How Substance Use Disorders Affect Physical Health

1. How Substance Use Disorders Affect Physical Health

2. Learning Objectives • Define the continuum of Substance Use Disorders • Understand the risk levels associated with various stages of use • Examine the general and specific health concerns related to Substance Use Disorders for users and others • Identify special problems experienced by substance using/abusing pregnant women and their babies • Demonstrate how behavioral and primary healthcare workers can intervene more effectively to reduce risks associated with substance use

3. Stigma .

4. Stereotype

5. Substance Use Disorders • Use • Abuse • Addiction

6. Use

7. The Drinkers’ Pyramid 3-7 % alcohol dependent or harmful users 10- 15% hazardous, at-risk users 35- 40% low-risk drinkers 40% abstainers

8. What is a Low-Risk Limit?

9. What is a Low-Risk Limit? • No more than two standard drinks a day for men, one per day for women (for daily drinkers) • Do not drink at least two days of the week

10. Definitions: Standard Drink

11. What is a Low-Risk Limit? There are times when even one or two drinks can be too much: • When operating machinery • When driving • When taking certain medicines • If you have certain medical conditions • If you cannot control your drinking • If you are pregnant

12. Abuse

13. Substance Abuse vs. Substance Dependence Substance Abuse: the misuse of alcohol, an illicit drug, prescription drug or over-the-counter medication. Substance abuseoften involves a pattern of harmful alcohol and/or drug use for mood altering purposes. A person diagnosed with substance abuse is not considered to be addicted or dependent (otherwise the diagnosis would be substance dependence).

14. Scope of the Problem • Substance abuse/dependence is strongly associated with health problems, disability, death, accident, injury, social disruption, crime and violence • Alcohol abuse/dependence alone generates nearly $185 billion in annual economic costs (NIAAA) • Drug abuse/dependence generates an estimated $98 billion annually in annual economic costs (NIDA)

15. Addiction

16. Lincoln on Addiction “In my judgment such of us who have never fallen victims (of alcoholism) have been spared more by the absence of appetite than from any mental or moral superiority over those who have.”(remarks to the Springfield, Illinois Washingtonian Society, February, 1842)

21. Addiction is Manageable Recovery Happens • Addiction is Manageable and, with treatment, has good outcomes. ….all this bad news! Is there no hope? Of course there is hope! Recovery is all around us. “No known cure” doesn’t mean not “untreatable.” We don’t cure diabetes, we manage it with proper diet, blood sugar monitoring and other acts of discipline.

22. Recovery • Recovery from alcoholism and drug addiction is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. (SAMHSA/CSAT)

23. General Health Concerns for the Abuser • Cardiovascular disease • Stroke • Cancer • HIV/AIDS • Hepatitis B and C • Liver disease • Lung disease • Mental disorders • Neurological disorders According to the American Cancer Society (ACS) the greater a person’s alcohol consumption is the greater the chances are that he or she will get certain kinds of cancer

24. General Health Concerns for Others • Prenatal exposure • Negative effects of second-hand smoke • Increased spread of infectious diseases • Automobile crashes and other accidents

25. Alcohol • Cardiovascular system • High blood pressure • Neurological system • Damage to • Cerebral cortex • Hippocampus • Cerebellum • Stroke • Endocrine system • Cirrhosis • Liver Cancer • Diabetes Alcohol dependence is the leading cause of cirrhosis, which is the eighth leading cause of death in the U.S. and kills about 25,000 people a year National Institute of Health, 2000; Stinson, Grant, and Dufour, 2001

29. Scope of the Problem • Alcohol is a factor in: • 60-70% of homicides • 40% of suicides • 40-50% of fatal motor vehicle accidents • 60% of fatal burn injuries • 60% of drownings • 40% of fatal falls

42. AlcoholPrenatal Exposure • Children with fetal alcohol spectrum disorder may: • Be born small • Have problems eating and sleeping • Have problems seeing and hearing • Have trouble following directions and learning how to do simple things • Have trouble paying attention and learning in school • Need special teachers and schools • Have trouble getting along with others and controlling their behavior • Need medical care all their lives

44. Tobacco • Smoking harms nearly every organ in the body • Adverse health effects from smoking account for about 443,000deaths (or nearly one of every 5 deaths) each year in the US • Smoking causes coronary heart disease, the leading cause of death in the US • Smoking causes abdominal aortic aneurysm • Smoking causes cancers, including acute myeloid leukemia, bladder cancer, cancer of the cervix, cancer of the esophagus, kidney cancer, cancer of the larynx, lung cancer • More deaths are caused each year by tobacco than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined (Centers for Disease Control and Prevention)

45. Tobacco and Pregnancy • Fetus exposed to dangerous chemicals like nicotine, carbon monoxide and tar. These chemicals lessen the amount of oxygen available for the developing fetus • For the mother, smoking can lead to an ectopic pregnancy, vaginal bleeding, placental abruption, placenta previa • Babies can born prematurely, with low birth weight • Birth defects can occur, such as cleft lip or palate

46. Second Hand Smoke • Sidestream v. Mainstream • 3,400 lung cancer deaths in non-smoking adults (est.) • 46,000 deaths from heart disease in non-smokers who live with smokers (est.) • Increases the number and severity of asthma attacks in children • More than 750,000 middle ear infections in children • Increased risk of low birth weight in babies born to pregnant women exposed to second hand smoke (American Cancer Society)

47. Marijuana • Cardiovascular • Increased heart rate • Respiratory system • Lung damage • Cancer • Reproductive system • Delay in development • Possible infertility Marijuana users have a 4.8-fold increase in the risk of heart attack in the first hour after smoking the drug Mittleman, M.A., Lewis, R.A., Maclure, M., Sherwood, J.B., Muller, J.E. Triggering myocardial infarction by marijuana. Circulation, 103(23), 2805–2809, 2001. Marijuana smoke contains 50–70% more carcinogenic hydrocarbons than tobacco smoke. Hashibe, M., Morgenstern, et al 2006

48. Heroin (and other opiates) • Cardiovascular system • Infection of the heart lining • Respiratory system • Chest pains • Respiratory failure • pneumonia • Digestive system • Abdominal pain • Nausea • Constipation • Weight loss and malnutrition • Kidney disease Estimated annual dialysis cost for just one person who has wrecked his own kidneys by shooting heroin ("heroin nephropathy") $50,000 AMERICAN JOURNAL OF KIDNEY DISEASES, 40(3):611-622, Lee H © 2002 National Kidney Foundation.

49. Heroin (and other Opiates)Prenatal Exposure • Physical issues • Low birth weight • Born physically dependent • Need to be tapered from opiates • Need for long-term hospitalization • Cognitive issues • Cognitive performance • Developmental delay

50. Heroin (and other Opiates) Route of Use • Snorting • Nose bleeds • Hole in septum • Injection • HIV/AIDS • Hepatitis C • Allergic reaction to additives • Collapsed veins.