ADDICTION

Addiction

  • Discussed by: Bethany Blevins, MSN, RN, NI-BC, CNE & Amber Moore, MSN, APRN, FNP-C

Objectives

  • Define key terms related to substance use and addiction:

    • Substance Use Disorder

    • Addiction

    • Intoxication

    • Tolerance

    • Withdrawal

    • Craving

    • Process Addiction

  • Explain addiction as an acute or chronic disease.

  • Describe neurobiological effects of:

    • Stimulants

    • Depressants

    • Behavioral addictions on the brain and central nervous system.

  • Apply the nursing process in the care for persons with substance use disorders.

Concept of Addiction

  • Definition: A compulsive, abnormal dependence on a substance or behavior, leading to adverse effects in psychological, physical, economic, social, or legal aspects.

  • Scope: Includes both substance addictions and behavioral addictions (process addictions).

Key Terms

  • Addiction: A pathological relationship with a substance or behavior.

  • Intoxication: Physical or mental impairment due to a substance.

  • Tolerance: Diminished response to a substance after repeated use, requiring increased amounts to achieve the same effect.

  • Withdrawal: Physical and mental symptoms occurring after stopping or reducing intake of a substance.

  • Substance Induced Disorder: Disorders resulting directly from the effects of substances on the body.

  • Substance Use Disorder: A medical condition characterized by an individual's inability to control their use of a substance despite harmful consequences.

  • Process Addiction (Behavioral Addictions): Addictions to non-substance-related behavior that can be as debilitating as substance use disorders.

  • Craving: Intense desire or urge for a substance.

Substance Use Disorder Symptoms

  1. Impaired Control: Difficulty in control over the substance use.

  2. Social Impairment: Failure to fulfill obligations at work, school, or home as a result of substance use.

  3. Risky Use: Using substances in hazardous situations.

  4. Physical Effects: Physiological effects resulting from substance use.

5 Drug Schedules

  • General Definition: Drugs are classified into five categories based on acceptable medical use and potential for abuse.

    • Schedule I: High potential for abuse, no accepted medical use. Examples: Heroin, LSD.

    • Schedule II: High potential for abuse, available by prescription. Examples: Methadone, Demerol, Ritalin.

    • Schedule III: Low to moderate potential for misuse, available by prescription. Examples: Testosterone, Tylenol with codeine.

    • Schedule IV: Low risk drugs, available by prescription. Examples: Xanax, Ativan.

    • Schedule V: Limited quantities of narcotics, some available over the counter. Examples: Lomotil, Robitussin AC, Lyrica.

What Makes a Drug Addictive?

  • The DEA classifies drugs into five categories based on addiction risk:

    • Schedule I: Highest level of addiction potential.

    • Schedule II: Significant risk of psychological and physical addiction.

    • Schedule III: Moderate potential for addiction.

    • Schedule IV: Lower potential for abuse and addiction.

    • Schedule V: Lowest level of addiction.

Common Psychoactive Substances

  • Categories:

    • Alcohol

    • Caffeine

    • Cannabis

    • Hallucinogens

    • Inhalants

    • Opioids

    • Sedative, hypnotic, and anxiety medications

    • Stimulants

    • Tobacco

Mental Health Disorder and Substance Use Disorder

  • Statistics: The likelihood of developing a substance use disorder (SUD) in people with mental health disorders (MHD) is significantly higher.

    • Statistical Likelihood:

    • Personality Disorders: 18 × more likely.

    • Bipolar Disorder: 11 × more likely.

    • Schizophrenia: 11 × more likely.

    • Anxiety Disorders: 8 × more likely.

    • Adjustment Disorders: 8 × more likely.

    • Depressive Disorders: 8 × more likely.

    • ADD/ADHD: 5 × more likely.

    • Overall Population: 36% likely.

Risk Factors for Addiction

  • Genetics

  • Neurochemical Factors

  • Environmental Factors

  • Sociocultural Factors

  • Comorbidity with other mental health issues.

Neurobiology of Addiction

  • What Happens in the Brain: Addiction alters brain functions, affecting neurotransmitter systems, particularly those involving reward and pleasure.

  • Stages of Addiction: Various behavioral stages that reflect changes in brain chemistry and behavior with substance use.

Clinical Picture of Various Substances

  • Substances and associated risks:

    • Caffeine: Addiction potential, withdrawal symptomatology.

    • Cannabis: Effects on cognition, motivation.

    • Hallucinogens: Variable effects on perception.

    • Tobacco: Significant addiction potential.

    • Sedatives/Hypnotics: Risk in withdrawal and addiction.

Diagnosis Criteria

  • Clinical Procedures: Require physical exams, blood work, and specialized screening tools to diagnose substance-related disorders.

