This document presents a case study on substance abuse. It provides background information on a 33-year-old male patient, including his personal details, education, occupation, and family status. It then discusses substance abuse in terms of definitions, prevalence, causes, signs and symptoms, management, and the nursing role in caring for patients with substance abuse issues. Key aspects covered include the genetic, biological, neurological, psychological, and social factors contributing to substance abuse, as well as the physical, behavioral, and intoxication signs of abuse for various substances. Treatment involves detoxification, rehabilitation, counseling, and pharmacological therapies. Nurses play an important role in meeting patient needs, developing trust, and providing education and support throughout the treatment process

1. TEERTHANKER MAHAVEER COLLEGE OF NURSING
CASE PRESENTATION
ON
SUBSTANCE ABUSE
SUBMITTED TO: SUBMITTED BY:
DR. NAGESHWAR. V MR. AMIT DAS
ASSOCIATE PROFESSOR M.SC NURSING 1ST YEAR
TMCON
DEPT OF PSYCHIATRIC NURSINGTMCON

3. BIODATA OF THE PATIENT:
• NAME: MR. VIKAS KUMAR
• AGE: 33 YEAR
• FATHER/SPOUSE: TEACHER
• EDUCATION: B.A
• OCCUPATION: PRIVATE BUSINESS
• RESIDENTIAL ADDRESS: THAKURDWARA ,MBD
• MARITAL STATUS: MARRIED
• RELIGION: HINDU
• SOCIO ECONOMIC BACKGROUND: MIDDLE CLASS

4. INTRODUCTION:
IT IS REPETITIVE USE OF SUBSTANCES RESULTING IN RECURRENT AND
SIGNIFICANT ADVERSE CONSEQUENCES,
E.G. • * FAILURE TO FULLFIL MAJOR ROLE OBLIGATIONS AT WORK,
SCHOOL OR HOME.
• * RECURRENT SUBSTANCE USE IN SITUATIONS IN WHICH IT IS
PHYSICALLY HAZARDOUS
(E.G. DRIVING AN AUTOMOBILE).
• * RECURRENT SUBSTANCE RELATED LEGAL PROBLEMS

5. DEFINITION:
SUBSTANCE ABUSE CAN SIMPLY BE DEFINED AS A PATTERN OF
HARMFUL USE OF ANY SUBSTANCE FOR MOOD-ALTERING PURPOSES.
"SUBSTANCES" CAN INCLUDE ALCOHOL AND OTHER DRUGS (ILLEGAL
OR NOT) AS WELL AS SOME SUBSTANCES THAT ARE NOT DRUGS AT
ALL.

6. PREVALENCE OF DRUG ABUSE
FINDINGS AND RECOMMENDATIONS MADE IN A REPORT OF THE NATIONAL COMMITTEE
ON DRUG ADDICTION (1977) FOCUSED ON THE FOLLOWING DEPENDENCE-PRODUCING
DRUGS AND OTHER SUBSTANCES COMMONLY MISUSED IN INDIA.
1) CANNABIS AND ITS PRODUCTS (E.G. BHANG, GANJAAND CHARAS).
2) HALLUCINOGEN E.G. LSD (LYSERGIC ACID DIETHYLAMIDE).
3) TRANQUILLIZERS, HYPNOTICS AND SEDATIVES )E.G. DIAZEPAM METHAQUALONE .
4) BARBITURATES (E.G.PHENOOARBITALAND SECOBARBITAL).
5) AMPHETAMINES (E.G. DEXTRO-AMPHETAMINE AND METHYL AMPHETAMINE).
6) TABBACCO
7) OTHER NARCOTIC DRUGS (E.G. OPIUM, PETHIDINE, MORPHINE, HEROIN AND
COCAINE
8) ALCOHOL.

7. ETIOLOGY:
GENETIC VULNERABILITY : FAMILY HISTORY OF SUBSTANCE USE
DISORDERS
BIOCHEMICAL FACTORS :
•ROLE OF DOPAMINE & NOR-EPINEPHRINE HAVE BEEN IMPLICATED IN
COCAINE, ETHANOL, & OPIOID DEPENDENCE.
• ABNORMALITIES IN ALCOHOL DEHYDROGENASE OR IN THE
NEUROTRANSMITTER MECHANISMS ARE THOUGHT TO PLAY A ROLE IN
ALCOHOL DEPENDENCE.

