Substance abuse: patient is using a substance that is causing work, law, or social problems but the patient is not yet dependent on the substance.

 

Substance Dependence: patient shows signs of tolerance and withdrawal and may realize the substance is bad for him but that this may not be enough to help him stop usage.

 

Substance Withdrawal: distress or impairment resulting after stopping the use of a substance.

 

Substance-Induced Disorders: includes dementia, delirium, persisting amnesia, psychotic disorder, sexual dysfunction, anxiety, etc. caused by using an intoxicating substance.

 

Evaluating for Substance Abuse: Physicians must determine how much of the drug the patient is using, how frequently, and how the drug is affecting the patient’s life.

 

Physical Examination: different drugs may have varying effects on the patient’s body.

 

Laboratory Evaluation: Drugs may show up in the blood or urine and the use of drugs increases the risk for certain diseases.

 

 

 

I.                    Alcohol, sedatives, anxiolytics, and hypnotics will cause problems with gait, coordination, speech, memory, and even coma.

a.       Amnesia and disinhibition

b.      Addictive. With sedatives, this is dangerous because once a person becomes tolerant, they want more of the drug to get the same high. If they take too much of the drug, they risk depressing their respiratory centers in the brain stem to a point where respiration is stopped.

II.                 Opioids: euphoria à dysphoria à sedation

a.       Can overdose and die or go into coma. Can get diseases from shooting it up via IV.

b.      Heroin is the most addictive (most withdrawal symptoms)

                                                               i.      Need to open up their airway, give naloxone. Methadone or Clonidine for withdrawal symptoms.

III.               Cocaine: euphoria, hyper, anxiety (paranoid)

a.       Chronic use results in paranoid ideation and depression.

b.      Medical issues: nasal problems, heart problems (arrhythmias), brain infarcts, cocaine induced seizures.

c.       Withdrawal: excessive sleep, depression, tiredness will last for up to 5 days.

d.      Clonidine, amantidine, carbamazepine, TCAs (desipramine) for treating withdrawal symptoms.

IV.              Nicotine: cant get intoxicated on it but do have a number of withdrawal symptoms like anxiety, irritability, problems concentrating, eating more.

a.       Can give nicotine gum, patches, nasal sprays, inhalers, or Bupropion to treat withdrawal symptoms.

V.                 Phencyclidine (PCP): involuntary eye movements, increased bp or fast heart rate, resistance to pain.

a.       Patient may be paranoid or have hallucinations

b.      Can detect PCP in the blood (within 5 days of use)

c.       Benzodiazepines (lorazepam) and Haloperidol for treating withdrawal symptoms.

VI.              Amphetamine/Methamphetamine (Speed, Crystal, Crank): feeling high (happy/euphoric), energetic, irritable

a.       Withdrawal symptoms include dreams, excessive sleep or little sleep, tiredness and anxiety.

b.      Treat withdrawal with Benzos (calm the patient).