1. KESHLATA COLLEGE OF NURSING
LESSON PLAN
ON
TOPIC- SUBSTANCE USE DISORDER
SUBMITTED BY:
HIMANSHU PAL
NURSING FACULTY
KESHLATA COLLEGE OF NURSING
SUBMITTED ON: ________________
2. IDENTIFICATION DATA
NAME OF TEACHER : Himanshu Pal
SUBJECT : Psychiatric
UNIT : IX UNIT
TOPIC : Substance Use Disorder
GROUP : B.SC IIIrd Year
NO. OF STUDENTS : 40
DURATION : 45 Minutes
VENUE : Class-room
METHOD OF TEACHING : Lecture cum discussion teaching method
A.V Aids : PPT & Black Board, Flash cards, Charts, Pamphlet etc.
PREVIOUS KNOWLEDGE : The students may have some knowledge regarding Substance use
disorder
3. GENERAL OBJECTIVE: After the class the students will be able to acquire knowledge in depth about substance use
disorder.
Executive Plan of action - At the end of the class student will be able to acquire the knowledge regarding substance use
disorder
TEACHER POINT OF VIEW:
To enhance the effectiveness of the teaching-learning process
To use appropriate teaching strategies
To make learning strategies
GROUP POINT OF VIEW:
To gain knowledge regarding the topic
To clarify the doubts and generate the new ideas
SPECIFIC OBJECTIVES: At the end of the teaching session the group will be able to determine these specific
Objectives
Discuss about introduction of substance use disorder
Define definition of substance use disorder
Define some terms used in this unit
Enlist the classification of substance use disorder
Enlist some commonly used psychotropic substances
Describe the epidemiology
State the etiological factors in substance use disorder
Explain psychiatric disorder and treatment caused by substance use
Elaborate nursing diagnosis of substance use disorder
4. S.No TIME
SPECIFIC
OBJECTIVE
CONTENT
TEACHING
LEARNING ACTIVITY
A.V
AIDS
EVALUATION
TEACHING LEARNING
1
.1
min
To Introduce the
substance, use
disorder
INTRODUCTION:
Substance use disorder commonly known as drug abuse/ drug
addiction refers to a maladaptive patterned use of a substance
in which the user consumes the substance in amounts or with
methods not advised by medical professional
Since ancient times men used psychoactive substance not only
to enhance pleasure and relieve discomfort
Lecture
cum
discussion
method
Students are
actively
participating
.
Guess the
topic?
2
3.
2 min
2 min
Define the
Substance use
disorder
Define Substance
abuse and some
related terms
DEFINITION:
Substance abuse: abuse is the use of any substance to that
extent when it interferes with individual’s normal functioning.
It can be distinguished by following criteria
1. A pattern of pathological use: It is manifested by
intoxication throughout the day, inability to cut down
or stop the use and continuation of substance use
despite of a serious physical disorders
2. Impairment in social or occupational functioning
due to pathological use: Social relations are
disturbed may be because of individual failure to meet
his role and responsibilities towards his family.
Substance dependence:
It is more severe form of substance abuse. Dependence is of
two types and is evident by tolerance and withdrawal. It can
be distinguish by following criteria
1. Physical dependence refers to need of a particular
substance to function normally or to carry out daily
activities.
Lecture
cum
discussion
method
Lecture
cum
discussion
method
Students are
actively
participating
Students are
actively
participate
and listening
PPT &
black
board
PPT
What is
Substance
abuse ?
What is
substance
dependence
tolerance,
withdrawal,
habit and
addiction ?
