Understanding Substance Use Disorders and Recovery-Oriented Practice

A collection of vocabulary flashcards based on the lecture notes covering substance use disorders, their impact, diagnostic criteria, and treatment options.

Substance Use Disorder (SUD)

• A problematic pattern of substance use leading to clinically significant impairment or distress, as indicated by 2 or more criteria occurring within a 12-month period.

• strongly linked to mental illness, trauma, chronic pain, social inequity

most commonly used substances

• alcohol

• cannabis

• opioids

Core Diagnostic Domains

Includes impaired control, social impairment, risky use, and pharmacological criteria such as tolerance and withdrawal.

Severity Levels for SUD

Classified as Mild (2-3 symptoms), Moderate (4-5 symptoms), Severe (6+ symptoms).

substance use disorder relevance to nurses

• nurses often first point of contact in screening and care

• understanding SUD helps us recognize signs of dependence, manage withdrawal, support recovery, reduce stigma

• promotes trauma informed care

Reward Pathway

The neural pathway involving the ventral tegmental area (VTA), dopamine, and the nucleus accumbens (NAc), responsible for euphoria and reinforcing substance use.

inhibition failure

prefrontal cortex (PFC) is weakened → reduced impulse control and risk awareness

stress and emotion circuitry

overactive stress systems (ex amygdala) heighten anxiety and cravings

cycle of dependence

use continues not for pleasure, but to avoid withdrawal and distress that comes from it

7 principles of addiction treatment

1. addiction is complex, but treatable → alters brain function and behaviour

2. no single treatment works for everyone

3. timely and accessibly treatment is essential

4. the care has to be holistic, not just focusing on substance use

5. combo of meds + counseling improve treatment outcomes

6. co-occurring mental health conditions are common

7. detox is only the first step - it is not sufficient on its own

recovery is not possible w/o hope. show people compassion. 

recovery oriented practices

includes support for

• housing

• employment

• education

• family

• healthy eating

• basic health promotion

recovery is seen as moving towards those conditions, not being free from symptoms. it is meant to build a meaningful, hopeful, successful life. 

recovery model (CHIME)

C. for connectedness

H. for hope

I. for identity

M. for meaning in life

E. for empowerment

applying recovery-oriented practice

• use therapeutic communication to reduce stigma and foster trust

• assess readiness for change

• interdisciplinary care - social work, addictions counseling, psychiatry, psychotherapy

• promote harm reduction

• support client-led goal setting

• advocate for continuity of care

Harm Reduction

• An approach that focuses on reducing the harms associated with substance use rather than aiming for complete abstinence.

• emphasizes access to care w/o requiring abstinence 

• recognizes that abstinence might not be realistic or immediate for all

• grounded in dignity, autonomy, public health evidence

• supported by CNA and AHS as best practice in addressing substance use 

• things like education, safe consumption sites, free naloxone kits and training, clean supplies 

CAGE-AID

A brief screening tool adapted to include drug use, used in primary care and mental health settings to identify problematic alcohol or drug use.

Opioid Use Disorder (OUD)

A problematic pattern of opioid use leading to clinically significant impairment or distress, observed with specific criteria within a 12-month period.

origins of opioid crisis in canada

• WHO pain ladder is developed to manage cancer pain

• it becomes widely applied to all types of pain

• aggressive pharmaceutical marketing downplays addiction risk, and they marketed directly to physicians and hospitals as well 

• new medical norms emphasize zero pain as a patient right, when zero pain is not always a realistic expectation

diagnostic criteria for opioid use disorder

• problematic pattern of use leading to clinically significant impairment or distress

• criteria observed w/in 12 month period

  • larger amounts over longer period of time

  • unsuccessful in cutting down or controlling use

  • excessive time spent obtaining, using, recovering from drug

  • cravings, strong desire

  • failure to fulfill occupational, personal, academic role obligations as result of use

  • persistent or recurrent social or interpersonal problems

  • social, occupational, recreational activities are given up or reduces

  • recurrent use in situations where it’s physically hazardous

  • continued use despite knowledge of having a problem

• 2 or more of criteria in year span qualify as disorder

clarification in asking about opioid use

• if asking a patient, clarify what opioids are! there are lots of meds that people might not recognize to be opioids

• things like codeine, morphine, oxycodone, hydrocodone, fentanyl, tramadol

tolerance

either

1. need for markedly increased amounts of opioids to achieve intoxication or desired effect, OR

2. markedly diminished effect with continued use of same amount of opioid

withdrawal

either:

1. cessation of or reduction in opioid use that has been heavy and prolonged (several weeks or longer), OR

2. administration of opioid antagonist after a period of opioid use

AND

3 or more of following, developing w/in minutes to several days after above criteria

• dysphoric mood, nausea, vomiting, muscle aches, lacrimation, rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, insomnia

Medication Assisted Treatment (MAT)

A treatment approach that combines medications with counseling and behavioral therapies to improve treatment outcomes for opioid use disorders. Therapies include clonidine, naltrexone, atypical anti-psychotics, and benzos

clonidine for med assisted treatment

• non-opioid

• suppresses opioid withdrawal

• does not produce physical dependency

naltrexone for med assisted treatment

• blocks euphoric effects of opioids up to 72 hours

• does not produce dependence

• can give false positive for fentanyl on urine drug tests

atypical antipsychotics for med assisted treatment

• adjunct treatments

• olanzapine and quetiapine

• reduces anxiety, cravings, withdrawal symptoms

benzos for med assisted treatment

• adjunct treatment

• suppresses hyperactive CNS functions r/t withdrawal

non-pharmacological supports for withdrawal

• hydration and nutrition (with caution, don’t want to feed too much because they may be nauseous)

