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Treatment Of Stimulant Use Disorder Discussion

Treatment Of Stimulant Use Disorder Discussion

Discussion week 4

Pharmacological intervention

There is currently no FDA-approved pharmacotherapy treatment for cocaine disorders according to, (Chan et al., 2018)Treatment Of Stimulant Use Disorder Discussion.  Even though some drugs often show encouraging data for the treatment of stimulant use disorder, the evidence remains uncertain and application is limited.

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Dopamine agonist

It has been used to successfully treat tobacco and opioid use disorders. In agonist treatment, the drug activates the similar effects as the abused drug thus bearing the same effects but have pharmacological properties that portray it less abusable than the abused drug. Ideally drugs which penetrate the brain more slowly tend to have a prolonged duration of action or are partial agonist rather than full agonist and are known to have less addictive potential (Kampman, 2019)Treatment Of Stimulant Use Disorder Discussion. Long-acting amphetamine has been used in various clinical trials and is showing promising results.

Cholinergic medications

Galantamine is a reversible and competitive behavior of acetylcholinesterase that increases the acetylcholine levels in the synaptic cleft leading to stimulation of both muscarinic and nicotinic receptors. Research studies have shown that disruption in the cholinergic system is linked with cocaine use and thus, galantamine might be useful in the management of cocaine abuse.

Noradrenergic agents

Doxazosin is a long-acting selective alpha-a adrenergic antagonist that decreases central noradrenergic activity which reduces the behavioral effect of stimulants.

Non-pharmacological intervention

Psychosocial treatment has been proven to be more beneficial. Psychotherapy; including drug counseling, CBT, and recurrence prevention is recommended as the mainstay treatment plan for stimulant addiction (Kampman, 2019). Contingency management strategies are among the most promising approaches in the management of stimulant use disorder as it utilizes ‘manipulative’ enforcement to accomplish the specific goal of short-term drug abstinence. The reinforcement includes; the using vouchers for goods and services or financial rewards. This method is effective in various clinical trials. On the other hand, CBT mainly concentrates on learning strategies that will help change maladaptive behaviors and increase coping skills with relapse prevention being a common goal Treatment Of Stimulant Use Disorder Discussion.

References

Chan, B., Kondo, K., Ayers, C., Freeman, M., Montgomery, J., Paynter, R., & Devan Kansagara. (2018, August). Pharmacotherapy for Stimulant Use Disorders: A Systematic Review. Nih.gov; Department of Veterans Affairs (US). https://www.ncbi.nlm.nih.gov/books/NBK536789/

‌ Kampman, K. M. (2019). The treatment of cocaine use disorder. Science Advances, 5(10). https://doi.org/10.1126/sciadv.aax1532

‌Substance-Related and Addictive Disorders

Subjective:

CC: The patient presents with a complaint of the fear of attending rehabilitation for her drug addiction.

HPI: The client is a 29-year-old White female who is afraid of going to treatment to get free from her drug addiction. She denies having had this anxiety in the past, but admits that she requires assistance. This worry began after she reconnected with her lover, Jeremy, who also smokes crack cocaine and drinks. The fear is constant and lingers in her mind as it should. It is exacerbated by the prospect of going to rehab and comforted by the knowledge that there are clean rehabilitation clinics that are not as filthy as the ones she is familiar with. She notices the worry whenever the topic of rehabilitation is brought up, and she ranks its severity as 6/10. Treatment Of Stimulant Use Disorder Discussion

Past Psychiatric History: She has a drug addiction past, specifically consuming crack cocaine and cannabis.

  • General Statement: She is a resident of West Palm Beach, Florida. She is currently on probation and detox, and the facility is exploring long-term rehabilitation for her.
  • Caretakers: She does not require caregivers because she is capable of meeting her own needs.
  • Hospitalizations: She had previously been hospitalized for both a heroin overdose and pneumonia.
  • Medication trials: She has previously been on psychiatric drugs.
  • Psychotherapy or Previous Psychiatric Diagnosis: She has a history of substance abuse disorder, for which she is currently receiving detox and rehabilitation Treatment Of Stimulant Use Disorder Discussion.

Substance Current Use and History: She has a long history of drug abuse. She admits to consuming crack cocaine on a daily basis. She also smokes marijuana once or twice a week and consumes alcohol once a week. She is currently detoxing and on probation.

Family Psychiatric/Substance Use History: Her mother, who lives in Alabama, has a history of addiction and anxiety. The older brother also suffers from opioid use disorder, and the father has a history of pedophilia. She was sexually molested by her father when she was 5-7 years old. The father was a drug addict as well, and he is presently serving jail time for defilement and drug related crimes.

Psychosocial History: She presently lives with her partner, and they both take crack cocaine. She is concerned that her partner is encouraging her to continue doing drugs. She claims to have a daughter who is staying with friends.

Medical History:

  • Current Medications: Modafinil 200 mg OD
  • Allergies: She is allergic to penicillin.
  • Reproductive Hx: She is heterosexual and in a relationship Treatment Of Stimulant Use Disorder Discussion.

