Substance Lec 2010

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SUBSTANCE-RELATED

DISORDERS

Ms. Jocelyn Alcera Nazario,RN MAN

6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN



Brain Mechanisms of Pleasure and Addiction.mp4




The limbic system operates by influencing the endocrine system

and the autonomic nervous system. It is highly interconnected

with the nucleus accumbens, the brain's pleasure center, which

plays a role in sexual arousal and the "high" derived fromcertain recreational drugs. These responses are heavily

modulated by dopaminergic projections from the limbic system.

(nucleus accumbens ventral tegmental area)



Substance ± Use Disorders

Substance Abuse The DSM-IV-TR (APA,2000)

identifies substance abuse as maladaptive pattern of

substance use manifested by recurrent and

significant adverse consequences related torepeated use of the substance. Referred to as any

use of substances that poses significant hazards to

health.




DSM-IV Criteria for Substance Abuse

A. Maladaptive pattern of substance use, manifested by

one or more of the following occurring at anytime within

a 12 month period

1. Recurrent substance use resulting in failure to fulfillmajor obligations at work, school or home

2. Recurrent substance use in situations in which it is

physically hazardous

3. Recurrent substance ±related legal problems4. Continued substance use despite having persistent

social or interpersonal problems caused by the

substance







Dependence- The physiological state of neuroadaptation produced by

repeated administration of a

drug, necessitating continued

administration to prevent theappearance of withdrawalsymptoms

Reinforcement: tendency of a pleasure-

producing drug to lead torepeated self administration




Addiction: A behavioral pattern of drug abuse

characterized by overwhelming

involvement with the use of drug

(compulsive use),the securing of its

supply and a high tendency to relapse

after discontinuation.










Tolerance: developed when after repeated

administration, a given dose of a drug produces adecreased effect, or conversely, larger doses mustbe administered to obtain the effects observed withthe original use

Cross-Tolerance : Is demonstrated when a persondependent on one substance requires higher dosesof another substance in the same general category;

for example an individual who develops tolerance toalcohol-a CNS depressant- will require a higher thannormal doses of another CNS depressant toachieve the desired effect.




Substance Dependence

Tolerance and withdrawal are the essential criteriain establishing substance dependence.

1. Physical Dependence- evidenced by a cluster

of cognitive, behavioral and physiologicalsymptoms indicating that the individual

continues use of the substance despite

significant substance-related problem

( APA, 2000)




2. Psychological Dependence ± There is an

overwhelming desire to repeat the use of a

particular drug in order to produce pleasureor avoid pleasure or discomfort.




Criteria for Substance Dependence

At least three of the following characteristics must be present for adiagnosis of substance dependence:

1. Tolerance

2. Withdrawal

3. Substance taken in larger amounts or longer periods4. Persistent desire or unsuccessful efforts to cut down substance

use

5. Much time spent in activities to obtain substance

6. Important social, occupational, recreational activities are given

up because of substance use

7. Substance use is continued despite knowledge of having

physical or psychological problem that is likely due to

substance use.6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN



Substance Intoxication

The development of a reversible substance specific

syndrome caused by the recent ingestion of ( exposure to)

a substance ( APA,2000).

This category does not apply to nicotine




DSM-IV-TR Criteria for Substance Intoxication

1.The development of a reversible substance specific

syndrome caused by recent ingestion of a substance.

2. Clinically significant maladaptive behavior or

psychological changes that are due to the effect of thesubstance in the CNS and develop during or shortly after

use of the substance.

a. mood lability c. impaired social/occupational

b. impaired judgement functioning3.The symptoms are not due to a general medical condition

and are not better accounted for by another mental

disorder.




Substance withdrawal ± is the developement of a

substance specific maladaptive behavioral change

with physiological and cognitive concomitants, that

that is due to the cessation of, or reductiion in, heavyand prolonged substance use ( APA,2000).




DSM-IV-TR Criteria for Substance Withdrawal

1. The development of substance-specific syndrome

caused by the cessation of ( or reduction in) heavy and

prolonged substance use.

2. The substance-specific syndrome causes clinicallysignificant distress or impairment in social, occupational

or other important areas of functioning.

3. The symptoms are not due to a general medical

condition and are not better accounted for by another

mental disorder.




CLASSES OF PSYCHOACTIVE SUBSTANCES

1. Alcohol2. Amphetamines and related substances

3. Caffeine

4. Cannabis

5. Cocaine

6. Hallucinogens

7. Inhalants

8. Nicotine

9. Opoids

10.Phencyclidine (PCP)

11.Sedatives, Hypnotics or Anxiolytics




Predisposing Factors:

A. Biological ±

1. Genetics:

An apparent hereditary factor is involved in the

development of substance-use disorders. This isespecially evident in alcoholism, but less so with other

substances.

2. Biochemical:

There is the possibility that alcohol may producemorphine like substances in the brain that are

responsible for alcohol addiction.




B. Psychological ±1. Developmental Influences:

Focuses on the superego and fixation at the oral stage

of psychosexual development ( Saddock & Saddock,

2003).

2. Personality Factors:Low self-esteem, frequent depression, passivity, the

inability to relax or defer gratification and inability to

communicate effectively.

Associated with antisocial personality and depressive

response styles.




C. Sociocultural-

1. Social Learning : The effects of modeling,imitationand identification on behavior can be observed from

early childhood onward.

