10 Substance Abuse

Substance Related Disorder

Paraggua, Resimin Plata, Alyssa Robin, Antonio Lorenzo Rogacion, Alex Substance-Related Disorders - Refers to the use and abuse of alcohol and illicit drugs or substances.
Alcohol is known to shorten an individual's life span by 12 to 15 years unless treatment is received. Like other chronic illnesses, it has certain observable symptoms. For example, tolerance occurs as the individual drinks more with less effect. Withdrawal occurs when an individual abruptly stops drinking after alcohol has become a necessity of life to maintain functioning. Finally, alcoholism CAN BE FATAL. The same can be said for substance abuse, because both the alcoholic and the substance or drug abuser lose control over when they drink or take drugs, how much they take, and where the abuse occurs.

Overview of Substance Related Disorder

Terminology Associated With SubstanceRelated Disorders: Addiction - an illness characterized by compulsion, loss of control, and continued patterns of abuse despite perceived negative consequences. Habituation (psychological dependence) - describe a continuous or intermittent craving for a substance to avoid a dysphoric or unpleasant mood state. Tolerance - person's ability to obtain a desired effect from a specific dose of a drug. Physiologic dependence - physical effects resulting from the multiple episodes of substance use. Behavioural Dependence - substanceseeking activities and pathological use patterns of the person using the substance. FACT: In 1964, the World Health Organization (WHO) suggested substituting the term drug dependence for addiction to better describe the two concepts of dependence: behavioral dependence and physiologic dependence.

Clinical Symptoms and Diagnostic Characteristics of SubstanceRelated Disorders

Two categories of alcohol-related disorders are included in this classification: Alcohol Dependence Characterized by tolerance to alcohol or by the development of withdrawal phenomena upon cessation of or reduction in intake. Essential features: cluster of cognitive, behavioural, and physiologic symptoms indicating that the individual continues use of the alcohol despite critical alcohol-related problems. * There is a maladaptive pattern of alcohol use resulting in distress as the individual experiences a cluster of three or more of seven stated symptoms during a 12-month period: Tolerance. Withdrawal symptoms or the continued use of alcohol to relieve or avoid withdrawal symptoms. Intended intake of alcohol in larger amounts or over a longer period of time. Persistent desire or unsuccessful efforts to cut down or control use of alcohol. A significant amount of time spent in activities necessary to obtain alcohol, drink alcohol, or recover from its effects.

Epidemiology of Substance-Related Disorders

Substance-related disorders are responsible for: Dysfunctional marital and family relationships Divorce Desertion Child abuse Displaced children Impoverished families

Disease Concept of Alcoholism

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Social, occupational, or recreational activities given up or reduced because of drinking alcohol. Continued drinking of alcohol despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. and prolonged alcohol consumption. Clinical symptoms Autonomic hyperactivity Increased hand tremor Sleep disturbances (insomnia, or nightmares) Nausea or vomiting Transient visual, tactile, or auditory hallucinations or illusions Psychomotor agitation Anxiety Grand mal seizures Alcohol Withdrawal Delirium (delirium tremens) Occurs from 24 to 72 hours after the client's last drink Clinical symptoms: Elevation of vital signs Restlessness Tremulousness Agitation Hyperalertness Exaggerated movements Illusions and hallucinations Incoherence Alcoholic-Induced Persisting Dementia May develop from prolonged/chronic dependence on alcohol Clinical symptom: Severe loss of intellectual ability that interferes with social or occupational functioning Impaired memory judgment, and abstract thinking. Alcoholic-Induced Persisting Amnestic Disorder Individuals who drink large amounts of alcohol over a prolonged period often have poor nutritional habits. Two CNS disorders are associated with alcoholism:

Alcohol Abuse Disorder The criteria for alcohol abuse disorder do not include tolerance, withdrawal, or a pattern of compulsive use. *The individual exhibits one or more of the following symptoms in a 12-month period: Recurrent drinking of alcohol resulting in a failure to fulfill major role obligations at work, school, or home. Recurrent drinking in situations in which it is physically hazardous. Recurrent alcohol-related legal problems. Continued use despite having persistent or recurrent social or interpersonal problems caused by alcoholism. ALCOHOL-INDUCED DISORDERS Alcohol Intoxication Occurs after the recent ingestion of alcohol Evidenced by behavioural changes: Impaired social or occupational functioning Fighting Impaired judgment Mood changes: Increased verbalization Impaired attention span Irritability Alcohol Withdrawal Symptoms of alcohol withdrawal within several hours to a few days after the cessation or reduction of heavy

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1. Korsakoff's Psychosis i. A form of amnesia characterized by a loss of short-term memory and the inability to learn new skills. ii. Clinical symptoms: 1. Disorientation 2. Use of confabulation Wernicke's Encephalopathy i. An inflammatory hemorrhagic, degenerative condition of the brain caused by a Thiamine Deficiency. ii. Clinical symptoms: 1. Double vision 2. Involuntary and rapid eye movements 3. Lack of muscular coordination 4. Mild or severe decrease in mental function Barbiturates Group of drugs in the class of drugs known as sedative hypnotics, which generally describes their sleep inducing and anxiety-decreasing effects. Overdose: Coma Respiratory arrest Cardiac failure Death Treatment Lavage Dialysis Withdrawal: Autonomic hyperactivity (increased pulse, blood pressure, respirations, and temperature) Hand tremor Insomnia Anxiety Nausea Psychomotor agitation Detoxification: Tapering, or administering decreasing doses of a medication, is essential with barbiturates to prevent coma and death that will occur if the drug is stopped abruptly.

