Transcript Substance Abuse and Chemical Dependence

Timby/Smith: Introductory
Medical-Surgical Nursing, 11/e
Chapter 71: Caring for Clients With
Chemical Dependence
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Substance Abuse and Chemical
Dependence
• Substance abuse: using meds for different reasons
than accepted purpose
• Withdrawal: physical symptoms; craving for drugs
when stopped
• Chemical dependence: need of drug to avoid
withdrawal symptoms
• Addiction: drug-seeking behaviors; interference with
life, relations, and work
• Tolerance: reduction in drug’s effect via persistent
use; demands increased dosage
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Question
Is the following statement true or false?
Substance abuse will produce a tolerance to the drug
ingested.
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Answer
True
Rationale: Substance abuse will produce a tolerance to
the drug ingested. Persistent use of a drug will
produce a decrease in its effects, demanding a larger
dose to produce the same euphoria.
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Substance Abuse and Chemical
Dependence—(cont.)
• Pathophysiology and Etiology: chemical
dependence: complex; psychobiologic factors
– Substance abuse: experimentation,
habituation, addiction, and dependence
• Factors: self-reinforcing pleasurable effects
– Effects of stimulant and depressant drugs
– Psychosocial dynamics: influence on family
members; peers
• Alcohol promotion; coping with stressors
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Other Abused Substances
• Hallucinogens, amphetamines, marijuana,
barbiturates, tranquilizers
– Signs and symptoms: similar to other substances
– Experimental use: until dependence and
addiction occur
• Consequence: increased defensive mechanisms;
disturbances in mood
• Treatment: withdrawal, abstinence, enrollment in
support group
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Chemical Dependence Treatment
• Treatment: difficult to initiate treatment as clients
deny addiction, rationalize substance use, blame
life situations
– Treatment, withdrawal managed: coping with
stressors; relationships
– Chemical detoxification
– Treatment plan: abstinence, counseling,
support of peers, 12-step program
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Question
Is the following statement true or false?
It is easy to receive treatment for substance
addiction.
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Answer
False
Rationale: Although there may be many
opportunities for treatment, it is difficult for someone
to admit his or her addiction and take personal
responsibility in the situation, which is the most
important step toward successful treatment.
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Alcohol Dependence
• Chronic, progressive, multisystem disease:
uncontrolled consumption
– Unchecked—fatal; medical consequences
– Women: health problems earlier than in men
• Pathophysiology and Etiology: unknown
– Theories: genetic factor; altered metabolism;
neurotransmitter connection
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Alcohol Dependence—(cont.)
• Assessment Findings: Signs and Symptoms
– Deny problem drinking; increasing
consumption; alcohol tolerance; cross-tolerance
for drugs; alcoholic behaviors
• Acute intoxication; hospitalization
• Withdrawal: nervous system stimulation
• Complications: impaired memory, CVA, metabolic
deficiencies, cardiomyopathy, neurologic disorders,
fetal alcohol syndrome
• Diagnostic Findings: blood alcohol level: extent of
alcohol toxicity; elevated liver and pancreatic
enzymes reflect alcohol-induced liver disease
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Alcohol Dependence—(cont.)
• Medical Management and Rehabilitation
– Detoxification: withdrawal without detox—fatal
– Nutritional therapy
– Psychotherapy: helps clients gain greater insight
into emotional problems; family therapy
– Drug therapy: aversion therapy—Antabuse
– Support groups: Alcoholics Anonymous (first 12step self-help program), includes family
• Emphasis: personal accountability, spirituality,
powerlessness over alcohol
• Nursing Management
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Question
Is the following statement true or false?
In treating alcohol dependence, it is vitally important
to undergo detoxification during withdrawal.
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Answer
True
Rationale: In treating alcohol dependence, it is vitally
important to undergo detoxification during withdrawal
as death may result by omitting detoxification.
Additionally, it is also important to include nutritional,
medication, and psychological therapies (including
support groups) to foster successful rehabilitation.
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Nicotine Dependence
• Nicotine: stimulant drug in tobacco; addictive, moodaltering substance
– Absorption: inhalation; mucous membranes of the
mouth
• Effects:  carbon monoxide blood levels; gastric ulcers;
peripheral blood vessel constriction; overstretched,
inelastic alveoli
• Consequences: smoking: 90% lung CA, COPD deaths;
coronary artery disease; peripheral vascular disease; lowbirth-weight babies
• Environmental tobacco smoke effects
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Nicotine Dependence—(cont.)
• Medical Management: cessation recommendation
with minimal approach; relapse common
– Brief counseling, follow-up
– Intense measures: behavior modification
programs
– Pharmacologic therapy: nicotine substitutes;
avoid withdrawal symptoms
• Nursing Management
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Cocaine and Methamphetamine
Dependence
• Central nervous system (CNS) stimulants: produce
extreme pleasure, euphoria, stimulation
– Cocaine forms: powder; dissolved; injected
• Crack: purified form of cocaine; mixed with
tobacco, marijuana; freebased
– Methamphetamine: combining OTC meds, chemicals;
smoked or IV injection
• Intense physical experience; rapid metabolism; cravings
recur after abstinence
• Risk of toxic effects; overdose reactions
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Cocaine and Methamphetamine
Dependence—(cont.)
• Assessment Findings: Signs and Symptoms
– Brief effect, rapid metabolism
– Signs correlate: route of administration;
consequence of chronic use
• Snorting: ulceration of nasal mucosa, perforation
of nasal septum
• Injection: needle marks
• Smoke, freebase: burns, chronic cough;
pulmonary congestion
– Polydrug abuse: offset agitation and irritability
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Cocaine and Methamphetamine
Dependence—(cont.)
• Complications: long-term abusers
– Anorexia; memory impairment; weight loss,
behavioral changes, paranoia, and hallucinations
– HTN, seizures, cerebral hemorrhage, MI,
respiratory arrest, cocaine bugs; mothers using
cocaine: withdrawal symptoms in newborns
• Methamphetamine added risks: contracting HIV,
hepatitis B
• Diagnostic Findings: blood, urine toxicology tests;
stimulant abuse
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Cocaine and Methamphetamine
Dependence—(cont.)
• Medical Management and Rehabilitation
– Referral to Cocaine Anonymous; group
psychotherapy
– Medications: increase, mimic effects of
dopamine; antidepressants: relieve dysphoria;
amino acid precursors
• Cocaine toxicity: immediate treatment
• Nursing Management
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Opiate Dependence
• Opioid: synthetic narcotics; sedation after initial
euphoria
– Rate of tolerance and chemical dependency:
drug, dose, and frequency of use
• Assessment Findings: Signs and Symptoms
– Pinpoint pupils, constipation, respiratory
depression; neonates: symptomatic
– Chronic use: anorexia, constipation, malnutrition,
needle marks, and scarring
• Diagnostic Findings: urine drug screen
• Antidote: Narcan
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Opiate Dependence—(cont.)
• Medical Management and Rehabilitation
– Withdrawal medications: clonidine; methadone
– Heroin addiction: methadone maintenance therapy
– Role of opiate antagonists in addiction
– Psychotherapy; Narcotics Anonymous
• Nursing Management
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