CARE OF THE SUSTANCE ABUSED PATIENTS

Drug use- refers to any taking of drug.

Substance abuse- a maladaptive pattern of substance use leading to a clinically significant impairment or
distress, manifested by one or more of the following:

• Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or
home
• Recurrent substance use in situations in which it is physically hazardous.
• Recurrent substance-related legal problems.
• Continued substance use despite having persistent or recurrent social or interpersonal problems
caused or exacerbated by the effects of the substance.

Drug Tolerance- is an acquired resistance to the effects of drug

Withdrawal- is a maladaptive behavioral change, with physiological and cognitive concomitants that
occurs when the blood or tissue concentrations off the substance decline in an individual who had
maintained prolonged heavy use of the substance.

Drug Dependence- occurs when individuals exhibit a set of behaviors associated with inability to control
use of the drug.

Craving- is the term often used to describe some of the behavior of the individuals who abuse or are
dependent on drugs.

Addiction

Behaviors associated with drug dependence

• Develop tolerance to drug effects

• Manifest withdrawal from a drug
• Use more drug than intended
• Try persistently or unsuccessfully to cut down on use
• Spend significant amount of time using or trying to obtain the drug
• Give up important activities because of the drug
• Continue to use a drug despite knowing it is causing physical or psychological problems

FREQUENTLY ABUSED SUBSTANCES

Depressant

• Alcohol
• Opium
• Barbiturates
• Benzodiazepines
• Volatile inhalants

Stimulants

• Amphetamines
 • Cocaine
• Crack
• Phenylcyclidine (PCP)
• Nicotine
• Caffeine

Hallucinogens

• Lysergic Acid Diethylamide (LSD)

• Mescaline
• Psilocybin MDMA (ecstasy)

Substance Abuse Overview

People abuse substances such as drugs, alcohol, and tobacco for varied and complicated reasons, but it is
clear that our society pays a significant cost. The toll for this abuse can be seen in our hospitals and
emergency departments through direct damage to health by substance abuse and its link to
physical trauma. Jails and prisons tally daily the strong connection between crime and drug dependence
and abuse. Although use of some drugs such as cocaine has declined, use of other drugs such
as heroin and "club drugs" has increased.

• Finding effective treatment for and prevention of substance abuse has been difficult. Through
research, we now have a better understanding of the behavior. Studies have made it clear that
drug education and prevention aimed at children and adolescents offers the best chance to curb
abuse nationally.

• The 1996 National Household Survey on Drug Abuse estimated the number of users of illicit
drugs in the United States to be about 13 million. In addition, the survey estimated that 10% of
Americans abuse or are dependent on alcohol, and 25% of Americans smoke cigarettes.
Abused substances produce some form of intoxication that alters judgment, perception, attention, or
physical control.
Many substances can bring on withdrawal-an effect caused by cessation or reduction in the amount of the
substance used. Withdrawal can range from mild anxiety to seizures and hallucinations. Drug
overdose may also cause death.
Nearly all these drugs also can produce a phenomenon known as tolerance where you must use a larger
amount of the drug to produce the same level of intoxication.
• Tobacco: People cite many reasons for using tobacco, including pleasure, improved performance
and vigilance, relief of depression, curbing hunger, and weight control.

○ The primary addicting substance in cigarettes is nicotine. But cigarette smoke contains
thousands of other chemicals that also damage health. Hazards include heart disease,
lung cancer and emphysema, peptic ulcerdisease, and stroke. Withdrawal symptoms of
smoking include anxiety, hunger, sleep disturbances, and depression.

○ Smoking is responsible for nearly a half million deaths each year. Tobacco use costs the
nation an estimated $100 billion a year, mainly in direct and indirect health care costs.
• Alcohol: Although many people have a drink as a "pick me up," alcohol actually depresses
the brain. Alcohol lessens your inhibitions, slurs speech, and decreases muscle control and
coordination, and may lead to alcoholism.
 ○ Withdrawal from alcohol can cause anxiety, irregular heartbeat, tremor, seizures, and
hallucinations. In its severest form, withdrawal combined withmalnutrition can lead to a
life-threatening condition called delirium tremens(DTs). Alcohol is the most common
cause of liver failure in the US. The drug can cause heart enlargement and cancer of
the esophagus, pancreas, andstomach.

○ In addition to its direct health effects, officials associate alcohol abuse with nearly half of
all fatal motor vehicle accidents. In 1992, the total economic cost of alcohol abuse was
estimated at $150 billion.
• Marijuana (also known as grass, pot, weed, herb): Marijuana, which comes from the
plant Cannabis sativa, is the most commonly used illegal drug in the United States. The plant
produces delta-9-tetrahydrocannabinol (THC), the active ingredient associated with intoxication.
Marijuana resin, called hashish, contains an even higher concentration of THC.

○ The drug is usually smoked, but it can also be eaten. Its smoke irritates yourlungs more
and contains more cancer-causing chemicals than tobacco smoke. Common effects of
marijuana use include pleasure, relaxation, and impaired coordination and memory.

○ Often, the first illegal drug people use, marijuana is associated with increased risk of
progressing to more powerful and dangerous drugs such as cocaine and heroin. The risk
for progressing to cocaine is 104 times higher if you have smoked marijuana at least once
than if you never smoked marijuana.
• Cocaine (also known as crack, coke, snow, rock): In 1997, an estimated 1.5 million people
abused cocaine in the United States.

