Substance abuse Definitions n n Substance abuse use

Substance abuse

Definitions n n Substance abuse: use of a pharmacological substance for purposes other than medically defined reasons Addiction: compulsive and overwhelming dependence on a drug; an addiction may be a physiological dependence, a psychological dependence or both

n n Physiological dependence: the resulting condition if removal of the drug causes adverse physical reactions. Occurs when, in absence of the drug, there is observable physiological impact Psychological dependence: use of the drug is required to prevent or relieve tension or emotional stress. The person experiences a strong need to have the drug repeatedly

n n Tolerance: the need to progressively increase the dose of a drug to reproduce the effect originally achieved by smaller doses Withdrawal: referring to alcohol or drug withdrawal in which the patient’s body reacts severely when deprived of the abused substance

n n Drug overdose: poisoning from pharmacological substance in excess of the dose the body can tolerate Compulsive drug use: the individual is preoccupied with the use and procurement of the drug

Commonly abused substances n n n n Alcohol Amphetamines Barbiturates Benzodiazepines Cocaine Methaqualone opiates

Drug and alcohol abuse is usually complicated by: n n External reinforcements such as: - peer acceptance - peer pressure - social approval Internal reinforcements such as: - relief from pain - frustration - boredom - fatigue

n n Drug and alcohol abuse is rarely the primary problem, rather it is often a sign of other problems such as medical and/or financial problems or marital stress Drugs and alcohol may be used as temporary relief from these problems. Because temporary relief is gained, the user is reinforced to continue

Intervention in drug abuse: General principles n n n Protect self, patient and others Treat medically according to symptoms Be alert to changes Preserve evidence Reduce anxiety and calm the person Focus on the present

Some specific techniques n n n n Do not argue Allow the person to speak freely Keep the person in contact with reality Only one person should talk to the patient Reduce external stimuli Don’t work alone Don’t make sudden movements

n n Speak in a soft, calm tone Let the patient know they are safe Tell them what they are experiencing is caused by the drugs You may need to reassure the person that hospital personnel are safe and will continue to care for them

Alcohol abuse n n n Most abused substance in Canada Drinking alcohol is a factor in a large number of assaults, murders, attempted murders, child abuse and other forms of violence Factor in many motor vehicle collisions

n n n 1 in 12 adults have alcohol abuse problem Highest in 18 -29 age group Lowest in 65+ age group More men than women – 46% vs 34% Drinking & driving: - 3% of drunk drivers account for 84% of incidents - in 2000; 420 pedestrian killed – 38% BAC > 0. 08 - 87. 5% male

- 56% of drivers killed in single MVC had +ve test - 20% had +ve test in multiple MVC - 62% of snowmobile operators killed in collisions had been drinking - 49% of off road vehicle operators

Physiological effects of alcohol n n Depresses the central nervous system At low doses alcohol has excitatory and stimulating effects, thus decreasing inhibitions At higher doses alcohol’s depressive effects are more obvious Alcohol is completely absorbed from the stomach and intestinal tract in 30 – 120 min.

n n n Once absorbed alcohol is distributed to all body tissues Has a diuretic effect Peripheral vasodilator resulting in flushing and a feeling of warmth. In cold conditions this results in increased loss of body heat

Warning signs of alcohol abuse n n n Drinking early in the day Drinking alone and secretly Binge drinking – may last for several days Partial or total memory loss during drinking episodes Unexplained GI problems

n n n “green tongue syndrome” - using chlorophyll containing breath mints to disguise the odour of alcohol Cigarette burns on clothing Chronically flushed face and palms Tremors Odour of alcohol on the breath under inappropriate conditions

Stages of alcohol dependency:

Stage 1 n n n Begins somewhat innocently with social drinking As the drinker notices a pleasant, euphoric mood he tends to drink more frequently The drinking increases, so does the denial, until he becomes dependent

Stage 2 n n Outsiders start to realize a problem exists Drinker starts to suffer blackouts – they can’t remember conversations or behaviours

Stage 3 n n n Loss of control The drinker still has a choice about whether or not to take the first drink but once he takes the first drink, he continues to drink Can’t control the amount they drink – drinks to achieve a sense of well-being

Stage 4 n n n Acute, chronic dependency Entire life revolves around drinking Suffers critical deterioration and impairment of thinking Can’t think when deprived of alcohol Values may be affected

Signs of alcohol intoxication n n n n Odour of alcohol on the breath Swaying, unsteadiness Slurred speech Flushing of the face Poor coordination Drowsiness Inappropriate display of emotions Tendency towards accidents

Stages of intoxication n n Mild high – reaction time impaired, fine motor impaired Intoxication – gross impairment of physical and mental functions Stupor – if conscious, presents with a blank stare, doesn’t respond Death – respiratory depression, cardiac problems

Be aware of drug-alcohol interactions n n n ASA + alcohol – increases gastric irritation Sedatives + alcohol – rapid sedation, may lead to respiratory depression NTG + alcohol – cardiovascular collapse

Alcohol withdrawal symptoms Tremulous stage n n n Mildest stage Characterized by agitation, mild muscle tremors, headaches, flushed face & nausea May have nightmares Starts within several hours of cessation of drinking Symptoms persist for 5 – 7 days

Acute hallucinosis stage n n n 2 -3 days after a very heavy drinker stops drinking Becomes fearful, may be paranoid Excessive sweating Marked agitation May be combative, suicidal

Delirium Tremens n n n Within 1 – 7 days after a serious drinker stops drinking Most severe stage Disoriented to time, place and person Vivid hallucinations, marked agitation, tremors, pallor, sweating, seizures, fever, tachycardia May lose consciousness

Signs & symptoms if withdrawal syndrome n n n n Coarse tremor of hands, tongue and eyelids Nausea and vomiting General weakness Tachycardia, sweating Anxiety Irritability or a depressed mood hallucinations

Dealing with drug and alcohol emergencies n Ask the following: - what was taken? - when was it taken? - how was it taken? - was anything else taken? - has anything been done to correct the situation by the patient or others?

n n The biggest impediment to helping is the patient’s denial of drug and alcohol use May be because of: - fear of police - fear of retaliation from person supplying them - fear of job loss, fear of losing their driver’s licence - fear of embarrassment

n n n Communications skills are very important in dealing with these emergencies Be patient Do not accuse the patient Be nonjudgmental Listen