Substance-Related and Addictive Disorders

Substance-Related and Addictive Disorders
Chapter 23 Substance-Related and Addictive Disorders

Substance-Related Disorders
Substance-Use Disorders Addiction Substance-Induced Disorders Intoxication Withdrawal Others discussed in chapters with which they share symptomatology

Substance-Use Disorder
Substance Addiction Physical Dependence Need for increasing amounts to produce the desired effects Syndrome of withdrawal upon cessation Psychological Dependence Overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort

Substance-Use Disorder (cont.)
Substance Addiction (cont.) Use of the substance interferes with ability to fulfill role obligations Attempts to cut down or control use fail Intense craving for the substance Excessive amount of time spent trying to procure the substance or recover from its use

Substance-Use Disorder (cont.)
Substance Addiction (cont.) Use of the substance causes the person difficulty with interpersonal relationships or to become socially isolated Engages in hazardous activities when impaired by the substance Tolerance develops and the amount required to achieve the desired effect increases Substance-specific symptoms occur upon discontinuation of use

Substance-Induced Disorder
Substance Intoxication Development of a reversible syndrome of symptoms following excessive use of a substance Direct effect on the central nervous system Disruption in physical and psychological functioning Judgment is disturbed and social and occupational functioning is impaired

Substance-Induced Disorder (cont.)
Substance Withdrawal Development of symptoms that occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period of time The symptoms are specific to the substance that has been used. There is a disruption in physical and psychological functioning, with disturbances in thinking, feeling, and behavior.

Classes of Psychoactive Substances
Alcohol Caffeine Cannabis Hallucinogens Inhalants Opioids Sedatives, Hypnotics, Anxiolytics Stimulants Tobacco

Predisposing Factors Biological Factors
Genetics: apparent hereditary factor, particularly with alcoholism Biochemical: alcohol may produce morphine-like substances in the brain that are responsible for alcohol addiction

Predisposing Factors (cont.)
Psychological Factors Developmental influences: Punitive superego Fixation in the oral stage of psychosexual development S. Freud

Psychological Factors (cont.) Personality factors: Certain personality traits are thought to increase a tendency toward addictive behavior. They include: Low self-esteem Frequent depression Passivity Inability to relax or defer gratification Inability to communicate effectively

Sociocultural Factors Social learning: children and adolescents more likely to use substances with parents who provide model for substance use Use of substances may also be promoted within peer group

Sociocultural Factors (cont.) Conditioning: Pleasurable effects from substance use act as a positive reinforcement for continued use of substance. Cultural and ethnic influences: Some cultures are more prone to substance abuse than others.

Which of the following has been implicated in the predisposition to substance abuse? A. Hereditary factor B. Fixation in the adolescent stage of psychosexual development C. Punitive ego D. Narcissistic and dependent personality traits

Correct answer: A Research has indicated that an apparent hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism.

Dynamics of Substance-Related Disorders
Alcohol Use Disorder Patterns of Use Phase I. Prealcoholic phase: Characterized by use of alcohol to relieve everyday stress and tensions of life. Phase II. Early alcoholic phase: Begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person.

Dynamics of Substance-Related Disorders (cont.)
Patterns of Use (cont.) Phase III. The crucial phase: Person has lost control; physiological dependence is clearly evident. Phase IV. The chronic phase: Characterized by emotional and physical disintegration. The person is usually intoxicated more often than sober.

Effects of Alcohol on the Body Peripheral neuropathy is characterized by: Peripheral nerve damage Pain Burning Tingling Prickly sensations of the extremities

Effects of Alcohol on the Body
Alcoholic myopathy: thought to result from the same B vitamin deficiency that contributes to peripheral neuropathy Acute: sudden onset of muscle pain, swelling, and weakness; reddish tinge to the urine; and a rapid rise in muscle enzymes in the blood Chronic: gradual wasting and weakness in skeletal muscles

Effects of Alcohol on the Body (cont.)
Wernicke’s encephalopathy Most serious form of thiamine deficiency in alcoholic patients Korsakoff’s psychosis Syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients

Alcoholic cardiomyopathy Effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition.