2. Conditioning: Effect of substance itself.

3. Cultural and Ethnic Influences: Factors within an

individual¶s culture help to establish patterns of

substance use by molding attitudes, influencing

patterns of consumption based on cultural acceptanceand determining the availability of the substance.




ADDICTION CYCLE

Consists of a 6-stage sequence thatconceptualize longitudinally the interaction of thebiopsychosocial factors

I. Factors operating at the Pre-Initiation: conductdisorder, anti-social behavior, family history of

disharmony and substance abuse, deprivedsocial environment

II. Initiation is stimulated by: availability,experimentation, peer group pressure, self-medication of physical and emotional pain

III. Continuation is promoted by: on-going stressesand recurrent pattern of reinforcement leading toacquisition of the drug habit





IV. Escalation is mediated by: crises related tosubstance use and by inadequate coping that leads

to dependence

V. Cessation is transient and related to: periods of

relief from pain and factors that reinforce the habit

VI. Relapse is precipitated by: a combination of intercurrent stresses and inadequate coping

mechanisms



Video : When a Man loves a Woman



THE DYNAMICS OF SUBSTANCE-RELATED

DISORDERS

Alcohol Abuse and Dependence:1. Profile

Ethyl alcohol

Classified as food because it contains calories

has no nutritional value

Alcohol exerts a depressant effect on the CNSresulting in behavioral and mood changes.

Most States consider legally intoxicated with a blood

level of 0.08 to 0.10




Patterns of Use/Abuse

Jellinek outlined four phases of alcoholic pattern of drinkingprogresses:

Phase I. The Prealcoholic Phase. Characterized by use of

alcohol to relieve the everyday stress and tensions of

life.Phase II. The Early Alcoholic Phase. Begins with

blackouts- brief periods of amnesia that occurs during or

immediately following a period of drinking.

Phase III.The Crucial Phase. The individual has lost

control and physiological dependence is evident.

Phase IV. The Chronic Phase. Characterized by

emotional and physical disintegration.





Rapidity of Alcohol absorption is influenced by:

a. Absorption is delayed when the drink is sipped

rather than gulp

b. When stomach contains food rather than

empty

c. When drink is wine or beer rather than distilled

beverages

Low doses:a. Produces relaxation

b. Loss of inhibitions

c. Lack of concentration

d. Drowsiness

e. Slurred speechf. Sleep

Chronic Abuse: Results in multisystem physiological

impairment



EFFECTS ON THE BODY

1. Peripheral Neuropathy.peripheral nerve damage,

results in pain,burning, tingling or prickly sensations of

the extremities.

2. Alcoholic Myopathy.In acute condition, muscle pain,swelling and weakness. In Chronic, gradual wasting and

weakness in skeletal muscles.

3. Wernicke¶s Encephalopathy. Most common form of

thiamine deficiency in alcoholics. Symptoms: paralysis

of ocular muscles.diplopia, ataxia,somnolence andstupor.







9. Alcoholic Hepatitis- Caused by long term alcohol use.

Clinical Manifestations:

a. Enlarged and tender liver b. N/V

c. Lethargy

d. Anorexia

e. Elevated WBC

f. Fever

g. Jaundice

h. Ascites

i. Weight loss

j. Hepatic encephalopathy




10. Cirrhosis of the Liver- end stage of alcoholic liver

disease and results from long ±term chronic alcohol

abuse.Clinical Manifestations:

a. N/V

b. Anorexia

c. Weight loss

d. Abdominal paine. Jaundice

f. Edema

g. Anemia

Portal hypertension

Ascites

Esophageal Varices

Hepatic Encephalopathy



11. Sexual Dysfunction. Alcohol interferes with the normal

production and maintenance of female and male hormones.

Alcohol intoxication:

a. mood lability

b. Impaired Judgementc. impaired social or occupational functioning

d. Slurred Speech

e. Incoordination

f. unsteady gait




Alcohol Withdrawal

4 to 12 hours of cessation or reduction in heavy and

prolonged alcohol use.

Symptoms:

1. coarse tremor of hands,tongue or eyelids2. Nausea or vomiting

3. Malaise or weakness

4. Tachycardia

5. Sweating6. Elevated BP

7. Anxiety




8. Depressed mood or irritability9. Transient hallucinations or illusions

10. Headache

11. Insomnia.

Alcohol Withdrawal Delirium- Onset: 2nd or 3rd day following

cessation of or reduction in prolonged ,heavy alcohol use.




Sedative,Hypnotic, or Anxiolytic

Abuse and Dependence

1. Profile of the substance:

The sedative ±hypnotic compounds are drugs of diverse

chemical structures that are all capable of inducing

varying degrees of CNS Depression, from tranqulizingrelief of anxiety to anesthesia, coma and even death.

a. Barbiturates

b. Nonbarbiturates hypnotics

c. Antianxiety agents Taken orally

³downers´




Categories Generic Names Street Names

Barbiturates

Nonbarbiturate

Antianxiety

Pentobarbital ( Nembutal)

Secobarbital ( Seconal) Amobarbital ( Amytal)

Secobarbital/Amobarbital

Phenobarbital

Butabarbital

Chloral Hydrate ( Noctec)

Triazolam (Halcion)Flurazepam (Dalmane)

Temazepam (Restoril)

Quazepam (Doral)

Diazepam ( Valium)

Chlordiazepoxidde (librium)

Meprobanate ( Miltown)Oxazepam ( Serax)

Alprazolam ( Xanax)

Lorazepam(Ativan)

Chlorazepate( Tranxene)

Yellow Jackets, yellow birds

GBs, red birds, red devilsBlue birds,blue angels

Tooies,Jelly beans

Peter, Mickey

SleepersSleepers

Sleepers

Sleepers

Vs(color, designates strength)

Green and Whites; roaches

Dolls ; dolliesCandy,downers ( the benzodia-

zepine)










CNS Depressants

1. Effects are additive with one another and with the

behavioural state of the user.

