substancce abuse

8/16/2019 Substancce Abuse

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1 substance abuse (escalante-saac)

polysubstance abuse Abuse of more than one substance is termed _

1. Alcohol2. Amphetamines or Similarly Acting Sympathomimetics3. Caffeine. Cannabis!. Cocaine". #allucinogens$. %nhalants&. 'icotine

. pioids1*. +hencyclidine (+C+) or Similarly Acting ,rugs11. Sedaties #ypnotics or An/iolytics

0he ,iagnostic and Statistical anual of ental ,isorders th edition 0e/t eision (,S-%-0)lists 11 diagnostic classes of substance abuse4

%t also categori5es substance-related disorders into t6o groups4 (1) those that include disorders of abuse and dependence and (2) substance-induced disorders suchas intoxication, withdrawal, delirium, dementia, psychosis, mood disorder, anxiety, sexual dysfunction, and sleep disorder.

%nto/ication is use of a substance that results in maladaptie behaior.

7ithdra6al syndrome refers to the negatie psychologic and physical reactions that occur 6hen use of a substance ceases ordramatically decreases.

,eto/ification is the process of safely 6ithdra6ing from a substance.

Substance abuse can be defined as using a drug in a 6ay that is inconsistent 6ith medical or social norms and despitenegatie conse8uences.

ONS! "N# $%&N&$"% $O'S

1! and 1$ 0he early course of alcoholism typically begins 6ith the first episode of into/ication bet6een_ years ofage

blacout ,uring this time the person e/periences his or her first * 6hich is an episode during 6hich the personcontinues to function but has no conscious a6areness of his or her behaior at the time or any latermemory of the behaior

tolerance for alcohol As the person continues to drin9 he or she often deelops a_: that is he or she needs more alcohol toproduce the same effect.

tolerance brea9 After continued heay drin9ing the person e/periences a _ 6hich means that ery small amounts ofalcohol into/icate the person.

substance use ;or many people_ is a chronic illness characteri5ed by remissions and relapses to former leels of use

!&O%O+

1. that is a reinforcing orpositie e/perience.

2. +sychologic ;actorsSome theorists beliee that inconsistency in the parent?s behaior poor role modeling and lac9 of nurturing pae the 6ay for the child to adopt a similar style ofmaladaptie coping stormy relationships and substance abuse. thers hypothesi5e that een children 6ho abhorred their family lies are li9ely to abuse substances asadults because they lac9 adaptie coping s9ills and cannot form successful relationships

3. Social and @nironmental ;actors-Cultural factors social attitudes peer behaiors la6s cost and aailability all influence initial and continued use of substances-. %n general younger e/perimenters use substances that carry less social disapproal such as alcohol and cannabis 6hereas older people use drugs such as cocaine andopioids that are more costly and rate higher disapproal

!S O S'/S!"N$S "N# !"!0N!

1. Alcohol central nerous system depressant that is absorbed rapidly into the bloodstream.

rela/ation and loss of inhibitions effects are _.

%nto/ication and erdose

Slurred speech unsteady gait lac9 of coordination andimpaired attention concentration memory and udgment

7ith into/ication there is _. Some people become aressie or display inappropriate sexualbehaior 6hen into/icated. 0he person 6ho is into/icated may e/perience a blacout.

B Cardiac myopathy B 7ernic9e?s encephalopathyB orsa9off?s psychosisB +ancreatitisB @sophagitisB #epatitis B CirrhosisB Deu9openia B 0hrombocytopeniaB Ascites

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omiting unconsciousness and respiratory depression. An oerdose or e/cessie alcohol inta9e in a short period can result in _ 0his combination can cause aspiration pneumonia or pulmonary obstruction.

cardioascular shoc9 and death. Alcohol induced hypotension can lead to

gastric laage or dialysis 0reatment of an alcohol oerdose is similar to that for any central nerous system depressant4_ toremoe the drug and support of respiratory and cardioascular functioning in an intensie care unit

4ithdrawal and #etoxification

to 12 #ES Symptoms of 6ithdra6al usually begin_ hours after cessation or mar9ed reduction of alcohol inta9e.

coarse hand tremors s6eating eleated pulse and bloodpressure insomnia an/iety and nausea or omiting.

