SUBSTANCE ABUSE

USE, ABUSE AND DEPENDENCE

Mary Vercoutere, RN Instructor

Topics

Historical Factors Risk Factors/Poly drug abuse Theory for cause Predisposing factors Addition in the Health Care

Professions

Historical Aspects

Neolithic Age 6400 B.C. Distillation introduced by the

Arabs in the Middle Ages. Alchemists: alcohol was the

cure for all ailments. “Whiskey” means “water of

life”

A Disease and an Addiction

Early 1800’s Dr. Benjamin Rush, a well respected Physician of the time, identified the widespread excessive use.

Strong religious beliefs of the time forced prohibition.

Mid-19th century 13 states prohibited the sale of alcohol.

Prohibition

Major effect in the USA was 1920-1933.

Profit in the underground Millions of dollars lost due to

Federal and State Taxes Human devastation and social

costs unmeasurable.

Alcohol Use in Today’s World

Alcohol consumption effects 2/3 of the USA population.

Acceptance culturally of college-age use and abuse as a rite of passage.

Stigma of admitting a ‘problem’ with alcohol.

History of Opium

Opium:the Greek word for “juice” References to the use date back

to 3000 B.C. in Egyptian, Greek and Arabian cultures.

Widely used 16th, 17th century in Europe medicinally/ recreationally.

1803 Morphine isolated

Opiate Abuse

Development of hypodermic syringe in 1853.

Self-administration Chinese immigration introduced

opium smoking late 19th century.

Harrison Narcotic Act 1914 due to widespread addiction.

Hallucinogens

Carbon dating show use has been in practice by Native American Indians for 7000 years.

The Peyote cactus has been used for rituals and in religious practices

Shamen would use it to induce a trance lasting days for healing purposes.

Synthesized

LSD was synthesized 1938 by Dr. Albert Hoffman.

Used as a clinical research tool on the mind and behavior for diseases such as schizophrenia and to investigate the unconscious mind.

The abuse on the illicit market.

Substance use is simply the ingestion of a chemically active agent, prescription or illicit drug, alcohol or tobacco

Substance abuse suggests a maladaptive pattern of substance use leading to significant difficulties in meeting major role obligations at home, work or school

DSM IV-TR CRITERIA FOR SUBSTANCE ABUSE A maladaptive pattern of substance

use leading to a clinically significant impairment or distress, as seen by one or more of the following within a 12 month period.

Inability to fulfill major role obligations at work, school or home.

Risks

Participation in physically hazardous situations while impaired….driving a car, operating a machine…

Recurrent legal or interpersonal problems

Continued use despite recurrent social and interpersonal problems caused or exacerbated by the effects of the substance

DSM IV- TR CRITERIA FOR SUBSTANCE DEPENDENCE Maladaptive pattern of substance

use leading to clinically significant impairment or distress, manifested by three or more of the following within a 12 month period

1. Presence of tolerance of the drug 2. Presence of withdrawal syndrome

due to the cessation or reduction of substance use that has been heavy and prolonged

Criteria

3. Substance is taken in larger amounts for longer periods than intended

4. Unsuccessful or persistent desire to cut down or control use

5. Increased time spent in getting, taking, and recovering from the substance. May withdraw from family and friend

Criteria

6. Reduction or absence of important social, occupational or recreational activities

7. Substance use despite knowledge of recurrent physical or psychological problems

CAUSATIVE THEORIES

Biological Factors: Neurobiological theory-craving

for drug is a cardinal feature of addictive disorders. Effects neurotransmitters, areas of the brain.

Opioid,dopamine, GABA systems.

Theory

Psychological Factors Behavioral theory Sociocultural Theory: Asians,

lack of enzyme that breaks down ETOH.

Aamerican Indians break down ETOH at faster rate.

ALCOHOL Alcohol can be classified technically

as a food, due to it’s high caloric content, but it does not require any digestive process in order to be metabolized by the body in most European decent peoples.

