SUBSTANCE

RELATED
DISORDERS
WILKINS CHAPTER 64
BY: KATELYN CROUCH & HOLLI SCHEXNIDER

What is a substance related

disorder?

A substance related disorder is a disorder of

intoxication, dependence, abuse, and substance
withdrawal, caused by various substances, whether legal
or illegal.

Drugs that have abuse potential include: alcohol,

tobacco, recreational drugs such as cocaine, heroin, or
marijuana, prescription medications, caffeine, and many
others.

There are two types of substances disorders: substance

Substance Dependence

Dependence occurs when the user is dependent on their

drug of choice to maintain a constant feeling of
satisfaction.

They may continue using the substance even after they

have been harmed.

User experiences cravings and need increased doses

over time.

May develop a tolerance to lesser doses.

Substance Abuse

Substance abuse is the misuse of alcohol, recreational drugs,

nicotine, prescription drugs, or any other substance that may
alter how the mind and body works.

Over time, substance abuse may or may not lead to substance

dependence.

Substance abuse can lead to health consequences, mental

impairment, bad judgement, and uncontrollable emotions or
actions.

These actions have been known to destroy families, contribute

to crime and violence, and even death.

https://youtu.be/zV6zKmt7S5E

Who is likely to abuse drugs or

alcohol?

People who are dependent on alcohol are more likely

than the general population to use other drugs, and vice
versa.

Substance use may vary from recreational to addiction.

There is no classic cultural, socioeconomic, or

educational profile for a substance abuser.

As a dental professional, we should be aware of the

characteristics of substance abuse, and address the
patient and their illness in an appropriate manner.

Alcohol
(ethyl alcohol or ethanol)

Alcohol

use can range from occasional social drinking, to

alcohol dependence where the person abuses alcohol daily.

Alcoholism

is defined as a chronic, progressive behavioral

disorder characterized by a strong urge to consume ethanol
and the inability to limit the amount, despite consequences.

Signs

of alcoholism include: cravings, loss of control,

dependence, tolerance.

Predisposition

to alcohol dependence may be caused by

genetics, biopsychosocial, or environmental factors.
GABRA2

and CHRM2

Alcohol

Alcohol can be detected in the blood just five minutes

after consumption.

Legal limit is .08% mg/dl.

Alcohol is metabolized in the liver.

Prolonged use can lead to a multitude of health

disorders such as:

Liver and/or cardiovascular diseases

Diminished immune response and infection

Injury to the digestive system

Nutrient deficiencies

Increased cancer risks

Effects of Alcohol

Behavior changes:

Aggressiveness, mood instability, impaired judgement

or functioning, impaired attention and memory, coma.

Physical changes:

Slurred speech, lack of coordination, unsteadiness.

Accidents

Suicide

Oral Implications and DH Care

Oral Implications

Xerostomia

Glossitis

High caries risk

DH Considerations

Avoid alcohol containing mouth

rinses

Be aware of impaired wound

healing

Use anesthetics without

epinephrine

Use ultrasonics and air polishers

with caution MUST use HVE
suction

Poor home care

Alcohol breath

Alcohol Withdrawal and

Treatment

Withdrawal symptoms may appear with a few hours after

alcohol cessation.

Withdrawal signs include tremors, anxiety, dry mouth,

headache, sweating, rapid pulse, elevated blood
pressure.

Complications: Alcohol delirium or alcohol hallucinosis

Treatment options include medical and psychiatric

therapy.

Tobacco

Tobacco use is the leading preventable cause of disease,

disability, and premature death in the United States.

According the CDC, cigarette smoking results in more

than 480,000 premature deaths a year.

Nicotine is the poisonous, addictive stimulant that is the

chief psychoactive ingredient in tobacco.

Cigarettes and other forms of tobacco, including cigars,

pipe tobacco, snuff, and chewing tobacco, contain the
addictive drug nicotine.

Nicotine is readily absorbed into the bloodstream when a

tobacco product is chewed, inhaled, or smoked.

Tobacco

Once in the bloodstream, nicotine immediately stimulates the

adrenal glands to release epinephrine.

Nicotine increases levels of the neurotransmitter dopamine,

which results in addiction when the brain pathways are changed.

In addition to nicotine, other harmful chemicals are present in

tobacco, such as pesticides, aldehydes, ketones, and amines.

Absorption occurs through the lungs, skin, and oral or nasal

mucosa.

Smokeless tobacco contains 3-4 times the amount of nicotine as a

Tobacco

Tobacco use can have systemic effects on the cardiovascular system,

can contribute to pulmonary diseases such as COPD, lead to cancer, and
can also have negative effects on others.

