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Addiction and its treatment

Addiction and its treatment. Rebecca Sposato MS, RN. Terminology – DSM IV. Intoxication: reversible syndrome specific to the induced substance, includes physical and mental changes

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Addiction and its treatment

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  1. Addiction and its treatment Rebecca Sposato MS, RN

  2. Terminology – DSM IV • Intoxication: reversible syndrome specific to the induced substance, includes physical and mental changes • Abuse: maladaptive pattern of use despite adverse consequences including physical hazard, legal, economic and social problems • Synergistic: Combination of substances increases effect of both (alcohol and sedatives) • Antagonistic: Drug is taken to inhibit effect of other drug (alcohol and energy drinks)

  3. Terminology – cont. • Dependence: cluster of cognitive, behavioral and physiological symptom resulting from repeated use of substance, often results in relapse • Compulsive: intense cravings and use beyond voluntary control • Tolerance: diminished effect of substance, requiring increase in dose amount to maintain baseline effects • Withdrawal: Psychological and physical disturbance resulting from lower presence of chemical in body

  4. Drug Enforcement Agency DEA • Schedule of controlled substances: • One: High potential for abuse, no accepted safe medical use, illegal except for approved studies. Ex.- heroin • Two: High potential for abuse and addiction with limited accepted and restricted medical use. Ex. – oxycodone • Three: Potential for abuse with and guarded medical use. Ex. – anabolic steroids • Four: low potential for abuse and limited dependence. Accepted medical use Ex. Valium • Five: minimal abuse potential, may be prescriptive or OTC. Ex cough syrup with codeine • www.justice.gov, 2011)

  5. DSM –IV Criteria for Addiction • 3 of more must be present within 12 months: • Tolerance • Withdrawal • Substance taken in greater amounts then intended • Unsuccessful efforts to reduce use of substance • Spending great amount of time in activities to obtain substance • Impairment of social, occupational and recreational activities • Using substance despite knowing of physical and mental hazard to self

  6. Physiology of addiction • Pre-existing low serotonin levels and euphoric sensitivity to endorphins and dopamine • Most addictive chemicals and behaviors stimulate dopamine activity in the nucleus accumbens • Even looking at pictures of drug paraphernalia triggers the addiction pathway (Carlson 1998)

  7. Alcohol • CNS depressant due to effects on GABA receptors, also NMDA antagonist leading to impaired memory • High comorbidity rate with depression, anxiety, personality disorders, systemic medical conditions and societal problems • Addiction patterns • Steady drinkers: anti-social tendencies • Hereditary influences • Binge drinkers: emotional, anxiety disorders • Hereditary and environmental influences • (Carlson 1998)

  8. Treatment - Physical • Labs – BAL, chem panel, CBC, liver panel, pancreas enzymes • Clinical Institute Withdrawal Assessment (CIWA) – items rated from 0-7 • N/V, tactile disturbance, tremor, auditory disturbance, sweaty, visual disturbance, anxiety, headache, agitation, orientation • Pharmacology – Vitamin/fluid/electrolyte replacement, Ativan, B-blockers • Naltrexone: opiate receptor blockers • Disulfiram (antabuse): causes unpleasant physiological reaction when combined with alcohol • Acamprosate (Campral): inhibits neuro excitability • Toprimate (Topamax): Inhibits dopamine in mesolimbic area

  9. Treatment – Alcoholics Anonymous • Alcoholics helping alcoholics: “A fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and other to recover from alcoholism” • Each chapter is stand alone and self-supporting, will not endorse any organization or position • No membership fees or affiliation required for participation in community meeting • Open – public availability, discuss progress of 12 steps • Closed – only those with drinking problem, discuss disruption of alcohol in life

  10. Twelve Steps of AA • 1. We admitted we were powerless over alcohol—that our lives had become unmanageable. • 2. Came to believe that a Power greater than ourselves could restore us to sanity. • 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. • 4. Made a searching and fearless moral inventory of ourselves. • 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. • 6. Were entirely ready to have God remove all these defects of character.

