chapter 049
TRANSCRIPT
Substance Abuse
Chapter 49Chapter 49
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Chapter 49
Lesson 49.1
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Slide 3
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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Slide 4
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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Slide 5
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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Slide 6
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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Slide 7
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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Slide 8
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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Slide 9
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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Slide 10
Substances of AbuseSubstances of Abuse
• Alcohol, nicotine, caffeine• Amphetamine• Cannabis (marijuana)• Cocaine• Hallucinogens• Inhalants• Opioids• Phencyclidine (PCP)• Sedatives and hypnotics
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Slide 11
Chapter 49
Lesson 49.2
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Slide 12
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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Slide 13
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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Slide 14
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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Slide 15
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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Slide 16
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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