Substance abuse now

SUBSTANCE ABUSE

Intake through various means or route of both legal and illegal substances with the intention of producing a different state of mind or overall feeling.

Intake of substances to achieve brain-altering effect

SUBSTANCE ABUSEPREVALENCE ..... DETRIMENTAL EFFECTS:

-Workplace injuries

-Motor vehicle accidents and fatalities

-Domestic abuse, homicide, and child abuse and neglect

Substance Abuse14% of adults have an alcohol-related disorder-

6.2% have a substance-related disorder (excluding nicotine)

Children of alcoholics are 4 times more likely than the general population to develop problems with alcohol

TYPES OF SUBSTANCE ABUSECLASSES OF SUBSTANCE ABUSE

- Alcohol- Amphetamines or similarly acting sympathomimetics- Caffeine- Cannabis- Cocaine- Hallucinogens- Inhalants- Nicotine- Opioids- Phencyclidine (PCP) or similarly acting drugs

- Sedatives, hypnotics, or anxiolytics

- Methamphetamine

SUBSTANCE ABUSE DEFINITIONSIntoxication is use of a substance that results in maladaptive behaviorWithdrawal syndrome refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreasesDetoxification is the process of safely withdrawing from a substance

SUBSTANCE ABUSESubstance abuse is using a drug in a way that is inconsistent with medical or social norms

(WHO) A maladaptive pattern of substance use leading to significant problems or distress such as

- failure to attend school, work- substance use in dangerous situations (driving a car) - substance-related legal problems- continued substance use that interferes with family relationships and friendships

DSM-IV Criteria for Substance Abuse- Maladaptive pattern of substance use,

manifested by >1 of the following occurring at anytime within a 12 month period

1. Recurrent substance use resulting in

failure to fulfill major obligations at work, school or home

2. Recurrent substance use in situations in which it is physically hazardous

3. Recurrent substance –related legal problem

4. Continued substance use despite having persistent social or interpersonal problems caused by the substance

SUBSTANCE DEPENDENCESubstance dependence includes problems associated with addiction such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance(WHO) Continued use of a

substance, despite its negative consequences or even when significant problems related to its use have developed.

DSM-IV Criteria for Substance DependenceMaladaptive pattern of substance use,

manifested by >3 of the following symptoms occurring at anytime in the same 12 month period:

1. Tolerance 2. Withdrawal 3. Substance taken in larger amounts or

longer periods 4. Persistent desire, unsuccessful efforts to

control substance use 5. Much time spent in activities to obtain

substance 6. Important social, occupational,

recreational activities are given up because of substance use

7. Substance use is continued despite knowledge of having physical or psychological problem that is likely due to substance use.

Onset and Clinical Course

Typically begins with the first episode ofintoxication between 15 and 17 years ofage More severe difficulties begin in the mid-20s to mid-30s

- Alcohol-related breakup of a significant relationship

- An arrest for public intoxication or driving while intoxicated

- Evidence of alcohol withdrawal- Early alcohol-related health problems- Significant interference with

functioning at work or school

ONSET AND CLINICAL COURSE

BLACKOUT....

TOLERANCE....

TOLERANCE BREAK...

ABSTINENCE OR TEMPORARY CONTROLLED DRINKING...

... OR SPONTANEOUS REMISSION......... (20%)

HIGHER RATES OF SUCCESSFUL RECOVERY:

PEOPLE WHO ABSTAIN

HIGHLY MOTIVATED TO QUIT

HISTORY OF LIFE SUCCESS

PROGNOSIS IS POOR WHEN:

EARLIER AGE AT ONSET

LONG PERIODS OF SUBSTANCE USE

CO EXIST WITH MAJOR PSYCH ILLNESS

EXTENDED USE COULD CAUSE RISK IN....

MENTAL AND PHYSICAL DETERIORATION

INFECTIOUS DISEASES

ETIOLOGY.......Biologic factors

- Genetic vulnerability - Neurochemical influences Psychological factors- Familial dynamics- Coping styles Social and environmental factors

- availability- cultural factors-social attitude- peer behavior

1. ALCOHOL (DEPRESSANT)STANDARD DRINKS - ALCOHOL

The Alcohol Use Disorders Identification Test:

0 1 2 3 4

1. How often do you have a drink containing alcohol?

never Monthlyor less

2-4x a month

2-3x a week

4 or more times a week

Please skip to Questions 9 and 10 if reply to Question 1 is NEVER, or if both answers to Q 2 and 3 are 0.

The Alcohol Use Disorders Identification Test:

0 1 2 3 4

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

1-2 drinks

3-4 drinks

5-6 drinks

7,8 or 9 drinks

10 or more drinks

3. How often do you have six or more drinks on one occasion?

never less than monthly

monthly weekly daily or almost daily

AUDIT:0 1 2 3 4

4. How often during the last year have you found that you were not able to stop drinking once you had started?



5. How often during the last year have you failed to do what was normally expected from you because of drinking?



AUDIT:0 1 2 3 4

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?



