Substance related disorders

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MR. JAYESH PATIDAR
www.drjayeshpatidar.blogspot.com

Introduction…
• Psychoactive substances have been used by people in
almost all cultures since prehistoric times.
• Psychoa...

Epidemiological Statistics…
• A high prevalence of substance-related
disorder occur between the ages of 18 & 24.
• Substan...

Defining the Terms…
Abuse
To use wrongfully or in a harmful way. Improper
treatment or conduct that may result in injury
D...

Count…
Intoxication
A physical & mental state of exhilaration &
emotional frenzy or lethargy & stupor
Withdrawal
The physi...

SUBSTANCE
USE
DISORDERS
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Substance Abuse
Definition:
The DSM-IV-TR (APA, 2000) identifies substance
abuse as a maladaptive pattern of substance use...

DSM-IV-TR Criteria for Substance Abuse
• Recurrent substance use resulting in a failure to
fulfill major role obligations ...

Count…
• Recurrent substance-related legal problems
(e.g., arrests for substance-related disorderly
conduct).
• Continued ...

Substance Dependence
Physical Dependence:
• Physical dependence on a substance is evidenced by a
cluster of cognitive, beh...

Count…
Psychological Dependence:
• An individual is considered to be psychologically
dependent on a substance when there i...

DSM-IV-TR Criteria for Substance Dependence
At least three of the following characteristics must
be present for a diagnosi...

Count…
2. Evidence of withdrawal symptoms, as
manifested by either of the following:
a. The characteristic withdrawal synd...

Count…
5. A great deal of time is spent in activities necessary to
obtain the substance (e.g., visiting multiple doctors o...

SUBSTANCE
INDUSED
DISORDERS
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Definition:
Substance intoxication is defined as the
development of a reversible substance-specific
syndrome caused by the...

DSM-IV-TR Criteria for Substance Intoxication
1.The development of a reversible substance-specific
syndrome caused by rece...

Definition:
Substance withdrawal is the development of a
substance-specific maladaptive behavioral
change, with physiologi...

DSM-IV-TR Criteria for Substance Withdrawal
1. The development of a substance-specific
syndrome caused by the cessation of...

Predisposing Factors of Substance-
related Disorders:-
A number of factors have been implicated in the
predisposition to a...

Biological Factors
Genetics:
• Hereditary factor is involved in the development of
substance-use disorders.
• This is espe...

Biochemical Factors:
• Alcohol may produce morphine-like substances
in the brain that are responsible for alcohol
addictio...

Psychological Factors
Developmental Influences:
• The psychodynamic approach - punitive superego and
fixation at the oral ...

Count…
Personality Factors:
• Low self-esteem, frequent depression, passivity,
the inability to relax or to defer gratific...

Sociocultural Factors
Social Learning:
• The effects of modeling, imitation, and identification on
behavior can be observe...

Count…
Conditioning:
• Important learning factor is the effect of the substance
itself.
• Many substances create a pleasur...

Count…
Cultural and Ethnic Influences:
• Factors within an individual’s culture help to establish
patterns of substance us...

CLASSES OF PSYCHOACTIVE
SUBSTANCES
1. Alcohol
2. Amphetamines &
related substances
3. Caffeine
4. Cannabis
5. Cocaine
6. H...

ALCOHOL
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Count…
• Distilled beverages (e.g., whiskey, scotch, gin, vodka, and
other “hard” liquors) derive their name from further
...

Count…
• Most states consider that an individual is legally
intoxicated with a blood alcohol level of 0.08 to 0.10
percent...

Why do people drink?
• Drinking patterns in the United States show that
people use alcoholic beverages to enhance the
flav...

Jellinek (1952) outlined four phases through which
the alcoholic’s pattern of drinking progresses.
(Psychopathology)
1. Ph...

Phase I. The Pre alcoholic phase
• This phase is characterized by the use of alcohol to
relieve the everyday stress and te...

Phase II. The Early Alcoholic Phase
• This phase begins with blackouts—brief periods of amnesia
that occur during or immed...

Phase III. The Crucial Phase
• In this phase, the individual has lost control, and
physiological dependence is clearly evi...

Count…
• In this phase, the individual is extremely ill.
Anger and aggression are common
manifestations.
• Drinking is the...

Phase IV. The Chronic Phase
• This phase is characterized by emotional and physical
disintegration.
• The individual is us...

EFFECTS OF ALCOHOL ON THE BODY
• Alcohol can induce a general, nonselective,
reversible depression of the CNS.
• About 20 ...

Count…
• The other 80 percent of the alcohol in one drink is
processed only slightly slower through the upper
intestinal t...

Peripheral Neuropathy
• It characterized by peripheral nerve damage,
results in pain, burning, tingling, or prickly
sensat...

Alcoholic Myopathy
• Alcoholic myopathy may occur as an acute or chronic
condition.
• In the acute condition, the individu...

Count…
• Laboratory studies show elevations of the enzymes creatine
phosphokinase (CPK), lactate dehydrogenase (LDH),
aldo...

Wernicke’s Encephalopathy
• Wernicke’s encephalopathy represents the
most serious form of thiamine deficiency in
alcoholic...

Korsakoff ’s Psychosis
• Korsakoff’s psychosis is identified by a syndrome
of confusion, loss of recent memory, and
confab...

Alcoholic Cardiomyopathy
• The effect of alcohol on the heart is an accumulation of
lipids in the myocardial cells, result...

