Psych- Addictive Disorders

What area of our brain is affected by substance use?

Dopamine

How is the dopamine effected?

• All addicting substances affect the dopamine pathways associated with the reinforcing effect of the substance

• Dopamine levels spike much higher and for a longer time than any natural reward such as food or sex.

What does repeated exposure of substances to the brain? 

• With repeated use over time, the brain no longer responds to natural rewards.

• Repeated exposure seems to alter neurons permanently.

Classifications of substances?

Alcohol, depressants, inhalants, opioids (narcotics), stimulants, amphetamines, hallucinogens 

When assessing a patient for substance use what should you include in the assessment? 

• Amount and type of alcohol or drugs (AOD), including prescription medication.

• Medical problems associated with AOD in patient and family members.

• Blood and urine drug screens (prevents AOD minimization).

• Look for suspicious signs and symptoms (e.g.,, tremors might indicate alcohol withdrawal).

• Use screening tests.

How should you go about interviewing someone with an addictive disorder? 

•Use manner that encourages forthrightness—matter-of-fact, nonjudgmental approach.

•Be prepared for defensiveness—genuine concern helps overcome this.

•Be aware of own feelings, and avoid projecting negative attitudes onto patient.

•Get accurate information—a high priority is to ask patient to state date and time of last drink.

•Initially focus on legal drug use—caffeine, nicotine.

When talking with a patient what language technique is best to use? 

Nonthreatening language

•Problem with drinking”

•“Difficulties with drug use”

•“Problems because of drinking”

“Using more than intended

What screening tools can be used for an alcohol disorder?

• Alcohol Use Disorder Identification Test (AUDIT)

• CAGE Questionnaire

• Transtheoretical model  

Alcohol Use Disorder Identification Test (AUDIT)?

Identifies hazardous alcohol use or alcohol use disorder.

• 10 question test

CAGE Questionnaire?

•Not useful in determining risky drinking.

•Quick indicator of candidacy for standardized interview for alcohol use disorder.

•Cut down, Angry, Guilty, Eye Opener

Transtheoretical model?

Identifies readiness to change harmful behaviors

What is the first screening exam you should do on someone? 

CAGE 

What does the CAGE questionnaire consist of?

• C:  Have you ever felt you should cut down on your drinking?

• A:  Have people annoyed you by criticizing your drinking?

• G:  Have you ever felt guilty  about your drinking?

• E:  Have you every had an eye-opener in the morning to steady your nerves or get rid of a hangover?

What effects does alcohol have on the body?

• Leading drug problem

• Disinhibition

• Impaired judgement 

• Overdose

• Withdrawal 

What is disinhibition?

Things that you do that you wouldn’t normally do if you weren’t under the influence of alcohol

Withdrawal signs of alcohol? 

• Tremors, nausea, vomiting, tachycardia, diaphoresis, seizures, anxiety, and depression – DRUG: BENZO (ATIVAN) 

Drugs that treat alcohol disorder? 

• Benzos 

• Disulfiram (Antabuse)

• Naltrexone (ReVia)

• Acamprosate (Campral) 

• Topiramate (Topamax) 

• Thiamine supplements

Benzo medication?

Treats alcohol withdrawal

What is the benzo antidote?

Flumazenil

Disulfiram medication?

Makes drinking painful- severe nausea, vomiting- very Severe reaction with any type of alcohol

Naltrexone medication?

Decreases the pleasure of drinking- makes it not enjoyable and take craving away

Acamprosate medication?

Restores the chemical balance in the alcoholic brain

Thiamine supplement medication?

Alcohol interferes with vitamin B absorption

• Lining of nerves alcohol takes away vitamin B 

When with a patient who suffers from alcohol use, how do you want to build that nurse to patient relationship? 

•Build trust.

•Be genuine, empathic. (towards situation)

•Discuss natural consequences of drinking and the need for total abstinence.

•Educate regarding the diagnosis; need to take one day at a time.

•Create a concrete plan for recovery; offer hope for long-term recovery.

•Encourage attendance at AA meetings. (support system)

What medications can be used for someone on depressants? 

Barbiturates and benzos 

Effects someone gets on depressants? 

Euphoria, disinhibition, drowsiness 

What is experienced during an overdose of a depressant? 

Respiratory depression 

• note: vitals on these individuals will naturally be lower

Opioid narcotic drugs? 

Opium, morphine, codeine, and heroin

How can opioids be taken? 

Smoked; IV; oral; IM; SC (skin-popping)

What is a withdrawl like for opioid users?

Unpleasant but not life threatening

What is the antidote for opioid overdose?

Nalaxone (Narcan)

• Opioid receptor blocker given by first responders. – antidote

• Gets ride of the respiratory depression experienced

• Can give as many doses as needed  

What are stimulants someone can take?

Caffeine and cocaine

Effects of taking a stimulant?

• Elation, grandiose thinking, talkativeness, sleeplessness

• Formication- feeling of bugs under skin

What are the effects of an overdose of a stimulant? 

Agitation, tachycardia, cardiac arrhythmias, and convulsions

What are amphetamines and related drugs?

•Methamphetamine

•Ecstasy

Different types of hallucinogens?

• Marijuana

• Mescaline

• LSD 

• PCP

Effects hallucinogen have on the body?

Illusions, hallucinations, diminished ability to perceive time and distance, anxiety, and paranoid thinking

Overdose on hallucinogens?

Intense trips, psychotic reactions, and panic

Treatment for opioids, stimulants, etc?

•Assist the patient to identify through motivational interviewing what changes the patient is willing to make to decrease the risk of the substance.- cognitive behavioral therapy

•Medication support: buprenorphine and naltrexone to decrease cravings or diminish the effect of the illicit drug should relapse occur

• Therapeutic goal: abstinence

Building that nurse patient relationship for opioids, stimulants, etc?

• Group work

• Education

• Confrontation and tough love

• Providing physical and nutritional needs

• Helping the patient become involved in groups such as AA and NA and families with Alanon

Mileu management?

Safety, Structure, Balance, Limit setting, norms and environmental modification

Recovery for alcohol addiction? 

•12-step program groups

•Alcoholics Anonymous (AA or Al-Anon) (for patients and partners)

•Alateen (for children/teenagers of alcoholic parents)

•Based on religion and God

Recovery for drug addiction? 

•Nar-Anon