5. 2. Psychological dependence, when in the absence of the
particular substance the user’s cognitive functioning is
impaired
Tolerance: it is failure of same amount of drug to produce
desired effect and a larger dose is required to produce the
same degree of substance effects
Withdrawal: substance withdrawal is characterized by
appearance of substance specific symptoms (physical and
psychological) when the substance intake is reduced or
stopped
Habit: It is characterized by only desire to take the drug, there
is no need to increase the dose or frequency and is usually not
followed by physical withdrawal
Addiction: It is a state of periodic or chronic intoxication,
harmful for individual and to the society, produced by
repeated consumption of the drug. It involves both
dependence and habit
4. 1min Enlist the
classification of
substance abuse
disorder
Classification
F10-F19 Mental and behaviour disorder due to psychoactive
substance use
F10 Mental and behavioural disorders due to use of alcohol
F11 Mental and behavioural disorders due to use of opioids
F12 Mental and behavioural disorders due to use of cannabinoids
F13 Mental and behavioural disorders due to use of sedatives or
hypnotics
F14 Mental and behavioural disorders due to use of cocaine
F15 Mental and behavioural disorders due to use of
Hallucinogens
Lecture
cum
discussion
method
Students are
actively
participating
PPT &
black
board
What is the
ICD-10
classification
5. 1 min Enlist commonly
used psychotropic
substances
Commonly used psychotropic substance
Alcohol rum, beer, whiskey and brandy
Lecture
cum
discussion
Students are
actively
participating
PPT What are the
commonly
used
6. Opioids Heroine, Morphine, pethidine, opium
Cannabis Bhang, Charas, Ganja
Cocaine Hashish, Marijuana Crash
Hypnosedatives Barbitutates, Benzodiazepines
Hallucinogens LSD, Mescaline
Inhalants Glue, Paint, Varnish
Psycho stimulants Methylphenidate
Nicotine Chewing Tobacco, cigarettes
Caffeine Coffee powder, soft drinks, tea leaf,cocoa
Method psychotropic
substances
6.
2min
Describe the
Epidemiology of
substance abuse
Epidemiology
Some of the substance use disorders are common like
nicotine, caffeine and alcohol in India
Alcohol use is seen predominantly seen in
males and in females less than 5%
Opiates addiction was between 6.3 to 18.9%
Cannabis 1.3 to 33%
Tranquilizers 3.5 to 53.8%
In United States about 90% of all US residents have had
an alcohol-containing drink
Lecture
cum
discussion
method
Students
are actively
participating
PPT &
black
board
Describe the
epidemiology
of substance
abuse ?
7. 5min State the
Etiological factors
of substance abuse
Etiology
Biological Factors
Genetic vulnerability: Family history of substance use
disorder, for example, twin studies suggest that genetic
mechanisms might account for alcohol consumption
Biochemical factors: Abnormalities in alcohol
dehydrogenase or in the neurotransmitter mechanism are
thought to play a role in alcohol dependence
Lecture
cum
discussion
method
Students
are actively
participating
PPT &
black
board
Explain the
etiological
factors of
substance
abuse
7. For example: role of dopamine and norepinephrine have
been implicated in cocaine, ethanol and opioids
dependence
Neurobiological theories: Drug addicts may have an
inborn deficiency of endomorphins
Behavioral theories
Behavioral scientists view drug abuse as the result of
conditioning or cumulative reinforcement from drug use
Drug use causes euphoric experience perceived as
rewarding, thereby motivating user to keep taking the
Stimuli and setting associated with drug use may
themselves become reinforcing
Psychological factors
General rebelliousness
Sense of inferiority
Poor impulse control
Low self-esteem
Loneliness, unmet needs
Pleasure seeking
Sexual immaturity
Desire to escape from reality
Social factors
Religious reasons
Peer pressure
Urbanization
Unemployment
Poor social support
Occupation: more common in chefs, barmen,
executives, salesmen, actors, army personnel, medical
personnel, etc…
Easy availability of drug
8. 6. 15
min
Discuss about the
the Psychiatric
disorder.
Psychiatric disorders
Substance use disorders are more common in depression,
anxiety disorders, personality disorders (antisocial) and
occasionally in organic brain diseases
Goals of treatment
Immediate goal: The immediate goal is treatment of
intoxication and then detoxification, treatment of acute
medical condition and crisis intervention
Short term goals: short term goals aim at treatment of co-
morbid and psychiatric disorder, maintenance of
abstinence, vocational placement and family reintegration
Long term goals: long term goals focus on relapse
prevention, occupational rehabilitation, social
reintegration, abstinent lifestyle and improvement of
quality of life
Phases of treatment:
Pre treatment phase: preparation and acceptance on the
part of client about the problem and need for external help
The detoxification phase: usually lasts 2-4 weeks
followed by active treatment phase
Active treatment phase: usually last 3-12 months or
more and involves the choosing from many
pharmacological and psychosocial modalities of treatment
Post treatment/ after care phase: usually lasts for 3-5
years or even longer. In this phase family members and
other social agencies play a more active role to maintain
abstinence and rehabilitation of the client
Alcohol Dependence syndrome
Alcoholism refers to the use of alcoholic beverages to the
point of causing damage to the individual, society or both
Properties of Alcohol
Alcohol is a clear colored liquid with strong burning taste
The rate of absorption of alcohol into the bloodstream is
more rapid than its elimination
Lecture
cum
discussion
method
Students
are actively
participating
PPT &
black
board
What are the
Psychiatric
disorder ?
