Substance-Related & Addiction Disorders

Impact & Epidemiology

  • Substance-related and addiction disorders affect physical, mental, family, and community health.
  • Highest onset risk: adolescents (self-medication for mental illness, pain, stress).
  • Reward pathway: limbic system → dopamine burst → basal ganglia (euphoria), amygdala (craving, anxiety), prefrontal cortex (compulsion).

Etiology

  • Risk factors: mental illness, stress, genetics, peer pressure, abuse.
  • Protective factors: positive family/caregiver support, healthy relationships, employment, community resources.

Common Comorbidities

  • Heart disease, stroke, dental issues, hepatitis, cirrhosis, co-occurring mental illness.

Clinical Presentation by Substance

  • Alcohol
    • Use: mood/behavior change, poor coordination, slurred speech.
    • Withdrawal (starts 4\text{–}6 h): tremors, diaphoresis, ↑BP/HR, N/V, anxiety, seizures; delirium tremens is fatal risk.
  • Hallucinogens
    • Use: hallucinations.
    • Concerns: safety, sexual assault, erratic behavior.
    • Withdrawal: headaches, ↑appetite, sleepiness, depression.
  • Opioids
    • Use: analgesia, euphoria, slowed breathing.
    • Risk: additive respiratory depression with alcohol → coma/death.
    • Withdrawal: restlessness, muscle/bone pain, insomnia, diarrhea, “cold turkey,” leg kicks.
  • Stimulants
    • Use: euphoria, ↑alertness, ↑BP/HR, hyperglycemia.
    • Risk with alcohol: ↑cardiac toxicity.
    • Withdrawal: depression, fatigue, ↑appetite, insomnia, vivid dreams, slowed thinking.
  • Sedatives (benzodiazepines, barbiturates, certain club drugs)
    • Use: anxiolysis, drowsiness, slurred speech, hypotension, respiratory depression.
    • Some agents used as date-rape drugs.
    • Withdrawal: potentially severe abstinence syndrome, seizures.

General Warning Signs

  • Mood swings, new peer group, weight/sleep changes, poor self-care, work/school decline, financial issues.

Nursing Role – Prevention

  • Address modifiable risk factors, strengthen protective factors, provide substance-use education, promote early treatment.

Nursing Role – Treatment

  • Manage intoxication/withdrawal:
    • Alcohol withdrawal: benzodiazepines/barbiturates, antiepileptics, thiamine.
  • Promote abstinence:
    • Naltrexone, acamprosate, disulfiram.
  • Support programs: 12-step, motivational enhancement, peer groups.

Client & Family Education

  • Addiction as a chronic disease, risk factors, difference between intoxication vs. withdrawal, coping skills, safety/milieu measures.

Treatment Settings

  • Outpatient, intensive outpatient, partial hospitalization, inpatient, residential.

Impaired Health-Care Professionals

  • Contributing factors: drug diversion, stress/burnout, staffing shortages, overtime, high physical demands.
  • Discipline process: report → written response → investigation → hearing → possible nurse assistance program or license action.