The rate of absorption of alcohol from the stomach and duodenum is effected by 4 variables:

Alcohol

1. The alcohol concentration in a drink

2. The amount of food in the stomach

3. Body weight 4. Drinking experience -

tolerance

Alcohol Abuse Taking large amt’s of alcohol Binge drinking Withdrawal syndrome….hangover …N&V, Gastritis,

Headache,Fatigue, Sweating and thirst,Restlessness, Irritability,The “shakes”Vasomotor instability

Alcohol

Time frame for withdrawal symptoms may begin within 12-24 hours following last drink. Symptoms may last 48-72 hours. Major withdrawal symptoms may appear within 2-3 days following last drink and may last 3- 5 days

DANGERS AND COMPLICATIONS Car accidents Physical injury Malnutrition Hepatitis Cirrhosis Suicide

Effects of Alcohol on the Body

Reproductive effects: fetal alcohol syndrome.

Cardiovascular effects, caardiomyopaathy.

Pancreatitis. GI bleeding, esophageal bleeding. Wernicke’s encephalopathy:

thiamine deficiency that causes paralysis and death if not corrected.

Effects of Alcohol on the Body

Korsakoff’s psychosis: confusion, loss of memory, confabulation.

Both Wernicke’s and Korsakoff’s are treated the same.

Peripheral Neuropathy: nerve dammage due to poor nutrition

DT’s:Delirium Tremens

Withdrawal

Withdrawal delirium a medical emergency: MI, PV collapse, electrolyte imbalance, aspiration pnemonia, suicide.

Orinda Center: a social model of de-toxicitation

MAJOR WITHDRAWALMEDICAL TREATMENT

Major withdrawal is the most advanced potentially life-threatening stage of alcohol withdrawal, develops within 72 hours after last drink

Symptoms autonomic hyperactivity: elevated temp, diaphoresis, hypertension, tachycardia

Behavioral:confusion, agitation, tremors and alterations in sensory perceptions, auditory and visual hallucinations

Treatment

Monitoring the fluid status Administering magnesium

sulfate to decrease irritability caused by low magnesium levels to prevent seizure

Prescribing detoxification protocol accepted at the facility.

TREATMENT QUIET NON STIMULATING

ENVIRONMENT Vitamins - thiamine and b-complex,

usually 200mg thiamine every day for three days.

Aversion therapy - Antabuse- can be fatal if patient drinks while on this drug. ReVia, Trexan…developed 1984 for treatment in heroin abuse…seems to work for craving with alcohol

Treatment

Psychotherapy AA - support groups Supportive life changes

NURSING ASSSESSMENT Nurse must begin relationship

development with a client with a substance abuse problem by examining his or her own attitudes and personal experiences with this area of caring and treatment.

Help client to find ways to cope. Family intervention. Need open, accepting, trusting

relationship.

Client Centered Hope

Lifetime problem….DENIAL is biggest problem

OTHER DRUGS Marijuana Cocaine Amphetamines Heroin and the Opiates Opioid Analogs called designer

drugs

Other Drugs

Semisynthetic narcotic, oxycodone (percodan) OxyContin,unfortunately street users of the drug are attracted to it’s euphoric high that is similar to heroin

Hallucinogens Club drugs Rohypnol….date rape drugs, alcohol-

69%, marijuana-18%, cocaine 5%

Chemical Dependency in the Health Professional

1983 California State Legislature revised the Nurse Practice Act to require that all RN’s have training in detection of substance abuse.

Caregivers with a substance problem.

Chemical dependency is a primary disease: chronic, progressive.

Occupational Hazard

Loss of control Compulsive Continued despite adverse

consequences. Genetics Nurses and physicians

knowledge about pharmaceuticals

Access

Signs/Symptoms

Difficulty concentrating Impaired judgment Undependable Moodiness, runny nose Daydreaming Constantly wearing long

sleeves

Interventions

Individuals Families Conclusions Questions