2.

Sedatives, Hypnotics and Anxiolytics

These drugs are used to relax the CNS or slow down body processes. They temporarily ease tension and induce sleep. Substance Included: Benzodiazepines Barbiturates Carbamates Hypnotics All prescription sleeping medications All anxiolytic medications Intoxication symptoms: Slurred speech Lack of coordination Unsteady gait Labile mood Impaired attention or memory Stupor and coma Benzodiazepines Slow down the activity of the central nervous system and the messages going between the brain and the body. Overdose: Lethargic Confused Treatment Gastric lavage followed by ingestion of activated charcoal Saline cathartic Dialysis (if severe)

Opioids
Narcotic drugs that induce sleep, suppress coughing, and alleviate pain. Intoxication symptoms: Apathy Lethargy Impaired judgment Psychomotor retardation or agitation Constricted pupils Drowsiness Slurred speech Impaired attention and memory Overdose: Coma Respiratory depression Pupillary constriction Unconsciousness Death Naloxone (Narcan) Withdrawal: o Initial symptoms: Anxiety Restlessness

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Aching back and legs Cravings for more opioids Symptoms that develop as withdrawal progresses: o Nausea o Vomiting o Dysphoria o Lacrimation o Rhinorrhea o Sweating o Diarrhea o Yawning o Fever o Insomnia Nicotine can be used as a pesticide on crops. How is Nicotine used? Tobacco can be: Smoked in cigarettes, cigars or pipes It can be chewed It can be powdered, sniffed How many teens use nicotine? More than 3 and one-half million teens between the ages of 12 and 17 use tobacco-that's about 15 percent of teens that age. Of those, just over 3 million, or 13 percent, smoke cigarettes. In the U.S., 66.5 million people, or about 29 percent of the population, use tobacco. Nicotine Effects:
With each puff of a cigarette, a smoker pulls nicotine into his or her lungs where it is absorbed into the blood. In eight seconds, nicotine is in the brain, changing the way the brain works. Acetylcholine is one of many chemicals called neurotransmitters that carry messages between brain cells. Nicotine locks into acetylcholine receptors in different parts of the brain: raises the heart rate and respiration (breathing) rate, and causes more glucose, or blood sugar, to be released into the blood. Nicotine also attaches to neurons (brain cells) that release a neurotransmitter called dopamine. Dopamine stimulates the brain's pleasure and reward circuit, a group of brain structures called the limbic system involved in appetite, learning, memory, and feelings of pleasure. Tobacco smoke contains more than 4,000 chemicals. Besides nicotine, the most dangerous chemicals in cigarette smoke are tar and carbon monoxide. Smokers also have a dulled sense of smell and taste, reduced stamina for exercise and sports, and they smell of smoke.

Caffeine
Caffeine is available in a variety of sources such as coffee, soda,tea, OTC analgesics and cold remedies, stimulants, and weight-loss aids. Intoxication symptoms: o Restlessness o Nervousness o Excitement o Insomnia o Flushed face o Diuresis o Gastrointestinal disturbance o Muscle twitching o Psychomotor agitation o Tachycardia or arrhythmia o Rambling thoughts or speech Overdose: o Jitters o Increased heartbeat o Nausea o Anxiety o Heart palpitations o Insomnia o Sweating o Dizziness o Vomitin g o Cardiac arrest

NICOTINE and INHALANTS

What is Nicotine? Nicotine is the drug in tobacco leaves. Whether someone smokes, chews, or sniffs tobacco, he or she is delivering nicotine to the brain. Each cigarette contains about 10 milligrams of nicotine.

Tobacco Kills Each year, nearly half a million Americans die from tobacco use. One of every six deaths in the United States is a result of smoking tobacco, making tobacco more lethal than all other addictive drugs combined.

Treatment
Smoking cessation Nicotine Replacement Therapy: Transdermal patches chewing gum

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inhalators tablets and lozenges nasal spray Electronic cigarette Medications: Buproprion Varenicline
A hemp plant that is widely cultivated for its fiber used to make rope and cloth and for oil from its seeds This resin contains more than 60 substance called CANNABINOIDS 9-Tetrahydrocannabinol is responsible for most psychoactive effect Cannabis is most often smoked in cigarettes but it can be eaten. Cannabis has short term effects of lowering intraocular pressure, but not approved for the treatment of Glaucoma Cannabis begins to act less than 1 min after inhalation. Peak effects usually occur 20-30 min and last at least 2 to 3 hours. Users reports: HIGH FEELING

What are inhalants?

