ALCOHOL, TOBACCO AND OTHER ADDICTIVE SUBSTANCES

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ALCOHOL, TOBACCO AND OTHER ADDICTIVE SUBSTANCES
Anderson Spickard, Jr., M.D.
Web Site www.mc.vanderbilt.edu/cph
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APPROACHES TO ADDICTION

• PREVENTION
• EARLY IDENTIFICATION
• TREATMENT
• RELAPSE PREVENTION
• POLICY AND ENVIRONMENTAL CHANGE

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Addiction Progression

• USE
• ABUSE
• DEPENDENCE

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THE DISEASE OF ADDICTION

• BIOPSYCHOSOCIAL AND SPIRITUAL

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BIOLOGICAL

• Alcohol affects
• Brain and Nerves
• GI (liver, stomach, pancreas)
• Lungs (with smoking)
• Reproductive organs

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PSYCHOLOGICAL

• Emotions (Fear and Anger)
• Dual Diagnosis (Depression, Bipolar,
  Schizophrenia, Personality Disorders,etc)
• Role of Adult Children of Alcoholic/Addict Issues

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SOCIAL

• Work impaired
• Family life impaired
• Recreational life impaired

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SPIRITUAL

• Guilt
• Shame
• Issue of sin for the faith community

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SUBSTANCES OF ADDICTION

• Alcohol
• Opiates
• Benzodiazepines and Hypnosedatives
• Cocaine, Amphetamines
• Cannabinoids
• Hallucinogens
• Inhalants
• Tobacco

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ABUSE (1 YR. OF AT LEAST 1 OF THESE)

• Major obligations not completed
• Use in dangerous situations
• Legal difficulties
• Social problems

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DEPENDENCE(1 YR. OF AT LEAST 3 OF THESE)

• Withdrawal syndrome
• Tolerance
• Greater use than intended
• Attempts to reduce use
• Excessive time to obtain substance
• Important activities curtailed or stopped
• Persistent use despite problems

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ASSESSMENT

• History of
• quantity
• frequency
• kind
• other drugs
• family history
• other treatments
• support systems
• CAGE questions
• History of DTs

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CAGE

• CHave you ever tried to Cut down on your
  drinking?
• AHave people Annoyed you by criticism of your
  drinking?
• GHave you ever felt Guilty about your drinking?
• EHave you ever taken a morning Eye opener to
  steady your nerves or to get rid of a hangover?

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Physician Intervention in Patients Alcoholism

• May be life saving to certain individuals
• Very important to family, employer
• Very effective if done well