9. Absorption of alcohol into the bloodstream is slower when
food is present in the stomach
A concentration of 80-100 mg of alcohol per 100ml of
blood is considered intoxication
A concentration of 200-250 mg will be toxic, sleepy and
confused
If the alcohol level is 300 mg/100 ml of the blood the
person may lose consciousness
A concentration of 500mg/100 ml is fatal
Signs and symptoms of alcohol dependence
Minor complaints: Malaise, dyspepsia, mood swings or
depression, increased incidence of infection
Poor personal hygiene, untreated injuries
Unusually high tolerance for sedatives and opioids
Nutritional deficiency (vitamins and minerals)
Consumption of alcohol containing products
Denial of problems
Tendency to blame others
ICD 10 criteria for alcohol dependence
A strong desire to take substance
Difficulty in controlling substance taking behavior
A physical withdrawal state
Development of tolerance
Progressive neglect of alternative pleasures or interests
Persisting with substance use despite clear evidence of
harmful consequences
Psychiatric disorders due to alcohol dependence
1. Acute intoxication:
It develops during or shortly after alcohol ingestion.
It is characterized by clinically significant maladaptive
behavior or psychological changes
10. For Example – inappropriate sexual or aggressive
behaviour, mood lability, impaired judgment, slurred
speech, unsteady gait, impaired attention
2. Withdrawal syndrome:
In persons who have been drinking heavily over a
prolonged period of time, any rapid decrease in the
amount of alcohol in the body is likely to produce
withdrawal symptoms. They are
o Simple withdrawal syndrome
o Delirium tremens
o Simple withdrawal syndrome: It is characterized by
mild tremors, nausea, vomiting, weakness, irritability,
insomnia and anxiety
o Delirium tremens: it occurs usually within 2-4 days of
complete or significant abstinence from heavy alcohol
drinking. The course is short, with recovery occurring 3-7
days Delirium tremens (DTs) is a rapid onset of
confusion usually caused by withdrawal from alcohol.
When it occurs, it is often three days into the withdrawal
symptoms and lasts for two to three days. Physical effects
may include shaking, shivering, irregular heart rate, and
sweating.
3. Alcohol induced amnestic disorders:
Chronic alcohol abuse associated with thiamine (Vit B)
deficiency is the most frequent cause of amnestic
disorders. This condition is divided into
o Wernick’s syndrome
o Korsakoff’s syndrome
o Wernick’s syndrome: This is characterized by prominent
cerebellar ataxia, palsy of the 6th
cranial nerve, peripheral
neuropathy and mental confusion
11. o Korsakoff’s syndrome: The prominent symptoms are
gross memory disturbance. Other symptoms include
o Disorientation
o Confusion
o Confabulation(the unconscious filling of memory
gaps by imagined)
o Poor attention span and distractibility
o Impaired of insight
4. Alcohol induced psychiatric disorders:
Alcohol induced dementia: it is a long-term
complication of alcohol abuse, characterized by global
decrease in cognitive functioning
Alcohol induced mood disorders: Excess drinking may
induce persistent depression or anxiety
Suicidal behavior: suicidal rates are higher in alcoholics
when compared to non-alcoholics of the same age
Alcohol-induced anxiety disorder: alcoholics report
panic attacks during acute withdrawal, similarly during
the first 4 to 6 weeks of abstinence
Alcoholic seizures (rum fits): Generalized tonic clonic
seizures occur usually within 12-48 hours after a heavy
bout of drinking. Sometimes, status epileptics may be
precipitated
Alcoholic hallucinosis: This is characterized by the
presence of hallucinations (auditory) during abstinence.
Diagnosis
Blood alcohol level to indicate intoxication (200mg/dl)
Urine toxicology to reveal use of other drug
Serum electrolyte analysis
Liver function test
Echocardiogram and electrocardiogram
Treatment modalities:
12. Symptomatic treatment, may involve respiratory support,
fluid replacement, IV glucose to prevent hypoglycaemia,
correction of hypothermia and emergency measures for
trauma, infection or GI bleeding
Treatment for withdrawal symptoms
a. Detoxification: it is the treatment for alcohol withdrawal
symptoms. The drug of choice is benzodiazepines.