○ Derived from the coca plant of South America, cocaine can be smoked, injected, snorted,
or swallowed. The intensity and duration of the drug's effects depend on how you take it.
Desired effects include pleasure and increased alertness.

○ Short-term effects also include paranoia, constriction of blood vessels leading to heart
damage or stroke, irregular heartbeat, and death. Severe depression and reduced energy
often accompany withdrawal.

○ Both short- and long-term use of cocaine has been associated with damage to the heart,
the brain, the lung, and the kidneys.
• Heroin (also known as smack, horse): Heroin use continues to increase. A 1998 National
Household Survey on Drug Abuse indicated 2.4 million Americans used heroin, including 81,000
new users in 1997. Officials see increased use mainly among people younger than 26 years, often
women. In 1997, 87% of heroin users were younger than 26 years, compared to 61% in 1992.

○ Effects of heroin intoxication include drowsiness, pleasure, and slowedbreathing.

Withdrawal can be intense and can include vomiting, abdominalcramps, diarrhea,
confusion, aches, and sweating.

○ Overdose may result in death from decreased breathing. Because heroin is usually
injected, often with dirty needles, use of the drug can trigger other health complications
including destruction of your heart valves, HIV/AIDS, infections, tetanus, and botulism.
• Methamphetamines (also known as meth, crank, ice, speed, crystal): Use of this drug also has
increased, especially in the West. Methamphetamine is a powerful stimulant that increases
alertness, decreases appetite, and gives a sensation of pleasure.
○ The drug can be injected, snorted, smoked, or eaten. It shares many of the same toxic
effects as cocaine-heart attacks, dangerously high blood pressure, and stroke.
 ○ Withdrawal often causes depression, abdominal cramps, and increased appetite. Other
long-term effects include paranoia, hallucinations, weight loss, destruction of teeth, and
heart damage.
• Club drugs: The club scene and rave parties have popularized an assortment of other drugs. Many
young people believe these drugs are harmless or even healthy. These are the more popular club
drugs.
○ Ecstasy (also called MDMA, Adam, STP): This is a stimulant andhallucinogen used to
improve mood and to maintain energy, often for all-night dance parties. Long-term use
may cause damage to the brain's ability to regulate sleep, pain, memory, and emotions.

○ GHB (also called Liquid XTC, G, blue nitro): Once sold at health food stores, GHB's
effects are related to dose. Effects range from mild relaxation to coma or death. GHB is
often used as a date-rape drug because it is tasteless, colorless, and acts as a
powerful sedative.

○ Rohypnol (also called roofies, roche): This is another sedative that can be used as a date-
rape drug. Effects include low blood pressure, dizziness, abdominal cramps, confusion,
and impaired memory.

○ Ketamine (also called Special K, K): This is an anesthetic that can be taken orally or
injected. Ketamine (Ketalar) can impair memory and attention. Higher doses can
cause amnesia, paranoia and hallucinations, depression, and difficulty breathing.

○ LSD (also called acid, microdot) and mushrooms (also called shrooms, magic
mushrooms, peyote, buttons): Popular in the 1960s, LSD has been revived in the club
scene. LSD and hallucinogenic mushrooms can cause hallucinations, numbness, nausea,
and increased heart rate. Long-term effects include unwanted "flashbacks"
and psychosis (hallucinations, delusions, paranoia, and mood disturbances).
○ PCP (also known as angel dust, hog, love boat): PCP is a powerful anesthetic used
in veterinary medicine. Its effects are similar to those of ketamine but often stronger. The
anesthetic effects are so strong that you can break your arm but not feel any pain.
Usually, tobacco or marijuana cigarettes are dipped into PCP and then smoked.

Substance Abuse Causes

Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the
teen years. Certain risk factors may increase someone's likelihood to abuse substances.
• Factors within a family that influence a child's early development have been shown to be related
to increased risk of drug abuse.
○ Chaotic home environment
○ Ineffective parenting
○ Lack of nurturing and parental attachment
• Factors related to a child's socialization outside the family may also increase risk of drug abuse.
○ Inappropriately aggressive or shy behavior in the classroom
○ Poor social coping skills
○ Poor school performance
○ Association with a deviant peer group
○ Perception of approval of drug use behavior
Substance Abuse Symptoms

Signs to watch for include the following:

• Giving up past activities such as sports, homework, or hanging out with new friends
• Declining grades
• Aggressiveness and irritability
• Forgetfulness
• Disappearing money or valuables
• Feeling rundown, hopeless, depressed, or even suicidal
• Sounding selfish and not caring about others
• Use of room deodorizers and incense
• Paraphernalia such as baggies, small boxes, pipes, and rolling paper
• Getting drunk or high on drugs on a regular basis

• Lying, particularly about how much alcohol or other drugs he or she is using

• Avoiding friends or family in order to get drunk or high

• Planning drinking in advance, hiding alcohol, drinking or using other drugs alone

• Having to drink more to get the same high

• Believing that in order to have fun you need to drink or use other drugs

• Frequent hangovers

• Pressuring others to drink or use other drugs

• Taking risks, including sexual risks

• Having "blackouts"-forgetting what he or she did the night before

• Constantly talking about drinking or using other drugs

• Getting in trouble with the law

• Drinking and driving

• Suspension from school or work for an alcohol or drug-related incident