Substancerelated disorders are composed of two groups The substance use disorders substance addiction the substanceinduced disorders intoxication withdrawal delirium neurocognitive disorder ID: 908464
Download Presentation The PPT/PDF document "1 Substance-Related and Addictive Disord..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
1
Slide2Substance-Related and Addictive Disorders
Substance-related disorders are composed of two groups:
The
substance use disorders (substance addiction) the substance-induced disorders (intoxication, withdrawal, delirium, neurocognitive disorder , psychosis, bipolar disorder, depressive disorder, obsessive-compulsive disorder [OCD], anxiety disorder, sexual dysfunction, and sleep disorders). This part of the lectures we will explain intoxication, and withdrawal. The remaining substance-induced disorders were explained in the previous lectures.
2
Slide33
Slide4Classes of Psychoactive Substances
The DSM-5 lists diagnostic criteria for addiction to specific
substances, including
:AlcoholCannabisHallucinogensInhalantsOpioidsSedative/ HypnoticsStimulantsTobacco4
Slide5Substance Addiction
Individuals
are considered to have a substance-use disorder when
use of the substance interferes with their ability to fulfill role obligations.There is an intense craving for the substance.An excessive amount of time is spent trying to procure more of the substance or recover from the effects of its use.Individuals with substance-use disorders often participate in hazardous activities when impaired by the substance, and continue to use the substance despite knowing that its use is contributing to a physical or psychological problem.
5
Slide6Substance Addiction
Addiction
is evident when
tolerance develops and the amount required to achieve the desired effect continues to increase.Tolerance: The need for larger amounts of the substance to get the same effect. OR A markedly diminished effect with continued use of the same amount of the substance.Addiction may occur with physiological dependence (evidence of tolerance or withdrawal) OR without physiological dependence (no evidence of tolerance or withdrawal).
6
Slide7Substance-Induced Disorders
-Substance
Intoxication-
Substance intoxication: The development of a reversible syndrome of symptoms following excessive use of a substance. The symptoms are drug-specific, and occur during or shortly after the ingestion of the substance. There is a direct effect on the CNS, and a disruption in physical and psychological functioning occurs. Judgment is disturbed, resulting in inappropriate and maladaptive behavior, and social and occupational functioning are impaired.
7
Slide8Substance-Induced Disorders
-Substance Withdrawal-
Substance withdrawal: occurs upon abrupt reduction
or discontinuation of a substance that has been used regularly over a prolonged period of time.The substance-specific syndrome includes clinically significant physical signs and symptoms as well as psychological changes, such as disturbances in thinking, feeling, and behavior.8
Slide9Predisposing Factors
Biological Factors: Genetics; Biochemical
Psychological
Factors: Developmental Influences; Personality FactorsSociocultural Factors: Social Learning; Conditioning; Cultural and Ethnic Influences9
Slide10Biological Factors
Genetics
An apparent hereditary factor is involved in
the development of substance-use disorders. This is especially evident with alcoholism, but less so with other substances. BiochemicalA second biological hypothesis relates to the possibility that alcohol may produce morphine-like substances in the brain that are responsible for alcohol addiction. These substances are formed by the
reaction of biologically active amines (e.g
., dopamine
, serotonin) with products of
alcohol metabolism
, such as acetaldehyde
10
Slide11Psychological Factors
Developmental
Influences :
The psychodynamic approach to the etiology of substance abuse focuses on a punitive superegoIndividuals with punitive superegos turn to alcohol to diminish unconscious anxiety and increase feelings of power and self-worth.
11
Slide12Personality
Factors:
Certain
personality traits have been associated with an increased tendency toward addictive behavior. some clinicians believe a low self-esteem, frequent depression, passivity, the inability to relax or to defer gratification, and the inability to communicate effectively are common in individuals who abuse substances. This may be explained by the inability of the individual to anticipate the aversive consequences
of his or
her behavior. Achievement of relief
then provides the positive reinforcement
to continue
abusing the substance.
