Unit 8 1125

Unit Overview

  • Instructor: M. Shackelford MSN, RN

Substance Abuse and Addiction

  • Definition: Significant impairment caused by the use of alcohol and/or drugs.

  • Impacts: Leads to health problems and failures in meeting personal responsibilities.

  • Types of substances: Include legal substances, prescribed medications, and illicit drugs.

  • Manifestations: Cognitive, behavioral, and psychological signs of dependency.

Substance Use & Codependency

  • Substance Use Disorder: Pathological use that may cause intoxication and withdrawal symptoms.

  • Codependency: Characterized by over-responsibility for others' behaviors, ignoring personal needs; self-worth tied to caring for others.

Risk Factors for Substance Abuse

  • Mental Illness: Existing mental health issues can increase risk.

  • Stress: High levels of stress contribute to substance use.

  • Genetics: Hereditary factors may predispose individuals to addiction.

  • Peer Pressure: Influence from social circles.

  • Abuse: History of abuse can lead to substance use.

  • Environment: Surrounding factors such as community and socio-economic status.

Comorbidities Associated with Substance Abuse

  • Health Conditions:

  • HIV/AIDS

  • Lung or heart disease

  • Stroke

  • Cancer

  • Mental health issues

  • Hepatitis

  • Cirrhosis

  • Pancreatitis

Warning Signs of Substance Use

  • Mood changes indicating possible substance use.

  • Change in social circles or peer group.

  • Noticeable changes in weight or sleeping patterns.

  • Loss of interest in activities previously enjoyed.

  • Decline in academic/work performance.

  • Financial issues such as loss of money or missing valuables.

Withdrawal Symptoms

  • Definition: Physiological and psychological symptoms occurring after stopping a substance of dependence.

Stimulants

  • Examples: Cocaine, Amphetamines, Methamphetamines.

  • Intoxication Symptoms: Tachycardia, dilated pupils, elevated blood pressure, grandiosity, impaired judgment, hypervigilance, paranoia with delusions.

  • Withdrawal Symptoms: Fatigue, depression, agitation, apathy, nightmares, anxiety, craving, increased appetite.

Opiates

  • Examples: Heroin, Meperidine, Fentanyl, Hydromorphone.

  • Intoxication Symptoms: Constricted pupils, slurred speech, impaired judgment, decreased respirations, euphoria followed by dysphoria.

  • Withdrawal Symptoms: Yawning, insomnia, panic, diaphoresis, rhinorrhea, cramps, nausea/vomiting, chills, fever, diarrhea, irritability, weakness.

Depressants

  • Examples: Benzodiazepines, Barbiturates, Cannabis.

  • Intoxication Symptoms: Slurred speech, unsteady gait, drowsiness, impaired judgment, nystagmus, disorientation.

  • Withdrawal Symptoms: Nausea/vomiting, tachycardia, diaphoresis, tremors, seizures, restlessness, irritability.

Alcohol Use

  • Intoxication Symptoms: Slurred speech, nystagmus, impaired memory, altered judgment, decreased motor skills, respiratory arrest.

  • Chronic Health Issues: Cardiovascular damage, liver damage, gastrointestinal issues, pancreatitis, and sexual dysfunction.

  • Withdrawal Symptoms: Cramping, vomiting, tremors, anxiety, increased heart rate, seizures.

  • DTs (delirium tremens)

Blood Alcohol Content (BAC)

  • Legal Limit: 0.08% considered legally intoxicated.

  • Dangerous Level: BAC of 0.4% or greater can be lethal.

  • Factors Affecting BAC: Body weight, gender, alcohol concentration, number of drinks, gastric absorption rate, individual tolerance.

Nursing Interventions

  • Ensure client safety.

  • Assessments: Monitor vital signs, hydration status, and self-worth.

  • Conduct toxicology tests/BAC checks.

  • Evaluate for signs of overdose or withdrawal.

  • Monitor for suicidal thoughts/behaviors.

  • Assess family dynamics for potential codependency.

  • Explore recovery program interests.

  • Provide emotional support.

Impairment in Health Care Professionals

  • Issues such as drug diversion and job stress can lead to substance misuse.

  • Considerations include staff shortages and inadequate nurse-client ratios affecting care quality.

Screening Tools

  • Common Tools:

  • MAST- Michigan abstinence screening tes

  • DAST or DAST-A- drug abuse screening test (dast-A for adolescents)

  • CAGE- asks questions to determine how client percieves their current alcohol use

  • AUDIT- Alcohol use disorder identification test

  • CIWA-Ar- Clinical Institute Withdrawal Assessment for Alcohol-Revised, a tool used to assess and manage alcohol withdrawal symptoms.

  • SBIRT- Screening, Brief Intervention, and Referral to Treatment, a comprehensive, integrated approach to delivering early intervention and treatment services for individuals with substance use disorders.

  • COWS- clinical opiate withdrawl scale

Therapies

  • Cognitive Behavioral Therapy (CBT): Focuses on changing negative thought patterns.

  • Acceptance and Commitment Therapy (ACT): Emphasizes psychological flexibility.

  • Relapse Prevention Therapy: Addresses potential triggers and coping strategies.

  • Group and Family Therapy: Enhances social support and recovery.

Client Education

  • Recognize early signs of relapse.

  • Identify triggers for relapse.

  • Encourage pleasurable activities.

  • Foster communication of personal needs.

  • Promote attendance at 12-step programs.

Pharmacology Overview

  • Alcohol Withdrawal Medications:

  • Benzos such as Chlordiazepoxide, Diazepam, Lorazepam, and Oxazepam for symptom management:

    • Vital sign maintenance.

    • Decrease seizure risk.

    • Manage withdrawal intensity.

    • Implement nursing actions: Administer as directed, monitor vitals, ensure safety precautions.

Alcohol Withdrawal Adjuncts

  • Medications:

  • Carbamazepine, Clonidine, Propranolol, Atenolol.

  • Effects include seizure risk reduction and stabilization of BP and HR.

  • Nursing Actions: Monitor vital signs, hold Propranolol if HR <60 bpm.

Alcohol Abstinence Maintenance

  • Disulfiram: Causes aversion when taken with alcohol (risk of Acetaldehyde syndrome). ( NOTHING WITH ALCOHOL)

  • Naltrexone: Suppresses cravings for alcohol and opioids.

  • Acamprosate: Reduces abstinence symptoms but should be avoided in pregnancy.

Opioid Withdrawal and Maintenance

  • Clonidine: Manages autonomic hyperactivity but does not reduce cravings.

  • Methadone: Long-term substitution therapy; rigorous administration control required.

  • Buprenorphine: Opioid agonist-antagonist for withdrawal and cravings; can be prescribed by PCPs.

Evaluation of Medication Effectiveness

  • Monitor for: SAFTY SAFTY SAFTY

  • Absence of injury.

  • Ongoing abstinence rates.

  • Reduction in cravings.

  • Improved coping skills.

  • Attendance in recovery programs.