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By C. Potros. Pennsylvania College of Technology.

The the motor cortex of the brain cheap avalide 162.5mg visa, extend location of the dysfunction determines down the spinal cord through descending the nature of the disorder order 162.5 mg avalide otc. Sensory (afferent) impulses A nerve is a bundle of fibers outside the from the body enter the spinal cord central nervous system that transmits through spinal nerve roots that also information between the central nervous extend through openings between verte- system and various parts of the body avalide 162.5mg overnight delivery. The brae and then travel up ascending tracts in peripheral nervous system consists of all the spinal cord to the brain discount avalide 162.5 mg visa. For ly, the peripheral nerves must be connect- example, the nerve roots that leave the ed to the central nervous system. Some spinal cord at the cervical level are labeled peripheral nerves connect directly to the C-1 through C-8, and the nerve roots that brain (cranial nerves), and others connect leave at the thoracic level are labeled T-1 directly to the spinal cord (spinal nerves). The sensory (afferent) Cranial and spinal nerves are essential nerves carry body sensations into the sen- links between the rest of the body and the sory nerve roots (posterior roots) at the back central nervous system. Some brain down the spinal cord and exit from cranial nerves contain only sensory fibers, motor nerve roots (anterior roots) at the whereas others contain both sensory and front of the spinal cord. Cranial nerves mediate fibers then carry impulses to the volun- many aspects of sensation and muscular tary muscles in the body. Many types of neurons work together Cranial nerves and their related functions to transmit impulses through the spinal are illustrated in Table 3–1. Sensory impulses entering the spinal Peripheral nerves that connect and cord at the lumbar region are relayed ver- transmit messages directly to the spinal tically to the brain through a number of cord are called spinal nerves. Each nerve divides impulses from the brain to the peripher- and then subdivides into a number of al nerves, however, are conducted branches. Nerves at each level travel to through two separate categories of motor specific parts of the body, conveying neurons. Upper motor neurons originate in information between those areas and the Normal Structure and Function of the Spinal Cord and Peripheral Nervous System 75 Table 3–1 Cranial Nerves and Related Functions Cranial Nerve Area of Function I. Trigeminal Sensation in head, face, and teeth, motor activity of chewing VI. Facial Taste, sensation of external ear, control of salivary glands, tears, muscles in facial expression VIII. Glossopharyngeal Swallowing, sensation of pain, taste, touch from tongue and throat X. Vagus Heartbeat, digestion, speech, swallowing, respiratory function, gland functions XI. Accessory Movement of head and shoulders, muscles of pharynx and larynx in throat, production of voice sounds XII. Spinal nerves and body, the autonomic nervous system their related functions are illustrated in stimulates immediate, involuntary re- Table 3–2. For example, in response to a Nerves control both voluntary and in- speck of dust in the eye, tears are pro- voluntary functions in the body. In response to a fearful situation, that control voluntary functions (such as the heart beats faster. Nerves that are concerned with the control of invol- Table 3–2 Spinal Nerves and untary functions are part of a subcatego- Related Functions ry of the peripheral nervous system called the autonomic nervous system. Spinal Nerve Area of Function The autonomic nervous system inte- grates the work of vital organs, such as the Cervical (C1-C8) Back of head, neck, heart and lungs. Its primary function is to shoulders, arms, hands, coordinate the activity of internal organs diaphragm so that they can make adaptive respons- Thoracic (T1-T12) Chest, back, regions of es to changing external situations in abdomen order to maintain internal equilibrium. Lumbar (L1-L5) Lower back, parts of Nerve fibers monitor the activities of thighs and legs internal organs as well as changes in the Sacral (S1-S5) Regions of thighs, external environment. When changes are buttocks, legs, bowel, necessary to maintain internal homeosta- bladder, genital function sis (equilibrium), or to protect the 76 CHAPTER 3 CONDITIONS OF THE NERVOUS SYSTEM: PART II The autonomic nervous system is divid- rupted. Consequently, some damage to ed into two subsystems: motor, sensory, or reflex function below the injury occurs.

