Chapter 15: Substance-Related Disorders and Addictive Behaviors Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Substance Abuse Causes more deaths, illnesses, and disabilities than any other preventable health condition The use of tobacco and illicit drugs changes in response to shifts in public tolerance of behaviors and with various political, economic, and social events Alcohol is the number one drug of choice in American society among adolescents and adults, and it is the most widely available legal drug

Statistically speaking.....

Addiction vs. Misuse Chemical of Substance Use Disorders (SUDs), eating disorders, or impulse control disorders Misuse: is the use of a psychoactive substance (drug or alcohol) other than that for which it was intended and that causes physical, social, and psychological harm

Misuse Use of psychoactive substance (drug or alcohol) for a purpose other than for which it was intended Use causes physical, social, and psychological harm

Historic Perspectives “Soma” “Moonshine”

US DEA Schedule of Controlled Substances How would you categorize marijuana? Cocaine? Valium?

Three Domains that Influence Addiction Individual Situational Environmental

Individual Factors Age Gender Ethnicity $$$ History of drug abuse Physiologic response Belief system Genetic predisposition (Twin studies) Stress

Genetics and Addiction

Situational Factors Peer pressure Social Norms Family influences Social supports

Environmental Factors

Epidemiology Demography Age Gender Race/ethnicity Education Employment

Strategies for Prevention of Adolescent Use: Provide positive role models Reinforce dangers of use Teach positive behaviors Establish limits and structure Anticipate pressures Reinforce positive coping Provide life-skills training Monitor media use

Perinatal/Fetal Alcohol Syndrome Adolescent/Illicit Drug Use Special Populations Perinatal/Fetal Alcohol Syndrome Adolescent/Illicit Drug Use

Dual Diagnosis (pg. 333) Co-occurring mental illness and substance abuse Either may precede the other Common comorbidities: Antisocial personality disorder, bipolar disorder, schizophrenia Alcohol, marijuana, cocaine

Alcohol Intoxication BAL Consequences 0.02-0.05 Mildly impaired coordination Potential changes in behavior 0.08-0.1 Impaired driving, slurred speech, ataxia,  sensory function 0.1-0.15 Impaired balance, gross judgment, and cognition impairment 0.2-0.3 All sensory motor function impaired 0.3 and  Potential cardiovascular and respiratory collapse Coma, death

Drug Categories Alcohol Cannabis Cocaine CNS depressants CNS stimulants Opioids Hallucinogens Inhalants Anabolic-androgenic steroids Synthetic OTC Club drugs

Withdrawal/Detoxification (pg. 347) Alcohol CNS depressants Opioids Stimulants Caffeine Nicotine

Nursing Interventions Physiologic functioning Safety Observations/assessments Treatment of withdrawal Establishing relationship Emotional support Nutrition Psycho-education 12-Step program Community resources

Treatment Modalities Psychotherapy Group therapy Family therapy Behavioral therapy Antabuse Relapse prevention strategies Harm reduction techniques Inpatient

Treatment Modalities, cont’d. Partial hospitalization Outpatient Halfway houses 12-Step programs Relapse prevention Medications Naltrexone (rapid detox) Methadone LAAM

Treatment Of SUDs requires perseverance Secondary complications of drug use are often causative factors related to physical illness and health concerns…… Can you name at least (2) physical illness that result from SUD?

Quick Quiz: Chapter 15 Substance –Related Disorders and Addictive Behaviours

Attention-deficit/hyperactivity disorder Fetal alcohol syndrome In the waiting room, a 4-year-old is restless, not responding to the parent’s directions, and touching everything. The child has very small eyes, a thin upper lip, and a short nose. Based on these observations, which problem is most likely? Attention-deficit/hyperactivity disorder Fetal alcohol syndrome Conduct disorder Autism b Reference p. 332

A person usually drinks 3 cups of coffee per day, 2 large glasses of iced tea, and 2 diet soft drinks. This individual decides to stop using caffeine. Which complaint would the nurse expect? Headache Increased appetite Heart palpitations Diarrhea a Reference p. 340

Hallucinations and delusions A nurse cares for 4 patients detoxifying from alcohol. The patient with which symptom would be the nurse’s priority? Diarrhea Diaphoresis Fine motor tremors Hallucinations and delusions d Reference p. 350-354

Disulfiram (Antabuse) Critical thinker: complete this analogy. Morphine : Myocardial infarction :: __________ : Alcohol withdrawal Tremor Diaphoresis Lorazepam (Ativan) Disulfiram (Antabuse) c Instructor: read Morphine is to myocardial infarction as (blank) is to alcohol withdrawal. Reference p. 350-354