substance related and addiction disorders

Substance-Related and Addiction Disorders

Learning Objectives

  • Describe the impact of substance-related and addiction disorders on a client’s overall health.
  • Explore epidemiological and etiological risk factors that contribute to clients experiencing substance-related and addiction disorders.
  • Differentiate the clinical presentation of clients experiencing substance-related and addiction disorders.
  • Explore the role of the nurse when caring for clients experiencing substance-related and addiction disorders.
  • Apply the nursing process through the use of clinical judgment functions while providing care to clients experiencing substance-related and addiction disorders.
  • Explore personal and nursing values related to the health care professional who is chemically impaired.

Overview of Substance-Related and Addiction Disorders

  • Addiction
  • Substances and behaviors
  • Overdose
  • Opioids
  • Mental health impacts
  • Effects on individual and family
  • Cognitive, behavioral, psychological manifestations (National Center for Drug Abuse Statistics, 2021).

Clinical Onset of Substance Use

  • Substance use throughout the lifespan can affect individuals differently at various ages.
  • Adolescents are identified as having the highest risk for developing substance-related issues.
  • Individuals may self-medicate to treat manifestations of mental illness, particularly depression and anxiety (National Institute on Drug Abuse, 2020).
  • Other reasons for substance use may include pain management and stress management.

Reward Pathway Involvement

  • Limbic system plays a critical role in addiction.
    • Dopamine burst: Release of dopamine creates feelings of pleasure. (National Institute on Drug Abuse, 2020c)
    • Basal ganglia: Controls motivation.
    • Excessive stimulation leads to feelings of euphoria.
    • Amygdala: Associated with anxiety and irritability, leading to illicit cravings.
    • Prefrontal cortex: Involved in compulsive behaviors associated with addiction.

Etiology of Addiction

  • Risk Factors:
    • Mental illness
    • Stress
    • Genetics
    • Peer pressure
    • Experience of abuse
  • Protective Factors:
    • Positive family support
    • Caregiver involvement
    • Positive relationships
    • Employment opportunities
    • Access to community resources (National Institute on Drug Abuse, 2020a)

Comorbidities Associated with Substance Use

  • Health conditions frequently seen in conjunction with substance use include:
    • Heart disease
    • Stroke
    • Dental issues
    • Hepatitis
    • Cirrhosis
    • Various mental illnesses (SAMHSA, 2021)

Clinical Presentation – Alcohol

  • Symptoms of Use:
    • Mood and behavior changes
    • Inability to coordinate movement
    • Slurring of words (APA, 2022)
  • Concerns When Under the Influence:
    • Safety risks
    • Increased accident prone behavior
    • Risk for bleeding
    • Possibility of DUI charges and accidents
  • Symptoms and Concerns of Withdrawal:
    • Agitation, anxiety, sweating, and insomnia
    • Range of tremors (mild, moderate, or severe)
    • Delirium – a severe and potentially fatal consequence of alcohol withdrawal (Delirium Tremens or DTs) includes vomiting, hallucinations, confusion, syncope, hypotension, hypertension, bradycardia, tachycardia, seizures.

Clinical Presentation – Hallucinogens

  • Symptoms of Use:
    • Hallucinations: false sensory experiences (APA, 2022)
  • Concerns When Under the Influence:
    • Increased risk for sexual assault
    • Potential for out-of-control behaviors
  • Withdrawal Symptoms:
    • Headaches, increased appetite, sleepiness, and depression.

Clinical Presentation – Opioids

  • Symptoms of Use:
    • Can relieve pain and lead to relaxation
    • Side effects include drowsiness, confusion, nausea, constipation, euphoria, and slowed breathing (APA, 2022)
  • Risks When Under the Influence:
    • Using with alcohol can dangerously suppress heart rate and respiration leading to coma or death.
  • Withdrawal Symptoms:
    • Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goosebumps (often termed "cold turkey"), leg movements.

Clinical Presentation – Stimulants

  • Symptoms of Use:
    • Euphoria, "a rush," increased alertness, attention, and energy
    • Physiological effects include increased blood pressure, heart rate, narrowed blood vessels, increased blood sugar, and opened-up breathing passages (APA, 2022)
  • Risks When Under the Influence:
    • Combining stimulants with alcohol increases the risk of cardiac toxicity.
  • Withdrawal Symptoms:
    • Symptoms include depression, tiredness, increased appetite, insomnia, vivid unpleasant dreams, slowed thinking and movement, and restlessness.

Clinical Presentation – Sedatives

  • Symptoms of Use:
    • Decrease anxiety, enhance sleep, inducing drowsiness
    • Observable effects include slurred speech, poor concentration, confusion, and dizziness.
  • Risks When Under the Influence:
    • Some sedatives are used as date-rape drugs such as flunitrazepam, GHB, GBL, and ketamine.
  • Withdrawal Concerns:
    • Withdrawal can result in severe symptoms including seizures.

Warning Signs of Substance Use

  • Changes in mood
  • Change in peer group
  • Change in weight or sleeping habits
  • Loss of interest in overall health
  • Decline in performance at work or school
  • Loss of money, missing valuables, or borrowing behavior.

Alcohol Withdrawal

  • Manifestations typically develop 4 to 6 hours after the last drink.
  • Symptoms include:
    • Tremors
    • Diaphoresis
    • Increased heart rate and blood pressure
    • Nausea and vomiting
    • Anxiety and irritability
    • Seizures (APA, 2022)

Role of the Nurse: Prevention

  • Address Risk Factors:
    • Promote protective factors through substance use education.
    • Promote access to treatment options.

Role of the Nurse: Treatment

  • Management of Symptoms:
    • Withdrawal management from alcohol through pharmacological means such as Benzodiazepines or Barbiturates, Antiepileptics.
    • Nutritional support such as Thiamine.
    • Promote alcohol abstinence considering medications like Naltrexone, Acamprosate, or Disulfiram.
    • Community-based treatment options including 12-step programs, motivational enhancement strategies, and peer support groups (APA, 2018).

Client and Family Education

  • Evaluation of treatment beliefs (Rayan, 2017).
  • Reinforcement of healthy coping skills.
  • Understanding addiction as a disease.
  • Differentiating between withdrawal and intoxication.
  • Importance of milieu management and safety in recovery settings.

Treatment Settings

  • Outpatient treatment
  • Intensive outpatient programs
  • Partial hospitalization
  • Inpatient treatment
  • Residential treatment.

Impaired Health Care Professionals

  • Issues like drug diversion, stress and job burnout, staffing shortages, working overtime, and inadequate nurse-client ratios are significant concerns (Boyd & Luebbert, 2022).

Discipline for Impaired Professionals

  • Processes involved in complaints:
    • Receiving a complaint by the state board of nursing.
    • Self-reporting incidents.
    • Responding to complaints in writing and undergoing evidence investigations.
    • Possible hearings for nursing practice violations.
    • Accessing a nurse assistance program for support.
    • Risk of losing or suspending license if violations are substantiated (NCSBN, 2021).