SUBSTANCE ABUSE

TERMINOLIGIES:

Substance abuse – using a drug in a way that is consistent with medical or social norms
and despite negative consequences.
Polysubstance abuse – abuse of more than one substance
Intoxication – use of that results in maladaptive behavior
Withdrawal syndrome – negative psychological and physical reactions that occur when
use of the substance ceases or is dramatically decreased
Detoxification – process of safety withdrawing from a substance
Blackout – an episode during which the person continues to function but has no
conscious awareness of his or her behavior of the time, or any memory of the behavior
later
Spontaneous remission – quit drinking on their own without a treatment program

Etiology of Drug Abuse

1. Biological factors
 The children of alcoholic parents are at higher risk for developing alcoholism and
drug dependence than children with nonalcoholic parents
 Higher incidence in identical twin than fraternal
 Neurochemical influences on substance use patterns according to studies revealed
that people without internals signaling mechanism experience high chances of
substance abuse because of the failure of CNS to be warned
2. Social and Environmental factors
 Cultural factors, social attitudes, peer behaviors, laws and cost and availability all
influences initial and continued use of substances
3. Psychological factors
 Family dynamics are thought to play a part
 Inconsistency in parent’s behavior, poor role modeling and lack of nurturing pave
the way for the child to adopt a similar style of maladaptive coping, stormy
relationships and substance abuse
4. Cultural consideration
 Depends on the attitude toward substance use

Flushing – a reddening of the face and neck due increased blood flow, has been linked to
variants of genes of enzymes involved in alcohol metabolism seen highest among people
of Asian ancestry

ALCOHOL
 A CNS depressant that is rapidly absorbed into the bloodstream
 Initially, the effects are relaxation and loss of inhibitions
 With intoxication, there is slurred speech, unsteady gait, lack of coordination, and
impaired attention, concentration, memory of judgment. Others become
aggressive or display
 Inappropriate sexual behavior and sometime experience blackout
 Overdose in a short period of time can result in vomiting unconsciousness and
respiratory depression

Treatment: gastric lavage or dialysis to remove the drug and support of respiratory and
CV FUNCTIONING IN AN ICU
Withdrawal and detoxification usually begin 4-12 hours after cessation or marked
reduction of alcohol intake, peaks on 2nd day and is over about 5 days (to 1-2 weeks)
Symptoms of withdrawal: course hand tremors, sweating, elevated pulse and BP,
insomnia, anxiety and N/V

 Severe or untreated withdrawal symptoms can lead to transient hallucinations,

seizures or delirium, called delirium tremens (DTS)

Psychological Effects of Long term Alcohol Use

 Cardiac myopathy  Hepatitis

 Esophagitis  Cirrhosis
 Wernick’s encephalopathy  Korsakoff’s psychosis
 Pancreatitis  Ascites
 Leukopenia  Thrombocytopenia

Drugs used to suppress withdrawal symptoms

 Benzodiazepines like Diazepam (Vallium)
 Chlordiazepoxide (Librium)
 Lorazepam (Ativan)

SEDATIVES, HYPNOTICS AND ANXIOLYTICS

 Include all CNS depressants
Example of these drugs are:
 Barbiturates
 Nonbarbiturate hypnotics
 Anxiolytics particularly benzodiazepines
Benzodiazepines and barbiturates
 The most frequently abused drugs under this category
 The effects of drugs, symptoms of intoxication, and withdrawal symptoms are
similar to those of alcohol

Benzodiazepines overdose
 Lethargic and confused, treated with gastric lavage followed by ingestion of
activated charcoal and a saline cathartic
 Confusion and lethargy will improve as the drug is excreted

Barbiturates overdose – can be lethal that can cause coma, respiratory arrest, cardiac
failure and death

Treatment
 Place in an ICU, lavage or dialysis is done immediately to remove the drug from
the system and support CV and respiratory function
Tapering or decreasing doses of medication is essential in barbiturates to prevent
coma and death which will occur if the drug is stopped abruptly

STIMULANTS (AMPHETAMINES, COCAINE)

Stimulants – drugs that stimulate or excite the CNS

Amphetamines (“Uppers”) – popular in the past used by people who wanted to lose
weight or stay awake.
Cocaine – an illegal drug that has virtually no clinical use in medicine, is highly
addictive and is a popular recreational drug because of the intense
and immediate feeling of euphoria it produces

Intoxication and Overdose

 High or euphoric feeling - Hallucination

 Hyperactivity - Stereotypic or repetitive behavior
 Hypervigilance - Anger
 Talkativeness - Fighting
 Anxiety - Impaired judgment
 Grandiosity

Physiological effects:

 Tachycardia - chest pain

 Elevated BP - confusion
 Dilated pupils - cardiac arrhythmias
 Perspiration or chills nausea

Overdose symptoms
 Seizures
 Coma
 Death
Chlorpromazine (Thorazine) – drug given to control hallucinations, lowers blood
pressure and relieves nausea