7. How often during the last year have you had a feeling of guilt or remorse after drinking?



AUDIT:

0 1 2 3 4

8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?



AUDIT:

0 2 4

9. Have you or someone else been injured as a result of your drinking?

No, never Yes, but not in the last

year

Yes, during the last year

10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

No, never Yes, but not in the last

year

Yes, during the last year

AUDIT:

Risk Level Intervention AUDIT score

Zone I – Low-risk drinking or abstinence

Alcohol Education 0-7

Zone II – Alcohol use in excess of low-risk guidelines

Simple Advice 8-15

Zone III – Harmful and hazardous drinking

Simple Advice + brief counseling & cont’d. monitoring

16-19

Zone IV – Alcohol Dependent Refer to specialist for Evaluation and Treatment

20-40

ALCOHOLCentral nervous system depressant.Intoxicated: relaxed, loss of inhibitions, slurred

speech, unsteady gait, impaired attention, aggressive , and inappropriate behavior.

Overdose can result in vomiting, unconsciousness, and respiratory depression.

Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake

Alcohol withdrawal usually peaks on the second day and is over in about 5 days

Withdrawal symptoms include:

Coarse hand tremors, irritability, heightened alertness, jerky movements, numbness, tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting

Severe or untreated withdrawal may progress to transient hallucinations, illusion,seizures, or delirium—called delirium tremens (DTs)

Benzodiazepines used for detoxification tx:

Lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium) suppress the withdrawal symptoms

ADDICTION RESEARCH FOUNDATION- CIWA- ARor CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL, REVISEDLess than 8= mild withdrawal

8- 15 = moderate withdrawalGreater than 15 = severe withdrawal

TREATMENT AND NSG INT.FOR ALCOHOLISM:- ANTABUSE (Disulfiram)1. DETOXIFICATION

- PREVENT SUICIDE- PREVENT CONVULSION/ SZ- PROVIDE WELL LIGHTED

ENVIRONMENT

- ESTABLISH NUTRITIONAL STATUS- Vitamin B1 (thiamine) to prevent or to

treat - Wernicke’s syndrome and Korsakoff’s syndrome

- Cyanocobalamin (vitamin B12) and folic acid for nutritional deficiencies

2. REHABILITATION

1. DEPRESSANTS- reduce nervous activity thus decrease body function

1. Narcotics Opiates, opioids- drugs that relieve pain

2. Sedatives Hypnotics, sleeping pills

3. Tranquilizers Produce emotional calmness and relaxation

4. Volatile Substances

“solvents”

Examples of Narcotics: (for pain)

1.Demerol2.Morphine SO43.Heroine- prohibited4.Codeine- found in cough

syrups 5.Opium- prohibited6.Methadone

Narcotics (for pain)Intoxication and WithdrawalINTOXICATION:1.DROWSINESS2.SLURRED SPEECH3.IMPAIRED

ATTENTION/ MEMORY4.ANALGESIA5.DECREASE SEXUAL

DRIVE6.HYPOACTIVITY

SWEATING

- NARCAN (NALOXONE)- ANTIDOTE (OPIOID)

- Stopped here........

WITHDRAWAL(8-12 hours after last dose) :1.INSOMNIA2.YAWNING 3.CRAVING FOR THE

DRUG4.NAUSEA, VOMITING,

AND DIARRHEA5.MUSCLE ACHES6.LACRIMATION,

RHINORRHEA (FEVER)

7.PUPILLARY DILATATION

Examples of the sedatives (to induce sleep):1.Barbiturates

- Phenobarbital (Luminal)- Secobarbital (Seconal)- Amobarbital (Amytal)

2. Non- barbiturates- Stilnox- Dalmane- Dormicum

Examples of Tranquilizers (produce calmness and relaxation) :1.Minor Tranquilizers- anxiolytic; anti-anxiety

drugsExamples:

- Valium and Anxionil – diazepam- Ativan- lorazepam- Xanax- Alprazolam- Librium- chlordiazepoxide- Serax- oxazepam- Tranxene- chlorazepate- Equanil- meprobamate Hcl

2. Major Tranquilizers- antipsychotics- Thorazine, Haldol, Nozinan and Mellaril or Melleril

SEDATIVES AND ANXIOLYTICS INTOXICATION AND WITHDRAWAL: 6-8 hrs.- 1 week1.Slurred speech2.Unsteady gait3. Impaired

attention and memory

1.Nausea and vomiting

2.Malaise/ weakness

3.Anxiety4.Irritability5.Hypersensitivity

to light and sound6.Coarse tremors7.Marked insomnia8. inc. VS9. seizures and

hallucinations

Narcotics, Sedatives, Tranquilizers, and Anxiolytics

Central nervous system depressants - Benzodiazepines alone, when taken orally in overdose, are rarely fatal, but the person will be lethargic and confused - Barbiturates, can be lethal when taken in overdose. They can cause coma, respiratory arrest, cardiac failure, and death

Examples of Volatile Substance/ INHALANTS1.Rugby2.Acetone3.Thinner4.Paint5.Vicks inhaler6.White flower7.Nail polish

