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4 categories of substance abuse disorders
- related to abuse of a substance
- related to dependence on a substance
- those induced by intoxication
- those induced by withdrawal
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substance abuse
- maladaptive pattern of substance use leading to clinically significant impairment or distres manifested by 1 or more of the following within 12 months:
- recurrent use causing failure to fulfill major role obligations at work, home or school
- recurrent use in situations that are physically hazardous
- recurrent substance-related legal problems
- continued use despite persistent or recurrent social and interpersonal problems caused or exacerbated by effects of substance
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substance dependence
- maladaptive pattern of substance use leading to impairment/distress as manifested by:
- tolerance
- withdrawal
- taking the substance in large amounts or over a longer period of time than was intended
- persistent desire or unsuccessful efforts to cut down or control use
- much time spent in activities necessary to obtain or use the substance
- reduction of important social, occupational or recreational activities
- continued use despite knowledge of persistent or recurrent physical or psychological problems likely caused/exacerbated by the substance
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substance intoxication
- reversible substance-specific syndrome due to recent ingestion of or exposure to a substance
- clinically significant maladaptive behavioral or psychological changes due to effect of substance on CNS
- symptoms not due to general medical condition or better accounted for by another mental disorder
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substance withdrawal
- development of substance-specific syndrome due to cessation or reduction in substance use
- syndrome causing significant distress or impairment in social, occupational, or other important areas of functioning
- symptoms not due to general medical condition or better accounted for by another mental disorder
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symptoms of alcohol withdrawal syndrome
- increased BP, HR, temp
- diaphoresis
- GI effects
- CNS effects: anxiety, restlessness, hand tremors, confusion, seizures, DTs
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mild withdrawal
- hangover
- headache, nausea, fatigue, thirst
- all due to dehydration, hypoglycemia, accumulation of lactic acid and aetaldehyde
- begins 4-6 hours after drinking
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moderate withdrawal
- worsening of same symptoms as mild, also see auditory/visual hallucinations
- begin about 12 hours after drinking
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severe withdrawal
- severe diaphoresis, gross uncontrollable tremors, rejection of all foods and fluids
- unable to sleep, agitated, can be in panic state
- generalized tonic-clonic seizures, can be 2-3 days after they stop drinking
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Delirium Tremens
- tachycardia, diaphoresis, hypertension, confusion
- tremor, disorientation, vivid hallucinations
- resolves in 3-4 days, can be fatal in 20% of cases
- pts with DTs are considered danger to themselves and others, very unpredictable
- can be prevented with benzos
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Wernicke's syndrome
- alcohol induced amnestic disorder
- sudden or indisious onset
- caused by thiamine deficiency, reversible
- ataxia (unsteady gait), confusion, ocular motor abnormalities ( horizontal nystagmus)
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Korsakoff's syndrome
- follows wernickes's, still thiamine deficiency
- loss of recent memory
- confabulation: unconsciously filling in memory gaps by imagining experiences that have no basis in fact but they think is true
- cannot fully recover from cognitive effects
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treatment of withdrawal
- benzos to produce sedation and reduce anxiety
- diazepam, librium, ativan
- antabuse: makes you sick if you drink alcohol
- naltrexone: developed for heroin use, reduces cravings
- campral: reduces cravings in someone already abstinent, not very effective
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