  11. Twelve Steps of AA • 7. Humbly asked Him to remove our shortcomings. • 8. Made a list of all persons we had harmed, and became willing to make amends to them all. • 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. • 10. Continued to take personal inventory and when we were wrong promptly admitted it. • 11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out. • 12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

  12. Opiates and Narcotic • Includes: Heroin, morphine, fentanyl, oxycodone, hydrocodone, hydromorphone, methadone, and demerol • Activate receptors for endorphins throughout the brain • Side Effects: impaired cognition, lethargy, constipation, • Signs of Overdose: Pinpoint pupils, LOC, bradypnea, and cool/clammy skin. Treatment: • Naloxone (Narcan) – blocks recepetors, given IVP or IV drip. Shorter half-life than most narcotics, requires heart monitor • Neltrexone: detox/addiction symptom management • Counseling

  13. Cocaine/Crack • Stimulant originally derived from Coca plant can be formulated for IV, nasal, or inhalation use • http://www.youtube.com/watch?v=4OS2C4NemJI • Effects: local vasoconstrictor, dilates pupils, tachypnea, hyperthermia, hypertension, delusions, anorexia, insomnia, injection and nasal irritation

  14. Hallucinogens and Psychedelics • Includes: Lysergic Diethylamide Acid, mescaline, psilocybin and phenylcyclidine piperidine, salvia. • Distort sense of self and sensory perceptions in low doses, hallucinatory in higher doses • Most act on serotonin and dopamine receptors. Category contains both CNS depressants and stimulants • Effects: safety risk, hyperthermia, agitated, delusions, pupil changes/nystagmus, abnormal vitals • US lifetime prevalence rate: 14% in 2003 • (http://emedicine.medscape.com/article/293752, 2011)

  15. Amphetamines • Neuro-stimulant on the dopamine pathways of the mesolimbic system • Includes ecstasy and methamphetamine (longer lasting) • Ingredients to meth: cold tablets, lye, ammonia, iodine, match heads, ether, Drano, brake fluid, butane, hydrochloric acid Effects: Increase all VS, polydipsia, delusions, mucosal irritation, skin lesions, insomnia, anorexia http:/http://www.lynnpolice.org/ingredients_of_meth.htm/, 2011)

  16. More on Meth • Has one of the highest relapse rates • Neuro-corrosive causing structural and functional changes in brain • MI and CVA risk • Annual prevalence 1.2%

  17. Inhalants (Huffing) • Cleaners, glues, paint etc. • Call poison control • Most materials are toxic, neuro-corrosive and damaging to lungs, nose and mouth • Signs: disoriented dysarthia, chemical smell on breath, irritated mucosa, nausea, dysrythmia, seizures, hypoxia 17 million Americans at some point in life. Highest rate among 12-18 y/o (www.justive.gov, 2011)

  18. Marijuana/Cannabis • Tetrahydrocannaibinol (THC) derived from plant, can be inhaled or eaten, acts upon anandamide neurons • Marinol: FDA approved synthetic tablet for appetite and pain management • Most used illegal drug in and most profitable crop in the United States Effects: Euphoria, analgesia, memory impairment, lung damage, stimulates appetite

  19. Treatment Programs • Over 50% of addicts will have relapse in disease • Highest rate in unsupported recovery • Lowest rate with combination of therapies • Inpatient: Medical, psych, detox, • Outpatient: Recovery centers, residential sobriety group homes, individual/family counseling, support groups • Treatment Team: Medical MD, psychiatrist, LPC, SW/CM, nurses, Certified Addiction Counselor (CAC), BHT

  20. References • Alcoholics Anonymous (2011) www.aa.org • Carlson, N. (1998) Physiology of Behavior (6th ed.). Allyn and Bacon: Boston, MA. • Department of Justice (2011) www.jusitce.gov • Lynn Police Department (2011) http://www.lynnpolice.org/ingredients_of_meth.htm • MedScape (2011). http://emedicine.medscape.com/article

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