Transcript cont.

Chapter 23
Substance-Related and Addictive Disorders
Copyright © 2014. F.A. Davis Company
Substance-Related Disorders
• Substance-Use Disorders
– Addiction
• Substance-Induced Disorders
– Intoxication
– Withdrawal
– Others discussed in chapters with which they
share symptomatology
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Substance-Use Disorder
Substance Addiction
• Physical Dependence
– Need for increasing amounts to produce the
desired effects
– Syndrome of withdrawal upon cessation
• Psychological Dependence
– Overwhelming desire to repeat the use of a
particular drug to produce pleasure or avoid
discomfort
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Substance-Use Disorder (cont.)
Substance Addiction (cont.)
– Use of the substance interferes with ability to
fulfill role obligations
– Attempts to cut down or control use fail
– Intense craving for the substance
– Excessive amount of time spent trying to
procure the substance or recover from its use
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Substance-Use Disorder (cont.)
Substance Addiction (cont.)
– Use of the substance causes the person difficulty
with interpersonal relationships or to become
socially isolated
– Engages in hazardous activities when impaired by
the substance
– Tolerance develops and the amount required to
achieve the desired effect increases
– Substance-specific symptoms occur upon
discontinuation of use
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Substance-Induced Disorder
Substance Intoxication
– Development of a reversible syndrome of
symptoms following excessive use of a substance
– Direct effect on the central nervous system
– Disruption in physical and psychological
functioning
– Judgment is disturbed and social and
occupational functioning is impaired
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Substance-Induced Disorder (cont.)
Substance Withdrawal
– Development of symptoms that occurs upon
abrupt reduction or discontinuation of a
substance that has been used regularly over a
prolonged period of time
– The symptoms are specific to the substance that
has been used.
– There is a disruption in physical and psychological
functioning, with disturbances in thinking, feeling,
and behavior.
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Classes of Psychoactive Substances
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Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives, Hypnotics, Anxiolytics
Stimulants
Tobacco
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Predisposing Factors
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
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Predisposing Factors (cont.)
Psychological Factors
• Developmental influences:
– Punitive superego
– Fixation in the oral stage of
psychosexual development
S. Freud
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Predisposing Factors (cont.)
Psychological Factors (cont.)
• Personality factors: Certain personality traits are
thought to increase a tendency toward addictive
behavior. They include:
– Low self-esteem
– Frequent depression
– Passivity
– Inability to relax or defer gratification
– Inability to communicate effectively
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Predisposing Factors (cont.)
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
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Predisposing Factors (cont.)
Sociocultural Factors (cont.)
• 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 substance abuse than others.
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Predisposing Factors (cont.)
1. Which of the following has been implicated
in the predisposition to substance abuse?
A. Hereditary factor
B. Fixation in the adolescent stage of
psychosexual development
C. Punitive ego
D. Narcissistic and dependent personality traits
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Predisposing Factors (cont.)
• Correct answer: A
– Research has indicated that an apparent
hereditary factor is involved in the development
of substance-use disorders. This is especially
evident with alcoholism.
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Dynamics of Substance-Related
Disorders
Alcohol Use Disorder
• Patterns of Use
– 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.
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Dynamics of Substance-Related
Disorders (cont.)
• Patterns of Use (cont.)
– Phase III. The crucial phase: Person has lost
control; physiological dependence is clearly
evident.
– Phase IV. The chronic phase: Characterized by
emotional and physical disintegration. The person
is usually intoxicated more often than sober.
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Dynamics of Substance-Related
Disorders (cont.)
Effects of Alcohol on the Body
• Peripheral neuropathy is characterized by:
– Peripheral nerve damage
– Pain
– Burning
– Tingling
– Prickly sensations of the extremities
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Effects of Alcohol on the Body
• Alcoholic myopathy: thought to result from
the same B vitamin deficiency that
contributes to peripheral neuropathy
– Acute: sudden onset of muscle pain, swelling, and
weakness; reddish tinge to the urine; and a rapid
rise in muscle enzymes in the blood
– Chronic: gradual wasting and weakness in skeletal
muscles
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Effects of Alcohol on the Body (cont.)
