Module 11 Chapter 19 Substance-Related and Addictive Disorders

Addiction

A chronic, relapsing brain disease characterized by compulsive drug-seeking behavior and long-lasting changes in the brain

Substance Use Disorder (SUD)

A DSM-5 diagnosis based on 11 criteria reflecting impaired control, social impairment, risky use, and pharmacological criteria (tolerance/withdrawal)

Tolerance

The need for increasing amounts of a substance to achieve the same effect

Withdrawal

A set of physiological and psychological symptoms that occur when a substance is reduced or stopped after prolonged use

Cross-Tolerance

Tolerance developed to one substance that also reduces the effects of a similar substance

Cross-Dependence

Dependence on one substance that suppresses withdrawal symptoms of another substance

Synergistic Effects

When two or more substances used together produce an effect greater than the sum of their individual effects

Antagonistic Effects

When one substance blocks or reduces the effects of another substance

Blackout

An episode of amnesia associated with alcohol intoxication where the person is conscious but forms no memory

Co-dependency

A dysfunctional relationship pattern where one person enables another's addiction or poor mental health

Post-Acute Withdrawal Syndrome (PAWS)

Prolonged withdrawal symptoms that can persist weeks to months after stopping alcohol or other substances

Neonatal Abstinence Syndrome

Withdrawal symptoms in a newborn due to prenatal exposure to opioids

Fetal Alcohol Syndrome (FAS)

A pattern of physical and cognitive birth defects caused by alcohol exposure during pregnancy; alcohol is the most toxic teratogen for fetuses

Genetic Vulnerability to Addiction

Genetic factors account for approximately 40%–60% of a person's susceptibility to developing addiction

Adverse Childhood Experiences (ACEs)

Potentially traumatic childhood events (e.g., abuse, neglect, domestic violence) that are a significant psychosocial risk factor for SUD

DSM-5 SUD Severity – Mild

2–3 of the 11 diagnostic criteria present

DSM-5 SUD Severity – Moderate

4–5 of the 11 diagnostic criteria present

DSM-5 SUD Severity – Severe

6 or more of the 11 diagnostic criteria present

Alcohol Intoxication Signs

Slurred speech, unsteady gait, drowsiness, decreased vital signs, disinhibition, impaired judgment and memory

Alcohol/Opioid Overdose Signs

Acute cardiovascular or respiratory depression, shock, convulsions, coma, and death

Alcohol/Opioid Withdrawal Signs

Elevated vital signs, nausea/vomiting, tremors, paroxysmal sweats, anxiety, insomnia, tactile/auditory/visual disturbances, seizures, delirium

Alcohol Withdrawal Delirium

A medical emergency; severe stage of alcohol withdrawal involving delirium; also known as delirium tremens

Disulfiram (Antabuse)

Medication-assisted treatment for alcohol use disorder; causes an unpleasant reaction if alcohol is consumed to deter drinking

Naltrexone (ReVia/Vivitrol)

Opioid antagonist used for long-term maintenance of both alcohol and opioid use disorder; reduces cravings

Acamprosate (Campral)

Medication used to maintain abstinence from alcohol by reducing withdrawal-related discomfort

Opioid Overdose Signs

Pinpoint pupils, respiratory depression, decreased level of consciousness

Naloxone (Narcan)

First-choice, short-acting opioid antagonist used to treat opioid toxicity/overdose

Methadone (Dolophine)

Long-acting opioid agonist used as a detox tool and maintenance therapy; blocks cravings and effects of heroin

Buprenorphine/Naloxone (Suboxone)

Partial opioid agonist combined with naloxone; used for detoxification and long-term opioid use disorder maintenance

Clonidine

Non-opioid medication that assists with autonomic instability symptoms during opioid withdrawal

Lucemyra (Lofexidine)

Non-opioid FDA-approved treatment to manage opioid withdrawal symptoms

CNS Depressants

Drug class including alcohol, benzodiazepines, and barbiturates that slow CNS activity

CNS Stimulants

Drug class including cocaine, methamphetamine, amphetamines, and nicotine; common signs of abuse include dilated pupils, dry nasal cavity, and excessive motor activity

Cocaine/Crack

Extracted from the coca bush; acts as anesthetic and stimulant; when smoked, effect onset is 4–6 seconds with a high lasting 5–7 minutes; causes neurotransmitter imbalance

Methamphetamine

Highly addictive neurotoxic stimulant; symptoms can mimic schizophrenia; chronic use can cause Parkinson-like symptoms, stroke, organ damage, and death

Nicotine

Highly toxic and addictive substance that can act as a stimulant, depressant, or tranquilizer; treated with patches, gum, varenicline (Chantix), or bupropion (Zyban)

Marijuana

Derived from the Indian hemp plant; active ingredient is THC; has depressant and hallucinogenic properties; long-term use linked to amotivational syndrome

Amotivational Syndrome

A condition associated with long-term marijuana use characterized by lethargy, anhedonia, difficulty concentrating, and memory loss

MDMA (Ecstasy)

A club drug producing stimulant and hallucinogenic effects; causes neurotransmitter release, particularly serotonin

GHB (Gamma-hydroxybutyrate)

A club drug/CNS depressant; known for use as a date rape drug; causes sedation and amnesia

Anabolic-Androgenic Steroid Risks

Liver damage, renal failure, heart attack, depression (especially in withdrawal), infertility, altered sex characteristics, growth stunting, paranoia

IV Drug Use Risks

Higher infection rates, venous sclerosis, increased HIV/AIDS risk, need for increasing doses

Intranasal Drug Use Risks

Sinusitis and perforated nasal septum

AUDIT

Alcohol Use Disorders Identification Test; a screening tool used to assess alcohol use patterns

B-DAST

Brief Drug Abuse Screening Test; a screening tool used to identify problematic drug use

Recovery Paradigm – 4 Dimensions

Health (managing disease), Home (stable living), Purpose (meaningful activities), Community (supportive social networks)

SMART (Self-Management and Recovery Training) Recovery

A self-help program focused on enhancing motivation to abstain, coping with urges, managing thoughts/feelings/behaviors, and achieving lifestyle balance

Harm Reduction

Practices designed to reduce the negative impact of drug-using behaviors on individuals and communities (e.g., needle exchange, naloxone access, methadone maintenance)

Motivational Interviewing (MI)

A patient-centered therapeutic technique used to enhance motivation for behavior change in individuals with SUD

Cognitive Behavioral Therapy (CBT) in SUD

Evidence-based therapy used to increase coping skills and support relapse prevention in substance use disorder

Co-occurring Disorders (Dual Diagnosis)

The simultaneous presence of a substance use disorder and one or more psychiatric disorders; both require concurrent treatment

Principles of Co-Occurring Disorder Treatment

Expect at least one co-occurring disorder; treat SUD and psychiatric disorder concurrently; individualize outcomes; match treatment to patient motivation and stage of recovery

Nurse's Role in SUD

Recognizing signs of SUD and withdrawal, conducting nonjudgmental assessments, using validated screening tools, and making appropriate referrals

Nurse Substance Use Statistics

An estimated 10%–20% of U.S. nurses are addicted to an illegal or controlled substance; many are underidentified and underreported; there is an ethical obligation to report impaired practice

Amotivational Syndrome

Associated with chronic marijuana use; characterized by lethargy, anhedonia, poor concentration, and memory loss

Flashback

A spontaneous re-experiencing of perceptual distortions or hallucinations originally caused by a hallucinogenic substance, occurring after the drug has worn off