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Substance abuse now

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Substance abuse now Presentation Transcript

  • 1. SUBSTANCE ABUSE Intake through various means or route of both legal and illegal substances with the intention of producing a different state of mind or overall feeling. Intake of substances to achieve brain-altering effect
  • 2. SUBSTANCE ABUSE PREVALENCE ..... DETRIMENTAL EFFECTS: -Workplace injuries -Motor vehicle accidents and fatalities -Domestic abuse, homicide, and child abuse and neglect
  • 3. Substance Abuse 14% of adults have an alcohol-related disorder6.2% have a substance-related disorder (excluding nicotine) Children of alcoholics are 4 times more likely than the general population to develop problems with alcohol
  • 4. TYPES OF SUBSTANCE ABUSE CLASSES OF SUBSTANCE ABUSE - Alcohol - Amphetamines or similarly acting sympathomimetics - Caffeine - Cannabis - Cocaine - Hallucinogens - Inhalants - Nicotine - Opioids - Phencyclidine (PCP) or similarly acting drugs -Sedatives, hypnotics, or anxiolytics -Methamphetamine
  • 5. SUBSTANCE ABUSE DEFINITIONS Intoxication is use of a substance that results in maladaptive behavior Withdrawal syndrome refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases Detoxification is the process of safely withdrawing from a substance
  • 6. SUBSTANCE ABUSE Substance abuse is using a drug in a way that is inconsistent with medical or social norms (WHO) A maladaptive pattern of substance use leading to significant problems or distress such as - failure to attend school, work - substance use in dangerous situations (driving a car) - substance-related legal problems - continued substance use that interferes with family relationships and friendships
  • 7. DSM-IV Criteria for Substance Abuse - Maladaptive pattern of substance use, manifested by >1 of the following occurring at anytime within a 12 month period 1. Recurrent substance use resulting in failure to fulfill major obligations at work, school or home 2. Recurrent substance use in situations in which it is physically hazardous 3. Recurrent substance –related legal problem 4. Continued substance use despite having persistent social or interpersonal problems caused by the substance
  • 8. SUBSTANCE DEPENDENCE Substance dependence includes problems associated with addiction such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance (WHO) Continued use of a substance, despite its negative consequences or even when significant problems related to its use have developed.
  • 9. DSM-IV Criteria for Substance Dependence Maladaptive pattern of substance use, manifested by >3 of the following symptoms occurring at anytime in the same 12 month period: 1. Tolerance 2. Withdrawal 3. Substance taken in larger amounts or longer periods 4. Persistent desire, unsuccessful efforts to control substance use 5. Much time spent in activities to obtain substance 6. Important social, occupational, recreational activities are given up because of substance use 7. Substance use is continued despite knowledge of having physical or psychological problem that is likely due to substance use.
  • 10. Onset and Clinical Course Typically begins with the first episode of intoxication between 15 and 17 years of age More severe difficulties begin in the mid-20s to mid-30s - Alcohol-related breakup of a significant relationship - An arrest for public intoxication or driving while intoxicated - Evidence of alcohol withdrawal - Early alcohol-related health problems - Significant interference with functioning at work or school
  • 11. ONSET AND CLINICAL COURSE BLACKOUT.... TOLERANCE.... TOLERANCE BREAK... ABSTINENCE OR TEMPORARY CONTROLLED DRINKING... ... OR SPONTANEOUS REMISSION......... (20%)
  • 12. HIGHER RATES OF SUCCESSFUL RECOVERY: PEOPLE WHO ABSTAIN HIGHLY MOTIVATED TO QUIT HISTORY OF LIFE SUCCESS
  • 13. PROGNOSIS IS POOR WHEN: EARLIER AGE AT ONSET LONG PERIODS OF SUBSTANCE USE CO EXIST WITH MAJOR PSYCH ILLNESS
  • 14. EXTENDED USE COULD CAUSE RISK IN.... MENTAL AND PHYSICAL DETERIORATION INFECTIOUS DISEASES
  • 15. ETIOLOGY....... Biologic factors - Genetic vulnerability - Neurochemical influences Psychological factors - Familial dynamics - Coping styles Social and environmental factors - availability - cultural factors -social attitude - peer behavior
  • 16. 1. ALCOHOL (DEPRESSANT) STANDARD DRINKS - ALCOHOL
  • 17. The Alcohol Use Disorders Identification Test: 0 1. How often do you have a drink containing alcohol? never 1 2 3 Monthly or less 2-4x a month 2-3x a week 4 4 or more times a week Please skip to Questions 9 and 10 if reply to Question 1 is NEVER, or if both answers to Q 2 and 3 are 0.
