Psychiatry [ADDICTION]

Introduction

(i) Substance Abuse is when the addiction is dominating

the patient’s life, finding any one of these: 1) Failure to
fulfill responsibilities in work or home, 2) Legal ABUSE
problems, often a result of 3) use in physical harmful Female to Full Responsibilities
situations (DWI, Sex for Drugs) or 4) Continued use Legal Problems
despite obvious problems caused by the addiction (legal Physically harmful situations
and familial). Continued use despite problems
(ii) Dependence is when the body can’t get enough or needs
more of it. There’ll be tolerance (requiring increasing
amount for the same effect) and often withdrawal DEPENDENCE
(physical symptoms when stopped). Because of both, Tolerance need more
there will be isolation from everything else in life while Withdrawal physical symptoms
the majority of time is spent getting the substance. Isolation from family, friends, and work
Finally, the patient may take too much - especially in an Time Spent getting it
unfamiliar environment. Too much in one go

The pathology of an addict has a genetic predisposition to

addiction. When he/she does the substance he/she feels really Good is REAL good
good - better than everyone else. Eventually he/she needs more
and becomes dependent. But it’s worse; without the drug he/she Party
is miserable. The loss of the substance causes him/her to feel
worse than normal people so it gets used to feel normal.
Because it keeps him/her alive he/she lives to use - doing Until you need it
anything to get a fix. Just a taste/gentle reminder can spark that Hangover just to be normal
feeling and lead to relapse. Most addicts live a life riddled with
relapses, tanking 6-7 times before finally succeeding.
Life without is
Alcohol worse than normal And Gets Worse And are miserable
Since alcohol is the most common abused substance in the without it
United States we’ll spend some time on it. It lends itself to the
identification of addiction to other substances and uses the
principals discussed above. It affects males > females (4:1) and CAGE
clusters in families. Screen for it using the CAGE Cut down?
questionnaire. Particular attention must be paid to alcohol Annoyed by criticism?
because it causes life-threatening withdrawals. It can cause Guilty about drinking?
psychosis and seizures (delirium tremens) typically 48-72 Eye opener to get started?
hours after the last drink. Protect patients with a
chlordiazepoxide (benzo) taper. Both Hypertension and
Tachycardia are potential warning signs. Tachycardia’s more Acute EtOH Intoxication
sensitive because a patient may simply have essential Blood Alcohol Concentration > 0.08 (2-3 drinks)
hypertension. Further, EtOH compromises the ability to Breathalyzer screen
metabolize sugar through a thiamine deficiency which is why Detox Rate is 0.03/hr = reverse extrapolation
we give the “coma cocktail” thiamine then D 50 . Long-term during criminal investigation
alcohol use can lead to the reversible cerebellar dysfunction “Found Down” = Thiamine and then D 50
(Weirnicke’s) and to the irreversible confabulation and
cerebral atrophy (Korsakoff’s). EtOH predisposes to
cirrhosis, GI bleeding, Varices, Mallory-Weiss and a host of DEPENDENCE
other disease. While medical therapy like antabuse (causes a S/S Withdrawal HTN and Tachycardia
disulfiram-like reaction) can be used to aid compliance, only PPx Withdrawal Benzo (also treatment)
long term group therapy (AA) is even remotely helpful. Weirnicke’s Reversible Cerebellum
Relapses are common. Korsakoff’s Irreversible confabulation
Others
For all drugs of addiction (addiction isn’t limited to drugs) it’s
useful to learn the symptoms of intoxication, withdrawal, if
there are antidotes or prophylaxis, and finally any particular
details.

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 Psychiatry [ADDICTION]

Drug Intoxication Withdrawal Drug / Antidote

Slurred speech, Disinhibition, Ataxia, Tremor, Tachycardia, HTN, Benzo Taper (withdrawal)
EtOH
Blackouts, Memory Loss, Impaired Judgment Seizures, Psychosis Disulfiram (Long-Term)
Delirium in elderly, Respiratory Depression Tremor, Tachycardia, HTN,
Benzos Flumazenil
and coma (with ↑ dose), amnesia Seizures, Psychosis
Euphoria, pupil constriction, respiratory Yawning, lacrimation, N/V and Naloxone
Opiates
depression, and potential tract marks hurts everywhere, sweating Methadone (long-term)
Psychomotor agitation, HTN, tachycardia,
Depression, suicidality, Supportive Care or Benzos
Cocaine dilated pupils, psychosis
“cocaine bugs” α then β blockade
Angina / HTN crisis
Overheat (fever, tachycardia) and water
Amphetamines Crash Supportive
intoxication. Pupillary Dilation, Psychosis
Haldol to subdue
Aggressive psychosis, vertical horizontal
PCP Severe random Violence Acidify Urine to enhance
nystagmus, impossible strength, blunted senses
excretion
Rarely seen, Hallucinations, Flashbacks,
LSD Flashbacks Supportive
heightened senses
Tired, slowed reflexes, conjunctivitis, the Supportive (often nothing
Marijuana Ø
munchies, overdose brings paranoia required)
Barbiturates Low safety margins, Benzos safer Redistribute into fat Ø
None - just jittery and stimulated. Pt has to OD
Nicotine Cravings Welbutrin
to go into a Vfib

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