Gender Ethnicracial And Life Span Considerations

Drug use and abuse are prevalent across the life span from young adolescents to the elderly. Increasing numbers of the elderly are abusing drugs as a way of coping with the stressors of aging. Young teens are vulnerable to experimentation as they attempt to conform to group norms and peer pressure. The typical users of barbiturates, sedatives, and tranquilizers are middle-class, middle-aged women. Cocaine use is often seen in younger adult professionals, entertainers, and business executives. Marijuana usage is seen most frequently in teens and young adults, but there is no propensity for any race or ethnicity. Rates of current cocaine use are slightly higher for African Americans and Hispanic/Latinos as compared with other populations. Males have a higher rate of current cocaine and marijuana use than females.

786 Psychoactive Substance Abuse

^ ASSESSMENT

HISTORY. The physiological signs and symptoms of use or intoxication vary, depending on the substance. Consequently, when a person is admitted in an intoxicated state or in withdrawal, it is important to know what drug or drugs have been used, the route used, and if possible, the amount of drug used. Determine if alcohol is also being used because there is a synergistic effect that increases the effect of both drugs.

Some patients may be misusing and abusing psychoactive drugs through ignorance. Others may have begun using them as part of a physician-prescribed treatment regimen and then became addicted. If the individual is unable to give a history because of overdose, friends or family members may provide needed information and clothing can be checked for drug paraphernalia. Elicit a history of previous detoxification treatments, effectiveness, length of recovery, and what influenced a return to drug usage.

PHYSICAL EXAMINATION. If the patient is admitted with intoxication and a drug history cannot be obtained, signs and symptoms can be indicators of the type of drug used (Table 5). Inspect the patient for evidence of how the drug is used, such as needle marks from mainlining, nasal irritation caused by snorting, ulcerations on lips and tongue from chewing, cellulitis from injecting drugs and missing the vein, and infections from sites used for mainlining.

• TABLE 5 Signs and Symptoms of Drug Use and Withdrawal

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