Rebecca Sposato MS, RN

Addiction and its treatment

Terminology – DSM IVIntoxication: 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)

Terminology – cont.Dependence: cluster of cognitive,

behavioral and physiological symptom resulting from repeated use of substance, often results in relapseCompulsive: intense cravings and use

beyond voluntary controlTolerance: 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

Drug Enforcement Agency DEASchedule 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)

DSM –IV Criteria for Addiction3 of more must be present within 12 months:

ToleranceWithdrawalSubstance taken in greater amounts then

intendedUnsuccessful efforts to reduce use of

substanceSpending great amount of time in activities to

obtain substanceImpairment of social, occupational and

recreational activitiesUsing substance despite knowing of physical

and mental hazard to self

Physiology of addictionPre-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)

AlcoholCNS 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 patternsSteady drinkers: anti-social tendencies

Hereditary influencesBinge drinkers: emotional, anxiety

disordersHereditary and environmental influences

(Carlson 1998)

Treatment - PhysicalLabs – BAL, chem panel, CBC, liver panel,

pancreas enzymesClinical Institute Withdrawal Assessment (CIWA)

– items rated from 0-7N/V, tactile disturbance, tremor, auditory

disturbance, sweaty, visual disturbance, anxiety, headache, agitation, orientation

Pharmacology – Vitamin/fluid/electrolyte replacement, Ativan, B-blockersNaltrexone: opiate receptor blockersDisulfiram (antabuse): causes unpleasant

physiological reaction when combined with alcoholAcamprosate (Campral): inhibits neuro excitability Toprimate (Topamax): Inhibits dopamine in

mesolimbic area

Treatment – Alcoholics AnonymousAlcoholics 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 meetingOpen – public availability, discuss progress of 12

stepsClosed – only those with drinking problem, discuss

disruption of alcohol in life

Twelve Steps of AA1. 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.

Twelve Steps of AA7. 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.

Opiates and NarcoticIncludes: 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 managementCounseling

Cocaine/CrackStimulant 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

Hallucinogens and PsychedelicsIncludes: Lysergic Diethylamide Acid, mescaline,

psilocybin and phenylcyclidine piperidine, salvia.Distort sense of self and sensory perceptions in

low doses, hallucinatory in higher dosesMost 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)

AmphetaminesNeuro-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, anorexiahttp:/http://www.lynnpolice.org/ingredients_of_meth.htm/,

2011)

More on Meth

Has one of the highest relapse rates

Neuro-corrosive causing structural and functional changes in brain

MI and CVA riskAnnual

prevalence 1.2%

Inhalants (Huffing)Cleaners, glues, paint

etc. Call poison controlMost 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)

Marijuana/CannabisTetrahydrocannaibinol

(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

Treatment ProgramsOver 50% of addicts will have relapse in

diseaseHighest rate in unsupported recoveryLowest 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

ReferencesAlcoholics Anonymous (2011) www.aa.orgCarlson, N. (1998) Physiology of Behavior

(6th ed.). Allyn and Bacon: Boston, MA. Department of Justice (2011)

www.jusitce.govLynn Police Department (2011)

http://www.lynnpolice.org/ingredients_of_meth.htm

MedScape (2011). http://emedicine.medscape.com/article