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.
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.