• psychoeducation — what they might feel in withdrawal, symptoms they might experience

• therapeutic communication

• emotional and peer support

• sensory and relaxation strategies

• sleep and rest support

• safe environment

opioid agonist treatment (OAT)

suboxone/sublocade and methadone

suboxone / sublocade

• buprenorphine and naloxone together

• partial opioid agonist, reduces cravings and prevents withdrawal

• lower risk of overdose compared to methadone

• fewer and less severe side effects compared to methadone

• lower risk of drug interactions compared to methadone

• preferred first line of treatment compared

methadone

• synthetic opioid

• blocks craving for / effects of opioids

• high physiological and psychological dependency

• tolerance and withdrawal can occur

• does not produce euphoria

• side effects include QT prolongation, weight gain, constipation, numbness, hallucinations

Cannabis Use Disorder (CUD)

A problematic pattern of cannabis use leading to significant impairment or distress, with specific diagnostic criteria observed within a 12-month period. After alcohol and nicotine, this. is the most used psychoactive substance in Canada

two main compounds in cannabis

• THC: psychoactive, affects dopamine and reward pathways

• CBD: non-psychoactive, used for pain, anxiety, sleep 

how cannabis works

• THC mimics anandamide, which is a natural cannabinoid in the brain

• increases dopamine and serotonin by reducing GABA activity

• can distort time perception, increase energy, libido, focus

• chronic high dopamine from use can lead to receptor downregulation, low mood, poor memory, fatigue, loss of motivation, even psychosis

cannabis use and psychosis risk

• cannabis use before 16 is linked to 5x higher risk of psychosis and persistent anxiety

• risk is increased with

  • high THC content >15%

  • genetic predisposition ex. family history of schizophrenia

  • history of trauma or ACEs

diagnostic criteria

• problematic pattern of cannabis use leading to clinically significant impairment or distress, demonstrated by 2+ of following criteria w/in 12 month period

  • larger amounts or longer period of time than intended

  • unsuccessful efforts to cut down or control use

  • excessive time spent obtaining, using, recovering from use

  • craving or strong desire to use

  • failure to fulfill major role obligations at work, school, home

  • persistent or recurrent social or interpersonal problems caused or worsened by use

  • important social, occupational, or recreational activities are reduced or given up

  • recurrent use in physically hazardous situations

  • continued use despite knowledge of physical or psychological problems likely caused or exacerbated by use

  • tolerance develops

  • withdrawal symptoms, or cannabis used to relieve or avoid withdrawal

key clinical cues for recognizing CUD

• behavioural → decline in work/school performance, social withdrawal, apathy

• cognitive → poor concentration, memory impairment, slowed reaction time

• mood/emotional → irritability, anxiety, depressed mood, paranoia

• physical → red eyes, dry mouth, increased appetite, altered coordination

• psychiatric red flags → onset or worsening of psychosis, persistent anxiety or panic attacks, suicidal ideation w heavy use

vaping and mental health

• linked to increased risk of depression and anxiety

• associated w worsened ADHD symptoms

• impairs impulse control, especially in youth

• higher use = greater mental health symptoms severity

smoking and schizophrenia

• 70-90% smoking rate among individuals w schizophrenia

• temporarily increases dopamine activity and improves cognition

• in long term, worsens positive symptoms and impairs cognition

• can reduce EPS

• can reduce negative symptoms like apathy and flat affect

nicotine as stimulant / depression

• as stimulant - first will release epinephrine (jump starts feelings of pleasure), then releases beta-endorphins, which inhibit pain

• as depressant - this is rebound effect. after effects wear off, mood will drop, fatigue increases, craving begins

nicotine withdrawal

• anger, hostility, aggression

• stress

• anxiety, depressed mood

• difficulty concentrating

• increased appetite

• cravings

nicotine replacement therapy

• recommended for those interested in quitting or cutting down, but contraindicated in acute coronary syndrome or angina

• patch slows onset of effects as nicotine is released over hours, low addictive potential, do not put patch over heart

• immediate release NRT like gum, inhaler, lozenge, spray

  • provide nicotine more rapidly than patch, but less rapidly than cigarettes

  • reaches lower plasma nicotine levels

  • less addictive potential than cigarettes

signs of drug diversion in workplace

• frequent sick days, unexplained absence from unit

• volunteering for hella overtime or high-narc assignments

• isolating behaviour: long breaks, disappearing from unit, avoiding supervision

• med related misconduct like tampering, false narc records, handling narcotics alone

• frequent reports of med spills or drug waste

• administering narcotics to other nurses’ clients

• documentation inconsistencies like MAR mismatches, discrepancies in end-of-shift counts, fictional patients

• increase in client complaints of unrelieved pain, especially if relief had been adequate before that

• damaged or torn packaging on controlled substances

• increased reports of “pharmacy error”

• trips to bathroom after contact w controlled substances

support pathways for nurses

• most employers offer confidential employee assistance programs (EAPs) → focus on early intervention, counseling, recovery support

• regulatory supports → CRNA and regulatory bodies offer non-punitive treatment pathways'

• CRNA health monitoring program (HMP): voluntary individualized monitoring agreements, emphasis on rehab rather than discipline, supports safe practice and sustained recovery

• the goal is to protect public safety AND support the nurse in their recovery and return to practice