Chapter 16 Addictive Disorders

Abuse  Use of a substance that falls outside of medical necessity or social acceptance resulting in adverse effects to the abuser or others Dependence or Addiction  Occurs when a tolerance to the drug occurs and the person has to take more and more of the drug to prevent withdrawal Operational Definition of Addiction  The 3 C’s Craving to Compulsive spectrum Continued use despite adverse consequences Loss of Control Substance abuse

Prevalence Lifetime prevalence for substance use disorders in US is 14.6% Alcohol  Most common substance abused (17.6 million US Illicit Drugs  Club drugs, cannabis, methamphetamines, heroin, opiates, cocaine Anabolic Steroids  Increased use 1-6% in athletes Nicotine: 46 million in US

Psychiatric  50% with mental disorder also have substance use disorder  High rate of suicide Medical  Cardiovascular  Seizures/ Stroke  MI  Infections  Sclerotic veins Comorbidity

Addiction  Characterized by Loss of control of substance consumption Substance use despite associated problems Tendency to relapse Biological  Genetic and all drugs affect the limbic system in brain (reward center) Psychological  Lack of tolerance for frustration, pain, impulsiveness, lack affection, lack of self regard lack of self esteem Theory

Asian cultures: Low incidence alcohol abuse Native Americans and Alaska Natives  70% as compared to other cultures Women: Lower rate than men but get hooked quicker Pregnant women & their partners Alcohol is neurotoxic, baby develops fetal alcohol syndrome Impaired professionals  Inability to practice due to substance use  Nurses have higher rate of chemical dependency than general population  Referral or self report: RAMP or Dr Baxter group for impaired professionals  Must be truthful when renewing license Cultural considerations

Tolerance: need for higher doses to achieve effect Withdrawal: occurs after using for long period so that stopping causes physical and psych S&S Flashbacks: transient recurrences of perceptual disturbances caused by earlier hallucinogenic use Codependence: behaviors involving family of substance abuse patients Synergistic Effects: Intensified or prolonged effects produced when drugs taken together Antagonistic Effects: Combining drugs to weaken or inhibit the effect of one of the drugs Clinical picture

Assessment  The complex due to polysubstance abuse (simultaneous use of many substances) and comorbidity (coexistence of psychiatric illness) define the dual diagnosis  Initial Interview Guidelines-use of drugs/alcohol and the need or want to cut down on use  Further assessment- Urine drug screen and BAL  Psychological Changes- Predictable defensive style (denial, projection, rationalization)  Signs of Intoxication and Withdrawal  Assessment Guidelines Application of nursing process

Signs of Intoxication & Withdrawal  CNS Depressants: alcohol, benzos, barbiturates Can result in severe morbidity and mortality  CNS Nervous System Stimulants: cocaine, crack, methamphetamines, nicotine  Opiates: morphine, heroin, fentanyl, methadone  Marijuana: Cannabis  Hallucinogens : LSD, PCP  Inhalants: paint, glue, lighter fluid  Rave & Techno drugs: Ecstasy (MDMA) Aplication of nursing process

Diagnosis  Numerous nursing dx associated with physical & psychiatric comorbidities Outcomes Identification  Factor in culture and values in plan of care Planning  Social status, income, ethnicity, gender, age, substance hx and current condition Implementation  Aim of tx is self-responsibility, not compliance  Communication Guidelines  Health teaching and promotion Relapse & Prevention Application of nursing process

 Psychotherapy & Therapeutic Modalities  Assist pts in identify & using alternative coping mechanisms to reduce reliance on substances  Self Help Groups for Patients and Family  12-Step program  Residential Program  Intensive Outpatient Program  Outpatient Drug Free Program  Employee Assistance Program Application of nursing process

Pharmacological, Biological & Integrative Therapies  Alcohol Withdrawal Treatment Help patient achieve safe detox Enhance patients’ motivation for abstinence and motivation Evaluation  Favorable treatment outcomes judged by increased lengths of time in abstinence, decreased denial, acceptable occupational functioning, improved family relationships, and ability to relate to normally to other human beings Application of nursing process