NRS 203 Mental Health Lecture 13. Lecture 23

Substance Abuse Disorders Overview

Definitions

  • Substance Abuse: A pattern of using a drug inconsistent with medical or social norms despite adverse consequences. It involves:

    • Repeated use of a chemical substance over 12 months.

    • At least one of the following problems:

    • Inability to perform essential duties at home, school, or work.

    • Engaging in hazardous situations while impaired (e.g., driving).

    • Experiencing legal or personal problems due to substance use (e.g., losing a job).

    • Continued use despite negative consequences.

  • Substance Dependence: A more severe condition characterized by:

    • Tolerance: Needing larger amounts of a substance for the desired effect.

    • Withdrawal: Withdrawal syndrome due to reduction or cessation, manifesting as physical and psychological symptoms (e.g., tremors, headaches).

    • Compulsive use and a persistent desire to control substance use.

    • Increased time spent obtaining, using, or recovering from the substance.

    • Reduction in normal social and occupational activities.

  • Intoxication: Use of a substance resulting in maladaptive behavior.

  • Detoxification: The process of safely withdrawing from a substance.

  • Polysubstance Abuse: Abuse of more than one substance.

  • Addiction: Psychological and physiological dependence on a substance, involving drug-seeking behavior:

    • Loss of control, persistence in use despite problems, and tendency to relapse, despite aiming for complete abstinence.

  • Denial: A defense mechanism employed by individuals with substance abuse or dependency issues.

Common Substances Abused

Alcohol

  • Classification: Central nervous system depressant; the most widely abused substance globally.

  • Effects: Relaxation, decreased social anxiety, impaired judgment.

  • Legal Limit: Blood alcohol concentration of 0.08% is legally intoxicated for adults in the U.S.

  • Consequences: Acute toxicity can lead to death at levels greater than 0.35%.

  • Street Names: Hooch, moonshine, brew.

Stimulants

  • Examples: Amphetamines (e.g., crystal meth), cocaine.

  • Effects: Increased energy, euphoria; can cause severe irritability and psychotic behaviors.

  • Routes of Administration: Oral, IV, smoked.

  • Cocaine Street Names: Coke, crack, snow, nose candy, rock.

Cannabis (Marijuana)

  • Classification: Most widely used illicit substance in the U.S.

  • Effects: Euphoria, sedation, impaired judgment.

  • Active Components: Contains over 60 cannabinoids, primarily THC (tetrahydrocannabinol).

  • Street Names: Grass, joint, pot, blunt.

  • Medical Uses: Marinol and K9 for nausea from cancer treatment; approved in some states for medical purposes.

Opioids

  • Examples: Morphine, heroin, oxycodone, hydrocodone.

  • Effects: Analgesia, euphoria; can lead to severe complications such as respiratory depression and coma.

  • Street Names: Smack, dope, horse.

  • Antidote: Naloxone (Narcan) for overdose.

Hallucinogens

  • Examples: LSD, PCP, and ecstasy.

  • Effects: Distorted perception, hallucinations, anxiety, and paranoia.

  • Street Names: Acid, angel dust, shrooms.

Inhalants

  • Common Substances: Household products like glue, paint thinner, and gasoline.

  • Effects: Euphoria; similar symptoms to alcohol intoxication.

  • Street Names: Poppers, buzz bombs.

Nicotine

  • Effects: Relaxation, decreased anxiety.

  • Long-Term Effects: Carcinogenic risks, cardiovascular issues, respiratory problems.

Medical Treatments for Substance Abuse

Alcohol Treatment

  • Benzodiazepines: Drugs like Librium and Valium are first-line to manage withdrawal symptoms.

  • Aversion Therapy: Antabuse, which induces unpleasant reactions upon alcohol consumption.

  • Medication: Nowrexone is an opioid antagonist to reduce cravings for alcohol.

Opioid Treatment

  • Methadone: Long-acting opioid agonist to treat cravings and come from withdrawal.

  • Subutex: A partial agonist similar to methadone with a lower risk for overdose.

Nicotine Treatment

  • Pharmacological Aids: Zyban, Chantix, Nicorette help in smoking cessation.

  • Assessments: Open-ended questions regarding type, frequency, and amount of substance use; evaluate family background and co-dependency.

Family Dynamics in Substance Abuse

  • Codependence: Relationships characterized by one partner maintaining responsibility while the other avoids their share of responsibility. This often perpetuates substance dependency in the abuser.

Nursing Interventions

  • Safety: Monitor vitals, manage withdrawal symptoms, provide emotional support.

  • Education: Inform clients about addiction, assist in developing alternative recreational activities, and encourage self-responsibility.

Screening Tools

  • CAGE Assessment: A tool questioning if a person feels the need to cut down, feels annoyed by criticism, feels guilty about drinking, or has used alcohol or drugs to steady nerves.

Conclusion

  • Substance abuse is a complex disorder requiring comprehensive assessment and intervention strategies, including pharmacological, psychological, and social components. Understanding the range of substances and their effects, along with the dynamics of addiction, is crucial for effective treatment and recovery.