8. NEUROBIOLOGICAL THEORIES :
•DRUG ADDICT MAY HAVE AN INBORN DEFICIENCY OF
ENDOMORPHINS.
•ENZYMES PRODUCED BY A GENE MIGHT INFLUENCE HORMONES &
NEUROTRANSMITTERS, CONTRIBUTING TO THE DEVELOPMENT OF A
PERSONALITY THAT IS MORE SENSITIVE TO THE PEER PRESSURE.
• WITHDRAWAL & REINFORCING EFFECTS OF DRUGS.
•CO-MORBID MEDICAL DISORDER (EG: TO CONTROL CHRONIC PAIN)

9. BEHAVIORAL THEORIES
• DRUG ABUSE AS THE RESULT OF CONDITIONING / CUMULATIVE
REINFORCEMENT FROM DRUG USE.
• DRUG USE CAUSES EUPHORIC EXPERIENCE PERCEIVED AS REWARDING,
THEREBY MOTIVATING USER TO STOP TAKING THE DRUG AND
SUBSTANCES
• STIMULI & SETTING ASSOCIATED WITH DRUG USE MAY THEMSELVES
BECOME REINFORCING OR MAY TRIGGER DRUG CRAVING THAT CAN LEAD
TO RELAPSE.

10. PSYCHOLOGICAL FACTORS
• GENERAL REBELLIOUSNESS
• SENSE OF INFERIORITY
• POOR IMPULSE CONTROL
• LOW SELF-ESTEEM
• INABILITY TO COPE UP WITH THE PRESSURES OF LIVING & SOCIETY (POOR STRESS
MANAGEMENT SKILLS)
• LONELINESS, UNMET NEEDS
• DESIRE TO ESCAPE FROM REALITY
• DESIRE TO EXPERIMENT, A SENSE OF ADVENTURE
• PLEASURE SEEKING
• SEXUAL IMMATURITY

11. SOCIAL FACTORS
• RELIGIOUS REASONS, PEER PRESSURE
• URBANIZATION, EXTENDED PERIOD OF EDUCATION
• UNEMPLOYMENT, OVERCROWDING
• POOR SOCIAL SUPPORT
• EFFECTS OF TELEVISION & OTHER MASS MEDIA
• OCCUPATION: SUBSTANCE USE IS MORE COMMON IN CHEFS, BARMEN, EXECUTIVES,
SALESMAN, ACTORS, ENTERTAINERS, ARMY- PERSONNEL, JOURNALISTS, MEDICAL
PERSONNEL, ETC.,

12. CONSEQUENCES OF SUBSTANCE ABUSE
• THIS COMMONLY LEADS TO PHYSICAL DEPENDENCE, PSYCHOLOGICAL DEPENDENCE
OR BOTH.
• IT MAY CAUSE UNHEALTHY LIFESTYLES & BEHAVIOURS SUCH AS POOR DIET.
• CHRONIC SUBSTANCE ABUSE IMPAIRS SOCIAL & OCCUPATIONAL FUNCTIONING,
CREATING PERSONAL, PROFESSIONAL, FINANCIAL, & LEGAL PROBLEMS (DRUG
SEEKING IS COMMONLY ASSOCIATED WITH ILLEGAL ACTIVITIES, SUCH AS ROBBERY
OR ASSAULT).

13. • DRUG USE BEGINNING IN EARLY ADOLESCENCE MAY LEAD TO EMOTIONAL &
BEHAVIORAL PROBLEMS, INCLUDING DEPRESSION, FAMILY PROBLEMS WITH
RELATIONS, PROBLEMS WITH OR FAILURE TO COMPLETE SCHOOL ETC.
• IN PREGNANT WOMEN, SUBSTANCE ABUSE JEOPARDIZES (DANGER OF LOSS) FETAL
AND MOTHER WELL-BEING.
• PSYCHOACTIVE SUBSTANCES PRODUCE NEGATIVE OUTCOMES IN MANY PATIENTS,
INCLUDING MALADAPTIVE BEHAVIOUR, “BAD TRIPS” – DRUG INDUCED PSYCHOSIS, &
EVEN LONG TERM PSYCHOSIS.
• DRUG ABUSE MAY LEAD TO LIFE THREATENING COMPLICATIONS.
• ILLICIT STREET DRUGS POSE ADDED DANGERS; MATERIALS USED TO DILUTE THEM
CAN CAUSE TOXIC OR ALLERGIC REACTIONS.