Symptoms include

delirium tremens (#!s) Seere or untreated 6ithdra6al may progress to transient hallucinations sei5ures or deliriumFcalled _


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second Alcohol 6ithdra6al usually pea9s on the_ day and is oer in about 5 days

medical superision. deto/ification needs to be accomplished under _

3 to ! %f the client?s 6ithdra6al symptoms are mild and he or she can abstain from alcohol he or she can betreated safely at home. ;or more seere withdrawal or for clients 6ho cannot abstain duringdeto/ification a short admission of_ days is the most common setting.

lora5epam (Atian) chlordia5epo/ide (Dibrium) or dia5epam(alium)

Safe 6ithdra6al is usually accomplished 6ith the administration of ben6odia6epines such as _to suppress the withdrawal symptoms.

2. Sedaties #ypnotics and An/iolytics


barbiturates nonbarbiturate hypnotics and an/iolyticsparticularly ben5odia5epines

0his class of drugs includes all central nerous system depressants4


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Cannabis is most often smo9ed in cigarettes (oints) but it can be eaten.

lo6ering intraocular pressure

dronabinol (arinol) and nabilone (Cesamet)

esearch has sho6n that cannabis has shortterm effects of_ but it is not approed for the treatment ofglaucoma. %t also has been studied for its effectieness in reliein the nausea and omitinassociated with cancer chemotherapy and the anorexia and weiht loss of "S. Currently t6ocannabinoids _ hae been approed for treating nausea and omiting from cancer chemotherapy.

&ntoxication and Oerdose

less than 1 minute Cannabis begins to act _after inhalation. +ea9 effects usually occur in 29 to :9 minutes and last at least2 to : hours.

lo6ered inhibitions rela/ation euphoria and increasedappetite.

Esers report a high feeling similar to that 6ith alcohol _

impaired motor coordination inappropriate laughter impaired udgment and short-term memory and distortions of time andperception.

Symptoms of into/ication include _. "nxiety, dysphoria, and social withdrawal may occur in someusers.

conunctial inection (bloodshot eyes) dry mouthhypotension and tachycardia.

+hysiologic effects in addition to increased appetite include ._@/cessie use of cannabis may producedelirium or, rarely, cannabis-induced psychotic disorder, both of which are treatedsymptomatically


Although some people hae reported withdrawal symptoms of muscle aches, sweatin, anxiety, andtremors no clinically significant 6ithdra6al syndrome is identified

!. pioids

pioids are popular drugs of abuse because they desensiti5e the user to both physiologic and psychologic painand induce a sense of euphoria and 6ell-being.

morphine meperidine (,emerol) codeine hydromorphoneo/ycodone methadone o/ymorphone hydrocodone andpropo/yphene as 6ell as illegal substances such as heroin andnormethadone.

pioid compounds include both potent prescription analgesics such as _


apathy lethargy listlessness impaired udgment psychomotorretardation or agitation constricted pupils dro6siness slurredspeech and impaired attention and memory.

pioid into/ication deelops soon after the initial euphoric feeling: symptoms include

coma respiratory depression pupillary constrictionunconsciousness and death.

Seere into/ication or opioid oerdose can lead to

nalo/one Administration of_ ('arcan) an opioid antaonist is the treatment of choice because it reerses allsigns of opioid to/icity.

'alo/one is gien eery fe6 hours until the opioid leel drops to nonto/ic: this process may ta9e days


an/iety restlessness aching bac9 and legs and craings formore opioids

%nitial symptoms are _ (Haffe I Strain 2**!).

Symptoms that deelop as 6ithdra6al progresses include nausea, omitin, dysphoria, lacrimation, rhinorrhea, sweatin, diarrhea, yawnin, feer and insomnia.

" to 2 Short-acting drugs such as heroin produce 6ithdra6al symptoms in_ hours: the symptoms pea in 2 to: days and radually subside in 5 to ; days.