2. CNS depressants are capable of producing

physiological dependency.3. CNS depressants are capable of producing

psychological dependence.

4. Cross-Tolerance and Cross-dependence may exist

between various CNS depressants.





1. An individual whose physician originally prescribed the

CNS depressant as treatment for antianxiety or

insomnia.

2. Involves young people in their teens or early 20s who in

the company of their peers use substances that were

obtained illegally.




Effects on the Body

1. Effects on sleep and dreaminga. Decreased amount of sleep time spent in dreaming

b. During drug withdrawal-dreaming becomes vivid and

excessive

c. Withdrawal from long term use-rebound insomniaand increases dreaming

2. Respiratory depression

a. Inhibiting reticular activating system

3. Cardiovascular Effectsa. Hypotension

b. Decreased cardiac output




4. Renal Function

a. Suppress urine function5. Hepatic Effects

a. Jaundice

6. Body Temperature

a. Decrease body temperature

7. Sexual Functioninga. Increase libido

b. Decrease in the ability to maintain erection




Sedative,Hypnotic, or Anxiolytic Intoxication

The presence of clinically significant maladaptive

behavioral or psychological changes that develop during

or shortly after, use of one of these substances.

a. Inapropriate sexual or aggressive behavior

b. Mood lability h. Impairment in

c. impaired judgement attention or memory

d. slurred speech i. Stupor or coma

e. Incoordinationf. Unsteady gait

g. nystagmus




Sedative, Hypnotic or Anxiolytic Withdrawal

Produces a characteristic syndrome of symptoms that

develops after a marked decrease in or cessation of

intake after several weeks or more of regular use.

1. Short- acting Anxiolytic ( lorazepam or oxazepam)

symptoms within 6 to 8 hrs.

2. Substances with longer half-lives ( Diazepam)

may not develop for more than a week

peak in intensity on 2nd

week decreased markedly on 3rd and 4th




3. Sedatives, Hypnotics or Anxiolytics

Hyperactivity ( sweating or pulse greater than 100)Increased hand tremor

Insomnia

Nausea or Vomiting

Hallucinations

IllusionsPsychomotor agitation

Anxiety

Grand mal seizures




CNS Stimulant Abuse and Dependence

Profile of the Substance

The CNS stimulants are identified by the behavioral

stimulation and psychomotor agitation that they induce.

The two most prevalent and widely used stimulants arecaffeine and nicotine.

Caffeine: tea

coffee

colaschocolate

Nicotine: Tobacco













The most common method of use includes:

Oral ingestionSmoking

Injection

Taken orally, inhaled or ingested

³uppers or speed´

Amount of CNS stimulation depends on both the area

in the brain or spinal cord that is affected by the drug

and cellular mechanism fundamental to the increasedexcitability



GRPS. CLASSIFIED ACCORDING TO

SIMILARITIES IN MECHANISMS OF ACTION

Psychomotor stimulants ± Induce stimulation by

augmentation or potentiation of the neurotransmitters

norephinephrine,epinephrine or dopamine

General Cellular Stimulants ± ( caffeine and Nicotine)

exerts their actions directly on cellular activity





1. Began using the substance for the appetite-suppressant

effects.

2. Chronic users tend to rely on CNS stimulants to feelmore powerful, more confident and decisive. They take

³uppers´ in the morning and ³downers´ at night.







Effects on the Body

1. CNS effects:

a. Tremor

b. Restlessness

c. Anorexiad. Insomnia

e. Agitation

f. Increased motor activity




Amphetamines, nonamphetamines stimulants and cocaine:

a.Alertness

b.Decreased in fatigue

c.Elation

d.Euphoria

e.Greater mental agility

f.Muscular power

Chronic Use:

a.Paranoia

b.Hallucinations

c.Aggressive behaviors





Fetal exposure to cocaine during the 1st

trimester = neurological damage leading to

learning and behavior problems.