• Wernicke’s encephalopathy
Most serious form of thiamine deficiency in
alcoholic patients
• Korsakoff’s psychosis
Syndrome of confusion, loss of recent
memory, and confabulation in alcoholic
patients
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Effects of Alcohol on the Body (cont.)
• Alcoholic cardiomyopathy
Effect of alcohol on the heart is an
accumulation of lipids in the myocardial cells,
resulting in enlargement and a weakened
condition.
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Effects of Alcohol on the Body (cont.)
• Esophagitis
Inflammation and pain in the esophagus
occurs because of the toxic effects of alcohol
on the esophageal mucosa and also because
of frequent vomiting associated with alcohol
use.
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Effects of Alcohol on the Body (cont.)
• Gastritis
Effects of alcohol on the stomach include
inflammation of the stomach lining
characterized by epigastric distress, nausea,
vomiting, and distention.
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Effects of Alcohol on the Body (cont.)
• Pancreatitis
– Acute: usually occurs 1 or 2 days after a
binge of excessive alcohol consumption.
Symptoms include constant, severe
epigastric pain, nausea and vomiting, and
abdominal distention.
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Effects of Alcohol on the Body (cont.)
• Pancreatitis (cont.)
– Chronic: leads to pancreatic insufficiency
resulting in steatorrhea, malnutrition, weight
loss, and diabetes mellitus
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Effects of Alcohol on the Body (cont.)
• Alcoholic Hepatitis
– Caused by long-term heavy alcohol use
– Symptoms: enlarged, tender liver; nausea and
vomiting; lethargy; anorexia; elevated white cell
count; fever; and jaundice. Also ascites and
weight loss in severe cases.
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Effects of Alcohol on the Body (cont.)
• Cirrhosis of the Liver
Cirrhosis is the end-stage of alcoholic liver
disease and is believed to be caused by
chronic heavy alcohol use. There is
widespread destruction of liver cells, which
are replaced by fibrous (scar) tissue.
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Effects of Alcohol on the Body (cont.)
• Cirrhosis of the Liver (cont.)
– Portal hypertension: Elevation of blood pressure
through the portal circulation results from
defective blood flow through cirrhotic liver.
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Effects of Alcohol on the Body (cont.)
• Cirrhosis of the Liver (cont.)
– Ascites: a condition in which an excessive amount
of serous fluid accumulates in the abdominal
cavity; occurs in response to portal hypertension
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Effects of Alcohol on the Body (cont.)
• Cirrhosis of the Liver (cont.)
– Esophageal varices: veins in the esophagus
become distended because of excessive pressure
from defective blood flow through the cirrhotic
liver.
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Effects of Alcohol on the Body (cont.)
• Cirrhosis of the Liver (cont.)
– Hepatic encephalopathy: occurs in response to
the inability of the diseased liver to convert
ammonia to urea for excretion; the continued rise
in serum ammonia, if allowed to progress, leads to
coma and eventual death.
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Effects of Alcohol on the Body (cont.)
• Leukopenia
Impaired production, function, and
movement of white blood cells
• Thrombocytopenia
Platelet production and survival are
impaired as a result of the toxic effects of
alcohol.
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Effects of Alcohol on the Body (cont.)
• Sexual Dysfunction
– In the short term, enhanced libido and failure of
erection are common.
– Long-term effects include gynecomastia,
sterility, impotence, and decreased libido.
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Effects of Alcohol on the Body (cont.)
2. A client is brought to the ED. The client is
aggressive, has slurred speech, and impaired
motor coordination. Blood alcohol level is
347 mg/dl. Among the physician’s orders is
thiamine. Which is the rationale for this
intervention?
A.
B.
C.
D.
To prevent nutritional deficits
To prevent pancreatitis
To prevent alcoholic hepatitis
To prevent Wernicke's encephalopathy
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Effects of Alcohol on the Body (cont.)
