1. SUBSTANCE ABUSE Substance: any drug, medication, or toxin that shares potential for abuse Addiction: physiologic/psychologic dependence causing withdrawal symptoms when discontinued

2. ETIOLOGY – Substance Use & Abuse Hereditary link Weak parent-child attachment/parenting More common in males - females tend to be more secluded in their habits Younger age when usage begins – greater potential for abuse/dependency Peer relationships Antisocial personality in biological parents

3. Social-Dynamic Factors Intolerance for frustration and pain Lack of success in life Lack of meaningful relationships Low self-esteem Risk-taking behaviors *Person uses drug to feel better (helpless without drug) > reinforced with “powerful me” when drug is used > behavior cycles into addiction

4. CO-DEPENDENCY Valuing self by what one does, looks like, or owns rather than by who one is Enabling - making excuses and engaging in behaviors to “make up” for the behavior of abuser Becoming captive of behavior –behaviors to avoid stress (ask kids to be quiet when Dad comes in, avoid going places where questions might be asked)

5. SUBSTANCE DEPENDENCE Craving – strong inner drive to use substance Tolerance – decreased effectiveness of drug over time with need for increased doses of substance to achieve same effect Withdrawal – unpleasant, maladaptive changes in behavior as blood/tissue concentrations of substance decline after prolonged heavy use

6. SYMPTOMS – Substance Dependence (DSM-IV- TR) Larger amounts over longer time period than intended Persistent desire/unsuccessful efforts to control use Much time used in obtaining substance Activities given up in lieu of substance use Continued use in spite of negative problems from usage

7. PHASES OF CHEMICAL DEPENDENCY PHASE 1 –Mood swings, altered emotional state PHASE 2 –Hangover effects, guilt about behavior PHASE 3 –Dependent lifestyle, control over substance is lost PHASE 4 –Dependency, addiction, blackouts, paranoia, helplessness

8. SUBSTANCE ABUSE  Maladaptive, recurring use of substance accompanied by repeated detrimental effects of drug  Present for one year or more  Episodic binges  Can occur without dependency  Encounters with law, school suspension, family/marital problems

9. SUBSTANCE INTOXICATION  Maladaptive, reversible pattern of behavior  Perceptual disturbances  Sleep—wake cycle changes  Disturbs attention, concentration, thinking, judgment, psychomotor activity  Interferes with relationships

10. SUBSTANCE WITHDRAWAL  Develops symptom-specific maladaptive changes in behavior  Accompanied by physiologic/cognitive symptoms from reduction in prolonged substance use  Impaired functioning

11. ALCOHOL WITHDRAWAL  Early Signs  Develop within few hours after cessation/peak at 24- 48 hours  Anxiety, anorexia, insomnia, tremors, hyperactivity, irritability, “shaking inside,” hallucinations, illusions, nausea/vomiting  DELIRIUM TREMENS (DTs)  Peak in 48-72 hours after cessation of drinking – last 2-3 days  20% fatality rate

12. Vitamin B1 Deficiency  Vitamin B1 (Thiamine) deficiency, poor dietary intake, malabsorption encephalopathy/psychosis  Wernicke-Korsakoff Syndrome  Encephalopathy and psychosis primarily in alcoholics caused by thiamine and niacin deficiency  Occurs with chronic use  Permanent progressive cognitive loss

13. Assessment  Tremors  Anxiety, agitation  Delirium, decreased LOC, delusions  Diaphoresis, fever (100˚- 103˚)  Tachycardia  Hypertension  Transient tactile/visual hallucinations  Seizure activity

14. Nursing Interventions  Medication – sedation  High protein, high vitamin diet (B/C)  Replace fluid/ electrolytes (I/O) –Diuresis with blood alcohol level increase –Retention may occur (overhydration)  MgSO4 to increase body’s response to thiamine/raise seizure threshold  VS q hour x 12 h, then q4h –Pulse good indicator of progress through withdrawal

15. Treatment Self-responsibility AA Concepts –People are powerless over their addictions –People are responsible for their recovery –Can no longer blame others for problem and feelings Al-Anon –Family members did not CAUSE disease, cannot CONTROL it, nor can they CURE it –Learn they are not responsible for disease or person who has it