12
Slide13Sociocultural Factors
Social Learning
The effects of modeling, imitation, and identification on behavior can be observed from early childhood onward.
the family appears to be an important influence. Peers often exert a great deal of influence in the life of the child or adolescent. Modeling may continue to be a factor in the use of substances once the individual enters the work force13
Slide14Conditioning
Another important learning factor is the effect
of the
substance itself. Many substances create a pleasurable experience that encourages the user to repeat it. Cultural and Ethnic InfluencesFactors within an individual’s culture help to establish patterns of substance use by molding attitudes, influencing patterns of consumption based on cultural acceptance, and determining the availability of
the
substance. Incidence
of alcohol addiction among Asians
is relatively
low. This may be a result of a
possible genetic
intolerance of the substance.
.
Unemployment and poverty, and
loss of the
religion that
some believe have led to the increased use
of alcohol
to fill the spiritual gap.
14
Slide151. Alcohol Use Disorder
Alcohol is a natural substance formed by the reaction of fermenting
sugar with
yeast spores. Although there are many alcohols, the kind in alcoholic beverages is known scientifically as ethyl alcohol and chemically as C2H5OH. Its abbreviation, ETOH, is sometimes seen in medical records and in various other documents and publications.By strict definition, alcohol is classified as a food because it contains calories; however, it has no nutritional value.Different alcoholic beverages are produced by using different sources of sugar for the fermentation process. For example, beer is made from malted barley, wine from grapes or berries, whiskey from malted grains, and rum from molasses. Distilled beverages (e.g., whiskey, scotch, gin, vodka,
and other
“hard” liquors) derive their name from further concentration of
the alcohol
through a process called distillation.
15
Slide16Patterns of Alcohol Use
Phase
I. The Pre-alcoholic Phase
Phase II. The Early Alcoholic PhasePhase III. The Crucial PhasePhase IV. The Chronic Phase16
Slide17Phase I. The Pre-alcoholic Phase
This
phase is characterized by the use of alcohol to relieve
the everyday stress and tensions of life. As a child, the individual may have observed parents or other adults drinking alcohol and enjoying the effects. The child learns that use of alcohol is an acceptable method of coping with stress. Tolerance develops, and the amount required to achieve the desired effect increases steadily.17
Slide18Phase II. The Early Alcoholic Phase
This phase begins with
blackouts (brief periods of amnesia that occur during or immediately following a period of drinking. Is an early sign of alcoholism).Now the alcohol is no longer a source of pleasure or relief for the individual but rather a drug that is required by the individual.Common behaviors include sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts.The individual feels enormous guilt and becomes very
defensive about
his or her drinking. Excessive use of denial
and rationalization
is evident.
18
Slide19Phase III. The Crucial Phase
In this phase, the individual has lost control, and physiological
addiction is clearly evident.This loss of control has been described as the inability to choose whether or not to drink. Binge drinking, lasting from a few hours to several weeks, is common. These episodes are characterized by sickness, loss of consciousness, squalor, and degradation. In this phase, the individual is extremely ill. Anger and aggression are common manifestations.Drinking is the total focus, and he or she is willing to risk losing everything that was once important, in an effort to maintain the addiction.By
this phase of the illness, it is common for the individual to
have experienced
the loss of job, marriage, family, friends, and most
especially, self-respect
.
19
Slide20Phase IV. The Chronic Phase
This
phase is characterized by emotional and physical
disintegration.The individual is usually intoxicated more than he or she is sober.Emotional disintegration is evidenced by profound helplessness and self-pity.Impairment in reality testing may result in psychosis.Abstention (stopping) from alcohol results in a terrifying syndrome of symptoms that include hallucinations, tremors, convulsions, severe agitation, and panic. Depression and ideas of suicide are not uncommon
.
20
Slide21Alcohol Use DisorderEffects on the Body
About
20% of a single dose of alcohol is absorbed directly
and immediately into the bloodstream through the stomach wall.Unlike other “foods,” it does not have to be digested. The blood carries it directly to the brain where the alcohol acts on the brain’s central control areas, slowing down or depressing brain activity.Only moments after alcohol is consumed, it can be found in all tissues, organs, and secretions of the body.
21
Slide22Alcohol Use Disorder
Effects on the Body: Peripheral Neuropathy
Peripheral
Neuropathy: Peripheral nerve damage, results in pain, burning, tingling, or prickly sensations of the extremities. Researchers believe it is the direct result of deficiencies in the B vitamins, particularly thiamine. Nutritional deficiencies are common in chronic alcoholics because of insufficient intake of nutrients as well as the toxic effect of alcohol that results in malabsorption of nutrients.The process is reversible with abstinence from alcohol and restoration of nutritional deficiencies. Otherwise, permanent muscle wasting and paralysis can occur.
