Addictive Disorders condensed

Addiction

State of physiological + psychological dependence; compulsive cravings/urges continue despite harmful consequences and interfere with work/personal life.

Substance use

Use of a legal/illegal substance outside medical necessity/social acceptance to alter mood, behavior, emotion, or consciousness.

Substance addiction

Chronic, relapsing brain disease with compulsive drug seeking/cravings despite harm; causes long-lasting brain changes.

Substance Use Disorder (SUD)

Pattern of continued substance use despite clinically significant cognitive, behavioral, physiologic, or functional impairment.

SUD diagnostic time period

Repeated substance use causing clinically significant impairment within a 12-month period.

Addiction reward pathway

Substances affect the limbic reward system and produce excessive dopamine → pleasure/reinforcement → continued use.

Basal ganglia & addiction

Involved in motivation; repeated substance use contributes to tolerance and need for increasing amounts to achieve euphoria.

Amygdala & addiction

Involved in anxiety/unease; absence of the substance can produce craving/dependence and drive further use.

Prefrontal cortex & addiction

Impaired balance/control contributes to compulsive substance-seeking behavior.

Tolerance

Need for increasing amounts of a substance to obtain the same effect or diminished effect from the same amount.

Cross-tolerance

Tolerance to more than one drug within the same drug class.

Dependence

Adaptation in which absence/reduction of a substance produces physical or psychological distress/withdrawal.

Predisposing factors for addiction

Genetics and biochemical factors; no single theory completely explains addiction.

Reasons for substance use

Relaxation, curiosity, peer acceptance, ↑ confidence/energy/focus, pain relief, boredom, social anxiety, weight control, trying new experiences.

4 C's of addiction

Compulsive behavior, Cravings, Chronic relapsing brain disorder, Cognitive impairment.

SUD manifestations: impaired control

Unable to cut down/regulate use; excessive time spent obtaining, using, or recovering from substance.

SUD manifestations: social problems

Repeated use disrupts relationships or responsibilities at work, home, or school.

SUD manifestations: risky use

Continued/recurrent use in hazardous situations despite danger to self or others.

SUD manifestations: physical dependence

Tolerance + withdrawal.

Protective factors against SUD

Positive family/peer support, self-esteem, involved caregiver, available community resources.

Sociocultural factors in substance use

Peer pressure can ↑ use; older adults may use substances as life stressors increase; alcohol-use patterns vary among cultural groups.

Common behavioral changes with addiction

Changes in attendance/grades/work, temper, appearance, finances, morals, and social associations.

Early warning signs of SUD

Mood changes; ↓ school/work performance; changes in weight/eating/sleep/health; new peer group; poor engagement in relationships; missing money/valuables.

Substance withdrawal

Physical/psychological symptoms after abrupt reduction/discontinuation following prolonged use; symptoms are substance-specific and disrupt thinking, feelings, behavior, and physical function.

Psychoactive substance classes

Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants, tobacco, and other substances.

Common SUD comorbidities

Psychiatric disorders/suicide risk plus CNS, cardiovascular, GI, and other medical complications.

Substance use & adolescent brain development

Early substance use can severely interfere with ongoing brain maturation.

Anabolic-androgenic steroid effects

Liver damage, renal failure, MI, depression during withdrawal, infertility, altered secondary sex characteristics, stunted growth, paranoia.

IV substance-use complications

↑ infection, venous sclerosis, HIV/AIDS risk; tolerance may require increasing doses.

Intranasal substance-use complications

Sinusitis and perforated nasal septum.

Smoking substance-use complications

Respiratory infections; tolerance may require increasing doses.

Substance use during pregnancy: alcohol

Alcohol is highly toxic to the fetus and can cause fetal alcohol syndrome/effects.

Substance use during pregnancy: nicotine

↑ risk of low birth weight and developmental problems.

Fetal alcohol syndrome (FAS) facial features

Small head/eye openings, flat midface, smooth philtrum, thin upper lip, short nose, low nasal bridge, epicanthal folds, underdeveloped jaw.

