Drug, alcohol abuse and family violence

Friday, 9 August 2013 10:09 AM

Addition Smoking and alcohol Family abuse Recognition, response, legal reporting Drug and alcohol abuse Drug abuse To use wrongly or improperly (too much on too many occasions with unhappy consequences (medical or other) Dependence Manifestation of neurological adaptation. Repeated exposure has regulated brain receptors --> tolerance and withdrawal syndrome Addicted Doing or using something has a habit or compulsively. Craving, loss of control, inability to quit Non prescription (illicit, illegal, party etc.) Prescription Narcotics, benzo's Smoking Alcohol Harm reduction vs. abstinence Some people just want to reduce, not stop Cycle of change Pre contemplation Contemplation Preparation Action Maintenance Relapse Benzodiazepines Sleep Temazepam (Temaze) Anxiety Alprazolam (Xanax) Diazapam (Valium) Can use clonazepam Why? Midazolam Very Short acting, <6hrs half life Alprazolam, Oxazepam (liver safe), Temazepam Short acting, 6-12 hours half life Lorazepam (liver safe) Medium, 12-24 hours half life Diazepam, clonazepam, nitrazepam Long acting, >24 hours half life Intoxication Sedation Droopy eyelids, slow speech, slow movement, sleepy Slurred speech Dis-inhibition (overly familiar, uncharacteristic cheeriness) Positive Romberg's test Ataxia
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 Ataxia Withdrawal Increased insomnia, increased anxiety Gradual dose reduction Slowly reducing diazepam Once daily dosing Alternative anxiety management strategies ?Drug screening (unauthorised benzo use) Opioids Types (weak to strongest, with equavalent doses shown) Codeine 120mg Pethidine Morphine (Kapanol, MS Contin) 10mg IM/SC Oxycodone (Endone/Oxycontin) Heroin Methadone Hydromorphone (Junista) Buprenorphine (Norspan) Fentanyl (Digesic) 100-150mcg Chronic pain Short term opioid for acute pain - addiction is unlikely to be problem Long term opioid use > tolerance, indicates dependence > earlier scripts Use slow release forms of opioids for chronic pain Controlled dispensing and script quantities Adjunct analgesia Multidisciplinary assessment PT, OT, Psych, Anaesthetist, surgeon, physician, GP Acute opioid withdrawal (way to manage) Sweat (Clonidine) N&V, ?D / Constipation (Metaclopramide) Gripping pain (Hyoscine) Muscle cramps (Quinine) Insomnia (Diazepam) Planned withdrawal Outpatient or inpatient Buprenorphine Legal registration program and training of practitioner Partial mu opioid receptor agonist, displaces other opioids from mu receptors Long half life > self tapering 5 ays No protection from craving and relapse when course ended - NB detox gets rid of the user's tolerance so greater risk of OD if re-use after detox Relapse rate 95% at 12 months Night sedation may be required Cannabis Over 200,000 Australians are dependent Delta-9 tetrahydro-cannabinol (THC) Psychiatric effects Severe anxiety/panic can be psychosis Rarely short term psychosis (hours-3 days) Schizophrenia (?trigger if FH, more severe illness if already diagnosed), bipolar affective disorder Unclear link with depression Thought to be a casual association with stroke in young adults (also male and smoker) Cannabis withdrawal
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Cannabis withdrawal Only 20% get withdrawal symptoms Onset >4 hours after last, peaks at 1 week, lasts 1-2 weeks Anxiety and irritability Mood swings Insomnia Muscle spasms Headache Daytime sedation may be required (diazepam) Insomnia relief may be required (mirtazepine, amitriptyline) Help for patients and professionals Professionals Drug and alcohol hotline - DACAS Drug and alcohol counsellor/team Headspace Patient support groups AA NA Ecstasy and amphetamines Ecstasy = 4,4-MDMA, amphetamine derivative Methamphetamine: Meth, speed, base, ice, clouds, crystal, glass, tik Tablets, capsules, powder Feel good, close to others, anxious, paranoid Stimulant Severe cases - hyperthermia, muscle