Substance Use Disorder

Substance Use Disorder (SUD)

Treatable chronic relapsing disorder with loss of control over use despite harmful consequences

Tolerance

Need for increased amounts of substance to achieve same effect

Dependence

Physiologic adaptation leading to withdrawal when substance is stopped

Withdrawal

Physical and psychological symptoms after stopping substance

Craving

Strong urge or desire to use substance

DSM-5 Substance Use Disorder Criteria

≥2 symptoms in 12 months including craving, tolerance, withdrawal, loss of control, risky use

Mild SUD

2-3 symptoms

Moderate SUD

4-5 symptoms

Severe SUD

≥6 symptoms

Signs & symptoms of a Substance Use Disorder

absenteeism,

frequent accidents or bruising,

drowsiness,

slurred speech,

disheveled appearance,

increasing isolation,

frequent secretive disappearances,

tremors,

flushed face or reddened eyes,

elevated HR (alc withdrawal)

Dopamine Pathway in Addiction

Substances increase dopamine in nucleus accumbens causing reward and reinforcement

Alcohol Neurotransmitters

Affects GABA (↑ increases GABA) and glutamate (↓ supresses glutamate) leading to CNS depression

Alcohol Pathophysiology

CNS depressant that initially stimulates then depresses brain activity

Alcohol Intoxication

Slurred speech,

impaired coordination,

decreased LOC

Alcohol Withdrawal

Tremors,

sweating,

anxiety,

insomnia,

hallucinations

seizures

headache

vomiting

tachycardia

Delirium Tremens (DTs)

Severe alcohol withdrawal with agitation,

visual hallucinations,

autonomic instability,

terror

severe seizures → high mortality

Alcohol Withdrawal Timeline

6-12 hr early symptoms,

24-48 hr seizures,

48-72 hr DTs (hallucinations)

Alcohol Withdrawal Treatment

Benzodiazepines (Ativan, Valium) to prevent seizures (q 2-4 hrs)

Thiamine Use

Prevents Wernicke’s encephalopathy in alcohol use disorder

Wernicke’s Encephalopathy

acute, life-threatening neurological emergency caused by a severe deficiency of thiamine (vitamin B1), which disrupts brain energy metabolism

Confusion, ataxia, ophthalmoplegia (abnormal eye movements) due to B1 deficiency

Opioid patho

relieves pain by increasing the pain threshold and by reducing anxiety and fear and can cause…

Respiratory depression,

pinpoint pupils,

sedation,

coma

constipation

Opioid tolerance

a person using opioids begins to experience a reduced response to medication, requiring more opioids to experience the same effect

Opioid dependence

the body adjusts its normal functioning around regular opioid use. Unpleasent physical symptms occur when medication is stopped

Opioid use disorder

occurs when attempts to cut down or control use are unsuccessful or when use results in social problems and a failure to fulfill obligations at work, school, and home. Disordered use often comes after the person has developed opioid tolerance and dependence making it physically challenging to stop opioid use and increase risk of withdrawal.

Opioid Withdrawal

Flu-like symptoms (n/v, muscle pain!, stiffness, fever)

abd cramps

sweating

intense cravings

diarrhea,

yawning,

pain (NOT usually fatal)

Opioid Overdose

RR <12,

unresponsive,

skin is cold, pale, and clammy

pupils dilate

hypoxia,

coma

Naloxone (Narcan)

Opioid antagonist used to reverse overdose

Methadone

Long-acting opioid agonist used for maintenance therapy

Buprenorphine

Partial opioid agonist used to reduce cravings

Naltrexone

Opioid antagonist used to prevent relapse

Stimulant (caffeine) Intoxication

Tachycardia,

restlessness

hypertension,

agitation,

excitement

diuresis

muscle twitching

paranoia,

hallucinations

Stimulant (caffeine) Withdrawal

headache

marked fatigue/drowsiness

depressed/irritable mood

flu like symptoms (n/v, muscle pain, stiffness)

Cocaine Mechanism

Blocks dopamine reuptake increasing dopamine levels

Cocaine Toxicity

Tachycardia,

hypertension,

hallucinations,

“bugs crawling” sensation

nasal septum perforation

Methamphetamine mechanism

a powerful, highly addictive stimulant that affects the CNS, crystal meth.

chemically similar to amphetamine which is used to treat ADHD, narcolepsy, and sleep disorders

made with pseudoephedrine

Methamphetamine Effects

Extreme weight loss,

paranoia,

severe dental problems

intense itching

violent behavior,

sleeping problems

hallucinations

Cannabis Effects

Euphoria,

increased appetite,

red eyes,

impaired memory

sedation

increased HR

increased BP

Cannabis Long-Term Effects

Memory issues,

emotional lability (rapid, exaggerated, and uncontrollable mood swings)

dysphoria (a profound state of unease, dissatisfaction, or unhappiness)

anxiety,

agitation

paranoia

decreased concentration

decreased BP

Inhalant Use

CNS depression from inhaling chemicals like glue or gasoline

Inhalant Complication

Sudden death from asphyxiation (choking)

Uppers (Stimulants)

Cocaine,

amphetamines,

caffeine increase CNS activity

Downers (Depressants)

Alcohol,

opioids,

benzodiazepines decrease CNS activity

inhalants

Mixing Uppers and Downers

Risk of arrhythmias and death

Overdose Priority Assessment

Airway, breathing, circulation (ABCs)

Opioid Overdose Priority

Administer naloxone and support airway

Alcohol Withdrawal Priority

Prevent seizures with benzodiazepines

Substance Use Nursing Approach

Nonjudgmental, assess for hidden use

Risk Factors for substance use disorders

Genetics,

trauma,

mental illness,

peer influence,

early exposure

Substance Use Treatment Principles

Individualized care,

long-term treatment,

address comorbidities