Chapter 48

Chapter Overview

  • Title: Substance Abuse

Learning Objectives

  • Lesson 48.1: Substance Abuse (Slide 1 of 2)

    • Identify differences: Mild, moderate, and severe substance abuse disorder.

    • Differentiate screening instruments for substance use disorders.

    • Cite responsibilities of professionals when suspecting a colleague of substance abuse.

    • Explain long-term treatment goals for substance abuse.

    • Identify withdrawal symptoms for major substances commonly abused.

Classification of Substance Abuse

  • DSM-5 Redefinition: Substance abuse is redefined as Substance Use Disorders.

    • Specific substance used determines the disorder classification.

    • Total of 12 categories defined.

Key Terms for Substance Abuse

  • Substance Abuse: Periodic purposeful use leading to clinically significant impairment.

  • Impairment: Failure to meet major obligations (work, school, home).

  • Dependence/Addiction: Compulsive use, tolerance, and withdrawal symptoms.

  • Illicit Substances: Chemicals that alter biological functions without health benefits.

  • Statistics: 7.1 million people (2.7% of the U.S. population) aged 12+ experienced illicit drug disorders.

Signs of Impairment

  • Family Life: Manifestations include violence, separation, divorce, and financial issues.

  • Social Life: Symptoms include public intoxication and social isolation.

  • Physical and Mental Changes:

    • Fatigue, illnesses, injuries, emotional crises.

  • Work Impairment: Flagrant evidence at work is rare but impactful.

Screening for Alcohol and Substance Abuse

  • Screening Instruments: Four main categories defined.

    • Comprehensive drug abuse screening and assessment.

    • Brief drug abuse screening.

    • Alcohol abuse screening.

    • Drug/alcohol screening for adolescents.

  • CAGE Assessment: A quick screening tool.

    • C—Cut down.

    • A—Annoyed.

    • G—Guilt.

    • E—Eye opener.

Health Professionals and Substance Abuse

  • Factors Contributing to Abuse:

    • Stress from patient care, managing more patients, zero tolerance for mistakes, and financial issues.

  • Signs of Abuse:

    • Behavioral changes such as hygiene neglect and mood swings.

    • Performance deterioration noted.

Substance Abuse Reporting

  • Protocol: Confidentially report to a supervisor, conduct investigation.

  • Protect Patient Welfare: Unreported cases can lead to severe consequences.

  • Legal Protections: Reported colleagues have a chance to retain licenses.

Substances of Abuse

  • Various substances include:

    • Alcohol, nicotine, caffeine.

    • Amphetamines, cannabis, cocaine.

    • Hallucinogens, inhalants, opioids, phencyclidine (PCP), sedatives, hypnosis.

Principles of Treatment for Substance Abuse

  • Treatment Goals:

    • Reduce or abstain from substances and their effects.

    • Minimize frequency and severity of relapse.

    • Improve psychological and social functioning.

Alcohol Withdrawal Symptoms

  • Symptoms include:

    • Visual/auditory hallucinations, seizures.

  • Treatment Approaches:

    • Hydration, electrolytes, nutritional support.

    • Thiamine and multiple vitamins.

    • Benzodiazepines for detoxification using fixed and symptom-triggered schedules.

Alcohol Relapse Prevention

  • Support Needed:

    • Social support and lifelong efforts.

  • Medications:

    • Disulfiram (Antabuse): Causes nausea with alcohol.

    • Naltrexone (Revia): Blocks effects of alcohol.

    • Acamprosate (Campral): Promotes abstinence.

  • Combined Use: Higher success when naltrexone and acamprosate are used together.

Opioids Withdrawal Symptoms

  • Symptoms include:

    • Mood swings, anxiety, impaired memory.

  • Treatment Strategies:

    • Substitute opioids to minimize withdrawal.

    • Social/community support, lifelong psychosocial, and pharmacological support.

Amphetamine-Type Stimulants

  • Uses: ADHD, addiction treatments, etc.

  • Intoxication Effects:

    • Heightened alertness, energy; possible extended wakefulness.

    • Poor oral hygiene issues.

  • Treatment:

    • No specific antidote; cognitive behavior therapy recommended.

Cocaine Withdrawal Symptoms

  • Withdrawal may start within hours of dosage reduction.

  • Common symptoms include fatigue and depression.

  • Treatment: No approved medications; high relapse risk.

Nursing Assessment

  • Components:

    • History, vital signs, mental status, appearance, neurologic assessment.

    • Comprehensive assessments of eyes, ears, throat, skin, and more.

Nursing Implementation

  • Immediate Care Needs: Stabilize the individual in emergency settings.

  • Supportive Environment: Ensure quiet and safe conditions for withdrawal.

  • Empower Patients: Encourage responsibility in their treatment decisions.

Patient Education

  • Focus on:

    • Nutrition, stress management, and health maintenance.

    • Involvement in self-assessment.

Drug: Acamprosate (Campral)

  • Action: NMDA receptor antagonist for chronic alcoholism.

    • Enhances abstinence; reduces drinking rates.

  • Common Side Effects: Diarrhea; serious effects include suicidal actions.

Drug: Disulfiram (Antabuse)

  • Action: Causes adverse effects when alcohol is consumed.

  • Uses: Chronic alcoholism as part of a larger treatment plan.

  • Adverse Effects: Drowsiness, hepatotoxicity, and hypersensitivity.

Questions?

  • Q&A Section: Open for any inquiries regarding substance abuse treatment.