Transcript Chapter 16

Chapter 16
Addictive Disorders
Substance abuse
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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
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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
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Psychiatric
 50%
with mental disorder also have substance use
disorder
 High rate of suicide
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Medical
 Cardiovascular
 Seizures/ Stroke
 MI
 Infections
 Sclerotic
veins
Theory
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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
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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
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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
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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
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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
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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
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Application of nursing process
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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