Substance Use Disorders

Substances and Psychoactive Drugs

  • Substances for therapeutic and recreational use include:
    • Alcohol
    • Sedative hypnotics
    • Narcotic analgesics
    • Stimulants
    • Hallucinogens
    • Cannabis
  • Psychoactive drugs alter mood, perception, malfunctioning, and behavior. They can be used legally and therapeutically, often as prescription medications.

Reasons for Substance Use

  • Relief of physical and emotional pain
  • Relaxation
  • Mood enhancement
  • Socialization
  • Improved alertness
  • Alterations in perception

Substance Use Disorders

  • Two main categories:
    • Substance use disorders
    • Alcohol use disorders
  • The term "substance use disorder" combines substance dependence and substance abuse.
  • Key terms:
    • Intoxication: Disturbance in cognition, perception, and other functions.
    • Withdrawal

Co-Occurring Disorders

  • Substance use disorders often co-occur with mental health disorders.
  • It can be unclear whether substance use causes or relieves mental health symptoms.
  • Substance use can affect brain function, leading to symptoms like aggression and impulsiveness.

Healthcare Workers and Substance Abuse

  • Healthcare workers are not exempt; they may abuse medications.
  • Impaired coworkers must be reported to supervisors for patient safety.

Key Terms

  • Substance
  • Substance abuse
  • Addiction
  • Enabling
  • Tolerance
  • Codependency: A family disease.

Tolerance

  • The brain adapts to repeated dosing, reducing the effects of a substance.
  • More of the substance is needed to achieve the same effect.
  • Decreased physical response; for example, more alcohol is needed to get drunk.

Alcoholism

  • Alcohol is the most commonly abused substance worldwide due to its availability and acceptance.
  • Alcohol content varies by beverage.
  • Risk alcohol use for most adults:
    • Up to 14 drinks a week for men
    • Up to 7 drinks a week for women and older people
  • Standard drink equivalents:
    • 12-ounce beer
    • 5-ounce glass of wine
    • 1. 5 ounces of distilled spirits
  • Addiction to alcohol is now termed "alcohol use disorder."
  • Women typically have a higher blood alcohol concentration than men, even with body size considered, and are more prone to long-term effects.

Early Warning Signs of Alcohol Problems

  • Drinking in secret
  • Drinking first thing in the morning
  • Gulping the first drink
  • Preoccupation with alcohol
  • Onset of blackouts
  • Binge drinking: Leads to high blood alcohol concentration levels and serious health consequences, especially in college students.

Alcoholism as a Family Disease

  • Alcoholism affects all family members.
  • Family members develop protective behaviors.
  • Codependency: Enabling behaviors that reinforce the addiction.
  • Enablers make excuses, cover-up, and blame themselves.
  • Codependent individuals often feel responsible for the alcohol user's problem and neglect their own needs.
  • The enabler may be financially dependent on the abuser.

Co-Occurring Disorders (Dual Diagnosis)

  • Individuals may self-medicate mental health symptoms with substances, leading to abuse.

Alcohol's Impact on Health

  • Third leading cause of preventable death in the United States.
  • A frequent factor in chronic illnesses.

Etiology of Abuse

  • Low self-esteem
  • Lack of support
  • Family history of addiction
  • Poor educational resources

Alcohol Withdrawal

  • Withdrawal symptoms start 4-12 hours after the last drink, especially in heavy abusers.
  • Symptoms include:
    • Hand tremors
    • Insomnia
    • Nausea and vomiting
    • Anxiety
    • Hallucinations or illusions
    • Seizures
  • Delirium tremens (DTs): Severe form of delirium with impaired consciousness, memory problems, hallucinations, and severe tremors.
  • Medical treatment: CNS depressants like Valium or Librium, anticonvulsants, and newer agents like Ativan to prevent oversedation.
  • Vitamins (folic acid, B vitamins) are also administered.

Recovery and Treatment

  • Treatment programs like Alcoholics Anonymous (AA): A 12-step program involving group support.
    • First step: Acknowledging powerlessness over alcohol.
  • AA also has traditions - twelve in total.
  • Family programs: Al-Anon, Adult Children of Alcoholics, Alateen.

Other Substances of Abuse

  • Chart on pages 261-264 of the textbook outlines drugs, intoxication, overdose, withdrawal, and nursing considerations.

