LEARNING OUTCOMES

• Discuss the characteristics, risk factors, and family

dynamics prevalent with substance use disorders.

• Explain the trends in substance abuse as well as its

management.

• Evaluate your feelings, attitudes, and responses to

clients and families with substance use disorders.
Review on NeuroScience!

What is Dopamine and its

function?
 Dopamine

• may be excitatory - active during

emotional responses, addictive
behaviors, & pleasurable
experiences
• may be inhibitory - help in the
regulation of skeletal muscle tone
and movement
Substance Abuse

- use of specific substances that are

intended to alter mood or behavior; use of
drugs other than their legitimate purposes

Polysubstance Abuse

- abuse of more than one substance.

Intoxication

- use of a substance that results in maladaptive

behavior.

Blackout

- an episode during which the person continues

to function but has no conscious awareness
of his or her behavior at the time or any later
memory of the behavior.
Withdrawal syndrome

- refers to the negative psychological and

physical reactions that occur when use of
a substance ceases or dramatically
decreases.

Detoxification

- the process of safely withdrawing from a

substance.
Drug Tolerance

- a person's diminished response to a drug, which occurs

when the drug is used repeatedly and the body adapts to
the continued presence of the drug.

Dependence

- a psychic and physical state of the person characterized

by behavioral and other responses resulting in
compulsions to take a drug, on a continuous or periodic
basis in order to experience its psychic effect and at
times to avoid the discomfort of its absence.
Factors that contribute to the
development of Substance Abuse:
• Biologic factors
✓ genetic vulnerability

• Psychological factors
✓ family dynamics

• Social and Environmental factors

✓ cultural factors, social attitudes, peer behaviors, laws, cost
and availability
DSM 5 Criteria of Substance Use
Disorder
Categories of drugs:

• Alcohol
• Sedatives, hypnotics, and anxioloytics
• Stimulants
• Opioids
• Hallucinogens
• Inhalants
 Acute Alcohol Intoxication

• Alcohol is a multisystem toxin

and CNS depressant
• In excess, alcohol may cause
stupor, coma and death.
• Occurs when blood levels
are >100 mg/dl; >400 mg/dl
is a medical emergency
Signs and Symptoms:

• slurred speech,
• incoordination, ataxia,
• belligerent behavior from stupor to coma,
• odor of alcohol on breath and clothing,
• respiratory depression.
 BLOOD ALCOHOL CONCENTRATION
20–99 mg/dL impaired coordination
and euphoria

100–199 mg/dL ataxia, poor judgement, labile

mood

200–299 mg/dL marked ataxia, slurred speech,

poor judgement, labile mood,
nausea and vomiting
300–399 mg/dL stage 1 anesthesia, memory lapse,
labile mood

400+ mg/dL respiratory failure, coma

 Management

• Protect airway
• Monitor CNS and respiratory depression
• Check for head injury and other trauma
• Administer IV fluids
• Magnesium sulfate to reduce risk for seizures
• Thiamine to prevent Wernickes-Korsakoff syndrome
• Glucose for hypoglycemia.
 Management
The 12 Steps of AA (Alcoholics Anonymous):
1. 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 wills and 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.
 Management
6. We’re entirely ready to have God remove all
these defects of character.
7. Humbly asked God 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 whenever
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.
 Management

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 a result of

these steps, we tried to carry this message to
alcoholics and to practice these principles in all
our affairs.
 Narcotics

• Heroin, Morphine, Codeine (Opioids)

s/s:
> pinpoint pupils
> respiratory depression
> stupor-coma
> seizures
> fresh needle marks along
superficial veins
 Management

• Respiratory and Cardiovascular support

• Administer Naloxone (Narcan) 0.4 to 2 mg IV or via
ET tube
• Constant monitoring of LOC and v/s
• Hemodialysis for severe intoxication
 Barbiturates (Sedatives)
• Pentobarbital, amobarbital, gamma-hydroxybutyrate (GHB “liquid
ecstasy)

