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NURS 406 > Addiction ppt > Flashcards

Addiction ppt Flashcards

Exam 4 (FINAL)

1
Q

Substance abuse is what kind of abuse?

A

A National health problem

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2
Q

What are the detrimental effects of substance abuse?

A

Alcohol-related death is the third leading preventable cause of death in United States.

Absenteeism at work

Prenatal exposure

Increased violence

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3
Q

What is the third leading preventing cause of death in the US?

A

Alcohol-related death is the third leading preventable cause of death in United States.

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4
Q

Addiction

A

continued use of substances (or reward-seeking behaviors) despite adverse consequences

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5
Q

Use:

A

ingestion, smoking, sniffing, or injection of mind-altering substance

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6
Q

Abuse

A

use for purposes of intoxication or beyond intended use

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7
Q

Withdrawal:

A

symptoms occurring when substance no longer used

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8
Q

Detoxification:

A

process for safe withdrawal

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9
Q

Relapse:

A

recurrence

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10
Q

Onset and Clinical Course: What is the average age for first episode of intoxication?

A

Average age for first episode of intoxication is adolescence.

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11
Q

When do episodes of “sipping” occur?

A

Episodes of “sipping” as early as 8 years old

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12
Q

Pattern of difficulties with alcohol become more severe when?

A

Pattern of more severe difficulties emerges in mid-20s to mid-30s.

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13
Q

For many people substance use is considered what? Why?

A

What? A chronic illness

Why? Remissions and relapses

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14
Q

Relapse rates for substance use (ETOH) are:

A

Relapse rates 60% to 90%

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15
Q

What will give someone the highest rates of a successful recovery? (ETOH or any drug)

A

Abstinence

High level of motivation

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16
Q

Poor outcomes of recovery are associated with:

A

Poor outcomes associated with earlier age at onset

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17
Q

Substance abusers have a low tolerance of…

A

Substance abusers have a low tolerance for frustration.

(no coping skills)

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18
Q

What do substance users get out of drugs?

A

Need immediate gratification to escape anxiety.

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19
Q

Etiology of Addiction

A

Biological factors

Psychological factors

Social and environmental factors

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20
Q

Biological factors having to do with addiction

A

Biologic factors
- Genetic vulnerability (no precise genetic marker identified)

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21
Q

Psychological factors having to do with addiction

A

Psychological factors
-Family dynamics
-Coping styles

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22
Q

Social and environmental factors having to do with addiction

A

Social and environmental factors
Cultural factors, social attitudes, peer behaviors

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23
Q

Alcohol intoxication leads to:

A

CNS depressant: relaxation/loss of inhibitions

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24
Q

What are the symptoms of Alcohol intoxication

A

Slurred speech, unsteady gait, lack of coordination, and impaired attention, memory, judgmentW

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25
Q

What kind of behavior is associated with Alcohol intoxication

A

Aggressive behavior or display of inappropriate sexual behavior; blackout

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26
Q

What is included in alcohol overdose?

A

vomiting, unconsciousness, respiratory depression

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27
Q

What is included in alcohol overdose treatment?

A

Treatment: gastric lavage or dialysis to remove the drug and support of respiratory and cardiovascular functioning in an intensive care unit

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28
Q

When is alcohol withdrawal onset occur/

A

Onset within 4 to 12 hours after cessation or marked reduction of alcohol intake;

usually peaks on the second day and complete in about 5 days

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29
Q

When does alcohol withdrawal peak?

A

Onset within 4 to 12 hours after cessation or marked reduction of alcohol intake; usually peaks on the second day and complete in about 5 days

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30
Q

Why is withdrawal considered dangerous?

A

Withdrawal can be life-threatening.

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31
Q

What are the three stages of Alcohol withdrawal?

A

Stage I: Mild

Stage II: Moderate

Stage III: Severe

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32
Q

What are the vital signs of someone with MILD withdrawal?

A

Heart rate, temp. elevated,

normal or slightly elevated systolic BP

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33
Q

What are the vital signs of someone with MODERATE withdrawal?

A

Heart rate 100-120, elevated systolic and temp.

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34
Q

What are the vital signs of someone with SEVERE withdrawal?

A

Heart rate 120-140, elevated systolic & diastolic pressure

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35
Q

What is the level of diaphoresis of someone MILD withdrawal?

A

Slight

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36
Q

What is the level of diaphoresis of someone MODERATE withdrawal?

A

Obvious

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37
Q

What is the level of diaphoresis of someone SEVERE withdrawal?

A

Marked

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38
Q

How is the Central Nervous System of someone with MILD withdrawal?

A

Orientated, no confusion, no hallucinations, mild anxiety, restless sleep, hand tremors* shakes, No convulsions

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39
Q

How is the Central Nervous System of someone with MODERATE withdrawal?

A

Intermittent confusion, transient visual and auditory hallucinations & illusions, anxiety, motor restlessness, insomnia, nightmares, tremors, rare convulsions

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40
Q

How is the Central Nervous System of someone with SEVERE withdrawal?

A

Marked disorientation, confusion, A & V hallucinations, delusions, delirium tremens*, disturbance in consciousness, agitation, panic, unable to sleep, gross tremors, convulsions

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41
Q

How is the GI of someone with MILD withdrawal?

A

Impaired appetite, nausea

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42
Q

How is the GI of someone with MODERATE withdrawal?