• Correct answer: D
– Wernicke’s encephalopathy is the most serious
form of thiamine deficiency in clients diagnosed
with alcoholism. If thiamine replacement therapy
is not undertaken quickly, death will ensue.
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Effects of Alcohol on the Body (cont.)
• Alcohol use during pregnancy can result in
fetal alcohol spectrum disorders (FASDs):
– Fetal alcohol syndrome (FAS): problems with
learning, memory, attention span,
communication, vision, and hearing
– Alcohol-related neurodevelopmental disorder
– Alcohol-related birth defects
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Effects of Alcohol on the Body (cont.)
• No amount of alcohol during pregnancy is
considered safe.
• Alcohol can damage a fetus at any stage of
pregnancy.
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Effects of Alcohol on the Body (cont.)
Characteristics of FAS:
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Abnormal facial features
Small head size
Shorter-than-average height
Low body weight
Poor coordination
Hyperactive behavior
Difficulty paying attention
Poor memory
Difficulty in school
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Learning difficulties
Speech and language delays
Intellectual disability
Poor reasoning skills
Sleep and sucking problems
as a baby
• Vision or hearing problems
• Problems with the heart,
kidneys, or bones
Dynamics of Substance-Related
Disorders
• 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.
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Dynamics of Substance-Related
Disorders (cont.)
Sedative-, Hypnotic-, or Anxiolytic Use
Disorder
• A Profile of the Substance
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Barbiturates
Nonbarbiturate hypnotics
Antianxiety agents
Club drugs
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Sedative-, Hypnotic, or Anxiolytic Use
Disorder
• Patterns of Use
• Effects on the Body
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Effects on sleep and dreaming
Respiratory depression
Cardiovascular effects
Renal function
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Sedative-, Hypnotic, or Anxiolytic Use
Disorder (cont.)
• Effects on the Body (cont.)
– Hepatic effects
– Body temperature
– Sexual functioning
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Sedative-, Hypnotic, or Anxiolytic Use
Disorder (cont.)
• Intoxication
– With these CNS depressants, effects can range
from disinhibition and aggressiveness to coma
and death (with increasing dosages of the
drug).
• Withdrawal
– Onset of symptoms depends on the half-life of
the drug from which the person is
withdrawing.
– Severe withdrawal from CNS depressants can
be life threatening.
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Dynamics of Substance-Related
Disorders
Stimulant Use Disorder
• A Profile of the Substance
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Amphetamines
Synthetic stimulants
Nonamphetamine stimulants
Cocaine
Caffeine
Nicotine
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Dynamics of Substance-Related
Disorders (cont.)
Stimulant Use Disorder (cont.)
• Patterns of Use
• Effects on the Body
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CNS effects
Cardiovascular effects
Pulmonary effects
Gastrointestinal and renal effects
Sexual functioning
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Dynamics of Substance-Related
Disorders (cont.)
Stimulant Use Disorder (cont.)
• Intoxication
– Amphetamine and cocaine intoxication produce
euphoria, impaired judgment, confusion, changes
in vital signs (even coma or death, depending on
amount consumed).
– Caffeine intoxication usually occurs following
consumption in excess of 250 mg. Restlessness
and insomnia are the most common symptoms.
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Dynamics of Substance-Related
Disorders (cont.)
Stimulant Use Disorder (cont.)
• Withdrawal
– Amphetamine and cocaine withdrawal may result in
dysphoria, fatigue, sleep disturbances, and increased
appetite.
– Withdrawal from caffeine may include headache, fatigue,
drowsiness, irritability, muscle pain and stiffness, and
nausea and vomiting.
– Withdrawal from nicotine may include dysphoria, anxiety,
difficulty concentrating, irritability, restlessness, and
increased appetite.
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Dynamics of Substance-Related
Disorders (cont.)
Inhalant Use Disorder
• A Profile of the Substance
– Aliphatic and aromatic hydrocarbons found in
substances such as fuels, solvents, adhesives,
aerosol propellants, and paint thinners
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Dynamics of Substance-Related
Disorders (cont.)
