Substance-Related and Addiction Disorders

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Introduction to Substance-Related and Addiction Disorders

• Learning Objectives:

  • Describe the impact of substance-related and addiction disorders on a client's overall health.

  • Explore the epidemiological and etiological risk factors that contribute to clients experiencing these disorders.

  • Differentiate the clinical presentation of clients experiencing substance-related and addiction disorders.

  • Explore the role of the nurse when caring for clients with these disorders.

  • Apply the nursing process through the use of clinical judgment functions while providing care.

  • Examine personal and professional values regarding healthcare professionals who are chemically impaired.

Overview of Substance-Related and Addiction Disorders

• Key Terms:

  • Addiction: A complex condition, a brain disorder that is manifested by compulsive substance use despite harmful consequences.

  • Substances and Behaviors: Involves various substances (e.g., alcohol, stimulants, opioids) and behaviors that lead to addiction.

  • Overdose: A medical emergency that occurs when an individual takes a toxic amount of a drug.

• Common Affected Areas:

  • Mental health issues in individuals and families.

  • Cognitive, behavioral, and psychological manifestations, as reported by the National Center for Drug Abuse Statistics (2021).

Clinical Onset of Substance Use

• Substance use impacts individuals throughout their lifespan.

  • Adolescents: Highest risk group.

  • Individuals may self-medicate to address mental illness symptoms, including depression and anxiety.

  • Other Factors: Pain and stress management, as reported by the National Institute on Drug Abuse (2020).

Neurobiology of Addiction

• Reward Pathway:

  • Involves the limbic system and the basal ganglia.

  • Dopamine burst associated with pleasure leads to feelings of euphoria.

  • Amygdala: Related to anxiety and irritability; contributes to cravings.

  • Prefrontal Cortex: Manages compulsive behaviors.

Etiology of Addiction

• Risk Factors:

  • Mental illness, stress, genetics, peer pressure, and history of abuse.

• Protective Factors:

  • Positive family support, caregiver involvement, meaningful relationships, employment, and availability of community resources as outlined by the National Institute on Drug Abuse (2020).

Comorbidities Related to Substance Use Disorders

• Common comorbid conditions include:

  • Heart disease, stroke, dental issues, hepatitis, cirrhosis, and mental illnesses (SAMHSA, 2021).

Clinical Presentation of Substance Use

• Alcohol:

  • Symptoms of Use: Mood changes, coordination issues, slurred speech.

  • Concerns Under Influence: Safety risks, accident-prone behavior, risk for DUI, risk for bleeding.

  • Withdrawal Symptoms: Agitation, anxiety, insomnia, hypertension, seizures, delirium tremens (DTs).

• Hallucinogens:

  • Symptoms of Use: Hallucinations, mood swings.

  • Concerns Under Influence: Safety risks, potential for sexual assault, out-of-control behaviors.

  • Withdrawal Symptoms: Depression, increased appetite.

• Opioids:

  • Symptoms of Use: Pain relief, drowsiness, confusion, nausea.

  • Concerns Under Influence: Breathing and heart rate depression, potential for coma or death when mixed with alcohol.

  • Withdrawal Symptoms: Restlessness, muscle pain, cold flashes ('cold turkey').

• Stimulants:

  • Symptoms of Use: Euphoria, increased alertness, energy, heightened blood pressure.

  • Withdrawal Symptoms: Depression, insomnia, vivid dreams.

• Sedatives:

  • Symptoms of Use: Drowsiness, decreased anxiety.

  • Withdrawal Symptoms: Severe abstinence syndrome, including seizures.

Warning Signs of Substance Use

• Observable changes in:

  • Mood

  • Peer groups

  • Weight or sleeping habits

  • Overall health interest

  • Performance at work or school

  • Financial issues (loss of money, missing valuables).

Alcohol Withdrawal

• Onset: Symptoms develop 4-6 hours after the last drink.

  • Common symptoms: Tremors, diaphoresis, nausea, vomiting, irritability, anxiety, and sometimes seizures (APA, 2022).

Role of the Nurse in Substance Use Disorders

• Prevention Strategies:

  • Address risk factors, promote protective factors, and provide substance use education.

• Treatment Strategies:

  • Manage symptoms and manifestations of withdrawal using medications like benzodiazepines or barbiturates, antiepileptics, thiamine, and abstinence programs such as Naltrexone, Acamprosate, and Disulfiram.

• Community-Based Treatment:

  • Involves 12-step programs and motivational enhancement, encouraging peer support groups (APA, 2018).

Client and Family Education

• Assess treatment beliefs and reinforce healthy coping strategies.

• Education on:

  • Nature of addiction as a disease.

  • Distinction between withdrawal and intoxication.

  • Importance of safety in milieu management.

Treatment Settings for Substance Use Disorders

• Various treatment settings include:

  • Outpatient treatment

  • Intensive outpatient

  • Partial hospitalization

  • Inpatient treatment

  • Residential treatment

Impaired Health Care Professionals

• Issues of drug diversion and its implications,

  • Contributing factors: stress, job burnout, and staffing shortages.

  • Professional responsibilities can lead to substance use disorder.

Discipline Protocols

• Upon receipt of a complaint, the state board of nursing may undertake:

  • Investigation, evidence collection, hearings regarding practice violations, and assistance programs addressing substance use issues.

• Risk of losing or having one's nursing license suspended is a potential consequence (NCSBN, 2021).