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Substance Abuse

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Psychoactive Substance Disorders By: Bryan Mae H. Degorio, BSN, RN
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Page 1: Substance Abuse

Psychoactive Substance Disorders

By:Bryan Mae H. Degorio, BSN, RN

Page 2: Substance Abuse

SUBSTANCE ABUSE- Misuse of substance with

significance and recurrent adverse consequences related to the repeated use.

- refers to the continued use despite the recurrence of the related problem

Substance or chemical dependence- cluster of cognitive and behavioral

and physiologic symptoms indicating continued use of the substance despite of the significance

Page 3: Substance Abuse

Characteristics of Substance Abuse

1. tolerance- increased amount of the substance to obtained

desired effect2. Withdrawal- behavioral, physiologic

and cognitive symptoms occuring when blood or tissue concentration of substance abruptly decline

3. Compulsive drug taking behavior

Page 4: Substance Abuse

Intoxication- is use of substance that results in maladaptive behavior

Detoxification- is the process of safe withdrawal

Habituation- a psychological dependence on the use of drug

Addiction- the physical dependence on a substance

Page 5: Substance Abuse

Concepts of Substance Abuse1. The most common abuse substance is

the alcohol2. About one in five nurses is a substance

abuser3. Substance abuse is a family problem4. Common personality traits are

associated with substance abuser5. Polysubstance abuse involves

concurrent use of two or more substance

Page 6: Substance Abuse

Etiology of Substance Abuse1. Exact cause of substance abuse remains

unclear2. Biologic theories:

a. genetic factorb. biochemical

3. Sociocultural Theorya. hopelessness and defeat of living

conditionb. peer pressurec. easy availability of the substanced. social ambivalence about the use

of substance.

Page 7: Substance Abuse

4. Family theory- implicates dysfunctional

family pattern5. Behavioral Pattern

- substance abuse is a response to stressful stimuli because substance provide temporary relief of anxiety

6. Psychoanalytic theory- maladaptation in the early

stage of development

Page 8: Substance Abuse

Management:1. Detoxification followed by residual

or outpatient program2. Self-help 12 step program designed

to help members achieve and maintain sobriety one day at a time

3. Psychotherapy on reality orientation focusing on coping without the use of the drug

Page 9: Substance Abuse

4. Family therapy- improves communication by encouraging the family members

to define and maintain family functioning

5. Alcoholic determinant therapy with disulfiram

6. Methodone treatment as a substitute for opioid

7. Family support such as self helping organizations

Page 10: Substance Abuse

COMMONLY ABUSE SUBSTANCESAlcohol

- immediate effect due to action to the brain manifested by slurring of speech, incoordination and unsteady gait, impaired attention and memory

- withdrawal symptoms:Stage 1- minor withdrawal

characterized by sleeplessness, restlessness, agitation, diaphoresis, tachycardia, hypertension and tremorss

Page 11: Substance Abuse

Stage 2- major withdrawal - stage 1 + visual and auditory

hallucinationStage 3- delerium tremens as

anifested by elevation of temperature, disorientation + stage 1 and 2

manifestations- Physiologic Effect of Chronic Alcohol Smoking

1. Cardiac myopathy

Page 12: Substance Abuse

2. wernicke’ encephalopathy- thiamine deficiency

3. Korsakoff psychosis- associated with thiamine

and vitamin b 12 deficiency4. pancreatitis, hepatitis, cirrhosis and

ascitis5. Fetal alcohol syndrome

- occurs to infant born to an alcoholic mother

Page 13: Substance Abuse

- Treatment of Withdrawal1. Anxiolytic- prevent withdrawal

manifestations2. Anticonvulsant- can be use for

seizure prevention3. Diet/Promotion of adequate

nutrition- vitamin

supplementation including multivitamins, vit. B12, B, folic acid

Page 14: Substance Abuse

CNS DepressantCLASSIFICATIONSA.Barbiturates, other sedatives,

hypnotics and anxiolytic- it is a CNS depressant that

have the same effect like alcohol

- chronic use can lead to depression and paranoia

Page 15: Substance Abuse

- commonly abuses types:a. Barbiturates- secobarbital,

pentobarbitalb. Sedative/hypnotics-

methoquolone, chloral hydrate

c. Anxiolytic- lorazipam, diazepam, alprazolam, valium

Page 16: Substance Abuse

- Withdrawal:- occurs within 24-72

hours after the last use- manifested by nausea,

vomiting, seizure, depression,

tachycardia and orthostatic hypotension

- Treatment of Withdrawal1. tapering of the anxiolytic2. narcoleptic for psychotic manifestations