Inhalant Use Disorder (cont.)
• Patterns of Use/Abuse
• Effects on the Body
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CNS effects
Respiratory effects
GI effects
Renal system effects
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Dynamics of Substance-Related
Disorders (cont.)
Inhalant Use Disorder (cont.)
• Intoxication
– Develops during or shortly after use of or
exposure to volatile inhalants
– Symptoms include:
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•
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•
Dizziness, ataxia, muscle weakness
Euphoria, excitation, disinhibition, slurred speech
Nystagmus, blurred or double vision
Psychomotor retardation, hypoactive reflexes
Stupor or coma
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Dynamics of Substance-Related
Disorders (cont.)
Opioid Use Disorder
• A Profile of the Substance
– Opioids of natural origin
– Opioid derivatives
– Synthetic opiate-like drugs
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Dynamics of Substance-Related
Disorders (cont.)
Opioid Use Disorder (cont.)
• Patterns of Use or Abuse
• Effects on the Body
– Central nervous system
– Gastrointestinal
– Cardiovascular
– Sexual functioning
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Dynamics of Substance-Related
Disorders (cont.)
Opioid Induced Disorder
• 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.
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Dynamics of Substance-Related
Disorders (cont.)
Opioid Induced Disorder (cont.)
• Withdrawal
– From short-acting drugs (e.g., heroin):
• Symptoms occur within 6 to 8 hours, peak within 1 to 3
days, and gradually subside in 5 to 10 days
– From long-acting drugs (e.g., methadone):
• Symptoms occur within 1 to 3 days, peak between 4
and 6 days, and subside in 14 to 21 days
– From ultra-short-acting meperidine:
• Symptoms begin quickly, peak in 8 to12 hours, and
subside in 4 to 5 days
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Dynamics of Substance-Related
Disorders (cont.)
Opioid Induced Disorder (cont.)
• Symptoms of Opioid Withdrawal
– Dysphoria, muscle aches, nausea and vomiting,
lacrimation or rhinorrhea, pupillary dilation,
piloerection, sweating, abdominal cramping,
diarrhea, yawning, fever, and insomnia
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Dynamics of Substance-Related
Disorders (cont.)
Hallucinogen-Induced Disorder
•A Profile of the Substance
–Naturally occurring hallucinogens
–Synthetic compounds
•Patterns of Use
–Use is usually episodic
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Dynamics of Substance-Related
Disorders (cont.)
Hallucinogen-Induced Disorder (cont.)
• Intoxication
– Occurs during or shortly after using the drug
– Symptoms include perceptual alteration,
depersonalization, derealization, tachycardia,
palpitations
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Dynamics of Substance-Related
Disorders (cont.)
Hallucinogen-Induced Disorder (cont.)
• Symptoms of PCP intoxication include
belligerence and assaultiveness and may
proceed to seizures or coma.
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Hallucinogens: Effects on the Body
• Physiological
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Nausea/vomiting
Chills
Pupil dilation
Increased BP, pulse
Loss of appetite
Insomnia
Elevated blood sugar
Decreased respirations
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• Psychological
– Heightened response to
color, sounds
– Distorted vision
– Sense of slowed time
– Magnified feelings
– Paranoia, panic
– Euphoria, peace
– Depersonalization
– Derealization
– Increased libido
Dynamics of Substance-Related
Disorders (cont.)
Cannabis Use Disorder
• A Profile of the Substance
– Marijuana
– Hashish
• Patterns of Use
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Dynamics of Substance-Related
Disorders (cont.)
Cannabis Use Disorder
• Effects on the Body
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Cardiovascular
Respiratory
Reproductive
Central nervous system
Sexual functioning
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Dynamics of Substance-Related
Disorders (cont.)
Cannabis Use Disorder
• 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.
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Dynamics of Substance-Related
Disorders (cont.)
Cannabis Use Disorder
• Withdrawal
– Occurs upon cessation of cannabis use that has
been heavy and prolonged.
