Medical Aspects of Chemical Dependency

Hal Vorse, M.D.

Chemical Dependency: A Disease

• To be a disease, a condition must qualify 4 ways:– A specific cause

– A specific group of signs and symptoms

– A predictable clinical course

– A predictable outcome

• Characteristics of Chemical Dependency– Primary

– Progressive

– Chronic

– Fatal

Clay Tablet

Dr. Benjamin Rush1746-1813

• 1St to define alcoholism• 1786- alcoholism as a

disease• Surgeon General of the

Continental Army• Member of Continental

Congress• Signed the Declaration of

Independence

AN INQUIRYINTO THE

EFFECTS OF ARDENT SPIRITSUPON THE

HUMAN BODY AND MIND

WITH AN Account of the Means of Preventing

AND OF THE

REMEDIES FOR CURING THEM.

BY BENJAMIN RUSH, M.D.Professor of Medicine in the University of

Pennsylvania.THE EIGHTH EDITION, WITH ADDITIONS.

BROOKFIELD:PRINTED BY E. MERRIAM & CO.

1814

1874 CartoonWoman’s Christian Temperance Union

volunteers picketing a saloon full of drunks

Federal Agent destroying a barrel of beer during prohibition

Repeal the 18th Amendment

Dr. Jellinek

The Alcoholic Progression

High Risk DrinkingMen:

More than 2 drinks per day or

Five or more drinks on one occasion each month

Women:

More than one drink per day or

More than 4 drinks on one occasion each month

A drink is:

12 ounces of beer

5 ounces of wine

11/2 ounces of liquor

The Alcoholic Progression

Occasional Relief drinking Constant relief drinking starts

The Alcoholic Progression

Occasional Relief drinkingConstant relief drinking starts

Increase in alcohol tolerance

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance

Stuporous drinking (drunk)

The Alcoholic Progression

Occasional relief drinking

Constant relief drinking starts

Increase in alcohol tolerance

Stuporous drinking Onset of memory loss while drinking (Blackouts)

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts)

Increase in alcohol dependence (Withdrawal)

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts) Increase in alcohol dependence (Withdrawal)

Urgency of the first drink

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking (Blackouts)

Increase in alcohol dependence (Withdrawal) Urgency of the first drink

Feelings of guilt Unable to discuss problem (DENIAL)

Problem?........

What problem?

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Cannot stop when others do

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do

Excuses made for drinking

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking

Grandiose and aggressive behavior

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior

Persistent remorse Efforts to control fail

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase Cannot stop when others do Excuses made for drinking

Grandiose and aggressive behavior Persistent remorse Efforts to control fail

Loss of other interests

GOLF

The Alcoholic Progression

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests

Geographic changes made

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Work problems

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

Avoiding family and friends

The Alcoholic Progression

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

Financial difficulty

The Alcoholic Progression

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems

Financial difficulty

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

Neglect of food

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems Financial difficulty Neglect of food

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

Early morning drinks

Drinks with “inferiors”

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems Financial difficulty Neglect of food

Early morning drinks

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems Financial difficulty Neglect of food

Early morning drinks Drinks with “inferiors”

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

Moral deterioration

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems Financial difficulty Neglect of food

Early morning drinks Drinks with “inferiors”

Moral deterioration

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

Loss of alcoholic tolerance Physical Complications

Medical Complications of Alcoholism

Gastrointestinal Tract Acute gastritis

Malabsorption Diarrhea

Liver Alcoholic hepatitis

Acute fatty liverCirrhosis

PancreasAcute pancreatitisPancreatic pseudocystDiabetes

Gastrointestinal Tract Acute gastritis Malabsorption DiarrheaHeart Cardiomyopathy ArrhythmiasFetal Alcohol Syndrome

Nervous System Peripheral Neuropathy Optic Neuritis Wernicke Encephalopathy

Musculoskeletal System Acute Proximal Myopathy Osteonecrosis of the Hip Trauma

Blood Anemia White Cell Dysfunction Decreased Platelet Function

Infectious Disease Tuberculosis Decreased response to bacterial infectionCancer Larynx Esophagus Liver

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems Financial difficulty Neglect of food

Early morning drinks Drinks with “inferiors”

Moral deterioration Loss of alcoholic tolerance Physical Complications

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

Brain Damage

Normal

Increase in alcohol dependence Urgency of the first drink

Feelings of guilt Unable to discuss problem ( denial) Blackouts increase

Occasional relief drinking Constant relief drinking starts Increase in alcohol tolerance Stuporous drinking Onset of memory loss while drinking

Avoiding family and friends Work problems Financial difficulty Neglect of food

Early morning drinks Drinks with “inferiors”

Moral deterioration Loss of alcoholic tolerance Physical Complications Brain Damage

Cannot stop when others do Excuses made for drinking Grandiose and aggressive behavior Persistent remorse Efforts to control fail Loss of other interests Geographic changes made

The Alcoholic Progression

DEATH

Drugs of Addiction• The Depressants (“Downers”)

– Alcohol– Opiates (Narcotics)

• Heroin (smack, “H”, horse)• Morphine• Codeine• Oxycodone (Oxycontin, Percocet, Tylox)• Hydrocodone (Lortab, Vicodin)• Demerol (Meperidine)• Dilaudid (Hydromorphone)• Tawin (Pentazocine)• Darvocet (Proxyphene)• Ultacet, Ultram (tramodol) *• Fentanyl

Drugs of Addiction

• The Depressants (“Downers”)– Sedatives/Hypnotics/Tranquilizers

• Barbituates (Seconal, Nembutal)• Memprobamate (Miltown, Equanil, Soma,carisoprodol*)• Benzodiazapines (Xanax, Valium, Klonopin, Ativan,

Librium, many others)• Methaqualone (Quaalude, ‘ludes)• Nitrous oxide• Chloral hydrate

• * These drugs are addictive but not controlled by the DEA

Depressants

• Drug effects: Neurological depression

• Symptoms of intoxication:– Loss of inhibitions– Decreased fine motor and gross motor

coordination– Stupor– Loss of consciousness (coma)– Respiratory depression and death

Overdose Deaths in Oklahoma By Type

0

100

200

300

400

500

2001 2002 2003 2005 2006

Accidental Suicide Unknown

0

100

200

300

400

500

600

2002 2003 2004 2005 2006 2008

Opiates Meth/cocaine

Depressants

• Symptoms of withdrawal:– Tremors (shaking)– Loss of appetite– Insomnia, sleep disturbances– Hypersensitive to stimuli– Gastrointestinal upset– Hallucinations – Seizures (convulsions)– Death– Withdrawal from these drugs is a serious medical condition which requires

supervision of a physician to be done safely– Overdoses and death commonly occur when two or more of these drugs are used in

combination– Brain damage is twice as sever when depressants are use with stimulants, i.e. alcohol

and methamphetamine.