SubstanceRelated Disorders West Coast University NURS 204 Overview

Substance-Related Disorders West Coast University NURS 204

Overview Addiction to psychoactive substances is a worldwide health problem } Addiction is one of the most serious public health problems in the US } Alcohol, by far is the leading substance abused by Americans }

Epidemiolgy of Alcohol } } About two-thirds of American adults consume alcohol; about 14% of them develop problems with dependence Roughly one-third of all hospital admissions are related to alcohol abuse The divorce rate for couples with and alcoholic spouse is seven times greater than that for other couples Approximately one-half of all traffic accidents are alcohol related

Substance-Related Disorders Substance abuse - repeated use of substances that is maladaptive } Substance dependence } § Tolerance: needing increased amount of a substance § Withdrawal: uncomfortable physiologic and cognitive behavioral changes } Substance intoxication: reversible syndrome of maladaptive physiologic and behavioral changes that are due to the effect of a substance

Biopsychosocial Theories } } } Biologic Genetic Psychological Sociocultural Family systems

Populations at Risk } } } } Teenagers Psychiatric clients Women General hospital clients Older Adults Adult Children of Alcoholics Health Care Providers

Alcohol Physical effects: Slurred speech, lack of coordination, unsteady gait, blackouts, nystagmus flushed face, sense of floating, and anorexia } Psychological effects: euphoria, mood lability, impaired judgment, sexual inhibition, decreased concentration, aggressive behavior } Withdrawal effects: Anxiety, agitation, and irritability, tremors, tachycardia, hypertension, diaphoresis, hallucinations, N/V, diarrhea, delirium tremens }

Wernicke-Korsakoff Syndrome } } Results from a deficiency in vitamin B complex (most commonly a thiamine deficiency) Severely impairs cognitive functioning Produces peripheral neuropathy, cerebellar ataxia, confabulation, and myopathies Death can occur if thiamine replacement therapy is not initiated immediately

Effects of Alcoholism } } Alcohol-induced persisting amnestic disorder Alcohol encephalopathy Fetal alcohol syndrome Suicide and alcoholism

Nursing Implications } } } Monitor the patient’s vital signs and behavior Seek a physician’s order for a benzodiazepine to decrease withdrawal symptoms Close observation Promote sleep and rest Institute seizure precautions Encourage fluids

CAGE Questionaire } Consist of four questions § 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 nerves or get rid of a hangover (eye-opener)?

Pharmacology Treatment Benzodiazepines: Valium and Librium for withdrawal symptoms } Disulfiram (Antabuse): inhibits Acetaldehyde Dehydrogenase } Naltrexone (Re Via, Trexan): block the need to ingest alcohol }

Barbiturates and Sedatives/Hypnotics Physical effects: Drowsiness, fatigue, orthostatic hypotension, anorexia, slurred speech, ataxia, seizure, dizziness } Psychological effects: Euphoria, irritability, anxiety, poor memory and understanding, delirium, depressed mood, violence } Withdrawal effects: N/V, generalized malaise, tachycardia, excessive sweating, anxiety, irritablity, ortho hypotension, insomnia, seizures, coarse tremors }

Nursing Implication } } } Monitor vital signs Close observation Promote sleep and rest Offer fluids and light foods as tolerated Administer medication, if ordered, to wean the patient Institute seizure precautions

Opioids Physical effects: pinhole pupils, skin picking, sleepiness, anorexia } Psychological effects: Anxiety, impaired cognition, delirium, euphoria } Withdrawal effects: lacrimation, rhinorrhea, excessive sweating, yawning, tachycardia, fever, insomnia, muscle aches, craving, N/V, dilated pupils, chills }

Nursing Implications } } } Monitor vital signs Close observation Offer fluids and light food as tolerated Keep environment nondistracting and soothing Methadone maintenance as ordered

Amphetamines Physical effects: anorexia, arrhythmia, restlessness, tremors, dizziness, generalized tonic -clonic seizures, dry mouth, dilated pupils, hyperactive reflexes, tachycardia } Psychological effects: Labile affect, anxiety, delirium, euphoria, violence, hallucinations, irritability } Withdrawal effects: Depression, fatigue, agitation, suicidal thought, paranoia, insomnia or hypersomnia, disorientation }

Nursing Implication } } } Promote sleep and rest Monitor vital signs Monitor suicidal ideation Antidepressant, if ordered Remain with a frightened or disoriented patient Orient the patient to reality

Cannabis Derived from an Indian hemp plant (Cannabis sativa) } Marijuana contains psychoactive substance (delta 6 -3, 4 -tetrahydrocannabinol) } THC is stored in the fatty tissues (especially in the brain and reproductive system) } THC can be detected in the body for up to 6 weeks. }

Cannabis Analgesic effect } Effective against nausea and vomiting } Treat weight loss } Dronabinol is a synthetic THC approved by the FDA. }

Cannabis Physical effects: slowed speech, slowed reflexes, red eyes, dry mouth, increased appetite, lower testosterone, 70% more benzopyrene (major cancer causing chemical, emphysema). } Psychological effects: apathy, reduced inhibition, altered stated of awareness } Withdrawal effects: Anxiety and restlessness }

