Substance Use & Addictive Disorders

What do addictive substances or behaviors do to the brain’s reward system?

They flood the nucleus accumbens with dopamine.

What effect does repeated exposure to addictive substances or behaviors have on the brain?

It causes nerve cells in the nucleus accumbens and prefrontal cortex to link liking something with wanting it.

What is the result of the brain linking liking with wanting?

It motivates a person to seek out the source of pleasure.

What is a substance use disorder (SUD)?

A disorder involving repeated use of chemical substances, leading to clinically significant impairment over a 12-month period.

What are the key characteristics of a substance use disorder?

Loss of control due to substance use or behavior, continued use despite problems, and risk of relapse.

What defense mechanism is commonly used by clients with substance use or addictive disorders?

Denial

What is dopamine and its function in the brain?

Dopamine is a neurotransmitter involved in pleasure, motivation, and reinforcement of behaviors. It helps promote healthy activities like eating, socializing, and achieving goals.

How does addiction hijack the dopamine system?

Substances or behaviors cause massive dopamine spikes, much higher than natural rewards, leading to dysregulation over time.

What causes dopaminergic dysregulation in addiction?

Repeated excessive dopamine release, downregulation of D2 receptors, dopamine deficiency, and impaired decision-making.

What happens during dopamine withdrawal?

People may experience depression, fatigue, anxiety, cravings, sleep issues, and difficulty feeling pleasure (PAWS).

Why does withdrawal often lead to relapse?

The brain craves dopamine stimulation, and without healthy coping strategies, people return to addictive behaviors.

What are some ways to rebalance dopamine in recovery?

Exercise, nutrition, mindfulness, building new rewards, improving sleep, and using medications if needed.

Which foods help restore dopamine?

Protein-rich foods, leafy greens, nuts, seeds, and moderate dark chocolate.

Which medications support dopamine recovery?

Bupropion (Wellbutrin), Naltrexone, and L-tyrosine supplements.

What are key takeaways for sustainable recovery?

Be patient, expect early discomfort, engage in meaningful activities, avoid quick dopamine fixes, and seek social support.

Why is recovery more than just quitting?

It’s about rewiring the brain and restoring dopamine balance through consistent, healthy habits over time.

Which ethnic groups have a higher rate of alcohol use disorder?

Alaska natives and native americans

Which ethnic group has a lower rate of alcohol use disorder?

Asian groups

What factors influence differences in alcohol use disorder rates among ethnic groups?

metabolism and cultural views

How does peer pressure affect alcohol use?

it can incr risk of use

Why might older adults develop patterns of substance use later in life?

Due to life stressors such as loss of friends/family, retirement, or social isolation.

What approach should the nurse use when gathering a substance use history?

Use open-ended questions.

What information should the nurse gather in a substance use assessment?

• Type of substance or addictive behavior

• Pattern and frequency of use

• Amount of substance used

• Age at onset

• Changes in work/school performance

• Changes in use patterns

• Periods of abstinence

• History of withdrawal symptoms

• Date of last use or behavior

What is a drug-related blackout?

A phenomenon caused by the intake of a substance or medication that impairs short-term and long-term memory creation, leading to an inability to recall past events.

What does the CAGE assessment screen for?

Alcohol use disorder.

What does each letter in the CAGE acronym stand for?

• Cut back

• Annoyed

• Guilty

• Eye-opener

What is the CIWA-Ar tool used for?

assess and manage alcohol withdrawal severity.

How is CIWA-Ar scored?

• Mild: ≤ 15

• Moderate: 16–20

• Severe: > 20

What treatment decision can CIWA-Ar scoring influence?

Whether to administer benzodiazepines for withdrawal symptoms.

What does SBIRT stand for?

Screening, Brief Intervention, and Referral to Treatment.

What is tolerance in substance use?

The need for increased amounts of a substance to achieve the desired effect.

What is withdrawal in substance use?

Physiological adverse effects that occur when the concentration of a substance in the bloodstream declines.

What is abstinence syndrome?

A potentially life-threatening condition that occurs when a client abruptly stops using a substance.

What is the action of opioid agonists in the CNS?