22
Slide23Alcohol Use Disorder
Effects on the Body: Alcoholic Myopathy
Alcoholic
Myopathy: may occur as an acute or chronic condition. In the acute condition, the individual experiences a sudden onset of muscle pain, swelling, and weakness; a reddish tinge in the urine caused by myoglobin, a breakdown product of muscle excreted in the urine; and a rapid rise in muscle enzymes in the blood.Muscle symptoms are usually generalized, but pain and swelling may selectively involve the calves or other muscle groups.Include a gradual wasting and weakness in skeletal muscles. Neither the pain and tenderness nor the elevated muscle enzymes seen in acute myopathy are evident in the chronic condition.Thought
to be a result of the same B vitamin deficiency that contributes to
peripheral neuropathy
. Improvement is observed with abstinence from alcohol and the return to
a nutritious
diet with vitamin supplements.
23
Slide24Alcohol
Use
Disorder Effects
on the BodyWernicke’s Encephalopathy: represents the most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. If thiamine replacement therapy is not undertaken quickly, death will ensue.Korsakoff’s Psychosis: a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. It is frequently encountered in clients recovering from Wernicke’s encephalopathy. Treatment is with
parenteral or
oral thiamine replacement.
24
Slide25Alcohol
Use
Disorder Effects
on the BodyAlcoholic CardiomyopathyEsophagitis; GastritisPancreatitis (Acute pancreatitis usually occurs 1 or 2 days after a binge of excessive alcohol consumption)Alcoholic HepatitisCirrhosis of the Liver (end-stage of alcoholic liver disease, is a widespread destruction of liver cells, which are replaced by fibrous or scar tissue). Complications
include
Portal hypertension; Ascites;
Esophageal
varices;
&
Hepatic
encephalopathy)
Leukopenia
and Thrombocytopenia
Sexual
Dysfunction
25
Slide26Alcohol
Use
Disorder Use
During PregnancyFetal Alcohol Syndrome: Prenatal exposure to alcohol can result in a broad range of disorders to the fetus, known as fetal alcohol spectrum disorders (FASDs), the most common of which is fetal alcohol syndrome (FAS).Fetal alcohol syndrome includes physical, mental, behavioral, and/or learning disabilities with lifelong implications.No amount of alcohol during pregnancy is considered safe, and alcohol can damage a
fetus at
any stage of pregnancy. Therefore, drinking alcohol should be avoided by women
who are
pregnant or by women who could become pregnant.
Children
with FAS may have the following characteristics: ■ Abnormal facial features (
see next
slide) ■ Small head size ■ Shorter-than-average height ■ Low body weight ■
Poor coordination
■ Hyperactive behavior ■ Difficulty paying attention ■ Poor memory
■ Learning
disabilities ■ Speech and language delays ■ Intellectual disability or low IQ ■
Poor reasoning
and judgment skills ■ Sleep and sucking problems as a baby ■ Vision or
hearing problems
■ Problems with the heart, kidneys, or bones.
26
Slide2727
Slide28Alcohol
Intoxication and Alcohol Withdrawal
Alcohol
Intoxication: Symptoms of alcohol intoxication include disinhibition of aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face. Intoxication usually occurs at blood alcohol levels between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/
dL
.
Alcohol
Withdrawal
: Within 4 to 12 hours of cessation of, or reduction in,
heavy and
prolonged alcohol use, the following symptoms may appear: coarse tremor
of hands
, tongue, or eyelids; nausea or vomiting; malaise or weakness;
tachycardia; sweating
; elevated blood pressure; anxiety; depressed mood or
irritability; transient
hallucinations or illusions; headache; and insomnia. A
complicated withdrawal
syndrome may progress to
alcohol withdrawal delirium.
Onset
of delirium
is usually on the second or third day following cessation of or reduction
in prolonged
, heavy alcohol use.
