alcohol during pregnancy is considered safe
• it could damage fetus at any stage of the pregnancy
• since FAS covers a wide range of problems, there are many possible symptoms. ranges from mild to severe

• abnormal facial features
• small head size
• shorter than average height
• low body wt
• poor coordination
• hyperactive behavior
• difficulty paying attention
• poor memory
• difficulty in school
• learning difficulties
• speech and language delays
• intelluctual disability
• poor reasoning skills
• sleep and sucking problems as a baby- lead to aspiration
• vision or hearing problems
• problems w/heart kidneys, or bones

• occurs at blood alcohol levels between 100-200 mg/dl
• s/s:
• - peak withdrawal 24-48hrs
• - 2-3 days do thru DT
• - DT last 2-3 days
• - s/s DT: severe disorientation, pyschotic symptoms, hallucination, severe HTN, cardiac dysrhythmia, delirum,
• alcohol and benzo progress to death
• death reported with levels between 400-700

• occurs within 4-12 hours of cessation of reduction in heavy and prolonged alcohol use
• s/s
• monitoring:
• administer meds
• aware of s/s
• dec stimuli environment
• rest and nutrition
• vita B
• fluidsa
• provide reality orientation
• can give librium or serax (if liver damager)
• antibuse will get u sick