Substance abuse

1. Substance abuse

2. Definitions • 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

3. 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

4. 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

5. 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

6. Commonly abused substances • Alcohol • Amphetamines • Barbiturates • Benzodiazepines • Cocaine • Methaqualone • opiates

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

9. 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

10. Intervention in drug abuse:General principles • 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

11. Some specific techniques • 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

12. 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

13. Alcohol abuse • 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

14. 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

15. - 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

16. Physiological effects of alcohol • 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.

17. 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

18. Warning signs of alcohol abuse • 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

19. “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

20. Stages of alcohol dependency:

21. Stage 1 • 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

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

23. Stage 3 • 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

24. Stage 4 • 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

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

26. Stages of intoxication • 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

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

28. Alcohol withdrawal symptoms Tremulous stage • 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

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

30. Delirium Tremens • 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

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

32. Dealing with drug and alcohol emergencies • 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?

33. 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

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