Substance related disorders are composed of two groups:
substance use, substance-induced
Substance abuse most often co-occurs with other mental health conditions such as _______ disorders, ______ disorders and _______ disorders
mood, anxiety, psychotic
The only non-substance addiction disorder covered in DSM 5
gambling
Substance use is only considered an issue if it ________ social/occupational functioning. Eg. someone could be drinking 2 26oz of whiskey a day and taking 620 mg of diazepam and be functioning normally with his family and job.
impairs
DSM5 lists specific substances including:
alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics, anxiolytics, stimulants, tobacco
Often what happens with substance is the person will express desire to reduce their substance but attempts will fail and then they ________ the use
increase
Substance use will begin to interfere with __________ and _____ ______ becomes evident
relationships, social isolation
Affected individuals may also engage in _______ behaviours resulting in physical injuries eg. bar fights
risky
Addiction becomes evident when the amount required to reach desired effected continues to ________
increase
A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor
substance intoxication
Defined as the physiological and mental adjustment that accompanies the discontinuation of an addictive substance
substance withdrawal
The symptoms of withdrawal are specific to the _______
substance
CNS depressants include:
anxiolytics, sedatives, hypnotics, anticonvulsants, anesthetics
CNS stimulants include:
caffeine, tobacco, amphetamines
CNS stimulants are used medically to manage _______ disorders, ______ And _____ management
hyperactivity, narcolepsy, weight
In hyperactivity disorder, CNS stimulants activates dopamine ___ receptors in basal ganglia and thalamus which depresses rather than stimulates motor activity
D4
Alcohol is considered a CNS ________
depressant
Higher levels of alcohol consumption affects ____ and _____ functioning as well as ______
motor, intellectual, mood
People who are alcoholics will often try to find substitutes when no alcohol is available. This can include:
cough syrups, cold medications, mouthwash, aftershave, rubbing alcohol, nail polish remover, hand sanitizer
____% of Canadians aged 15 and older consumed alcohol in the 12 months before the survey
70
___% admitted to drinking more than 4 times per week
10
Typically, for those who drank in the previous year, ___% drank 2 drinks per day, ___% had 3-4 drinks and ___% had more than 5 drinks
64, 20, �6
One standard drink of wine is ___ oz
3
Opioids are medically used for ____, ____ a nd ________
analgesia, antitussives, antidiarrheals
Opioids of natural origin from opium poppy include : (2)
morphine, codeine
Opioid derivatives include: (4)
heroin, hydromorphone, hydrocodone, oxycodone
Synthetic opioids include: (3)
fentanyl, methadone, meperidine
Hallucinogens work by stimulating the ______ nervous system
sympathetic
___ and ___ are two big hallucinogens on the market
LSD, PCP
Cannabinoids depress ______ centers in the brain
higher
Eg. of cannabinoids: (2)
marijuana, hashish
Cannabinoids have been used to treat: (2)
pain, seizures
Inhalants are ________ ________ such as fuels, solvents, adhesives, aerosol propellants, and pain thinners
aromatic hydrocarbons
Inhalants are usually short acting CNS _______
depressants
Eg of inhalants:
gasoline, varnish remover, lighter fluid, glue, rubber cement, cleaning fluid, spray paint
Etiology of substance abuse: (4)
genetic, biochemical, psychodynamic, social learning
Children of people dx with alcoholism are __x more likely to than other children
4
It is suggested that alcohol may produce a _______-like substance in the brain that is responsible for addiction
morphine
The psychodynamic theory holds that alcoholism is due to a ______ _______ fixed at the _____ stage of Freud's psychosexual development
punitive superego, oral
The social learning theory holds that children ________ adults or that substance use modelled elsewhere, such as the workplace, may predispose someone to become an alcoholic
mimic
Alcohol use disorder begins with _______ drinking, then progresses where they need more to acquire the same effects and then results in drinks in ______
social, secret
Patterns of use:
blackouts, amnesia, peripheral neuropathy, wernicke-korsakoff, alcoholic cardiomyopathy, esophagitis, esophageal varices, gastritis, pancreatitis, alcoholic hepatitis, cirrhosis
Symptoms of alcohol intoxicaiton:
disinhibition of sexual or aggressive impulses, mood lability, impaired judgement, impaired social and occupational functioning, slurred speech, unsteady gait, difficulties coordinating, flushed face, nystagmus
Note: physical and behaviour impairments based on blood alcohol concentrations differ according to:
gender, body size, physical condition, tolerance
Alcohol withdrawal occurs within ___(range) hours of cessation or reduction of prolonged use
4-12
Symptoms of alcohol withdrawal
tremors of hands, tongue, eyelids, n+v, malaise, tachycardia, diaphoresis, high bp, irritability, headache, hallucinations, seizures
Without intervention, the patient may progress to alcohol withdrawal ______ within ____(range) days of drinking cessation
delirium, 2-3
Assessment for alcohol withdrawal
CIWA
Threshold for withdrawal of CIWA assessment is a score of ___ or greater.
10
The CIWA assessment was mandated in ______(year) after a pt had died from withdrawal
2013
Medications used for alcohol withdrawal
benzodiazepines, alpha adrenergic blockers, antipsychotic, naltrezone, topiramate
_______ is used to diminish possibility of seizures, tremors, irritability and delirium
diazepam
_______ is used to diminish irritability, tremors, insomnia and delirium
lorazepam
______ is used to promote sleep
oxazepam
_____ is used to reduce autonomic withdrawal symptoms eg. high blood pressure
clonidine
______ is more commonly used for opioid withdrawal but may be used for alcohol especially where there are intense cravings
naltrexone
________ decreases alcohol cravings
topiramate
S+S of opioid intoxication:
euphoria, lethargy, somnolence, apathy, dysphoria, impaired judgement, pupillary constriction, slurred speech, constipation, increases RR and BP
S+S of opioid withdrawal:
drug craving, n+v, muscle aches, lacrimation, rhinorrhea, pupillary dilation, piloerection or sweating, diarrhea, yawning, insomnia, fever
Opioid withdrawal appears within ___(range) hours after last dose and peaks in the ________(range) day
6-8, 2-3
Opioid withdrawal typically subsides in _____(Range) days
5-10
Synthetic opioid that dec cravings for opioids and may be used in pregnancy
methadone
Drug given when opioid overdose is suspected (2)
naltrexone, naloxone
This drug blocks the euphoric effects of opioids and is used to block IV opioids.. available in tabs and IV
naltrexone
This drug reverses the effects of opioids including respiratory depression, sedation and hypotension... can be administed IM, IV or SC
naloxone
S+S of cannabis intoxication:
euphoria, anxiety, suspiciousness, sensation of slowed time, impaired judgement, social withdrawal, tachycardia, conjunctival redness, increased appetite, hallucinations
Most common 2 signs of cannabis intox:
conjunctival redness, increased appetite
s+S of cannabis withdrawal:
restlessness, irritability, insomnia, loss of appetite
With cannabis, intoxication occurs immediately and lasts ___ hours
3
Oral ingestation of cannabis is absorbed more _____ and has ______ effects
slowly, longer
Gambling can be _______ or _______ during a specific time in a person's lifetime
episodic, chronic
Symptoms of gambling disorder:
persistent need to gamble with increasing amounts of money, preoccupied with gambling, irritability when trying to stop, gambles when distressed, returns to gambling after a loss, conceals effects, attempts to get money from others