This document defines substance abuse and dependence, describes the signs and symptoms of intoxication and withdrawal for various classes of drugs, and outlines nursing considerations for treatment. Key classes discussed include alcohol, sedatives, stimulants, opioids, and hallucinogens. Intoxication can cause impaired control and risky behavior while withdrawal can involve symptoms like anxiety, insomnia, nausea and seizures. Treatment focuses on safety, monitoring, supportive care, and gradual medication-assisted withdrawal when needed.

1. SUBSTANCE ABUSE

2. D E F I N T I O N S
• DRUG ABUSE- The maladaptive and
consistent use of a drug despite social,
occupational, psychological, or physical
problems exacerbated by the drug ; or
recurrent use in situations that are
physically risky, such as driving while
intoxicated (APA 1994)

3. D E F I N T I O N S ( CONT..)
• DRUG DEPENDANCE- Impaired control of
drug use despite adverse consequences,
the development of a tolerance to the
drug, and the occurrence of withdrawal
symptoms when drug intake is reduced or
stopped

4. PHYSICAL DEPENDENCE
• CONSUMES MORE THAN INTENDED
• UNABLE TO CONTROL USE
• PREOCCUPIED WITH OBTAINING SUBSTANCE
• USES DURING risky ACTIVITIES
• USES RATHER THAN PARTICIPATES IN USUAL
ACTIVITIES

5. PHYSICAL DEPENDENCE (CONT.)
• USES DESPITE KNOWLEDGE THAT A PROBLEM
EXISTS
• SIGNIFICANT TOLERANCE DEVELOPS
• SYMPTOMS DEVELOP WITH REDUCTION
• SUBSTANCE TAKEN TO RELIEVE OR AVOID w/D
SYMPTOMS

6. CLASSES OF PSYCHOACTIVE
SUBSTANCES
• ALCOHOL
• NARCOTICS (Opioids, synthetics)
• SEDATIVES- HYPNOTICS
• STIMULANTS- Caffeine, Nicotine
Cocaine, Amphetamine

7. CLASSES OF PSYCHOACTIVE
SUBSTANCES
• HALLUCINOGENS
• CANNABIS
• INHALANTS
• RAVE AND TECHNO DRUGS “Designer
drugs”

8. ALCOHOL STATISTICS 2001
14 million Americans considered themselves
to be alcoholics (1 out of every 10)
USA- 53% of those surveyed stated they had
one or more relatives with an alcohol problem
Costs - $100 billion/year
30% of all traffic related fatalities
35 % of suicides
3rd leading cause of death in the USA

9. ALCOHOL
LEGAL INTOXICATION
• BLOOD ALCOHOL LEVEL 0.08
DEFENSE MECHANISMS
• DENIAL, PROJECTION, RATIONALIZATION
BEHAVIOR
• MANIPULATIVE

10. ALCOHOL ( CONT..)
WITHDRAWAL
• EARLY 6-8 HOURS AFTER LAST DRINK
• ANXIETY, ANOREXIA, INSOMNIA,, “SHAKY”,
DELIRIUM, PULSE & B.P., DIAPHORESIS
• POSSIBLE SEIZURES
• VISUAL, TACTILE HALLUCINATIONS

11. Nursing Diagnosis
Substance Abuse
 Risk for injury…. (withdrawal)
 Risk for violence to self… (withdrawal)
• Ineffective denial related to weak ego…
• Ineffective coping related to inadequate coping
skills…
• Low self-esteem related to a weak ego…
• Risk for infection related to altered immunity and
poor nutrition…
• Imbalanced nutrition less than body requirements/
fluid volume deficit related to not eating or
drinking….

12. TREATMENT OF ALCOHOL WITHDRAWAL
• SEDATIVES (Librium, Valium or Phenobarbital)
• THIAMINE
• MAGNESIUM SULFATE
• MULTIVITAMINS
• ANTIEMETICS
--------------------------------------------------------
• ANTABUSE Used only during rehabilitation phase

13. NURSING CARE
• FLUID-ELECTROLYTE REPLACEMENT
• MONITOR VITAL SIGNS
• SAFETY-ONE-TO ONE
• PRESENT REALITY, DECREASE ANXIETY
• SEIZURE PRECAUTIONS
• SUPPORTIVE LIMIT-SETTING
• REINFORCE DISEASE CONCEPT
• CONSISTENCY
• REFER TO ALCOHOLICS’ ANONYMOUS &
EDUCATION PROGRAM AFTER DETOX.