14. CLINICAL FEATURES:
• PHYSICAL SIGNS
• INABILITY TO SLEEP, AWAKE AT UNUSUAL TIMES, UNUSUAL LAZINESS.
• LOSS OR INCREASED IN APPETITE, CHANGES IN EATING HABITS
• COLD, SWEATY PALMS & SHAKING HANDS (TREMORS)
• RED, WATERY EYES, PUPILS LARGER OR SMALLER THAN USUAL
• UNUSUAL SMELLS ON BREATH, BODY OR CLOTHES. (BAD ODOUR)
• EXTREME HYPERACTIVITY & EXCESSIVE TALKATIVENESS.
• SLOWED OR STAGGERING WALK & POOR PHYSICAL COORDINATION.

15. •IRREGULAR HEARTBEAT.
•RUNNY NOSE & COUGH
•PUFFY FACE, BLUSHING OR PALENESS
•FREQUENT RUBBING OF THE NOSE (TICS)
•FREQUENT TWISTING OF THE JAW, BACK AND FORTH
•DETERIORATION OF HYGIENE OR PHYSICAL HEALTH
•NEEDLE MARKS ON LOWER ARM, LEG OR BOTTOM OF FEET.
•NAUSEA, VOMITING OR EXCESSIVE SWEATING.
•TREMORS OR SHAKES OF HANDS, FEET OR HEAD.

16. BEHAVIORAL SIGNS:
•CHANGE IN OVERALL ATTITUDE/PERSONALITY WITH NO OTHER
IDENTIFIABLE CAUSE.
•DROP IN GRADES AT SCHOOL OR PERFORMANCE AT WORK;
•SKIPS SCHOOL OR IS LATE FOR SCHOOL.
•CHANGE IN ACTIVITIES OR HOBBIES.
•CHRONIC DISHONESTY.
•SUDDEN OVER SENSITIVITY, TEMPER TANTRUMS, OR RESENTFUL
BEHAVIOR.
•DIFFICULTY IN PAYING ATTENTION & FORGETFULNESS.

17. • GENERAL LACK OF MOTIVATION, ENERGY, SELF-ESTEEM, “I DON’T CARE” ATTITUDE.
• CHANGE IN HABITS AT HOME; LOSS OF INTEREST IN FAMILY AND FAMILY ACTIVITIES.
• PARANOIA
• SILLINESS OR GIDDINESS.
• MOODINESS, IRRITABILITY, OR NERVOUSNESS.
• EXCESSIVE NEED FOR PRIVACY; UNREACHABLE.
• SECRETIVE OR SUSPICIOUS BEHAVIOUR.
• CAR ACCIDENTS.
• CHANGE IN PERSONAL GROOMING HABITS.
• POSSESSION OF DRUG PARAPHERNALIA.
• CHANGES IN FRIENDS: FRIENDS ARE KNOWN DRUG USERS.
• UNEXPLAINED NEED FOR MONEY, STEALING MONEY OR ITEMS
• MISSING PRESCRIPTION PILLS
• COMPLAINTS OF A SORE JAW

18. SIGNS OF INTOXICATION, BY SPECIFIC
DRUG
• MARIJUANA
GLASSY, RED EYES; LOUD TALKING AND INAPPROPRIATE LAUGHTER FOLLOWED BY SLEEPINESS;
A SWEET BURNT SCENT; LOSS OF INTEREST, MOTIVATION; WEIGHT GAIN OR LOSS.
• ALCOHOL
CLUMSINESS; DIFFICULTY WALKING; SLURRED SPEECH; SLEEPINESS; POOR JUDGMENT; DILATED
PUPILS.
• COCAINE, CRACK, METH, AND OTHER STIMULANTS
HYPERACTIVITY; EUPHORIA; IRRITABILITY; ANXIETY; EXCESSIVE TALKING FOLLOWED BY
DEPRESSION OR EXCESSIVE SLEEPING AT ODD TIMES; GO LONG PERIODS OF TIME WITHOUT
EATING OR SLEEPING; DILATED PUPILS; WEIGHT LOSS; DRY MOUTH AND NOSE.
• HEROIN
NEEDLE MARKS; SLEEPING AT UNUSUAL TIMES; SWEATING; VOMITING; COUGHING AND
SNIFFLING; TWITCHING; LOSS OF APPETITE; CONTRACTED PUPILS; NO RESPONSE OF PUPILS TO
LIGHT.