  • 18. The Alcohol Use Disorders Identification Test: 0 1 1-2 2. How many drinks containing alcohol do drinks you have on a typical day when you are drinking? 3-4 drinks 3. How often do you have never six or more drinks on one occasion? less than monthly 2 5-6 drinks monthly 3 4 7,8 or 9 10 or drinks more drinks weekly daily or almost daily
  • 19. AUDIT: 0 1 2 never less than monthly 4. How often during the monthly last year have you found that you were not able to stop drinking once you had started? 5. How often during the last year have you failed to do what was normally expected from you because of drinking? never less than monthly monthly 3 4 weekly daily or almost daily weekly daily or almost daily
  • 20. AUDIT: 0 2 less than monthly monthly 3 4 weekly daily or almost daily never less than monthly weekly 7. How often during the monthly last year have you had a feeling of guilt or remorse after drinking? daily or almost daily 6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? never 1
  • 21. AUDIT: 0 1 2 3 never less than monthly weekly 8. How often during the monthly last year have you been unable to remember what happened the night before because you had been drinking? 4 daily or almost daily
  • 22. AUDIT: 2 4 No, never Yes, but not in the last year Yes, during the last year No, never Yes, but not in the last year Yes, during the last year 0 9. Have you or someone else been injured as a result of your drinking? 10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
  • 23. AUDIT: Risk Level Intervention Zone I – Low-risk drinking or abstinence Zone II – Alcohol use in excess of low-risk guidelines Zone III – Harmful and hazardous drinking Alcohol Education 0-7 Simple Advice AUDIT score 8-15 Simple Advice + 16-19 brief counseling & cont’d. monitoring Zone IV – Alcohol Dependent Refer to specialist 20-40 for Evaluation and Treatment
  • 24. ALCOHOL Central nervous system depressant. Intoxicated: relaxed, loss of inhibitions, slurred speech, unsteady gait, impaired attention, aggressive , and inappropriate behavior. Overdose can result in vomiting, unconsciousness, and respiratory depression. Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake Alcohol withdrawal usually peaks on the second day and is over in about 5 days
  • 25. Withdrawal symptoms include: Coarse hand tremors, irritability, heightened alertness, jerky movements, numbness, tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting Severe or untreated withdrawal may progress to transient hallucinations, illusion,seizures, or delirium—called delirium tremens (DTs) Benzodiazepines used for detoxification tx: Lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium) suppress the withdrawal symptoms
  • 26. ADDICTION RESEARCH FOUNDATION- CIWA- AR or CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL, REVISED Less than 8= mild withdrawal 8- 15 = moderate withdrawal Greater than 15 = severe withdrawal
  • 27. TREATMENT AND NSG INT.FOR ALCOHOLISM: - ANTABUSE (Disulfiram) 1. DETOXIFICATION - PREVENT SUICIDE - PREVENT CONVULSION/ SZ - PROVIDE WELL LIGHTED ENVIRONMENT ESTABLISH NUTRITIONAL STATUS - Vitamin B1 (thiamine) to prevent or to treat - Wernicke’s syndrome and Korsakoff’s syndrome Cyanocobalamin (vitamin B12) and folic acid for nutritional deficiencies 2. REHABILITATION -
  • 28. 1. DEPRESSANTS- reduce nervous activity thus decrease body function 1. Narcotics Opiates, opioids- drugs that relieve pain 2. Sedatives Hypnotics, sleeping pills 3. Tranquilizers Produce emotional calmness and relaxation 4. Volatile Substances ―solvents‖