Taken into the body discount avalide 162.5 mg on-line, nicotine pro- scribed for treatment of a specific condi- duces initial stimulation avalide 162.5 mg on line, followed by se- tion or symptom or whether they have dation avalide 162.5 mg lowest price. Withdrawal effects of nicotine in- been obtained illegally order 162.5 mg avalide with mastercard, sedatives may be clude restlessness, irritability, and tension. Cancer of the lung or oral Individuals commonly abuse sedatives cavity and a variety of other lung diseases in combination with alcohol, and they have been linked to tobacco use. In addi- often abuse opiates and stimulants con- tion, tobacco use has been shown to currently. Commonly abused sedatives are aggravate other preexisting conditions, barbiturates (e. An early study reported that and chlorzepate dipotassium [Tranzene]), at least 50 percent of individuals recover- and other central nervous system depressants ing from surgery for a smoking-related (e. Some sedatives, ing shortly after they were discharged such as benzodiazepines, may have a (Burling, Stitzer, Bigelow, et al. If ceptable, pressure from various groups and individuals have become sedative depend- public awareness of the health hazards of ent on lower doses of the drug, withdraw- smoking have resulted in sanctions on al symptoms may consist only of irri- public smoking behavior. Treatment of tability, sleep disturbance, and generalized nicotine dependence varies widely, rang- anxiety. If, however, individuals became ing from the use of nicotine-containing dependent on higher doses, withdrawal gum to hypnosis to behavioral and group can be life-threatening. The success of most programs drawal, especially from barbiturates, can designed to stop tobacco use is directly result in acute psychosis and seizures. Therapeutic withdrawal from a sedative, like the therapeutic withdrawal from Sedatives alcohol, usually involves the administra- tion of a cross-tolerant drug to suppress Sedation implies calmness and tranquil- withdrawal symptoms with gradual taper- ity. The drug being with- pharmacologic action they produce, drawn determines the length of time namely, depression of the central nervous required for tapering. Examples of sedative drugs are 7 to 10 days is sufficient for detoxification. Many symptoms of withdrawal are flulike, Opioids although they may include anxiety, irri- tability, and restlessness. Because opioids (narcotic drugs such as Opiate substitution drugs are sometimes morphine, meperidine [Demerol], pro- used in treatment of opiate addiction and poxyphene [Darvon], oxycodone [Perco- may be used for either detoxification or dan], and codeine) are frequently maintenance. Methadone and another prescribed for pain, addiction can occur opiate-substitute, levomethadyl acetate, through regular prescription use. In oth- may be used to reduce the use of illicit opi- er instances, these medications are ates and the high-risk behaviors associat- obtained illegally. O’Connor, 2000), as well as to provide In addition to producing pain relief, medical assistance with withdrawal of opi- narcotics produce euphoria, sedation, and ates. At first, individu- drug dosage is gradually tapered during als may take illegal narcotics primarily for the withdrawal period. Repeated admin- may be enrolled in a maintenance program istration rapidly produces tolerance and in which they do not undergo detoxifica- intense physical dependence. Eventually, tion but rather receive maintenance dos- as the dosage and/or frequency of drug es of an opiate substitute along with administration increases, individuals need counseling. The goal of such programs is to continue to take the drug regularly to first to help individuals return to a social- avoid symptoms of physical withdrawal. Drugs that are injected increase individuals’ risk of Stimulants contracting HIV infection or hepatitis C if needles are shared. Adding adulterants to Acting directly on the central nervous substances or using nonsterile techniques system, stimulants create an increased state of injection may also produce medical of arousal and concentration and speed up complications. Individuals may (inflammation of tissues), thrombophle- take stimulants for such effects as in- bitis (inflammation of a vein with associ- creased alertness and increased sense of ated clot formation), septicemia (presence well-being, increased confidence, reduc- of toxins in the blood), and bacterial tion of fatigue, or decrease in appetite. They can be taken Withdrawal symptoms vary in severity orally, topically, intravenously, or by inhala- and duration, depending on the particu- tion. In addition to central nervous system 216 CHAPTER 7 CONDITIONS RELATED TO SUBSTANCE USE effects, stimulants have generalized sys- lasts only a matter of minutes, however, temic effects, including an increase in heart and is often followed by irritability, rest- rate, an increase in blood pressure, a rise in lessness, and depression. The aftereffects body temperature, and the constriction of of crack can be so intense that individuals peripheral blood vessels (Sarnyai, Shaham, continue to smoke it, despite obvious & Heinrichs, 2001). It Aside from its psychological, social, and may be taken orally, used intranasally vocational consequences, cocaine use can (snorted), smoked, or injected intraven- have serious medical consequences. The technique of free-basing basing or smoking crack can lead to pul- cocaine, which gained popularity in the monary complications.

