The new england journal of medicine d r u g t h e r a p y Therapeutic Strategies for Rheumatoid Arthritisheumatoid arthritis, a chronic, systemic, inflammatoryFrom the Department of Internal Medicine,University of Nebraska Medical Center;autoimmune disease, has as its primary target the synovial tissues. When thedisease is unchecked, it leads to substan
Substance-related disordersSubstance-Related Disorders
Throughout history, cultures have used psychoactive drugs for various purposes such as: recreation, rituals, ceremonies, and medicinal. A major concern for today’s medical professionals is substance abuse and its effect on society. The student will identify the most commonly abused drugs and list their effects. TEKS: 121.26 (c) 1F, 1G KEY POINTS
A. major categories of substances that are abused: 5. cocaine 6. hallucinogen 7. inhalant 8. nicotine 9. opioid 10. sedative, hypnotic, or anxiolytic Substance Dependence and Substance Abuse A. dependence:
1. individual’s symptoms have persisted for at least 1 month 2. individual must manifest three of the following symptoms: i. need for markedly increased amounts of substance to achieve ii. markedly diminished effect with continued use of same b. withdrawal c. substance is taken in larger amounts or over a longer period than was d. a pattern of persistent desire e. great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects f. important social, occupational, or recreational activities are given up g. substance use is continued despite knowledge that it is a problem B. abuse:
1. pattern of substance use by one (or more) of the following: a. recurrent substance use resulting in failure to fulfill obligations at b. recurrent substance use in situations in which it is physically c. recurrent substance-related legal problems d. continued substance use despite having persistent relationship 1. daily use of alcohol necessary to function 2. person unable to cut down or stop drinking 3. binges last longer than 2 days 4. person occasionally consumes as much as a fifth of liquor per day 5. amnesia occurs during periods of intoxication (blackouts) 6. inability to function at work or with friends and/or family B. intoxication symptoms: slurred speech, lack of coordination, unsteady walking, and nystagmus (involuntary, rhythmic eyeball movement) a. takes place in hospital or rehabilitation center 2. major treatment options frequently presented to recovering alcoholics a. aversive therapy (Disulfiram/Antabuse therapy) i. form of behavior therapy that uses learning principles to cause patient to associate thought of drinking with unpleasant stimulus ii. motivates the patient to avoid drinking iii. Disulfiram (Antabuse) is drug that causes metabolism of iv. result is buildup of toxic alcoholic by-product called v. produces unpleasant symptoms: flushing, sweating, palpitations, dyspnea, hyperventilation, tachycardia, hypotension, nausea, and vomiting b. inpatient rehabilitation treatment program ii. intensive education and behavior modification to teach new coping skills to individuals who previously turned to alcohol iii. teach patient communication skills and stress management i. worldwide / available in most communities iv. related organizations for families of alcoholics (AL-Anon) 1. amphetamines 2. dexedrine 3. methamphetamine (speed) 4. appetite suppressants 2. used by students to stay alert & study 3. used by truck drivers to stay awake 4. used by soldiers to decrease fatigue & increase aggression C. intoxication symptoms: euphoria, grandiosity, excessive wordiness, excessive vigilance, agitation, dilated pupils, elevated blood pressure, tachycardia, nausea, and vomiting, chills or perspiration D. evidence today suggests that amphetamine and related drugs produce both E. most dangerous drugs presently available 1. can produce toxic psychosis in the most mentally stable people 2. death from over dosage (usually associated with hyperpyrexia, convulsions, F. amphetamine-induced psychotic disorder clears in a matter of days or weeks G. withdrawal depression may reach suicidal proportions 1. may be treated with tricyclic antidepressants A. substances included in this category: 1. marijuana 2. hashish 3. purified delta-9-tetrahydrocannabinol (THC) B. marijuana the most commonly used substance in this category 1. widely prescribe for variety of ailments during the 19th-century a. coughing, fatigue, migraine, asthma, delirium tremens, etc. a. ability to cause euphoria b. tendency to produce sedation i. effects last 2 to 4 hours from smoking and 5 to 12 hours from 3. intoxication symptoms: tachycardia, perception of slowed time, intensified subjective perceptions, apathy, elation, dry mouth, increased appetite, redness of eyes a. appear to be dose related and environment in which it is used b. rare reactions: i. anxiety states (with or without paranoid thinking) A. cocaine abuse is a problem of almost epidemic proportions in our society today B. derived from leaves of coca plant which is indigenous to Bolivia and Peru 1. leaves chewed by natives for many years for ceremonial highs and religious C. intoxication symptoms: cocaine “high” is similar to that of amphetamines (euphoria, exhilaration, powerful sense of well-being and confidence, agitation, dilated pupils, elevated blood pressure, tachycardia, nausea, and vomiting, chills or perspiration ) D. commonly abused form of cocaine is crack 1. inexpensive, very potent, readily available E. crack/cocaine intoxication marked by: 1. excitement, euphoria, restlessness, stereotyped movement, gnashing, F. tolerance and physical