Ch. 19 Videbeck's Psychiatric-Mental Health Nursing: Addiction

12-step program

based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety

blackout

an episode during which the person continues to function but has no conscious awareness of his or her behavior at the time or any later memory of the behavior; usually associated with alcohol consumption

codependence

a maladaptive coping pattern on the part of family members or others that results from a prolonged relationship with the person who uses substances

controlled substances

drug classified under the Controlled Substances Act; includes opioids, stimulants, benzodiazepines, anabolic steroids, cannabis derivatives, psychedelics, and sedatives

denial

defense mechanism; clients may deny directly having any problems or may minimize the extent of problems or actual substance use

designer drugs

synthetic substances made by altering existing medications or formulating new ones not yet controlled by the FDA; amphetamine-like effects, some also have hallucinogenic effects; called club drugs

detoxification

the process of safely withdrawing from a substance

dual diagnosis

the client with both substance abuse and another psychiatric illness

flushing

reddening of the face and neck as a result of increased blood flow

hallucinogens

substances that distort the user's perception of reality and produce symptoms similar to psychosis, including hallucinations (usually visual) and depersonalization

inhalants

a diverse group of drugs including anesthetics, nitrates, and organic solvents that are inhaled for their effects

intoxication

use of a substance that results in maladaptive behavior

opioids

controlled drugs; often abused because they desensitize the user to both physiological and psychological pain and induce a sense of euphoria and well-being; some are prescribed for analgesic effects, but others are illegal in the United States

polysubstance abuse

abuse of more than one substance

spontaneous remission

natural recovery that occurs without treatment of any kind

stimulants

drugs that stimulate or excite the central nervous system

substance abuse

can be defined as using a drug in a way that is inconsistent with medical or social norms and despite negative consequences

tapering

administering decreasing doses of a medication, leading to discontinuation of the drug

tolerance

the need for increased amount of a substance to produce the same effect

tolerance break

very small amounts of a substance will produce intoxication

withdrawal syndrome

refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases

alcohol (intoxication)

This substance is a central nervous system depressant that is absorbed rapidly into the bloodstream. Initially, the effects are relaxation and loss of inhibitions. With intoxication, there is slurred speech, unsteady gait, lack of coordination, and impaired attention, concentration, memory, and judgment. Some people become aggressive or display inappropriate sexual behavior when intoxicated. The person who is intoxicated may experience a blackout.

alcohol (overdose)

An overdose, or excessive intake of THIS substance in a short period, can result in vomiting, unconsciousness, and respiratory depression. This combination can cause aspiration pneumonia or pulmonary obstruction.

alcohol (withdrawal)

Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of substance intake. Symptoms include coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium, called delirium tremens. Withdrawal usually peaks on the second day and is over in about 5 days. This can vary, however; and withdrawal may take 1 to 2 weeks.

alcohol (detoxification)

Because withdrawal from this substance can be life-threatening, detoxification needs to be accomplished under medical supervision. If the client’s withdrawal symptoms are mild and he or she can abstain, he or she can be treated safely at home. For more severe withdrawal or for clients who cannot abstain during detoxification, a short admission of 3 to 5 days is the most common setting. Some psychiatric units also admit clients for detoxification, but this is less common. Safe withdrawal is usually accomplished with the administration of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the withdrawal symptoms. Withdrawal can be accomplished by fixed-schedule dosing known as tapering, or symptom-triggered dosing in which the presence and severity of withdrawal symptoms determine the amount of medication needed and the frequency of administration.

sedatives, hypnotics, and anxiolytics (intoxication)

This class of drugs includes all central nervous system depressants: barbiturates, nonbarbiturate hypnotics, and anxiolytics, particularly benzodiazepines. Benzodiazepines and barbiturates are the most frequently abused drugs in this category. The intensity of the effect depends on the particular drug. The effects of the drugs, symptoms of intoxication, and withdrawal symptoms are similar to those of alcohol. In the usual prescribed doses, these drugs cause drowsiness and reduce anxiety, which is the intended purpose. Intoxication symptoms include slurred speech, lack of coordination, unsteady gait, labile mood, impaired attention or memory, and even stupor and coma.

sedatives, hypnotics, and anxiolytics (overdose)

Benzodiazepines alone, when taken orally in overdose, are rarely fatal, but the person is lethargic and confused. Treatment includes gastric lavage followed by ingestion of activated charcoal and a saline cathartic; dialysis can be used if symptoms are severe (Burchum & Rosenthal, 2018). The client’s confusion and lethargy improve as the drug is excreted.

