Some important terms/definitions to know :
Substance abuse - maladaptive pattern of substance use in-spite of its adverse effects
Substance Dependence - Presence of both tolerance and withdrawal. craving, preoccupation with substance in terms of need to use it and ways to get it, spend more time in substance use (either getting the substance/using of sub, or in after effects), taking more amount than intended, reducing occupational and social activities, continually using substance despite knowing its effects
Substance intoxication - development of reversible substance specific syndrome as a result of recent ingestion of substance, must include maladaptive behviour pattern and changes in nervous system.
Substance withdrawal - A substance-‐specific maladaptive behavioral change with physiological and cognitive correlates, due to cessation or reduction of heavy or prolonged substance use.
tolerance - a need for greatly increased amounts of the substance to achieve intoxication/desired effect or markedly diminished effect with continued use of the same amount of substance.
Substance specific intoxication and withdrawal symptoms
1. Alcohol intoxication : inappropriate sexual or aggressive behavior, unsteady gait, slurred speech, stupor, coma, rhythmic eye movement, in-coordination, impaired attention and memory, emotional lability, impaired judgement.
Alcohol withdrawal - insomnia, agitation, anxiety, hand tremor, grand mal seizures, tachycardia, sweating, nausea, vomiting, transient illusions or hallucinations
2. Amphetamine/cocaine intoxication - euphoria, anxiety, hyperactivity, confusion, anger, hallucinations, insomnia, nausea, vomiting, grandiosity, pychomotor agitation, elevated or lowered blood pressure, dilated pupils, prespiration or chills, weight loss, muscular weakness, tachycardia
Amphetamine/cocaine withdrawal - insomnia, dysphoric mood, vivid and unpleasant dreams, increased appetite, psycho-motor agitation or retardation.
3. Caffeine intoxication - dieresis, restlessness, nervousness, flushed face, excitement, insomnia, gastrointestinal disturbance, muscle twitches, rambbling flow of thought and speech, tachycardia, periods of inexhaustibility, psycho motor agitation
4. Cannabis intoxication - impaired motor incordination, tachycardia, dry mouth, increased appetite, euphoria, anxiety, sense of slowed time, impaired judgement, conjunctival injection
5. Hallucinogen intoxication - perceptual changes, anxiety, depresson, ideas of reference, paranoid ideation, pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremors, incordination
6. opioid intoxication - initial euphoria followed by apathy or dysphoria, pupillary constriction, drowsiness or coma, slurred speech impairment in attention and memory
Opioid withdrawal - dysphoric mood, nausea/vomitting, muscle aches, lacrination or rhinoria (runny eyes or nose),pupilary dilation, diarrhea, yawning, fever, insomnia
Screening
- self administered instruments (clients filling data themselves)
- CAGE
- MAST Michigan alcoholism screening test
- DAST Drug abuse screening test
- AUDIT Alcohol use disorders identification test
- SASSI Substance abuse subtle screening inventory
- T-ACE - specifically for women
- TWEAK - for women drinking during pregnancy
- Addiction severity index
Stages of change in behavior for clients with chemical dependency
- Precontemplation (they are not aware a problem exists)
- contemplation (they develop an awareness of the problem and start thinking about making changes)
- Preparation - (they intend to make changes soon)
- Action (they successfully change their situation)
- Maintenance (there is continued change to avoid relapse)
Treatment planning
one of the best guides for chemical dependancy treatment planning by ASAM II is as follows :
- early intervention
- opioid maintenance therapy (in case of physical dependency on opiates)
- outpatient services
- intensive outpatient services
- partial hospitalization
- clinically manages low intensity residential services
- clinically managed medium intensity residential services
- clinically managed medium/high intensity residential services
- medically monitored intensive inpatient services
- medically managed intensive inpatient services
the level of treatment is decided by the following factors:
- intoxication or withdrawal (need for detoxification or ambulatory services)
- other biomedical conditions and complications
- emotional and behavioral conditions and complications
- treatment acceptance or resistance
- relapse and continued use
- the individuals recovery environment
Treatment proved to work in chemical dependency issues
- AA groups 12 step facilitation process
- motivational enhancement therapy (4) sessions
- Cognitive behavioral therapy (12) sessions
- pharmacotherapy used adjunct to psychotherapies (meethadone maintenance for opioid dependency, naltrexone for reducing craving in alcohol and opioids, )
Points to keep in mind :
- Wernicke’s Encephalopathy: caused by thiamine deficiency often associated with alcoholism; symptoms include confusion, loss of muscle coordination (leg tremors) and vision changes (abnormal eye movements, double vision, eyelid drooping).
- Korsakoff’s Syndrome: retrograde and anteretrograde amnesia and confabulation (attempts to compensate for memory loss by fabricating memories); hallucinations.
- alcohol is a tranquilizer
- crack is the street name for smokeable form of cocaine
- ice is the street name for smokeable free base form of potent concentrated methamphtetamine
- cannabis- is a substance derived from cannbis plant, smoked as marijuana
- cocaine - is a naturally occuring substance produced by coca plant
- cocaine is usually snorted or dissolved in water and injected
- speedball is the name of the drug mixture of cocaine and heroin
- MDMA - ecstasy
- tuolene, benzene, acetone, tetrachlorethylyne are commonly misused inhalants
- morphiine is an opioid, opioids are also smoked, injected and snorted
- PCP street name angel dust, hog
Reference :
DSM IV
Social work desk reference by albert and gilbert pg 598
SAMHSA website and free materials
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