Substance-Related and Addictive Disorders Overview of Disorders

Substance Use Disorder vs Substance Induced Disorder

• Substance Use Disorder: Refers to a chronic, relapsing disorder characterized by compulsive drug seeking behavior, continued use despite harmful consequences, and long-lasting changes in the brain. It can significantly impair social, occupational, and psychological functioning.

• Substance Induced Disorder: Refers to conditions that are a direct result of the effects of substances, such as intoxication, withdrawal manifestations, and other medical conditions caused by substance use. For instance, prolonged alcohol use may lead to alcohol-induced psychotic disorder.

Key Concepts of Substance Intoxication

• Definition: A temporary physiological and psychological state caused by the ingestion of substances that affect the central nervous system (CNS).

• Effects: Impacts judgment, motor coordination, and can alter mood, which influences social behavior and occupational performance.

• Common Examples: Can occur in social or recreational settings, with substances like alcohol being pervasive at parties.

Withdrawal Symptoms

Nicotine Withdrawal

• Symptoms: Include cravings, irritability, anxiety, depression, restlessness, sleep disturbances, concentration difficulties, appetite changes, and potential weight gain. Cravings can last for months, exacerbating potential relapse.

Substance Withdrawal

• General Symptoms: Vary across substances, but often disrupt both physical and psychological functioning. Common symptoms may include nausea, sweating, shaking, and seizures, depending on the substance.

Opiate Withdrawal Timeline

• Timeline:

  • Start: Post last dose; symptoms can manifest within 6 to 12 hours.

  • 72 Hours: Peak physical symptoms occur, which can include chills, fever, muscle pain, sweating, and gastrointestinal distress.

  • 1 Week: Physical symptoms begin to lessen significantly, but psychological symptoms may remain.

  • 2 Weeks: Psychological symptoms usually manifest, including depression, anxiety, and irritability, which may lead to cravings.

  • 1 Month: Cravings and depressive symptoms can persist for months, making long-term recovery challenging.

Classes of Psychoactive Substances

• Categories:

  • Alcohol: A depressant that slows down the CNS, leading to impaired motor skills and judgment.

  • Caffeine: A stimulant found in coffee and tea, known for enhancing alertness.

  • Cannabis: Can induce relaxation but affects short-term memory and motor coordination.

  • Hallucinogens: Such as LSD, cause significant alterations in sensory perception and thought processes.

  • Inhalants: Household products that can induce euphoria but have severe long-term health effects.

  • Opioids: Powerful pain relievers that can lead to euphoria, yet have high addiction potentials.

  • Stimulants: Including cocaine and various amphetamines, they can increase energy, but pose significant risks for cardiovascular health.

  • Tobacco: Contains nicotine, leading to addiction and serious health impacts like lung cancer.

Predisposing Factors

• Psychological Factors: Include genetics which may predispose individuals to addiction, developmental influences from childhood, personality traits (e.g., impulsivity), and cognitive styles that may influence behavior.

• Sociocultural Factors: Peer influences, environmental conditioning from childhood, and broader cultural contexts that either encourage or deter substance use.

Alcohol Use Disorder

Patterns of Use

• Phases of Alcohol Use:

  • Phase I: Prealcoholic phase - initial use to cope with stress; no noticeable consequences.

  • Phase II: Early alcoholic phase - increased use, reliance on alcohol for mood regulation.

  • Phase III: Crucial phase - loss of control over drinking; attempts to cut down lead to withdrawal.

  • Phase IV: Chronic phase - severe consequences on health and life functioning.

Effects of Alcohol on the Body

• Peripheral Neuropathy: Leads to nerve damage resulting in pain and tingling sensations in the limbs.

• Complications: Alcoholic myopathy affects muscle function while cardiomyopathy can weaken the heart muscle. Potential gastrointestinal issues such as pancreatitis and liver diseases, including cirrhosis, are also common due to long-term use.

Fetal Alcohol Syndrome

• Risks: Alcohol use during pregnancy increases the likelihood of Fetal Alcohol Spectrum Disorders (FASDs), leading to intellectual disabilities, developmental delays, and behavioral problems in children.

Alcohol Intoxication and Withdrawal Symptoms

• Intoxication: Symptoms might include significant disinhibition, mood swings, impaired judgment, slurred speech, and at higher doses, loss of coordination.

• Withdrawal: Symptoms can include tremors, nausea, anxiety, fatigue, sweating, elevated blood pressure, and in severe cases, delirium tremens (DTs).

Sedative Hypnotic Use Disorder

Profiles

• Categories: Includes Barbiturates (e.g., phenobarbital) and Nonbarbiturate Hypnotics (e.g., zolpidem). Common street names vary by substance.

Effects

• Health Impact: Sedative hypnotics can impair sleep, respiration (risk of overdose), cardiovascular health, and cognitive functioning, requiring careful management.

Stimulant Use Disorder

Profile of Substances

• Substances: Includes various amphetamines (Adderall) and cocaine. They act primarily on the CNS, increasing dopamine levels.

Induced Disorders

• Effects: Intoxication can lead to euphoria, increased energy, while withdrawal symptoms may include fatigue, depression, headaches, and intense cravings for the substance.

Inhalant Use Disorder

Effects

• Intoxication Symptoms: Dizziness, uncoordinated movement, and hallucinations; can have serious long-term risks to CNS and cognitive functioning.

Opioid Use Disorder

Intoxication Symptoms

• Euphoric Effects: Respiratory depression is a critical danger that can lead to coma or death.

Withdrawal Symptoms

• Painful Experience: Symptoms may include muscular aches, vomiting, diarrhea, and insomnia, often leading to increased substance-seeking behavior.

Hallucinogen Use Disorder

Profile and Effects

• Characteristics: Includes substances such as LSD and psilocybin leading to distorted perceptions, increased sensory awareness, psychological symptoms like paranoia, and euphoria during use.

Cannabis Use Disorder

Symptoms

• Impairments: Motor coordination issues, judgment difficulties; withdrawal symptoms commonly include irritability, sleep disturbance, and appetite changes.

Nursing Process Applications

• Assessment and Diagnosis: Comprehensive drug history including standardized assessments such as the CAGE questionnaire, MAST (Michigan Alcohol Screening Test). Evaluating for co-occurring mental health disorders is vital.

Outcomes

• Goals: Address irrational beliefs about substance use, facilitate the development of adaptive coping mechanisms, and enhance patient education on the impacts of substance use to promote recovery.

Client and Family Education

• Emphasis: Providing education on the nature of substance-related disorders, coping strategies for stress, nutritional guidance, and information on support services available to families.

The Chemically Impaired Nurse

Characteristics

• Indicators: Behavioral changes, high absenteeism, neglect of personal appearance, altered job performance, and discrepancies in documentation. Such issues can significantly hinder patient care quality.

Codependency Dynamics

• Common Behaviors: Denial, caretaking, control, and enabling tendencies impact personal well-being and relationships. Recognizing codependent patterns is essential for recovery.

Treatment Modalities

• Substance-Related Treatments: Incorporate a combination of behavioral and cognitive therapies, pharmacological interventions (such as methadone for opioids), and support groups like Alcoholics Anonymous and Narcotics Anonymous aimed at facilitating rehabilitation and long-term recovery from substance use disorders.

Key Facts to Remember

• Substance Use Disorder is a chronic condition requiring complex treatment.

• Withdrawal symptoms can vary substantially between substances and affect survival.

• Impact on health can be profound; early intervention is crucial to mitigating effects.