After birth :

a. Abnormal sleep patterns

b. Tremorsc. Occasional seizures

d. Irritability

e. Feeding difficulties



2. Cardiovascular/Pulmonary Effects:

a. Amphetamines ± increased systolic and diastolic BP

- increased heart rate and cardiac

arrythmias

b. Cocaine ± rise in myocardial demand for oxygen

- increase in heart rate

- Myocardial Infarction

- Ventricular Fibrillation- Sudden death

- ( inhaled) pulmonary hemorrhage,chronic

broncholitis and pneumonia

- ( Cocaine snorting) Nasal rhinitis

c. Caffeine ± increased heart rate

- palpitations

- extrasystoles

- cardiac arrythmias




d. Nicotine ± stimulates sympathetic Nervous system

- increase heart rate,BP & cardiac

contractility

- Lung cancer

- Emphysema

3. Gastrointestinal and Renal Effects:

- ( Amphetamines) constipation

- difficult in urination- ( Caffeine) diuretic effects

- (nicotine) reducing excretion of urine

4. Sexual Functioning:

- promote coital urge in both men & women

- (women) feel sexier & more orgasm

- ( Men) sexual dysfunction

- Some aphrodisiac effects


CNS Stimulants



Categories Generic Names Common StreetNames

Amphetamines

Noramphetamine

Stimulants

Cocaine

Caffeine

Nicotine

Dextroamphetamines ( Dexedrine)

Methamphetamine (Desoxyn)

3,4-Methylenedioxyamphetamine

(MDMA) Amphetamine +dextroamphetamine

(Adderall)

Phendimetrazine ( Prelu-2)

Benzphetamine ( Didex)

Diethylpropion (Tenuate)

Phentermine ( Adipex-P)

Sibutramine ( Meridin)

Methylprenidate ( Ritalin)

Cocaine Hydrochloride

Coffee, Tea, colas, chocolate

Cigarettes,cigars,pipe,snuff,

Dexies, uppers,truck

drivers

Meth, speed,crystal,ice

Adam,Ecstacy,Eve,XTC

Diet pills

Speed, uppers

Coke,blow,crack,flake

Java,mud,brew,cocoa

Weeds,fags,butts,chaw,

CNS Stimulants












CNS Stimulant Intoxication

Produces maladaptive behavioral and psychological

changes that develop during, or shortly after, use of

these drugs.

Amphetamines and Cocaine intoxication produces:

a. Euphoria or affective blunting

b. Changes in sociability

c. Hypervigilance

d. Interpersonal sensitivitye. Anxiety,tension or anger

f. Stereotyped behaviors




Physical Effects include:

a. Tachycardia or bradycardiab. Pupillary dilation

c. Elevated or lowered blood pressure

d. Perspiration or chills

e. N/V

f. Wt. Lossg. Psychomotor agitation or retardation

h. Muscular weakness

i. Respiratory depression

j. Chest pain

k. Cardiac arrhythmias

l. Confusions, seizures

m. Dystonias or coma






CNS Stimulant Withdrawal

Presence of characteristic withdrawal syndrome that

develops within a few hours to several days after

cessation of, or reduction in, heavy and prolonged use

( APA,2000).

Withdrawal from Amphetamines and Cocaine:

a. Dysphoria e. Increased appetite

b. Fatigue f. Psychomotor retardationc. Vivid unpleasant dreams or agitation

d. Insomnia or hypersomnia




CAFFEINE WITHDRAWAL

An intake of 500 to 600mg/day ( 4 cups of coffee)

Headache

Fatigue

Anxiety

Irritability

Depression

Impaired psychomotor performance

N/V

Craving for caffeine

Muscle pain and Stiffness




NICOTINE WITHDRAWAL

Dysphoric or depressed mood

Insomnia

Irritability

Frustration or Anger

Anxiety

Difficulty concentrating

Restlessness Decreased heart rate

Increased appetite or weight gain




Inhalant Abuse and Dependence

Profile of the substance: Are induced by inhaling the aliphatic and aromatic

Hydrocarbons found in substances such as fuels,

solvents, adhesives,aerosol propellants and paint

thinners.

e.g.

Gasoline cleaning fluid

Varnish remover spray paint

Lighter fluid shoe conditioner

Airplane glue typewriter correction fluidRubber cement

They are particularly dangerous








Inhalant substances are readily available,legal andinexpensive.

Use may begin by ages 9 to 12 and peak in adolescentyears; less common after age 35.

Highest use was seen in the ages 12 to 25 year old grp. Methods of use include ;

a. ³huffing´

b. ³bagging´

Sadock & Sadock ( 2003) reports;a.use among adolescent may be most common in those

whose parents or older siblings use illegal substances.








b. Associated with an increased likelihood of conduct

disorder or antisocial personality disorder.

Tolerance has reported with heavy use Children with inhalant disorder may use inhalants several times

a week.

Adults with inhalant dependence may use the substance at

varying times during each day.



Effects on the Body

1. CNS:

a. Central & Peripheral nervous system damage

b. Generalized weakness and peripheral neuropathies

c. Cerebral atrophyd. Cerebellar degeneration

2. Respiratory:

a.Upper or lower airway irritation e. Cyanosis from

b.pulmonary hypertension pneumonitis or c.acute respiratory distress asphyxia

d.dyspnea/rales or rhonchi





3. Gastrointestinal:

a. Abdominal pain , nausea and vomitingb. Rash around nose and mouth

c. Unusual breath odors

4. Renal system:

a. Chronic renal failure

b. Hepatorenal syndromec. Proximal renal tubular acidosis



INHALANT INTOXICATION

The DSM-IV-TR : Clinically significant maladpative

behavioral or psychological changes-

a. Belligerence d. Impaired judgement

b. Assaultiveness e. Impaired social or

c. Apathy occupational functioning

Two or more of the following signs are present:

a. Dizziness e. Unsteady gait

b. Nystagmus f. Lethargyc.Incoordination g. Depressed reflexes

d. Slurred speech h. Psychomotor retardation





i. Tremor

j. Generalized muscle weaknessk. Blurred vision/diplopia

l. Stupor or coma

m. Euphoria

Although withdrawal syndrome has not been

established: symptoms has been documented 24 to

48 hrs. After last dose

a. Sleep disturbances e. N/Vb. Tremor f.fleeting illusions

c. Irritabilityd. diaphoresis



Opioids Abuse and Dependence

A Profile of the Substance:

a. ³Opioids´ refers to a group of compounds that includes

opium,opium derivatives and synthetic substitutes.

