SUBSTANCE ABUSE Substance any drug medication or toxin

SUBSTANCE ABUSE Substance: any drug, medication, or toxin that shares potential for abuse Addiction: physiologic/psychologic dependence causing withdrawal symptoms when discontinued

ETIOLOGY – Substance Use & Abuse • Hereditary link • Weak parent-child attachment/parenting • More common in males - females tend to be more secluded in their habits • Younger age when usage begins – greater potential for abuse/dependency • Peer relationships • Antisocial personality in biological parents

Social-Dynamic Factors • Intolerance for frustration and pain • Lack of success in life • Lack of meaningful relationships • Low self-esteem • Risk-taking behaviors *Person uses drug to feel better (helpless without drug) > reinforced with “powerful me” when drug is used > behavior cycles into addiction

CO-DEPENDENCY • Valuing self by what one does, looks like, or owns rather than by who one is • Enabling - making excuses and engaging in behaviors to “make up” for the behavior of abuser • Becoming captive of behavior – behaviors to avoid stress (ask kids to be quiet when Dad comes in, avoid going places where questions might be asked)

SUBSTANCE DEPENDENCE • Craving – strong inner drive to use substance • Tolerance – decreased effectiveness of drug over time with need for increased doses of substance to achieve same effect • Withdrawal – unpleasant, maladaptive changes in behavior as blood/tissue concentrations of substance decline after prolonged heavy use

SYMPTOMS – Substance Dependence (DSM-IVTR) • Larger amounts over longer time period than intended • Persistent desire/unsuccessful efforts to control use • Much time used in obtaining substance • Activities given up in lieu of substance use • Continued use in spite of negative problems from usage

PHASES OF CHEMICAL DEPENDENCY • PHASE 1 – Mood swings, altered emotional state • PHASE 2 – Hangover effects, guilt about behavior • PHASE 3 – Dependent lifestyle, control over substance is lost • PHASE 4 – Dependency, addiction, blackouts, paranoia, helplessness

SUBSTANCE ABUSE Ø Maladaptive, recurring use of substance accompanied by repeated detrimental effects of drug Ø Present for one year or more Ø Episodic binges Ø Can occur without dependency Ø Encounters with law, school suspension, family/marital problems

SUBSTANCE INTOXICATION Ø Maladaptive, reversible pattern of behavior Ø Perceptual disturbances Ø Sleep—wake cycle changes Ø Disturbs attention, concentration, thinking, judgment, psychomotor activity Ø Interferes with relationships

SUBSTANCE WITHDRAWAL Ø Develops symptom-specific maladaptive changes in behavior Ø Accompanied by physiologic/cognitive symptoms from reduction in prolonged substance use Ø Impaired functioning

ALCOHOL WITHDRAWAL Ø Early Signs Ø Develop within few hours after cessation/peak at 2448 hours Ø Anxiety, anorexia, insomnia, tremors, hyperactivity, irritability, “shaking inside, ” hallucinations, illusions, nausea/vomiting Ø DELIRIUM TREMENS (DTs) Ø Peak in 48 -72 hours after cessation of drinking – last 2 -3 days Ø 20% fatality rate

Vitamin B 1 Deficiency Ø Vitamin B 1 (Thiamine) deficiency, poor dietary intake, malabsorption encephalopathy/psychosis Ø Wernicke-Korsakoff Syndrome Ø Encephalopathy and psychosis primarily in alcoholics caused by thiamine and niacin deficiency Ø Occurs with chronic use Ø Permanent progressive cognitive loss

Assessment Ø Tremors Ø Anxiety, agitation Ø Delirium, decreased LOC, delusions Ø Diaphoresis, fever (100˚- 103˚) Ø Tachycardia Ø Hypertension Ø Transient tactile/visual hallucinations Ø Seizure activity

Nursing Interventions Ø Medication – sedation Ø High protein, high vitamin diet (B/C) Ø Replace fluid/ electrolytes (I/O) – Diuresis with blood alcohol level increase – Retention may occur (overhydration) Ø Mg. SO 4 to increase body’s response to thiamine/raise seizure threshold Ø VS q hour x 12 h, then q 4 h – Pulse good indicator of progress through withdrawal

Treatment • Self-responsibility • AA Concepts – People are powerless over their addictions – People are responsible for their recovery – Can no longer blame others for problem and feelings • Al-Anon – Family members did not CAUSE disease, cannot CONTROL it, nor can they CURE it – Learn they are not responsible for disease or person who has it