The most common used drug is chlordiazepoxide 80-
200mg/day and diazepam 40-80 mg/day in divided doses
b. Others:
For vitamin B deficiency–vitamin B containing 100 mg of
thiamine administered parenterally, twice daily 3 to 5
days. Followed by oral administration at least 6 months
Administration of anticonvulsants
Maintaining fluid and electrolyte balance
Monitoring of vitals
Level of consciousness and orientation
Alcohol deterrent therapy
Deterrent agents are those which are given to
desensitize the individual to the effects of alcohol and
maintain abstinence.
The most commonly used drug id disulfiram (tetraethyl
thiuram disulfide)
5.Opioids Use Disorder
In the last few decades, the use of opioids has increased
markedly world over.
The most important dependence producing derivatives are
morphine and heroin
The commonly abused opioids in our country are heroin
(brown sugar, smack)
Synthetic preparation like pethidine, fortwin
(pentazocine) and tidigesic (buprenorphine)
13. The drugs that are injected through needle are heroin,
buprenorphine and pentazocine. Though most opiate users
had begun chasing (inhaling the smoke or chasing the
dragon (Chasing the dragon is a way of smoking heroin. It
usually involves placing powdered heroin on foil and heating it
from below with a lighter. The heroin turns to a sticky liquid
and wriggles around like a Chinese dragon, hence the name))
Acute intoxication
It is characterized by apathy, bradycardia, hypotension,
respiratory depression, subnormal temperature and
pinpoint pupils.
Delayed reflexes, thready pulses and coma can occur
Withdrawal syndrome
Narcotic withdrawal rarely produces a life threatening
situation
Withdrawal symptoms begin within 12 hrs of the last
dose, peak in 24 to 36 hrs and disappear in 5 to 6 days
Common symptoms include watery eyes, running nose,
yawning, loss of appetite, diarrhea, raised body
temperature
Complication
Due to illicit drug use: Parkinsonism, peripheral
neuropathy, transverse myelitis
Due to intravenous use: Skin infection, thrombophlebitis,
pulmonary embolism, endocarditis, septicemia, AIDS,
viral hepatitis
Involvement in criminal activities
Treatment
Opioids overdose can be treated with narcotic antagonists,
for example naloxone, naltrexone
14. 7.
Naltrexone is available as 50 mg tablet. It is well absorbed
from GI tract and after ingestion effective receptor
blockade is obtained for 48-72 hrs
Three common regimens available for naltrexone
administered first 50mg daily, second is thrice a week
(mon and wed 100mg and 150 mg on fri), third is twice a
week (150mg on mon and 200mg on thrus) however daily
is prefered
Withdrawal symptoms can be managed by mrthadone,
clonidine, naltrexone, buprenorphine
In some settings opioids dependence is treated by aversion
therapy in which a small dose of opium is given followed
by an emetic agent.
6.Cannabis Use Disorder
Cannabis is derived from hemp plant, cannabis sativa.
The dried leaves and flowering tops are often referred to
as Ganga or marijuana
The resin of the plant is referred as hashish.
Bhang is a drink made from cannabis
Acute intoxication
Mild intoxication: mild impairment of consciousness,
orientation, a sense of floating in the air, euphoria,
alteration in psychomotor activity
Severe intoxication: perceptual disturbances like
depersonalization, derealization, synesthesias (may see
sounds, taste words or feel a sensation on their skin when they
smell certain scents.) and hallucination
Withdrawal symptoms
They are mostly found in the first 72-96 hours and include
increased salivation, hyperthermia, insomnia, decreased
appetite, loss of weight and insomnia
Complications
15. 3 min Enumerate Nursing
Diagnosis of
substance use
disorder
Short lasting psychiatric disorders such as
o acute anxiety
o Paranoid psychosis
o Hysterical fugue-like states
o Hypomania
o Schizophrenia-like state
A motivational syndrome
Memory impairment
Treatment:
Supportive and symptomatic treatment
7.Cocaine Use Disorder
Common street name is ‘crack’. It can be administered
orally, intranasal by smoking or parenterally
Acute intoxication
Characterized by papillary dilatation, tachycardia,
hypertension, sweating and nausea
Withdrawal syndrome
Agitation, depression, anorexia, fatigue and sleepiness
Complication
Acute anxiety reaction, uncontrolled compulsive
behaviour, seizures, respiratory depression
Treatment
Management of intoxication: Amyl nitrite is an antidote;
diazepam or propranolol is also used
Management of withdrawal symptoms: Antidepressants
(imipramine or amitriptyline) and psychotherapy
8. Amphetamine use disorder
Amphetamine are powerful CNS stimulants with
pheripheral sympathomimetic effects
Commonly used amphetamines are pemoline and
methylphenidate
16. Acute intoxication
Characterized by tachycardia, hypertension, cardiac
failure, papillary dilation, paranoid hallucinatory
syndrome and amphetamine induced psychosis
Withdrawal syndrome
Characterized by depression, apathy, fatigue,
hypersomnia or insomnia, agitation and hyperphagia
Complication
Seizures, delirum, arrhythmias, aggressive behavior,
coma
9. LSD Use Disorder (Lysergic acid diethylamide)
LSD is a powerful hallucinogen
It was first synthesized in 1938
A common pattern of LSD use is ‘trip’ (occasional use
followed by a long period of abstinence)
It produces its effects by acting on 5-HT ( 5
hydrotryptamine receptors or serotonin receptors.)level in
brain
Intoxication
Characterized by perceptual changes occurring in clear
consciousness
For examples depersonalization, derealization, illusion,
synesthesias (colours are heard, sounds are felt), paranoid
ideation and impaired judgment
Withdrawal syndrome
Flashbacks (brief experiences of the hallucinogenic
state)
Complication
Anxiety, depression, psychosis or visual hallucinosis
Treatment
17. Symptomatic treatment with anti anxiety, antidepressant
or antipsychotic medication
10. Inhalants or volatile solvent use disorders
The commonly used volatile solvents include petrol,
aerosols, thinners, varnish remover and industrial
solvents.