Page 17: Substance Abuse

3. anticonvulsant to prevent and treat seizure

B. Narcotics- a CNS depressant that are

use medically to relieve moderate and severe pain

- morphin, heroin and cocain- derivatives of opium

- demerol and methadone- are synthetic substitutes

Page 18: Substance Abuse

- manifestations:- euphoria, well being, impaired attention,

apparent sedation, complete relaxation and PINPOINT or constricted pupil

and scattered pigment of hypodermic needle

- Withdrawal:- occurs within few hours after last dose of short

acting opiates

Page 19: Substance Abuse

- begins 2-3 days after the last dose of long acting opioids

- manifested by:a. Dilated pupil, tearing,

runny nose and restlessness

b. Heroin- coryza, tears, yawning, sneezing, restlessness and irritability

Page 20: Substance Abuse

- Treatment for Withdrawal:1. use of Methodone for the first 3-5 days2. Clonidine hydrochloride to block the

withdrawal manifestations and maybe given for 14 days

CNS StimulantA. Cocain- a CNS stimulant and causes

dopamine depletion- can cause euphoria, anxiety, anger, tachycardia and

DILATION OF PUPIL

Page 21: Substance Abuse

- Common Drugs:1. Cocaine powder- snorted or injected2. Crack crystals- usually smoked- Withdrawal:

- severe depression, fatigue, hypersomnia and psychomotor agitation

- Treatment:1. anxiolytic to treat psychomotor agitation2. antidepressant to counteract depression

Page 22: Substance Abuse

3. Betacholinegic blockers to treat hypertension and tachycardia

4. Dopamine receptor agonist or dopaminergic

B. Amphetamines- medically use to treat ADHD

and to loss weight or stay awake- Physiologic Effect:

- raise of BP, increase of energy level, euphoria,

tachycardia, nausea and vomiting and dilated pupil

Page 23: Substance Abuse

- withdrawal Manifestations:-severe depression, vivid

dreams, insomnia, hypersomnia and psychomotor agitation

- treatment:1. anti depressant- to counteract

depression2. neuroleptic- to treat paranoia

and psychosis3. Anxiolytic- to treat psychomotor

agitation

Page 24: Substance Abuse

Cannabinol/ marijuana- the most common type of

cannabis composed of dried leaves, stems and flowers of a plant cannabis sativa that can be smoked of added to food

- it alters sensory percepion due t active ingredients TETRAHYCANNABINOL ( THC )

Page 25: Substance Abuse

- immediate affect:- euphoria, sensation of

slowed time, impaired motor coordination, conjunctivitis, increased appetite, dry

mouth and tachycardia- chronic use:

- decrease testosterone level and chronic lung disease

- reverse tolerance

Page 26: Substance Abuse

- common drugs:a. Marijuana b. Hashish

Nicotine- is found in tobacco in 1-2

percent concentration - manifestations:

- reduce appetite- Physiologic effect:

a. Respiratory- COPD,

Page 27: Substance Abuse

b. Cardiovascular- ischemic heart disease, CVA and peripheralvascular disease- Withdrawal:- increase appetite along with intense craving for tobacco that may persist for 6 months or longer- Treatment:1. Nicotine Replacement Therapy- use of nasal patch, nasal spray or inhaler

Page 28: Substance Abuse

- use of non- nicotine prescription such as

BUPROPION ( zyban)2. developing of support system

- relapse is highest during the first few weeks and diminishes considerably

Hallucinogen / LSD or Acids- refer to the group of naturally

occurring and synthetic agent that produce essentially the same altering mind effect

Page 29: Substance Abuse

- manifestations:1. similar to psychosis and

depersonalization2. presence of mystical experience3. intensified perception - dangerous due to the following:1. makes the individual believe that they have supernatural power and more than one person has been killed in an attempt to fly

Page 30: Substance Abuse

2. panic reaction occurring for the first user and is referred to as BAD TRIP.3. Flashback as manifested by

hallucinationSTEROIDS

- are synthetic derivatives of testosterone

- can cause androgenic and anabolic effect

Page 31: Substance Abuse

- Associated problem1. cholestatis2. hepatoadenoma3. hepatocarcinoma4. gynecomastia

- ttt- manifestation subside upon withdrawal

Inhalant- are inexpensive and easy to

obtain substances

Page 32: Substance Abuse

- examples:- gasoline, kerosene, isopropyl alcohol, thinner, acetone,

nitrous oxide, fluorocarbons- effects:

- euphoria, hallucination and unsteady gait

- problem:- COPD and acidosis

- treatment: O2 and resp support


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