b. Exerts both sedative and analgesic effectc. Major medical uses- relief of pain, treatment of

diarrhea and relief of coughing.

d. Have addictive qualities

e. Methods of administration include oral or smoking and by subcutaneous,intramuscular and

intravenous injection





Sensitize an individual both psychological and

physiological pain induces a sense of euphoria

Lethargy and indifference to environment






Categories Generic Names Common Street Names

Synthetic opiate-

Like drugs

Meperidine ( Demerol)

Methadone ( Dolophine)

Propoxyphene ( Darvon)Pentazocine (Talwin)

Fentanyl (Actiq;Duragesic)

Doctors

Dollies,done

Pinks and graysTs

Apache,China girl,China town,

Dance fever, goodfella,jackpot



Patterns of Use /Abuse

Individuals who had obtained the drug by prescription

Individuals increases the amount and frequency of use

Individuals who uses for recreational purposes and

obtain them from illegal sources

May be used alone to induce euphoric effects or in

combination with stimulants

Babies born to heroin ± dependent women are also

heroin ± dependent and need to go through withdrawal.




Effects on the Body

1. CNS

a. Euphoria f.pupillary constriction

b. Mood changes g. Nausea and vomiting

c. Mental clouding h. Respiratory depressiond. Drowsiness

e. Pain reduction

2.Gastrointestinal

a. Constipationb. Fecal impaction





3. Cardiovascular-

a. Induce hypotension

4. Sexual Functioninga. Decreased sexual function

b.diminished libido

c. Retarded ejaculation

d.impotencee.orgasm failure

Watery eyes

Runny nose

Constricted pupils



Opioid Intoxication

Constitutes clinically significant maladaptive behavioral

or psychological changes that develop during or shortly

after opioid use.

Symptoms:

a. Euphoria d. Psychomotor agitation

b. Apathy or retardation

c. Dysphoria e. Impaired judgement

Physical symptoms:

a. Pupillary constriction c.slurred speech

b. Drowsiness d.impairement in attention




Opioid Withdrawal

Produces a syndrome of symptoms that develops after

cessation of, or reduction in, heavy and prolonged use of

an opiate.

Symptoms:

a. Dysphoric mood g. sweating

b. Nausea/vomiting h. Abdominal cramping

c.Muscles aches i. sweating

d. Lacrimation or rhinorrhea j.diarrhea

e. Pupillary dilation k.yawning

f. Piloerection l.fever & insomnia





Heroin ( short- acting drugs), withdrawal symptoms occur

Within 6 to 12 hrs. after the last dose,peak within 1 to 3 days

and gradually subsides over a period of 5 to 7 days.

Methadone ( long- acting drugs), withdrawal symptoms

begins within 1 to 3 days after the last dose and are

complete in 10 to 14 days.

Meperidine ( ultra-short acting drugs), withdrawal begins

quickly, reaches a peak in 8 to 12 hrs. and is complete in 4

to 5 days.



HALLUCINOGENS ABUSE AND DEPENDENCE

Profile of the Substance

Hallucinogens are capable of distorting an individual¶sperception of reality.

Ability to alter sensory perception and induce visual

hallucinations. Referred to as ³ mind expanding´.

Perceptual distortions- spiritual, sense of depersonalization ( observing oneself having theexperience) or as being at peace with self and universe.

³bad trips´

Report feelings of panic and fear of dying or goinginsane.





A common danger is that of ³ flashbacks´ can occur after

months after the drug was taken.

Recurrent use induces psychological dependence which

Varies according to the drug, dose and individual user.

Hallucinogenic substances have structural similarities. Someproduced synthetically and others are natural products of

Plants and fungi.

Taken orally, inhaled

HALLUCINOGENS




HALLUCINOGENSCATEGORIES GENERIC NAMES STREET NAMES

Naturally occuring

Hallucinogens

Synthetic compounds

Mescaline( peyote cactus)

Psilocybin and psilocin (psilo-

cybe mushroon)

Ololiuqui ( morning glory

seeds)

Lysergic acid diethylamide(LSD)-from fungal sub. Found

on rye

Dimethyltryptamine (DMT)

and Diethyltryptamine (DET)

2,5- Dimethoxy-4-

methylamphetamine(STP,DOM)

Phencyclidine (PCP)

3,4-Methylene-

dioxyamphetamine (MDMA)

Methoxy-amphetamine

Cactus,mesc,mescal,half

Moon,big chief,badseed,peyote

Magic mushroom,Gods

flesh,shrooms

Heavenly blue,pearly gates

Acid,cube,big D, californiasunshine,microdots,blue

dots,sugar,orange wedges

Businessmans trip

STP

(serenity,tranquility,peace)

Angel dust,hog,peace pill

XTC, ecstacy,Adam,Eve

Love drug




MAGIC MUSHROOM



PATTERNS OF USE/ABUSE

Use is episodic

cognitive and perceptual abilities are

markedly affected by these substances, the user setsaside normal daily activities for indulging inconsequences.

