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SUBSTANCE ABUSE
DISORDERS
Why do we need to know about
chemical dependency?
 Many

M/S patients are chemically
dependent
 Your chances of being in...
 Substance

abuse is not a one person

illness.
 It affects personal and professional
relationships with those associate...
SUBSTANCE ABUSE:
 Repeated

use of chemical substances leading
to clinically significant impairment over 12
month period ...
ADDICTION:
 Physical

dependence on a substance
 Repeated compulsive use of substance that
continues in spite of negativ...
TOLERANCE:
 Increased

amounts of substance are
needed over period of time to achieve
same effect as obtained previously ...
CROSS TOLERANCE:
 Tolerance

to one drug causes tolerance
to another drug or class of drugs
WITHDRAWAL:
 Unpleasant

physical, psychological or
cognitive effects resulting from
decreasing or stopping use of chemic...
DEPENDENCY:
 Condition

in which person has several of
the following symptoms for a single 12
month period
 Needs

more ...
DEPENDENCY continued:
 Has

tired at least once to quit
 Experience difficulty with job, family or
social activities bec...
DUAL DIAGNOSIS:
 Means

that an individual has both a
mental illness, such as depression, as
well as a problem with subst...
DYSFUNCTIONAL:
 Often

used to refer to relationships
within alcoholic family or work
environment
 Characterized by dish...
CODEPENDENCE:
 Members

of a family group or
relationship begin to lose own sense of
identity and purpose and exist solel...
NON-SUBSTANCE RELATED DEPENDENCY /
ADDICTIVE PERSONALITY:
 Includes

all kinds of addictive behavior
 May include addict...
ETIOLOGICAL THEORIES:
 Some

believe in existence of addictive
personality
 Biological theories – some sort of
genetic m...
ETIOLOGICAL THEORIES:
 Cognitive

behavioral theorists – suggest way
person perceives high may influence act of
becoming ...
SOCIO-CULTURAL THEORIES:
 Certain

cultures within US, such as:

 Native

American have a high percentage of
members wit...
SELECTED SUBSTANCES
OF ABUSE
ALCOHOL
 Use

and abuse are present in all walks
of life, on all economic levels and in both
men and women
 Differentiat...
DELIRIUM TREMENS (DT’S)
 Visual

hallucinations
 Tremors
 Possibly tonic-clonic seizures
 Elevated blood pressure
 El...
FETAL ALCOHOL SYNDROME
 Leading

known preventable causes of mental
retardation and birth defects
 Lifelong condition th...
What are the symptoms of FAS?
 Fetal

Alcohol Syndrome symptoms include

Small head, small jaw, and small, flat cheeks
 ...
How is FAS diagnosed?
 Based

on mother’s history and the
appearance of the baby, based on a
physical examination by a ph...
Treatment for FAS?
 Specific

drugs for treating the symptoms
of withdrawal from alcohol in babies
 No treatment for lif...
Prevention of FAS?
 100°

preventable – however, requires
the following
 Mother

to stop using alcohol before
becoming p...
KORSAKOFF’S PSYCHOSIS:
 Form

of amnesia often seen in chronic
alcoholics that is characterized by a loss of
short-term m...
Therapeutic Interventions for
Alcohol Abuse and Dependence
 Treatment

is a slow process
 Single most effective treatmen...
ANTABUSE
 Medication

that is sometimes prescribed
as a deterrent to alcohol
 Need full informed consent to start
antabu...
CAMPRAL
 New

drug that works on
neurotransmitters to alter functions of
other brain chemicals that have been
affected by...
REVIA
 May

decrease alcohol cravings (and
opoid drugs) and impulsive behavior
VALIUM AND ATIVAN
 Can

help prevent symptoms of DT’s
during acute withdrawal but are not used
long term
 Hospitalizatio...
Assessment of Patient with Alcohol
Abuse
 CAGE
 Have

questionnaire

you ever felt you should Cut down on
your drinking?...
Assessment of Patient with Alcohol
Abuse continued:
 Objective,

