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By: Sarah Neel Carly Meriwether Lam Tran The Patient With a Substance- Related Disorder

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Two types of Patient of Substance Disorder Alcoholic Patient Drug Abuse Patient Patients who are alcohol dependent are more likely to use other drugs, as are patients with a drug dependence are more likely to drink alcohol. For these reasons drug and alcohol dependence are often related to one another.

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Alcoholic Patient Alcohol use is common in a large percentage of the population and varies from social drinking to alcoholism. Physical dependence and tolerance are both present in an individual suffering from alcoholism. Alcoholism and its dependency develop after periods of unhealthy alcohol use followed by abuse. Behavioral changes from alcohol includes Aggressiveness Mood instability Impaired judgment Impaired attention and memory Physical characteristics associated with alcohol use Slurred speech Lack of coordination Unsteady gait

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Etiology of Alcohol Dependence Genetics - GABRA2 and CHRM2 are two genes identified to involved in the predisposition to alcohol dependence. Biopsychosocial - Children of alcohol-dependent parents are exposed to a higher risk factors, leading to alcohol dependence. Environmental - Emotional (stress reduction, mood enhancement) and cognitive (beliefs about alcohol) motivational factors may play a role in an individuals decision to drink. Stress, family, peers, and social forces. Current lifestyle, culture, advertisements, and economics.

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Alcohol and the Body Alcohol is quickly absorbed from stomach and small intestine upon intake and diffused into the bloodstream. The liver and its enzymes metabolize the alcohol for excretion. More than 90% of ingested alcohol converted into acetaldehyde, then acetone, and finally into CO2 and H20. High level of acetaldehyde and chronic alcohol consumption can impair liver function leading to liver damage. Less than 10% is excreted directly from breathing, sweating, and urination.

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Health Hazards Tooth decay alcoholic beverages contain high amounts of sugar and frequent consumption will demineralize tooth enamel. Liver disease most frequent. Immunity and infection alcohol abuse diminished immune response. Digestive system alcohol alters stomach mucosa and stimulates unneeded secretion of gastric acid. Nutritional deficiencies alcohol abuse result to malabsorption of vitamins and nutrients. Wernicke-Korsakoffs syndrome Brain disorder of the cerebellum from thiamine deficiency. Cardiovascular diseases heavy consumption increases risk. Neoplasm risk for many types of cancers increase with combined use of tobacco. Nervous system judgment and actions are affected. Long-term abuse can lead to damage of CNS, PNS, and the brain. Reproductive system alters endocrine hormones. There is no safe amount of alcohol use during pregnancy. Prenatal alcohol exposure is cited as the leading cause of birth defects.

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Signs & Symptoms of Alcohol Abuse Tremor of hands, tongue, and eyelids. Nervousness and irritation. Malaise, weakness, and headache. Dry mouth. Autonomic hyperactivity: sweating, rapid pulse, and elevated blood pressure. Insomnia. Grand mal seizures. Nausea or vomiting.

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Treatment for Alcoholic Patient Early intervention counsel patients who are not yet dependent. Detoxification management of acute intoxication and the withdrawal syndrome. Withdrawal occurs after an abrupt cessation of alcohol intake in the alcohol-dependent person. Signs appear within few hours and can include fatigue, depression, and anxiety. Pharmacotherapy for withdrawal management. Disulfiram (Antabuse) interferes with alcohol metabolism in the liver. Naltrexone (ReVia) interferes with neurotransmitter system that produce pleasure effects. Acamprosate affects certain neurotransmitter. Toirimate an anticonvulsant. Rehabilitation Counseling and Education Group Therapy and Alcoholics Anonymous (AA) Psychiatric Treatment Aftercare Services

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Drug Abuse Patient Drug abuse: habitual use of drugs not needed for therapeutic purposes. Prescription drug abuse: taking prescription medication that is not prescribed for that person. Drugs interfere with the function of the brain and create long-term effects on brain metabolism and activity. Dependency develops after periods of drug use followed by pathologic abuse. There is no classic cultural, socioeconomic, or educational profile for a substance abuser.

