1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 25Substance-Related Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Substance abuse and addiction can negatively impact health, relationships, finances, school, and employment. Some people hit bottom and seek treatment in an effort to recover. Treatment involves helping the individuals become and remain free from substances, ideally for the rest of their lives. London, 2009

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Explain the disease concept of alcoholism and the following theories of addiction: biologic, genetic, behavioral and learning, sociocultural, psychodynamic, and the disease concept of alcoholism Differentiate the following terms: substance use, addiction, psychological dependence, tolerance, and physiologic dependence Discuss the dynamics of enabling and codependency Articulate the difference between alcohol dependence and alcohol abuse Recognize the more common physiologic effects of alcoholism Identify the common medical problems associated with illicit abuse of substances (drugs)

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Describe the rationale for the use of substance abuse screening tools during the initial assessment of a client with a substance-related disorder Articulate the rationale for the use of the Stages of Change Model when planning interventions for a client with a substance-related disorder Evaluate the treatment measures, including nursing interventions, for a client with a substance-related disorder Formulate a list of nursing interventions for a client with clinical symptoms of acute substance intoxication Develop a list of services available to clients who abuse substances

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Substance-related disorders refer to the use and abuse of alcohol, illicit drugs, or substances such as over-the-counter or prescription drugs. When substance use creates difficulties for the user or ceases to be entirely volitional, it becomes the concern of all the helping professions, including nursing.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Epidemiology of Substance-Related Disorders Alcohol use and abuse –World Health Organization Approximately 76.3 million individuals have been diagnosed with alcohol use disorder. –National Institute on Drug Abuse Approximately 20 million individuals commonly abuse drugs.

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Specialty Practice: Addictions Nursing Practice Addictions nursing was defined as an area of specialty practice concerned with care related to dysfunctional patterns of human response that have one or more of the following key characteristics: some loss of self-control capacity, episodic or continuous maladaptive behavior or abuse of some substance, and development of dependence patterns of a physical and/or psychological nature.

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Substance-Related Disorders Biologic theories Genetic theories Behavioral and learning theories Sociocultural theories Psychodynamic theories Disease concept of alcoholism

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Alcohol-Related Disorders Alcohol use disorders –Alcohol dependence –Alcohol abuse disorder Alcohol-induced disorders –Alcohol intoxication –Alcohol withdrawal –Alcohol withdrawal delirium –Alcoholic-induced persisting dementia –Alcoholic-induced persisting amnestic disorder –Other alcohol-induced disorders

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Other Substance- Related Disorders Sedative-, hypnotic-, or anxiolytic-related disorders Opioid-related disorders Amphetamine-related disorders Cocaine-related disorders Cannabis-related disorders Hallucinogen- and phencyclidine-related disorders Inhalant-related disorders Caffeine- and nicotine-related disorders

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Other Substance- Related Disorders: Designer Drugs, Club Drugs, and Anabolic Steroids Designer drugs Club drugs Anabolic steroids Prescription drug abuse Internet addiction disorder

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Assessment of the client who abuses alcohol: –General description –Behavior –Screening tools for alcohol use or abuse –Diagnostic tests

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment (cont.) Assessment of the client who abuses substances other than alcohol: –General description –Behavior –Screening tools –Diagnostic tests Transcultural considerations

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Anxiety Ineffective health maintenance Imbalanced nutrition: less than body requirements Hopelessness Impaired verbal communication Impaired social interaction Ineffective denial Ineffective coping Deficient knowledge regarding illness Risk for injury Risk for other-directed violence Disturbed sleep pattern Spiritual distress

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes focus on the following: Providing a safe environment to prevent injury Stabilizing existing medical complications secondary to substance use or abuse Improving impaired cognition and communication Establishing nutritious eating patterns Establishing a balance of rest, sleep, and activity Establishing alternative coping skills Resolving any personal or family issues related to the client’s disorder

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Planning focuses on the following: Psychobiological, social, and pharmacological aspects of the client’s substance abuse Involves the client and family Includes a multidisciplinary approach –Stages of Change Model

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Provision of a safe environment Assistance in meeting basic needs Stabilization of medical condition Stabilization of behavior Medication management

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Detoxification Disulfiram and naltrexone therapy (alcohol aversion therapy) Harm avoidance Pain management of clients with substance-related disorders

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Intervention strategy Interactive therapies Individual and cognitive–behavioral psychotherapy Group therapy Family therapy CRAFT reinforcement and family training program Client education Smoking-cessation program Support and self-help groups

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation The ultimate outcome is complete freedom from drug use and abuse. However, the potential for relapse is ever present. Services available to clients who relapse are the following: –“28-day” inpatient program –Short-term residential rehabilitation for 3 months –Long-term therapeutic community programs for 6 to 18 months –Day-treatment centers –Reentry programs –Outpatient or aftercare programs

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Possible Signs of an Impaired Nurse Volunteers to work overtime frequently especially on weekends when staffing ratios are less than during the weekdays Leaves the floor or unit frequently or spends a considerable amount of time in the bathroom Is frequently involved in incidents in which clients report they haven’t received relief for pain (narcotic analgesics), insomnia (sedative hypnotics), or anxiety (benzodiazepines) although documentation indicates that they have received prescribed medication Exhibits lapses in memory, changes in personal appearance, and appears preoccupied Is on duty when the inaccurate drug counts occur Gives questionable explanations regarding drug wastage and discrepancies in documentation

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Addiction Addictions nursing Addictive personality Alcohol intoxication Alcohol withdrawal Aversion therapy Behavioral dependence Codependency Delirium tremens Detoxification Drug dependence Enabling Habituation Harm avoidance or reduction Impaired nurse Intervention Korsakoff’s psychosis Physiological dependence Psychological dependence Stages of Change Model Substance use Tolerance Wernicke’s encephalopathy

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Reflect on the chapter-opening quote. Compare and contrast the serious medical and social consequences of alcohol abuse and drug abuse. Which abuse do you think is more detrimental to a client’s quality of life? Why? Which abuse do you think is more detrimental to a client’s family? Explain your answers. ?