Substance abuse
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Nur448
Substance Abuse
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DSMIV CriteriaSubstance Abuse
1 or more of following within 12 months Substance abuse resulting in failure of major
obligation—work, school, home Substance abuse resulting in physical hazard Substance related legal problems Continued substance use despite social, or
interpersonal problems
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Substance Dependence
3 or more of the following over 12 months Tolerance Withdrawal Larger amounts or longer period of time than
intended Persistent desire to control use Reduced important personal, social or work
activities Continued use despite problems
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Substance Intoxication
Reversible substance specific syndrome due to ingestion of substance
Clinically significant maladaptive behaviorSymptoms not due to medical condition
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Substance withdrawal
Development of substance specific syndrome due to cessation of substance
Clinically significant distress or impairmentSymptoms not due to medical condition or
other mental state
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Alcohol abuse- two types
Type 1 relatively mild influenced by environmental factors begins later in life
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Type 2
Severe family HxAntisocial personality featuresStrong genetic componentEarlier onset (before age 25)Reduced serotonin functionDifficulty abstaining from alcoholLoss of control while drinking
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Etiologic Theories
Biological/Genetic-disease model-low levels of dopamine
Behavioral-self-doubt and passivity, difficulty with intimacy, narcissistic
Sociological-poverty, teen-agers, ETOH western culture- Marijuana-eastern culture
Family systems- co-dependent, enabler
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Family Roles
The Hero or MartyrThe Troublemaker or ScapegoatThe Lost ChildThe Mascot
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Alcohol Withdrawal Syndrome
HangoverAlcoholic HallucinosisGeneralized SeizuresDelirium Tremens
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Acute ETOH withdrawal interventions
Force fluids and sleepHallucinations
usually disappearConvulsions
magnesium sulfateTremors
Librium (chlordiazepoxide) or Ativan (lorazepam)
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Delirium Tremens
High feverFailure of all ego functionsViolenceConvulsionsDeath
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Amnestic disorders associated with ETOH abuse
Blackouts--dehydrationKorsokoff’s psychosis—thiamine deficiencyWernecke’s encephalopathy-ataxia damage to
6th cranial nerve
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Physical effects
Peripheral neuropathyAlcoholic cardiomiopathyEsophagitisGastritisPancreatitisHepatitisCirrhosisLeukopeniaThrombocytopenia
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ETOH Long term Rx
AA, Al AnonAntabuse (Disulfuram)ReVia (Naltrexone)
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Sedative, hypnotic or anxiolyticPhysical effects
Interrupt sleep and dreamsRespiratory depression Cardiovascular effectsRenal functionHepatic effectsSexual function
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Sedative, hypnotic or anxiolytic abuse and dependence
Intoxication Disinhibition Aggression Coma,and or death
Withdrawal Depends on ½ life of drug Can be life-threatening Requires hospitalization
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CNS stimulants
AmphetaminesCocaineCaffeineNicotine
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CNS Stimulants Physical effects
CNS effectsCardiovascular effectsGastrointestinal effectsSexual function
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CNS stimulant intoxication
Euphoria, impaired judgment, anxietyNausea, vomiting, psychomotor agitationMuscle weaknessConfusion, seizures, deathNicotine—restlessness and insomnia
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CNS withdrawal
Dysphoria, fatigue, sleep disturbanceHeadache, fatigue, anxiety, nausea and
vomitingNicotine- restlessness, increased appetite,irritability
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Opioid Physical Effects
CNSGI effectsCardiovascularSexual function
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Opioid intoxication
Consistent with half-life Drowsy, euphoria Respiratory depressioin- coma-death
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Opioid withdrawal
6-12 hours after last doseNausea vomiting diarrheaLacrimationRhinorrheaPupilary dilitation, \sweating, fever
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Opiate Long Term Rx
Narcotics AnonymousCatapres (Clonidine)MethadoneReVia (Naltrexone)Anti-depressants
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Cannabis
MarijuanaHash-hish
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Effects
Slowed time assessmentImpaired motor skillsImpaired judgment
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Questions
What are substances typically abused?What is difference between abuse and
dependence?What are the names of the short term and
long term treatment facilities in the South Florida area?