nonjudgmental approach by
nurse is imperative
 Self ass...
Assessment of Patient with Alcohol
Abuse continued:
 Type

of substance
 Type of compulsive behavior
 Pattern and frequ...
NURSING INTERVENTIONS:
 Safety
 Closely

observe for withdrawal, possibly
even 1-1 observation
 Reorient patient
 Adeq...
WHAT IS DETOXIFICATION?
Removal of poisonous effects of a substance
ALCOHOL DETOXIFICATION
 Process

which a heavy drinker’s system is
brought back to normal after being used to
having alco...
DRUG DETOXIFICATION
 Used

to reduce or relieve withdrawal
symptoms while helping the addicted
individual adjust to livin...
WHAT IS REHABILITATION?
 Restore

to health or normal life by
training and therapy – restore to a
former condition
 Gett...
SIGNS & SYMPTOMS OF
ALCOHOL INTOXICATION
 Glazed

eyes
 Smell on breath
 Pupils
 Unsteady gait
 Unusual behavior for ...
NICOTINE:
 Cigarettes,

cigars, and smokeless

tobacco
 Experts believe the single most difficult
addition to overcome
OPIOIDS:
 Heroin
 Prescription

opiods
 Can be injected, smoked or inhaled
BARBITURATES:
 Ingested

orally and injected
 Pentathol, phenobarbital
 Sedatives, hypnotics
BENZODIAZEPINES:
 Valium
 Many

have replaced earlier used
barbiturates
 Can be taken orally or injected
AMPHETAMINES:
 Crystal

meth which is a growing
substance use / abuse problem affecting
families and society
 Can be tak...
COCAINE:
 Can

be injected, smoked or inhaled
nasally
CANNABIS:
 Marijuana

or hashish
 Can be smoked or eaten
INHALANTS
 Nitrous

oxide and solvents that are
sniffed, huffed or bagged
 Often young teenagers or young children
to us...
PSYCHEDELICS: LSD
Usually

ingested orally, can be injected or smoked
Symptoms include:






Very

Sleeplessness
...
Bath Salts
A synthetic, stimulant powder product that contains
amphetamine-like chemicals, including mephedrone,
which may...
Signs and Symptoms of drug abuse
and dependence
 Very

similar as those s/s of alcohol
abuse
 Read, watery eyes
 Runny ...
Therapeutic interventions for drug
abuse and dependence
 Narcotics
 Group

anonymous

therapy

 Psychotherapy
 Meth

p...
Nursing interventions for drug abuse
and dependence
 Essentially

the same as for those who
are alcohol dependent
 Remem...
The chemically impaired nurse
 Nurses

have 32 – 50% increased rate of
chemical dependency than general
population. Acces...
Indication evident in the chemically
impaired nurse
 Changing

life style to focus activities that
encourage substance us...
PRIORITIES OF NURSE
WHO IS A WITNESS OR
SUSPECTS CHEMICALLY
IMPAIRED COLLEAGUE
 Ethically

and legally remove nurse from
patient care
 Clear accurate documentation by coworker is vital
 Report to nu...
Withdrawal Symptoms
 Alcohol-increase

in VS, psychosis, seizures
 LSD-no withdrawal symptoms
 Crystal Meth-increased s...
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9.substance abuse disorders

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Transcript of "9.substance abuse disorders"

