Substance Abuse

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Substance Abuse
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Causes

• Link between neurotransmitters and substance
  abuse
• Individuals with chronic pain
• Teenagers
• Socio economically depressed
• Personality traits
• Individuals with a history of alcohol abuse,
  child abuse or sexual assault
• Avialability of drugs

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Pharmacodynamics

• Dependence
• Psychological and Physical
• Tolerance

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Tolerance increasing levels of drug are
required to maintain desired effect
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Categories

• CNS Stimulants
• CNS depressants
• Hallucinogens
• Non controlled substances

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CNS Stimulants Speeds

• Caffeine, Nicotine
• amphetamines ( uppers, whites, dexies,
  minibennies, hearts, Black beauties)
• Cocaine (snow, flake, cola, oca, crack, uptown,
  nose candy)

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Pharmacodynamics

• mimic the sympathetic nervous system
• Also cause the release of serotonin, dopamin
  which create a euphoric effect

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• Excess amounts may cause over stimulations of
  the CNS resulting in cardiovascular problems,
  hypertension and panic attacks
• Withdrawal effects anxiety, confusion,
  irritability, paranoia and violence, anhedonia,
  depression
• Physical / psychological dependency

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Cocaine

• Pharmacotherapeutics Ophthalmic preparations
• Pharmacokinetics
• absorbed mainly through inhalation
• highly metabolised in the liver
• Pharmacodynamics
• Activates adrenergic system
• Enhances effects of dopamin and serotonin

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CNS Depressants downers

• Alcohol
• Barbiturates (amobarbital) downers, red
  devils,yellows , blues, rainbows, christmas trees
• Benzodiazepams(diazepam) coral, MMs, tranq,
  Uncle Milty, ups and downs
• Opiods ( heroin, codeine, morphine) Chinawhite,
  smack, horse, junk, hardstuff, downtown)
• Date rape drugs

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Pharmacodynamics

• Decrease heart rate, relax muscles, promote
  sedation, suppress mental /physical pain
• Sudden withdrawal is serious and potentially
  fatal, due to depression of the respiratory and
  cardiovascular system
• Withdrawal effects are known as cold turkey
  Agitation, dysphoria, insomnia, nausea , vomiting
  , diarrhea, ataxia , hallucinations, panic
  attacks
• Physical / psychological dependency

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CNS Depressants Alcohol

• Pharmacotherapeutics Nil
• Pharmaokinetics
• Absorption within 2 hrs (on empty stomach)
• Distributed immediately rapid onset
• Metabolism 90-98 in the liver
• Pharmacodynamics CNS depressant, narrow margin
  between therapeutic and lethal dose

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• At low doses
• depresses CNS at higher centers causing
  individual to shed behavior and social
  inhibitions
• Impairs gait and muscle coordination
• dilates blood vessels , lowers blood pressure and
  deduces risk of MI
• At high doses
• Respiratory / Cardiovascular depressions and
  death
• Other adverse effects
• Alcohol increases liver enzymes therefore reduces
  bio availability of other drugs

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CNS Depressants Opoids ( heroin and Morphine)

• Pharmacotherapeutics analgesics, anti diarrhea,
  suppress cough
• Pharmacokinetics
• Poor oral availabtility
• Converted to morphia and excreted by kidneys
• Pharmacodynamics as for other CNS depressants
• Adverse effects
• High risk for AIDS and Hepatitis
• Toxic reactions due to contaminants injected
  along with heroin

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Hallucinogens

• LSD (acid, microdots, sunshine, window pane)
• Marijuana / Hash (pot, grass, weed, Jamaican
  red, Colombian, kona gold, joint)
• Ectasy (hallucinogenic amphetamine)

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Hallucinogens Marijuana

• Pharmacotherapeutics
• to treat anorexia in AIDS
• Reduces nausea and vomiting
• Reduces intraocular pressure
• Pharmacokinetics
• absorption through inhalation / ingestion
• Pharmacodynamics
• Psychic effects such as altered sense of time,
  euphoria, enhanced visual stimuli
• Adverse Effects
• Permanent brain damage
• Emphysemia
• Tolerance

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Halloginogens LSD and PCP

• Therapeutics No medical use Category One
• Pharmacotherapeutics
• ingested / inhaled
• effects occur after 30 90 mins and last 8 12
  hours
• Pharmacodynamics
• Alterations in sensory perception, distortion of
  size, body parts
• Vivid visual illusions and hallucinations
• Adverse Effects
• good versus bad trips

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Non Controlled Substances

• Volatile substances that produce behavioral
  effects ( glue, spray paint, gasoline)
• Pharmacotherapeutics Nil
• Pharmacokinetics inhalation
• Pharmacodynamics
• sense of exhilaration and lightheadedness
• CNS depression
• Abusive, violent behavior
• Adverse effects
• Brain damage

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Assessment

• Health Status
• Lifespan and Gender
• Particularly significant in the pregnant
  female
• Alcohol fetal alcohol syndrome
• Cocaine teratogenic
• Abruptio placental
• preterm labour / delievery
• fetal hypoxia
• mirocephaly and cerebral infarction
• neonatal withdrawal syndrome tremor,
  poor feeding, high pitched cry, increased
  muscle tone
• Opiods - hypoglycaemia, septicaemia, risk for
  pneumonia
• Narcotic withdrawal syndrome

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Assessment (cont)

• Life span and gender
• Childhood psychosocial and physical effects
  in alcohol abuse
• Teenagers are more prone to substance abuse
• -stressful family events
• -poor parent child relationships
• -Psychological disturabnces
• -low academic motivation
• -absence of religion
• -early tobacco use
• Older adults are also prone due to presence of
  disease, loniness, depression .

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Intervention

• Life support may be necessary
• Monitor Vital signs
• Provide quiet dim non stimulating/ non
  threatening environment
• Medical detoxification

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Alcoholism

• Acute Stage
• Airway management
• Monitor vitals
• Alleviate hypoglycaemia, ketoacidosis, dehydratin
  and neurological symptoms
• Benzodiazepams, lorazepam to suppress withdrawal
• Chronic alcoholism
• Complete abstinence
• AAA and al-Anon
• Antabuse
• Hypnosis, psychotherapy, cognitive therapy

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Heroin / Opoids

• Methdone supresses withdrawal symptoms
• Clonidine inhibits sympathetics nerve response
• Naltrexone long acting narcotic antagonist

• Cocaine
• Amantadine
• Marijuana
• Non pharmacological treatmetn aombined with
  exercise program to dea with cravings

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• LSD / PCP
• Quiet room / reduce stimuli
• Administer tranquilisers, barbiturates and
  benzodiazepams prn
• Verbal communication with LSD but not with PCP
• CNS depressants
• Oxygen ventilation
• Monitor vitals
• No vasopressor therapy

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Provide Patient and Family Education

• To prevent substance abuse
• Reinforce positive coping mechanisms
• Stress management
• Self help organisations
• Counseling / emotional support