2 to days Donger-acting substances such as methadone may not produce significant 6ithdra6al symptoms for _days and the symptoms may ta9e 2 6ee9s to subside.

ethadone can be used as a replacement for the opioid and the dosage is then decreased oer 2 6ee9s

7ithdra6al symptoms such as anxiety, insomnia, dysphoria, anhedonia, and dru crain may persist for wees or months.

". #allucinogens are substances that distort the user?s perception of reality and produce symptoms similar to psychosisincluding hallucinations (usually isual) and depersonali5ation.

increased pulse blood pressure and temperature: dilatedpupils: and hyperrefle/ia.

#allucinogens also cause

mescaline psilocybin lysergic acid diethylamide and=designer drugs> such as @cstasy.

@/amples of hallucinogens are


an/iety depression paranoid ideation ideas of reference fearof losing one?s mind and potentially dangerous behaior suchas umping out a 6indo6 in the belief that one can fly

#allucinogen into/ication is mar9ed by seeral maladaptie behaioral or psychologic changes4

+hysiologic symptoms include sweatin, tachycardia, palpitations, blurred ision, tremors, and lac of coordination. $ intoxication often inoles

bellierence, aression, impulsiity, and unpredictable behaior.

psychologic 0o/ic reactions to hallucinogens (e/cept +C+) are primarily_:

+sychotic reactions are managed best by isolation from external stimuli< physical restraints may be necessary for the safety of the client and others. +C+ to/icitycan include sei6ures, hypertension, hyperthermia, and respiratory depression. 0edications are used to control sei5ures and blood pressure. Cooling deices such ashyperthermia blan9ets are used and mechanical entilation is used to support respirations

7ithdra6al and ,eto/ification

'o _ 6ithdra6al syndrome has been identified for hallucinogens although some people hae reported acraing for the drug.

flashbac9s 6hich are transient recurrences of perceptualdisturbances li9e those e/perienced 6ith hallucinogen use.

#allucinogens can produce _.0hese episodes occur een after all traces of the hallucinogen are gone andmay persist for a fe6 months up to ! years.

$. %nhalants are a dierse group of drugs that include anesthetics nitrates and organic solents that are inhaled for


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substance abuse (escalante-saac)

their effects.

0he most common substances in this category are aliphatic and aromatic hydrocarbons found in asoline, lue, paint thinner, and spray paint.

ost of the apors are inhaled from a rag soa9ed 6ith the compound from a paper or plastic bag or directly from the container. %nhalants can cause significant braindamage peripheral nerous system damage and lier disease.


di55iness nystagmus lac9 of coordination slurred speechunsteady gait tremor muscle 6ea9ness and blurred ision.

%nhalant into/ication inoles

Stupor and coma can occur. Significant behaioral symptoms are bellierence, aression, apathy, impaired =udment, and inability to function.

ano/ia respiratory depression agal stimulation anddysrhythmias.

Acute to/icity causes

#eath may occur from bronchospasm cardiac arrest suffocation or aspiration of the compound or omitus

0reatment consists of supportin respiratory and cardiac functionin until the substance is remoed from the body. 0here are no antidotes or specific medications totreat inhalant to/icity.


no 0here are _6ithdra6al symptoms or deto/ification procedures for inhalants as such although fre8uentusers report psychologic craings.

persistent dementia or inhalant-induced disorders such aspsychosis an/iety or mood disorders

+eople 6ho abuse inhalants may suffer from_ een if the inhalant abuse ceases.

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"ssessment

?3istory-Clients 6ith a parent or other family members 6ith substance abuse problems may report a chaotic family life although this is not al6ays the case. 0hey generallydescribe some crisis that precipitated entry into treatment such as physical problems or deelopment of 6ithdra6al symptoms 6hile being treated for another condition

J+N"% """N$ "N# 0O!O /3"@&O 1. eeals appearance and speech to be normal.2. Appear an/ious tired and disheeled if they hae ust completed a difficult course of deto/ification.3. Clients are some6hat apprehensie about treatment resent being in treatment or feel pressured by others to be there.

