Substance abuse intoxication

Overall, intoxication with any of the substances discussed above is evidence of substance abuse and is strongly suggestive of substance dependence. In all cases it is important to strongly emphasize to the patient that this is an issue that needs to be addressed, and that entry into a treatment program could be very beneficial. 

Observe the patient until the intoxication has resolved [if alcohol, the BAL should be less than 80 mg% (0.08% or 17.4 mmol/L)]. Encourage the patient to consider treatment for substance abuse, especially if this is not the first episode of intoxication. 

The DSMIV notes the potential for caffeine to be abused and includes Caffeine Intoxication under the category of Substance Abuse Disorders.262 Despite this official classification, there continues to be controversy as to whether or not caffeine is actually a drug of abuse. Some researchers maintain that caffeine has very low, if any, potential for abuse,235 while others believe that it can be addictive and has characteristics similar to those of other addictive drugs.263... 

Substance Use Disorder. Patients abusing alcohol or other substances may be prone to erratic behavior reminiscent of the Cluster B personality disorders. If these behaviors occur exclusively in a context of intoxication or during periods of heavy substance use, then the diagnosis of a Cluster B personality disorder is not warranted. Instead, treatment should be focused on the substance use disorder. This is not to say, however, that substance use disorders and Cluster B personality disorders cannot occur together. In fact, the difficulty that these patients have in self-soothing leaves them especially vulnerable to substance abuse. 

Analysis of substances of abuse involves different fields of application including diagnosis of acute/ lethal intoxication, differentiation between chronic and occasional substance abuse (as it may imply different legal consequences for the substance abuser), enforcement of drug traffic safety (driving under influence), and the identification of the source of origin of illicit drugs. 

Exposure to toxicants can vary, producing what is known as acute or chronic poisoning. Poisoning can also be classified according to the intent of use. Poisoning can either be suicidal (non-accidental) or accidental in nature. Recreational poisoning, such as substance abuse, can be a source of harmful intoxication and, in some cases, can lead to addiction and withdrawal symptoms. Intentional harm is observed when there is criminal doping with sedative-hypnotic medicines, often associated with robberies. 

Substance-related disorders are divided in DSM-IV into dependence, abuse, intoxication, and withdrawal. In addition, each substance may have related disorders phenomenologically similar to other disorders delirium, dementia, amnestic, psychotic, mood, anxiety, sex, and sleep disorders. 

Substance Dependence Abuse Intoxication Withdrawal Persisting... 

The characteristic feature of substance abuse is a maladaptive pattern of substance use indicated by repeated adverse consequences related to the repeated use of the substance. Examples include failure to fulfill important obligations at work, school, or home repeated use in situations in which it is physically dangerous, such as driving under the influence legal problems and social or interpersonal problems such as arguments and fights. Intoxication refers to the... 

A child is at increased risk of suicide if.. . the child has substance abuse problems. . . Alcohol increases the risk of suicidal behavior by worsening feelings of depression and by diminishing self-control. About half of those who attempt suicide are intoxicated at the time of the attempt.. . Drug overdose is the method most frequently used in suicide attempts." (See Suggested Reading, Merck, pp. 413414.)... 

Today, if anaesthesia is excluded, acute poisoning with solvents and other volatile substances usually follows deliberate inhalation of vapour in order to become intoxicated [volatile substance abuse (VSA)]. Patients who ingest solvents or solvent-containing products either by accident or... 

Toxic Effects of Acute Overdoses Acute poisoning with tricyclic antidepressants or MAO inhibitors is potentially hfe-threatening. Fatalities are much less common since modern antidepressants have widely replaced these drugs however, suicide rates have not declined consistently as clinical usage of modern antidepressants has increased. Deaths have been reported with acute doses of 2 g of imipramine, and severe intoxication can be expected at doses >1 g, or about a week s supply. If a patient is severely depressed, potentially suicidal, impulsive, or has a history of substance abuse, prescribing a relatively safe antidepressant agent with close clinical follow-up is appropriate. If a potentially lethal agent is prescribed, it is best dispensed in small, sublethal quantities, with the risk that sustained adherence to recommended treatment may be compromised. 

Nursing implementation may focus on managing the patient s acute intoxication and withdrawal and then monitoring the effectiveness of therapy to treat the patient s substance abuse problem. 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Unfortunately, unlike some medical diseases, substance dependence cannot be cured with medications alone. However, we can sometimes alleviate the effects of drug intoxication, attenuate the adverse effects of withdrawal, or use agents that may somewhat decrease craving for, and relapse to, abused substances. 

The intoxicating effects of opioids appear to be due to their action as agonists on mu (p) receptors of the opioid neurotransmitter system. Competitive p opioid antagonists such as naloxone and naltrexone acutely reverse many of the adverse effects of opioids. To date we do not have specific antagonists for most other abused substances, so rapid pharmacologic reversal of intoxication is usually not possible. 

Immunochemical methods have been reported for the determination of these substances in body fluids (see Table 8) in clinical and forensic analyses. In the case of illicit use of opioid drugs, methods have also been reported for the control of drug abuse and assessment of intoxication using body fluids, tissue extracts, post-mortem specimens, and seizure samples. For this reason there are several commercially available immunochemical methods (see Table 4). 

Inhaled substances may be associated with practices and equipment that may lead to suffocation. Commonly abused inhalants include model glue, spray paints, cleaning fluids, gasoline, liquid typewriter correction fluid, and aerosol propellants for deodorants or hair sprays. Most inhalants produce a rapid high that resembles alcohol intoxication. If sufficient amounts are inhaled, nearly all solvents and gases produce a loss of sensation, and even unconsciousness. Adverse effects may include severe organ damage. 

Substance or Drug Class Drug Abuse Potential Acute Intoxication Withdrawal Symptoms Additional Consequences of Use ... 

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