dependency develops G. toxic psychosis with visual, auditory, and tactile hallucinations and paranoia A. not categorized by intoxication or withdrawal—instead by their ability to alter B. includes LSD, DMT, mescaline C. episodes of hallucinogenic flashbacks can occur at unpredictable times for years A. intoxication symptoms: belligerence, impaired social functioning, dizziness, nystagmus, lack of coordination, slurred speech, unsteady gait, lethargy, depressed reflexes, tremor, muscle weakness, stupor or coma, euphoria A. tobacco dependence withdrawal symptoms: 1. depressed mood 2. insomnia 3. irritability, frustration, anger 4. anxiety 5. difficulty concentrating 6. restlessness 7. decreased heart rate 8. increased appetite or weight gain A. include opium, heroin, morphine, meriperidine (Demerol), codeine, and methadone B. the most addictive drugs abused C. depresses areas of the brain that reduce hunger, thirst, and sex drive D. Demerol, morphine, and codeine used in healthcare facilities as painkillers E. methadone used to treat heroin addiction F. intoxication symptoms: euphoria, drowsiness (“nodding out”), constriction of pupils (dilation if major overdose), dysphoria, apathy, psychomotor retardation, tachycardia, fever, lacrimation, rhinorrhea, piloerection, sweating, diarrhea, and yawning 1. sweats, shakes, chills, diarrhea, vomiting sharp stomach pain A. CNS depressants such as Librium, Valium, Seconal, and Serax B. used to relieve anxiety; “chill-pills”—feelings of relaxation and inhibition C. this class of drugs most often abused because they create longer acting effect than D. extremely addictive E. intoxication symptoms: cognitive confusion (memory impaired) F. withdrawal symptoms: coarse tremors of hands, eyelids, and tongue; nausea and vomiting; malaise or weakness; autonomic hyperactivity; anxiety; depressed or irritable mood A. this is a sedative category which relaxes the central nervous system B. synthetic drugs made from barbituric acid C. prescribed to treat insomnia, high blood pressure, and epilepsy D. when taken with alcohol, they tend to enhance effect E. cause mood shifts, restlessness, euphoria, excitement, confusion, and in some, F. dependent individuals need to be withdrawn very slowly since sudden withdrawal G. withdrawal symptoms: cramps, nausea, delirium, convulsions A. healthcare workers (high risk due to availability of drugs) 1. highest addiction rate—anesthesiologists B. family history of substance abuse C. emotional problems D. ineffective coping mechanisms E. history of childhood physical or sexual abuse F. “addictive” personality? ACTIVITIES
Write a critical analysis on an article related to substance abuse (e.g. Addiction As A Disease, Can the Addicted Brain Change Back?, The Role of Biology and Addiction, Gateway Drugs. (See MATERIALS NEEDED for subject information on-line site.) MATERIALS NEEDED
True/False Quiz for Substance-Related Disorders Key for quiz ational site for summary ACTIVITY. Topics include: Addiction as a Disease, Can the Addicted Brain Change Back? The Role of Biology and Addiction, and Gateway Drugs - The Addicted Brain, Films For The Humanities & Sciences (Psychology & Mental Health), 800, 257-5126, # DPM1363. (Excellent documentary video that examines the biochemistry of addiction and addictive behavior.) Mental Health & Mental Illness, Sixth Edition, Patricia Barry, ISBN 0-397-55473-7, (Chapters 21 & 22) Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV), ISBN 0-89042-062-9 ASSESSMENT
Critical Analysis Rubric True/False Quiz for Substance-Related Disorders ACCOMMODATIONS
For reinforcement, the student will create a chart identifying substance related disorders and symptoms. For enrichment, the student will research and develop charts and graphs depicting the cost of substance abuse to our society (e.g. treatment costs, law enforcement costs, etc .). REFLECTIONS
Critical Analysis Rubric
Scoring criteria Excellent
The critical analysis has all
required parts from introduction to
body to conclusion.
The critical analysis is concise
The critical analysis demonstrates
that the writer comprehends
addiction and related disorders.
The critical analysis demonstrates
accurate spelling, grammar,
The overall content of critical
analysis emphasizes appropriate
The writer shows an
understanding of sentence
structure, paragraphing, and
The source of the critical analysis
is clearly and accurately
The critical analysis demonstrates
correct use of medical language.
NOTE: N/A represents a response to the performance, which is "not appropriate."
TRUE / FALSE (Circle correct answer.)
1. Individuals who are abuse alcohol might use it daily in order to function.
2. Valium is a good aversive therapy for alcoholics. 3. Medical supervision is necessary for alcohol detoxification. 4. Amphetamines depress the central nervous system. 6. The byproduct of cocaine that is inexpensive, very potent is derived from the hashish plant. 7. There are no adverse reactions to marijuana. 8. Unpredictable hallucinogenic flashbacks can be caused by LSD. 9. Withdrawal from nicotine might result in drowsiness and lethargy. 10. Sedatives can depress the central nervous system, but are not addictive.
Key: True/False Quiz
GELLER: AN INTERNATIONAL PATENT UTOPIA?:  E.I.P.R. 515 The old regime has not kept pace on critical points: An International Patent The crisis of the old regime can be seen, to start, in thedifficulty of efficiently applying patent criteria. In theseventeenth and eighteenth centuries, patent laws wereto provide incentives for bringing ‘‘new’’ technologies toa country.5 Moving i