28
Slide2929
Slide3030
Slide3131
Slide3232
Slide3333
Slide3434
Slide3535
Slide3636
Slide37Counseling
Counseling on a one-to-one basis is often used
to help
the client who abuses substances. The relationship is goal-directed, and the length of the counseling may vary from weeks to years. The focus is on current reality, development of a working treatment relationship, and strengthening ego assets. The counselor must be warm, kind, and nonjudgmental, yet able to set limits firmly. In addition
to technical counseling skills, many
important therapeutic
qualities affect the outcome
of counseling
, including insight, respect,
genuineness, concreteness
, and
empathy.
37
Slide38Counseling
Counseling of the client who abuses
substances passes
through various phases, each of which is of unspecified length. In the first phase, an assessment is conducted. the working phase of the relationship, the counselor assists the individual to work on acceptance of the fact that the use of substances causes problems in significant life areas and that he or she is not able to prevent it from
occurring
.
The
strength of the denial system is
determined by
the duration and extent of
substance related adverse
effects in the person’s life
.
Once the problem has been identified and sobriety is achieved, the client must have a concrete and workable plan for getting through the early weeks of abstinence
.
Counseling
often includes the family or specific family members.
Referrals are often made to self-help groups.
38
Slide39Group
Therapy
Group
therapy with substance abusers has long been regarded as a powerful agent of change. In groups, individuals are able to share their experiences with others who are going through similar problems. They are able to “see themselves in others,” and confront their defenses about giving up the substance. Some groups may be task-oriented education groups in which the leader is charged with presenting material
associated with substance
abuse and
its various effects on the person’s life.
39
Slide40Self-help groups
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. The only requirement for membership is a desire on the part of the alcoholic person to stop drinking. (“AA” Alcoholics Anonymous is a major self-help organization for the treatment of alcoholism in United states).40
Slide41The sole purpose of AA is to help members
stay sober
. When sobriety has been achieved, they
in turn are expected to help other alcoholic persons. The Twelve Steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety.AA accepts alcoholism as an illness and promotes total abstinence as the only cure, emphasizing that the alcoholic person can never safely return to social drinking. They encourage the members to seek sobriety, taking one day at a time. The Twelve Traditions
are the statements
of principles
that govern the organization
.
41
Slide4242
Slide43Relapse prevention
Alcohol relapse is common among recovering alcoholics; however, preventative measures can greatly reduce the risk of relapse.
Common triggers of relapse among
recovering alcoholics include:- Exposure to small amounts of alcohol.- Environmental triggers.- Stress. It is impossible to avoid all temptations and triggers, so recovery must include steps that will help them make the right decision when faced with a potential trigger.Relapse prevention measures for recovering alcoholics can include support groups, therapy, and medication.AA encourages members to follow or work with their 12-step program. These 12 steps are a list of suggested ideas and actions to help recovering alcoholics mend their lives and stay sober.
43
Slide442. Sedative, Hypnotic, or Anxiolytic Use Disorder
The sedative, hypnotic, and anxiolytic
are drugs capable
of inducing varying degrees of CNS depression, from tranquilizing relief of anxiety to anesthesia, coma, and even death.44
Slide452. Sedative, Hypnotic, or Anxiolytic Use Disorder
They are generally categorized as (1) barbiturates, (2)
nonbarbiturate
hypnotics, and (3) antianxiety agents. Originally prescribed to treat anxiety and insomnia.Intoxication: clinically significant maladaptive behavioral or psychological changes that develop during, or shortly after, use of one of these substances. Maladaptive changes may include inappropriate sexual or aggressive behavior, mood liability, impaired judgment, or impaired social or occupational functioning.45
Slide46Withdrawal: Onset of the symptoms depends on the drug type. With short-acting sedative-hypnotics (e.g., alprazolam,
lorazepam
), symptoms may begin between 12 and 24 hours after the last dose, while longer half-lives (e.g., diazepam, phenobarbital,
chlordiazepoxide) may begin within 2 to 7 days, Withdrawal symptoms include autonomic hyperactivity (e.g,sweating or pulse rate greater than 100), increased hand tremor, insomnia, nausea or vomiting, hallucinations, illusions, psychomotor agitation, anxiety, or grand mal seizures.46
Slide473. Stimulant Use Disorder
47
The psychomotor stimulants induce stimulation by augmentation
or potentiation of the neurotransmitters norepinephrine, epinephrine, or dopamine. The general cellular stimulants (caffeine and nicotine) exert their action directly on cellular activity.Caffeine inhibits the enzyme phosphodiesterase, allowing increased levels of adenosine 3´,5´-cyclic phosphate (cAMP), a chemical substance that promotes increased rates of cellular metabolism. Nicotine stimulates ganglionic
synapses. This results in increased acetylcholine,
which stimulates
nerve impulse transmission to the entire autonomic
nervous system
.