• s/s:
> respiratory depression
> flushed face
> depressed PR and BP
> decreased DTR
> increasing nystagmus
> decreasing mental alertness
> poor motor coordination
> coma, death
 Management
• Respiratory and cardio support
• Intubation or Tracheostomy for severe
respiratory depression
• Administer flumazenil to reverse or diminish
effects of benzodiazepines
• Gastric lavage or give activated charcoal
 Non Barbiturate sedatives
• Diazepam (Valium), Flunitrazepam (Rohypnol),
“roofies”
• s/s:
> respiratory depression
> decreasing alertness
> confusion, slurred speech
> ataxia
> coma, death
 Management

• ABC
• Endotracheal intubation. Observe for laryngeal
edema and sudden apnea
• Evacuate stomach contents
• Administer flumazenil (Romazicon), a
benzodiazepine antagonist
 Amphetamine-type drugs
(Stimulants)
• “uppers”, “crystal meth”
• Amphetamine (Benzedrine)
• 3,4 –Methylenedioxymethamphetamine
(MDMA) (Ecstasy)
• Methylphenidate (Ritalin)
• When drug wears off, depression, exhaustion,
irritability, sleeplessness occurs
• s/s:
> nausea and vomiting, anorexia
> palpitations, tachycardia
> increased BP, diaphoresis
> anxiety, nervousness
> irritability, insomnia, agitation
> auditory hallucinations
> hyperactivity, euphoria, rapid speech
> decreased inhibition
> seizures, coma, hyperthermia,
> cardiovascular collapse
 Management
• ABCs
• Evacuate gastric contents (lavage, activated
charcoal)
• Maintain normothermia
• Administer diazepam (Valium) or Haloperidol
(Haldol) for CNS and muscular hyperactivity
• Monitor ECG and provide oxygen for ischemia
• antiarrhythmics for dysrhythmias
 Hallucinogens or
psychedelic-type drugs
• Lysergic acid diethylamide[LSD], Psilocybin
mushroom, Jimson weed seeds, marijuana,
• s/s:
> Marked anxiety bordering on panic
> hypertension, nystagmus
> confusion, incoherence, flashbacks,
hyperactivity,
> hallucinations, hazardous behavior,
> convulsions, coma,
> circulatory collapse, death
 Management

• Talk with patient by understanding what he

has gone through,
• Reduce fears, establish contact with reality,
• Reduce sensory stimuli,
• Monitor for hypertensive crisis and signs of
trauma, sedate if hyperactivity cant be
controlled,
• Placed in a protected environment
 Inhalants

• Amyl nitrate, freon, propane, gasoline, toluene

(metallic spray paint)
s/s:
> dizziness and imbalance
> euphoria
> respiratory depression
> vasodilation
> nosebleeding
> renal, hepatic, and cardiac toxicity
 Management

• ABC
• Treat dysrhythmias
• Monitor for profound hypotension
• Advance life support if necessary
Rehabilitation

- involves extensive therapy, which aims to rectify

drug-seeking behaviors, instill better coping
mechanisms, and teach important relapse prevention
skills.

- Phases of Rehabilitation:
➢ Phase 1 – Intake
➢ Phase 2 – Detox
➢ Phase 3 – Rehabilitation
➢ Phase 4 – Recovery and Aftercare
ALCOHOL TREATMENT MEDICATIONS

Acamprosate Used to reduce alcohol

cravings and withdrawal
symptoms.

Naltrexone Used to reduce cravings for

alcohol as well as its
pleasurable effects.

Disulfiram Causes severe negative

effects when alcohol is
consumed.
OPOIOD TREATMENT MEDICATIONS

Methadone Suppress withdrawal symptoms

and drug craving without
providing a significant high or
oversedation.
Buprenorphine Used increasingly for
maintenance. It blocks opoiod
receptors and inhibits
concomitant illicit use of heroin or
other opioids.
Naltrexone An opioid antagonist, blocks the
effects of heroin and other
opioids.
Points to Remember!
• Remember that substance abuse is a chronic,
recurring disease for many people.
• Substance use and dependence include major
impairment in the user’s social, occupational
functioning and behavioural and psychological
changes.
• Substance abuse is a family illness.
• Approach each treatment experience with an open
and objective attitude.