chapter 14 substance abuse and addiction disorders

substance abuse disorder

continued substance craving and use despite significant life disruption and/or physical risk

4-12 hours

_______ ______ after last drink is when withdrawal symptoms start to show.

super ego (freud)

The conscience or "moral stopper" (guilt is here)

- the reason why you would grab for the drink

addictive personalities

impulsivity and people prone to experiencing negative emotions

- self-esteem issues

- anti-social people

predisposing factors to substance abuse

Biological (genetics, biochemical)

Psychological (developmental, personality)

Sociocultural (social learning, conditioning, cultural and ethnic influences)

alcohol use disorder patterns of use

Phase I. Prealcoholic phase: Characterized by use of alcohol to relieve everyday stress and tensions of life

Phase II. Early alcoholic phase: Begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person.

Phase III. The crucial phase: Person has lost control; physiological dependence is clearly evident.

Phase IV. The chronic phase: Characterized by emotional and physical disintegration. The person is usually intoxicated more often than sober.

phase i prealcoholic phase

response to stress is to get a drink

- relieves everyday stress and tensions of life

- not maladaptive yer

phase ii early alcoholic phase

blackouts (cant remember what happened last night)

- alcohol becoming more required

phase iii crucial phase

- person has LOST CONTROL

- dependent on alcohol

- cannot go a day without a drink.

- physiological dependence is clearly evident

phase iv chronic phase

person is usually intoxicated more than theyre sober

0.08

legal BAC limit for a driver over 21

effects of alcohol on the body

peripheral neuropathy

alcoholic myopathy

wernickes encephalopathy

korsakoffs psychosis

esophagitis

gastritis

pancreatitis

alcoholic hepatitis

cirrhosis of liver

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

honest lying

occurs in alzheimer's patients and alcoholics due to korsakoff's psychosis

Antabuse

A drug that, when combined with alcohol, causes violent nausea; it is used to control a person's alcohol drinking.

Thiamine

needed in order to absorb vitamin b

- given to alcoholics when they go to the hospital

Alcohol withdrawal symptoms

- nausea and vomiting, tremors, anxiety, agitation, paroximal sweats, cloudy orientation, tactile disturbances, auditory disturbances, visual disturbances, headache, hallucination

8

CIWA score of ___ or more calls for immediate intervention and to start withdrawal meds

Opiate withdrawal symptoms

- can be felt few days after last usage

sweating, GI upset diarrhea, sweating, tremor, yawning, restlessness, pupil size, anxiety/irritability, bone/joint aches, runny nose, gooseflesh skin

- stimulates the CNS badly

effects of opioids on the body

-Central nervous system - (Narcotic analgesic, CNS depression, constricted pupils, drowsiness)

-Gastrointestinal - (Stomach & intestinal tone increased, peristalsis decreased, constipation)

-Cardiovascular - (High doses - hypotension)

-Sexual functioning - (Decreased sexual function and diminished libido)

Narcan (naloxone)

1. Opioid antagonist that reverses the effects of opioid drugs

2. Used to treat opioid overdose (heroin)

3. Found in dental emergency kits

lsd , marijuana

narcan does not work on ___ or _________.

Methadone (Dolophine)

Abstinence maintenance med. Binds with opiate receptors in CNS to produce analgesic and euphoric effects. Prevents withdrawal symptoms in clients who were addicted to opiate drugs.

Clonidine (Catapres)

Antihypertensive (for blood pressure) that helps with withdrawal symptoms. great to mix with opioid antagonists.

chemically impaired nurse

Illegal use of prescription & no prescription drugs.

Use of illegal drugs

Alcohol abuse

- High absenteeism may be present if the person's source is outside the work area.

-Or, the person may rarely miss work if the substance source is at work.

state

it depends on the _____ for how to respond to a chemically impaired nurse

treatment

Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek _________.

symptoms of alcohol intoxication

slurred speech, incoordination, unsteady gait, nystagmus, impairments in attention or memory, stupor or coma

Symptoms of opioid intoxication

euphoria, lethargy, slurred speech

decreased biological drives, N/V, decreased respiratory rate and blood pressure, constricted pupils

Naltrexone (Revia)

A medication used to treat alcohol and opioid dependence by blocking the effects of opioids and reducing cravings.