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

2. 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

3. Statistically speaking.....

4. 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

5. 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

6. Historic Perspectives
“Soma”
“Moonshine”

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

8. Three Domains that Influence Addiction
Individual
Situational
Environmental

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

10. Genetics and Addiction

11. Situational Factors Peer pressure Social Norms Family influences
Social supports

12. Environmental Factors

13. Epidemiology
Demography
Age
Gender
Race/ethnicity
Education
Employment

14. 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

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

16. 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

17. Alcohol Intoxication
BAL Consequences Mildly impaired coordination Potential changes in behavior Impaired driving, slurred speech, ataxia,  sensory function Impaired balance, gross judgment, and cognition impairment All sensory motor function impaired 0.3 and  Potential cardiovascular and respiratory collapse Coma, death

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

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

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

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

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

23. 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?

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

25. 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

26. 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

27. 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

28. 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