Substance Abuse and Alcohol

Substance Abuse and Mental Health Overview

Alcohol

  • Accessibility of Alcohol

    • Alcohol is easily accessible as it is legal and can be purchased anywhere, including supermarkets and convenience stores.

    • The average American is likely to have some form of alcohol at home, contributing to its potential danger.

Opioids

  • Definition and Use

    • Opioids are strong pain medications often initially prescribed for pain management. They are classified as controlled substances.

  • Examples

    • Opioids include:

    • Oxycodone

    • Fentanyl

    • Morphine

    • Heroin is an illegal opioid commonly found on the streets.

  • Addiction and Prescription Practices

    • Many patients who undergo major surgeries are prescribed opioids without proper education on their use and potential for addiction.

    • Complications can arise when patients misuse these medications, leading to severe consequences like divorce, loss of child custody, and homelessness.

CNS Depressants

  • Purpose

    • CNS depressants are controlled substances used to treat anxiety and insomnia.

  • Examples

    • Benzodiazepines such as Lorazepam (Ativan), Xanax, Valium, and Ambien are commonly prescribed.

  • Nature of Controlled Substances

    • These substances are classified as controlled due to their addictive properties.

Stimulants

  • Use in Treating ADHD

    • Medications like Ritalin and Adderall are used to treat Attention Deficit Hyperactivity Disorder (ADHD).

  • Abuse and Street Drugs

    • While not all ADHD treatments are stimulants, stimulants can be abused, and cocaine is commonly found as a street alternative.

Prevalence of Substance Abuse

  • Factors Contributing to Substance Use in the U.S.

    • High stress levels and fast-paced living contribute to substance abuse.

    • The opioid epidemic highlights an increasing trend in substance abuse across various demographics.

    • Substance abuse issues often tie to stress coping mechanisms.

Mental Health and Substance Abuse

  • Concurrent Diagnoses

    • Up to fifty percent of individuals with significant mental illnesses are also dependent on, or addicted to, alcohol or drugs.

    • The interaction between mental illness and substance abuse indicates a complex relationship where one may exacerbate the other.

Assessment of Substance Use

  • Key Elements in Assessment

    • Identify what type of substance or addictive behavior is present.

    • Determine the frequency of use:

    • Daily, weekly, or periodically.

    • Assess the amount of substance used:

    • Avoid vague answers and obtain standardized measurements (e.g., how many 12-ounce drinks).

  • Age of First Use

    • Capture when substances were first used, noting that earlier use correlates with more severe treatment outcomes.

  • Monitoring Performance Changes

    • Look for noticeable declines in work or school performance due to substance use.

Nutrition and Substance Abuse

  • Impacts on Nutrition

    • Individuals with substance use disorders often spend more on drugs than food, leading to poor nutritional health.

    • Substance abuse can also suppress appetite, causing additional health complications.

Nursing Considerations

  • Approaches to Substance Use Care

    • Foster empathy towards substance-abusing patients by understanding their situations and backgrounds, recognizing they face complex challenges and traumas.

    • Implement thorough assessments and interventions focusing on both mental and physical health.

Goals of Substance Use Treatment

  • Safety

    • Prioritize the patient's physiological and psychological safety, especially during withdrawal phases.

  • Support Systems

    • Encourage long-term support and recovery through community resources and network building.

Screening Tools

  • CAGE Screening Tool

    • Assess substance abuse through specific questions related to Alcohol Use:

    1. Have you ever felt you should cut down on your drinking?

    2. Have people annoyed you by criticizing your drinking?

    3. Have you ever felt bad or guilty about your drinking?

    4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

  • Scoring and Interpretation

    • Answers yield points that help discern the level of substance dependence, particularly for alcohol.

Treatment Strategies

  • Nursing Interventions

    • Encourage adequate nutrition and hydration by providing nutritional supplements like Ensure, especially when oral intake is poor.

    • Use antiemetics (e.g., Zofran, Phenergan) to manage nausea associated with withdrawal, with the understanding that they can be administered under proper orders.

  • Preventing Risks Related to Withdrawal

    • Monitor for seizure activity and implement precautions such as soft bedding or mats around the bed to prevent injury during a seizure.

    • Address fluctuations in vital signs that can occur during withdrawal, ensuring appropriate monitoring and interventions.

Addressing Psychological Needs

  • Mental Health Focus

    • Providing a supportive environment that addresses confusion and disorientation during withdrawal is essential for patient safety and recovery.

    • Engage patients with compassion, respecting their dignity and creating therapeutic relationships to aid recovery.

Community Engagement

  • Enhancing Public Awareness

    • Implement community programs aimed at destigmatizing substance use and reaching those in need of help through appropriate support and education.

    • Foster humility in communication and education, allowing for more effective outreach to assist individuals with substance use disorders.