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Most Common Drugs of Abuse Cannabinoids Depressants Dissociative anesthetics Hallucinogens Opioids Stimulants Steroids Inhalants

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Medical Effects of Drug Abuse Cardiovascular effects increase blood pressure, arrhythmias, vasoconstriction, and induce angina. Neurological effects memory lapses, attention problems, seizure, intracerebral hemorrhage, and dementia. Gastrointestinal effects many drugs of abuse have been known to cause nausea and vomiting. Cocaine has been associated with GI complications and life-threatening hemorrhage. Kidney damage toxic effects of drug reduce and affect renal function. Liver damage because liver detoxifies drugs, chemicals, and alcohol, it can be damage from abuse. Musculoskeletal effects steroid use during adolescence can result in a short stature. Respiratory effects smoking tobacco or marijuana damage sensitive lung tissue. Prenatal effects miscarriage, premature birth, and low birth weight. Infections risk for acquiring infections are higher for drug users. HIV from sharing needles.

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Oral Effects of Drug Abuse Lips & Tongue Drug induced xerostomia and soft tissue abnormalities. Tongue coated with bacteria. Gingiva - Heavy biofilm, moderate-severe inflammation, periodontal infections. Palate - Perforation of palate due to chronic cocaine use. Teeth - Chipped and fractured from falls and injuries, attrition due to bruxism. Dental Caries - Diet high in cariogenic substances, poor diet, lack of dental care, xerostomia. Stimulants like ecstasy, amphetamines and cocaine are known to cause individuals to clench and grind their teeth when under the influence, damaging roots and gum. Chronic dry mouth are also common. Meth Mouth is a term to describe the discoloration, rotting and broken teeth from chronic use of methamphetamine. Methamphetamine stop the saliva glands from producing saliva, causing extreme xerostomia and allowing increased acid attacks on the enamel.

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Treatment Methods for Drug Abuse Patient Behavioral changes Counseling Support groups Psychotherapy Family therapy Medications substitute with comparable drug with milder withdrawal symptoms, and then gradually taper off the medications. Methadone associated with narcotic addiction. LAAM (Levo-Alpha-Acetyl-Methadol) suppresses withdrawal symptoms and drug cravings. Naltrexone blocks the effects of heroin at the opioid receptor sites, does not eliminate drug cravings. Phenobarbital/Diazepam use to treat sedative withdrawal symptoms.

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Contraindication Rinses, antibacterial agents, and oral hygiene products that contain alcohol need to be avoided for patients suffering from an alcohol use problem. Drug interactions, use of epinephrine, and using nitrous oxide verses local anesthesia needs to be reviewed with the patients physician. Consult with patients physician to determine whether prophylactic antibiotic premedication is indicated. Patients are at an increased risk for infection, use ultrasonic scalers and air polishers with caution.

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Dental Concerns and Management Medical and dental history of the patient does not always provide information necessary to determine if the patient abuse alcohol or use substances. Patient might be reluctant to reveal information about their substance-use; many patients with drug abuse problem are in denial, which makes their medical history less reliable. It is the Dental Hygienists professional responsibility to be aware of signs and symptoms of drug abuse, and to view chemical dependency as an illness. Use effective communication and refrain from using comments that will place the patient on the defensive. Be empathetic, respectful and nonjudgmental. Motivate your patient! Develop maintenance program to prevent progression of reoccurrence of disease. Evaluate treatment plans and goals with patient, and make changes according to the patients progress. Provide information about basic dietary needs. Recall: 3 months.

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Question 1 What are the signs and symptoms of alcohol abuse? A) Tremor of hands, tongue, and eyelids. B) Nervousness and irritation. C) Malaise, weakness and headache. D) All of the above.

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Question 2 Which of these are NOT physical characteristics associated with alcohol use? A) Slurred speech B) Lack of coordination C) Increased concentration D) Unsteady gait

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Question 3 Drug abuse generally have no negative effects on the cardiovascular system. A) True B) False

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References www.ada.org/en/member-center/oral-health-topics/drug- use#talking www.alcoholrehab.com/drug-addiction/substance-abuse-and- oral-health www.morningsiderecoverynewportbeach.com/wp- content/uploads/2013/05/Morningside-Recovery-Effects- of-Alcoholism-and-Alcohol-Abuse.jpg Wilkins, Esther M. Clinical Practice of the dental Hygienist. Philadelphia: Walters Kluwer Health/Lippincott Willams & Wilkins, 2013. Print.