Substance Use

In what types of healthcare settings is alcohol use and abuse commonly encountered?

It has a high incidence of occurrence across patient care settings.

What health complications are increased by alcohol dependence?

It increases the risk of ED visits, ICU admissions, and sepsis.

• you see a lot of alcohol withdrawel in ICU

What type of drinking behavior is linked to rising health risks?

Binge drinking is associated with increasing health risks.

How many categories of illicit drug use are defined?

There are 7 categories of illicit drug use.

What are the 7 categories of illicit drug use?

The categories include: Marijuana*, Cocaine (including crack), Heroin, Hallucinogens, Inhalants, Methamphetamines, and non-medical use of psychotherapeutics (Rx pain relievers, tranquilizers, and sedatives).

• there is a lot of education for pain meds

• questions to ask if someone comes in and you ask if they have used any drugs:

  • what

  • how often

  • when last

  • how much

What cause of death has surpassed motor vehicle accidents in recent years?

Deaths from drug overdose.

What are some contributing factors to prescription drug abuse and the opioid crisis?

• Increased prescriptions for pain medications

• Marketing strategies promoting medications

• Misrepresentation of the addictive nature

• Combination addictions, such as drinking while taking alcohol-interactive medications

What is considered the gold standard for diagnosing mental disorders?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).

Why is the Sexual and Gender Minority (SGM) community considered higher risk across the lifespan?

Due to increased exposure to stigma, minority stress, and health disparities.

What substances are SGM individuals more likely to use to cope with stigma and minority stress?

Alcohol and illicit drugs.

Are there many tailored interventions available for the SGM community?

No, there are few tailored interventions.

What kind of bias are SGM individuals more likely to experience in healthcare settings?

Implicit bias from healthcare providers.

What is needed to better support the SGM community in healthcare?

Additional research and specialized treatment options.

How does aging affect metabolic functions?

There is a decrease in metabolic functions.

What happens to muscle mass as adults age?

Muscle mass decreases.

What medication-related issue is common among aging adults?

The effects of polypharmacy.

• polypharmacy- taking a lot of medication

• these medications can interact with alcohol and heighten their effects

What cognitive issue becomes more likely in aging adults?

Increased risk for cognitive decline.

What physical and mental health risks increase with age?

Increased risk for falls, depression, and gastrointestinal (GI) problems.

What question can be asked to assess the consequences of alcohol use over the past year?

“In the past 12 months, has your drinking repeatedly caused or contributed to bodily harm, relationship trouble, role failure, or run-ins with the law?”

How can you assess if someone has trouble controlling their drinking limits?

Ask, “Have you not been able to stick to drinking limits, or have you repeatedly gone over them?”

What are signs of problematic drinking behavior?

Tolerance, withdrawal, continued drinking despite problems, spending excessive time drinking or recovering, and neglecting other important or pleasurable activities.

What question helps identify use of illicit substances?

“Do you sometimes take illicit drugs or street drugs, such as marijuana, cocaine, hallucinogens, narcotics?”

If a patient reports using drugs, what follow-up question should be asked?

“When was the last time you used drugs, and how much did you take that time?”

What is the definition of moderate drinking for men?

Less than or equal to 2 drinks per day.

What is the definition of moderate drinking for women and adults over 65?

Less than or equal to 1 drink per day.

What qualifies as at-risk drinking for men?

More than 14 drinks per week or more than 4 drinks on one occasion.

What qualifies as at-risk drinking for women?

More than 7 drinks per week or more than 3 drinks on one occasion.

What does the AUDIT questionnaire help detect?

Less severe alcohol problems (hazardous and harmful drinking), as well as alcohol abuse and dependence.

Why is the AUDIT useful in emergency and trauma settings?

It is sensitive to current, not just past, alcohol problems.

What are two advantages of the AUDIT in terms of bias?

It is relatively free of gender and cultural bias.

What is the purpose of the TWEAK questionnaire?

To identify at-risk drinking in women, especially pregnant women.

What does the "T" in TWEAK stand for, and what does it ask?

Tolerance – “How many drinks can you hold?” or “How many drinks does it take to make you feel high?”