J0ood and "ffect1. Some clients are sad and tearful e/pressing guilt and remorse for their behaior and circumstances. 2. thers may be angry and sarcastic or 8uiet and sullen un6illingto tal9 to the nurse. %rritability is common because clients are ne6ly free of substances.3. Clients may be pleasant and seemingly happy appearing unaffected by the situation especially if they are still in denial about the substance use.J

?!houht rocess and $ontent

1. Clients are li9ely to minimi5e their substance use blame others for their problems and rationali5e their behaior.2. 0hey may beliee they cannot surie 6ithout the substance or may e/press no desire to do so. 3. 0hey may focus their attention on finances legal issues oremployment problems as the main source of difficulty rather than their substance use.. 0hey may beliee that they could 8uit =on their o6n> if they 6anted to and they continue to deny or minimi5e the e/tent of the problem.

JSensorium and &ntellectual rocesses1. riented and alert unless they are e/periencing lingering effects of 6ithdra6al. %2. ntellectual abilities are intact unless clients hae e/perienced neurologic deficits from long-term alcohol use or inhalant use.

JAudment and &nsiht1. @/ercised poor udgment especially 6hile under the influence of the substance.2. Hudgment may still be affected4 clients may behae impulsiely such as leaing treatment to obtain the substance of choice.3. %nsight usually is limited regarding substance use.. Clients may hae difficulty ac9no6ledging their behaior 6hile using or may not see loss of obs or relationships as connected to the substance use. 0hey may stillbeliee they can control the substance use.

?Self-$oncept1. Clients generally hae lo6 self-esteem 6hich they may e/press directly or coer 6ith grandiose behaior.

2. 0hey do not feel ade8uate to cope 6ith life and stress 6ithout the substance and often are uncomfortable around others 6hen not using.3. 0hey often hae difficulty identifying and e/pressing true feelings: in the past they hae preferred to escape feelings and to aoid any personal pain or difficulty 6iththe help of the substance.

Joles and elationships1. Clients usually hae e/perienced many difficulties 6ith social family and occupational roles. 2. Absenteeism and poor 6or9 performance are common.3. Clients may be angry 6ith family members 6ho 6ere instrumental in bringing them to treatment or 6ho threatened loss of a significant relationship.

?hysioloic $onsiderations1. any clients hae a history of poor nutrition (using rather than eating) and sleep disturbances that persist beyond deto/ification.2. 0hey may hae lier damage from drin9ing alcohol hepatitis or #% infection from intraenous drug use or lung or neurologic damage from using inhalants.

,ata Analysis @ach client has nursin dianoses specific to his or her physical health status. 0hese may include the follo6ing4 B %mbalanced 'utrition4 Dess 0han B %neffectie ,enialB %neffectie ole +erformanceB ,ysfunctional ;amily +rocesses4 AlcoholismB %neffectie Coping

utcome &dentification0reatment outcomes for clients 6ith substance use may include the follo6ing4B 0he client 6ill abstain from alcohol and drug use.B 0he client 6ill e/press feelings openly and directly.B 0he client 6ill erbali5e acceptance of responsibility for his or her o6n behaior.B 0he client 6ill practice nonchemical alternaties to deal 6ith stress or difficult situations.


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! substance abuse (escalante-saac)

B 0he client 6ill establish an effectie after-care plan.

%nterentions4J+roiding #ealth 0eaching for Client and ;amilyJAddressing ;amily %ssues-$odependence is a maladaptie coping pattern on the part of family members or others that results from a prolonged relationship 6ith the person 6ho uses substances.Characteristics of codependence are poor relationship s9ills e/cessie an/iety and 6orry compulsie behaiors and resistance to change.J+romoting Coping S9ills

+oints to Consider 7hen 7or9ing 6ith Clients and ;amilies 6ith Substance Abuse +roblems

B emember that substance abuse is a chronic recurring disease for many people ust li9e diabetes or heart disease.B @/amine substance abuse problems in your o6n family and friends een though it may be painful.B Approach each treatment e/perience 6ith an open and obectie attitude

substancce abuse

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