rebecca sposato ms, rn addiction and its treatment
TRANSCRIPT
Terminology – DSM IVIntoxication: reversible syndrome specific
to the induced substance, includes physical and mental changes
Abuse: maladaptive pattern of use despite adverse consequences including physical hazard, legal, economic and social problems
Synergistic: Combination of substances increases effect of both (alcohol and sedatives)
Antagonistic: Drug is taken to inhibit effect of other drug (alcohol and energy drinks)
Terminology – cont.Dependence: cluster of cognitive,
behavioral and physiological symptom resulting from repeated use of substance, often results in relapseCompulsive: intense cravings and use
beyond voluntary controlTolerance: diminished effect of
substance, requiring increase in dose amount to maintain baseline effects
Withdrawal: Psychological and physical disturbance resulting from lower presence of chemical in body
Drug Enforcement Agency DEASchedule of controlled substances:
One: High potential for abuse, no accepted safe medical use, illegal except for approved studies. Ex.- heroin
Two: High potential for abuse and addiction with limited accepted and restricted medical use. Ex. – oxycodone
Three: Potential for abuse with and guarded medical use. Ex. – anabolic steroids
Four: low potential for abuse and limited dependence. Accepted medical use Ex. Valium
Five: minimal abuse potential, may be prescriptive or OTC. Ex cough syrup with codeine
www.justice.gov, 2011)
DSM –IV Criteria for Addiction3 of more must be present within 12 months:
ToleranceWithdrawalSubstance taken in greater amounts then
intendedUnsuccessful efforts to reduce use of
substanceSpending great amount of time in activities to
obtain substanceImpairment of social, occupational and
recreational activitiesUsing substance despite knowing of physical
and mental hazard to self
Physiology of addictionPre-existing low
serotonin levels and euphoric sensitivity to endorphins and dopamine
Most addictive chemicals and behaviors stimulate dopamine activity in the nucleus accumbens
Even looking at pictures of drug paraphernalia triggers the addiction pathway
(Carlson 1998)
AlcoholCNS depressant due to effects on GABA
receptors, also NMDA antagonist leading to impaired memory
High comorbidity rate with depression, anxiety, personality disorders, systemic medical conditions and societal problems
Addiction patternsSteady drinkers: anti-social tendencies
Hereditary influencesBinge drinkers: emotional, anxiety
disordersHereditary and environmental influences
(Carlson 1998)
Treatment - PhysicalLabs – BAL, chem panel, CBC, liver panel,
pancreas enzymesClinical Institute Withdrawal Assessment (CIWA)
– items rated from 0-7N/V, tactile disturbance, tremor, auditory
disturbance, sweaty, visual disturbance, anxiety, headache, agitation, orientation
Pharmacology – Vitamin/fluid/electrolyte replacement, Ativan, B-blockersNaltrexone: opiate receptor blockersDisulfiram (antabuse): causes unpleasant
physiological reaction when combined with alcoholAcamprosate (Campral): inhibits neuro excitability Toprimate (Topamax): Inhibits dopamine in
mesolimbic area
Treatment – Alcoholics AnonymousAlcoholics helping alcoholics: “A fellowship of
men and women who share their experience, strength and hope with each other that they may solve their common problem and other to recover from alcoholism”
Each chapter is stand alone and self-supporting, will not endorse any organization or position
No membership fees or affiliation required for participation in community meetingOpen – public availability, discuss progress of 12
stepsClosed – only those with drinking problem, discuss
disruption of alcohol in life
Twelve Steps of AA1. We admitted we were powerless over
alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us 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 fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
Twelve Steps of AA7. Humbly asked Him to remove our
shortcomings.8. Made a list of all persons we had harmed, and
became willing to make amends to them all.9. Made 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 were wrong 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.
Opiates and NarcoticIncludes: Heroin, morphine, fentanyl, oxycodone,
hydrocodone, hydromorphone, methadone, and demerol
Activate receptors for endorphins throughout the brain
Side Effects: impaired cognition, lethargy, constipation,
Signs of Overdose: Pinpoint pupils, LOC, bradypnea, and cool/clammy skin. Treatment: Naloxone (Narcan) – blocks recepetors, given IVP or
IV drip. Shorter half-life than most narcotics, requires heart monitor
Neltrexone: detox/addiction symptom managementCounseling
Cocaine/CrackStimulant originally
derived from Coca plant can be formulated for IV, nasal, or inhalation use
http://www.youtube.com/watch?v=4OS2C4NemJI
Effects: local vasoconstrictor, dilates pupils, tachypnea, hyperthermia, hypertension, delusions, anorexia, insomnia, injection and nasal irritation
Hallucinogens and PsychedelicsIncludes: Lysergic Diethylamide Acid, mescaline,
psilocybin and phenylcyclidine piperidine, salvia.Distort sense of self and sensory perceptions in
low doses, hallucinatory in higher dosesMost act on serotonin and dopamine receptors.
Category contains both CNS depressants and stimulants
Effects: safety risk, hyperthermia, agitated, delusions, pupil changes/nystagmus, abnormal vitals
US lifetime prevalence rate: 14% in 2003
(http://emedicine.medscape.com/article/293752, 2011)
AmphetaminesNeuro-stimulant on the
dopamine pathways of the mesolimbic system
Includes ecstasy and methamphetamine (longer lasting)
Ingredients to meth: cold tablets, lye, ammonia, iodine, match heads, ether, Drano, brake fluid, butane, hydrochloric acid
Effects: Increase all VS, polydipsia, delusions, mucosal irritation, skin lesions, insomnia, anorexiahttp:/http://www.lynnpolice.org/ingredients_of_meth.htm/,
2011)
More on Meth
Has one of the highest relapse rates
Neuro-corrosive causing structural and functional changes in brain
MI and CVA riskAnnual
prevalence 1.2%
Inhalants (Huffing)Cleaners, glues, paint
etc. Call poison controlMost materials are
toxic, neuro-corrosive and damaging to lungs, nose and mouth
Signs: disoriented dysarthia, chemical smell on breath, irritated mucosa, nausea, dysrythmia, seizures, hypoxia
17 million Americans at some point in life. Highest rate among 12-18 y/o
(www.justive.gov, 2011)
Marijuana/CannabisTetrahydrocannaibinol
(THC) derived from plant, can be inhaled or eaten, acts upon anandamide neurons
Marinol: FDA approved synthetic tablet for appetite and pain management
Most used illegal drug in and most profitable crop in the United States
Effects: Euphoria, analgesia, memory impairment, lung damage, stimulates appetite
Treatment ProgramsOver 50% of addicts will have relapse in
diseaseHighest rate in unsupported recoveryLowest rate with combination of therapies
Inpatient: Medical, psych, detox, Outpatient: Recovery centers, residential
sobriety group homes, individual/family counseling, support groups
Treatment Team: Medical MD, psychiatrist, LPC, SW/CM, nurses, Certified Addiction Counselor (CAC), BHT
ReferencesAlcoholics Anonymous (2011) www.aa.orgCarlson, N. (1998) Physiology of Behavior
(6th ed.). Allyn and Bacon: Boston, MA. Department of Justice (2011)
www.jusitce.govLynn Police Department (2011)
http://www.lynnpolice.org/ingredients_of_meth.htm
MedScape (2011). http://emedicine.medscape.com/article