Addiction

national health problem
16.6 million adults (age 18 years and older)
697,000 adolescents (age 12-17 years)
3rd leading preventable cause of death in the United States
absenteeism at work
prenatal exposure
increased violence

cause of estimated 130 overdose deaths daily in the US
crosses lines of gender, race, age
department of health and human services have 5 point program to improve

alcohol
sedatives, hypnotics, and anxiolytics
stimulants
cannabis
opioids
hallucinogens
inhalants

use of substances to the point where it affects you

negative physical and/or psychological reactions when stop using substances

how you safely withdraw from susbtances

continuous use despite negative affects on your life

can be dependent without abusing it
dr prescribes opioids for pain so don't abuse them but become dependent

average age for first episode of intoxication: adolescence
pattern of more severe difficulties is mid-20s to mid-30s
blackout
tolerance breaks

gambling disorder
caffeine and tobacco addictions
substances can induce symotoms similar to other mental illness diagnoses - stop taking drugs and bipolar symptoms are gone = drug induced
hallucinogens = mimic psychosis

biologic factors
- genetic vulnerability
- neurochemical influence
psychological factors
- family dynamics
- coping mechanism
social and environmental factors
- cultural factors, social attitudes, peer behaviors
- laws, cost, availability

attitudes vary among cultures
- alcohol use is not acceptable in Muslims culture
- wine is an integral part of Jewish religious rites
- some native american tribes use peyote (hallucinogen) in religious ceremonies
certain ethnic groups have genetic traits that predispose them to or protect them against alcoholism
vartiations in genes for enzymes invovled in alcohol metabolism among various ethnic groups
- flushing: a reddening of the face and neck due to increased blood flow
aclohol abuse: plays a part in the five leading causes of death for Native Americans and Alaska Natives

cns depressant: relaxation/loss of inhibitions
intoxication
- slurred speech, unsteady gait, lack of coordination, and impaired attention, memory, judgment
- aggressive behabior or display of inappropriate sexual behavior, blackout
overdose
- vomiting, unconsciousness, repsiratory depression
- treatment: gastric lavage (pump your stomach) or dialysis to remove the drug; support of respiratory and cardiovascular functioning in an ICU

onset within 4-12 hours after cessation or marked reduction of alcohol intake
usually peaks on the second day and complete in about 5 days
symptoms: coarse hand tremors, sweating, elevvated pulse and bp, insomnia, anxiety
severe or untreated withdrawal may progress to transient hallucinations (tactile), seizures, or delirium, called delirium tremens (DTs) - life threatening
withdraw can be life-threatening

benzodiazepines

high or euphoric feeling, hyperactivity, hypervigilancem anger, elevated bp, chest pain, confusion
seizures, coma with overdose

onset within hours to several days
primary symptom is marked dysphoria (very sad)
"crashing" (feel like your going to die but won't)
not reated pharmacologically
can't die from stimulant withdraw

used for psychoactive effects
medical applications
intoxication
non clinically significant withdrawal syndrome

lowered inhibitions, relaxation, euphoria, increased appetite
symptoms of intoxication impaired motor control, impaired judgment
delirium, cannabis-induced psychotic disorder
no overdose
withdraw = possible muscle aches, sweating, anxiety, tremors

desensitization to pain, euphoria, well-being
intoxication: apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech, and impaired attention and memory
overdose: coma, respiratory depression, pupil constriction, unconsciousness, death
treatment = naloxon

nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia
symptoms cause significant distress but do not require pharm intervention to support life or bodliy functions
short-acting drugs (heroin) onset in 6-24 hours peaking in2-3 days and gradually subsiding in 5-7 days
longer-acting drugs (methadone) onset 2-4 days subsiding in 2 weeks
withdrawal will not kill you

reality distortion; symptoms similar to psychosis including hallucinations (visual), depersonalization - detached from self
- causes increased pulse, BP, and temperature; dilated pupils; hyperreflexia
intoxication: maladaptive behavioral/psychological changes, anxiety, depression, paranoid ideation
no overdose; toxic reactions are primarily psychological
phencyclidine (PCP) toxicity; seizures, HTN, hyperthermia, respiratory depression
- medications to control seizures and bp
- cooling devices
- mechanical ventilation
no withdrawal syndrome
some report craving for the drug
flashbacks possible for few months up to 5 yearrs

intoxication: neurologic, behavioral symptoms
acute toxicity
- anoxia, respiratory depression, vagal stimulation, dysrhythmias
death possible from bronchospasm, cardiac arrest, suffocation, or aspiration = need to support cardiac and respiratory system when in toxicity
intoxication can kill
no withdrawal or detoxification = frequent users report cravings
symptomatic treatment of relatex disorders