  1. 1. SUBSTANCE ABUSE DISORDERS
  2. 2. Why do we need to know about chemical dependency?  Many M/S patients are chemically dependent  Your chances of being in a close relationship with someone who is chemically dependent is great  Our profession holds statistically high users of drugs and alcohol
  3. 3.  Substance abuse is not a one person illness.  It affects personal and professional relationships with those associated with the user.  We need to treat user and family and significant other.
  4. 4. SUBSTANCE ABUSE:  Repeated use of chemical substances leading to clinically significant impairment over 12 month period manifested by 1 or more of the following: Inability to fulfill major role obligations at work, school, or home;  Recurrent legal or interpersonal problems;  Continued use despite social and interpersonal problems; and  Participation in physically hazardous situations while impaired such as driving 
  5. 5. ADDICTION:  Physical dependence on a substance  Repeated compulsive use of substance that continues in spite of negative consequences physical, social or legal  Characterized by loss of control due to participation in the dependency, whether that dependency is to a substance or to a process  A tendency to relapse into dependency  Denial (a defense mechanism) is commonly used by patients who have problems with abuse and dependency
  6. 6. TOLERANCE:  Increased amounts of substance are needed over period of time to achieve same effect as obtained previously with smaller amounts
  7. 7. CROSS TOLERANCE:  Tolerance to one drug causes tolerance to another drug or class of drugs
  8. 8. WITHDRAWAL:  Unpleasant physical, psychological or cognitive effects resulting from decreasing or stopping use of chemical after regular use for extended period of time.
  9. 9. DEPENDENCY:  Condition in which person has several of the following symptoms for a single 12 month period  Needs more of substance and more frequent intervals to achieve same high or desired effect of the substance  Spends significant time obtaining substance  Give up important social or professional functions to use substance
  10. 10. DEPENDENCY continued:  Has tired at least once to quit  Experience difficulty with job, family or social activities because of use or withdrawal symptoms  Uses substance regardless of problem it causes  Uses substance to avoid withdrawal symptoms  Usually has unsatisfied emotional needs
  11. 11. DUAL DIAGNOSIS:  Means that an individual has both a mental illness, such as depression, as well as a problem with substance abuse  Patients with serious mental illness often have a dual diagnosis of some type of substance abuse
  12. 12. DYSFUNCTIONAL:  Often used to refer to relationships within alcoholic family or work environment  Characterized by dishonesty inability to discuss situation, and covering up for users behaviors
  13. 13. CODEPENDENCE:  Members of a family group or relationship begin to lose own sense of identity and purpose and exist solely for the abuser  Enable abuser by taking responsibility for own actions away from abuser
  14. 14. NON-SUBSTANCE RELATED DEPENDENCY / ADDICTIVE PERSONALITY:  Includes all kinds of addictive behavior  May include addiction to food, sex, gambling. Shopping / spending, or internet use
  15. 15. ETIOLOGICAL THEORIES:  Some believe in existence of addictive personality  Biological theories – some sort of genetic metabolic disorder A person who is alcohol dependent is 3-4 times as likely to come from parents who abused alcohol than a person who did not abuse alcohol
  16. 16. ETIOLOGICAL THEORIES:  Cognitive behavioral theorists – suggest way person perceives high may influence act of becoming high, another word, may start out very innocent, just want to repeat that good feeling!  Psychological theories – the person who abuses substances / processes may have certain personal tendencies including: lower self esteem, lower tolerance for pain or frustration.
  17. 17. SOCIO-CULTURAL THEORIES:  Certain cultures within US, such as:  Native American have a high percentage of members with alcohol dependency  Asian’s have low percentage of dependency  Peer pressure and other sociologic factors can increase likelihood of substance use
  18. 18. SELECTED SUBSTANCES OF ABUSE
  19. 19. ALCOHOL  Use and abuse are present in all walks of life, on all economic levels and in both men and women  Differentiation between social drinker and abuser is the degree of need or compulsion to drink  Decreases a persons life expectancy an 10-12 years