Esophagitis Inflammation and pain in the esophagus occurs because of the toxic effects of alcohol on the esophageal mucosa and also because of frequent vomiting associated with alcohol use.

Gastritis Effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention.

Pancreatitis Acute: usually occurs 1 or 2 days after a binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain, nausea and vomiting, and abdominal distention.

Pancreatitis (cont.) Chronic: leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus

Alcoholic Hepatitis Caused by long-term heavy alcohol use Symptoms: enlarged, tender liver; nausea and vomiting; lethargy; anorexia; elevated white cell count; fever; and jaundice. Also ascites and weight loss in severe cases.

Cirrhosis of the Liver Cirrhosis is the end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue.

Cirrhosis of the Liver (cont.) Portal hypertension: Elevation of blood pressure through the portal circulation results from defective blood flow through cirrhotic liver.

Cirrhosis of the Liver (cont.) Ascites: a condition in which an excessive amount of serous fluid accumulates in the abdominal cavity; occurs in response to portal hypertension

Cirrhosis of the Liver (cont.) Esophageal varices: veins in the esophagus become distended because of excessive pressure from defective blood flow through the cirrhotic liver.

Cirrhosis of the Liver (cont.) Hepatic encephalopathy: occurs in response to the inability of the diseased liver to convert ammonia to urea for excretion; the continued rise in serum ammonia, if allowed to progress, leads to coma and eventual death.

Leukopenia Impaired production, function, and movement of white blood cells Thrombocytopenia Platelet production and survival are impaired as a result of the toxic effects of alcohol.

Sexual Dysfunction In the short term, enhanced libido and failure of erection are common. Long-term effects include gynecomastia, sterility, impotence, and decreased libido.

A client is brought to the ED. The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dl. Among the physician’s orders is thiamine. Which is the rationale for this intervention? A. To prevent nutritional deficits B. To prevent pancreatitis C. To prevent alcoholic hepatitis D. To prevent Wernicke's encephalopathy

Correct answer: D Wernicke’s encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.

Alcohol use during pregnancy can result in fetal alcohol spectrum disorders (FASDs): Fetal alcohol syndrome (FAS): problems with learning, memory, attention span, communication, vision, and hearing Alcohol-related neurodevelopmental disorder Alcohol-related birth defects

No amount of alcohol during pregnancy is considered safe. Alcohol can damage a fetus at any stage of pregnancy.

Characteristics of FAS: Learning difficulties Speech and language delays Intellectual disability Poor reasoning skills Sleep and sucking problems as a baby Vision or hearing problems Problems with the heart, kidneys, or bones Abnormal facial features Small head size Shorter-than-average height Low body weight Poor coordination Hyperactive behavior Difficulty paying attention Poor memory Difficulty in school

Alcohol Intoxication Occurs at blood alcohol levels between 100 and 200 mg/dl. Alcohol Withdrawal Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use.

Sedative-, Hypnotic-, or Anxiolytic Use Disorder A Profile of the Substance Barbiturates Nonbarbiturate hypnotics Antianxiety agents Club drugs

Sedative-, Hypnotic, or Anxiolytic Use Disorder
Patterns of Use Effects on the Body Effects on sleep and dreaming Respiratory depression Cardiovascular effects Renal function

Sedative-, Hypnotic, or Anxiolytic Use Disorder (cont.)
Effects on the Body (cont.) Hepatic effects Body temperature Sexual functioning

Sedative-, Hypnotic, or Anxiolytic Use Disorder (cont.)
Intoxication With these CNS depressants, effects can range from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug). Withdrawal Onset of symptoms depends on the half-life of the drug from which the person is withdrawing. Severe withdrawal from CNS depressants can be life threatening.

Stimulant Use Disorder A Profile of the Substance Amphetamines Synthetic stimulants Nonamphetamine stimulants Cocaine Caffeine Nicotine

Stimulant Use Disorder (cont.) Patterns of Use Effects on the Body CNS effects Cardiovascular effects Pulmonary effects Gastrointestinal and renal effects Sexual functioning

Stimulant Use Disorder (cont.) Intoxication Amphetamine and cocaine intoxication produce euphoria, impaired judgment, confusion, changes in vital signs (even coma or death, depending on amount consumed). Caffeine intoxication usually occurs following consumption in excess of 250 mg. Restlessness and insomnia are the most common symptoms.

