SUBSTANCE ABUSE • Levels:

- .1% - .2% - slow coordination, slurred

Overindulgence in or dependence on and addictive speech
substance, especially alcohol or drugs. - .2% - .3% - tremors, irritability, violence
UPPERS – stimulation of SNS - .3% and above – unconsciousness

DOWNERS – depression of SNS

EFFECTS OF ALCOHOL INTAKE:

Most abused substances: • Aggression

• Blackouts
• Alcohol – leading abused subs. • Coordination problem
• Opiates • Difficulty walking (unsteady gait)
• Narcotics • Experience slurred speech
• Hallucinogens • Polyuria
• Stimulants • Impaired attention, concentration,
• Inhalants memory, and judgement.
• Cigarettes – commonly abused substance by
psychiatric patients.
An overdose or excessive alcohol intake in a short
DEFINITION OF TERMS period of time can result to (ABCD):

INTOXICATION Altered level of consciousness

• a condition when physical or mental control Breathing is depressed and vomiting.
markedly diminished by the effects of alcohol
or drugs. Coma
DETOXIFICATION Death
• the process of removing toxic substances in
the body.
WERNICKE-KORSAKOFF’S SYNDROME
WITHDRAWAL
Characterized by amnesia, clouding of consciousness,
• when the person stops using drugs or alcohol confabulation (falsification of memory), and peripheral
and the brain rebounds by producing a surge of neuropathy.
adrenaline that causes withdrawal symptoms.

COMMON BEHAVIORAL PROBLEMS OF ALCOHOLICS

Denial
Dependency
Demanding
Destructive
Domineering

ALCOHOL WITHDRAWAL SYNDROME

Alcohol withdrawal syndrome occurs when a heavy
drinker suddenly stops or significantly reduces their
alcohol intake.

