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____ is the periodic purposeful use of a substance that leads to clinically significant impairment.
The impairments results in:
failure to fulfill major obligations at work, school, and home.
If substance abuse behavior is not stopped, substance abuse may lead to another more serious medical condition known as substance ____ or ______ that includes symptoms of overwhelming compulsive use, tolerance, and withdrawal on discontinuation.
dependence or addiction
____ is any chemical or mixture of chemicals that alters biologic function and is not required to maintain health; applies primarily to illegal substances.
______ hypothesizes that substance abuse is caused by a person's genetic profile, making a predisposition to substance abuse a hereditary condition.
_____ see alcoholics as fixated at the oral stage of development, thus seeking satisfaction through oral behaviors such as drinking.
_____ view addictive behaviors as overlearned, maladaptive habits that can be examined and changed in the same way as other habits.
Behavior or learning theories
____ suggest that addiction is based on a distorted way of thinking about substance abuse.
____ emphasizes the pattern of relationships among family members through the generation as an explanation of substance abuse.
family system theories
____ play a role in a person's choice of whether to use drugs, which drugs to use, how much to use, and treatment for substance abuse.
SIGNS OF IMPAIRMENT: The disease usually first manifested in family life:
- 1. domestic violence
- 2. seperation
- 3. financial problems
- 4. problem behavior in children
SIGNS OF IMPAIRMENT: then in social life:
- 1. Over public intoxication
- 2. Isolation from friends, peers, church
SIGNS OF IMPAIRMENT: Physical and mental changes
- 1. Excessive tiredness
- 2. Multiple illnesses
- 3. Frequent injuries or accidents
- 4. Emotional crisis
Deterioration in ____ status is an important sign, but occurs late in the disease(IMPAIRMENT)
Screening instruments for substance abuse can be divided into four categories:
- 1. Comprehensive drug abuse screening and assessment
- 2. Brief drug abuse screening
- 3. Alcohol abuse screening
- 4. Drug and alcohol abuse screening for use with adolescents.
What is a disadvantage of some of the comprehensive screening instruments?
The length of time required to administer the assessment and the availability of a qualified data interpreter.
Some contributors leading to substance abuse among health professionals:
- 1. Inability to manage stress brought on by intense pt care practice.
- 2. Managing more pts with the same resources
- 3. zero tolerance for making a mistake in association with the expectation of 100% perfection.
- 4. financial debt are thought to be major contributing factors.
Signs that raise suspicion of substance abuse in health professionals:
- 1. Wearing long sleeves all the time
- 2. Diminishing alertness
- 3. Lack of attention to hygiene
- 4. Mood swings
- 5. Request for frequent schedule changes
- 6. Errors in clinical judgment
- 7. Excessive absenteeism
- 8. Frank odor of alcohol on breath
- 9. Frequent or long breaks
- 10. Deterioration in profession and pt care.
If a health professional suspects that a colleague is impaired, a ____ report should be made to an appropriate supervisor familiar with institutional policy.
WHEN CONSIDERING WHETHER TO REPORT SUSPECTED SUBSTANCE ABUSE, REMEMBER:
1.Clinical practice is a privilege, not a ___.
2.Good faith reporting should not be considered unfair or ____ to a colleague.
3. You cannot be sued if a reasonable effort is made to establish that the concerns are legitimate and it is clear that ____ safety is the primary concern.
4. An unreported colleague to more likely than a reported one to ___ as a result from impairment.
5. Colleagues who are reported to licensing authorities have a very good chance of retaining their ____.
6. If a health professional has knowledge of suspected impairment of another health professional but fails to report it, the health professional may potentially be named in a ____ lawsuit or be named as a _____ in a malpractice suit against the impaired health provider.
- 1. right
- 2. disloyal
- 3. patient
- 4. die
- 5. license
- 6. civil; contributor
It is important to recognize that substance abuse and addiction are ____ and are treatable disorders.
Long term goals in treating substance abuse:
- 1. Reduction or abstinence in use and effects of substances
- 2. Reduction in frequency and severity of relapse
- 3. Improvement in psychological and social functioning
Key factors associated with long-term recovery are
- 1. negative consequences of substance abuse
- 2. social and community support
Immediate ____ needs must be addressed first
____ initiates abstinence, reduces the severity of withdrawal symptoms, and retains the person in treatment to forestall relapse.
_____- 5 or more drinks on one or more occasions in the past month.
___ - 2 or more drinks per day or more than 60 drinks per month.
Stimulation of ____ and ____ receptors appears to be related to the alcohol "high" or the rewarding aspects of drinking alcohol.
opioid and dopamine
_____ is the ingestion of alcohol to the point of clinically significant maladaptive behavioral or psychological changes; accompanied by evidence of slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, or stupor or coma.
If a person frequently drinks to intoxication over long periods, a physical dependence develops and a decrease in the blood alcohol level over 4 to 12 hours may cause symptoms of alcohol _______.
Withdrawal can progress to more severe symptoms including, ____ and ___ hallucinations, and ___. Less than 1% of patients develop _____, the worst withdrawal symptom.
visual and auditory hallucinations and seizures. less than 1 % develop delirium, the worst symptom.
DT's are manifested by:
- 1. hyperactivity
- 2. delirium
- 3. severe hyperthermia
The mortality rate of pts who progress to DTs is ____
If a person addicted to alcohol seeks treatment for withdrawal symptoms, _______ are commonly used for detoxification.
Three medicines have been approved for use in helping promote abstinence:
- 1. Disulfiram
- 2. Naltrexone
- 3. Acamprosate
Commonly abused opiates:
- 1. heroin
- 2. morphine
- 3. hydro-morphine
- 5. oxycodone
- 6. hydrocodone
Indications of opioid intoxication are:
- 1. Initial euphoria ( "high" ) followed by it
- 2. apathy
- 3. dysphonia
- 4. impaired judgment
- 5. agitation
- 6. impaired social and occupational functioning
- 7. pupillary constriction
- 8. drowsiness
- 9. slurred speech
- 10. impairment of attention
Physical signs and symptoms associated with withdrawal are :
- 1. anxiety and restlessness
- 2. increased blood pressure and pulse
- 3. pupillary dilation
- 4. rhinorrhea
- 5. sweating
- 6. nausea
- 7. vomiting
- 8. diarrhea
Treatment is focused on relieving the ___ symptoms.
When injected IV, inhaled as smoke, or sniffed onto the mucous membranes of the nose, Cocaine blocks the reuptake of catecholamine's in the brain, causing sudden CNS ____ with euphoria.
Acute cocaine intoxication usually begins with :
- 1. euphoric feeling ( the rush)
- 2. enhanced vigor
- 3. hyperactivity
- 4. restlessness
- 5. hyper vigilance
- 6. talkativeness
- 7. anxiety
- 8. tension
- 9. alertness
- 10. grandiosity
- 11. anger
- 12. impaired judgment
Signs and symptoms that develop with Cocaine
- tachycardia or bradycardia
- pupillary dilation
- hyper or hypotension
- sweating or chills
- nausea and vomiting
Withdrawal symptoms of cocaine
- vivid and unpleasant dreams
- extreme depression
- increased appetite
- insomnia or hypersomnia
Depression with ____ is generally the most serious problem associated with cocaine withdrawal.
There are ______ medications approved to treat cocaine dependence, therefore, the rated of relapse for pts who develop a cocaine dependency is VERY high.