Elevated levels of en- Treatment of Substance Use Disorders 223 zymes such as serum glutamic-oxaloacetic use consider themselves as “recovering buy cheap avalide 162.5mg on line,” transaminase (SGOT) and serum gluta- denoting the long-term and chronic mate pyruvate transaminase ( SGPT) cheap avalide 162.5mg mastercard, may nature of the recovery process discount 162.5mg avalide. Relapse is also be associated with substance abuse; a common part of recovery and 162.5mg avalide fast delivery, rather than however, increased concentrations of being thought of as failure, can be viewed enzymes such as SGOT and SGPT can also as an opportunity for learning and growth be associated with other conditions (e. Many individuals with substance use disorders eventually experience physical, Behavioral and Psychological social, or psychological crises that require Screening inpatient or residential treatment. The type of treatment received varies greatly Investigation of subtle psychological or from facility to facility and depends on the behavioral symptoms is also important in particular type of crisis experienced. In addi- Treatment usually begins with detoxifi- tion, the incidence of accidents and cation, which may or may not involve injury is often increased. Detoxification is only an initial step in the treatment of substance The first step in the treatment of sub- use disorders, however. Ongoing therapy stance-related disorders is identifying and that includes a variety of rehabilitation acknowledging the problem. Screening may strategies, such as psychotherapy, family be hampered by several barriers, including: therapy, and self-help programs (e. In almost all instances, typically accompany it as well as for their abstinence is a treatment goal. In some instances, drugs are prescribed Successful treatment of substance use dis- in the ongoing treatment of substance orders generally requires more than one dependence. Antabuse and methadone (or level of care during the long recovery pro- other opiate substitute), which were dis- cess. Treatment may involve outpatient or cussed earlier, are drugs commonly used inpatient care and continued aftercare. They deny that a substance use Because nutritional deficiencies frequent- problem exists or may rationalize their ly accompany substance use disorders, behavior by redefining their substance most detoxification centers and residential use so that it appears to be acceptable. Educational pro- perform violent acts when they are under grams that stress the importance of nutri- the influence of certain substances. Those tion, as well as other aspects of a healthy who are predisposed to this type of reac- lifestyle, are often incorporated into the tion may become involved in criminal general treatment program. PSYCHOSOCIAL AND VOCATIONAL As individuals become increasingly ISSUES IN SUBSTANCE ABUSE dependent on the substance, the concept of living without it produces fear and Psychological Issues dread. Individuals interpret removal of the substance as removal of all joy and excite- The extent to which psychological dis- ment from life. As with all types of per- ability is the direct result of a substance- ceived loss, individuals may experience related disorder or the cause of the dis- grief and bereavement. Individuals Recovery from a substance use disorder with substance use disorders frequently involves restoration of self-esteem and have low self-esteem and experience confidence, as well as willingness to depression. They may have feelings of in- accept responsibility for personal behav- adequacy, loneliness, and isolation that ior. Influenced the losses they have experienced and to and controlled by the substance, they may develop skills for coping in the future. Doubt that they will be able to includes long-term vigilance and a contin- cope without the substance may erode uing commitment to remain drug-free. Lifestyle Issues Individuals who are psychologically dependent on a substance feel a need and A substance-related disorder affects longing for the substance and become irri- every aspect of individuals’ daily life. As table, depressed, anxious, and resentful dependence on the substance becomes when the substance is not available. Indi- more pronounced, individuals may lose viduals with a psychological craving for a interest in self-care, may show a decreased substance may attribute their need to a desire for food, and may have a variety of personal flaw in their character or may sleep disturbances, resulting in sleep dep- consider their need as a negative reflection rivation. Either interpretation fur- focused on obtaining more of the sub- ther contributes to lowered self-esteem stance. Psychosocial and Vocational Issues in Substance Abuse 225 Substance use can affect individuals’ Individuals with a substance use disor- ability to drive. Poor driving performance der may be unable to function within can result in accidents or arrests, which their social network. Social and family rela- problem, so that individuals must depend tionships are strained and often destroyed on others for their transportation needs. Decreas- experience not only decreased libido but ing reliability in performing social roles also adverse effects on sexual perform- and continued inability to maintain com- ance, including impotence, a common mitments cause those affected by the indi- side effect of chronic alcohol abuse.

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