The Patient With a SubstanceRelated Disorder

By: Sarah Neel

Carly Meriwether
Lam Tran

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.

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

Etiology of Alcohol
Dependence
Genetics - GABRA2 and CHRM2 are two

genes identified to involved in the

predisposition to alcohol dependence.
Biopsychosocial - Children of alcoholdependent 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.

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.

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.

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.

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

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.

Most Common Drugs of

Abuse
Cannabinoids
Depressants
Dissociative anesthetics
Hallucinogens
Opioids
Stimulants
Steroids
Inhalants

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.

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.

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.

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

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.

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.

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

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

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