ALCOHOL ABUSE Stage 1

• Alcohol is a CNS depressant that is rapidly
absorbed into the bloodstream.
• Alcoholism is considered to be present when
there is 0.1% or 10mL for every 1000mL of
blood.
• 6-8 hours after last intake
• Anxiety and anorexia
• Insomnia and tremors
• N/V and hyperactivity
• Increase pulse and BP
• Depression
Stage 2 • Dyspnea
• Tremors
• 8-12 hours after last intake
• Weakness
• Confusion
• Gross tremors
• Nervousness
FETAL ALCOHOL SYNDROME (FAS)
• Disorientation
• Auditory and visual hallucinations is the result of alcohol’s inhibiting effects on fetal
• Illusions development during the first trimester of pregnancy.
• Nightmares
CHARACTERISTICS:
Stage 3
1. Microcephaly
• 12-48 hours after last intake 2. Severe mental retardation
• Severe hallucinations 3. Stillbirth
• Seizures (DILANTIN – drug of choice)
Stage 4
SEDATIVES, HYPNOTICS, AND ANXIOLYTICS
• 3-5 days after last ingestion
Intoxication symptoms: (“SIC LULI”)
• Confusion and delirium
• Clouding of consciousness Slurred speech and stupor
• Disorientation
• Visual and tactile hallucinations Impaired verbal communication
• Fever and increase BP
Coma
• Tremors and tachycardia
• Medical emergency Lack of coordination
Unsteady gait
Alcohol withdrawal can be life-threatening, so
Labile mood
detoxification needs to be accomplished under medical
supervision. Impaired attention or memory
Drugs used to reduce alcohol withdrawal symptoms
are BENZODIAZEPINES.
Benzodiazepines – an anxiolytic drug, when taken
➢ LORAZEPAM (Ativan) – drug of choice orally are rarely fatal.
➢ DIAZEPAM (Valium)
➢ DISULFIRAN (Antabuse) ex. Valium & Xanax
- Used to treat chronic alcoholism. 1. Lethargy and Confusion
- An alcohol antagonist
- Should never be administered until the Barbiturates and Hypnotics (Parenteral or Oral) – can
patient has abstained from alcohol for be lethal when taken in overdose (2-10g can be fatal).
at least 12 hours. ex. Phenobarbital
- Inhibiting the enzyme acetaldehyde to
convert into acetaldehyde 1. Respiratory arrest
dehydrogenase. 2. Cardiac failure
- Once Disulfiram is started, the patient 3. Coma Death
must not take alcohol because of the
danger of these adverse effects.
- May cause severe adverse reactions WITHDRAWAL SYMPTOMS
such as: arrythmias, MI, cardiac failure, Usually occurs 6-8 hours after cessation.
seizures, coma, and death.
Manifested by:
DISULFIRAM-ALCOHOL REACTION
- Increased PR, RR, BP, and TEMP
MODERATE: - Hand tremors
• Sweating - Anxiety
• Flushing of the neck and face - Nausea
• Tachycardia and palpitations - Insomnia
• Hypotension - Psychomotor agitation
• Throbbing headache Detoxification often managed by TAPERING the amount
• Nausea and vomiting of barbiturates.
OPIODS • Restlessness
• Irritability
are popular drugs because these desensitize the
• Coryza
person to both physiologic and psychological pain.
• Yawning
Examples:
METHADONE – is used to replace opioid during
1. Morphine* detoxification reduce signs and symptoms of
2. Opium* withdrawal.
3. Meperidine (Demerol)*
STIMULANTS - also known as “UPPERS”
4. Codeine
5. Hydrocodone - these drugs excite the CNS
6. Methadone – drug of choice during - these drugs have limited clinical indications
detoxification. and a high potential for abuse.
OPIOD INTOXICATION AMPHETAMINES – are commonly used before to lose
weight (ex. IONAMINE)
Happens after the initial euphoric feeling:
COCAINE and ECSTASY – have NO clinical use and is
1. Pinpoint pupils*
highly addictive.
2. Apathy
3. Respiratory depression - commonly used as a recreational drug
4. Lethargy and restlessness because of intense and immediate feelings of
5. Attention and memory impairment. euphoria.
6. Uncoordinated movements
INTOXICATION from stimulants develops rapidly:
7. Slurred speech
1. Super active
2. Talkative
NALOXONE (Opioid Antagonist) - drug of choice for 3. Impaired judgment
toxicity. 4. Weight loss
5. Unhappiness or anger
- It reverses all the signs of opioid toxicity.
6. Loss of appetite (anorexia)
- Immediately improves patient’s respiration and
7. Anxiety
consciousness.
8. The presence of hallucinations and illusions
Withdrawal to opioid develops when: 9. Euphoria
10. Physiologic effects:
1. drug intake ceases or is
- Tachycardia
2. markedly decreased, or it can also be
- Elevated BP
3. precipitated by the administration of naloxone.
- Dilated pupils
- Diaphoresis with chills
- Nausea
“CRANDS FIL”
- Chest pain and confusion
1. Craving - Cardiac arrythmias
2. Restlessness and rhinorrhea
3. Anxiety with aching backs and legs
COCAINE users may also report “bugs” crawling
4. Nausea and vomiting beneath the skin (FORMICATION) and foul smells.
5. Dysphoria and diarrhea
NASAL SEPTUM PERFORATION is associated with
6. Sweating
chronic snorting cocaine.
7. Fever
8. Insomnia COCAINE OR STIMULANT WITHDRAWAL occurs within a
few hours to several days.
9. Lacrimation
Manifestations: Depressive symptoms
1. Marked dysphoria – feeling of unhappiness and
HEROIN – an opioid, most commonly used as a
anger.
recreational drug for its euphoric effects.
2. Agitation
- highly pure heroin can be snorted or smoked. 3. Nightmare
4. Increase appetite.
HEROIN WITHDRAWAL:
5. Psychosis
• Sneezing 6. Increase suicidal ideations.
• Tears 7. Sleeping disturbances
CANNABIS (Marijuana) contain DELTA-9 • Penycyclidine (PCP) – most potent
TETRAHYDROCANNABINOL (THC) - the active • DMT – Dimethyltryptamine
substance. • MDA – Methylenedioxyamphetamine
MARIJUANA – upper leaves, flowering tops, and stems
of the plant.
HALLUCINOGEN INTOXICATION – is marked by a variety
HASHISH – is the dried resinous exudates from the of maladaptive behavioral or psychological changes.
leaves of the female plant.
- Hallucinations
- Anxiety
- Paranoid ideation
Therapeutics use of cannabis:
- Depression and dangerous behaviors
1. Lowers IOP - Ideas of reference
2. Relieves nausea and vomiting associated with
cancer chemotherapy (Dronabinol, Nabilone)
Toxic reactions to hallucinogens (except PCP) are
Cannabis Intoxications:
primarily psychological and overdose usually will not
- Begins to act less than 1 minute after occur.
inhalation.
- Peak levels occur in 20-30 minutes and lasts
at least 2-3 hours. Psychotic reactions are best managed by:
- Isolation from stimuli
SYMPTOMS OF CANNABIS INTOXICATION - Using physical restraints, as a last resort and
if necessary, from the CLIENT’S SAFETY.
1. Tachycardia
2. Hypotension
3. Eye redness
INHALANTS – are diverse groups of drugs that are
4. Psychotic symptoms
inhaled for their effects.
5. Abnormal motor coordination
6. Short-term memory loss • Oxygen deprivation
7. Inappropriate laughter • Neurotoxicity
8. Social withdrawal • Seizures
9. Increase appetite. • Brain shrinkage (cognitive impairment)
10. Disorientation, delirium, & dysphoria • Behavioral changes
Inhalants may cause ACUTE TOXICITY
• Treatment is usually symptomatic, and
overdose does not occur. - Repression depression
• Withdrawal symptoms are usually not present - Anoxia
when sudden cessation is performed. - Vagal stimulation
- Arrythmias
- Death (due to bronchospasm, cardiac arrest,
HALLUCINOGENS suffocation, or aspiration.)
• Hallucinogenic drugs, also known as
“psychedelics,” are drugs that change the way
Treatment consists of supporting respiratory and
a person perceives the world.
cardiac functions until the substance is removed from
• Example: LSD (Lysergic Acid Diethylamide) &
the body.
Magic Mushrooms (Psilocybin)
There are no withdrawal or detoxification procedures
from inhalants.
TWO BASIC GROUPS:
Some ways to remove inhalant toxicity from the body:
NATURAL
• Stop using inhalants.
• Mescaline – peyote from cactus • Seek medical attention.
• Psilocybin – psilocin from mushrooms • Provide supportive care.
• Cannabis • Detoxification (addressing the effects of
inhalants to the body)
SYNTHETIC
• Rehabilitation
• LSD – Lysergic Acid Diethylamide
• STP – Dimethoxy-4-Methylamphetamine
EFFECTS OF SUBSTANCE ABUSE
1. Decrease number of social friends.
2. Reduction of leisure activities.
3. Erosion of spiritual values and moral
standards.
4. Abnormal physical functions.
5. Mounting family tension and mental
deterioration.
6. Sexual and occupational problems.