Barbiturates, in contrast, can be lethal when taken in overdose. They can cause coma, respiratory arrest, cardiac failure, and death. Treatment in an intensive care unit is required using lavage or dialysis to remove the drug from the system and to support respiratory and cardiovascular function.

sedatives, hypnotics, and anxiolytics (withdrawal)

The onset of withdrawal symptoms depends on the half-life of the drug (see Chapter 2). Medications such as lorazepam, with actions that typically last about 10 hours, produce withdrawal symptoms in 6 to 8 hours; longer-acting medications, such as diazepam, may not produce withdrawal symptoms for 1 week. The withdrawal syndrome is characterized by symptoms that are the opposite of the acute effects of the drug—autonomic hyperactivity (increased pulse, blood pressure, respirations, and temperature), hand tremor, insomnia, anxiety, nausea, and psychomotor agitation. Seizures and hallucinations occur only rarely in severe benzodiazepineterm-33 withdrawal (Tamburin et al., 2017)..

sedatives, hypnotics, and anxiolytics (detoxification)

Detoxification is often medically managed by tapering the amount of the drug the client receives over a period of days or weeks, depending on the drug and the amount the client had been using. Tapering is essential with barbiturates to prevent coma and death that occur if the drug is stopped abruptly.

stimulants (intoxication)

Intoxication from these substances develops rapidly; effects include the high or euphoric feeling, hyperactivity, hypervigilance, talkativeness, anxiety, grandiosity, hallucinations, stereotypic or repetitive behavior, anger, fighting, and impaired judgment. Physiological effects include tachycardia, elevated blood pressure, dilated pupils, perspiration or chills, nausea, chest pain, confusion, and cardiac dysrhythmias.

stimulants (overdose)

Overdoses of these substances can result in seizures, and coma; deaths are rare. Treatment with chlorpromazine (Thorazine), an antipsychotic, controls hallucinations, lowers blood pressure, and relieves nausea.

stimulants (withdrawal)

Withdrawal from these substances occurs within a few hours to several days after cessation of the drug and is not life-threatening. Marked dysphoria is the primary symptom and is accompanied by fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation. Marked withdrawal symptoms are referred to as “crashing”; the person may experience depressive symptoms, including suicidal ideation, for several days. Withdrawal for these substances is not treated pharmacologically.

cannabis (intoxication)

This substance begins to act less than 1 minute after inhalation. Peak effects usually occur in 20 to 30 minutes and last at least 2 to 3 hours. Users report a high feeling similar to that with alcohol, lowered inhibitions, relaxation, euphoria, and increased appetite. Symptoms of intoxication include impaired motor coordination, inappropriate laughter, impaired judgment and short-term memory, and distortions of time and perception. Anxiety, dysphoria, and social withdrawal may occur in some users. Physiological effects, in addition to increased appetite, include conjunctival injection (bloodshot eyes), dry mouth, hypotension, and tachycardia. Excessive use may produce delirium or rarely, [substance]-induced psychotic disorder, both of which are treated symptomatically.

cannabis (overdose)

Overdose of this substance does not occur.

cannabis (withdrawal)

Although some people have reported withdrawal symptoms of muscle aches, sweating, anxiety, and tremors, no clinically significant withdrawal syndrome is identified with this substance.

Cannabis sativa

the hemp plant that is widely cultivated for its fiber used to make rope and cloth and for oil from its seeds

opioids (intoxication)

Intoxication from this substance develops soon after the initial euphoric feeling; symptoms include apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech, and impaired attention and memory.

opioids (overdose)

Severe intoxication or overdose can lead to coma, respiratory depression, pupillary constriction, unconsciousness, and death. Administration of naloxone (Narcan), is the treatment of choice because it reverses all signs of toxicity. Naloxone is given every few hours until the [substance] level drops to nontoxic; this process may take days.

opioids (withdrawal)