– Symptoms occur within a week following
cessation of use.
– Symptoms include irritability, anger, aggression,
anxiety, sleep disturbances, decreased appetite,
depressed mood, stomach pain, tremors,
sweating, fever, chills, or headache.
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Application of the Nursing Process
• Nurses must begin relationship
development with an individual
who abuses substances by
examining own attitudes and
personal experiences with
substances.
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Nursing Process: Assessment
• Various assessment tools are available for
determining the extent of the problem a
client has with substances.
– Drug History and Assessment
– Clinical Institute Withdrawal Assessment of
Alcohol Scale
– Michigan Alcoholism Screening Test (MAST)
– CAGE Questionnaire
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Nursing Process: Assessment
• 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)?
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Dual Diagnosis
• Clients with a coexisting substance disorder
and mental disorder may be assigned to a
special program that targets the dual
diagnosis.
• Program combines special therapies that
target both problems.
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Nursing Diagnosis/Outcome
Identification
• Ineffective denial related to weak,
underdeveloped ego
• Outcome: Client will demonstrate acceptance
of responsibility for own behavior and
acknowledge association between personal
problems and use of substance(s).
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Nursing Diagnosis/Outcome
Identification (cont.)
• Ineffective coping related to inadequate
coping skills and weak ego
• Outcome: Client will be able to demonstrate
more adaptive coping mechanisms that can
be used in stressful situations (instead of
taking substances).
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Nursing Diagnosis/Outcome
Identification (cont.)
• Imbalanced nutrition less than body
requirements/fluid volume deficit related to
drinking or taking drugs instead of eating
• Outcome: Client will be free from signs or
symptoms of malnutrition/dehydration.
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Nursing Diagnosis/Outcome
Identification (cont.)
• Risk for infection related to malnutrition and
altered immune condition
• Outcome: Shows no signs or symptoms of
infection.
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Nursing Diagnosis/Outcome
Identification (cont.)
• Chronic low self-esteem related to weak ego,
lack of positive feedback
• Outcome: Exhibits evidence of increased selfworth by attempting new projects without
fear of failure and by demonstrating less
defensive behavior toward others.
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Nursing Diagnosis/Outcome
Identification (cont.)
• Deficient knowledge (effects of substance
abuse on the body) related to denial of
problems with substances evidenced by
abuse of substances
• Outcomes: Verbalizes importance of
abstaining from use of substances to maintain
optimal wellness
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Nursing Diagnosis/Outcome
Identification (cont.)
• For the client withdrawing from CNS
depressants:
– Risk for injury related to CNS agitation
• For the client withdrawing from CNS
stimulants:
– Risk for suicide related to intense feelings of
lassitude and depression, “crashing,” suicidal
ideation
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Planning/Implementation
• Detoxification
– Provide safe and supportive environment.
– Administer substitution therapy.
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Planning/Implementation (cont.)
• Intermediate Care
– Provide explanations of physical symptoms.
– Promote understanding and identify causes of
substance dependency.
– Help client accept use of substance as a problem.
– Provide education and assistance to client and
family.
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Planning/Implementation (cont.)
• Rehabilitation
Alcoholics Anonymous
– Encourage continued
participation in long-term
treatment.
– Promote participation in outpatient support
system.
– Assist client to identify alternative sources of
satisfaction.
– Provide support for health promotion and
maintenance.
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Client/Family Education
Nature of the Illness
• Effects (of Substance) on the Body
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Alcohol
Other CNS depressants
Hallucinogens
Inhalants
Opioids
Cannabinols
• Ways in Which Use of Substance Affects Life
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Client/Family Education (cont.)
Management of the Illness
• Activities to substitute for (substance) in times
of stress
• Relaxation techniques
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Progressive relaxation
Tense and relax
Deep breathing
Autogenics
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Client/Family Education (cont.)
Management of the Illness (cont.)
• Problem-solving skills
• Essentials of good nutrition
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Client/Family Education (cont.)
