Addiction

Introduction

  • Trigger Warning: Lecture discusses topics related to addiction and substance use disorders, which may be triggering for some. Take breaks as needed.

Objectives

  • By the end of this unit, students should:

    • Define addiction, intoxication, and withdrawal.

    • Discuss predisposing factors in the etiology of substance-related and addictive disorders.

    • Differentiate symptoms of intoxication and withdrawal from various substances.

    • Identify common problems in patients with substance-related disorders and appropriate nursing interventions.

    • Identify relevant topics for patients and families affected by substance abuse.

    • Discuss collaborative approaches and treatment modalities for managing care.

Required Reading

  • Chapter 19 in the Vita Beck textbook.

Key Terminology

  • Substance Abuse: Use of a drug inconsistent with medical or social norms despite negative consequences.

  • Addiction: A condition where a person compulsively engages in substance use despite harmful consequences.

  • Intoxication: Use of a substance leading to maladaptive behavioral changes.

  • Withdrawal Syndrome: Negative psychological/physical reactions after cessation of a substance.

  • Detoxification (Detox): Process of safely withdrawing from a substance.

  • Cross Tolerance: Occurs when tolerance to one substance affects tolerance of another.

  • Tolerance: Need for increased amounts of a substance to achieve the same effect.

Statistics and Risk Factors

  • Statistics:

    • 40.3 million individuals affected by substance use disorder in 2020.

    • Only 6.5% received treatment.

  • Risk Factors for Development of Substance Abuse:

    • Genetics: Offspring of alcoholic parents at greater risk.

    • Adolescents: Increased experimentation and poor decision-making.

    • Coping Mechanisms: Using substances to alleviate chronic stress.

    • Socioeconomic Factors: Influence on substance use and type of substances abused.

    • History of Trauma: Particularly linked to PTSD and sexual trauma.

    • Low Self-Esteem: Can lead to substance abuse issues.

Substances Overview

CNS Depressants

  • Examples: Opioids, alcohol, sedative-hypnotics, anxiolytics, cannabis.

Opioids

  • Types: Heroin, morphine, fentanyl, oxycodone.

  • Effects of Intoxication: Euphoria, pain relief, slurred speech, impaired judgment, decreased respirations.

  • Withdrawal: Symptoms include sweating, tremors, flu-like symptoms, peak within 2-3 days. Non-life threatening but very unpleasant.

  • Treatment Options:

    • Methadone: Long-term maintenance, reduces withdrawal symptoms, administered daily at treatment centers.

    • Clonidine: Reduces withdrawal symptoms, does not reduce craving, can cause drowsiness.

    • Buprenorphine (Suboxone): For withdrawal and maintenance, reduces cravings without transferring dependence.

Alcohol

  • Effects of Intoxication: Relaxation, decreased anxiety, impaired judgment, risk of respiratory arrest at high levels.

  • Withdrawal: Starts within 4-12 hours, can progress to severe symptoms like seizures and delirium tremens (medical emergency).

  • Long-term Effects: Cardiac issues, Wernicke-Korsakoff syndrome, liver damage, etc.

  • Treatment: Benzodiazepines for withdrawal management; Disulfiram (Antabuse) for abstinence maintenance, and Naltrexone to suppress cravings.

Sedatives, Hypnotics, and Anxiolytics

  • Examples: Benzodiazepines (Xanax, Valium), barbiturates.

  • Intoxication Effects: Drowsiness, agitation, disorientation, respiratory depression.

  • Withdrawal Symptoms: Anxiety, insomnia, tremors; important to taper due to seizure risk.

Cannabis

  • Intended Effects: Euphoria, relaxation, medical uses for nausea/pain management.

  • Intoxication Effects: Increased appetite, dry mouth, paranoia in high doses.

  • Withdrawal Symptoms: Muscle aches, anxiety, sweating.

CNS Stimulants

  • Examples: Cocaine, methamphetamines, inhalants, and hallucinogens.

Cocaine

  • Effects of Intoxication: Dizziness, irritability, severe cardiovascular effects including hypertension.

  • Withdrawal: Depression, fatigue, cravings; generally not life-threatening.

Amphetamines/Methamphetamines

  • Intended Effects: Increased energy and euphoria; potential for brain damage.

  • Withdrawal Symptoms: Cravings, fatigue, depression.

Inhalants

  • Commonly Used By: Children/adolescents; used for its euphoric effects.

  • Intoxication Effects: Dizziness, drowsiness, possible coma.

Hallucinogens

  • Examples: LSD, PCP.

  • Intoxication Effects: Altered perception, anxiety, impaired functioning.

  • **No withdrawal symptoms but may cause persisting perception disorders (flashbacks).

Nursing Care for Substance Disorders

  • Self-Assessment: Nurses should assess personal feelings to ensure they do not affect patient care.

  • Safety/Food/Nutrition: Prioritize safety, provide adequate nutrition, and supplement deficiencies (e.g., thiamine for alcoholics).

  • Education: Explain addiction, abstinence goals, and recovery strategies.

  • Dual Diagnosis: Recognize co-occurring mental health disorders for comprehensive treatment.

  • Support Systems: Encourage attendance to support groups (AA, NA).

Closing Remarks

  • Attend an AA or NA meeting for assignment.

  • Reach out for questions or further support.