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Nursing Process in Substance Abuse Treatment

Assessment

  • Includes Subjective and Objective Data

    • Subjective Data:

    • Questions to ask patients regarding substance use:

      • Type of substance used

      • Quantity used

      • Frequency of use

      • Last use of the substance

    • Importance of Last Use:

      • Helps in anticipating withdrawal symptoms

    • Additional Questions:

    • Previous experiences with withdrawal

    • Symptoms experienced during previous withdrawal

  • Objective Data:

    • Assess for physical signs of substance abuse:

    • Tremors

    • Skin for needle marks (for injected drugs)

    • Vital signs assessment:

    • Tachycardia

    • Hypertension

    • Diagnostic Testing:

    • Blood and urine toxicology screens

    • Evaluation of liver enzymes to identify liver dysfunction

    • Monitoring electrolytes (e.g., sodium, potassium)

CAGE Questionnaire

  • A screening tool for alcoholism

    • Components:

    • C (Cut down): Have you ever felt you needed to cut down on your drinking?

    • A (Annoyed): Have you ever been annoyed by people criticizing your drinking?

    • G (Guilty): Have you ever felt bad or guilty about drinking?

    • E (Eye Opener): Have you ever had a drink first thing in the morning to calm your nerves or get rid of a hangover?

    • Interpretation of Results:

    • Positive indication of probable alcoholism if the patient answers 'yes' to two or more questions

Nursing Interventions

  • Primary Concern: Safety

    • Assess and maintain airway, especially for intoxicated patients

    • Positioning:

    • Sidelying position to prevent aspiration in case of vomiting

    • Elevated head of the bed to improve breathing

    • Provide IV fluids to correct dehydration and electrolyte imbalance

    • Banana Bag:

      • IV fluids with added multivitamins (e.g., folic acid, thiamine)

      • Named for its bright yellow color

  • Medications Used:

    • For Alcohol Withdrawal:

    • Librium (Chlordiazepoxide)

    • Ativan (Lorazepam)

    • Anticonvulsants to prevent seizures

    • Cardiac Monitoring:

    • For patients withdrawing from stimulants

  • Protocol Procedures:

    • Upon admission, patients undergo specific alcohol withdrawal protocols that commonly include:

    • Immediate administration of a banana bag

    • Tapering of medications like Librium

      • Start with a high dose and reduce before discharge to prepare for rehab

    • Additional medications: Folic acid and thiamine orally, PRN meds for withdrawal symptoms

Environmental and Emotional Support

  • Reduce noise and stimulation

  • Allow activity but prevent overexertion

  • Use calm, simple explanations and therapeutic communication

  • Address denial in a nonjudgmental manner

  • Nutritional Support:

    • Nutrient and vitamin replacement through snacks and foods due to malnutrition common in addicts

  • Nursing Intervention Cycle for Addiction and Detox:

    • Sequence: Safety → Stabilization → Support → Education → Rehabilitation

  • Medications Post-Rehabilitation:

    • Antabuse (Disulfiram)

    • Aversion therapy medication that causes severe illness if alcohol is consumed while taking it

    • Symptoms include flushing, nausea, tachycardia, dyspnea, confusion

Group and Residential Therapy

  • Encourage participation in Alcoholics Anonymous (AA)

    • Founded in 1935 using a twelve-step program

    • Emphasizes acceptance of addiction, peer support, and spiritual growth

  • Other Support Groups:

    • Narcotics Anonymous, Overeaters Anonymous

  • Residential Treatment Programs:

    • Provide structured recovery environment post-detox

    • Often staffed with nurses for monitoring

    • Counseling and peer support focus on emotional behavioral support

  • Post-Detox Phase:

    • Patients live in substance-free environments

    • Focus on developing healthy coping skills and social interactions without substance use

    • Program duration typically lasts one to six months

    • Funding may be private or governmental

Pain Management in Patients with Addiction

  • Challenges in managing pain medications due to addictive potential

  • Modern Pain Management Approaches:

    • Multimodal therapy combining:

    • Nonopioid medications

    • Carefully monitored opioids when necessary

    • Non-pharmacological therapies

  • Nursing Responsibilities:

    • Thorough pain assessments

    • Monitor for tolerance, dependence, and drug-seeking behaviors

    • Promote alternatives: relaxation techniques, positioning, heat/cold therapy, exercise, distraction methods

General Insights on Drug Abuse

  • Growing health concern includes illegal and prescription medication misuse

  • Common Patterns of Abuse:

    • Sharing medications

    • Seeking prescriptions from multiple providers

    • Purchasing drugs illegally

    • Using medications in higher doses than prescribed

  • Types of Drugs:

    • CNS Depressants:

    • Slow down brain activity and nervous system function (e.g., alcohol, sedatives, benzodiazepines, barbiturates, opioids)

    • Risks include respiratory depression, rapid tolerance development, and potential seizures upon withdrawal

    • Examples:

    • Benzodiazepines: Xanax, Klonopin (anxiolytics frequently abused)

    • Barbiturates used for sedation and anesthesia with a high risk of dependence

    • Club Drugs (Date Rape Drugs):

    • Rohypnol and GHB that cause sedation, muscle relaxation, and amnesia

    • High risk of overdose and respiratory depression when combined with alcohol

    • Opioids:

    • Act by replacing endorphins in the CNS, leading to pain relief and euphoria

    • Rapid development of tolerance and dependence

    • Fentanyl Crisis:

      • Significant health concern in the U.S. with high potency and risk of accidental overdose

      • Patients often unknowingly transition from prescribed opioids to fentanyl, resulting in severe addiction

    • Suboxone:

      • Becoming popular for treating opioid dependency (especially from fentanyl), but carries risk of new addiction to synthetic opioids

  • Opioid Overdose Indicators:

    • Classic triad: severe respiratory depression, pinpoint pupils, decreased consciousness

    • Administer Narcan for intervention

Withdrawal Symptoms and Treatment

  • Opioid Withdrawal:

    • Begins 6 hours after last dose

    • Symptoms: flu-like (body aches, vomiting, diarrhea), tachycardia, hypertension

    • Peaks in 2-3 days, resolving within 5-10 days

  • CNS Stimulants:

    • Examples include caffeine and nicotine

    • Withdrawal from caffeine may include headaches; nicotine may prompt irritability and cravings

    • Cocaine is characterized by intense euphoria followed by a crash leading to severe depression and craved use

    • Methamphetamine Use:

    • Creates intense euphoria with severe depletions of dopamine, leading to emotional issues similar to Parkinson's disease

  • Polysubstance Abuse Risks:

    • Drugs may cause altered perception leading to injuries rather than direct toxicity

    • PCP: can cause violent behavior and detachment from reality

    • LSD: causes altered perception and potential long-term psychological effects

    • MDMA: leads to serotonin depletion, resulting in long-term anxiety and depression

Cannabis Use and Effects

  • Derived from cannabis sativa, active ingredient is THC

  • Fat-soluble, detectable in body tissues for weeks

  • Effects include impaired coordination, chronic motivational syndromes, mood swings

  • Viewed as a gateway drug for subsequent substance use

  • Withdrawal symptoms can indicate both psychological and physical dependence.

Conclusion

  • Ongoing education, assessment, and support are crucial in managing addiction and withdrawal symptoms effectively in substance abuse nursing. Understanding the complexities of substance use and its implications assists nurses in providing informed and holistic care.