  20. 20. DELIRIUM TREMENS (DT’S)  Visual hallucinations  Tremors  Possibly tonic-clonic seizures  Elevated blood pressure  Elevated heart rate  Cardiac dysrhythmias  Symptoms 4 – 12 hrs after patient has stopped drinking and will peak in 24 – 48 hours
  21. 21. FETAL ALCOHOL SYNDROME  Leading known preventable causes of mental retardation and birth defects  Lifelong condition that causes physical and mental disabilities  Abnormal facial features, growth deficiencies, and central nervous system problems  Problems learning, memory, attention span, communication, vision, hearting or a combination of these
  22. 22. What are the symptoms of FAS?  Fetal Alcohol Syndrome symptoms include Small head, small jaw, and small, flat cheeks  Malformed ears  Small eyes, poor development of optic nerve, crossed-eyes  Upturned nose, low bridge  Small upper mouth structure and teeth  Umbilical or diaphragmatic hernia  Caved-in chest wall  Heart murmurs, heart defects, abnormalities of large vessels 
  23. 23. How is FAS diagnosed?  Based on mother’s history and the appearance of the baby, based on a physical examination by a physician
  24. 24. Treatment for FAS?  Specific drugs for treating the symptoms of withdrawal from alcohol in babies  No treatment for life-long birth defects and retardation  Damage often need developmental follow-up and possibly, long-term treatment and care
  25. 25. Prevention of FAS?  100° preventable – however, requires the following  Mother to stop using alcohol before becoming pregnant  Women should stop drinking immediately if pregnancy is suspected
  26. 26. KORSAKOFF’S PSYCHOSIS:  Form of amnesia often seen in chronic alcoholics that is characterized by a loss of short-term memory and an inability to learn new skills  Usually disoriented, may present with delirium and hallucinations, and confabulates to conceal the condition  Often traced to degenerative changes in the thalamus as a result of a deficiency of B complex vitamins, especially thiamine and B12
  27. 27. Therapeutic Interventions for Alcohol Abuse and Dependence  Treatment is a slow process  Single most effective treatment is Alcoholics Anonymous, 12-step program that offers support through others who have stopped drinking  Cognitive behavioral therapy and psychotherapy are also sometimes used  Family therapy
  28. 28. ANTABUSE  Medication that is sometimes prescribed as a deterrent to alcohol  Need full informed consent to start antabuse therapy  Severe reaction will occur if ingest alcohol, chest pain, nausea, vomiting, confusion and other symptoms  Effects last 2-3 weeks after last dose
  29. 29. CAMPRAL  New drug that works on neurotransmitters to alter functions of other brain chemicals that have been affected by long term drinking
  30. 30. REVIA  May decrease alcohol cravings (and opoid drugs) and impulsive behavior
  31. 31. VALIUM AND ATIVAN  Can help prevent symptoms of DT’s during acute withdrawal but are not used long term  Hospitalization may range from in house of 2 weeks or more to step down to halfway houses  To eventual independence  Is typical for patients to seek treatment multiple times
  32. 32. Assessment of Patient with Alcohol Abuse  CAGE  Have questionnaire 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 as an Eye opener to steady your nerves or get rid of a hangover?
  33. 33. Assessment of Patient with Alcohol Abuse continued:  Objective, nonjudgmental approach by nurse is imperative  Self assess your own feelings  Use open ended questions  “when was your last drink”  “how much do you drink”  Ask about each substance or behavior separately
  34. 34. Assessment of Patient with Alcohol Abuse continued:  Type of substance  Type of compulsive behavior  Pattern and frequency  Amount  Age of regular use  Changes in use patterns  Previous withdrawal symptoms
  35. 35. NURSING INTERVENTIONS:  Safety  Closely observe for withdrawal, possibly even 1-1 observation  Reorient patient  Adequate nutrition and fluid balance  Low stimulation environment  Administer withdrawal meds PRN  Emotional support to patient and family
  36. 36. WHAT IS DETOXIFICATION? Removal of poisonous effects of a substance
  37. 37. ALCOHOL DETOXIFICATION  Process which a heavy drinker’s system is brought back to normal after being used to having alcohol in the body on a continual basis  Precipitous withdrawal from long-term addition without medical management can cause severe health problems and can be fatal  Treatment must be undergone to deal with underlying addiction that caused the alcohol use