When
used in moderation, these stimulants tend to increase alertness.
Slide48Cocaine
is the most potent stimulant derived from nature. It is
extracted from
the leaves of the coca plant, which has been cultivated in South America. The coca leaves must be mixed with lime to release the cocaine alkaloid.The chemical formula for the pure form of the drug was developed in 1960. Physicians began using the drug as an anesthetic in eye, nose, and throat surgeries.It is illegally distributed as a white crystalline powder, often mixed with other ingredients to increase its volume and, therefore, create more profits. The drug is most commonly “snorted,” and chronic users may manifest symptoms
that resemble the congested nose of a common cold.
The intensely
pleasurable effects of the drug create the potential
for extraordinary
psychological addiction.
48
Slide49Amphetamine
prescribed only to treat narcolepsy (a rare disorder resulting in
an uncontrollable
desire for sleep), hyperactivity disorders in children, and in certain cases of obesity. No specific medications have been found helpful in treatment.Because of their pleasurable effects, CNS stimulants have a high abuse potential.Many individuals who abuse or are addicted to CNS stimulants began using the substance for the appetite-suppressant effect in an attempt at weight control. Higher and higher doses are consumed in an effort to maintain the pleasurable effects.With continued use, the pleasurable effects diminish. However, there is a persistent craving for the substance, however, even in the face of unpleasant adverse
effects from the continued drug taking.
49
Slide50Stimulant Intoxication:
produces
maladaptive behavioral and
psychological changes that develop during, or shortly after, use of these drugs.50
Slide51Amphetamine and cocaine intoxication typically produce euphoria or affective blunting; changes in sociability;
hypervigilance
; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; or impaired
judgment.51
Slide52Physical effects include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain,
cardiac
arrhythmias, confusion, seizures, dyskinesias, dystonias, or coma.52
Slide53Intoxication from caffeine usually occurs following consumption in excess of 250 mg. Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation.
53
Slide54Stimulant Withdrawal:
Cessation
or reduction of amphetamine (
or cocaine) use may lead to a withdrawal syndrome often referred to as a “crash.” Symptoms include fatigue and depression, nightmares, headache, profuse sweating, muscle cramps, and hunger. Withdrawal symptoms usually peak in 2–4 days. Intense dysphoria can occur, peaking between 48 and 72 hours after the last dose of the stimulant.54
Slide55Withdrawal from nicotine results in dysphoric or depressed mood
; insomnia
;
irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain.55
Slide56Treatment
of stimulant intoxication usually begins with minor
tranquilizers such
as chlordiazepoxide and progresses to major tranquilizers such as haloperidol (Haldol). Antipsychotics should be administered with caution because of their propensity to lower seizure threshold. Repeated seizures are treated with intravenous diazepam.56
Slide57Withdrawal treatment is usually aimed at reducing drug craving and managing severe depression. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as is needed or desired. Suicide precautions may need to be instituted. Antidepressant therapy may be helpful in treating symptoms of depression.
Desipramine
has been specially successful with symptoms of cocaine withdrawal and abstinence.
57
Slide5858
Slide594
. Inhalant Use Disorder
Inhalant disorders are induced by inhaling
the aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners. Specific examples of these substances include gasoline, varnish remover, lighter fluid, airplane glue, rubber cement, cleaning fluid, spray paint, shoe conditioner, and typewriter correction fluid.Inhalant substances are readily available, legal, and inexpensive. These three factors make inhalants the drug of choice among poor people and among
children and
young adults.