Nursing Implication Help patient with memory loss to fill in gaps of information } Attend to self-care needs that a lethargic or apathetic patient may have neglected }

Cocaine } } } Extracted from the leaves of the coca plant, found in Bolivia and Peru. Stimulant and decreases appetite. Ingredient in Coca-cola until 1903. Used as a local anesthetic. Not physically addicting by psychologically addicting. Develop tolerance

Cocaine Intoxication Similar to alcohol withdrawal: sweating, dilated pupils, psychomotor agitation, increase BP and HR, high fever, arrythmias, seizures, hallucinations } The “Post-Coke” Blues }

Cocaine Treatment } } } Diazepan (Valium) Phenobarbital Imipramine hydrochloride (Tofranil) Propranolol (Inderal) Bromocriptine (Parlodel) Amantadine (Symmetrel)

Hallucinoges } Physical effects: Hyperactive reflexes, tachycardia, labile mood, anorexia, hypertension, dizziness § Lysergic acid diethylamide (LSD): anxiety, sleep disturbance, tremors, and dilated pupils § Phecyclidne (PCP): slurred speech, blank stare, irritability, seizures, nystagmus, violence, ataxia, delirium, depression, fatigue, memory loss, poor impulse control § Peyote used in religious rituals § Psilocybin “magic mushrooms” Psychological effects: euphoria, restlessness, suspiciousness, hallucination } Withdrawal effects: No physical withdrawal symptoms for LSD, PCP: depression, lethargy, craving }

Inhalants Physical effects: dizziness and lightheadedness } Psychological effects: euphoria and excitement } Withdrawal effects: none }

Nicotine Psychoactive stimulating substance found in tobacco. } Occupies the receptors for acetylcholine in both dopamine and serotonin neural pathways } Associated with cancer, heart disease, emphysema, hypertension and death }

Caffeine } } } Acts as a stimulant Found in coffee, tea, and chocolate 64 mg in instant coffee, 112 mg in filtered coffee, 40 mg in tea, 7 mg chocolate, 40 mg cola drinks, 80 mg in Red Bull Diuretic, increases cholesterol and LDL Withdrawal symptoms: irritability and headaches

Treatment Approaches } } } } } Pharmacological Detoxification In-facility treatment Specialty hospital care Residential rehabilitation Extended residential care Outpatient (Day) treatment Self-help groups Twelve-step programs (AA)

Dual Diagnosis Challenges Psychiatric clients are vulnerable to substance use and abuse } Treatment must address both problems } Specialized treatment programs }

Interventions } } } Confrontation strategies Education Referral and self-help groups Lifestyle change Family – Al-non

Relapse Prevention } } Relapse is common Recognize symptoms of relapse Relapse prevention groups Levels of addiction prevention § Primary: education programs § Secondary: early identification of and intervention § Tertiary: rehabilitation

Outcome Criteria Abstinence from alcohol and drugs } Coping } Decision-making } Impulse control }

Maintaining Therapeutic Optimism } } } Substance abuse is a chronic relapsing condition. The power of a therapeutic relationship Talk to people in recovery. Talk to clients about spirituality. Find mentors. Take care of yourself!

Review Question } Ten hours after admission to the ICU following an auto accident, a client begins to exhibit mild tachycardia, irritability, and tremors. Three hours later the client has a grand mal seizure. The staff suspect that the client has § § A. Undetected internal bleeding. B. Korsakoff's syndrome. C. Alcohol withdrawal syndrome. D. Wernicke's encephalopathy.

Review Question } The nurse is taking the history of a psychiatric client suspected of abusing alcohol. Which assessment question is best to ask? § § A. When was your last drink? B. Do you drink regularly? C. Who are your drinking partners? D. Are you experiencing blackouts?

Review Question } Which is the priority intervention for a client admitted with acute alcohol intoxication? § § A. Place the client in seizure precaution. B. Restrain the client when restless and agitated. C. Darken the room. D. Monitor vital signs frequently.

Review Question The nurse anticipates that a client who has sedative hypnotic dependence will experience withdrawal symptoms. The nurse should assess for the onset of which set of symptoms? A. Nausea and vomiting, sweating, anxiety, and coarse tremors B. Runny nose, diarrhea, yawning C. Depression, restlessness, disorientation D. Craving, hypersomnia, irritability

Review Question } An adolescent client presented to the emergency room after ingesting LSD that produced a bad trip. The drug’s effects wore off after 10 hours. What health teaching should be provided to the client before discharge? 1. Information about the risks of narcotic use 2. Information about the risks of cocaine use 3. Information about the carcinogenic effects of marijuana 4. Information about flashbacks

Review Question } Which of the following treatment approaches would be most appropriate in helping a client maintain long-term smoking cessation? 1. Bupropion (Zyban) 2. Nicotine patch 3. Nicotine gum 4. Counseling

Review Question } The nurse anticipates that a client who has sedative hypnotic dependence will experience withdrawal symptoms. The nurse should assess for the onset of which set of symptoms? 1. Nausea and vomiting, sweating, anxiety, and coarse tremors 2. Runny nose, diarrhea, yawning 3. Depression, restlessness, disorientation 4. Craving, hypersomnia, irritability