When the addicted user tries to quit they experience withdrawal

symptoms.

Within 24 hours of tobacco cessation, the patient may experience

physical and psychological symptoms such as: depressed mood, anxiety,
anger, decreased heart rate, hunger, and tobacco cravings.

Treatment: self help and assisted strategies. Nicotine patches, gum, and
lozenges may also be used to aid in quitting.

Oral Implications and DH Care

Oral Implications

DH Considerations

Bad breath & stained teeth

Teach oral cancer screening

Increase in periodontal diseases

Non-alcoholic mouth rinses

Increased risk of oral cancers

Nutritional counseling

Bone and tooth loss

Delayed healing

Reduced inflammatory response

Longer, more frequent

appointments due to build up
and periodontal problems

Recreational Drugs

Recreational Drugs are drugs that are taken for

enjoyment or leisure, rather than true medical purposes.

Alcohol, tobacco, and caffeine are the most popular

recreational drugs and certainly the most widespread.

Among college students, the most abused recreational

drugs include marijuana, prescription medications, and
ecstasy.

Use of psychoactive drugs can alter ones mental state in

a way that modifies emotions, perceptions, and feelings
for recreational purposes.

Most are illegal, so their use comes with breaking the

law.

Recreational User

Can easily say no when drugs are offered.

Generally has good relationships with family, friends,

and coworkers who are primarily non-users.

Does not depend on drug for personal power, such as he

doesnt think of taking them for gaining extra
confidence.

Rarely thinks about drugs and the next high during the
day.

Wise with money, thinking twice about using hard-

Addicted User

Using drugs may be (falsely) connected with the illusion

of more power in personal relationships, feel more joyful
or have more hope.

Difficulty saying no when offered.

Makes friendships with other users; distances self from

non-using friends

Conflict oriented when using. Very defensive of habits.

Will choose drugs at all costs may lie, steal, betray

others.

Drugs and the next high are thought about all day long.

https://www.youtube.com/watch?v=zV6zKmt7S5E

Oral Implications and DH Care

Patient may need prophy pre

med

Know potential drug

DHinteractions
Care

Oral Implications

Xerostomia

Glossitis; gingival
inflammation

Avoid alcohol containing

products

Fluoride treatments

Poor oral hygiene

Caries; tooth loss

NO local for 24 hours after

meth use

Tissue abnormalities
(perforated palate)

Attrition; erosion

Use ultrasonic and air

polishers with caution Must
use HVE.

Treatment Options

Drug addiction is a treatable disorder, but the user must be

willing to acknowledge that their addiction is a problem.

Treatment is tailored to the patients individual needs.

Medications may be used to suppress the cravings and the

withdrawal symptoms.

Medications: Methadone, LAAM (levo-alpha-acetylmethadol), Naltrexone, Diazepam/Phenobarbitol

Behavioral changes: counseling, support groups, therapy.

Question 1

Substance dependent individuals are at very low risk for

developing a tolerance to their drug of choice; they can safely
use the lowest possible dose of a drug each time to maintain
the desired effect.

a.

The first statement is true and the second is false.

b.

The first statement is false and the second is true.

c.

Both statements are true.

d.

Both statements are false.

Question 2

Tobacco use can lead to an increase in bone and tooth loss.

Tobacco will also increase the inflammation response, usually
causing heavy bleeding.

a.

both statements are true

b.

both statements are false

c.

the first statement is true and the second statement is false

d.

the first statement is false and the second statement is true

Question 3

The top 3 recreational drugs used on college campuses in the

United States include:

a.

Alcohol, tobacco, cocaine

b.

Tobacco, marijuana, cocaine

c.

Marijuana, prescription pills, ecstasy

d.

Alcohol, tobacco, prescription pills

Answers

1. D both statements are false.

2. C the first statement is true and the second is false.

3. C marijuana, prescription pills, and ecstasy

Sources

Wilkins, E., & Wyche, C. (2013). Clinical Practice of the Dental Hygienist
(11th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

https://www.watersedgerecovery.com/the-top-3-most-used-drugs-on-college
-campuses
/

http://patient.info/health/recreational-drugs

http://alcoholrehab.com/drug-addiction/substance-abuse-and-oral-health/

https://www.aspenridgerecovery.com/blog/recreational-drug-use-vs-addictionwhats-the-difference/

http://www.oralhealthgroup.com/features/recreational-illicit-drug-use/

https://youtu.be/zV6zKmt7S5E