rigidity, convulsions, coma, rhabdomyolysis, cardiac arrhythmia, jaundice, renal failure, IIC, cerebral haemorrhage Supportive treatment, ABCDE Cocaine Derivative "crack" Sniffed or smoked Similar to amphetamine Severe cases - hyperpyrexia, convulsions, hypotension, hypertension, tachycardia, tachyarrhythmias, Severe: aortic dissection, cerebral haemorrhage, MI or myocardial ischaemia LSD Lysergic acid diethylamide Visual hallucinations, agitation, excitement Tachycardia, dilated pupils Hypertension, pyrexia Severe: delusions, coma, respiratory arrest, coagulation disturbances GHB Gamma hydroxybutyrate CNS depressant, sedative, hypnotic Sense of well being, relaxation, drowsiness, increased confidence, reduced inhibitions, dizziness, heightened sense of touch, nausea and headaches Hallucinations, tremors, episodes of tachycardia, hypotension Severe: respiratory depression, collapse, rapid onset of drowsiness, muscle spams, movement and speech impairments, disorientation, slurred speech, memory loss, vomiting Narrow therapeutic index, coma and result within 15-30 minutes after ingestion Alcohol Recommended limits <2 standard drinks per day < 4 drinks per session Detox Medications Naltrexone Acamprosate
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 Acamprosate Disulfuram THIAMINE Hospital/community withdrawal Benzodiazepines (Diazepam and thiamine) in reducing doses Withdrawal symptoms Onset 6-24 hours after lasst Raised temperature Raised P, RR, BP N&V Tremors Agitation, anxiety, sleep disturbance Tactile disturbances (formication) Visual and auditory disturbance (even hallucinations) Usually over in 1 week Seizures in 2-5% withdrawals Smoking OTC options for treatment Nicabates Nicorette Gum/Patch/Lozenge/Inhaler Prescription Patches Bupropion (Zyban) Varencicline (Champix) Family abuse Here we did worksheets on Definitions, Bio/Psycho/Social signs and symptoms as well as Questions to ask, Answers to give on disclosures Abuse = a misuse, an unjust or corrupt practice, abusive words, insults Child abuse Any type of abuse that involves physical, emotional, sexual or economic abuse or neglect of a child under 18 years (16 for NSW, 17 for Vic) Risk factors Bruises, breaks, failure to thrive/malnutrition (always measure height and weight), poor hygiene, unusual behaviour/not reaching developmental milestones/strange play, frequent presentations, parental behaviour, teacher/corroborative stories Questions HEADSS Ask directly Answers Affirm it was good they've said something Explore situation and act accordingly Mandatory reporting Domestic violence Any behaviour within an intimate relationship that causes physical, emotional, sexual, economic and social harm to those in the relationship. An intimate relationship may refer to a victim's current or previous partner or living companion Risk Factors GP will see 5/week who have experienced intimate partner violence in last 12 months S&S Injury, chronic pain, FIT/gynae conditions, mental health, drug and alcohol, frequent attender or delayed attendance, inconsistent history, non-compliance, accompanying overattentive partner, previous childhood abuse, social isolation,
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attentive partner, previous childhood abuse, social isolation, recent separation/divorce Elder abuse Any type of abuse (physical, emotional, sexual or economic) or neglect of people 65 years or older, either in a residential aged care facility, in private care or living independently Who is at risk? Anyone (particularly those in residential care, home care, family and friend support) Intellectual and cognitive impairment ?3-5% of elderly persons abused in some reports Reporting No legal obligation! Sexual --> Police Progessional malpractice --> Health Services Commissioner Residential care facility regulation Department of Health, Office of Aged Care Quality and Copliance Office of the Public Advocate DOCUMENT EVERYTHING!

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