26 Dec Club Drug Addiction

1 day ago

Richard Vowles 

Week 4: Club Drug Addiction – Richard Vowles

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Week 4: Club Drug Addiction

            This week we are assigned a substance abuse disorder based on our name.  This post will concentrate on Club Drug Addiction diagnosis.  We will explain the diagnostic criteria for diagnosis.  We will touch on evidenced-base psychotherapy and psychopharmacologic treatments.  Then we will describe clinical features of the disorder we may find with a patient.

Club Drug Addiction

            Club Drug Addiction deals with a specific subset of drugs of abuse that are socially abused and mostly are hallucinogens.  “The National Institute on Drug Abuse (NIDA) has identified six substances as club drugs: ketamine, methylenedioxymethamphetamine (MDMA), methamphetamine, gamma-hydroxybutyrate (GHB), flunitrazepam, and lysergic acid diethylamide (LSD).” ("Club Drug Addiction", 2020) These drugs tend to be very popular at bars and dance clubs.  They produce an increased response to light and sound.  While they can be fun in the moment, they can also be permanently damaging if abused.  Long term use of many of these drugs will create chronic depression, psychosis, anxiety issues, or unexpected “flash backs”.

Diagnostic Criteria

            For this disorder the diagnostic criteria are based on the pattern of abuse.  There are 4 criteria for a substance abuse addiction.  The first criteria “Criterion A criteria can be considered to fit within overall groupings of impaired control, social impairment, risky use, and pharmacological criteria. Impaired control over substance use is the first criteria grouping. “ ("Substance Abuse Disorder", 2020)  The rest of the criteria deal with how often the patient uses the drug, efforts in obtaining the drug, effects from the drug, how the individual tailors their life around the drug, and the desire to use the drug.  It also dives into how the drug affects the patient’s social obligations.  The continued use of the drug after it has begun to damage the patient physically in some way or harmed their life.  It touches on tolerance and on withdrawal syndromes.

Clinical Features

            The clinical features of these drugs can vary depending on the drug used.  The patient may be experiencing euphoria, a rise in core temperature, vision and hearing issues, tachycardia, bradycardia, lethargy, or confusion.  GHB can produce dangerous CNS depression, especially if potentiated by alcohol use as well.  They also increase the risk of seizures.

Conclusion

            Club drugs can be fun.  They can produce vivid light and sound hallucinations, make you feel euphoric, make you feel more social than you might normally feel.  But like all drugs, they have a dark side and they can be very dangerous.  The use of club drugs can be life threatening and it can also increase your chances of being taken advantage of in your altered state which can have its own detrimental effects on the patient.

 

 

References

Club Drug Addiction. Psychiatryonline-org.ezp.waldenulibrary.org. (2020). Retrieved from  https://psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.1176/appi.books.9781585625048.gg53 .

Substance Abuse Disorder. Dsm-psychiatryonline-org.ezp.waldenulibrary.org. (2020). Retrieved from https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.1176/appi.books.9780890425596.dsm16#CHDCCGHF.

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9 hours ago

Stephanie East 

Anxiolytic Use Disorder

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Diagnostic Criteria

 

Anxiolytic use disorder (AUD) is a problematic pattern of use manifested by two or more of the following over a 12 month period:  1) anxiolytics taken in larger amounts or over a longer period than was intended, 2) persistent desire or unsuccessful efforts to cut down use,  3) great deal of time spent trying to obtain anxiolytic, 4) Cravings, 5) Impact of anxiolytic use is affecting work, school and/or home, 6) continued use despite negative impacts, 7) tolerance, 8) withdrawal (American Psychiatric Association, 2013).    Lifetime prevalence is around 1% and anxiolytic use is associated with other psychiatric Axis I and II comorbidities (Huang et al., 2006).  

Clinical Features

 

Clinical features of AUD include physical dependence and addiction, misuse of prescribed anxiolytic and use of diverted medication.  Misuse can be difficult to distinguish from untreated anxiety or insomnia.  Severity of withdrawal symptoms depends on the duration prior to discontinuation, higher doses, drugs with shorter half life and whether the drug was abruptly discontinued (Peterson, 1994).  Signs and symptoms of benzodiazepine withdrawal are nausea, vomiting, tremors, insomnia, headache, agitation and anxiety.  The onset of withdrawal symptoms typically occurs 1-3 days after last use.   Benzodiazepine withdrawal is can be life threatening as patients can develop seizures or status epilepticus (Sadock et al., 2017). Longer durations of use  are associated with a higher likelihood of symptoms during the taper (De Gier et al., 2011).

 

Psychotherapeutic and Psychopharmacological Treatment for Anxiolytic Use Disorder 

 

Anxiolytic tapers can be done on an outpatient basis unless there are complicated medical comorbidities or history of seizures.  Anxiolytic tapers can be done by gradual reduction of the medication by 25-50% every 1-2 weeks over a period of 6-10 weeks or by switching to a longer acting benzodiazepine such as Diazepam (De Gier et al., 2011). 

Clients undergoing benzodiazepine taper should be in cognitive behavioral therapy (CBT).  In one meta-analysis that included nine trials, adding CBT to a benzodiazepine taper resulted in higher rates of benzodiazepine discontinuation compared with taper alone at three months follow-up (Darker et al., 2015).  For patients who have successfully tapered off benzodiazepines, we continue counseling regarding the risks of benzodiazepine use disorder.   As above, prevention of recurrent benzodiazepine use disorder mainly consists of avoidance of benzodiazepines and psychosocial support. 

  

 

References

 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association Publishing.  

 

Darker, C. D., Sweeney, B. P., Barry, J. M., Farrell, M. F., & Donnelly‐Swift, E. (2015). Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane database of systematic reviews, (5).

 

DeGier, N. A., Gorgels, W. J., Lucassen, P. L., Oude Voshaar, R., Mulder, J., & Zitman, F. (2011). Discontinuation of long-term benzodiazepine use: 10-year follow-up. Family practice, 28(3), 253–259.  https://doi.org/10.1093/fampra/cmq113

 

Huang, B., Dawson, D. A., Stinson, F. S., Hasin, D. S., Ruan, W. J., Saha, T. D., Smith, S. M., Goldstein, R. B., & Grant, B. F. (2006). Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: Results of the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry, 67(7), 1062–1073.  https://doi.org/10.4088/jcp.v67n0708

 

Peterson H. (1994). The benzodiazepine withdrawal syndrome. Addiction (Abingdon, England), 89(11), 1455–1459.  https://doi.org/10.1111/j.1360-0443.1994.tb03743.x

 

Sadock, B., Sadock, V. and Ruiz, P. (2017). Kaplan & Sadock’s Synopsis of