Amphetamines

  • Examples: Ritalin, Dexedrine, Adderall, crystal meth.
  • Symptoms of use:
    • High energy
    • Impaired judgment
    • Anorexia
    • Aggressive behavior
    • Paranoia
  • Overdose: High body temperature, seizures, hypertension, arrhythmias, cardiovascular collapse.
  • Withdrawal: Depression, agitation, anxiety, insomnia, confusion, vivid dreams followed by lethargy.
  • Stay in urine and blood for up to three days.
  • Therapeutic uses: Narcolepsy, ADHD.

Cannabis (Marijuana)

  • Most widely used illicit drug; legal in some states.
  • Remains in urine for up to seven days.
  • K2, ketamine, and spice contain THC.

Cocaine

  • High-risk patients due to injection use.
  • Can be injected or smoked.

Hallucinogens

  • Examples: LSD, ketamine.
  • Flashbacks can occur up to five years after use.
  • Can precipitate psychiatric disorders.
  • Ketamine: Used in behavioral health facilities, emergency rooms, and by law enforcement to control violent suspects; also a date rape drug.

Inhalants

  • Examples: Glue, gasoline, cleaning solution, aerosols.
  • Intoxication is brief (15-45 minutes).
  • Risk of death by aspiration or emesis.

Nicotine and Caffeine

  • Included in substance use disorders.

Opioids

  • Examples: Heroin, morphine, meperidine, oxycontin, fentanyl, hydrocodone, codeine.
  • Patients often doctor shop to obtain these drugs.
  • Treatment: Clonidine for anxiety and methadone for opioid withdrawal.

Sedative Hypnotics

  • Combining with alcohol can cause extreme CNS depression.
  • Must be tapered off slowly.

Club Drugs

  • Examples: Flunitrazepam (Rohypnol), GHB.
  • Date rape drugs causing memory loss; detectable in urine.

Substance Use Disorder Treatment

  • Same philosophy as alcohol addiction: Acknowledging powerlessness and the importance of group support.
  • Defense mechanisms: Denial, projection, rationalization, minimizing, manipulation, grandiosity.
  • Corus substance use and abuse can result in serious health problems, criminal behavior, job loss, also increase in child abuse and neglect, premature deaths.
  • Often preventable
  • Alcohol most abused by Americans.
  • Becomes problematic when it interferes with life, continues despite negative consequences, and hurts others.
  • Genetic and family links exist, especially in alcoholism.
  • Younger age of onset increases the risk of addiction.
  • Chaotic home environments and weak parent-child attachments predispose individuals to use disorders.
  • Peer pressure, brain or genetic disorders, and personality characteristics also contribute.
  • Co-occurring disorders: Using substances to relieve anxiety or depression.
  • Blood alcohol level (BAL):
    • 0. 05%: Impairment, giddiness, mood changes.
    • 0. 08%: Legal limit for driving.
    • 1%: Difficulty driving, coordinating movements.
  • Substance withdrawal: Alcohol withdrawal begins 4-12 hours after cessation, peaks on the second day, and is over in about five days.

Phases of Substance Dependency (Four Phases)

  • Alcoholism contributes to chronic illnesses: Liver disease, heart disease, diabetes.
  • Treatment: Alcoholics Anonymous (AA), medications to reduce withdrawal symptoms.

Medications

  • Antabuse (Disulfiram) causes vomiting upon alcohol consumption.

Wernicke-Korsakoff Syndrome

  • Nutritional disease of the central nervous system found only in alcoholics.
  • Symptoms: Progressive memory loss, disorientation, emotional liability, apathy, weakness.
  • Treatment: Thiamine, multivitamin.
  • Delirium tremens (DTs) lasts 72-80 hours; ensure patient safety.

Other Substance Abuse Disorders

  • Hallucinogens, inhalants (intoxication lasts 15-45 minutes; linked to sudden sniffing death).

Opioid-Related Disorders

  • Heroin, prescription meds (oxycodone, hydrocodone, morphine, codeine, fentanyl).
  • Methadone used to treat opioid-related disorders.

Stimulant Use Disorders

  • Methamphetamines

Caffeine-Related Disorders

  • No established link between caffeine and substance abuse, but withdrawal can be clinically significant.

Nicotine

  • Causes odor, cough, wrinkles, pulmonary disease, lung, and oral cancers.

Sedative Hypnotics

  • Treatment: Detoxification (3-5 days).

Treatment Programs

  • Inpatient, outpatient, cognitive behavioral therapy.
  • Maintain honesty, observe defense mechanisms, avoid manipulation, set limits.