19. • DEPRESSANTS (INCLUDING BARBITURATES AND TRANQUILIZERS)
SEEMS DRUNK AS IF FROM ALCOHOL BUT WITHOUT THE ASSOCIATED ODOR OF ALCOHOL;
DIFFICULTY CONCENTRATING; CLUMSINESS; POOR JUDGMENT; SLURRED SPEECH;
SLEEPINESS; AND CONTRACTED PUPILS.
• INHALANTS (GLUES, AEROSOLS, AND VAPORS)
WATERY EYES; IMPAIRED VISION, MEMORY AND THOUGHT; SECRETIONS FROM THE NOSE
OR RASHES AROUND THE NOSE AND MOUTH; HEADACHES AND NAUSEA; APPEARANCE OF
INTOXICATION; DROWSINESS; POOR MUSCLE CONTROL; ANXIETY; IRRITABILITY
• HALLUCINOGENS
DILATED PUPILS; BIZARRE AND IRRATIONAL BEHAVIOR INCLUDING PARANOIA,
AGGRESSION, HALLUCINATIONS; MOOD SWINGS; DETACHMENT FROM PEOPLE;
ABSORPTION WITH SELF OR OTHER OBJECTS, SLURRED SPEECH; CONFUSION.

20. MANAGEMENT OF SUBSTANCE
ABUSE/DEPENDENCE
• THE FIRST IS ABSTINENCE FROM THE SUBSTANCE
• THE SECOND IS PHYSICAL, PSYCHIATRIC, AND PSYCHOSOCIAL WELL-BEING OF THE
PATIENT.
• INPATIENT OR OUTPATIENT SETTINGS.
• DETOXIFICATION,
• REHABILITATION.
• THROUGHOUT TREATMENT, INDIVIDUAL, FAMILY, AND GROUP THERAPIES (ALCOHOLIC &
NARCOTIC ANONYMOUS) CAN BE EFFECTIVE.
• ANY UNDERLING PSYCHIATRIC DISORDER SHOULD BE DIAGNOSED AND APPROPRIATELY
TREATED

21. PHARMACOLOGICAL TREATMENT OF
SUBSTANCE ABUSE :
• NALTREXONE (AN OPIATE RECEPTOR BLOCKING AGENT) DECREASES ALCOHOL CONSUMPTION
AND RELAPSE IN ALCOHOLIC PATIENTS, ALSO IN OPIATE ABUSE.
• NICOTINE REPLACEMENT USING NICOTINE GUM, PATCH, SPRAY AND INHALATION HAVE BEEN
USED WITH SUCCESSFUL RESULTS IN NICOTINE DEPENDENCE.
• METHADONE - AN OPIATE RECEPTOR AGONIST PROVED TO BE HIGHLY EFFECTIVE IN
ABSTINENCE .
• ANTIPSYCHOTIC MEDICATIONS HAVE NOT BEEN FOUND TO BE USEFUL. ACAMPROSTATE IS A
GLUTAMATERGIC NMDAANTAGONIST, WHICH HELPS WITH ALCOHOL WITHDRAWAL
SYMPTOMS BECAUSE ALCOHOL WITHDRAWAL IS ASSOCIATED WITH A HYPERGLUTAMATERGIC
SYSTEM.
• PSYCHEDELICS, SUCH AS LSD AND PSILOCIN, MAY HAVE ANTI-ADDICTIVE PROPERTIES.

22. NURSING MANAGEMENT :
.ACTIVITIES PERFORMED BY A NURSE ON ADMISSION
• MEETING THE BASIC NEEDS.
• DEVELOPING THERAPEUTIC RELATIONSHIP.
• CAREFULLY MONITORING THE VITALS.
• COLLECTING COMPREHENSIVE HISTORY.
• GENERAL PHYSICAL EXAMINATION & MENTAL STATUS EXAMINATION.
• EXPLAIN ABOUT WARD RULES, REGULATIONS, CHARGES &
ACTIVITIES.
• LAB INVESTIGATIONS

23. ACTIVITIES:
• GROUP THERAPIES – CONDUCTED BY PSYCHIATRIC SOCIAL
WORKERS, ATTENDED AND SUPERVISED BY NURSING STAFF.
•RELAPSE PREVENTION SKILLS
• MOTIVATION
• TRIGGERS OF CRAVING AND HOW TO HANDLE IT.
• PROBLEM SOLVING TECHNIQUES
• DEVELOPING ACTIVITY PLAN.
• PLANNING SUBSTANCE FREE LIFE.