  38. 38. DRUG DETOXIFICATION  Used to reduce or relieve withdrawal symptoms while helping the addicted individual adjust to living without drugs  Not meant to treat addition – early step in long-term treatment  Treatment occur in a community program that lasts sever months and takes place in residential atmosphere rather than medical center
  39. 39. WHAT IS REHABILITATION?  Restore to health or normal life by training and therapy – restore to a former condition  Getting back on your feet, finding your old self again, learning to live a normal life, the way – before alcohol took over  Need to be strong to stay off the booze of course – always about changing life
  40. 40. SIGNS & SYMPTOMS OF ALCOHOL INTOXICATION  Glazed eyes  Smell on breath  Pupils  Unsteady gait  Unusual behavior for the patient, passive aggressive, violent
  41. 41. NICOTINE:  Cigarettes, cigars, and smokeless tobacco  Experts believe the single most difficult addition to overcome
  42. 42. OPIOIDS:  Heroin  Prescription opiods  Can be injected, smoked or inhaled
  43. 43. BARBITURATES:  Ingested orally and injected  Pentathol, phenobarbital  Sedatives, hypnotics
  44. 44. BENZODIAZEPINES:  Valium  Many have replaced earlier used barbiturates  Can be taken orally or injected
  45. 45. AMPHETAMINES:  Crystal meth which is a growing substance use / abuse problem affecting families and society  Can be taken orally, injected IV or smoked
  46. 46. COCAINE:  Can be injected, smoked or inhaled nasally
  47. 47. CANNABIS:  Marijuana or hashish  Can be smoked or eaten
  48. 48. INHALANTS  Nitrous oxide and solvents that are sniffed, huffed or bagged  Often young teenagers or young children to use lighter fluid, paint, paint thinners, and gasoline (or other easily accessed household substances) to get high  Highly toxic substances that are potentially lethal
  49. 49. PSYCHEDELICS: LSD Usually ingested orally, can be injected or smoked Symptoms include:      Very Sleeplessness Increased heart rate Increased blood pressure Loss of appetite Powerful hallucinogenic addictive- Provides a mental escape
  50. 50. Bath Salts A synthetic, stimulant powder product that contains amphetamine-like chemicals, including mephedrone, which may have a high risk for overdose. "Agitation, paranoia, hallucinations, chest pain, suicidality”
  51. 51. Signs and Symptoms of drug abuse and dependence  Very similar as those s/s of alcohol abuse  Read, watery eyes  Runny nose  Hostile behavior  Paranoia  Needle tracts on arms or legs
  52. 52. Therapeutic interventions for drug abuse and dependence  Narcotics  Group anonymous therapy  Psychotherapy  Meth programs
  53. 53. Nursing interventions for drug abuse and dependence  Essentially the same as for those who are alcohol dependent  Remember nurses and doctors can not “fix” the patient who is chemically dependent  Desire to be chemically free needs to come from within the patient themselves
  54. 54. The chemically impaired nurse  Nurses have 32 – 50% increased rate of chemical dependency than general population. Access! When clinically impaired nurse is on duty patient may have increase complaints of pain, with little relief of pain meds, patients may ask more often for pain med. You may also see inaccurate narcotic counts, frequent vial breakage may also occur.
  55. 55. Indication evident in the chemically impaired nurse  Changing life style to focus activities that encourage substance use  Inconsistency between statements and actions  Increase irritability  Projecting blame  Isolating self from social contacts  Deteriorating physical appearance  Tardiness or absences  Depression
  56. 56. PRIORITIES OF NURSE WHO IS A WITNESS OR SUSPECTS CHEMICALLY IMPAIRED COLLEAGUE
  57. 57.  Ethically and legally remove nurse from patient care  Clear accurate documentation by coworker is vital  Report to nurse manager  Impaired nurse should be allowed referral to treatment program  Report to state board of nursing
  58. 58. Withdrawal Symptoms  Alcohol-increase in VS, psychosis, seizures  LSD-no withdrawal symptoms  Crystal Meth-increased sleeping, depression  Heroin-muscle pain, cramps in abdomen, increased yawning  Cigarettes-craving, nervous/anxious, increased appetite, irritable  Caffeine-irritability, headache, jittery  Marijuana-no withdrawal symptoms
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