7Psychological Dependence Moderate to High Potential
8Withdrawal Must be monitored closely due to potential fatalities Risk of seizures and delirium tremensProlonged symptoms can last for months, resolve, then reappear. Especially with Benzodiazepines (Valium, Librium, Tranzene, and Zanax).
9Depressant Withdrawal – Stage I Tremors (shakes) occur in the morning after heavy use the night beforePeak intensity is about hours after last dose“Jitters”, irritability, nausea, vomiting, easily startled, facial flushing, rapid heart rateLoss of appetite insomnia, inattention, mildly disoriented, poor recent memory, sense of uneasiness.
10CNS Depressant Withdrawal Stage II Hallucinations (disordered perceptions) vary in intensitymisinterpreted shadows and movementsObjects seeming distorted and unrealMay occur when the rest of the sensorium is clear, and seem intensely real.
11CNS Depressant Withdrawal Stage III Seizures (grand mal)Bursts of 2-6 full body seizures90% occur 7-48 hours after the last drinkOne third of patients with seizures will go on to develop delirium tremens
12CNS Depressant Withdrawal Stage IV Delirium Tremens (Profound Confusion, Delusions, Vivid Hallucinations, Tremor, Agitation, Sleeplessness, Dilated Pupils, Fever, Tachycardia, Profuse PerspirationUsually occurs 3-5 Days after the last doseMost cases mild, and end abruptlySevere cases considered a medical emergency, and carry a 15% fatality rateSingle episode lasts 72 hours or less in 80% of the cases
14Alcohol as a drugAlcohol is a psychoactive drug that is a CNS depressantAlcohol is the second most widely used and abuse of all psychoactive drugsQ. What drug is the most widely used and abused drug?A. Caffeine
16Physical effects of alcohol The body is affected by alcohol in two ways:Direct contact with mouth, esophagus, stomach, and intestineInfluence on almost every organ system in the body after entering the bloodstream
17Physical Effects of Alcohol Absorption is the process in which the drug molecules reach the bloodstreamThe effects of alcohol on the human body depend on the amount of alcohol in the blood (BAC)
18Physical effects of alcohol BAC produced depends on the:1. Presence of food in the stomach2. Rate of alcohol consumption3. Concentration of alcohol4. Drinker’s body compositionAlcohol beverages have almost no vitamins, mineral, protein, or fat - just large amount of carbohydrates
19Physical effects of alcohol Alcohol can cause severe physical and psychological dependence1. Cross-tolerance2. Behavioral tolerance compensation of motor impairments by chronic alcohol users through behavioral pattern modification
20Blood alcohol levelAlmost 95% of the consumed alcohol is inactivated by liver metabolism.The liver metabolizes alcohol at a slow and constant rate and is unaffected by the amount ingested.Thus, if on can of beer is consumed each hour, the blood alcohol level (BAL) will remain constant.
21Blood alcohol levelBlood alcohol level (BAL) is the concentration of alcohol expressed as a percentage.
23Short-term effects of alcohol Low to moderate dosesDisinhibitionSocial setting and mental stateEuphoric, friendly, talkativeAggressive and hostileInterfere with motor activity, reflexes, and coordination
24Short-term effects of alcohol Moderate quantitiesSlightly increases in heart rateSlightly dilates blood vessels in arms, legs, skinModerately lowers blood pressureStimulate appetiteIncreases production of gastric secretionsIncreases urine output
25Short-term effects of alcohol At higher dosesDifficulty in walking, talking, and thinkingInduces drowsiness and cause sleepIn large amounts - severe depression of the brain systems and motor control area of the brain
26Large Doses of AlcoholUncoordination, confusion, & disorientationStupor, anesthesia, coma, and even deathLethal level of alcohol is between 0.4 and 0.6% by volume in the blood
27? True of False ?Drinking black coffee, taking a cold shower, or breathing pure oxygen will hasten the sobering up processThe type of alcohol beverage you drink can influence the hangover that resultsTaking an aspirin-caffeine combination before drinking helps the sobering up process and the chances of having a hangover
28Long-term effects of alcohol Light or moderate drinking does little permanent harm (exception - FAS)Heavy drinkingSeriously damages the heartKidney and liver damageMental disorders, irreversible damage to the brain and peripheral nervous systemLowers resistance to pneumonia and other infectious diseasesIrritates the gastrointestinal tract
29Principal control centers of the brain affected by alcohol
30Alcohol and pregnancyWomen who are alcoholics or who drink heavily during pregnancy have a higher rate of spontaneous abortion.Infants born to drinking mothers have a high probability of being afflicted with fetal alcohol syndrome.
31Effects of alcohol on organ systems and bodily functions Brain and nervous systemLiverhepatotoxic effectalcoholic hepatitiscirrhosisDigestive system
32Effects of alcohol on organ systems and bodily functions BloodCardiovascular systemalcoholic cardiomyopathySexual organsEndocrine system
33Effects of alcohol on organ systems and bodily functions KidneysMental disorder and damage to the brainWernicke-korsakorr’s syndromeThe fetus (FAS)Malnutrition
34Barbiturates Derivatives of barbituric acid First synthesized in 1868 Used as anticonvulsants and sedative hypnoticsHigh abuse liabilityHigh lethal dose rate
35BarbituratesUsed with other analgesic combinations (aspirin, codeine) for treatment of tension and migraine headachesPhenobarbital and belladonna alkaloid combinations used to treat peptic ulcers and irritable bowel syndrome
36Barbiturates - Medical Uses Used as an anticonvulsantSedative HypnoticDetoxification medication for alcohol withdrawal syndrome
41Barbiturate – Long Term Effects Reproductive System – cross the placental barrier and cause fetal abnormalitiesNewborn withdrawal symptomsRespiratory System – hypoventilation, apneaOther Reactions - headache, injection site reactions, fever, liver damage, megablastic anemia (with long term use)
42Tolerance Develops quickly Psychological tolerance develops more quickly than physicalIncreased amounts approach lethal dosageMetabolize faster in the liver as dosage increases
43Half Life Psychoactive chemicals have age dependent metabolism Younger people tolerate a higher dose than older (over 50).Half life = length of time in hours required for one half of the dose taken to be excreted from the body.
44Toxicity/Overdose Cold, clammy skin Weak, rapid, shallow breathing Combined with ETOH –suppression of respiratory center of brainDependence defined by amounts taken 8-10 times normal taken daily for 30 daysDeath will occur if drowsiness, loss of consciousness, depressed breathing, and coma are left untreated.
45Psychological Effects Early - calming, tension reduction,Middle – Euphoria, hypnotizing, impaired judgment, sense of “no worry”Later – mood swings, depression, irritability, obnoxious behavior, manipulation, drug seeking
46Withdrawal from Sedative Hypnotics Within 6-8 hours of last doseCan be life threatening if breathing and blood pressure problems untreatedNausea, vomiting, increased heart rate, excessive sweating, abdominal cramps, tremorsWithdrawal deaths more frequent than overdose deaths.
47National Institute of Drug Abuse http://www.nida.nih.gov/ References - Material from this module was Developed from the following sources, which are recommended reading for the LADAC exam:Basics Of Addiction Counseling: Desk Reference And Study Guide National Association for Addiction ProfessionalsNational Institute of Drug AbuseNational Institute of Alcohol Abuse and Alcoholism