Chapter 049

Substance Abuse

Chapter 49Chapter 49

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Chapter 49

Lesson 49.1

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ObjectivesObjectives

• Differentiate among the key terms associated with substance abuse

• Explore biologic, psychological, and sociocultural models that influence the assessment and treatment of substance abuse

• Describe the different types of screening tools used to assess alcohol and substance abuse

• Cite the responsibilities of professionals who suspect substance abuse by a colleague

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Keys Terms of Substance AbuseKeys Terms of Substance Abuse

• Substance abuse – periodic purposeful use of a substance that leads to clinically significant impairment

• Impairment – failure to fulfill major obligations at work, school, or home

• Dependence/addiction – symptoms of compulsive use, tolerance, and withdrawal symptoms on discontinuation

• Illicit substances – any chemical that alters biologic function and is not required for health maintenance

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TheoriesTheories

• Biologic model Abuse caused by genetic profile; hereditary

condition

• Psychological theories Psychoanalytic theories Behavior or learning theories Cognitive theories

• Sociocultural factors Attitudes, values, norms affect susceptibility to

abuse

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Signs of ImpairmentSigns of Impairment

• First manifested in family life Violence, separation, divorce, financial

problems

• Disintegration of social life Public intoxication, isolation

• Physical and mental changes Fatigue, multiple illnesses, injuries, accidents,

emotional crises

• Flagrant evidence of impairment at work (rare)

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ScreeningScreening

• Four categories of instruments Comprehensive drug abuse screening and

assessment Brief drug abuse screening Alcohol abuse screening Drug and alcohol abuse screening for use with

adolescents (see Table 49-2 for details)

• CAGE Used for quick assessment C - cut down, A - annoyed, G - guilt, E - eye

opener

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Health Professionals Health Professionals and Substance Abuseand Substance Abuse

• Factors leading to substance abuse Stress of intense patient care Managing more patients with same resources “Zero tolerance” for mistakes Financial debt

• Signs of abuse Behavioral changes: lack of attention to

hygiene, mood swings Performance deterioration

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Substance Abuse ReportingSubstance Abuse Reporting

• Confidential report to appropriate supervisor• Investigation• Observation and documentation over time• Clinical practice is a privilege• Need to protect patients• Unreported colleague may die as result of

impairment• Reported colleagues have good chance of

retaining their licenses; legal protections do exist

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Substances of AbuseSubstances of Abuse

• Alcohol, nicotine, caffeine• Amphetamine• Cannabis (marijuana)• Cocaine• Hallucinogens• Inhalants• Opioids• Phencyclidine (PCP)• Sedatives and hypnotics

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Chapter 49

Lesson 49.2

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ObjectivesObjectives

• Explain the primary long-term goals in the treatment of substance abuse

• Study the withdrawal symptoms and approaches to treatment and relapse prevention for major substances that are commonly abused

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Long-Term Goals of TreatmentLong-Term Goals of Treatment

• Reduction or abstinence in the use and effects of substances

• Reduction in the frequency and severity of relapse

• Improvement in psychological and social functioning

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AlcoholAlcohol

• Withdrawal symptoms Visual and auditory hallucinations Seizures

• Treatment Assess hydration, electrolytes, nutritional

status Thiamine and multiple vitamins Benzodiazepines for detoxification• Fixed dose schedule• Symptom-triggered medication regimen

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Alcohol Relapse PreventionAlcohol Relapse Prevention

• Social support and lifelong effort required• Medications used

Disulfiram (Antabuse) – helps reduce the desire for alcohol by causing nausea and vomiting with ingestion of alcohol

Naltrexone (ReVia) – blocks the effects of the high

Acamprosate (Campral) - promotes abstinence Slightly higher success rate of preventing relapse

when naltrexone and acamprosate are used together

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Opioids, CocaineOpioids, Cocaine

• Withdrawal symptoms Mood swings, impaired memory, slurred

speech Anxiety, restlessness, increased blood

pressure and pulse, sweating, nausea, vomiting, sometimes aches and fever

• Treatment May substitute another opioid to reduce

severity of withdrawal symptoms

• Relapse prevention Rate of relapse is high for cocaine

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Amphetamine-Type StimulantsAmphetamine-Type Stimulants

• Uses Treat schizophrenia, depression, radiation

sickness, attention deficit hyperactivity disorder (ADHD), opiate and nicotine addiction

• Intoxication Produce sense of heightened alertness,

attentiveness, self-confidence, powerfulness and energy; frequently lead to additional dose and may stay awake for 7-10 days

Often little water or food is taken when high “Meth mouth” occurs from poor oral hygiene

and grinding of teeth

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Amphetamine TreatmentAmphetamine Treatment

• No antidotes for methamphetamine• Psychiatric evaluation due to damaged

dopaminergic and serotonergic neurons• Cognitive behavior therapy• Contingency management programs• Support groups

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