24. ACTIVITIES CONTU……..
• COGNITIVE BEHAVIOURAL THERAPY (CBT) AND FAMILY THERAPY CURRENTLY HAS THE MOST
RESEARCH EVIDENCE FOR THE TREATMENT OF SUBSTANCE ABUSE PROBLEMS.
• BEHAVIOURAL MARITAL THERAPY,
• MOTIVATIONAL INTERVIEWING,
• COMMUNITY REINFORCEMENT APPROACH,
• EXPOSURE THERAPY,
• CONTINGENCY MANAGEMENT
• DAILY WARD ACTIVITIES
• EXERCISE
• ENTERTAINMENT PROGRAMS
• SPIRITUALACTIVITIES
• HEALTH EDUCATION ON COMPLICATIONS AND MANAGEMENT OF SUBSTANCE ABUSE.

25. NURSES ROLE ON SUBSTANCE
ABUSING PATIENT’S :
• NURSE PLAY A VITAL ROLE IN THE CARE OF CLIENTS EXPERIENCING INTOXICATION AND
WITHDRAWAL
• NURSES ALSO MEET THE BASIC NEEDS LIKE SAFETY, HYGIENE, COMFORT, CALM & QUITE
ENVIRONMENT OF THE PATIENTS.
• ADMINISTER SUBSTITUTION THERAPY AS ORDERED.
• HELP THE PATIENT TO UNDERSTAND & IDENTIFY THE CAUSES OF SUBSTANCE DEPENDENCE
OR SUBSTANCE ABUSE AND THE NEED OF LIFE CHANGES.
• DEVELOP TRUST, CORRECT MISCONCEPTIONS, DO NOT ALLOW BLAMING OTHERS, IDENTIFY
THE MAL ADAPTIVE BEHAVIOURS FOR INEFFECTIVE DENIAL.

26. ROLE OF NURSE CONTI…..
• MAINTENANCE OF STRICT SELF DISCIPLINE BY ONGOING SUPERVISION.
• ASPD – SET LIMITS ON MANIPULATIVE BEHAVIOUR, EXPLORE OPTIONS OF
DEALING WITH STRESS & TO GIVE POSITIVE REINFORCEMENT FOR INEFFECTIVE
COPING.
• RESTRICT ACCESS TO ADDICTING SUBSTANCES.
• TEACH ABOUT SKILLS LIKE RELAPSE PREVENTION, SUPPORTIVE SKILLS &
DEVELOPMENTAL SESSIONS.
• ADVICE ON HEALTH HAZARDS OF INJECTING (ABSCESS HIV, HBS AG ETC..)
• ENCOURAGE THE PATIENT TO FOCUS ON THE PRESENT AND FUTURE NOT THE
PAST.

27. ROLE OF NURSE CONTI….
• BEHAVING TO PATIENTS IN SUCH A CONSISTENT MANNER CONFRONTING THEM IN
A NON JUDGMENTAL, NON PUNITIVE MANNER.
• HELPING THE PATIENTS AND FAMILY TO FOLLOW THE WARD DISCIPLINE
EFFECTIVELY BY STRICT RULES OF SMUGGLING THE SUBSTANCES INSIDE THE
WARD.
• RANDOM CHECK OF PATIENTS AND HIS BELONGINGS.
• MONITORING THE SIGNS AND SYMPTOMS OF INTOXICATION.
• VIOLATION OF RULES MUST BE HANDLED BY ALL THE TREATING MEMBERS.
• ON DISCHARGE THE PATIENTS ARE INSTRUCTED ABOUT THE NEED FOR REGULAR
FOLLOW UP AND TO CONTINUE THE MEDICATIONS.
• ADVICE THE PATIENT TO GET INVOLVED IN ACTIVITIES.

28. ROLE OF NURSE CONTI….
• TEACHING THE FAMILY ABOUT THE SUBSTANCE ABUSE & ITS
EFFECTS ON THE ENTIRE FAMILY.
• MEETING THE POTENTIAL HEALTH PROBLEMS & NUTRITION
ADVICES FOR PATIENTS AND THE FAMILY MEMBERS.
• EXPLAIN THE FAMILY MEMBERS ABOUT THE NEED OF CARE,
SUPPORT AND CONCERN TOWARDS THE PATIENT.