II. Pathophysiology: Mechanisms of primary effects
- Intoxication via CNS G Protein-coupled receptors
-
Intoxication via direct Central Nervous System (CNS) toxicity
- Toxic inhalants and other highly lipophilic agents
- Psychostimulation (Agitated Delirium) mediated by multiple Neurotransmitters (Epinephrine, Norepinephrine, Serotonin, Dopamine)
- Hallucinogenic effects mediated by Serotonin release (mediated at 5-HT-2A receptor)
- Dissociation ("out-of-body") mediated by NMDA Receptor mediated Glutamate modulation
- Ketamine
- Phencyclidine (PCP)
- Dextromethorphan (DM)
- Sedation (with anxiolysis and Amnesia) via Gamm-aminobutyric acid (GABA)
III. Precautions: Children and Teens
- See Adolescent Drug Abuse
- Substance Abuse and addiction is a developmental disease starting in children and teens
- Development of judgment and restraint are delayed in children and teens (higher risk for Substance Abuse)
IV. Stages: Step 1 - Child of Substance Abuser (e.g. Alcoholic)
- Childhood rejection by Alcoholic parent
- Maladaptive Family response
- Co-dependent spouse overprotects child
- Child given premature responsibility
- Excessive Dependent Needs develop in child
- Rejection triggers worsening of above
- Anxiety reaction results in:
- Denial or
- Reactive grandiosity
- "I don't need anyone"
- False sense of well being
V. Stages: Step 2 - Children of Alcoholics become Alcoholics
- Adaptive mechanisms fail
- Anger
- Depression
- Anxiety
- Guilt
- Genetic Predisposition to Alcoholism
- Permissive environment for drinking (e.g. Military)
VI. Stages: Step 3 - Substance Abusers
- Obsessive Thought
- Patient becomes more and more self centered
- Relationships become less important
- Patient becomes alienated from self
- Avoid guilt by avoiding self awareness
- Compulsive Behavior
- All work is centered at feeding addiction
VII. Stages: Step 3 - Substance Abuse Phases
- Contact with Substance
- Socially introduced
- Mind altering effect
- "The hook of addiction"
- Provides some benefit or relief
- Prodromal
- Acute Substance Abuse
- Chronic Substance Abuse
VIII. Stages: Step 4 - Recovery
- Abstain from substance
- Attain serenity (12 step AA program)
- Spirituality
- Rebuild relationships
IX. Stages: Step 5 - Relapse
- Craving
- Similar to waves (wax and wane)
- Craving goes away if not responded to
- Maladaptive decision making
- Self Efficacy
- Comfort with high risk situations
- Outcome Expectation
- What will come of reusing substance
- Response to Trigger or environmental cues
- Prior associations with substance use
- Paycheck
- Sexual partner
- Prior associations with substance use
- Self Efficacy