Stimulant Use Disorder (cont.) Withdrawal Amphetamine and cocaine withdrawal may result in dysphoria, fatigue, sleep disturbances, and increased appetite. Withdrawal from caffeine may include headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting. Withdrawal from nicotine may include dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite.

Inhalant Use Disorder A Profile of the Substance Aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners

Inhalant Use Disorder (cont.) Patterns of Use/Abuse Effects on the Body CNS effects Respiratory effects GI effects Renal system effects

Inhalant Use Disorder (cont.) Intoxication Develops during or shortly after use of or exposure to volatile inhalants Symptoms include: Dizziness, ataxia, muscle weakness Euphoria, excitation, disinhibition, slurred speech Nystagmus, blurred or double vision Psychomotor retardation, hypoactive reflexes Stupor or coma

Opioid Use Disorder A Profile of the Substance Opioids of natural origin Opioid derivatives Synthetic opiate-like drugs

Opioid Use Disorder (cont.) Patterns of Use or Abuse Effects on the Body Central nervous system Gastrointestinal Cardiovascular Sexual functioning

Opioid Induced Disorder Intoxication Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours. Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. Severe opioid intoxication can lead to respiratory depression, coma, and death.

Opioid Induced Disorder (cont.) Withdrawal From short-acting drugs (e.g., heroin): Symptoms occur within 6 to 8 hours, peak within 1 to 3 days, and gradually subside in 5 to 10 days From long-acting drugs (e.g., methadone): Symptoms occur within 1 to 3 days, peak between 4 and 6 days, and subside in 14 to 21 days From ultra-short-acting meperidine: Symptoms begin quickly, peak in 8 to12 hours, and subside in 4 to 5 days

Opioid Induced Disorder (cont.) Symptoms of Opioid Withdrawal Dysphoria, muscle aches, nausea and vomiting, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal cramping, diarrhea, yawning, fever, and insomnia

Hallucinogen-Induced Disorder A Profile of the Substance Naturally occurring hallucinogens Synthetic compounds Patterns of Use Use is usually episodic

Hallucinogen-Induced Disorder (cont.) Intoxication Occurs during or shortly after using the drug Symptoms include perceptual alteration, depersonalization, derealization, tachycardia, palpitations

Hallucinogen-Induced Disorder (cont.) Symptoms of PCP intoxication include belligerence and assaultiveness and may proceed to seizures or coma.

Hallucinogens: Effects on the Body
Physiological Nausea/vomiting Chills Pupil dilation Increased BP, pulse Loss of appetite Insomnia Elevated blood sugar Decreased respirations Psychological Heightened response to color, sounds Distorted vision Sense of slowed time Magnified feelings Paranoia, panic Euphoria, peace Depersonalization Derealization Increased libido

Cannabis Use Disorder A Profile of the Substance Marijuana Hashish Patterns of Use

Cannabis Use Disorder Effects on the Body Cardiovascular Respiratory Reproductive Central nervous system Sexual functioning

Cannabis Use Disorder Intoxication Symptoms include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment. Physical symptoms include conjunctival injection, increased appetite, dry mouth, and tachycardia. Impairment of motor skills lasts for 8 to 12 hours.

Cannabis Use Disorder Withdrawal Occurs upon cessation of cannabis use that has been heavy and prolonged. Symptoms occur within a week following cessation of use. Symptoms include irritability, anger, aggression, anxiety, sleep disturbances, decreased appetite, depressed mood, stomach pain, tremors, sweating, fever, chills, or headache.

Application of the Nursing Process
Nurses must begin relationship development with an individual who abuses substances by examining own attitudes and personal experiences with substances.

Nursing Process: Assessment
Various assessment tools are available for determining the extent of the problem a client has with substances. Drug History and Assessment Clinical Institute Withdrawal Assessment of Alcohol Scale Michigan Alcoholism Screening Test (MAST) CAGE Questionnaire

Nursing Process: Assessment
CAGE Questionnaire Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)?

