Chapter 14: Substance Abuse

Pathophysiology

Chapter 14: Substance Abuse

I. Overview

A. substance abuse/chemical dependency - older concepts of addiction/alcoholism

B. Numbers

1. 20 million use illicit drugs (marijuana mainly)

2. 20,000/year die from drug related cause

3. numbers do not include legal drugs

C. Consequences other than death

1. cirrhosis of liver

2. brain damage

3. heart damage/disease

4. AIDS

II. Terminology

A. Substance abuse/chemical dependency

1. inappropriate use of drugs/chemicals

2. impairs function in some way

3. cause euphoria ("high")

4. perceptions altered

5. decrease awareness

6. interferes with brain's reward system

a. increases craving

b. promotes tolerance and dependence

B. Habit

1. practice of using drugs at regular/frequent intervals

2. does not include occasional use

C. dependence

1. psychological

a. desire to take drug

b. needed to function

2. physical

a. body adapted to presence of drug

b. discontinuing drug results in withdrawals (cramps, headaches, tremors, nightmares, cold sweats, etc.)

D. Tolerance - increase amt. to get same effect

E. Addiction

1. most serious form of abuse

2. uncontrollable compulsion to use

F. Classifying abused substances

1. mode of action

a. cns depressants or tranquilizers - alcohol, valium, thorazine, haldol, risperdal, xanax, ativan, klonopin

b. narcotics or pain-killers - codeine, morphine, oxycontin, percocet, vicodin (hydrocodone), dilaudid

-euphoria

-drowsiness

c. stimulants: coffee or amphetamines

d. psychedelics or hallucinogens - LSD, peyote, psilocybin

-alter perception/awareness

-produce illusions

e. some drugs can manifest both stimulant and depressant effects: alcohol

2. source

a. legally prescribed

b. shared medications

c. legally prescribed + alcohol

d. legally prescribed + nonprescription meds

e. prescriptions acquired from several sources

f. otc substances

-sleep-inducing (tylenol PM)

-energy pills

-alcohol based solutions (perfume, hair lotions, shaving lotions, mouthwash, etc.)

-glue

-solvents

-aerosols

-nail polish removers

-whippets (canister filled with nitrous oxide for huffing)

-paint thinner

-anti-freeze

-dusting (key board aerosol can)

g. some illegal or street drugs - content unpredictable

-amphetamines: speed, uppers, white cross, black mollies, pseudo, crank, ice

-PCP: angel dust

-cocaine: snow, crack

-methamphetamines - stimulates by increasing dopamine levels in brain

-ecstasy - euphoria, special effects, elevated body temperature

-heroin

-marijuana

-LSD

-anabolic steroids

-date rape drugs - GHB or lorazepam (depress cns)

III. Predisposing Factors

A. psychological imbalances

B. personality deficits

C. biologic abnormalities

D. Dysfunctional interpersonal relationships

E. Heredity

F. Disease

G. Gender

H. Stress/medical use of antianxiety agents

I. Breakdown of nuclear family

J. increased social/cultural acceptance of alcohol or marijuana

K. any above combination

IV. Recognition of abuse

A. Difficult - pattern of consumption/possible combinations may vary from person to person

B. General indicators

1. changes in:

-behavior

-daily living patterns

-work habits

2. secretive behavior

3. personal appearance declines

4. possible malnourishment

5. possible criminal activity

V. Potential complications of substance abuse

A. Overdose

1. some drugs have small safety margin

2. contamination of street drugs

3. combination of drugs = stronger reaction (synergism)

4. some drugs used alone - okay; combined with alcohol or other drugs = seizures, coma, brain damage, and/or death

B. Withdrawal

1. signs

a. irritability

b. tremors

c. nausea

d. vomiting

e. stomach/intestinal cramps

f. hypertension

g. psychotic episodes

h. convulsions

i. seizures

2. best to withdraw with medical supervision

C. Pregnancy

1. many substances pass through placenta to fetus

2. possible outcomes

a. physical deformities

b. cognitive abnormalities

c. behavioral abnormalities

d. low birth weight

e. higher risk of pregnancy complications

f. increased risk of stillbirth and miscarriages

g. possible maternal hypertension

h. decrease in blood flow/oxygen to fetus

D. Cardiovascular problems

1. irregular heartbeat

2. increased blood pressure

3. heart attack

4. stroke

5. heart failure

6. death

E. Psychedelic experiences - LSD/PCP

1. increased unreal/distorted interpretation of sensory input

2. increased blood pressure

3. nausea

4. tremors

5. impaired judgment

6. impaired memory

F. Infection

1. HIV

2. Hepatitis B

G. Alcohol

1. cirrhosis

a. alcohol is hepatoxin

b. causes metabolic changes

-fat accumulation in cells (fatty liver)

-inflammation of liver tissue

-necrosis of liver tissue(alcoholic hepatitis)

-fibrosis or scar tissue in liver

2. nervous system damage

a. brain damage - due to neurotoxicity and malnutrition

b. confusion

c. disorientation

d. loss of motor coordination

e. altered personality

f. amnesia

VI. Assistance with substance abuse

A. Overdose - ER

B. Withdrawal - medical supervision

C. Possible psychiatric intervention

D. Complications may need medical attention

E. Long term therapy/support usually required

F. Methadone program for heroin addiction

G. Medication deterrent for alcoholism - Antabuse (disulfiram)

1. prescription

2. taken daily

3. produces unpleasant reactions if ingest any alcohol

a. nausea/vomiting

b. headache

c. difficulty in breathing

d. vision problems

H. Counseling/behavior modification

I. Alcoholics Anonymous (AA)

J. Al-Anon - support for families

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