Tolerance develop quickly and to high degree. LSD used repeatedly for a period of 3 to 4 days may

develop tolerance to the drug.

Recovery from tolerance occurs rapidly in 4 to 7 days.

PCP is taken episodically in binges that lasts for severaldays.

Chronic users take them daily

Psychological dependence in PCP is characterized by


Craving for the drug




g g

a.Tolerance develops quickly for frequent users.

Psilocybin is an ingredient of Psilocybe mushroom

indigenous in the US and Mexico. Ingestion produces an

effect similar to that of LSD but of short duration.

Mescaline is used legally for religious purposes by

members of the Native American Church of the US.a. Tolerance can develop quickly for frequent users

Derivatives of Amphetamines such as 2,5-dimethoxy-4

methylamphetamine are among the most potenthalllucinogens.

a. Lower doses- produces ³high´ assoc. With CNS

stimulants.

b. Higher doses- hallucinogenic effects occurs.



EFFECTS ON THE BODY

Physiological Effects-a. Nausea and Vomiting f. Trembling

b.Chills g. Loss of appetite

c.Pupil dilation h. Insomnia

d. Increased pulse,BP & Temp. i. sweatinge. Mild dizziness j. A slow respiration

k. Elevation of blood

Conjunctival injection sugar

( bloodshot eyes)





Psychological Effects-

a. Heightened response j. Serenity,

to color,texture & sounds peace

b. Heightened body awareness k. Depersona-

c. Distortion of vision lization

d. Sense of slowing time l.derealization

e. All feelings magnified: m.increaseslove,lust,hate,joy,anger,pain libido

terror,despair n. laughing

f. Fear of losing control giggling

g.paranoia, panic blank stares

h.euphoria,blissi. Projection of self into dreamlike

images



Hallucinogen Intoxication

Symptoms develop during, or shortly after hallucinogen

use ( within minutes or a few hours)

Maladaptive behavioral or psychological changes

include;

1. marked anxiety or depression

2. ideas of reference

3. fear of losing one¶s mind

4. paranoid ideation

5. impaired judgement





Perceptual changes occurs in a state of wakefulness and

alertness;

1. intensification of perceptions

2. depersonalization

3. derealization

4. illusions

5. hallucinations6. synesthesia

Physical symptoms ;

1. pupillary dilation 5. blurring of vision

2. tachycardia 6. tremors

3. sweating 7. incoordination

4. palpitations






6. muscle rigidity

7. seizures or coma

8. hyperacusis



CANNABIS ABUSE AND DEPENDENCE

Profile of the substance

1.Cannabis is only second to alcohol

2. Major psychoactive ingredient is delta-9-

tetrahydrocannabinal (T

HC)3. Occurs naturally in the plant Cannabis sativa

4. Marijuana, the most prevalent type of cannabis preparationis composed of dried leaves,stems and flowers of the plant

5. Hashish is a more potent concentrate of the resin derived

from the flowering tops of the plant tops of the plant.







CATEGORY COMMON

PREPARATIONS

STREET NAMES

Cannabis Marijuana Joint,weed,pot,grass,

Mary jane,texas tea,

locoweed,MJ,hay,

stickHashish Hash,

bhang,ganja,charas

CANNABINOIDS













f /




In 2003, The Saddock & Saddock states , Marijuana is

the most widely used illicit drug among high school

students. It has been termed as a ³ gateway drug´.

Cannabis is incorrectly regarded as a substance of low

abuse potential.

Tolerance can occur in chronic users


EFFECTS ON THE BODY



EFFECTS ON THE BODY

1. Cardiovascular effects:

a. Tachycardia

b. Orthostatic hypotension

2. Respiratory effects:

Marijuana

a. Obstructive Airway disorders

b. Laryngitis

c. Bronchitis

d. Coughe. hoarseness




C bi ( h l t )




Cannabis ( heavy long-term use)

a. Associated with syndrome called

amotivational syndrome.b. Lethargy

c. Apathy

d. Social and personal deterioration

e. Lack of motivation

5. Sexual functioning: ( Marijuana)a. Enhances sexual experience (men &

women) thus increasing sexual satisfaction




higher doses:

a. Impairment in judgment of time and distance

b. Recent memory and learning ability Physiological symptoms:

a. Tremors

b. Muscle rigidity

c. Conjunctival rednessToxic effects ± panic reactions

Very heavy usage ± precipitate an acute psychosis





Precipitating event




Predisposing factors

Cognitive appraisal

primary

Perceived threat

secondary

Ineffective coping

Quality of

response

Adaptive Maladaptive

Substance

abuse

Substance

dependence

DYNAMICS OF SUBSTANCE USE DISORDERS

APPLICATION OF THE NURSING PROCESS



APPLICATION OF THE NURSING PROCESS

ASSESSMENT

a. Pre-introductory phase:

1.nurse must examine his or her feelings about

working with a client who abuses substances.

2.attitudes are examined





What are my drinking patterns?

If I drink, why do I drink? When,where and how much?

If I don¶t drink, why do I abstain? Am I comfortable with my drinking patterns?

If I decided not to drink anymore, would that be a problem

for me?

What did I learn from my parents about drinking?

Have my attitudes changed as an adult?