What does the "W" in TWEAK stand for, and what does it ask?

Worry – “Have close friends or relatives complained about your drinking?”

What does the "E" in TWEAK stand for, and what does it ask?

Eye-opener – “Do you sometimes take a drink in the morning when you first get up?”

What does the "A" in TWEAK stand for, and what does it ask?

Amnesia – “Has a friend or family member told you about things you said but could not remember?”

What does the "K" in TWEAK stand for, and what does it ask?

Kut down – “Do you sometimes feel the need to cut down?”

What is the SMAST-G questionnaire used for?

Screening aging adults who report social or regular drinking of any amount of alcohol.

Why is the SMAST-G questionnaire important for older adults?

Older adults have specific emotional responses and physical reactions to alcohol, and the SMAST-G addresses these factors.

How many questions are in the SMAST-G questionnaire, and what type of responses does it require?

The SMAST-G contains 10 questions with yes/no responses.

What should you do if your assessment indicates at-risk drinking or illicit substance use?

State your conclusion and recommendation clearly.

What is an example of how to clearly communicate a recommendation to a patient with at-risk drinking?

“You are drinking more than is medically safe.”

• then ask them “what do you think about that” or “how does that make you feel”

• always assessing readiness to change; you cannot change them

Lab tests for alcohol

Serum protein, gamma glutamyl transferase (GGT): commonly used
biochemical marker of alcohol drinking

• Carbohydrate-deficient transferring (CDT)
  • Serum aspartate aminotransferase (AST)

How does breath alcohol analysis work?

Breath alcohol analysis detects alcohol in exhaled air following deep inhalation until all ingested alcohol is metabolized.

What can breath alcohol analysis be correlated with?

Breath alcohol analysis can be correlated with blood alcohol concentration (BAC) and used for legal interpretations of drinking.

What does CIWA measure?

CIWA uses 10 measured criteria with individual scoring to arrive at a composite score for alcohol withdrawal.

What vital signs and measures are included in the CIWA assessment?

CIWA includes vital signs and oxygen saturation.

How many criteria are used in the CIWA subscales, and which subscale has 4 criteria?

Individual subscales include 7 criteria, except for Orientation, which has 4 criteria.

What does the CIWA score help determine?

The score provides trended results to determine the level of monitoring needed.

When can you monitor a patient every 4 hours according to CIWA scoring?

score of 0 to 7 allows monitoring every 4 hours.

When can you discontinue CIWA monitoring?

All scores below 8 for 72 hours allow discontinuation of monitoring.

What does "substances" refer to in the context of substance abuse disorders?

"Substances" refers to non-medical agents taken to alter mood or behavior.

What is intoxication in relation to substance abuse?

Intoxication is characterized by maladaptive behavioral changes due to the effects on the CNS from a substance.

What defines abuse in substance use disorders?

Abuse is daily or recurrent use that leads to impairment and decreased functioning, causing ongoing problems.

What is dependence in substance abuse disorders?

Dependence is physiological reliance on a substance.

What does tolerance mean in the context of substance abuse?

Tolerance means requiring more of the substance to achieve the desired effect.

What is withdrawal in substance abuse?

Withdrawal occurs when cessation of the substance leads to physiological effects.

The nurse is assessing a patient who has been abusing
opiates for 4 years. The patient says, “I can quit anytime I
want.” The nurse should interpret this statement to be a
sign that this individual
1. may be in denial of needing help or having a problem
with opiates.
2. is ready to quit and can do so with little intervention.
3. is motivated to enter rehabilitation.
4. should not be trusted because this individual is not of
sound mind.

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The nurse is caring for a patient in the ED who has been a patient many
times before in the ED. In fact, this is the patient’s second overdose in 1
month. The nurse says, “Here we go again. I don’t know why we bother
with this guy, because he will be back out there as soon as he is
discharged”. The nurse
1. is not being professional and cannot give unbiased care.
2. is obligated to provide care.
3. is not obligated to provide care.
4. must find a way to come to terms with the way he or she
feels about these types of issues and work on ways to
deal with them.

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