Alcohol intoxication assessment

Determine time of last drink and blood alcohol level (BAL); BAL provides an objective measure of intoxication/tolerance.

BAC 0.01-0.03%

Slight mood elevation; usually no obvious effects.

BAC 0.04-0.06%

Relaxation/warmth; minor impairment in reasoning and memory.

BAC 0.07-0.09%

Impaired balance, speech, vision, and control; 0.08% is the common legal driving limit.

BAC 0.10-0.12%

Significant motor impairment, poor judgment, possible slurred speech.

BAC 0.13-0.15%

Gross motor impairment, blurred vision, major balance loss, anxiety/restlessness.

BAC 0.16-0.20%

Dysphoria, nausea, obvious intoxication.

BAC 0.25-0.30%

Severe intoxication, difficulty walking, confusion, nausea/vomiting.

BAC 0.35-0.40%

Loss of consciousness; near coma.

BAC ≥0.40%

Coma and possible death from respiratory failure.

Alcohol Use Disorder criteria

Use more/longer than intended; unsuccessful control; excessive time obtaining/using/recovering; craving; role failure; social problems; activities sacrificed; hazardous use; continued use despite harm; tolerance; withdrawal/use to prevent withdrawal.

Alcohol withdrawal onset/peak

Early symptoms begin within hours and peak ~24-48 hr after cessation.

Alcohol withdrawal findings

Irritability, internal shaking/tremor, illusions; grand mal seizures may occur ~7-48 hr after cessation.

Alcohol withdrawal delirium (DTs)

Medical emergency with delirium, autonomic hyperactivity, perceptual disturbances, fluctuating LOC, paranoid delusions, agitation, hallucinations, severe tremor/seizures, and fever.

Alcohol withdrawal delirium timing

Usually peaks ~2-3 days after cessation/reduction and can be fatal.

DT autonomic findings

↑ temperature, respiratory rate, pulse, and other autonomic activity.

Alcohol withdrawal vs DTs

Withdrawal = starts within hours, peaks 24-48 hr; DTs = severe medical emergency, commonly peaks 2-3 days after cessation.

Denial & alcohol use

Common defense mechanism in alcohol use disorder; client may minimize or deny drinking/problem severity.

Wernicke-Korsakoff cause

Thiamine (vitamin B1) deficiency associated with chronic alcohol use causing brain damage.

Wernicke encephalopathy

Acute thiamine-deficiency condition; confusion, visual disturbances, ataxia, hypotension, hypothermia, possible coma; potentially reversible if treated early.

Korsakoff amnesic syndrome

Chronic memory disorder associated with thiamine deficiency; amnesia, disorientation, tremors, visual disturbances, possible coma.

Wernicke/Korsakoff treatment

Thiamine (B1) replacement, nutrition, hydration, and stopping alcohol use.

GI effects of chronic alcohol use

Gastritis/bleeding, cirrhosis/varices, acute/chronic pancreatitis, esophagitis, alcoholic hepatitis.

Neurologic/muscular effects of alcohol

Peripheral neuropathy from vitamin deficiency and alcoholic myopathy.

Hematologic effects of alcohol

Impaired WBC production/function, leukopenia, thrombocytopenia from ↓ platelet production.

Alcohol & sexual function

Short term may ↑ libido; long term may cause gynecomastia, sterility, impotence, and ↓ libido.

Alcoholic cardiomyopathy

Alcohol-related heart muscle disease that can cause CHF and dysrhythmias.

Priority alcohol-withdrawal nursing care

Baseline assessment, anticipate withdrawal, use CIWA-Ar, monitor safety/vitals, prevent seizures, and administer medications as ordered.

CIWA-Ar

Clinical Institute Withdrawal Assessment for Alcohol-Revised; measures alcohol-withdrawal severity and guides treatment.

CIWA-Ar assessment components

Nausea/vomiting, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances, headache, orientation/clouding of sensorium.

First-line medications for alcohol withdrawal

Benzodiazepines: chlordiazepoxide, diazepam, lorazepam.