ROS:

  • GENERAL: Negative for weariness, malaise, chills, or fever.
  • HEENT: Negative for diplopia, photophobia, tinnitus, otorrhea, rhinorrhea, sneezing, sore throat, or dysphagia.
  • SKIN: Negative for itching or rashes.
  • CARDIOVASCULAR: Negative for chest pain or edema.
  • RESPIRATORY: Negative for dyspnea, wheezing, or coughing.
  • GASTROINTESTINAL: Negative for nausea, vomiting, diarrhea, or bowel control problems. Regular bowel movements are reported.
  • GENITOURINARY: Negative for frequency, hesitancy, dysuria, or incontinence.
  • NEUROLOGICAL: Negative for loss of bowel and bladder control, numbness, dizziness, paresis, or loss of sensation.
  • MUSCULOSKELETAL: Denies myalgia, joint pains, and arthralgia.
  • HEMATOLOGIC: Negative for a history of blood or clotting disorders.
  • LYMPHATICS: Denies lymphadenopathy and splenectomy.
  • ENDOCRINOLOGIC: Negative for a history of hormonal replacement therapy, excessive diaphoresis, heat or cold intolerance, excessive thirst, or excessive drinking of water Treatment Of Stimulant Use Disorder Discussion.

Objective:

Vital signs: T 98.7; P 82; BP 150/90; BMI 23.5 kg/m2 (normal weight for height).

Physical exam: She is properly dressed, albeit her hair appears unkempt. She is aware of people, places, times, and events. Her discourse is coherent, albeit hesitating at times, and goal-oriented.

Diagnostic results: ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for cocaine, THC. She is negative for alcohol or other drugs in blood.

Assessment: Treatment Of Stimulant Use Disorder Discussion

MSE

The client is a 29-year-old White female who is aware and aware of her surroundings, including place, person, time, and event. Her attire is suited for the time of day and season. Her communication is hesitant, but it is also coherent, goal-oriented, and unambiguous. She keeps her gaze fixed on you and appears to be yawning. There were no other movements or tics observed. Her self-reported mood is “anxious,” however she has euthymic affect. As a result, there is no correspondence between the mood and the affect. She denies having auditory hallucinations, having delusions, or having paranoid thoughts. She denies having homicidal or suicidal thoughts, and her insight and judgment are sound. Diagnosis is Stimulant Use Disorder – Cocaine (APA, 2013; Sadock et al., 2015)Treatment Of Stimulant Use Disorder Discussion.

Differential Diagnoses

  1. Stimulant Use Disorder (Cocaine): 304.20 (F14.20)

A habit of cocaine use causing major clinically recognizable suffering is required by the DSM-5 diagnostic criteria for this disorder. This should be exhibited by at least two of a variety of symptoms within a year. These include getting the stimulant in greater quantities over a longer period of time than was originally assumed; actions to minimize use are ineffective; a lot of fruitful time is spent attempting to obtain the cocaine for use; there is extreme yearning for the cocaine; inability to fulfil vocational, household, and educational commitments; continued abuse notwithstanding experiencing issues linked to cocaine use; and ongoing use even in risky situations. Tolerance and withdrawal are also factors (APA, 2013).

  1. Primary Mental Disorders

Stimulant use disorder’s clinical signs may resemble those of other major psychiatric conditions such as major depression, bipolar disorder, or even generalized anxiety disorder or GAD (APA, 2013)Treatment Of Stimulant Use Disorder Discussion. Any of these symptoms could be mistaken for cocaine use disorder. These diagnoses can only be ruled out by obtaining a thorough history.

  • Phencyclidine Intoxication: F16.929

PCP is another name for phencyclidine. When used, it produces almost identical symptoms to cocaine abuse. It is one of the illicit chemicals known as synthetic or designer drugs. It can only be ruled out if urine or blood tests show that cocaine is present in the body (APA, 2013)Treatment Of Stimulant Use Disorder Discussion.  

Reflection

In this case, I learned how vital it is to take a thorough history when dealing with a suspected addiction diagnosis. I feel I did my best by following evidence-based standards for history taking and physical examination (Ball et al., 2019), and if given the opportunity again, I would do the same. Advised agreement was sought to ask questions, and the patient was informed that they were free to leave if they so desired, in accordance with ethical and legal issues. This complied with informed consent and autonomy (Haswell, 2019). Furthermore, by urging her to accept the offer of long-term rehabilitation, the bioethical norm of beneficence was upheld because this was what was best for her at the time. The client was urged to face her fears and pursue long-term therapy because it would benefit both her and her daughter in the long run. This patient has various risk factors that will be addressed through health education and promotion. Her drug abuse past and socioeconomic condition stand evident. She will need psychoeducation to be convinced that drug and substance usage is not normal Treatment Of Stimulant Use Disorder Discussion.

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References

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.

Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, 9th ed. Elsevier.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer Treatment Of Stimulant Use Disorder Discussion