Clinical Management

  • Factors Influencing Treatment:

    • Type of substance used.

    • Duration and amount of use.

    • Last known dose.

    • Use appropriate assessment tools and advocate for patients.

  • Assessment should be ongoing throughout treatment.

United States Addiction Statistics

  • 23.5 million Americans suffer from substance use issues.

  • Only 2.6 million receive treatment.

  • Treatment gap: 1 in 10 receive help for substance use disorders.

Substance Abuse - Alcohol

  • Characteristics:

    • Most common depressant.

    • Higher abuse rates in men compared to women (approximately 2 ×).

    • Potentially dangerous withdrawal.

  • Management of Withdrawal:

    • Early recognition of symptoms is crucial.

    • Question patients about their last drink.

Alcohol Withdrawal Timeline

  • Stages:

    1. 8 Hours: Initial symptoms like anxiety and tremors.

    2. 1-3 Days: Intensified withdrawal symptoms including hallucinations.

    3. 3+ Days: Severe symptoms such as delirium tremens.

Wernicke-Korsakoff Syndrome

  • Symptoms include:

    • Ataxia (loss of coordination).

    • Confusion.

    • Eye movement abnormalities.

    • Low magnesium levels.

    • Confabulation (memory errors).

    • Amnesia and psychosis.

Nursing Interventions & Treatment for Alcohol Withdrawal

  • Monitor levels of consciousness and vital signs.

  • Prevent aspiration during episodes of vomiting or loss of consciousness.

  • Administer medications such as benzodiazepines, vitamins (thiamine), magnesium, and fluids.

  • Long-term management options include Antabuse, which creates adverse reactions to alcohol consumption.

Blood Alcohol Levels

  • Effects by body weight categorized to show blood alcohol percentage implications for intoxication levels.

    • General Guideline: 1 drink affects blood alcohol levels differently based on body weight and gender.

Complications of Alcohol Abuse

  • Potential outcomes include:

    • Blackouts

    • Fetal Alcohol Syndrome

    • Various organ failures (including liver, kidneys).

    • Increased risks of certain cancers.

    • Neuropathy and depression.

Substance Abuse - Opioids/Opiates

  • Characteristics:

    • Symptoms and risks differ from alcohol withdrawal (no seizures, less confusion).

    • Treatment includes Naloxone (Narcan) for overdoses.

    • Often manage symptoms with supportive care and long-term solution options.

Opioid Intoxication vs. Withdrawal

  • Intoxication Symptoms: Bradycardia, hypotension, sedation.

  • Withdrawal Symptoms: Tachycardia, hypertension, insomnia, cravings, abdominal cramps, etc.

Opioid Withdrawal Timelines

  • Symptoms range regarding onset:

    • Starts within hours and peaks in intensity over days.

Medications for Opioid Overdose, Withdrawal & Addiction

  • Classes of Medications:

    • Opioid Receptor Agonists: Block withdrawal symptoms.

    • Partial Agonists: Ease symptoms and cravings.

    • Antagonists: Block effects of opioids.

    • Non-opioid alternatives offer a pathway for management.

The Opioid Epidemic by the Numbers

  • Current statistics indicate over 130 deaths daily due to opioid-related overdoses.

  • Significant increase in prescription rates correlating with misuse and complications.

Substance Abuse - Stimulants

  • Common Stimulants: Cocaine, methamphetamine, and prescription stimulants.

  • Serious withdrawal effects include severe depression.

  • Management includes supportive therapy and medications.

Signs of Impaired Nurse

  • Warning signs include a pattern of drug wasting, erratic documentation, poor judgment, and physical symptoms of intoxication.

Stages of Change Model

  • Outlines transitional phases individuals go through during addiction treatment, emphasizing the constant possibility of relapse and necessary steps toward change.

12 Steps of Alcoholics Anonymous (AA)

  • A structured approach to recovery from alcohol addiction, emphasizing moral inventory, amends to harm done, and spiritual growth.

WRAP (Wellness Recovery Action Plan)

  • A personalized plan developed with clinician guidance aimed at preventing and managing mental health challenges.

Assessment Tools Used in Addiction Care

  • AUDIT: Alcohol Use Disorders Identification Test for screening alcohol use.

  • CAGE: Four questions addressing alcohol use behavior.

  • COWS: Clinical Opiate Withdrawal Scale for assessing opioid withdrawal.

  • CIWA: Clinical Institute Withdrawal Assessment for Alcohol to assess alcohol withdrawal severity.

Key Takeaway Points

  • Awareness of personal feelings about substance abuse enhances care.

  • Recognizing addiction as a chronic disease is crucial for effective management.

  • Be vigilant regarding withdrawal symptoms and advocate for appropriate treatment options.

  • Familiarize with stages of change and assessment tools to aid in client support and intervention strategies.