Dual Diagnosis Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis. Program combines special therapies that target both problems.

Nursing Diagnosis/Outcome Identification
Ineffective denial related to weak, underdeveloped ego Outcome: Client will demonstrate acceptance of responsibility for own behavior and acknowledge association between personal problems and use of substance(s).

Nursing Diagnosis/Outcome Identification (cont.)
* 07/16/96 Nursing Diagnosis/Outcome Identification (cont.) Ineffective coping related to inadequate coping skills and weak ego Outcome: Client will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances). *

Imbalanced nutrition less than body requirements/fluid volume deficit related to drinking or taking drugs instead of eating Outcome: Client will be free from signs or symptoms of malnutrition/dehydration.

Risk for infection related to malnutrition and altered immune condition Outcome: Shows no signs or symptoms of infection.

Chronic low self-esteem related to weak ego, lack of positive feedback Outcome: Exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others.

Deficient knowledge (effects of substance abuse on the body) related to denial of problems with substances evidenced by abuse of substances Outcomes: Verbalizes importance of abstaining from use of substances to maintain optimal wellness

For the client withdrawing from CNS depressants: Risk for injury related to CNS agitation For the client withdrawing from CNS stimulants: Risk for suicide related to intense feelings of lassitude and depression, “crashing,” suicidal ideation

Planning/Implementation
Detoxification Provide safe and supportive environment. Administer substitution therapy.

Planning/Implementation (cont.)
Intermediate Care Provide explanations of physical symptoms. Promote understanding and identify causes of substance dependency. Help client accept use of substance as a problem. Provide education and assistance to client and family.

Planning/Implementation (cont.)
Rehabilitation Encourage continued participation in long-term treatment. Promote participation in outpatient support system. Assist client to identify alternative sources of satisfaction. Provide support for health promotion and maintenance. Alcoholics Anonymous

Client/Family Education
Nature of the Illness Effects (of Substance) on the Body Alcohol Other CNS depressants Hallucinogens Inhalants Opioids Cannabinols Ways in Which Use of Substance Affects Life

Client/Family Education (cont.)
Management of the Illness Activities to substitute for (substance) in times of stress Relaxation techniques Progressive relaxation Tense and relax Deep breathing Autogenics

Management of the Illness (cont.) Problem-solving skills Essentials of good nutrition

Support Services Financial assistance Legal assistance Alcoholics Anonymous (or other support group specific to another substance) One-to-one support person

Nursing Process: Evaluation
Evaluation involves reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care.

The Chemically Impaired Nurse
It is estimated that 10 to 15 percent of nurses suffer from the disease of chemical addiction. Alcohol is the most widely abused drug, followed closely by narcotics.

The Chemically Impaired Nurse (cont.)
Clues for recognizing substance impairment in nurses vary according to the substance being used. High absenteeism may be present if the person’s source is outside the work area. Or the person may rarely miss work if the substance source is at work.

Increase in “wasting” of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs compared to other nurses may be present. Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall Problems with relationships Irritability, tendency to isolate, elaborate excuses for behavior

Unkempt appearance, impaired motor coordination, slurred speech, flushed face Patient complaints of inadequate pain control, discrepancies in documentation

State Board Response May deny, suspend, or revoke a license based on a report of chemical abuse by a nurse Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment

During the Suspension Period Successful completion of an inpatient, outpatient, group, or individual counseling treatment program

Evidence of regular attendance at nurse support groups or 12-step programs Random negative drug screens Employment or volunteer activities

Peer assistance programs serve to assist impaired nurses to: Recognize their impairment Obtain necessary treatment Regain accountability within profession

Codependency Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions

Codependency (cont.) Codependent people sacrifice their own needs for the fulfillment of others to achieve a sense of control. Derive self-worth from others Feel responsible for the happiness of others Commonly deny that problems exist

Codependency (cont.) The person keeps feelings in control, and often releases anxiety in the form of stress-related illnesses, or compulsive behaviors such as eating, spending, working, or use of substances.

