Substance Abuse (Alcohol, Drug Withdrawal)

Definition/Etiology:

• Drug Withdrawal
  • “Detox” outpatient or inpatient
    • Depressants
    • Stimulants
    • Opioids
  • Gradual (e.g. heroin)
    • Methadone
    • Bupronorphine (w. or w.o naloxone)

Pathophysiology:

• Alcohol withdrawal
  • Can be more concerning
  • Should be done with support
  • *Focus*of this lesson

Noticing: Assessment & Recognizing Cues:

• Delirium Tremens “DTs”
  • Shaking
  • Hallucinations
  • Seizure
• CIWA assessment
• Physical assessment
• Detox
  • Starts hours to 5 days after
  • Lasts 2 to 7 days

Interpreting: Analyzing & Planning:

• Consult psych
• Blood work
  • Blood alcohol level
  • Liver function tests
  • Basic Metabolic Panel
  • Magnesium
  • Vitamin deficiency test

Responding: Patient Interventions & Taking Action:

• Medications
  • Benzos
  • Clonidine
  • Carbamazepine
  • Beta-blockers
  • Antipsychotic meds
  • Prenatal vitamin
• Physical support
  • Gastritis
  • GI bleeding
  • Liver disease
  • Cardiomyopathy
  • Pancreatitis
  • Vitamin deficiency (folate, thiamine)
  • Electrolyte imbalance

Reflecting: Evaluating Patient Outcomes:

• DT’s limited or prevented
• In “Recovery” for life
• Continued support (e.g. AA)

Linchpins (Key Points):

• Assess DTs
• Benzos
• CIWA
• Prenatal vitamin
• Alcohol =ABC and P