INHALANTS:Overdose:

Anoxia, respiratory depression, vagal stimulation, and dysrhythmias

Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus

People who abuse inhalants may suffer from persistent dementia or inhalant-induced disorders such as psychosis, anxiety, or mood disorders even if the inhalant abuse ceases

Withdrawal symptoms: none Treatment:

Supporting respiratory and cardiac functioning until the substance is removed from the body

2. STIMULANTS:

1. Shabu Methamphetamine HCL- poor man’s cocaine

2. Cocaine Cocaine, coke, C, snow, Crack (hard form of cocaine)

3. Amphetamines

Diet pills

Stimulants intoxication and withdrawal:1. Restlessness2. Nervousness3. Tirelessness4. Insomnia5. Anorexia6. Weight loss7. Hallucinations 8. Suspiciousness9. Dilated pupils

(shabu and cocaine)

10.Muscle fasciculation

11.Nasal perforation, epistaxis b/c of ulceration in the nasal mucosa

1. Dysphoria2. Fatigue3. Sleep DO4. Agitation5. Craving6. unpleasant dreams7.increased appetite8.psychomotor

retardation or agitation

9. “crashing”--the person may experience depressive symptoms, including suicidal ideation, for several days

3. HALLUCINOGENS

1.Marijuana- cannabis sativa ; maryjane. Pot, grass, jules2.LSD – LySergic Diethylamide (acid)

Excessive use of cannabis may produce delirium or cannabis-induced psychotic disorder; overdoses of cannabis do not occurWithdrawal symptoms:Insomnia, muscle aches, sweating, anxiety, and tremors. Effects are treated symptomaticallyHallucinogens can produce flashbacks that may

persist for a few months up to 5 years.

Assessment

History: chaotic family life, family history, crisis that precipitated treatment

General appearance and motor behavior: depends on physical health; likely to be fatigued, anxious

Mood and affect: may be tearful (expressing guilt and remorse), angry, sullen, quiet, unwilling to talk

Application of the Nursing Process: Substance Abuse (cont’d)

Thought processes and content: minimize substance use, blame others for problems, rationalize their behavior, say they can quit on their own

Sensorium and intellectual processes: alert and oriented; intellectual abilities intact (unless neurologic deficits from long-term alcohol or inhalants)

Judgment and insight: poor judgment while intoxicated and due to cravings for substance; insight limited


Self-concept: low self-esteem, feels inadequate at coping with life

Roles and relationships: strained relationships and problems with role fulfillment due to substance use

Physiologic considerations: may have trouble eating and sleeping; HIV risk if IV drug user


Treatment is based on the concept that alcoholism and drug addiction are medical illnesses: chronic, progressive, characterized by remissions and relapses

Treatment models include:

The Hazelden Clinic model

12-step program of Alcoholics Anonymous (AA)

Individual and group counseling

Substance Abuse Treatment

TWELVE STEPS OF ALCOHOLICS ANONYMOUS1. We admitted that we were powerless over

alcohol, that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our wills and lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

TWELVE STEPS OF ALCOHOLICS ANONYMOUS

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people whenever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him,

praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics and

to practice these principles in all our affairs.

Pharmacologic Treatment

2 main purposes:

To permit safe withdrawal from alcohol, sedative/hypnotics, and benzodiazepines

Prevent relapse

Pharmacologic Treatment (cont’d)Safe withdrawal from alcohol involves:

Benzodiazepines to suppress withdrawal symptoms- Lorazepam, chlordiazepoxide, and diazepam

Antipsychotics- Chlorpromazine (to reduce anxiety-tremor state and prevent more serious withdrawal symptom

Vitamin B1 (thiamine) to prevent or to treat Wernicke’s syndrome and Korsakoff’s syndrome (food rich in thiamine, lean pork, organ meat, nuts)

Cyanocobalamin (vitamin B12) and folic acid for nutritional deficiencies

Pharmacologic Treatment (cont’d)Relapse prevention involves:

Disulfiram (Antabuse) Acamprosate (Campral) MethadoneNaltrexone (ReVia) Clonidine (Catapres) Ondansetron (Zofran)Propanolol (Inderal)Topiramate (Topamax)

Data analysisNursing diagnoses common to physical

health needs include: oImbalanced nutrition: less than body

requirementsoRisk for infectionoRisk for injuryoDiarrheaoActivity intoleranceoSelf-care deficits



Data analysis (cont’d)

Nursing diagnoses common to psychosocial health needs include:

oIneffective denial

oIneffective role performance

oInterrupted family processes: alcoholism

oIneffective coping


Outcomes

The client will:

oAbstain from alcohol/drugs

oExpress feelings openly and directly

oAccept responsibility for own behavior

oPractice nonchemical alternatives to deal with stress or difficult situations

oEstablish an effective aftercare plan


InterventionProviding health teaching for client

and familyAddressing family issues:

oCodependence

oChanges in rolesPromoting coping skills


Date post:	01-Dec-2014
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