Codependency (cont.) May have experienced abuse or emotional neglect as a child Are outwardly focused on others and know very little about how to direct their lives from their own sense of self

The Codependent Nurse Classic Characteristics Caretaking Perfectionism
Denial Poor communication

Treating Codependence
Recovery Process Survival stage Reidentification stage Core issues stage Reintegration stage

Treatment Modalities for Substance-Related Disorders
Alcoholics Anonymous Is a major self-help organization for the treatment of alcoholism Based on the concept of: Peer support Acceptance Understanding from others who have experienced the same problem Alcoholics Anonymous

Treatment Modalities for Substance-Related Disorders (cont.)
Alcoholics Anonymous (cont.) The 12 steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety. Total abstinence is promoted as the only cure; the person can never safely return to social drinking.

Various support groups patterned after AA but for individuals with problems with other substances Counseling Group therapy

Pharmacotherapy for Alcoholism Disulfiram (Antabuse) Other medications: Naltrexone (ReVia) Nalmefene (Revex) SSRIs Acamprosate (Campral)

Psychopharmacology for substance intoxication and substance withdrawal: Alcohol Benzodiazepines Anticonvulsants Multivitamin therapy Thiamine

Psychopharmacology for substance intoxication and substance withdrawal (cont.): Opioids Narcotic antagonists Naloxone (Narcan) Naltrexone (ReVia) Nalmefene (Revex) Methadone Buprenorphine Clonidine

Psychopharmacology for substance intoxication and substance withdrawal (cont.): Depressants Phenobarbital (Luminal) Long-acting benzodiazepines

Psychopharmacology for substance intoxication and substance withdrawal (cont.): Stimulants Minor tranquilizers Major tranquilizers Anticonvulsants Antidepressants

Psychopharmacology for substance intoxication and substance withdrawal (cont.): Hallucinogens and cannabinols Benzodiazepines Antipsychotics

A client, diagnosed with chronic alcoholism, says to the nurse, “I’m tired of using and I want to stop. Is there a medication that can help me maintain sobriety?” About which medication would the nurse provide information? A. Carbamazepine (Tegretol) B. Clonidine (Catapres) C. Disulfiram (Antabuse) D. Folic acid (Folvite)

Correct answer: C Disulfiram is used as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol, are strictly prohibited when taking this drug.

Nonsubstance Addictions
Gambling Disorder Persistent and recurrent problematic gambling behavior that intensifies when the individual is under stress. As the need to gamble increases, the individual may use any means required to obtain money to continue the addiction.

Nonsubstance Addictions
Gambling Disorder (cont.) Gambling behavior usually begins in adolescence, although compulsive behaviors rarely occur before young adulthood. The disorder usually runs a chronic course, with periods of waxing and waning. The disorder interferes with interpersonal relationships, social, academic, or occupational functioning.

Predisposing Factors to Gambling Disorder
Biological Influences Genetic Increased incidence among family members Physiological Abnormalities in neurotransmitter systems

Predisposing Factors to Gambling Disorder (cont.)
Psychosocial Influences Loss of a parent before age 15 Inappropriate parental discipline Exposure to gambling activities as an adolescent Family emphasis on material and financial symbols Lack of family emphasis on saving, planning, and budgeting

Predisposing Factors to Gambling Disorder (cont.)
Psychosocial Influences (cont.) The psychoanalytical view suggests that gambling is used to release a buildup of tension. S. Freud

Treatment Modalities for Gambling Disorder
Behavior Therapy Cognitive Therapy Psychoanalysis Psychopharmacology SSRIs Clomipramine Lithium Carbamazepine Naltrexone

Treatment Modalities for Gambling Disorder (cont.)
Gamblers Anonymous Organization modeled after Alcoholics Anonymous Only requirement for membership is an expressed desire to stop gambling Reformed gamblers help others resist the urge to gamble

Treatment Modalities for Gambling Disorder (cont.)
Related Organizations Gam-Anon For family and spouses of compulsive gamblers Gam-a-Teen For adolescent children of compulsive gamblers

Substance-Related and Addictive Disorders

Similar presentations

Presentation on theme: "Substance-Related and Addictive Disorders"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Substance-Related and Addictive Disorders

Similar presentations

Presentation on theme: "Substance-Related and Addictive Disorders"— Presentation transcript:

Similar presentations

About project

Feedback