Psych Exam 2 Substance Abuse

• Biological: genetics, low MAO, dehydrogenase, dopamine, acetate
• Social: stigma, environment, peers, family, abuse
• Psychological components: STRESS, depression, low self esteem, need for power, coping, hyperactivity, antisocial

• Deals with the limbic system
• Dopamine and pleasure circuit
• Drugs change brain physically and mentally

• Back: areas of emotion, memory, impulse, psychomotor activity
• Front: areas of fxn, planning, problem-solving, judgement, impulse control, organization (rational decision making)

Pathways change & not always recovered

• Aggressiveness
• Isolation
• Depression

• Addiction changes brain circuits
• Which leads to control circuit being impaired

Uncontrollable, compulsive drug seeking & use, even in the face of negative health & social consequences

• Chronic relapsing disorder/ disease
• Erodes self control and ability to make decisions
• No longer "free choice"
• Intense impulses to seek and take drugs
• Characterized by neuro-chemical and molecular changes in brain

• Early physical or sexual abuse
• Witnessing violence
• Stress
• Peers who use drugs
• Drug avaliability

• Intense wanting
• The more you want the drug, the less you like it

• Just 1 drink makes you want more
• Acetate accumulates, causing the want more more acetate

• Amygdala
• Part of the limbic system that controls memory and emotions

• Genetics, experience, environment, & drug effects create positive responses
• Changes in neurotransmitters lead to tolerance and withdrawl syndromes

• Abuse is using beyond the intended use
• Dependence is physiological dependence with tolerance and withdrawl

• Not the same as addiction
• An adaptive physiological state that results in withdrawl
• Not drug seeking
• Body requires more of substance to sustain the effect- body has gotten used to medication

• Maladaptive pattern of use leading to clinical significant impairment or distress manifested by one of the following within a 12 mo period:
• Recurrent use with a failure to fulfill a major role at work, school, or home
• Recurrent use in situations where use is physically hazardous
• Recurrent substance-related legal problems
• Recurrent use despite persistent social or interpersonal problems caused or exacerbated by substance use

• At least 3 characteristics over 12 mos:
• Evidence of tolerance
• Evidence of withdrawl
• Substance taken in larger amt or over long period of timd than intended
• Persistent or unsuccessful desire to cut down or control use
• Great deal of time spent in obtaining, using or recovering from substances
• Cont'd use despite knowledge of persistent psychological or physical problems

• Dependence includes tolerance, withdrawl, or a pattern of compulsive use
• Abuse includes only harmful consequences of repeated use

• A mood disturbance is prominent and persistent and is characterized by either (or both) of the following:
• Depressed mood and markedly diminished interest or pleasure in all, or almost all, activities
• Elevated, expansive, or irritable mood
• Rule out: Axis 1 mood d/o or delerium

• Sx developed during, or within a month of Substance Intoxication or Withdrawal
• Sx cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
• Med use is etiologically r/t the disturbance

• Blood ETOH level (BAC)- 1oz/hr healthy liver metabolized
• Drugs of Abuse Screen
• Blackouts- still can fxn, but doesn't remember/aware
• Withdrawal
• Intoxication
• Delirium Tremens
• Relapse- recurrance of drug or ETOH abuse for significant amt of time

• Opioids bind special proteins causing a block in transmission of pain messages to the brain
• Opioids SE- drowsiness, constipation, respiratory depression
• Cause Euphoria- pleasure in the brain

• CNS Depressant
• sedation
• confusion
• impaired motor fxn or speech
• coma
• respiratory failure
• death

• cerebellar degeneration
• impaired coordination
• broad-based unsteady gait
• fine tremors
• Dependence
• Cirrhosis
• ETOH-induced amnestic d/o

• Speeds up brain, nervous system, and body
• Inc RR, BP, Temp
• More alert/awake
• Restlessness
• Insomnia
• Dec appetite

• Brain/heart damage
• Labile mood
• Violent/ aggressive behavior
• Hallucinations
• Paranoia
• Wt loss

• Speeds up body and brain
• Inc RR, BP, Temp
• More alert/awake

• Lung damage
• Nasal ulcers
• Personality changed
• Violent/ aggressive bahavior
• Paranoia
• Hallucinations

• Diaphoresis
• Hallucinations
• Confusion
• Tremor
• Restlessness

• Check neck for diaphoresis
• Observe pt for hallucinations
• Check abdomen for tremors

• Prevent falls due to Orthostatic Hypotension
• Get up slowly
• Sit on edge of bed for 1 min
• Drink 8-10 glasses of water
• Report Dizziness
• Do NOT flush vomit or diarrhea

• Dialated pupils
• Gooseflesh
• Muscle Twitching
• BP
• Pulse
• Temp
• Vomitting
• Diarrhea

• Run fingers over forearm for gooseflesh
• Sit for 5 min before BP
• Tell pt- save vomit
• Warm shower for aches
• Non-med interventions

• Obvious impaired judgement and functioning, & maladaptive behavior
• Scales: arousal, speech, gait, romberg, nystagmus

• Co-existing substance d/o and mental d/o may be assigned to special program
• Program combines special therapies that target both problems

• Safe removal of the chemical from the body
• Provide for physical, emotional, and psychological safety

• Benzos
• Anticonvulsants
• Multivitamin Therapy
• Thiamine
• (note: tremors preceed seizures)

• Occur w/in 24-48 hrs, and continue 1 week
• Agitation, confusion, anxiety, delusions, coarse tremors, fever, diaphoresis, inc heart rate, precordial pain
• Seizures
• Hallucinations- tactile & auditory

• Life-support
• Labs (electrolytes)
• Hydrate
• VS
• Tx seizures
• Tx BP w/ Clonidine
• Tx w/ haldol

• Narcan (if resp distress)
• ReVia or Revex (long term antagonists)
• Methadone or Bupreorphine (slow replacement)
• Clonidine (emergency BP)

• Steady State for baby
• Baby 2-3X more intense

• Holistic Care (esp. non-med interventions)
• Referrals to programs
• Care and nurture

• Ineff denial
• Early: Imbalanced Nutrition
• After: Ineffective Coping
• Not urgent: Risk for infection, low self-esteem, knowledge deficit

• ETOH: Disulfiram, Naltrexone, Campral
• Opioids: Burenorphine

• Feedback- drinking is risky
• Responsibility- client change behavior
• Advice to change
• Menu of ways to reduce drinking
• Empathic counseling
• Self-efficacy (give message of empowerment)

• Reduce
• Harm reduction
• Consequences (job)
• Follow-up

• Encourage cont'd participation in long-term tx
• Promote participation in outpt support system
• Assist client to id alternative sources of satisfaction
• Provide support for health promotion and maintenance

• Provide support
• Strengthen coping skills
• Facilitate learning
• Promote family involvement
• Facilitate family growth/dev
• Provide info

• Responsibility for own life
• Plan for substance-free
• Family relationships addressed
• Tx program started
• Condition, prognosis, therapy understood

• Activities to substitute substances in times of stress
• Relaxation techniques
• Problem-solving skills
• Essentials of good nutrition

• Blocks receptors resulting in Reduced Craving
• Contraindicated in acute opioid withdrawal
• Precipitates severe withdrawal if depended on opioids
• Monitor liver fxn

• Action: Affects glutamate neurotrasmitter
• Monitor renal fxn
• Adverse: SI and behavior

• Action: inhibits metabolism
• DO NOT DRINK ETOH w/in 12 hrs!!!
• Rxn- flushing, sweating, nausea, tachycardia