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let's talk now about some other
substance related disorders starting
with marijuana so the main active
component in marijuana is THC an
assessment for marijuana consists of
urine drug screenings and it'll actually
stay positive for about four weeks after
use some of the assessment signs are
going to be seeing a patient who seems
euphoric they may have impaired
coordination during times of marijuana
intoxication fast heartbeat or
tachycardia conjunctival injection which
is really a key marker for marijuana
intoxication dry mouth and increased
appetite during the withdrawal phase of
marijuana patient may present with
irritability insomnia nausea and
decreased appetite so want to talk a
little bit about motivational syndrome
and what this is so motivational
syndrome is really associated with
cannabis abuse and it's characterized by
an unwillingness to participate in tasks
that require prolonged attention so this
can be seen in somebody who's really a
chronic user of marijuana and they
really are unwilling to engage in things
that are gonna require a lot of
attention and focus moving on now to
caffeine a very highly abused substance
so intoxication with caffeine looks like
the following anxiety insomnia twitching
rambling speech flushed face diary C's
GI disturbance and also restlessness
some results of caffeine consumption
over one gram so a huge amount of
caffeine can result in tinnitus severe
agitation and it can actually cause a
cardiac arrhythmia in extreme cases of
caffeine consumption the symptoms can
also include seizures and respiratory
failure some of the symptoms of
withdrawal from caffeine include
headache nausea and vomiting
zena's anxiety and actually depression
and usually caffeine withdrawal will
begin in within 24 hours of its last use
and it will peak within about two days
the good news is for people hoping to
get off of caffeine coffee soda whatever
usually withdrawal will remit after
about a week and then person basically
resets and no longer has any of these
undesirable symptoms now let's talk
about nicotine another very highly
abused substance nicotine addiction is
very prominent in other mental health
disorders so it's often seen in patients
who have schizophrenia depression
anxiety the lifetime prevalence of
nicotine addiction is actually 20% so
it's very high and two of the most
common causes of death associated with
nicotine are actually cardiovascular
disease which could be stroke or heart
attack and lung disease in the form of
COPD cancer or pneumonia so very serious
consequences with this with this
substance and a little bit more about
nicotine so of course it's derived from
the tobacco plant it stimulates
nicotinic receptors in the autonomic
ganglia of the sympathetic and
parasympathetic nervous systems it's
highly highly addictive because of its
work through the dopaminergic system so
when somebody say takes a hit of
nicotine through smoking or whatnot they
get a surge of dopamine release and then
this is what drives them to keep smoking
so they can keep releasing dopamine and
it becomes very addictive during the
intoxicated State with nicotine people
can appear Restless they can have
insomnia anxiety and Gi upset they can
also have cravings dysphoria anxiety
increased appetite irritability and
insomnia again so health and cognitive
problems that come along Oh what kind of
things can you think about that
put people especially children of
smoking parents at risk so children in a
home with a smoking parent are gonna be
a particular risk for developing otitis
media pneumonia asthma sudden infant
death syndrome they'll have a low birth
weight low performance on standardized
tests and also poorer athletic
performance so there are a lot of
drawbacks to that secondhand smoke
especially when it's a child who's
incurring the secondhand smoke treatment
options for nicotine include behavioral
counseling
replacement through gum or a patch and
also other medications like clonidine
bupropion and varan cycling cocaine is a
commonly abused substance and this works
by blocking dopamine uptake from the
synaptic cleft causing a stimulant
effect in patients and dopamine plays a
critical role in the brain's reward
system a very important point because
this really is what drives addictions
during cocaine intoxication a patient
may appear euphoric have changes to
their blood pressure and heart rate they
may have some nausea you'll see dilated
pupils a very important point to
remember weight loss and sometimes
psychomotor changes they can also have
chills respiratory problems sweating
seizures arrhythmias and hallucinations
so when you're meeting somebody who's
testing positive for cocaine and they
seem to be in the intoxicated state
because they're still euphoric you
really do want to monitor them closely
for an arrhythmia by checking an EKG
you might monitor them closely for
seizure disorder maybe even check an EEG
and you want to screen them for
psychiatric symptoms as well cocaine's
vasoconstrictive effects may result in a
myocardial infarction or cerebrovascular
accident so paying close attention to
their cardiac system is very very
important because cocaine use can
actually lead to death through these
things
how long do you think the urine drug
screen stays positive for cocaine after
use the answer is three days so for a
while
and do you know any street names that
are used for cocaine here are a few just
to keep in mind the causes of death from
cocaine use include a myocardial
infarction cerebrovascular accident and
also Mueller's maneuver and what this is
is a pneumothorax and it's caused when a
patient will exhale against a closed
glottis thereby causing the pneumothorax
here's a question for you which of the
following treatments here is for cocaine
dependence so take a moment and look
over these treatments and if you guess
psychotherapy and group therapy you're
exactly right so the long-term treatment
for a dependency problem is really going
to be psychotherapy and support through
peers however if you're in the emergency
room or an acute care setting and you
encounter a patient who is intoxicated
on cocaine they're probably going to
benefit from some of the following so
because they're overly excited and
euphoric benzodiazepines might be
helpful in the very short term to help
calm them down they also we're going to
need some symptomatic support they're
gonna need to be hydrated you're gonna
have to check their vital signs always
make sure their ABCs are under control
and monitor them at on on an EKG for
cardiac arrhythmia the patient is also
going to respond positively to
haloperidol which is an anti-psychotic
and this can be used in the patient
who's having hallucinations during the
period of intoxication especially if
those hallucinations are at all
dangerous such as command auditory
hallucinations telling the patient to
harm themselves or others and then
eventually as the patient comes down
from there intoxication they're going to
start to withdraw from the cocaine and
they're really going to experience
what's called a crash and this is going
to look like hyper somnolence and the
best thing you can do for your patient
is really to let them sleep
off that crash
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