substance severity
Large Time CRASH PRO TOL W/D
Larger amounts and longer duration
Increase in time to obtain, and recover
Craving
Role failure
Attempts to cut down unsuccessful
social/interpersonal problems
Hazardous use
Physiological and Psychological issues
Reduced important activities
Ongoing use despite harm
Tolerance
Withdrawal
Alcohol intoxication
Recent ingestion of ETOH
Clinically significant problematic behavioural and psychological changes
1 or more:
Slurred speech
Unsteady gate
Stupor, coma
incoordination
Nystagmus
impaired memory
Alcohol withdrawal
Cessation of alcohol use following heavy and prolonged use
2 or more:
autonomic hyperactivity
GTC
Sleep disturbances (insomnia)
PD transient
Anxiety
increase in tremor
N/V
Psychomotor agitation
Management of Alcohol withdrawal
Biological:
12 ours after, 48-72hours
?status epilepticus- phenobarbitol or propofol
Do full examination and Rx Sx
Start on Benzos (diazepam and titrate to response)
no improvement add haloperidol
?risk of epilepsy- phenytoin
Monitor fluids- IV
Thiamine and Folate (Vit B complex) and glucose (wernickes)
Vitamin C
Nutritional support
Psychological
Nurse in a quiet and safe room
Psychoeducate
Involve in groups
?reason for self-medicating CBT- stressors
Social
Collateral
Impact on family, occupation, income and finances
Assess habits
Cannabis Intoxication
Recent cannabis use
Clinical significant problematic behavioural and psychological change
2 or more within 2 hours
Redness of conjunctiva
Dry mouth
increase appetite
Tachycardia
Cannabis withdrawal
Cessation following prolonged and heavy use
3 or more:
Irritability, anger or aggression
Sleep disturbances
decrease appetite
depressed mood
anxiety
restlessness
at least one of the following- abdominal pain, tremors, shakiness or headache
Methamphetamine intoxication
N/V
Psychomotor agitation or retardation
Cardiac arrythmias
Respiratory depression
hypervigilence
euphoria
aggression
Chronic
weightloss
muscular weakness, confusion, delirium or comas
Meth withdrawal
2 or more
dysphoric mood
vivid dreams
sleep disturbances
Psychomotor agitation and retardation