  • 29. Examples of Narcotics: (for pain) 1.Demerol 2.Morphine SO4 3.Heroine- prohibited 4.Codeine- found in cough syrups 5.Opium- prohibited 6.Methadone
  • 30. Narcotics (for pain)Intoxication and Withdrawal INTOXICATION: 1. DROWSINESS 2. SLURRED SPEECH 3. IMPAIRED ATTENTION/ MEMORY 4. ANALGESIA 5. DECREASE SEXUAL DRIVE 6. HYPOACTIVITY SWEATING - NARCAN (NALOXONE)ANTIDOTE (OPIOID) - Stopped here........ WITHDRAWAL(8-12 hours after last dose) : 1. INSOMNIA 2. YAWNING 3. CRAVING FOR THE DRUG 4. NAUSEA, VOMITING, AND DIARRHEA 5. MUSCLE ACHES 6. LACRIMATION, RHINORRHEA (FEVER) 7. PUPILLARY DILATATION
  • 31. Examples of the sedatives (to induce sleep): 1.Barbiturates - Phenobarbital (Luminal) - Secobarbital (Seconal) - Amobarbital (Amytal) 2. Non- barbiturates - Stilnox - Dalmane - Dormicum
  • 32. Examples of Tranquilizers (produce calmness and relaxation) : 1.Minor Tranquilizers- anxiolytic; anti-anxiety drugs Examples: - Valium and Anxionil – diazepam - Ativan- lorazepam - Xanax- Alprazolam - Librium- chlordiazepoxide - Serax- oxazepam - Tranxene- chlorazepate - Equanil- meprobamate Hcl 2. Major Tranquilizers- antipsychotics - Thorazine, Haldol, Nozinan and Mellaril or Melleril
  • 33. SEDATIVES AND ANXIOLYTICS INTOXICATION AND WITHDRAWAL: 6-8 hrs.- 1 week 1.Slurred speech 2.Unsteady gait 3. Impaired attention and memory 1.Nausea and vomiting 2.Malaise/ weakness 3.Anxiety 4.Irritability 5.Hypersensitivity to light and sound 6.Coarse tremors 7.Marked insomnia 8. inc. VS 9. seizures and hallucinations
  • 34. Narcotics, Sedatives, Tranquilizers, and Anxiolytics Central nervous system depressants - Benzodiazepines alone, when taken orally in overdose, are rarely fatal, but the person will be lethargic and confused - Barbiturates, can be lethal when taken in overdose. They can cause coma, respiratory arrest, cardiac failure, and death
  • 35. Examples of Volatile Substance/ INHALANTS 1.Rugby 2.Acetone 3.Thinner 4.Paint 5.Vicks inhaler 6.White flower 7.Nail polish
  • 36. INHALANTS: Overdose: Anoxia, respiratory depression, vagal stimulation, and dysrhythmias Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus People who abuse inhalants may suffer from persistent dementia or inhalant-induced disorders such as psychosis, anxiety, or mood disorders even if the inhalant abuse ceases Withdrawal symptoms: none Treatment: Supporting respiratory and cardiac functioning until the substance is removed from the body
  • 37. 2. STIMULANTS: 1. Shabu 2. Cocaine 3. Amphetamines Methamphetamine HCL- poor man’s cocaine Cocaine, coke, C, snow, Crack (hard form of cocaine) Diet pills
  • 38. Stimulants intoxication and withdrawal: 1. 2. 3. 4. 5. 6. 7. 8. 9. Restlessness Nervousness Tirelessness Insomnia Anorexia Weight loss Hallucinations Suspiciousness Dilated pupils (shabu and cocaine) 10. Muscle fasciculation 11. Nasal perforation, epistaxis b/c of ulceration in the nasal mucosa 1. Dysphoria 2. Fatigue 3. Sleep DO 4. Agitation 5. Craving 6. unpleasant dreams 7. increased appetite 8. psychomotor retardation or agitation 9. ―crashing‖--the person may experience depressive symptoms, including suicidal ideation, for several days
  • 39. 3. HALLUCINOGENS 1.Marijuana- cannabis sativa ; maryjane. Pot, grass, jules 2.LSD – LySergic Diethylamide (acid) Excessive use of cannabis may produce delirium or cannabis-induced psychotic disorder; overdoses of cannabis do not occur Withdrawal symptoms: Insomnia, muscle aches, sweating, anxiety, and tremors. Effects are treated symptomatically Hallucinogens can produce flashbacks that may persist for a few months up to 5 years.