Withdrawal and Detoxification

 Occurs within a few hours to several days after cessation of the drug and is not
life threatening
 Marked dysphoria is the primary symptom and is accompanied by fatigue, vivid
and unpleasant dreams, insomnia or hypersomnia, increased appetite and
psychomotor retargationand agitation
 Marked withdrawal symptoms are referred to as “crashing” wherein the person
may experience depressive symptoms for several days including suicidal ideation
 No pharmacological treatment is necessary

CANNABIS (MARIJUANA)
 Most often smoked in cigarettes (“joints”) but it can be eaten
 Cannabis sativa- the hemp plant, which is widely used for its fiber, used to make
robe and cloth and for seeds, used to make oil
 Widely known for its pychoactive resin
 Marijuana- refers to the upper leaves, flowering tops, and stems of the plant
 Hashish – are dried resinous exudates from the leaves of the female plant

Intoxication and overdose

 Begins to act less than 1 minute after inhalation, peak effects usually occur 20-30
minutes and last for 2-3 hours
 Users report a:
 High feeling similar to that of alcohol
 Lowered inhibitions
 Relaxation
  Euphoria
 Increased appetite
Intoxication symptoms:
 Impaired motor coordination
 Inappropriate laughter
 Impaired judgment
 Short term memory
 Distortion of time and perception
 Anxiety, dysphoria and social withdrawal may occur at times
Physiological effects:
 Conjunctival injection (blood-shot eye)
 Dry mouth
 Hypotension
 Thachycardia
 Delirium
 Cannabis-induced psychotic disorder
- Over dose of cannabis do not occur
- No clinically significant withdrawal syndrome is identified

OPIOIDS
Popular drugs of abuse because they desensitize the user to both physiologic and
psychological pain and induce a sense of euphoria and well-being

Examples are:
 Morphine
 Meperidine(Demerol)
 Codeine
 Methadone
 Heroin
 Normethadone

Intoxication and overdose

Develops soon after the initial euphoric feeling
 Apathy
 Lethargy
 Listlessness
 Impaired judgment
 Psychomotor retardation or agitation
 Dilated pupils drowsiness
 Slurred speech
 Impaired attention and memory

Overdose/severe intoxication:
 Coma
 Respiratory depression
 Papillary constriction
 Unconsciousness to death

Naloxone hydrochloride (Narcan)

An opioid antagonist is the drug of choice to reverse all signs of opioid toxicity

Withdrawal and Detoxification

Develops when drug intake ceases or markedly decreased or by the administration of an
opioid antagonist
Initially:
 Anxiety
 Restlessness
 Aching back and legs
 Cravings for more opioids

Withdrawal Progresses to:

 N/V
 Dysphoria
 Lacrimation
 Rhinorrhea
 Sweating
 Diarrhea
 Yawning
 Fever and insomnia
 No pharmacological interventions required to treat withdrawal

HALLUCINATION
 Substances that distort the user’s perception of reality and produces symptoms
similar to psychosis, including hallucinations(usually visual) and
depersonalization
Examples are:
 Lasergic acid diethylamide (LSD)
 Designer drugs such as Ecstasy Phencyclidine (PCP)-an anesthetic

Intoxication and overdose

Marked by a variety of maladaptive behavioral or psychological changes
 Anxiety depression
 Paranoid ideation
 Ideas of reference
 Fear of losing one’s mind potentially dangerous behavior such as jumping out a
window in the belief that one can fly
Physiologic symptoms:
 Sweating tachycardia
 Palpitation blurred vision
 Tremors
 Lack of coordination

PCP intoxication
 Belligerence
 Aggression
 Impulsitivity
 Unpredictable behavior

PCP toxicity:
 Seizure
 Hypertension
 Hyperthermia
 Respiratory depression

Treatment: (supportive)
 Psychotic reactions are best managed by isolation from external stimuli and using
physical restraints if necessary for safety
  For PCP toxicity – medication to lower BP and control seizures, cooling devices
like the hyperthermia blanket are used; mechanical ventilation is used to support
respiration
 No withdrawal syndrome have been identified for hallucinogens but some people
may report craving for the drug

INHALANTS
 Are diverse group of drugs, including anesthetics, nitrates and organic solvents
that are inhaled for their effect
 Inhalants can use significant brain damage, peripheral nervous system damage,
peripheral nervous system damage and liver disease
 Examples are:
Aliphatic and aromatic hydrocarbons found in:
 Gasoline
 Glue
 Paint thinner
 Spray paint
Others are Halogenated hydrocarbons like:
 Cleaners
 Correction fluids
 Spray can propellants

Intoxication and Overdose

 Overdose
 Nystagmus
 Lack of coordination
 Slurred speech
 Unsteady gait
 Tremor and muscle weakness
 Blurred vision
 Stupor to coma