Substance Use Disorders Review

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Substance Related and Addictive Disorders

• Instructor: Kris Lambert, PhD, RN
• Institution: CSUSM

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Pre-Test
SECTION 1

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True or False Quiz

1. True: Brain imaging shows changes in brain areas involved in judgment, decision-making, learning, memory, and behavior control in people with addiction.
2. False: Surges of dopamine caused by drugs do not directly cause the euphoria felt during substance use.
3. False: The feeling of pleasure is not solely how an unhealthy brain identifies beneficial behaviors.
4. True: Drug use affects areas of the brain like the basal ganglia, prefrontal cortex, and extended amygdala.
5. True: People may use drugs to feel better, socialize, perform better, or for enjoyment.

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Key Elements of Substance Use Disorders

• Increasing dose/tolerance
• Desire to cut down on use
• Excessive time spent obtaining/using medication
• Strong desire to use
• Interference with obligations
• Continued use despite life disruption
• Use in hazardous situations
• Elimination of important activities due to use
• Continued use despite problems
• Need for increased doses
• Withdrawal symptoms when decreasing dosage

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Definitions and Review

Substance-Related Disorders

• Substance Induced Disorders: Occur when medications used for health problems cause intoxication, withdrawal, or other health issues.
• Substance Use Disorder: Continues use despite cognitive, behavioral, and physiological symptoms.

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Defining Terms

Addiction:

• A primary, chronic neurobiological disease influenced by genetics, psychosocial, and environmental factors.
• Characterized by impaired control, compulsive use, continued use despite harm, and craving (ASAM).
• NIH defines drug addiction as compulsively using a drug despite dangerous consequences.

Dependence:

• A state of adaptation manifested by a withdrawal syndrome from abrupt cessation or rapid dose reduction.

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Tolerance and Withdrawal

Tolerance:

• The need for larger amounts of a drug to achieve the same effect.

Withdrawal:

• Occurs when a reduced dose or cessation leads to specific withdrawal symptoms, varies by drug; some can cause emergencies if stopped abruptly.

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Intoxication and Toxicity

Intoxication:

• Condition following the administration of a psychoactive substance resulting in disturbances of cognition, perception, behavior, and other functions.

Toxicity:

• Injury caused by excessive drug amounts; overdose can be fatal or nonfatal and is a medical emergency.

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Predisposing Factors for Substance Use Disorders

• No single theory explains etiology; it involves biological, psychological, and sociocultural factors.

Biological Factors:

• Genetics account for 40-60% of vulnerability; hereditary aspects play a role in substance use disorders.
• Changes in brain structure and neurochemistry occur with addiction development.

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Continued Predisposing Factors

Psychological Factors:

• Developmental influences, personality traits, and cognitive patterns contribute.

Sociocultural Influences:

• Social learning, conditioning, and cultural attitudes shape substance use behaviors.

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Review of Substance Use Disorder (SUD)

• Initial substance use is generally voluntary; addiction leads to significant brain changes affecting judgment, decision-making, and behavior control.
• Brain circuitry changes can persist beyond detoxification, leading to compulsive behaviors and cravings.

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DSM-5 Substance Use Disorder Criteria

1. Impaired control.
2. Social impairment.
3. Risky use.
4. Pharmacological indicators (tolerance and withdrawal).

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Alcohol Use Disorders

• Alcohol Metabolism: Alcohol (ethanol) is produced by yeast fermentation of sugars.
• BAC levels indicate levels of intoxication and corresponding effects.

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Alcohol and CNS Impairment

• CNS impairment levels depend on the amount consumed and individual weight factors.
• Intoxication level assessed by Blood Alcohol Level (BAL), with a legal limit set at 0.08 in California.

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Stages of Alcohol Intoxication

1. Sobriety
2. Low Level Intoxication
3. Euphoria
4. Excitement
5. Confusion
6. Stupor
7. Coma
8. Death

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Alcohol Withdrawal

• Changes experienced when stopping after prolonged alcohol use can lead to severe withdrawal syndromes resulting in mortality.
• Symptoms appear within 5-10 hours of cessation.

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Medical Management of Alcohol Withdrawal

• Goals include safe withdrawal and prevention of seizures and further complications.
• Use pharmacotherapy such as benzodiazepines, thiamine supplementation, and antihypertensives as necessary.

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Relapse Prevention Strategies

• Antabuse (Disulfiram):
• Used to deter alcohol consumption by inducing unpleasant effects when alcohol is ingested.

Revia (Naltrexone):

• An opioid antagonist that helps reduce cravings for alcohol.

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Opioids and Opiates

• Opioids bind to receptors blocking pain signals, inducing euphoria, and reinforcing drug use.

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Toxic Overdose with Opioids

• Symptoms include pinpoint pupils and respiratory depression; naloxone is used as emergency management.

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Stimulants Overview

• Stimulants enhance CNS activity, often used for performance or medical benefits, as well as recreation.

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Hallucinogens Effects

• Alter awareness, with types including classic hallucinogens and dissociative drugs.

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Club Drugs and Designer Drugs

• MDMA (Ecstasy) alters mood and perception, possibly leading to cognitive impairment with high-risk withdrawal effects.

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Treatment Options Overview

• Options include inpatient and outpatient therapy, withdrawal management, counseling, medication, and support groups.

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Harm Reduction Strategies

• Practical approaches to reduce negative effects of drug use, emphasizing safety and realistic engagement with existing behaviors.

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Drug Disposal Options

• Safe disposal methods for medications include drug take-back sites or flushing per FDA recommendations.

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Nursing Diagnoses Overview

• Primary: Substance Use Disorder, Risk for Injury, Ineffective Health Maintenance, Ineffective Coping, etc.

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Risk Management of Substance Use

• Develop continuous assessments for withdrawal symptoms, provide a safe environment, and monitor for complications to ensure patient safety.

Notes

• Understanding addiction involves recognizing symptoms, management protocols, and the complex interplay of biological, psychological, and sociocultural factors.
• Interventions may involve patient education, continuous support, and various therapeutic strategies to achieve sustainable recovery.