14. SEDATIVE, HYPNOTIC OR ANXIOLYTIC
INTOXICATION
• LABILITY
• DECREASED CONTROL OF IMPULSES/INHIBITIONS
• IRRITABLE
• SLURRED SPEECH
• INCOORDINATION/UNSTEADY GAIT
• IMPAIRED ATTENTION AND JUDGEMENT
• CAN LEAD TO COMA AND DEATH

15. SEDATIVE, HYPNOTIC OR ANXIOLYTIC (
CONT..)
WITHDRAWAL
• POTENTIAL FOR SEIZURES
• MUST BE W/D GRADUALLY

16. AMPHETAMINES
INTOXICATION
• INCREASED PULSE AND B.P.
• DILATED PUPIL
• GRANDIOSE/EUPHORIC
• PSYCHOSIS
• CONVULSIONS, COMA AND DEATH

17. AMPHETAMINES ( CONT..)
WITHDRAWAL
• DEPRESSION
• AGITATION
• SLEEPINESS
• DISORIENTATION
• APATHY

18. NURSING CARE FOR
AMPHETAMINE O/D AND W/D
OVERDOSE
MANAGEMENT FOR:
– INCREASED TEMP
– CONVULSIONS
– RESPIRATORY DISTRESS
– SHOCK
WITHDRAWAL
– ANTIDEPRESSIVE THERAPY

19. COCAINE / CRACK
INTOXICATION
• INCREASED PULSE AND B.P.
• DILATED PUPILS
• INSOMNIA
• ANOREXIA
OVERDOSE
• SEIZURES
• CARDIAC ARREST
• CONVULSIONS & DEATH

20. COCAINE / CRACK ( CONT..)
WITHDRAWAL
• FATIGUE
• DEPRESSION
• APATHY
• ANXIETY

21. NURSING CARE FOR
COCAINE / CRACK O/D AND W/D
SAME AS FOR
AMPHETAMINES

22. OPIODS / NARCOTICS
INTOXICATION
• DECREASED B.P. AND RESPIRATIONS
• CONSTRICTED PUPILS
• DROWSINESS
• SLURRED SPEECH
• PSYCHOMOTOR RETARDATION
• EUPHORIA/DYSPHORIA
• IMPAIRED MEMORY/JUDGEMENT

23. OPIODS / NARCOTICS ( CONT..)
OVERDOSE
• PUPILS CONSTRICTED, BUT CAN BE DILATED
• RESPIRATORY DEPRESSION/ARREST
• COMA
• SHOCK
• CONVULSIONS AND DEATH

24. OPIODS / NARCOTICS ( CONT..)
WITHDRAWAL
• YAWNING
• ANOREXIA
• INSOMNIA
• RUNNY NOSE
• CHILLS
• NAUSEA
• PILORECTION OF SKIN

26. NURSING CARE FOR O/D AND W/D
NARCOTICS
OVERDOSE
• NARCAN
WITHDRAWAL
• SUPPORTIVE MEASURES, IF NOT LIFE
THREATENING.
• (METHADONE MAY BE USED IN SEVERAL
SITUATIONS)

27. HALLUCINOGENS- LSD / PCP
INTOXICATION/OD
• INTENSIFIED PRECEPTIONS
• DILATED PUPILS AND TACHYCARDIA, TPR. AND BP
• ANXIETY/DEPRESSION
• ILLUSIONS AND HALLUCINATIONS
• DEPERSONALIZATION
• PANIC REACTION GRANDIOSITY, PARANOIA
PCP : ASSAULTIVENESS; JERKING; SEIZURES
LSD: “TRIPS” AND “FLASHBACKS”

28. HALLUCINOGENS- LSD / PCP
NURSING CARE
• BENZODIAZAPINES (eg, diazepam, lorazepam)
• ANTIPSYCHOTICS (eg, haloperidal)
• ROOMS WITH LOW STIMULATION
• LSD- STAY WITH THE PATIENT “TALK DOWN”
• PCP- SPEAK SLOWLY, CLEAR. DO NOT ATEMPT TO
“TALK DOWN”
• MEDICAL INTERVENTION FOR- HYPERTENSION,
HYPERTHERMIA, RESPIRATORY DISTRESS

29. CANNABIS
(CNS DEPRESSANT AND HALLUCINOGEN)
• ALTERED SENSORY PERCEPTIONS
• EUPHORIA, IMPAIRED COORDINATION
• SOCIAL WITHDRAWAL
• “RED EYES” EYE IRRITATION
• INCREASED APPETITE

30. PSYCHOPHARMACOLOGY
ADDICTION
ADDITIONAL MEDICATIONS USED
 TREXAN, REVIA
 ANTABUSE
 ZYBAN
 METHADONE
 CATAPRESS
 SUBUTEX
 NICOTINE PATCH