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 SUD 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 SUD

absenteeism, frequent accidents or bruising, drowsiness, slurred speech, disheveled appearance, increasing isolation, frequent secretive disappearancs, tremors, flushed face, wattery 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 (↑ inhibition) and glutamate (↓ excitation) 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, seizures

Delirium Tremens (DTs)

Severe alcohol withdrawal with agitation, hallucinations, autonomic instability, high mortality

Alcohol Withdrawal Timeline

6-12 hr early symptoms, 24-48 hr seizures, 48-72 hr DTs

Alcohol Withdrawal Treatment

Benzodiazepines (Ativan, Valium) to prevent seizures

Thiamine Use

Prevents Wernicke’s encephalopathy in alcohol use disorder

Wernicke’s Encephalopathy

Confusion, ataxia, ophthalmoplegia due to B1 deficiency

Opioid Intoxication

Respiratory depression, pinpoint pupils, sedation, coma

Opioid Withdrawal

Flu-like symptoms, diarrhea, yawning, pain (NOT usually fatal)

Opioid Overdose

RR <12, unresponsive, 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 Intoxication

Tachycardia, hypertension, agitation, paranoia, hallucinations

Cocaine Mechanism

Blocks dopamine reuptake increasing dopamine levels

Cocaine Toxicity

Tachycardia, hypertension, hallucinations, “bugs crawling” sensation

Methamphetamine Effects

Extreme weight loss, paranoia, violent behavior, hallucinations

Cannabis Effects

Euphoria, increased appetite, red eyes, impaired memory

Cannabis Long-Term Effects

Memory issues, anxiety, decreased concentration

Inhalant Use

CNS depression from inhaling chemicals like glue or gasoline

Inhalant Complication

Sudden death from asphyxiation

Caffeine Intoxication

Restlessness, nervousness, insomnia, tachycardia

Caffeine Withdrawal

Headache, fatigue, irritability

Uppers (Stimulants)

Cocaine, amphetamines, caffeine increase CNS activity

Downers (Depressants)

Alcohol, opioids, benzodiazepines decrease CNS activity

Mixing Uppers and Downers

Risk of arrhythmias and death

Delirium

Acute, reversible confusion with fluctuating LOC

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 SUD

Genetics, trauma, mental illness, peer influence, early exposure

Substance Use Treatment Principles

Individualized care, long-term treatment, address comorbidities