What are my feelings about people who are intoxicated?

Does it seem more acceptable for some individuals than

for others?

Do I ever use terms like ³sot´,´drunk´ or ³boozer´ todescribe some individuals who overindulge, yet overlook it

in others?



ASSESSMENT TOOLS



ASSESSMENT TOOLS

Drug history and Assessment

Michigan Alcoholism Screening Test ( MAST)

The CAGE Questionnaire


DRUG HISTORY AND ASSESSMENT



DRUG HISTORY AND ASSESSMENT

1. When you were growing up,did anyone in your family drink alcohol

or take other kinds of drugs?

2. If so, how did the substance use affect the family situations?

3. When did you have your first drink/drugs?

4. How long have you been drinking/taking drugs on a regular basis?5. What is your pattern of substance use?

a. When did you use substances?

b. What do you use?

c. How much do you use?

d. Where are you and with whom when you use substances?6. When did you have your last drink/drug? What was it and how much

did you consume?




CAGE QUESTIONNAIRE



CAGE QUESTIONNAIRE

1. Have you ever felt you should Cut down on your

drinking?

2. Have people Annoyed you by criticizing your drinking?

3. Have you ever felt bad or Guilty about your drinking?

4. Have you ever had a drink first thing in the morning to

steady your nerves or get rid of hangover ( Eye-opener)

Scoring: 2 or 3 ³yes´ answers strongly suggests a problem

with alcohol.


MICHIGAN ALCOHOLISM SCREENING TEST ( MAST)



MICHIGAN ALCOHOLISM SCREENING TEST ( MAST)

Yes No

1. Do you enjoy a drink now and then?

2. Do you feel you are a normal drinker?

(drink less than or as much as most people)

3. Have you ever awakened the morning after some

drinking the night before and found that you couldnot remember a part of the evening?

4. Does your wife,husband,parent or other near relative

ever worry or complain about your drinking?

5. Can you stop drinking without a struggle after one or

two drinks?

6. Do you ever feel guilty about your drinking?






DUAL DIAGNOSIS



DUAL DIAGNOSIS

If with co-existing substance disorder and mental illness,

a special program that targets both problems will be

assigned to the client.

Counselling for a mentally ill who abuses substance

takes a different approach( supportive). Peer support groups

Psychodynamic Therapy

Cognitive and Behavioral Therapy

12-step recovery programs ( Alcoholics Anonymous or Narcotics Anonymous)


THE TWELVE STEPS OF ALCOHOLICS



THE TWELVE STEPS OF ALCOHOLICS

1. We admitted we are powerless over alcohol-that our lives havebecome unmanageable.

2. Came to believe that a power greater than ourselves could restoreus to sanity.

3. Made a decision to turn our will and our lives over to the care of

God as we understood him.4. Made a searching and a fearless moral inventory of ourselves.

5. Admitted to God, ourselves and to another human being the exactnature of our wrongs.

6. Were entirely ready to have GOD remove all these defects of character.

7. Humbly ask him to remove our shortcomings.

8. Made a list of all persons we have harmed and became willing tomake amends to them all.





9. Make direct amends to such people wherever possible

except when to do so would injure them or others.

10. Continued to take personal inventory and when we werewrong promptly admitted it.

11. Sought through prayer and meditation to improve our

conscious contact with GOD as we understood him, praying

only for knowledge of His will for us and the power to carry that

out.

12.Having had a spiritual awakening as the result of these

steps, we tried to carry this message to alcoholics and to

practice these principles in all our affairs.

DIAGNOSIS/OUTCOME IDENTIFICATION



DIAGNOSIS/OUTCOME IDENTIFICATION

Ineffective denial related to weak underdeveloped egoevidenced by ³ I don¶t have a problem with ( substance).I can quit anytime I want to´.

Ineffective coping related to inadequate coping skills andweak ego evidenced by the use of substances as copingmechanism.

Imbalanced nutrition:Less than body requirements/deficient fluid volume related to drinking or taking drugsinstead of eating, evidenced of loss of weight,pale

conjunctiva and mucous membranes,poor skin turgor,electrolyte imbalance,anemias and other s/s of malnutrition/dehydration





Risk for infection related to Malnutrition and altered

immune condition

Low self-esteem related to weak ego,lack of positive

feedback evidenced by criticism of self and others and

use of substances as a coping mechanism ( self-

destructive behavior)

Deficient knowledge ( effects of substance abuse on thebody) related to denial of problems with substances

evidenced by abuse of substances

Substance Withdrawal:




Risk for injury related to CNS agitation ( withdrawal from

CNS depressants)

Risk for suicide related to depressed mood ( withdrawal

from CNS stimulant)

PLANNING/IMPLEMENTATION



PLANNING/IMPLEMENTATION

A. Detoxification:1. provide a safe and supportive environment for the

detoxification process

2. Controlled withdrawal from an abusive substance in amedically prescribed program using gradually tapered

sedation,controlled environment and nutritional supplements.3. Takes several days to 1 week.

