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48 Cards in this Set
- Front
- Back
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Concept of addiction |
chronic, relapsing brain disease; may be substance free for long period of time followed by relapse |
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four C's of addiction |
-compulsive behavior -cravings -chronic relapsing brain disorder -cognitive impairment |
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Abuse |
-habitual use that falls outside the medical necessity or social acceptance for the purpose of altering ones mood, emotion, or state of consciousness -adverse effects to the abuse or others |
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Biological theory of addiction |
-specific effects on selected neurotransmitters -limbic reward system -opioids: GABA receptros -cocaine/amphetamines: dopamine/serotonin |
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Genetic theory of addiction |
believed to account for 40-60% of vulnerability -3-4x more likely w/ parents who use |
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Psychological theory of addiction |
-defense against anxious impulses -lack of impulse control -low self-esteem -self-medication for depression/anxiety (multiple substances) |
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Behavioral theory of addiction |
positive reinforcement effects of drug seeking behavior |
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Sociocultural theory of addiction |
-social and cultural |
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Tolerance vs. withdrawal |
Tolerance: body adapts to the substance and requires increasing ants to reproduce same effect Withdrawal: after long period of continued use, stopping or reducing drugs results in specific physical or psychological s/s |
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Psychiatric disorders associated with substance abuse |
-acute/chronic cognitive impairment disorders -attention deficit disorder -borderline and antisocial PD -anxiety disorders -depression (high risk for suicide) -eating disorders -compulsive behavior |
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DSM 5 substance disorder vs substance induced DO |
-doesn't distinguish between abuse vs. dependence -can be mild (2-3), moderate (4-5) or severe (>6 sxs) |
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What are the two questions of importance? |
1. In the last year have you ever drank or used drugs more than you meant to? 2. Have you felt you wanted or needed to cut down on your drinking or drug use in the last year? |
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Details for assessment |
-route -quantity -time of last use -usual pattern of use |
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0.05 BAL |
change in mood, behavior, and impaired judgement |
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0.08 BAL |
Clumsiness in voluntary motor activity |
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0.20 BAL |
Staggering, ataxia, emotional lability |
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0.40 BAL |
Coma |
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0.50 BAL |
death from resp depression |
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S/S of alcohol withdrawal |
Early signs a few hrs after decreasing alcohol Signs peak after 24-48 hrs then rapidly disappear -hyperalertness -jerky movements -irritability -easily startled -shaking inside |
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Withdrawal delirium |
-medical emergency that can result in death (MI, aspiration, pneumonia, peripheral vascular collapse) -Peaks 2-3 days after cessation of alcohol and lasts 2-3 days |
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S/S of withdrawal delirium aka Delirium tremens (DTs) |
-tachycardia, diaphoresis, elevated BP -disorientation and clouding of consciousness -visual or tactile hallucinations -hyperexcitability to lethargy -paranoid delusions, agitation -fever (100 to 103) -grand mal seizures |
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Assessment of chemically impaired clients |
-suicidal/homicidal? -overdose needing immediate attention -withdrawal symptoms -physical complications -clients interest in tx addiction -clients and family's knowledge of community resources |
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Intervention |
Aim of tx: self-responsibility -Challenge: matching clients with types of tx considering various needs (type of addiction, age, physical health, neuropsychological health, financial situation, location of program, length of program, family needs) |
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Communication guidelines |
Behaviors to be addressed -dysfunctional anger, manipulation, impulsiveness, grandiosity Make abstinence and sobriety worthwhile for client Communicate in culturally appropriate ways |
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Trexan, REvia (naltrexone) |
-blocks opiate receptros -interferes w/ mechanism of reinforcement -reduces or eliminates the "high" and drug craving |
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Campral (acamprosate) |
-Helps client abstain from alcohol; reduces unpleasant effects of abstinence (anxiety, dysporia), and reduces craving -mechanism not well understood |
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Antabuse (disulfiram) |
-works on classical conditioning principle -alcohol-disulfiram reaction causes unpleasant physical effects |
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What else can help treat alcoholism? |
B12 and thiamine Wenicke/Korsakoff syndromes are considered to be caused by thiamine deficiency secondary to alcohol abuse |
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Health education: FRAMES |
F: feedback of personal risk R: Responsibility of the patient A: advice to change M: menu of ways to reduce substance use E: empathetic counseling S: self-efficacy or optimism of the patient |
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Common signs of stimulant abuse |
-dilation of the pupils -dryness of the nasal cavity -excessive motor activity |
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Cocaine and crack |
-extracted from leaf of cocoa bush -when smoked takes effect in 4-6 seconds; a 5-7 min high follows then a deep depression Two main effects on body -anesthetic -stimulant Produces imbalance in neurotransmitters |
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Withdrawal symptoms of cocaine/crack |
-depression -paranoia -lethargy -anxiety -insomnia -nausea/vomiting -sweating/chills |
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Tx of withdrawal of cocaine/crack |
antidepressants (desipramine) dopamine agonist bromocriptine |
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Marijuana |
-indian hemp plant -THC active ingredient -usually smoked, depressant and hallucinogenic properties -Desired effects: euphoria, detachment, relaxation |
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Effects of marijuana |
talkativeness, slowed perception of time, inappropriate hilarity, heightened sensitivity to external stimuli, anxiety, paranoia Long term: lethargy, anhedonia, difficulty concentrating, loss of memory |
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Hallucinogens types |
-LSD or acid -mescaline -psilocybin (mushrooms) -PCP, angel dust, horse tranquilizer, peace pill |
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Hallucinogens affect |
produces dreamlike state, flashbacks, hallucinations Sxs: pupil dilation, tachycardia, tremors, diaphoresis, grandiosity toxicity: psychosis, brain damage, death |
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Inhalants types |
volatile solvents -spray paint -glue -cigarette lighter fluid -propellant gases used in aerosols |
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Inhalants effects |
similar to alcohol OD effects: interferes w/ o2 to vital organs; fatal cardiac rhythms |
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"rave/techno" drugs types |
-ecstasy -MDA "love" -MDE "eve" |
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Techno drug effects |
-euphoria, increased energy -increased self confidence -increased sociability -feeling of closeness to others |
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Techno drug adverse effects |
-hyperthermia -HF -kidney failure -acute dehydration Tx: NO antidote; treat symptoms |
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Date rape drugs types |
-Flunitrazepam (roofies) -GHB |
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Date rape drug effects Tx |
-rapidly produces disinhibition, relaxation of voluntary muscles, anterograde amnesia -TX: flumazenil (reduces sedative effect) |
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Opiates types |
-morphine -heroin -codeine -fentanyl -methadone ect |
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Opiates effects, withdrawal and toxicity |
desired: euphoria withdrawal: stomach cramps, NV, muscle aches, yawning, diaphoresis, chills, fever Toxicity: resp depression, cardiac arrest
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Tx of opiate |
Narcan (reverses CNS depressioN) |
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Treatment of opioid addictions |
-Dolophine (methadone): blocks craving for and effects of heroin, only drug approved to tx pregnant opioid addict -LAAM: alternative to methadone -Naltrexone/Naloxone: antagonist that blocks euphoric effects of opioids -Clonidine: non opioid suppressor of opioid withdrawal symptoms, effective somatic tx when combined w/ naltrexone |
