1. Chapter 95: Substance Use Disorders

2. Substance Abuse
Some individuals respond to stress by using harmful, mood-altering chemicals.
Drug-substance that activates the pleasure center of the brain*
Used as a response to stress, low self-esteem, obsessed with food, work, sex, gambling
Recognizing and caring for those with addictions requires a high-level nursing assessment, nursing skills, patience, and compassion.

3. Chemical Abuse A maladaptive pattern of substance use
Clinically significant impairment or distress with one or more of the following in a 12-month period
Failure to fulfill role obligations
Use that presents a danger
Recurrent use-related legal problems
Continued use, despite related interpersonal problems

4. Chemical Dependency Substance dependence or chemical dependency (CD)
Tolerance and withdrawal
Uses the drug in larger amounts or for a longer time than planned; unable to stop use or cut down
Spends much time and energy planning to obtain and use the drug
Gives up important activities, secondary to drug use
Continues to use, knowing that the drug is causing problems

5. Chemical Dependency (cont.)
Classified as
Active
In remission (not currently active, but still existing)
On agonist/blocking therapy
In a controlled environment

6. Theories of causes of Chemical Dependency
Physical factors theory
Genetic theory
Emotional and psychological theories
Low self-esteem and difficulties in interpersonal relations
General uneasiness and dissatisfaction with life
Low tolerance for frustration and tendency toward excessive and self-destructive acts
Co-existing mental illness (in many cases)
Dual disorders

7. Nature Progressive nature Defense mechanisms Denial Rationalization
Projection

8. Management
Recognition
Intervention
Treatment
Recovery

9. Question Is the following statement true or false?
Older adults are not at risk for substance abuse.

10. Answer
False
Research shows that over 33% of emergency department admissions and 20% of acute hospital admissions of older adults can be traced to complications related to substance abuse.
Chemical dependency and alcoholism among older people are increasing public health problems. Many seniors overuse prescription medications, OTC drugs, or alcohol as a result of loneliness, depression, or confusion. Seniors often live alone, and the problem is not recognized until it has become very serious.

11. Nursing Care Measures
Identification of the chemically dependent person
Nursing data gathering
Dealing with an intoxicated person in the healthcare facility

12. Nursing Process: Substance Abuse
Assessment priorities
Behavior changes
Physical signs
Complications with overdose
Possible nursing diagnoses
Planning
Implementation
Evaluation

13. Question Is the following statement true or false?
A person’s frequency of drug use is the best criteria for determining whether he or she is chemically dependent.

14. Answer
False
How often and how much a person drinks or uses drugs are not always the best criteria for determining whether someone is alcoholic or chemically dependent.
Rather, explore the role that drugs play in the individual’s life. Loss of control or inability to stop drinking or using is a cardinal sign of chemical dependency. If a person’s use affects their job, interpersonal relationships, or family, he or she has a substance abuse or chemical dependency.

15. Detoxification and Recovery
The process of removing a drug and its physiologic effects from the person’s body
Goals in detoxification management
Comfort and safety
Detoxification must occur before long-term chemical dependency treatment can begin
When a person reduces intake of drugs, such as barbiturates or cocaine, the future danger of overdose exists

16. Motivation for CD Treatment
The detoxification center
The therapeutic community

17. Immediate Treatment in Detoxification
Complete medical workup
Rating scales
CIWA (Clinical Institute Withdrawal for Alcohol)
Withdrawal symptoms
Nutrition and general health
Refeeding syndrome

18. Long-Term Follow-up and Treatment
Inpatient or outpatient treatment
12-step programs
Rational recovery
Dialectical behavioral therapy (DBT)
Individual therapy
Group therapy
Health realization (HR)
Family counseling
After-care

19. Alcohol Abuse and Dependence
Signs and symptoms
Slurred speech, unsteady gait, confusion, and behavioral changes
Breathalyzer level is 0.08 to 0.15 g/dL, and the person does not appear to be impaired.
Specific disorders caused by alcohol abuse
Dietary deficiencies, sequela of thiamine deficiency, cirrhosis of the liver and hepatitis, and other disorders

20. Alcohol Abuse and Dependence
Treatment
Stages of withdrawal
Autonomic hyperactivity
Neuronal excitation
Sensory-perceptual disturbances
Family considerations
The codependent or enabler
Family programs
Medication therapy
Antabuse, Campral, Naltrexone, Kudzu

21. Abuse of Other Substances
Sedatives, hypnotics, and anxiolytic drugs
GHB (gamma hydroxybutyrate)
Cannabis-related drugs
Narcotics
Central nervous system (cerebral) stimulants
Amphetamines
Cocaine and related drugs
Catha edulis (Khat)

22. Abuse of Other Substances (cont.)
Hallucinogens
LSD, mescaline, and “mushrooms”
Phencyclidine hydrochloride
Huffing of volatile substances
Anabolic steroids
Nicotine
Aids to smoking cessation
Caffeine
Over-the-counter drugs and herbals

23. Question Is the following statement true or false?
Herbal and dietary supplements can cause medical conditions.

24. Answer
True
Although herbal and dietary supplements often have beneficial effects, they can also cause or aggravate medical conditions. Herbal supplements can inhibit blood clotting, increase hypertension, adversely affect diabetes, or cause kidney/liver damage. Many of these products also have adverse effects when combined with certain prescribed drugs.

25. Hallucinogens Traditional psychedelics Other amphetamine-like drugs
Anticholinergics
Scopolamine

26. Special Abusers Pregnant women Adolescents Older adults Alcohol abuse
Paradoxical reaction

27. Nurses
Drugs are readily available in healthcare facilities; nurses are at high risk for substance abuse.
The nurse is bound by law, the nursing code of ethics, and the pledge taken on entering nursing to report any staff person suspected of abusing drugs or alcohol.

28. End of Presentation