Detoxification

1
Detoxification

• Appropriate for depressants, opiates and
  stimulants
• Symptoms unique to drug class
• Withdrawal symptoms are the opposite

4.1
2
Characteristics of Withdrawal

• Depressants
• Opiates
• Stimulants

4.2
3
Duration of Withdrawal
.....predicted by the half-life of the drug

• Short half-lives
• Long half-lives

4.3
4
Treatment in Detox
Address all medical problems as soon as
possible....

• Pre-existing medical problems
• Education and reassurance
• Symptoms are temporary

4.4
5
Using Medications in Detox Treatment

• Use same class of drug
• Administer enough to diminish symptoms
• Decrease medication
• three to five days for short-acting drugs
• two to four weeks for longer-acting drugs

4.5
6
Treatment of Alcohol Withdrawal
4.6
7
Treatment for Opiate Withdrawal
4.7
8
Treatment for Stimulant Withdrawal
4.8
9
Comorbidity
Two of three individuals with SUD have second
diagnosis

• Half of these have additional SUD or ASPD
• One of three with SUD appears to meet criteria
  for an Axis I major psychiatric disorder

5.1
10
Other Common Psychiatric Syndromes in SUD

• Anxiety
• Depression
• Psychotic symptoms

5.2
11
Temporary Substance-Induced Disorders

• Temporary but Intense
• Two classes of drugs
• DSM-IV
• Duration of symptoms

5.3
12
The Relationship Between Alcohol Dependence
Major Depressive Disorder

• Study by Brown
• Other studies
• Low percentage exhibited
• Symptoms independent of periods of heavy drinking

5.4
13
Time Line Approach

• Identify the approximate age of onset of
  substance dependence
• Determine any periods of abstinence
• Documentation of periods of full-blown DSM-IV
  psychiatric disorder
• Assess if psychiatric disorder was ever clearly
  developed before dependence or during periods of
  abstinence
• Follow patient prospectively to see if
  psychiatric symptoms improve or disappear within
  a month or so

5.5
14
Time Line Example
6 Month Period of Abstinence
Onset of Alcohol Dependence
X
X
43
33 33.5

Birth 27
Major Depressive Episodes
5.6
15
Substance Use Disorders Exacerbate Pre-existing
Psychiatric Disorders

• Heavy intake likely to exacerbate
• Problematic disorders
• Symptoms may improve temporarily with abstinence
• Escalation of substance intake is likely to
  worsen the symptoms of the prior syndrome

5.7
16
PsychiatricDisordersContributing to Substance
Use Disorders (SUD)

• Limited number of disorders
• Data does not support other suppositions
• Children of Alcoholics
• Other psychiatric syndromes showing a
  relationship with SUD

5.8
17
Risks

• Lifetime risk for alcohol abuse or dependence
• approximately 15 in men
• 5 to 8 in women
• Abuse or dependence on drugs other than alcohol
• 6 or so in the general population
• Dependence on alcohol or other drugs has a
  probable lifetime risk
• approximately 10 for men
• approximately 5 for women

6.1
18
Personality Disorders

• Frequency
• Characteristics
• Environment

6.2
19
Psychological Theories

• Psychodynamic issues
• Tension reduction
• Other psychological theories
• Behavioral conditioning

6.3
20
Socio-Cultural Theories

• Availability/supply
• Reinforcement
• Cultural/religious predisposition

6.4
21
Genetic Factors

• Family studies
• Twin studies
• Adoption studies

6.5
22
Complicating Factors

• High risk sub-groups
• Environment
• Mode of inheritance

6.6
23
Biological Factors

• Enzymes
• Brainwave patterns
• Level of response to alcohol

6.7
24
COA Study

• 453 Sons of alcoholics
• FHP (family history positive)
• FHN (family history negative)
• Response of COAs

6.8
25
Diagnosis at Follow-up by Family History
Percentages
6.9
26
Considerations Each Clinician is to Review

• Overdose/toxic reaction
• Abstinence syndrome/state of withdrawal
• Organic Brain Syndrome (OBS)
• Psychosis
• Depression/anxiety

1.3
27
Rebuild a Life Without Substances
Substances have been a very important part of
life and are very difficult to give up.
Lectures and discussion groups to talk about
issues.

• Appropriate use of free time
• Interaction with relatives and friends now that
  you are sober
• Appropriate interaction with or avoidance of
  substance-using friends
• Saying no to substances when offered
• (refusal skills)

3.9