Mental Health Chapter 14 substance abuse Exam 2

What a physical dependency?

–Need for increasing amounts to produce the desired effect

–Pattern of withdraw symptoms (alcohol vs opioids)

A tolerance

What is psychological dependence?

–Overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort

–Not all patients take drugs to get high (someone may be going through divorce and use it to cope)

What is substance intoxication?

–symptoms following excessive use of a substance

–Direct effect on the central nervous system

–Disruption in physical and psychological functioning

–Judgment is disturbed and social and occupational functioning is impaired

–“risky behavior”

What is substance withdrawal?

–symptoms that occurs upon reduction or discontinuation of a substance that has been used regularly over a prolonged period of time

–Symptoms are specific to the substance that has been used

–Disruption in physical and psychological functioning, with disturbances in thinking (suicidal thoughts), feeling, and behavior

Predisposing factors for substance abuse:

Genetics: apparent hereditary factor, particularly with alcoholism

Personality factors

-certain personality traits are thought to increase a tendency toward addictive behavior.

Socio-cultural factors

-Social learning: children and adolescents more likely to use substances with parents who provide model for substance use

-Native Americans have a lot of alcoholism (metabolism is issue)

Effects of alcohol on the body:

–Peripheral neuropathy

–Cardiomyopathy (heart gets too big)

–Esophagitis/Gastritis (diaheraa)

–Pancreatitis

–Hepatic encephalopathy

–Sexual functioning

•Cirrhosis of the liver

-There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue.

•Portal hypertension

-elevation of blood pressure through the portal circulation results from defective blood flow through cirrhotic liver

-Ascities may develop (excess fluid in abdomen)

-Esophageal varices  (distended veins from pressure)

Wernicke’s encephalopathy: 

most serious form of thiamine deficiency in alcoholic patients

Korsakoff’s psychosis:

syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients

What happens to the 20% of alcohol that doesn’t need to digest:

It goes to the blood stream directly to the brain.

Nursing diagnosis for alcoholism: 

malnourish, look for dry mucus membrane and poor turgor.

When does alcohol intoxication occur? 

at blood alcohol levels between 100 and 200 mg/dl

Alcohol withdraws:

•4 to 12 hours of cessation

Tremors, insomnia, elevated b/p, irritability, sweating

Treatment of alcoholism:

–Encourage pt to take responsibility of actions

–Encourage AA (90 meetings for 90 days)

–Codependency (partner can only control their own behavior)

Stimulants that are abused: 

–Amphetamines (Meth)

–   Synthetic stimulants (bath salts)

–   Non-amphetamine stimulants (diet pills)

–   Cocaine

–   Caffeine

   Nicotine

A sign that someone uses meth:

Bad teeth

Stimulant use disorder effects on the body:

•CNS effects (tremors)

• Cardiovascular effects (increased heart rate)

• Pulmonary effects (pneumonia)

• Gastrointestinal and renal effects

• Sexual functioning

What are the two most common stimulants?

Nicotine and caffeine 

Intoxication of stimulants: Amphetamines and cocaine

produce  euphoria, impaired judgment, confusion, changes in vital signs (even coma or death, depending on amount consumed).

Intoxication of stimulants: Caffeine

•usually occurs following consumption in excess of 250 mg. Restlessness and insomnia are the most common symptoms.

Amphetamine and cocaine withdrawal:

may result in dysphoria, fatigue, sleep disturbances, and increased appetite.

Caffeine withdrawal:

headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting.

Nicotine withdrawal:

dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite.

Opioid use dirsorder:

–A profile of the substance

• Opioids of natural origin (Opium,Morphine,Codeine)

• Opioid derivatives (Heroin,OxyContin,Vicodin)

• Synthetic opiate-like drugs (Demerol,Talwin)

Opioids of natural origin:

(Opium,Morphine,Codeine)

Opioid derivatives: 

(Heroin,OxyContin,Vicodin)

Synthetic opiate like drugs:

(Demerol,Talwin)

Opioid use disorder effects on the body:

•CNS effects

• Gastrointestinal effects

• Cardiovascular effects (watch for hypotension)

• Sexual functioning

Pupils constrict and euphoria (when off the drugs, pupils dilate)

Opioid induced disorder intoxication: 

•Symptoms usually last for several hours.

•Symptoms include euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment.

•Severe opioid intoxication can lead to respiratory depression, coma, and death.

Opioid disorder withdrawal from short acting drugs:

Example: heroin

•Symptoms occur within 6 to 8 hours, peak within 1 to 3 days, and gradually subside in 5 to 10 days

Opioid disorder withdrawal from long acting drugs: 

Example: methadone

•Symptoms occur within 1 to 3 days, peak between days 4 and 6, and subside in 14 to 21 days

Symptoms of opioid withdrawal:

Dysphoria, muscle aches, nausea/vomiting, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal cramping, diarrhea, yawning, fever, and insomnia

Cannabis effects on the body:

–Helps with nausea

–Youth might think weed is the same as cigarettes but that is not correct

Cannabis intoxication:

•Symptoms include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment

•Physical symptoms include increased appetite, dry mouth, and tachycardia

•Impairment of motor skills lasts for 8 to 12 hours

Withdrawal from cannabis:

–Symptoms occur within a week following cessation of use

–Symptoms include irritability, anger, aggression, anxiety, sleep disturbances, decreased appetite, depressed mood, stomach pain, tremors, sweating, fever, chills, or headache

Pharmacotherapy for alcoholism: Disulfiram (Antabuse)

–A form of behavioral modification

Get super sick when you drink because of this, helps person to stop drinking

Psychopharmacology for substance intoxication and substance withdrawal, following medications help with Alcohol withdrawal

•Benzodiazepines (may use to prevent seizures)

• Anticonvulsants

• Multivitamin therapy

• Thiamine

Psychopharmacology for substance intoxication and withdrawal: for opioids

•Methadone

• Buprenorphine (Subutex)

• Clonidine (Catapres)

Varenicline:

•Used for smoking cessation

•Blocks the pleasant effect of nicotine from smoking on the brain.

Bupropion: 

•May be used for nicotine withdrawal from tobacco use.

•May also use nicotine gum and nicotine patch.

•Nicotine patch is usually used for 24 hours.

•Can remove before bedtime if having vivid dreams. Place patch on upper chest or arm

Wash hands with soap after applying patch