  • 40. Application of the Nursing Process: Substance Abuse (cont’d) Assessment History: chaotic family life, family history, crisis that precipitated treatment General appearance and motor behavior: depends on physical health; likely to be fatigued, anxious Mood and affect: may be tearful (expressing guilt and remorse), angry, sullen, quiet, unwilling to talk
  • 41. Application of the Nursing Process: Substance Abuse (cont’d) Thought processes and content: minimize substance use, blame others for problems, rationalize their behavior, say they can quit on their own Sensorium and intellectual processes: alert and oriented; intellectual abilities intact (unless neurologic deficits from long-term alcohol or inhalants) Judgment and insight: poor judgment while intoxicated and due to cravings for substance; insight limited
  • 42. Application of the Nursing Process: Substance Abuse (cont’d) Self-concept: low self-esteem, feels inadequate at coping with life Roles and relationships: strained relationships and problems with role fulfillment due to substance use Physiologic considerations: may have trouble eating and sleeping; HIV risk if IV drug user
  • 43. Substance Abuse Treatment Treatment is based on the concept that alcoholism and drug addiction are medical illnesses: chronic, progressive, characterized by remissions and relapses Treatment models include: The Hazelden Clinic model 12-step program of Alcoholics Anonymous (AA) Individual and group counseling
  • 44. TWELVE STEPS OF ALCOHOLICS ANONYMOUS 1. We admitted that we were powerless over alcohol, that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our wills and lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings.
  • 45. TWELVE STEPS OF ALCOHOLICS ANONYMOUS 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people whenever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
  • 46. Pharmacologic Treatment 2 main purposes: To permit safe withdrawal from alcohol, sedative/hypnotics, and benzodiazepines Prevent relapse
  • 47. Pharmacologic Treatment (cont’d) Safe withdrawal from alcohol involves: Benzodiazepines to suppress withdrawal symptomsLorazepam, chlordiazepoxide, and diazepam Antipsychotics- Chlorpromazine (to reduce anxietytremor state and prevent more serious withdrawal symptom Vitamin B1 (thiamine) to prevent or to treat Wernicke’s syndrome and Korsakoff’s syndrome (food rich in thiamine, lean pork, organ meat, nuts) Cyanocobalamin (vitamin B12) and folic acid for nutritional deficiencies
  • 48. Pharmacologic Treatment (cont’d) Relapse prevention involves: Disulfiram (Antabuse) Acamprosate (Campral) Methadone Naltrexone (ReVia) Clonidine (Catapres) Ondansetron (Zofran) Propanolol (Inderal) Topiramate (Topamax)
  • 49. Application of the Nursing Process: Substance Abuse (cont’d) Data analysis Nursing diagnoses common to physical health needs include: Imbalanced nutrition: less than body requirements Risk for infection Risk for injury Diarrhea Activity intolerance Self-care deficits o o o o o o
  • 50. Application of the Nursing Process: Substance Abuse (cont’d) Data analysis (cont’d) Nursing diagnoses common to psychosocial health needs include: oIneffective denial oIneffective role performance oInterrupted family processes: alcoholism oIneffective coping
  • 51. Application of the Nursing Process: Substance Abuse (cont’d) Outcomes The client will: oAbstain from alcohol/drugs oExpress feelings openly and directly oAccept responsibility for own behavior oPractice nonchemical alternatives to deal with stress or difficult situations oEstablish an effective aftercare plan
  • 52. Application of the Nursing Process: Substance Abuse (cont’d) Intervention Providing health teaching for client and family Addressing family issues: Codependence Changes in roles Promoting coping skills o o