Support Services
• Financial assistance
• Legal assistance
• Alcoholics Anonymous (or other support
group specific to another substance)
• One-to-one support person
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Nursing Process: Evaluation
• Evaluation involves reassessment to determine
whether the nursing interventions have been
effective in achieving the intended goals of care.
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The Chemically Impaired Nurse
• It is estimated that 10 to 15 percent of nurses
suffer from the disease of chemical addiction.
• Alcohol is the most widely abused drug,
followed closely by narcotics.
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The Chemically Impaired Nurse (cont.)
• Clues for recognizing substance impairment in
nurses vary according to the substance being
used.
• High absenteeism may be present if the
person’s source is outside the work area.
• Or the person may rarely miss work if the
substance source is at work.
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The Chemically Impaired Nurse (cont.)
• Increase in “wasting” of drugs, higher
incidences of incorrect narcotic counts, and a
higher record of signing out drugs compared
to other nurses may be present.
• Poor concentration, difficulty meeting
deadlines, inappropriate responses, and poor
memory or recall
• Problems with relationships
• Irritability, tendency to isolate, elaborate
excuses for behavior
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The Chemically Impaired Nurse (cont.)
• Unkempt appearance, impaired motor
coordination, slurred speech, flushed face
• Patient complaints of inadequate pain control,
discrepancies in documentation
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The Chemically Impaired Nurse (cont.)
State Board Response
• May deny, suspend, or revoke a license based
on a report of chemical abuse by a nurse
• Diversionary laws allow impaired nurses to
avoid disciplinary action by agreeing to seek
treatment
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The Chemically Impaired Nurse (cont.)
During the Suspension Period
• Successful completion of an inpatient,
outpatient, group, or individual counseling
treatment program
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The Chemically Impaired Nurse (cont.)
• Evidence of regular attendance at nurse
support groups or 12-step programs
• Random negative drug screens
• Employment or volunteer activities
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The Chemically Impaired Nurse (cont.)
• Peer assistance programs serve to assist
impaired nurses to:
– Recognize their impairment
– Obtain necessary treatment
– Regain accountability within profession
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Codependency
• Defined by dysfunctional behaviors that are
evident among members of the family of a
chemically dependent person or among
family members who harbor secrets of
physical or emotional abuse, other cruelties,
or pathological conditions
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Codependency (cont.)
• Codependent people sacrifice their own needs
for the fulfillment of others to achieve a sense of
control.
• Derive self-worth from others
• Feel responsible for the happiness of others
• Commonly deny that problems exist
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Codependency (cont.)
• The person keeps feelings in control,
and often releases anxiety in the
form of stress-related illnesses, or
compulsive behaviors such as eating,
spending, working, or use of
substances.
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Codependency (cont.)
• May have experienced
abuse or emotional neglect
as a child
• Are outwardly focused on others and know
very little about how to direct their lives from
their own sense of self
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The Codependent Nurse
• Classic Characteristics
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–
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Caretaking
Perfectionism
Denial
Poor communication
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Treating Codependence
• Recovery Process
– Survival stage
– Reidentification stage
– Core issues stage
– Reintegration stage
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Treatment Modalities for SubstanceRelated Disorders
• Alcoholics Anonymous
– Is a major self-help organization
for the treatment of
alcoholism
– Based on the concept of:
• Peer support
• Acceptance
• Understanding from others who have
experienced the same problem
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Alcoholics Anonymous (cont.)
– The 12 steps that embody the philosophy of AA
provide specific guidelines on how to attain and
maintain sobriety.
– Total abstinence is promoted as the only cure; the
person can never safely return to social drinking.
