Substance Use and Addictive disorders

Phases of Alcoholism

1. Prealcoholic

   1. using alcohol to relax, pleasure, starts tolerance

2. Early alcoholic

   1. blackouts, they need alcohol, denial

3. Critical

   1. loss of control, angry, aggressive, burning bridges

4. Chronic

   1. Drunk more than sober, self pity, psychosis (brain shrivels up), seizures common w/ w/d

Long term effects of alcohol on body

• peripheral neuropathy (thyamine helps lower)

• alcoholic cardiomyopathy

• alcoholic hepatitis (inflamed liver)

• alcoholic myopathy

• esophagitis

• cirrhosis of liver

• wernicke’s encephalopathy (thyamine helps lower)

• gastritis

• thrombocytopenia

• korsakoff’s psychosis

• pancreatitis

• sexual dysfunction

Alcohol during pregnancy

• Fetal alcohol syndrome

  • Facial abnormalities (ears sit low, eyes close tg)

  • Feeding problems (growth retardation)

  • Cognitive delays

  • Behavioral issues

Blood alcohol level

• Intoxication level

  • 100-200 mg/dL

• Death level

  • 400-700 mg/dL

  • Considered alcohol poisoning

  • Will go to sleep have possible seizure and aspirate

S/S of intoxication

• Disinhibition

• Mood liability

• Impaired judgement

• Impaired social/occupational functioning

• Slurred speech

• Incoordination

• Unsteady gait

• Nystagmus (eyes darting back and forth)

• Flushed face

• Hypoglycemia

• HTN or hypo

• CNS dep

• Vomiting

S/S of alcohol detox/withdrawl

• Seizures

• HTN

• Tachycardia

• Coarse tremors

• N/V

• Anxiety

• Irritability

• Transient hallucinations (senses)

• Illusions (change in environment)

• Headache

• Depressed mood

• Weakness

• Sweating

• Insomnia

• Malaise

Nursing process for alcohol w/d

• Interview

  • Use empathy and reflection to explore pt readiness to change

• Assessment tools

  • CAGE (to see risk level)

  • CIWA-AR (to determine sliding scale 4 benzo)

• Pharm

  • Benzo (cloradiapoxide)

  • Thiamine

  • Disulfiram

    • No alcohol w/

    • Reaction in 5-10 mins of drinking alcohol w/

    • Don’t give until alcohol free for 12 hrs

    • Avoid alcohol containing substances (vanilla, hand sanitizer, perfume/cologne)

• Treatment

  • Self help groups

    • AA

    • Al-Anon (for pt support system)

Opioid Intoxication

• Drowsy

• Impaired memory

• Psychomotor agitation

• Slurred speech

• Impaired concentration

• Psychomotor retardation

• Papillary constricition

• Euphoria followed by apathy

• Impaired judgement

Opiod W/D

• S/S

  • dysphoric mood

  • Rhinorrhea (runny nose)

  • Diarrhea

  • N/V

  • Papillary dilation

  • Yawning

  • Muscle aches

  • Piloerection

  • Fever

  • Lacrimation

  • Sweating

  • Insomnia

• W/D

  • Occurs in 6-8 hrs after last dose (1-3 days w/ strong doses)

  • Peaks 1-3 days (4-6 days)

  • Gradually subsides over 5-10 days (14-21 days)

Nursing Process Opioid w/d

• Assessment

  • COWS

• Pharm

  • Clonidine

  • Methadone

Sedative, Hypnotic, Anxiolytic Intoxication

• Unsteady gait

• Mood lability

• Inappropriate sexual/aggressive behavior

• Impaired judgement

• Stuppor

• Impaired attention/memory

• Nystagmus

• Slurred speech

• Impaired social/occupational functioning

• Incoordination

• Coma

Alprazolam/lorazepam w/d

• Begins 12-24 hrs after last dose

• Peaks between 24 and 72 hrs

• Subsides in 5-10 days

Diazepam/phenobarbital/chlordiazepoxide

• Begins 5-7 days after last dose

• Peaks between 5th and 8th day

• Subsides in 10-16 days

Sedative/ Hypnotic/Anxiolytic w/d

• Autonomic hyperactivity

• Increased hand tremor

• Insomnia

• N/V

• Hallucinations

• Illusions

• Depersonalization

• Psychomotor agitation

• Anxiety

• Grand mal seizures

• Delirium

Stimulant Use disorder—Stimulants, intoxication, w/d

• Stimulants

  • Caffeine, Nicotine, Amphetamines, cocaine

• Intoxication

  • Euphoria

  • Affective blunting

  • Hypervigilance

  • Anger

  • Paranoia

  • Cardiac arrythmias

• W/D

  • Fatigue

  • Cramps

  • Depression

  • Headaches

  • Nightmares

Inhalant Use disorder

• Fuels, Solvents, Adhesives, Aersoles, Propellant, Pant thinner

• Intoxication

  • Dizzy, ataxia, euphoria, hypoactive reflexes, double vision/blurred vision, coma

• W/D

  • Restless, N/V, runny nose, watery eyes, poor attention/concentration, mood changes

Hallucinogen Use disorder

• S/S of intoxication

  • Ideas of reference, paranoia, perceptual changes, depersonalization/derealization, tachycardia, papillary dilation

Cannabis Use disorder

• Intoxication can last 8-12 hrs

  • Impaired motor coordination

  • Euphoria

  • Anxiety

  • Sensation of slowed time

  • Social w/d

• W/D

  • Abd pain

  • Tremors

  • Sweating

  • Fever

  • Chills

  • Headache

  • Irritability/anger/aggression

  • Nervousness/restlessness/anxiety

  • Sleep difficulty

  • Decreased appetite/wt loss

Phases of recovery

• Detox

  • Process of managed w/d from substance

  • Provide safe environment

  • Admin meds assisted treatment as ordered

• Intermediate care

  • Provide explanation of physical symptoms

  • Promote understanding and identify the cause of tx to pt and fam

• Rehab

  • Encourage continued participation in long term tx

  • Promote participation in outpt support

  • Assist pt to identify alternative sources of satisfaction

  • Provide support for health promotion and maintenance

• Ed

  • Dysfunctional family patterns

  • Codependency

  • Core components of tx

• Outcome

  • Has detox occured w/o comps

  • Is pt no longer in denial

  • Does pt accept responsibility for their own behavior

  • Has correlation been made between personal problems and the use of substances

Codependency recovery stages

• Survival

• Re-identification

• Core issues

• Reintegration