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TERMINOLIGIES:
Substance abuse – using a drug in a way that is consistent with medical or social norms
and despite negative consequences.
Polysubstance abuse – abuse of more than one substance
Intoxication – use of that results in maladaptive behavior
Withdrawal syndrome – negative psychological and physical reactions that occur when
use of the substance ceases or is dramatically decreased
Detoxification – process of safety withdrawing from a substance
Blackout – an episode during which the person continues to function but has no
conscious awareness of his or her behavior of the time, or any memory of the behavior
later
Spontaneous remission – quit drinking on their own without a treatment program
1. Biological factors
The children of alcoholic parents are at higher risk for developing alcoholism and
drug dependence than children with nonalcoholic parents
Higher incidence in identical twin than fraternal
Neurochemical influences on substance use patterns according to studies revealed
that people without internals signaling mechanism experience high chances of
substance abuse because of the failure of CNS to be warned
2. Social and Environmental factors
Cultural factors, social attitudes, peer behaviors, laws and cost and availability all
influences initial and continued use of substances
3. Psychological factors
Family dynamics are thought to play a part
Inconsistency in parent’s behavior, poor role modeling and lack of nurturing pave
the way for the child to adopt a similar style of maladaptive coping, stormy
relationships and substance abuse
4. Cultural consideration
Depends on the attitude toward substance use
Flushing – a reddening of the face and neck due increased blood flow, has been linked to
variants of genes of enzymes involved in alcohol metabolism seen highest among people
of Asian ancestry
ALCOHOL
A CNS depressant that is rapidly absorbed into the bloodstream
Initially, the effects are relaxation and loss of inhibitions
With intoxication, there is slurred speech, unsteady gait, lack of coordination, and
impaired attention, concentration, memory of judgment. Others become
aggressive or display
Inappropriate sexual behavior and sometime experience blackout
Overdose in a short period of time can result in vomiting unconsciousness and
respiratory depression
Treatment: gastric lavage or dialysis to remove the drug and support of respiratory and
CV FUNCTIONING IN AN ICU
Withdrawal and detoxification usually begin 4-12 hours after cessation or marked
reduction of alcohol intake, peaks on 2nd day and is over about 5 days (to 1-2 weeks)
Symptoms of withdrawal: course hand tremors, sweating, elevated pulse and BP,
insomnia, anxiety and N/V
Benzodiazepines overdose
Lethargic and confused, treated with gastric lavage followed by ingestion of
activated charcoal and a saline cathartic
Confusion and lethargy will improve as the drug is excreted
Barbiturates overdose – can be lethal that can cause coma, respiratory arrest, cardiac
failure and death
Treatment
Place in an ICU, lavage or dialysis is done immediately to remove the drug from
the system and support CV and respiratory function
Tapering or decreasing doses of medication is essential in barbiturates to prevent
coma and death which will occur if the drug is stopped abruptly
Amphetamines (“Uppers”) – popular in the past used by people who wanted to lose
weight or stay awake.
Cocaine – an illegal drug that has virtually no clinical use in medicine, is highly
addictive and is a popular recreational drug because of the intense
and immediate feeling of euphoria it produces
Physiological effects:
Overdose symptoms
Seizures
Coma
Death
Chlorpromazine (Thorazine) – drug given to control hallucinations, lowers blood
pressure and relieves nausea
CANNABIS (MARIJUANA)
Most often smoked in cigarettes (“joints”) but it can be eaten
Cannabis sativa- the hemp plant, which is widely used for its fiber, used to make
robe and cloth and for seeds, used to make oil
Widely known for its pychoactive resin
Marijuana- refers to the upper leaves, flowering tops, and stems of the plant
Hashish – are dried resinous exudates from the leaves of the female plant
OPIOIDS
Popular drugs of abuse because they desensitize the user to both physiologic and
psychological pain and induce a sense of euphoria and well-being
Examples are:
Morphine
Meperidine(Demerol)
Codeine
Methadone
Heroin
Normethadone
Overdose/severe intoxication:
Coma
Respiratory depression
Papillary constriction
Unconsciousness to death
HALLUCINATION
Substances that distort the user’s perception of reality and produces symptoms
similar to psychosis, including hallucinations(usually visual) and
depersonalization
Examples are:
Lasergic acid diethylamide (LSD)
Designer drugs such as Ecstasy Phencyclidine (PCP)-an anesthetic
PCP intoxication
Belligerence
Aggression
Impulsitivity
Unpredictable behavior
PCP toxicity:
Seizure
Hypertension
Hyperthermia
Respiratory depression
Treatment: (supportive)
Psychotic reactions are best managed by isolation from external stimuli and using
physical restraints if necessary for safety
For PCP toxicity – medication to lower BP and control seizures, cooling devices
like the hyperthermia blanket are used; mechanical ventilation is used to support
respiration
No withdrawal syndrome have been identified for hallucinogens but some people
may report craving for the drug
INHALANTS
Are diverse group of drugs, including anesthetics, nitrates and organic solvents
that are inhaled for their effect
Inhalants can use significant brain damage, peripheral nervous system damage,
peripheral nervous system damage and liver disease
Examples are:
Aliphatic and aromatic hydrocarbons found in:
Gasoline
Glue
Paint thinner
Spray paint
Others are Halogenated hydrocarbons like:
Cleaners
Correction fluids
Spray can propellants