Benzodiazepines in alcohol withdrawal

↓ seizure risk, stabilize vital signs, and ↓ withdrawal severity/psychomotor agitation.

Adjunct medications for alcohol withdrawal

Carbamazepine, clonidine, propranolol, atenolol; may reduce seizures, autonomic symptoms, and/or cravings.

Thiamine in alcohol withdrawal

Used to prevent/treat complications of thiamine deficiency such as Wernicke encephalopathy.

Disulfiram

Alcohol-abstinence medication that causes an unpleasant reaction if alcohol is consumed.

Disulfiram + alcohol reaction

N/V, weakness, sweating, palpitations, hypotension.

Disulfiram teaching

Avoid ALL alcohol including mouthwash/cough syrup; read labels; wear medical-alert ID; avoid alcohol-containing paints/stains/stripping compounds.

Disulfiram pretreatment abstinence

Abstain from alcohol for 14 days before use.

Naltrexone for alcohol use

Opioid antagonist that suppresses pleasurable effects of alcohol; long-acting IM form available.

Acamprosate

Taken TID to reduce alcohol-withdrawal effects; maintain fluids because diarrhea can occur; avoid during pregnancy.

Recovery & relapse

Addiction is chronic; relapse and multiple treatment episodes are common; strong aftercare and recovered-peer support improve outcomes.

Alcoholics Anonymous (AA)

Peer-support recovery program promoting sobriety and abstinence.

Opioid examples

Morphine, heroin, codeine, fentanyl, methadone, meperidine.

Opioid intoxication findings

Constricted pupils, drowsiness, slurred speech, psychomotor retardation, impaired concentration/judgment/memory; initial euphoria may progress to dysphoria.

Priority for unconscious opioid-intoxicated client

Establish and maintain a patent AIRWAY first.

Opioid withdrawal findings

Yawning, insomnia, irritability, rhinorrhea, panic, diaphoresis, cramps, N/V, muscle aches, chills/fever, lacrimation, diarrhea, gooseflesh/piloerection.

Naloxone (Narcan)

First-choice opioid-toxicity antidote; airway remains priority.

Naloxone nursing care

Monitor airway and vital signs about every 15 min because naloxone is short acting and opioid toxicity can recur.

Naloxone-induced withdrawal

May cause acute withdrawal such as gooseflesh, abdominal cramps, and muscle aches.

Methadone

Long-term opioid agonist treatment that reduces cravings and need for illicit opioids; administered through approved treatment programs.

Buprenorphine (Subutex)

Agonist-antagonist used for opioid withdrawal and maintenance; reduces withdrawal signs/symptoms.

Buprenorphine + naloxone

Combination used for long-standing opioid use, withdrawal, and maintenance treatment.

Naltrexone for opioid use

Opioid antagonist that blocks euphoric opioid effects.

Clonidine for opioid withdrawal

Reduces autonomic withdrawal symptoms such as diarrhea and N/V; does NOT reduce craving.

Opioid antidote

Naloxone (Narcan).

Benzodiazepine antidote

Flumazenil.

Common CNS stimulants

Cocaine/crack, methamphetamine, caffeine, nicotine.

Common stimulant-use findings

Dilated pupils, dry oral/nasal cavity, excessive motor activity.

Cocaine/crack effects

Powerful stimulant with anesthetic effects; smoked drug acts within seconds and can cause sudden cardiac dysrhythmias.

Cocaine/crack withdrawal

Depression, paranoia, lethargy, anxiety, insomnia, N/V, sweating, chills.

Priority during cocaine withdrawal

Closely monitor for depression and suicidal ideation.

Cocaine assessment

Assess nasal passages for deterioration, especially with intranasal use.

Nicotine

Highly toxic/addictive substance that can have stimulant, depressant, or tranquilizing effects.

Long-term nicotine complications

Cancers of mouth/throat/lung, emphysema, cardiovascular disease, dependence/withdrawal.

Nicotine replacement therapy

Patches, gum, lozenges, sprays, inhalers; suppress nicotine-withdrawal symptoms.

Non-nicotine smoking-cessation medications

Varenicline and bupropion.