Transcript Chapter 16
Chapter 16
Addictive Disorders
Substance abuse
Abuse
Use of a substance that falls outside of medical necessity or
social acceptance resulting in adverse effects to the abuser or
others
Dependence or Addiction
Occurs when a tolerance to the drug occurs and the person has
to take more and more of the drug to prevent withdrawal
Operational Definition of Addiction
The 3 C’s
Craving to Compulsive spectrum
Continued use despite adverse consequences
Loss of Control
Prevalence
Lifetime prevalence for substance use disorders in US is
14.6%
Alcohol
Most common substance abused (17.6 million US
Illicit Drugs
Club drugs, cannabis, methamphetamines, heroin,
opiates, cocaine
Anabolic Steroids
Increased use 1-6% in athletes
Nicotine: 46 million in US
Comorbidity
Psychiatric
50%
with mental disorder also have substance use
disorder
High rate of suicide
Medical
Cardiovascular
Seizures/ Stroke
MI
Infections
Sclerotic
veins
Theory
Addiction
Characterized by
Loss of control of substance consumption
Substance use despite associated problems
Tendency to relapse
Biological
Genetic and all drugs affect the limbic system in brain (reward
center)
Psychological
Lack of tolerance for frustration, pain, impulsiveness, lack
affection, lack of self regard lack of self esteem
Cultural considerations
Asian cultures: Low incidence alcohol abuse
Native Americans and Alaska Natives
70% as compared to other cultures
Women: Lower rate than men but get hooked quicker
Pregnant women & their partners
Alcohol is neurotoxic, baby develops fetal alcohol syndrome
Impaired professionals
Inability to practice due to substance use
Nurses have higher rate of chemical dependency than general
population
Referral or self report: RAMP or Dr Baxter group for impaired
professionals
Must be truthful when renewing license
Clinical picture
Tolerance: need for higher doses to achieve effect
Withdrawal: occurs after using for long period so that stopping
causes physical and psych S&S
Flashbacks: transient recurrences of perceptual disturbances
caused by earlier hallucinogenic use
Codependence: behaviors involving family of substance abuse
patients
Synergistic Effects: Intensified or prolonged effects produced when
drugs taken together
Antagonistic Effects: Combining drugs to weaken or inhibit the effect
of one of the drugs
Application of nursing process
Assessment
The complex due to polysubstance abuse (simultaneous use of
many substances) and comorbidity (coexistence of psychiatric
illness) define the dual diagnosis
Initial Interview Guidelines-use of drugs/alcohol and the need or
want to cut down on use
Further assessment- Urine drug screen and BAL
Psychological Changes- Predictable defensive style (denial,
projection, rationalization)
Signs of Intoxication and Withdrawal
Assessment Guidelines
Aplication of nursing process
Signs of Intoxication & Withdrawal
CNS Depressants: alcohol, benzos, barbiturates
Can result in severe morbidity and mortality
CNS Nervous System Stimulants: cocaine, crack,
methamphetamines, nicotine
Opiates: morphine, heroin, fentanyl, methadone
Marijuana: Cannabis
Hallucinogens : LSD, PCP
Inhalants: paint, glue, lighter fluid
Rave & Techno drugs: Ecstasy (MDMA)
Application of nursing process
Diagnosis
Numerous nursing dx associated with physical & psychiatric
comorbidities
Outcomes Identification
Factor in culture and values in plan of care
Planning
Social status, income, ethnicity, gender, age, substance hx and
current condition
Implementation
Aim of tx is self-responsibility, not compliance
Communication Guidelines
Health teaching and promotion
Relapse & Prevention
Application of nursing process
Psychotherapy
& Therapeutic Modalities
Assist pts in identify & using alternative coping
mechanisms to reduce reliance on substances
Self Help Groups for Patients and Family
12-Step program
Residential Program
Intensive Outpatient Program
Outpatient Drug Free Program
Employee Assistance Program
Application of nursing process
Pharmacological, Biological & Integrative Therapies
Alcohol Withdrawal Treatment
Help patient achieve safe detox
Enhance patients’ motivation for abstinence and
motivation
Evaluation
Favorable treatment outcomes judged by increased
lengths of time in abstinence, decreased denial,
acceptable occupational functioning, improved family
relationships, and ability to relate to normally to other
human beings