Substance-related Disorders students.ppt

1. Substance-related Disorders

2. Substance-Use Disorders
Substance Abuse DSM-IV-TR Criteria
• Recurrent substance-related legal problems
• Continued substance use despite having
persistent or recurrent social or interpersonal
problems

3. Substance Dependence
• Physical dependence
Substance Dependence (cont.)
• Psychological dependence
Extremely powerful, producing intense craving for a substance as well as
compulsive use of it
Substance Dependence DSM-IV-TR Criteria
• Evidence of tolerance
– Evidence of withdrawal
– Symptoms associated with the substance
– Substance taken to relieve withdrawal symptoms

4. -Substance often taken in larger amounts
or over a longer period
• Persistent desire or unsuccessful efforts to
cut down or control use
• A great deal of time is spent
– Obtaining the substance
– Using the substance
– Recovering from the effects
• Social, occupational, recreational activities
given up or decreased

5. • Substance use continued despite knowledge
of having a persistent or recurrent physical or
psychological problem

6. Substance Intoxication DSM-IV-TR Criteria
• Development of reversible substance
syndrome caused by recurrent ingestion of
substance
• Clinically significant maladaptive behavior or
psychological changes
– Resulting from the effect of the substance on the CNS
– Developed during or shortly after use of substance
Symptoms not due to a general medical condition
and not better accounted for by another mental
disorder

7. Substance Withdrawal DSM-IV-TR Criteria
• Development of a substance-specific syndrome
caused by cessation of or reduction in heavy and
prolonged substance use
• Clinically significant distress or impairment in
• Symptoms not due to a general medical condition
and not better accounted for by another mental
disorder.

8. Classes of Psychoactive Substances
• Alcohol
• Amphetamines and
related substances
• Caffeine
• Cannabis
• Cocaine
• Hallucinogens
• Inhalants
• Nicotine
• Opioids
• Phencyclidine and
related substances
• Sedatives, hypnotics, or
anxiolytics

9. Biological Factors
• Genetics: apparent hereditary factor, particularly with alcoholism
Biochemical: alcohol may produce morphine-like substances in the
brain that are responsible for alcohol addiction
Psychological Factors
• Developmental influences:
– Punitive superego
– Fixation in the oral stage of psychosexual development
• Personality factors: certain personality traits suggested to play a part in both
development and maintenance of alcohol dependence, including
– Low self-esteem
– Frequent depression
– Passivity
– Inability to relax or defer gratification
– Inability to communicate effectively
Predisposing Factors

10. Sociocultural Factors
• Social learning: children and adolescents more likely to
use substances with parents who provide model for
substance use
• Use of substances may also be promoted within peer
group
• Conditioning: pleasurable effects from substance use
act as a positive reinforcement for continued use of
substance
• Cultural and ethnic influences:
some cultures are more prone
to the abuse of substances
than others

11. Alcohol: Patterns of Use or Abuse
Alcohol Abuse and Dependence
Patterns of Use or Abuse
• Phase I: Prealcoholic phase: characterized by use of
alcohol to relieve everyday stress and tensions of life
• Phase II: Early alcoholic phase: begins with blackouts:
brief periods of amnesia that occur during or
immediately following a period of
drinking; alcohol is now required by the person.
• Phase III: The crucial phase: person has lost control;
physiological dependence clearly evident
• Phase IV: The chronic phase: characterized by
emotional and physical disintegration; person is usually
intoxicated more often than sober

12. Alcohol: Effects on the Body
• Peripheral neuropathy characterized by:
– Peripheral nerve damage
• Alcohol myopathy
– Acute:
– Chronic:
• Wernicke’s encephalopathy
• Korsakoff’s psychosis
• Alcoholic cardiomyopathy
Effect of alcohol on the heart is in an accumulation of lipids
in the myocardial cells, resulting in enlargement and a
weakened condition.

13. • Esophagitis
• Gastritis
• Pancreatitis
– Acute:
– Chronic:

14. • Alcoholic hepatitis
– Caused by long-term heavy alcohol use
– Symptoms:
• Cirrhosis of the liver
– Portal hypertension:
– Ascites:
– Esophageal varices:.
– Hepatic encephalopathy:
• Leukopenia
• Thrombocytopenia

15. • Sexual dysfunction
• Alcohol intoxication
Occurs at blood alcohol levels between 100
and 200 mg/dL
• Alcohol withdrawal
Occurs within 4 to 12 hours of cessation of or
reduction in heavy and prolonged alcohol use.

16. Sedative, Hypnotic, or Anxiolytic
Abuse and Dependence
• A profile of the substance
– Barbiturates
– Nonbarbiturate hypnotics
– Antianxiety agents
• Pattern of use/abuse
• Effects on the body
• Intoxication
• Withdrawal

17. CNS Stimulant Abuse and
Dependence
• A profile of the substance
– Amphetamines
– Nonamphetamine stimulants
– Cocaine
– Caffeine
– Nicotine
• Patterns of use and abuse
• Effects on the body
– CNS effects
– Cardiovascular effects
– Pulmonary effects
– GI and renal effects
– Sexual functioning

18. • Intoxication
– Amphetamine and cocaine intoxication produces euphoria or affective
blunting, hypervigilance, anxiety, tension, anger, and impaired
judgment.
– Physical effects include tachycardia or bradycardia, pupillary dilation,
elevated or lowered blood pressure, perspiration or chills, nausea or
vomiting, weight loss, psychomotor agitation or retardation, muscular
weakness, respiratory
depression, chest pain,
confusion, seizures, coma.
– Intoxication from caffeine usually occurs following consumption
in excess of 250 mg
– Symptoms include restlessness, nervousness, excitement,
insomnia, flushed face, diuresis, GI disturbance, muscle
twitching, rambling flow of thoughts and speech,
tachycardia or cardiac arrhythmia, periods of
inexhaustibility, and psychomotor agitation.

