Substance Abuse

1
Substance Abuse

• Mechanisms, Evaluation, and Treatment

2
Epidemiology

•   
• An estimated 14 million Americans (6.3 percent of
  the population) reported using an illicit drug in
  the month prior to interview in 2000.   
• More than a quarter (27.5 percent) of young
  people aged 12 to 20 in 2000 had used alcohol in
  the month prior to interview. This translates to
  an estimated 9.7 million underage drinkers in the
  U.S., including 6.6 million who were binge
  drinkers.  
• On an average day, 5,556 persons (including 3,814
  youths aged 12 to 17) try marijuana for the first
  time and 3,737 (including 2,145 youths aged 12 to
  17) begin smoking cigarettes on a daily basis.  

3
Language of Substance Abuse

• Abuse
• Addiction
• Dependence
• Physiological Dependence
• Psychological Dependence
• Tolerance
• Withdrawal

4
Neurobiology of Addiction

• Pleasure-Reward Center
• Most Substances Affect the Brain
• Has a toxic effect on the central nervous system.
  
• Results in changes to metabolism, heart
  functioning and blood supply.
• Interferes with the absorption of vitamin B1
  (thiamine), which is an important brain nutrient.
  
• May be associated with poor nutrition.
• Can cause dehydration, which may lead to wastage
  of brain cells.
• Can lead to falls and accidents that injure the
  brain.

5
Families of Addictive Drugs

• Nicotine
• Alcohol
• Opiates
• Cocaine and amphetamines
• Cannabis
• Caffeine
• Hallucinogens

6
Reduction in Smoking of Teens

• A 50-percent reduction in the number of teens who
  smoke cigarettes can cut marijuana use by 16 to
  28 percent, according to a new report by the
  American Legacy Foundation and The National
  Center on Addiction and Substance Abuse (CASA)
  at Columbia University

7
Examples of Questions from Cocaine Addiction
Questionnaire

• Do you ever use more cocaine than you planned?
• Has the use of cocaine interfered with your job?
• Is your cocaine use causing conflict with your
  spouse or family?
• Do you feel depressed, guilty, or remorseful
  after you use cocaine?
• Do you use whatever cocaine you have almost
  continuously until the supply is exhausted?
• Have you ever experienced sinus problems or
  nosebleeds due to cocaine use?
• Do you ever wish that you had never taken that
  first line, hit, or injection of cocaine?

8
Caffeine Reduction

• Most people report a very good success ratio by
  cutting down caffeine intake at the rate of 1/2
  cup of coffee a day. This is known as Caffeine
  Fading.
• Alternatively you might try reducing coffee
  intake in discrete steps of two-five cups of
  coffee less per week (depending on how high is
  your initial intake).
• The best way to proceed is to consume caffeine
  regularly for a week, while keeping a precise log
  of the times and amounts of caffeine intake
  (remember that chocolate, tea, soda beverages and
  many headache pills contain caffeine as well as
  coffee). At the end of the week proceed to reduce
  your coffee intake at the rate recommended above.
  
• Remember to have substitutes available for
  drinking if you are not going to have a hot cup
  of coffee at your 10 minute break, you might
  consider having hot chocolate or herbal tea, but
  NOT decaff, since decaff has also been shown to
  be addictive. This should take you through the
  works without much problem.

9
Alcohol

• Effects on the brain and behavior
• Other physiological effects
• Withdrawal symptoms

10
Identification of Abuse

• Settings
• Primary Care
• Psychiatric
• ANYWHERE

11
Identification of Abuse (cont.)

• Screening
• CAGE
• Have you ever felt you should Cut down on your
  drinking?
• Have people Annoyed you by criticizing your
  drinking?
• Have you ever felt bad or Guilty about your
  drinking?
• Have you Ever had a drink first thing in the
  morning to steady your nerves or to get rid of a
  hangover?
• Biochemical measures
• No marker alone is better than clinical
  interview.

12
Symptoms of Alcoholism

• - Craving--A strong need, or urge, to drink.
• - Loss of control--Not being able to stop
  drinking once drinking has begun.
• - Physical dependence--Withdrawal symptoms, such
  as nausea, sweating, shakiness, and anxiety after
  stopping drinking.
• - Tolerance--The need to drink greater amounts of
  alcohol to get "high."

13
Interventions

• Prevention
• Treatment decisions
• Severity
• Risk of suicide
• Ability to sustain in environment
• Settings
• Medications

14
Medications for Alcohol Addiction

• A range of medications is used to treat
  alcoholism. Benzodiazepines (Valium , Librium)
  are sometimes used during the first days after a
  person stops drinking to help him or her safely
  withdraw from alcohol.
• Other medications help people remain sober. One
  medication used for this purpose is naltrexone
  (ReVia). When combined with counseling
  naltrexone can reduce the craving for alcohol and
  help prevent a person from returning, or
  relapsing, to heavy drinking.
• Disulfiram (Antabuse), discourages drinking by
  making the person feel sick if he or she drinks
  alcohol.

15
Role of Health Care Provider in Rehab

• Independent living skills
• Help client develop healthy ways to enjoy leisure
  time.
• Find new ways to manage stress.

16
Special Populations

• Adolescent
• Pregnancy

17
Fetal Alcohol Syndrome

• FAS is one of the known leading causes of mental
  retardation and birth defects. A woman who drinks
  alcohol during her pregnancy can put her baby at
  risk for this lifelong condition that is
  physically and mentally disabling. FAS is
  characterized by abnormal facial features, growth
  deficiencies, and problems with the central
  nervous system. Persons with FAS also may have
  problems with learning, memory, attention span,
  problem solving, speech, and/or hearing. These
  problems often lead to difficulties in school and
  in getting along with others.