Count…
• Changes may be observed by electrocardiogram (ECG),
and congestive heart failure may be evident on chest x-
ray f...

Esophagitis
• Esophagitis—inflammation and pain in the
esophagus— occurs because of the toxic
effects of alcohol on the es...

Gastritis
• The effects of alcohol on the stomach include
inflammation of the stomach lining
characterized by epigastric d...

Pancreatitis
• This condition may be categorized as acute or
chronic.
• Acute pancreatitis usually occurs 1 or 2 days afte...

Alcoholic Hepatitis
• Alcoholic hepatitis is inflammation of the liver caused by
long-term heavy alcohol use.
• Clinical m...

Cirrhosis of the Liver
• Cirrhosis is the end stage of alcoholic liver disease and
results from long-term chronic alcohol ...

Leukopenia
• The production, function, and movement of
the white blood cells are impaired in chronic
alcoholics.
• This co...

Thrombocytopenia
• Platelet production and survival are impaired
as a result of the toxic effects of alcohol.
• This place...

Sexual Dysfunction
• Alcohol interferes with the normal production
and maintenance of female and male hormones
(National
•...

Alcohol Dependence:
• Many alcoholics hide or deny their addiction &
temporarily manage to maintain a functional life whic...

Count…
• Assess for signs of nutritional deficiency, including
vitamin & mineral deficiency. Watch for secretive
behavior ...

Count…
Overt signs & symptoms:
• Overt indications of excessive alcohol use
include:
- Episodes of anesthesia or amnesia d...

Alcohol Intoxication:
Intoxication usually occurs at blood alcohol
levels between 100 & 200 mg/dl. Death has
been reported...

Alcohol Withdrawal:
A heavy drinker who stops drinking or abruptly
reduces his alcohol intake is likely to go through
with...

Count…
• Alcohol withdrawal delirium – onset of
delirium is usually on the second or third day
following cessation of or r...

Various laboratory tests may suggest alcoholism &
help evaluate for complication for such as
cirrhosis of liver.
• A blood...

Count…
• Serum electrolyte analysis may identify electrolyte
abnormalities associated with alcohol use.
• Blood urea nitro...

• Acute alcohol intoxication calls for
symptomatic treatment, which may
involve respiratory support, fluid
replacement, IV...

Alcohol Anonymous
• Alcoholics Anonymous (AA) is a major self-help
organization for the treatment of alcoholism.
• It was ...

Alcohol Anonymous
• The only requirement for membership is a desire on the
part of the alcoholic person to stop drinking.
...

The Twelve Steps of Alcoholics:-
1. We admitted we were powerless over alcohol—that our
lives have become unmanageable.
2....

Count…
8. Made a list of all persons we had harmed and became
willing to make amends to them all.
9. Made direct amends to...

Pharmacotherapy
Disulfiram (Antabuse):
• Disulfiram is a drug that can be administered to
individuals who abuse alcohol as...

Count…
• Disulfiram works by inhibiting the enzyme
aldehyde dehydrogenase, thereby blocking the
oxidation of alcohol at th...

Count…
• Mild reactions can occur at blood alcohol levels as low as
5 to 10 mg/dl.
• Symptoms are fully developed at appro...

Count…
• Disulfiram should not be administered until it has been
ascertained that the client has abstained from alcohol fo...

Count…
• These products (e.g., liquid cough and cold preparations,
vanilla extract, aftershave lotions, colognes, mouthwas...

Other Medications for Treatment of
Alcoholism
• The narcotic antagonist naltrexone (ReVia) was
approved by the Food and Dr...

Count…
• SSRIs in the decrease of alcohol craving among
alcohol dependent individuals has yielded
mixed results
• Acampros...

Managing Acute Withdrawal
• The patient may require IV glucose administration &
administration of fluids containing thiami...

Treatment of Chronic Alcoholism
• Alcohol dependence has no known cure & total
abstinence is the only effective treatment....

Aversion Therapy
• In aversion therapy, the patient receives a daily
oral dose of disulfiram (antabuse) to prevent
compuls...

Counseling and Psychotherapy
• For long term abstinence, supportive programs
that offer detoxification, rehabilitation &
a...

Count…
• For alcoholics who have lost contact with
family & friends & have a long history of
unemployment, trouble with th...

NURSING MANAGEMENT
• In the preintroductory phase of relationship
development, the nurse must examine his or her feelings
...

Count…
Am I comfortable with my drinking patterns?
If I decided not to drink any more, would that be
a problem for me?
...

Count…
Do I ever use terms like “sot,” “drunk,” or
“boozer” to describe some individuals who
overindulge, yet overlook it...

Nursing Diagnosis
• Ineffective denial related to weak, underdeveloped ego
evidenced by “I don’t have a problem with (subs...

Count…
• Risk for infection related to malnutrition and
altered immune condition.
• Low self-esteem related to weak ego, l...

Count…
For the client in substance withdrawal,
possible nursing diagnoses include:
• Risk for injury related to CNS agitat...

Nursing Intervention
• If the patient is taking disulfiram, warn him that
even a small amount of alcohol (such as the amou...

Count…
• Tell the patient about AA, a self-help group with
more than a million members worldwide that
offers emotional sup...

Count…
• Teach the patient’s family about Al-Anon &
Alateen, two other self-help groups. By joining
these groups, family m...

Thank
You
www.drjayeshpatidar.blogspot.com

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