Substance Abuse 2

Opioids Effects

• Euphoria

• Sedation

• Reduced libido

• Memory and concentration difficulties

• Constipation

• Constricted pupils​

Opioid Overdose

• Respiratory depression

• Stupor

• Coma​

Opioid Withdrawal

• Abdominal cramps

• Rhinorrhea

• Watery eyes

• Dilated pupils

• Yawning

• Diaphoresis

• Insomnia

• Fever ​

Opioid Prolonged Use

Infection risk related to needle use

Sedatives (anxiolytics/hypnotics) Effects

• Euphoria

• Sedation

• Reduced Libido

• Emotional Lability

• Impaired Judgement

Sedatives (anxiolytics/hypnotics) Overdose

• Resp Depression'

• Cardiac Arrest

Sedatives (anxiolytics/hypnotics) Withdrawal

• Anxiety rebound and agitation

• HTN

• Tachycardia

• Sweating

• Hyperpyrexia

• Sensory excitement

• Motor excitation

• Nightmares​

Sedatives (anxiolytics/hypnotics) Prolonged Use

Often alternated with stimulants. Use with alcohol enhances chance for overdose

Inhalants Effects

• Euphoria

• Giddiness

• Excitation

Inhalants Overdose

• CNS depression:

  • ataxia

  • nystagmus

  • dysarthria

  • coma

  • convulsions​

Inhalants Withdrawal

Similar to findings with alcohol, but milder with anxiety, tremors, hallucinations, and sleep disturbance​

Inhalants Prolonged Use

Long term use can lead to hepatic and renal failure, damage to the lungs, CNS damage​

Nicotine Effects

• Stimulation

• Enhanced performance and alertness

• Appetite suppression​

Nicotine Overdose

Anxiety

Nicotine Withdrawal

• Mood changes

• Poor concentration

• Sleep disturbances

• Headaches

• Gastric distress, and increased appetite ​

Nicotine Prolonged Use

Increased chance for cardiac disease and lung disease ​

Caffeine Effects

• Stimulation

• Increased mental acuity

• Inexhaustibility​

Caffeine Overdose

• Restlessness

• Nervousness

• Excitement

• Insomnia

• Flushing

• Diuresis

• GI distress

• Muscle twitching

• Tachycardia or cardiac arrythmia ​

Caffeine Withdrawal

Headache, drowsiness, fatigue, craving, impaired psychomotor performance, difficulty concentrating, yawning, nausea ​

Alcohol Detoxification

period of time where the patient is observed and given medications to avoid withdrawal symptoms ​

• Uncomplicated withdrawal usually completed within 48 to 96 hours ​

• Can use Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar)​

Stage 1 Alcohol Withdrawal

• Increased HR, elevated temperature, normal or slightly elevated systolic BP​

• Slight Diaphoresis

• Oriented; no confusion; no hallucinations

• Mild anxiety and restlessness​

• Restless sleep​

• Hand tremors; “shakes”; no convulsions​

• Impaired Appetite and Nausea

Stage 2 Alcohol Withdrawal

• Heart rate 100-120 bpm; elevated systolic blood pressure and temperature​

• Notable Diaphoresis

• Intermittent confusion; transient visual and auditory hallucinations and illusions​

• Painful anxiety and motor restlessness​

• Insomnia and nightmares ​

• Visible tremulousness​

• Anorexia, nausea, and vomiting​

Stage 3 Alcohol Withdrawal

• Heart rate 120-140 bpm; elevated systolic and diastolic blood pressure; elevated temperature ​

• Excessive Diaphoresis

• Marked disorientation, confusion, disturbing visual and auditory hallucinations, misidentification of objects, delusions related to the hallucinations, delirium tremens, agitation, extreme restlessness, and panic states​

• Rejecting all fluid and food

Stimulants

• Cocaine ​

• Amphetamines​

• Methamphetamine​

• MDMA​

• Nicotine​

  • Nicotine replacements such as nicotine transdermal patches, nicotine gum, nasal spray, and inhalers have been used successfully to assist in withdrawal by reducing the craving for tobacco​

• Caffeine​

Rx Drug Abuse

• Taking a medication that has been prescribed for someone else​

• Taking a drug in higher quantity or in another manner than prescribed​

• Taking a drug for another purpose than prescribed​

Inhalants

• Organic solvents that are CNS depressants ​

• When inhaled cause euphoria, sedation, emotional lability, and impaired judgment ​

  • Volatile solvents- liquids that vaporize at room temperatures (e.g., paint thinners, dry-cleaning fluids)​

  • Aerosols- spray that contains propellent and solvents (e.g., spray paint, hair spray)​

  • Gases- e.g., propane tanks​

  • Nitrites​

Substance Use Disorders

• Characterized By

  • loss of control due to the substance use or behavior​

  • participation that continues despite continuing associated problems​

  • A tendency to relapse back into the substance use or behavior​

• Denial common defense mechanism ​

SUD Risk Factors

• Genetics

• Family Hx

• Trauma Hx

• Socioeconomic Characteristics

• Culture

Assessment

Use open-ended questions to assess for:​

• Type of substance?​

• Frequency? ​

• Amount?​

• Time of last use?​

• Impact on health? ​

  • Blackout? ​

  • Sleep problems? ​

  • Concern over use? ​

Acute Intoxication Interventions

Safety is the priority ​

• Maintain a safe environment to prevent falls​

• Seizure precautions as necessary​

• Close observation​

• Adequate nutrition, fluid, and rest​

Nursing Care

Nurses should self-assess their own feelings, take a nonjudgmental approach

• Educate client and family about addiction and initial goal of abstinence​

• Provide emotional support and reassurance​

• Begin to develop motivation for recovery​

• Encourage self-responsibility​

• Help client develop emergency plan​

• Encourage attendance at self-help groups​

• SBIRT​

SBIRT

Screening, Brief Intervention, and Referral to Treatment

Therapies

• Individual psychotherapies​

  • CBT​

  • Acceptance and commitment therapy (ACT)​

• Group therapy ​

• Family therapy​

  • Identifies codependency ​

  • Educated on family coping, problem-solving, indications of relapse)​

​

Education

• Recognize signs of relapse and signs that contribute to relapse​

• Develop communication skills​

• Encourage to attend a 12-step program​