Substance-Related Disorders

Substance: Drug of abuse, a medication, or a toxin.
Substance use: Ingestion of any chemical that affects the body.
Abused substances: Chemicals that alter the individual’s perception by affecting the central nervous system (CNS).
Substance (drug) abuse: Excessive use of a substance that differs from societal norms.
Habituation: An individual depends on a substance to provide pleasure or relief.
Substance (chemical) dependency: A user must take his or her usual dose of the drug to prevent the onset of withdrawal signs and symptoms.
Addiction: Individual’s dependence on the substance is physical.
Abstinence: An addicted individual is not using an addictive substance.

Risks associated with pregnant women: There are no safe drugs for pregnant women.
Excessive alcohol use:
- Can result in fetal alcohol syndrome (FAS).
- Children with FAS are characterized by smaller size, smaller heads, and failure to develop normally.
Cocaine use:
- Infants exposed to cocaine in utero may exhibit sleeping and eating problems, unusual levels of irritation, and high-pitched cries.

Children also abuse substances, typically legal and accessible.
Alcohol: Most frequently abused drug among adolescents.
Patterns of adolescent substance abuse include experimentation and usage in social settings for relaxation or intoxication.
Teens with addiction are prone to illegal activities.

Substance abuse is prevalent in adults.
Approximately 10% of the adult population regularly abuses alcohol.
Patterns of substance abuse can vary across minority groups:
- Cocaine: More common among African Americans.
- Alcohol: Preferred by White and Hispanic individuals.

Substance abuse incurs significant financial and human costs.
Many deaths from falls, drowning, and burns are connected to alcohol and drug use.
Individuals with serious mental illness who also abuse chemicals are said to have a dual diagnosis.

Effect: Alcohol exerts a depressant effect on the CNS.
Intoxication symptoms:
  - Slurred speech
  - Unsteady gait
  - Lack of coordination
  - Impaired attention/memory/judgment
Overdose risks:
- Vomiting, unconsciousness, and respiratory depression.
- Complications may lead to aspiration pneumonia or pulmonary obstruction. - Alcohol-induced hypotension can result in cardiovascular shock and death.
Treatment of overdose:
- Options include gastric lavage or dialysis and supporting respiratory and cardiovascular function.

Classification: CNS depressants present naturally, semi-synthetically, and synthetically.
Examples:
- Naturally occurring: Opium, morphine
- Semi-synthetic: Heroin, hydromorphone, thebaine derivatives.

Commonly abused stimulants:
  - Caffeine
  - Cocaine, crack
  - Prescription medications (e.g., amphetamines, appetite suppressants, methylphenidate (Ritalin), cannabis).

Comprised of natural and synthetic substances that alter reality perception.
Examples:
  - Peyote cactus, mescaline
  - Lysergic acid diethylamide (LSD)
  - Psilocybin
  - Phencyclidine (PCP)
Users may experience varying effects from profound insights to “bad trips.”

Cocaine and Crack: Commonly abused varieties.
Designer drugs: Created by manipulating the molecular structure of existing drugs.
Examples: MDMA (Ecstasy), STP, “Ice.”

Many therapeutic drugs can be abused.
Examples:
  - Morphine, hydromorphone
  - Amphetamines
  - Methylphenidate (Ritalin)
  - Diazepam (Valium), laxatives, diuretics.

Definition: Volatile substances or chemical gases inhaled for their effects.
Examples: Alcohol solvents, gasoline, glue, paint thinner, and nicotine.
Complications: Can lead to significant health risks including sudden death, respiratory depression, hyperactive motor responses, loss of coordination, and seizures.

Unknown origins: Causes are not definitively known.
Biological theories: Suggest variations among ethnic groups provide genetic and biochemical explanations for substance abuse.
Psychological theories: Personality and emotional problems may lead to substance abuse.
Environmental theories: Include the individual, family, and sociocultural surroundings affecting substance abuse.

Early stage: The individual can still use without adverse effects.
Middle stage: Increased intoxication episodes occur as the body adapts; tolerance develops, needing more for the same effect.
Chronic (late) stage: High tolerance, leading to loss of control over behavior associated with substance use.

Individuals must meet specific criteria:
- The substance use pattern must be disabling, leading to impaired functioning and distress.
- Signs of tolerance, withdrawal, and dependence must be exhibited.

Disease model: Considers substance abuse a disease requiring treatment.
12-step process: Focuses on admitting powerlessness and seeking help from a higher power.
Medical model: Views addiction as a public health issue, considering both chronic and acute diseases.
Psychiatric models: See substance abuse as an expression of underlying emotional or mental disorders.
Sociocultural models: Emphasize changing environmental factors to treat substance abuse.

Definition: The recurrence of substance-abusing behaviors after a period of abstinence.
Individuals who relapse often experience distressing emotions.

Nursing diagnoses for clients with substance abuse problems are based on identified issues and goals.
Care plans must be tailored individually for each client, recognizing the challenges and frustrations of treating substance-related problems.