Intoxication
Inhalation of a volatile solvent leads to euphoria,
excitement, and slurring speech
Withdrawal symptoms
Anxiety, depression
Complications
Irreversible damage to the liver and kidneys, peripheral
neuropathy, perceptual disturbances and brain damage
Treatment
Reassurance and diazepam for intoxication
Nursing Diagnosis
1. Disorientation and/or confusion related to alcohol
withdrawal and environmental misinterpretation
2. Potential for injury to self or others related to aggressive
behaviour, suicidal ideation or environmental
misinterpretation
3. Ineffective denial related to weak and underdeveloped ego
evidenced by statement explaining no problem with
substance use
4. Ineffective coping as evidenced by substance taking
behaviour (as a coping mechanism)
5. Imbalanced nutrition less than body requirements related
to substance use rather than eating as evidenced by loss of
weight, malnutrition, weakness.
18. 8. 5
.min To summarize the
substance, use
disorder
SUMMARY:
In this class we had to discuss about the introduction
of substance use and its disorder, definition Discuss
about introduction of substance use disorder Define
definition of substance use disorder Define some
terms used in this unit Enlist the classification of
substance use disorder Enlist some commonly used
psychotropic substances Describe the epidemiology
State the etiological factors in substance use disorder
Explain psychiatric disorder and treatment caused by
substance use Elaborate nursing diagnosis of
substance use disorder
Lecture
Method
Students are
actively
participating.
9. 5
min
To recapitulation of
the substance use
disorder
RECAPITULATION-
What substance use disorder
What is the definition of substance use disorder
What are classification of substance use disorder
what are commonly used psychotropic substances
what is epidemiology of substance use in India or USA
What are the etiological factors in substance use
disorder
What is psychiatric disorder and treatment caused by
substance use
What is nursing diagnosis of substance use disorder
Lecture cum
discussion
10.
3
min To conclude the
topic.
CONCLUSION:
19. 11. To enhance the
Further reading.
By the end students know about the substance use
disorder and what the bad impact of substance in our
body and they also know the commonly used
psychotropic substance. Substance abuse problems
are very common they have a great impact on the
individuals families and community. Etiology is
multi- factorial substance abuse problems should be
considered in the differential diagnosis of any
psychiatric disorder.
ASSIGNMENT/ APPLICATION:
Assignment Topic- An Assignment on
classification of ICD F10 to F19, Substance use
disorder.
Date of Submission.-
REFERENCES:
Townsend M .C. Psychiatric Mental Health
Nursing.(Latest edn) Jaypee brothers;New Delhi
R. sreevani, a textbook of mental health nursing
psychiatric nursing 2nd
volume 3rd
edition jaypee
publications page No- 255.
20. Bimila kapoor 1994 a text book of psychaitric
nursing volume 2nd
edition 11th
kumar
publications.
Ram kumar gupta mental and heath nursing vica
and company medical publication 10th
edition
page no.223
Mary werghese essential of psychiatric and
mental health nursing 3rd
edition page no.334
NET REFRENCES
WHO.ICD 10 Classification of Mental &
Behavioural Disorder.
https://www.webmd.com/mental-
health/addiction/substance-abuse#1