They attach to CNS receptors and alter perception and response to pain, leading to generalized CNS depression.

What are some examples of opioid agonists?

heroin, morphine, hydromorphone

What are the routes of administration for opioids like heroin, morphine, and hydromorphone?

injection, smoked, inhaled, swallowed

What is the intended effect of opioid agonists?

euphoria and pain relief

What are the effects of opioid intoxication?

impaired judgment, reduced social functioning, decr respirations & LOC, which can l/t death

When does opioid withdrawal typically begin?

w/in hrs to days after last use

What are common manifestations of opioid withdrawal?

sweating, rhinorrhea, piloerection (goose bumps), tremors, irritability, weakness, N/V, muscle aches, fever

Is opioid withdrawal life-threatening?

No, but it’s very unpleasant and carries high risk for suicide

What is the intended effect of methadone substitution?What is the intended effect of methadone substitution?

To replace opioid the pt is dependent on, prevents abstinence syndrome, and reduces need for illegal opioids

What are key nursing actions when administering methadone?

• Encourage 12-step program participation

• taper dose slowly for detox

  • Admin only thru approved tx centers

What are the intended effects of clonidine in opioid withdrawal?

reduces w/drawal sxs like anxiety, agitation, sweating, musc aches, and elev HR/BP; helps maintain abstinence

What does clonidine not help with in opioid treatment?

it doesn’t reduce cravings for opioids

What client education is important for clonidine?

avoid activities requiring alertness until drowsiness subsides; chew gum, suck on candy, or sip water to help w/dry mouth

What is buprenorphine used for?

opioid w/drawal and maintenance; reduces cravings and supports tx compliance

What is a key nursing action for buprenorphine administration?

it can be prescribed and dispensed by PCP and is given SL

What is naloxone (Narcan) used for?

reverses respiratory depression, coma, and opioid toxicity effects

How is naloxone administered?

IM, SQ, IV, or inhalation

What is flumazenil used for?

reverse sedative effects and toxicity from benzos

How is flumazenil administered?

IV

At what blood alcohol level is an adult legally intoxicated in most states?

0.08%

At what blood alcohol level could death occur from acute toxicity?

>0.4%

What are the symptoms of fetal alcohol syndrome?

Microcephaly, craniofacial malformations, limb and heart defects, and other developmental problems.

What are the effects of alcohol intoxication?

slurred speech, nystagmus, memory impairment, altered judgment, decr motor skills, decr LOC

What are the effects of chronic alcohol use?

CV damage, liver damage (fatty liver, cirrhosis), erosive gastrititis, GI bleeding, acute pancreatitis, and sexual dysfunction

What are common symptoms of alcohol withdrawal?

ABD cramping, vomiting, tremors, restlessness, insomnia, incr HR, transient hallucinations or illusions, anxiety, incr BP, incr respiratory rate, incr temp, tonic-clonic seizure

When can alcohol withdrawal delirium occur?

2-3 days after cessation

Why is alcohol withdrawal delirium considered a medical emergency?

can involve severe disorientation, hallucinations, severe hypertension, cardiac dysrhythmias, and delerium, which can progress to death

When do alcohol withdrawal symptoms typically begin?

w/in 4-12hrs after last intake

How long can alcohol withdrawal symptoms last?

5-7 days

What class of medication is used as first-line treatment for alcohol withdrawal?

benzos

What are the intended effects of benzodiazepines during alcohol withdrawal?

maintain V/S w/in expected range
decr risk of seizures
reduce w/drawal sx
provide substitution therapy

What are key nursing actions for benzodiazepine administration in alcohol withdrawal?

• admin around the clock or PRN

• monitor V/S & neuro status

• obtain baseline vitals

  • implement seizure precautions

What are the adjunct medications used in alcohol withdrawal?

carbamazepine, clonidine, propranolol, atenolol

What is the purpose of Carbamazepine in alcohol withdrawal?

reduce risk of seizures

What is the purpose of Clonidine, Propranolol, and Atenolol in alcohol withdrawal?

• depress autonomic response (decr BP & HR)

• decr alcohol cravings (propranolol & atenolol)

What are important nursing actions for adjunct medications in alcohol withdrawal?