Withdrawal develops when substance intake ceases or decreases markedly, or it can be precipitated by the administration of an antagonist. Initial symptoms are anxiety, restlessness, aching back and legs, and cravings for more [substance]. Symptoms that develop as withdrawal progresses include nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia. Symptoms of withdrawal cause significant distress, but do not require pharmacologic intervention to support life or bodily functions.

opioids (detoxification)

Methadone can be used as a replacement for [this substance], and the dosage is then decreased over 2 weeks. Substitution of methadone during detoxification reduces symptoms to no worse than a mild case of flu. Withdrawal symptoms such as anxiety, insomnia, dysphoria, anhedonia, and drug craving may persist for weeks or months.

hallucinogens (intoxication)

Intoxication from these substances is marked by several maladaptive behavioral or psychological changes: anxiety, depression, paranoid ideation, ideas of reference, fear of losing one’s mind, and potentially dangerous behaviors such as jumping out a window in the belief that one can fly. Physiological symptoms include sweating, tachycardia, palpitations, blurred vision, tremors, and lack of coordination. PCP intoxication often involves belligerence, aggression, impulsivity, and unpredictable behavior.

hallucinogens (overdose)

Toxic reactions to [these substances] (except PCP) are primarily psychological; overdoses as such do not occur. These drugs are not a direct cause of death, though fatalities have occurred from related accidents, aggression, and suicide. Treatment of toxic reactions is supportive. Psychotic reactions are managed best by isolation from external stimuli; physical restraints may be necessary for the safety of the client and others. PCP toxicity can include seizures, hypertension, hyperthermia, and respiratory depression. Medications are used to control seizures and blood pressure. Cooling devices such as hyperthermia blankets are used, and mechanical ventilation is used to support respirations.

hallucinogens (withdrawal)

No withdrawal syndrome has been identified for [these substances], though some people have reported a craving for the substance. These substances can produce flashbacks, which are transient recurrences of perceptual disturbances. These episodes occur even after all traces of the substance are gone and may persist for a few months up to 5 years.

inhalants (intoxication)

Intoxication from these substances involves dizziness, nystagmus, lack of coordination, slurred speech, unsteady gait, tremor, muscle weakness, and blurred vision. Stupor and coma can occur. Significant behavioral symptoms are belligerence, aggression, apathy, impaired judgment, and inability to function.

inhalants (overdose)

Acute toxicity from these substances causes anoxia, respiratory depression, vagal stimulation, and dysrhythmias. Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus. Treatment consists of supporting respiratory and cardiac functioning until the substance is removed from the body.

inhalants (withdrawal)

There are no withdrawal symptoms or detoxification procedures for these substances as such, though frequent users report psychological cravings. People who abuse these substances may suffer from persistent dementia or [substance]-induced disorders, such as psychosis, anxiety, or mood disorders even if the substance abuse ceases. These disorders are all treated symptomatically.

12 step program slogans

Key slogans for WHAT PROGRAMS reflect the ideas in the 12 steps, such as “one day at a time” (approach sobriety one day at a time), “easy does it” (don’t get frenzied about daily life and problems), and “let go and let God” (turn your life over to a higher power)?

vitamin B1 (thiamine)

For clients whose primary substance is alcohol, WHAT is often prescribed to prevent or to treat Wernicke-Korsakoff syndrome, which are neurologic conditions that can result from heavy alcohol use?

Wernicke-Korsakoff syndrome

For clients whose primary substance is alcohol, vitamin B1 (thiamine) is often prescribed to prevent or to treat WHAT, which are neurologic conditions that can result from heavy alcohol use?

Cyanocobalamin (Vitamin B12)

This drug used for substance abuse treatment treats nutritional deficiencies.

disufiram (antabuse)

This drug used for substance abuse treatment maintains abstinence from alcohol.

Acamprosate (Campral)

This drug used for substance abuse treatment suppresses alcohol cravings.

Methadone (Dolophine)

This drug used for substance abuse treatment maintains abstinence from heroin.

higher (rates of dependence)

Do physicians, dentists, and nurses have higher or lower rates of dependence on controlled substances, such as opioids, stimulants, and sedatives, than other professionals of comparable educational achievement, such as lawyers?

higher (rates of alcoholism)

Do health care professionals also have higher or lower rates of alcoholism than the general population?