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

2. 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. 3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Addiction  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

4. 4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

5. 5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Three Domains that Influence Addiction  Individual  Situational  Environmental

6. 6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Epidemiology  Demography  Age  Gender  Race/ethnicity  Education  Employment

7. 7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

8. 8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Dual Diagnosis  Co-occurring mental illness and substance abuse  Either may precede the other  Common comorbidities:  Antisocial personality disorder, bipolar disorder, schizophrenia  Alcohol, marijuana, cocaine

9. 9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Alcohol Intoxication BALConsequences 0.02-0.05Mildly impaired coordination Potential changes in behavior 0.08-0.1Impaired driving, slurred speech, ataxia,  sensory function 0.1-0.15Impaired balance, gross judgment, and cognition impairment 0.2-0.3All sensory motor function impaired 0.3 and  Potential cardiovascular and respiratory collapse Coma, death

10. 10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Drug Categories  Alcohol  Cannabis  Cocaine  CNS depressants  CNS stimulants  Opioids  Hallucinogens  Inhalants  Anabolic-androgenic steroids  Synthetic  OTC  Club drugs

11. 11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Withdrawal/Detoxification  Alcohol  CNS depressants  Opioids  Stimulants  Caffeine  Nicotine

12. 12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Interventions  Physiologic functioning  Safety  Observations/assessments  Treatment of withdrawal  Establishing relationship  Emotional support  Nutrition  Psycho-education  12-Step program  Community resources

13. 13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Treatment Modalities  Psychotherapy  Group therapy  Family therapy  Behavioral therapy  Antabuse  Relapse prevention strategies  Harm reduction techniques  Inpatient

14. 14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Treatment Modalities, cont’d.  Partial hospitalization  Outpatient  Halfway houses  12-Step programs  Relapse prevention  Medications  Naltrexone (rapid detox)  Methadone  LAAM

15. 15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Treatment  Of SUDs requires perseverance  Secondary complications of drug use are often causative factors related to physical illness and health concerns