59
Slide604
. Inhalant Use Disorder
Methods of use include “huffing”—a
procedure in which a rag soaked with the substance is applied to the mouth and nose and the vapors breathed in.Another common method is called “bagging,” in which the substance is placed in a paper or plastic bag and inhaled from the bag by the user. The substancemay also be inhaled directly from the container or sprayed in the mouth or nose.60
Slide614
. Inhalant Use Disorder
Tolerance to inhalants has been reported
with heavy use. A mild withdrawal syndrome has been documented but does not appear to be clinically significant. Among children with inhalant disorder, the products may be used several times a week, often on weekends and after school. Adults with inhalant addiction may use the substance at varying times during each day, or they may binge on the substance during a period of several days.
61
Slide624. Inhalant Use Disorder
Inhalants
are absorbed through the lungs and reach the CNS very rapidly.
Inhalants can cause both central and peripheral nervous system damage. Neurological damage, such as ataxia, peripheral and sensorimotor neuropathy, speech problems, and tremor, can occur.Respiratory effects of inhalant use range from coughing and wheezing to dyspnea, emphysema, and pneumonia.Abdominal pain, nausea, and vomiting may occur. A rash may be present around the individual’s nose and mouth.Acute and chronic renal failure and hepatorenal syndrome have
occurred. 45
62
Slide634
. Inhalant Use Disorder
Inhalant
Intoxication: clinically significant problematic behavioral or psychological changes that developed during or shortly after exposure to inhalants.Symptoms are similar to alcohol intoxication and may include the following: - Dizziness; Ataxia; Euphoria; Disinhibition; Slurred speech; Blurred vision; Hypoactive reflexes; Psychomotor retardation; Lethargy; Generalized muscle weakness; Stupor or coma.
63
Slide645. Opioids Use Disorder
Opioids
exert both a sedative and an analgesic effect, and their
major medical uses are for the relief of pain, the treatment of diarrhea, and the relief of coughing. These drugs have addictive qualities; that is, they are capable of inducing tolerance and physiological and psychological addiction.Opioid abusers usually spend much of their time nourishing their habit. Individuals who are addicted to opioids are seldom able to hold a steady job that will support their need. They must therefore secure funds from friends, relatives, or whoever. It is not uncommon for individuals who are addicted to opioids to resort to illegal means of obtaining funds, such as burglary, robbery, prostitution, or selling drugs.
Methods
of administration of opioid drugs include oral, snorting,
or smoking
, and by subcutaneous, intramuscular, and intravenous injection.
64
Slide6565
Slide665. Opioids Use Disorder
The
development of opioid addiction may follow one of two typical behavior patterns:The first occurs in the individual who has obtained the drug by prescription from a physician for the relief of a medical problem. Abuse and addiction occur when the individual increases the amount and frequency of use, justifying the behavior as symptom treatment.The second pattern of behavior associated with addiction to opioids occurs among individuals who use the drugs for recreational purposes and obtain them from illegal sources. Opioids may be used alone to induce the euphoric effects or in combination with stimulants or
other drugs
to enhance the euphoria or to counteract the depressant effects
of the
opioid.
66
Slide675. Opioids Use Disorder
Opiates
are sometimes classified as narcotic analgesics. They exert their
major effects primarily on the CNS, the eyes, and the GI tract.Opioid Intoxication: Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. Physical symptoms include pupillary constriction (or dilation due to anoxia from severe overdose), drowsiness, slurred speech, and impairment in attention or memory. Severe opioid intoxication can lead to respiratory depression, coma, and death. 67
Slide68Opioid Withdrawal: Symptoms include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, and insomnia.
With
short-acting drugs, such as heroin, withdrawal symptoms occur within 6 to 8 hours after the last dose, peak within 1 to 3 days, and gradually subside over a period of 5 to 10 days (Walton-Moss et al, 2010).
With longer-acting drugs such as methadone, withdrawal symptoms begin within 1 to 3 days after the last dose, peak between days 4 and 6, and are complete in 14 to 21 days. Withdrawal from the ultrashort-acting meperidine begins quickly, reaches a peak in 8 to 12 hours, and is complete in 4 to 5 days68
Slide696. Hallucinogen Use Disorder
Hallucinogenic
substances are capable of distorting an individual’s perception
of reality.The hallucinations experienced by an individual with schizophrenia, however, are most often auditory, whereas substance-induced hallucinations are usually visualRecurrent use can produce tolerance, encouraging users to resort to higher and higher dosages.Hallucinogens are highly unpredictable in the effects they may induce each time they are used.Most common: Lysergic acid diethylamide (LSD) and Phencyclidine (PCP).Tolerance develop quickly and to a high degree. Recovery from the tolerance
also occurs
very rapidly.