• monitor V/S continuously

• implement seizure precautions

• check HR before propanolol admin & hold if <60 BPM

What is Disulfiram used for in alcohol use disorder?

aversion therapy to maintain abstinence by causing unpleasant effects if alcohol is consumed

What happens if a person consumes alcohol while taking Disulfiram?

acetaldehyde syndrome: N/V, weakness, sweating, palpitations, hypotension, possible progression to resp depression, CV collapse, seizures, and death

What client education is important for someone taking Disulfiram?

• avoid all alcohol containing products (mouthwash, cough syrup, hand sanitizer, etc)

• wear medical alert bracelet

• participate in self-help program

• don’t consume alcohol

What nursing action should be taken for clients on Disulfiram?

monitor LFTs to detect hepatotoxicity

What is the purpose of Naltrexone in alcohol use disorder?

to suppress the craving and pleasurable effects of alcohol

What nursing actions are important when giving Naltrexone?

• assess for opioid dependence d/t risk of toxicity

• suggest monthly IM depot injections for pts w/adherence issues

What client education is important for Naltrexone?

take w/meals to reduce GI distress

What is Acamprosate used for?

reduce unpleasant effects of abstinence (dysphoria, anxiety, restlessness)

What are important client education points for Acamprosate?

• diarrhea may occur; maintain hydration

• avoid during pregnancy

What are examples of CNS depressant sedatives and their categories?

• benzos: diazepam

• barbiturates: pentobarbital (hypnotic)

  • club drugs (anxiolytic): flunitrazepam

What are the intended effects of CNS depressants like sedatives and hypnotics?

decr anxiety and sedation

What are the effects of intoxication from CNS depressants?

• Increased drowsiness and sedation

• Agitation

• Slurred speech

• Uncoordinated motor activity

• Nystagmus

• Disorientation

• Nausea and vomiting

• Respiratory depression and decreased LOC (can be fatal)

What is the antidote for benzodiazepine toxicity?

flumazenil

Is there an antidote for barbiturate toxicity?

No

What are the withdrawal manifestations of CNS depressants?

• Anxiety and insomnia

• Diaphoresis

• Hypertension

• Psychotic reactions

• Hand tremors

• Nausea and vomiting

• Hallucinations or illusions

• Psychomotor agitation

• Possible seizures

What are two forms of cannabis?

marijuana and hashish

What are the intended effects of cannabis use?

• Euphoria

• Sedation

• Hallucinations

• Decreased nausea and vomiting (e.g., from chemotherapy)

• Chronic pain management

A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should expect prescriptions for which of the following medications to promote long-term abstinence from alcohol?

(SATA)

disulfiram, naltrexone, acamprosate

A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol?

disulfiram

What are some common hallucinogens?

LSD (lysergic acid diethylamide), mescaline (peyote), PCP (phencyclidine piperidine)

How are hallucinogens commonly administered?

orally, injected, or smoked

What are the intended effects of hallucinogens?

Heightened sense of self, altered perceptions, vivid colors

What are effects of hallucinogen intoxication?

Anxiety, depression, paranoia, impaired judgment, pupil dilation, tachycardia, diaphoresis, palpitations, blurred vision

What is a withdrawal manifestation of hallucinogens?

hallucinogen persisting perception disorder: visual disturbances or flashbacks that can occur intermittently for years

What are common sources of caffeine?

coffee, tea, cola, chocolate, energy drinks

What are the intended effects of caffeine?

incr alertness, decr fatigue

At what dose is caffeine intoxication likely to occur?

>250mg (some 2oz energy drinks have 215-240mg)

What are symptoms of caffeine intoxication?

tachycardia, arrhythmias, flushed face, musc twitching, restlessness, GI upset, anxiety, insomnia, diuresis

When does caffeine withdrawal begin, and what are the symptoms?

Starts ~24 hours after last use; symptoms include headache, N/V, muscle pain, irritability, drowsiness, inability to focus

What receptors does nicotine affect in the body?

Nicotinic receptors in the brain, carotid body, aortic arch, and CNS.

How does nicotine mimic other addictive substances?

It activates reward pathways similar to cocaine and other addictive drugs.