19. Withdrawal
– From amphetamines and cocaine may include dysphoria,
fatigue, sleep disturbances, increased appetite, and
psychomotor retardation or agitation.
– From caffeine may include headache, fatigue, anxiety,
irritability, depression, impaired psychomotor
performance, nausea, vomiting, craving for caffeine, and
muscle pain and stiffness
– From nicotine may include dysphoria, anxiety, difficulty
concentrating, restlessness, insomnia, irritability,
frustration, decreased heart rate, and increased appetite

20. Inhalant Abuse and Dependence
• A profile of the substance
– Aliphatic and aromatic hydrocarbons found in substances such as
fuels, solvents, adhesives, aerosol propellants,
and paint thinners
• A profile of the substance
– Aliphatic and aromatic hydrocarbons found in substances such as
fuels, solvents, adhesives, aerosol propellants,
and paint thinners
• Patterns of use/abuse
• Effects on the body
– CNS effects
– Respiratory effects
– GI effects
– Renal system effects

21. • Inhalant Intoxication
– Develops during or shortly after use of or
exposure to volatile inhalants
– Symptoms include
• Dizziness, incoordination, unsteady gait
• Nystagmus, slurred speech, tremor
• Lethargy, psychomotor retardation
• Blurred vision, euphoria
• Stupor or coma

22. Opioid Abuse and Dependence
• A profile of the substance
– Opioids of natural origin
– Opioid derivatives
– Synthetic opiate-like drugs
• Patterns of use or abuse
• Effects on the body
– CNS
– Gastrointestinal effects
– Cardiovascular effects
– Sexual functioning
• Intoxication
– Symptoms are consistent with the half-life of most opioid drugs
and usually last for several hours.
– Symptoms include initial euphoria followed by apathy, dysphoria,
psychomotor agitation or retardation, and impaired judgment.
– Severe opioid intoxication can lead to respiratory depression,
coma, and death.

23. Withdrawal
– From short-acting drugs (e.g., heroin):
• Symptoms occur within 6–12 hr and subside in 5–7
days
– From long-acting drugs (e.g., methadone):
• Symptoms occur within 1–3 days and subside in 10–14
days
– From ultra-short-acting meperidine:
• Symptoms begin quickly, peak in 8–12 hr, and subside
in 4–5 days
• Symptoms of Opioid Withdrawal

24. Hallucinogen Abuse and Dependence
• A profile of the substance
– Naturally occurring hallucinogens
– Synthetic compounds
• Patterns of use/abuse
– Use is usually episodic
• Hallucinogen intoxication
– Occurs within minutes to a few hours after using drug
– Symptoms include perceptual alteration,
depersonalization, derealization, tachycardia,
palpitations

25. Effects on the Body
• Physiological
– Nausea/vomiting
– Chills
– Pupil dilation
– Increased BP, pulse
– Loss of appetite
– Insomnia
– Elevated blood sugar
– Decreased respirations
• Psychological
– Heightened response to color,
sounds
– Distorted vision
– Sense of slowed time
– Magnified feelings
– Paranoia, panic
– Euphoria, peace
– Depersonalization
– Derealization
– Increased libido

26. • Hallucinogen intoxication
– Symptoms of PCP intoxication include belligerence and assaultiveness and may proceed to
seizures or coma
Cannabis Abuse and Dependence
• A profile of the substance
– Marijuana
– Hashish
• Patterns of use or abuse
• Effects on the body
– Cardiovascular effects
– Respiratory effects
– Reproductive effects
– CNS effects
– Sexual functioning
• Intoxication
– Symptoms include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired
judgment.
– Physical symptoms include conjunctival injection, increased appetite, dry mouth, and tachycardia.
– Impairment of motor skills lasts for 8 to 12 hours.

27. Assessment
• Various assessment tools are available for determining the
extent of the problem a client has with substances
– Michigan Alcoholism Screening Test (MAST)
– CAGE Questionnaire
• CAGE Questionnaire
– Have 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 to
steady your nerves (Eye-opener)

28. Nursing Diagnosis
Dual Diagnosis

29. • Detoxification
– Provide safe and supportive environment
– Administer substitution therapy
• Intermediate Care
– Provide explanations of physical symptoms.
– Promote understanding and identify causes of substance
dependency.
– Provide education and assistance to client and family.
• Rehabilitation
• Nature of the illness
• Management of the illness

30. Treatment Modalities for Substance-
Related Disorders
• Alcoholics Anonymous
• Disulfiram (Antabuse)
• Other medications for treatment
of alcoholism
• Counseling
• Group therapy
• Alcohol
– Benzodiazepines
– Anticonvulsants
– Multivitamin therapy
– Thiamine
• Opioids
– Narcotic antagonists
• Naloxone (Narcan)
• Naltrexone (ReVia)
• Nalmefene (Revex)
– Methadone
– Buprenorphine
– Clonidine
• Stimulants
– Minor tranquilizers
– Major tranquilizers
– Anticonvulsants
– Antidepressants
• Hallucinogens and Cannabinols
– Benzodiazepines
– Antipsychotics