B. Intermediate Care

1. Provide explanations of physical symptoms

2. Promote understanding and identify the causes of

substance dependency3. Provide education and assistance in course of

treatment to client and family


C. Rehabilitation

1 Encourage continued participation in long term




1. Encourage continued participation in long-term

treatment

2. Promote participation in outpatient supportsystem (e.g. AA)

3. Assist client to identify alternative sources of

satisfaction

4. Provide support for health promotion and

maintenance

D. Client/Family Education

1. nature of the illness- effects on the body and

ways in which the use of substances affects life

2. management of illness- activities to substitute for substance in times of stress, relaxation techniques,

problem solving skills, essentials of good nutrition.

3 i fi i l/l l i




3. support services- financial/legal assistance,

alcoholic anonymous, one-to-one support person

EVALUATION



Reassessment is done by using information gathered

from the reassessment questions.

1. Has detoxification occured without complications?

2. Is the client still in denial?

3. Does the client accept responsibility for his or her own

behavior? Has he or she acknowledged a personal

problem with substances?

4. Has a correlation been made between personal

problems and the use of substances?5. Does the client still makes excuses or blame others for

use of substances?


6. Has the client remained substance-free during

hospitalization?




hospitalization?

7. Does the client cooperate with treatment?

8. Does the client refrain from manipulativebehavior and violation of limits

9. Is the client able to verbalize alternative

adaptive coping strategies to substitute for

substance use? Has the use of these strategies

been demonstrated? Does positive reinforcementencourage repetition of these adaptive behaviors?

10. Has nutritional status been restored?Does the

client consume diet adequate for his or her size

and level of activity? Is the client able to discussthe importance of adequate nutrition?

11. Has the client remained free of infection during

hospitalization?




12. Is the client able to verbalize the effects of

substance abuse on the body?

13. Does the client verbalize that he or she wants to

recover and lead a life free of substances?

TREATMENT MODALITIES FOR SUBSTANCE-

RELATED DISORDERS



RELATED DISORDERS

Alcoholics Anonymous

is a major self help organization for the treatment of

alcoholism. Founded by 2 alcoholics, Bill wilson and Dr.

Bob Smith.

The self help groups are based on the concept of peer support ±acceptance and understanding from others

who have experienced the same problems in their lives.

Membership requirement: desire to stop drinking

Sole purpose: help members stay sober


PHARMACOTHERAPY



Disulfiram ( Antabuse):

a. Drug administered to individuals who abuse alcohol as

a deterrent to drinking.

b.Works by inhibiting the enzyme aldehyde

dehydrogenase, thereby blocking the oxidation of

alcohol at the stage when acetaldehyde is converted

to acetate.

c. Assessment done before beginning therapyd. Medical screening done

e. Written informed consent


f Contraindicated for high risk clients for alcohol




f. Contraindicated for high risk clients for alcohol

ingestion, psychotic, clients with severe

cardiac,renal or hepatic diseaseg. Disulfiram therapy is not a cure for alcoholism

but for the maintenance of sobriety

h. Provides measure of control for the individual

who desires to avoid impulse drinking.




Symptoms of disulfiram-alcohol reaction can occur

within 5 to 10 minutes of ingestion of alcohol.

Blood alcohol levels of approximately 50mg/dl:

flushed skin

throbbing in the head and neck respiratory difficulty - Tachycardia

Dizziness - Hypotension

n/v - weakness

Sweating - blurred vision

Hyperventilation

Blood level of approximately 125 to 150 mg/dl severe




Blood level of approximately 125 to 150 mg/dl,severe

reactions can occur:

respiratory depression

cardiovascular collapse

arrthymias

myocardial infarction

acute congestive heart failure

unconsciousness

convulsions

death

Administration of disulfiram should be at least 12 hrs




Administration of disulfiram should be at least 12 hrs

from no alcohol intake

Sensitivity to alcohol lasts for a 2 week period after discontinuation of disulfiram

Alcohol containing substances:

1. liquid cough and cold preparations

2. vanilla extract3. aftershave lotions

4. colognes

5. mouthwash

6. nail polish remover

7. isopropyl alcohol

OTHER MEDICATIONS FOR TREATMENT OF

ALCOHOLISM



ALCOHOLISM

1. Naltrexone :

a. Treatment of alcohol dependence

b. Works on same receptors in the brain that produce thefeelings of pleasure when heroin or other opiates bind tothem

c. An opiate antagonist

2. Benzodiazepines:

a. Effectively reduce signs and symptoms of withdrawal andprevent seizures


MANAGEMENT OF OPIATE WITHDRAWAL



1. Methadone :

Initial administration to stabilize symptoms of heroin

withdrawal.

10-40 mg 1st 24 hrs.

Stabilized- dose is slowly tapered ( 5mg/day)

2. Clonidine:

Available in oral, sublingual or transdermal patch

preparations

0.1 to .03 mg in 3 divided doses on the 1st day

BP shld be initially checked every 45 minutes


MANAGEMENT OF NICOTINE WITHDRAWAL



1. Nicotine gum and Nicotine patch:

Serves to replace the nicotine the nicotine in cigarettes

Optimum length of treatment before tapering is 4 to 6 weeks

Dosing: 2-4 mg/hr for the gum ( 2- and 4- mg sticks)

Patches ± 15mg/16 hr patch ( while awake)

2. Buproprion

Non-nicotine replacement therapy for nicotine replacement

150mg in AM for 3 days,then 150mg BID

Tx begins 1-2 wks before initial quit date/lasts 8 to 12wkswith 6 months maintenance







Drug abuse pictures before and after.mp4

Documents

Substance Lec 2010