substance disorders

  1. 4 categories of substance abuse disorders
    • related to abuse of a substance
    • related to dependence on a substance
    • those induced by intoxication
    • those induced by withdrawal
  2. substance abuse
    • maladaptive pattern of substance use leading to clinically significant impairment or distres manifested by 1 or more of the following within 12 months:
    • recurrent use causing failure to fulfill major role obligations at work, home or school
    • recurrent use in situations that are physically hazardous
    • recurrent substance-related legal problems
    • continued use despite persistent or recurrent social and interpersonal problems caused or exacerbated by effects of substance
  3. substance dependence
    • maladaptive pattern of substance use leading to impairment/distress as manifested by:
    • tolerance
    • withdrawal
    • taking the substance in large amounts or over a longer period of time than was intended
    • persistent desire or unsuccessful efforts to cut down or control use
    • much time spent in activities necessary to obtain or use the substance
    • reduction of important social, occupational or recreational activities
    • continued use despite knowledge of persistent or recurrent physical or psychological problems likely caused/exacerbated by the substance
  4. substance intoxication
    • reversible substance-specific syndrome due to recent ingestion of or exposure to a substance
    • clinically significant maladaptive behavioral or psychological changes due to effect of substance on CNS
    • symptoms not due to general medical condition or better accounted for by another mental disorder
  5. substance withdrawal
    • development of substance-specific syndrome due to cessation or reduction in substance use
    • syndrome causing significant distress or impairment in social, occupational, or other important areas of functioning
    • symptoms not due to general medical condition or better accounted for by another mental disorder
  6. symptoms of alcohol withdrawal syndrome
    • increased BP, HR, temp
    • diaphoresis
    • GI effects
    • CNS effects: anxiety, restlessness, hand tremors, confusion, seizures, DTs
  7. mild withdrawal
    • hangover
    • headache, nausea, fatigue, thirst
    • all due to dehydration, hypoglycemia, accumulation of lactic acid and aetaldehyde
    • begins 4-6 hours after drinking
  8. moderate withdrawal
    • worsening of same symptoms as mild, also see auditory/visual hallucinations
    • begin about 12 hours after drinking
  9. severe withdrawal
    • severe diaphoresis, gross uncontrollable tremors, rejection of all foods and fluids
    • unable to sleep, agitated, can be in panic state
    • generalized tonic-clonic seizures, can be 2-3 days after they stop drinking
  10. Delirium Tremens
    • tachycardia, diaphoresis, hypertension, confusion
    • tremor, disorientation, vivid hallucinations
    • resolves in 3-4 days, can be fatal in 20% of cases
    • pts with DTs are considered danger to themselves and others, very unpredictable
    • can be prevented with benzos
  11. Wernicke's syndrome
    • alcohol induced amnestic disorder
    • sudden or indisious onset
    • caused by thiamine deficiency, reversible
    • ataxia (unsteady gait), confusion, ocular motor abnormalities ( horizontal nystagmus)
  12. Korsakoff's syndrome
    • follows wernickes's, still thiamine deficiency
    • loss of recent memory
    • confabulation: unconsciously filling in memory gaps by imagining experiences that have no basis in fact but they think is true
    • cannot fully recover from cognitive effects
  13. treatment of withdrawal
    • benzos to produce sedation and reduce anxiety
    • diazepam, librium, ativan
    • antabuse: makes you sick if you drink alcohol
    • naltrexone: developed for heroin use, reduces cravings
    • campral: reduces cravings in someone already abstinent, not very effective
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substance disorders