The
effects of hallucinogens are not always pleasurable for the user.
69
Slide706. Hallucinogen Use Disorder
Effects
on the Body: Physiological Effects
o Nausea and vomiting; Chills; Pupil dilation; Increased pulse, blood pressure, and temperature; Mild dizziness; Trembling; Loss of appetite; Insomnia; Sweating; A slowing of respirations; Elevation in blood sugar.Effects on the Body: Psychological Effectso Heightened response to color, texture, and sounds; Heightened body awareness; Distortion of vision; Sense of slowing of time; All feelings magnified: love, lust, hate, joy, anger, pain, terror, despair; Fear of losing control; Paranoia, panic; Euphoria; Projection of self into dreamlike images; Serenity, peace; Depersonalization; Derealization; Increased libido.
70
Slide71Intoxication
: Maladaptive behavioral or psychological changes include
marked anxiety
or depression, ideas of reference, fear of losing one’s mind, paranoid ideation, and impaired judgment. Perceptual changes occur while the individual is fully awake and alert and include intensification of perceptions, depersonalization, derealization, illusions, hallucinations, and synesthesias. Because hallucinogens are sympathomimetics, they can cause tachycardia, hypertension, sweating, blurred vision, papillary dilation, and tremors. Benzodiazepines (e.g., diazepam or chlordiazepoxide) may be prescribed to
prevent harm
to the client or others. Psychotic reactions may be treated with
antipsychotic medications
.
No
evidence of physical addiction is detectable when the drug is
withdrawn; however
, recurrent use appears to induce a psychological addiction, which
varies according
to the drug, the dose, and the individual user, and the environment
in which
the substance is used.
71
Slide727
. Cannabis Use Disorder
Occurs
naturally in the plant Cannabis sativa, which grows readily in warm climates. Marijuana, the most prevalent type of cannabis preparation, is composed of the dried leaves, stems, and flowers of the plant. Hashish is a more potent concentrate of the resin derived from the flowering tops of the plant. Hash is very concentrated made by boiling hashish in a solvent and filtering out the solid matter.Many people incorrectly regard cannabis as a substance of low abuse potential.Intoxication: Symptoms include impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment, and social withdrawal. Physical
symptoms include
conjunctival
injection, increased appetite, dry mouth, and tachycardia.
Withdrawal
: Symptoms are heavy and prolonged. Include: Irritability, anger, or
aggression; Nervousness
or anxiety; Sleep difficulty; Decreased appetite or weight loss;
Restlessness; Depressed
mood; Physical symptoms, such as abdominal pain, tremors, sweating,
fever, chills
, or headache.
72
Slide73Dual
Diagnosis
If
it is determined that the client has a coexisting substance disorder and mental illness, he or she may be assigned to a special program that targets both problems.Counseling for the mentally ill person who abuses substances takes a different approach than that which is directed at individuals who abuse substances but are not mentally ill.Many counselors use direct confrontation of the substance-use behaviors. But with dual diagnosis programs take a more supportive and less confrontational approach.
Severe
psychiatric disorders often preclude full treatment in substance abuse clinics or
self
-
help
groups
. The addition of other [psychiatric] disorders to a substance use
disorder
greatly
complicates diagnosis and makes treatment more difficult.
73
Slide7474
Slide75Implementation with clients who abuse
substances
is a long-term process, often beginning with detoxification and progressing to total abstinence. The following common major treatment objectives have been identified for clients with substance use disorders. Detoxification: Provide
a safe and supportive environment
for
the
detoxification process.
■ Administer substitution therapy as ordered.
Intermediate Care
■ Provide explanations of physical symptoms.
■ Promote understanding and identify the
causes
substance addiction.
■ Provide education and assistance in course
of
treatment
to client and family.
75
Slide76Rehabilitation
■ Encourage continued participation in
long-term
treatment.■ Promote participation in out-patient support system (e.g., AA).■ Assist client to identify alternative sources of satisfaction.■ Provide support for health promotion and maintenance
.
76