Inhalants are a diverse group of drugs including anaesthetics, nitrates, and organic solvents that are inhaled for their effects. The most common substances in this category are aliphatic and aromatic hydrocarbons found in gasoline, glue, paint thinner, and spray paint. Most of the vapours are inhaled from a rag soaked with the compound, from a paper or plastic bag, or directly from the container.

Inhalant effects Inhalant intoxication involves: Dizziness Nystagmus Lack of coordination Slurred speech Unsteady Gait Tremors Muscle Weakness Blurred Vision What are the kinds of inhalants? Solvents - paint thinners or removers, degreasers, dry-cleaning fluids, gasoline, and glue. Gases - butane lighters and propane tanks, whipping cream aerosols or dispensers (whippets), and refrigerant gases Nitrites - room odorizers; medicine Treatment Smoking cessation Nicotine Replacement Therapy: Transdermal patches chewing gum inhalators tablets and lozenges nasal spray Electronic cigarette Medications: Buproprion Varenicline

Symptoms of Intoxication Impaired motor coordination Inappropriate laughter, impaired judgment, short term memory, distortion of time and perception Excessive use may produce Delirium or rarely Cannabis induced psychotic disorder

Hallucinogens
Under the influence of hallucinogens, people see images, hear sounds, and feel sensations that seem real but do not exist. Some hallucinogens also produce rapid, intense emotional swings. Effects: Disrupting the interaction of nerve cells and the neurotransmitter serotonin Distributed throughout the brain and spinal cord LSD(Lysergic Acid Diethylamide) Drug most commonly identified with the term "hallucinogen" and the most widely used in this class of drugs. It is considered the typical hallucinogen. Examples of Hallucinogens 1. 2. 3. 4. Mescaline Psilocybin Lysergic Acid Diethylamide (LSD) Designer Drugs such as Ecstasy

Cannabis Sativa (Marijuana)

Cannabis Sativa

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Phencyclidine (PCP), developed as an anesthetic, is included in this section because it acts similarly to hallucinogens. INTOXICATION AND OVERDOSE
Hallucinogen intoxication: Anxiety Depression Paranoid ideation Ideas of reference Fear of losing ones mind Potentially dangerous behaviour such as jumping out a window in the belief that one can y (Abraham, 2000). Treatment of toxic reactions is supportive. Psychotic reactions are managed best by isolation from external stimuli; physical restraints may be necessary for the safety of the client and others. Overdoses of stimulants can result in seizures and coma; deaths Treatment with chlorpromazine (Thorazaine).
NURSING ISSUES WITHDRAWAL AND DETOXIFICATION Withdrawal from stimulants occurs within a few hours to several days after cessation of the drug and is not life threatening. Marked dysphoria is the primary symptom and is accompanied by fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation. Marked withdrawal symptoms are referred to as crashing; the person may experience depressive symptoms including suicidal ideation for several days. Stimulant withdrawal is not treated pharmacologically. Physicians, dentists, and nurses have far higher rates of dependence on controlled substances, such as opioids, stimulants, and sedatives, than other professionals. Health care professionals also have higher rates of alcoholism than the general population. One reason is thought to be the ease of obtaining controlled substances. General warning signs of abuse Poor work performance Frequent absenteeism Unusual Behaviour Slurred Speech Isolation from peers Incorrect drug counts Increased reports of pharmacy error Unexplained absences from the unit Trips to the bathroom after contact with controlled substances Self-awareness issues The nurse must examine his or her beliefs and attitudes about substance abuse A history of substance use in the nurses family can influence strongly his or her interaction with clients Examining ones own substance use or the use by close friends and family may be difficult and unpleasant but is necessary if the nurse is to have therapeutic relationships with clients Possible Nursing Diagnosis: Anxiety r/t misperception of environmental stimuli Ineffective health maintenance r/t chemical use Hopelessness r/t addiction Impaired social interaction r/t unpredictable or irresponsible behavior pattern Ineffective coping r/t effects of chemical use Nursing Interventions Provide a safe environment Promote sleep and rest Aversion therapy Detoxification Cognitive Behavioural Psychotherapy Interactive therapy

WITHDRAWAL AND DETOXIFICATION

No withdrawal syndrome has been identied for hallucinogens, although some people have reported a craving for the drug. Hallucinogens can produce ash backs, which are transient recurrences of perceptual disturbances like those experienced with hallucinogen use.

Stimulants
A drugs that stimulate or excite the central nervous system Amphetamines Used by people who wanted to lose weight or to stay awake. Cocaine An illegal drug with virtually no clinical use in medicine is highly addictive and a popular recreational drug because of the intense and immediate feeling of euphoria it produces. Methamphetamine Is particularly dangerous. It is highly addictive and causes psychotic behaviour. Brain damage related to its use is frequent, primarily as a result of the substances used to make it. Intoxication and Overdose Effects include: High or euphoric feeling Talkativeness Hyperactivity Anxiety Hypervigilance Grandiosity hallucinations Fighting Anger Stereotypic or repetitive behaviour impaired judgment

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