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Various support groups patterned
after AA but for individuals with
problems with other substances
• Counseling
• Group therapy
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Pharmacotherapy for Alcoholism
– Disulfiram (Antabuse)
– Other medications:
• Naltrexone (ReVia)
• Nalmefene (Revex)
• SSRIs
• Acamprosate (Campral)
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Psychopharmacology for substance intoxication
and substance withdrawal:
– Alcohol
• Benzodiazepines
• Anticonvulsants
• Multivitamin therapy
• Thiamine
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Psychopharmacology for substance
intoxication and substance withdrawal (cont.):
– Opioids
• Narcotic antagonists
–Naloxone (Narcan)
–Naltrexone (ReVia)
–Nalmefene (Revex)
• Methadone
• Buprenorphine
• Clonidine
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Psychopharmacology for substance
intoxication and substance withdrawal (cont.):
– Depressants
• Phenobarbital (Luminal)
• Long-acting benzodiazepines
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Psychopharmacology for substance
intoxication and substance withdrawal (cont.):
– Stimulants
• Minor tranquilizers
• Major tranquilizers
• Anticonvulsants
• Antidepressants
Copyright © 2014. F.A. Davis Company
Treatment Modalities for SubstanceRelated Disorders (cont.)
• Psychopharmacology for substance
intoxication and substance withdrawal (cont.):
– Hallucinogens and cannabinols
• Benzodiazepines
• Antipsychotics
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Treatment Modalities for SubstanceRelated Disorders (cont.)
3. A client, diagnosed with chronic alcoholism,
says to the nurse, “I’m tired of using and I
want to stop. Is there a medication that can
help me maintain sobriety?” About which
medication would the nurse provide
information?
A.
B.
C.
D.
Carbamazepine (Tegretol)
Clonidine (Catapres)
Disulfiram (Antabuse)
Folic acid (Folvite)
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Treatment Modalities for SubstanceRelated Disorders (cont.)
• Correct answer: C
– Disulfiram is used as a deterrent to drinking.
Ingestion of alcohol while disulfiram is in the body
results in a syndrome of symptoms that can cause
varying degrees of discomfort. It can even result
in death if blood alcohol levels are high. It is
important that the client understands that all
alcohol, oral or topical, and medications that
contain alcohol, are strictly prohibited when
taking this drug.
Copyright © 2014. F.A. Davis Company
Nonsubstance Addictions
Gambling Disorder
• Persistent and recurrent problematic gambling
behavior that intensifies when the individual is
under stress.
• As the need to gamble
increases, the individual
may use any means
required to obtain money
to continue the addiction.
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Nonsubstance Addictions
Gambling Disorder (cont.)
• Gambling behavior usually begins in adolescence, although
compulsive behaviors rarely occur before young adulthood.
• The disorder usually runs a chronic course, with periods of
waxing and waning.
• The disorder interferes with
interpersonal relationships,
social, academic, or
occupational functioning.
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Predisposing Factors to Gambling
Disorder
• Biological Influences
– Genetic
• Increased incidence among family members
– Physiological
• Abnormalities in neurotransmitter systems
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Predisposing Factors to Gambling
Disorder (cont.)
• Psychosocial Influences
– Loss of a parent before age 15
– Inappropriate parental discipline
– Exposure to gambling activities as an adolescent
– Family emphasis on material and financial
symbols
– Lack of family emphasis on saving, planning, and
budgeting
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Predisposing Factors to Gambling
Disorder (cont.)
• Psychosocial Influences (cont.)
– The psychoanalytical view
suggests that gambling is
used to release a buildup
of tension.
S. Freud
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Treatment Modalities for Gambling
Disorder
•
•
•
•
Behavior Therapy
Cognitive Therapy
Psychoanalysis
Psychopharmacology
–SSRIs
–Clomipramine
–Lithium
–Carbamazepine
–Naltrexone
Copyright © 2014. F.A. Davis Company
Treatment Modalities for Gambling
Disorder (cont.)
• Gamblers Anonymous
– Organization modeled after Alcoholics
Anonymous
– Only requirement for membership is an expressed
desire to stop gambling
– Reformed gamblers help others resist the urge to
gamble
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Treatment Modalities for Gambling
Disorder (cont.)
• Related Organizations
– Gam-Anon
• For family and spouses
of compulsive gamblers
– Gam-a-Teen
• For adolescent children of compulsive
gamblers
Copyright © 2014. F.A. Davis Company