A

Anorexia, N & V

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43
Q

How is the GI of someone with SEVERE withdrawal?

A

Rejecting all food & fluid

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44
Q

Delirium Tremors is considered:

A

Medical emergency*

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45
Q

What is the mortality rate of someone with delirium tremors?

A

Mortality rate 20%

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46
Q

What percent of delirium tremors occur in dependent alcoholics?

A

Occurs in 5% dependent alcoholics

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47
Q

When do delirium tremors occur?

A

Occurs usually within 48-72 hours after last drink

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48
Q

Symptoms of delirium tremors

A

Symptoms; tremors, fever, tachycardia, hypertension, agitation (also have stupor), & hallucinations (often tactile and/or visual), confusion, disorientation

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49
Q

Alcohol dose- BAC

A

Blood Alcohol Content (body wt., gender; women 25% higher r/t gastric metabolism)

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50
Q

How is BAC expressed?

A

Expressed as percentage of alcohol in the blood

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51
Q

What is legal limit of ETOH?

A

Legal limit usually 0.08%;

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52
Q

BAL decreases by what an hour?

A

BAL decreases by 0.02g/dL/hr

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53
Q

How does absorption of alcohol occur?

A

Food in the stomach slows absorption of alcohol, especially high fat food

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54
Q

What disorder is often associated with alcohol use?

A

Wernicke’s Encephalopathy

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55
Q

Symptoms of Wernicke’s Encephalopathy

A

Symptoms: nystagmus(repetitive eye movements) /diplopia (double vision), gait ataxia & confusion

Encephalopathy

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56
Q

Encephalopathy

A

Encephalopathy: Elevated spinal fluid protein levels

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57
Q

What may prevent Wernicke’s Encephalopathy

A

May be prevented with thiamine (vitamin B1) & folic acid*

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58
Q

If not treated immediately, Wernicke’s Encephalopathy can lead to?

A

If not treated immediately can lead to Korsakoff’s psychosis

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59
Q

Korsakoff’s psychosis tell tale sign/

A

The telltale sign is the loss of short-term memory*

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60
Q

What are other signs of Korsakoff’s psychosis?

A

The urge to make up stories without knowing it to fill in any gaps

A hard time putting words into context

Trouble understanding or processing information

Hallucinations

Coma & death is rare

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61
Q

Chronic effects of Alcohol use/abuse?

A

Long-term heavy drinking is detrimental to almost every organ system of the body, specifically the brain and the liver

Fetal alcohol syndrome

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62
Q

What organs specifically does alcohol have detrimental effects for

A

specifically the brain and the liver

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63
Q

Fetal Alcohol Syndrome occurs in response to what?

A

Can occur as a result of excessive alcohol consumption by a woman during pregnancy

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64
Q

What does fetal alcohol syndrome lead to?

A

Subsequently, leading to slowed growth; cranial, facial, or neural abnormalities; and developmental disabilities

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65
Q

What is used the most widely used screening test for alcohol abuse and dependence?

A

Cage Questionnaire

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66
Q

Cage Questionnaire- what are the questions?

A
  1. Have you ever felt you should Cut down on your drinking?
  2. Do people Annoy you by criticizing your drinking?
  3. Do you feel Guilty about your drinking?
  4. Do you have an Eye opener first thing on the morning to steady your nerves?
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67
Q

What is another test (other than CAGE) to assess alcohol use?

A

The Alcohol Use Disorders Identification Test (AUDIT-C)

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68
Q

The Alcohol Use Disorders Identification Test (AUDIT-C)

A

is an alcohol screen that can help identify patients who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence).

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69
Q

Questions in the Audit-C test?

A

Q1: How often did you have a drink containing alcohol in the past year?

Q2: How many drinks did you have on a typical day when you were drinking in the past year?

Q3: How often did you have six or more drinks on one occasion in the past year?

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70
Q

How is the AUDIT-C scored?

A

The AUDIT-C is scored on a scale of 0-12 (scores of 0 reflect no alcohol use).

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71
Q

In men, how is AUDIT-C scored?

A

In men, a score of 4 or more is considered positive;

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72
Q

In women, how is AUDIT-C scored?

A

in women, a score of 3 or more is considered positive.

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73
Q

The higher the AUDIT-C score, what does that mean?

A

Generally, the higher the AUDIT-C score, the more likely it is that the patient’s drinking is affecting his/her health and safety.

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74
Q

The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR)

A

is an instrument used by medical professionalsto assess and diagnose the severity of alcohol withdrawal.

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75
Q

What is the most sensitive tool for assessment of the patient experiencing alcohol withdrawal.

A

The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR)

76
Q

How do the score for the The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR) range?

A

Scores range from 0-67

77
Q

What does it mean if a pt scores less than 10 of The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR)?

A

Patients scoring less than 10 do not usually need additional medication for withdrawal

78
Q

The (CIWA-AR) can measure how many alcohol withdrawal symptoms?

A

The CIWA-AR can measure 10 alcohol withdrawal symptoms

79
Q

TheCIWA-AR can measure 10 alcohol withdrawal symptoms including:

A

Nausea & Vomiting
Tremor
Sweats
Anxiety
Agitation
Tactile disturbances
Auditory disturbances
Visual disturbances
Headache, fullness in head
Orientation

80
Q

What is the cornerstone treatment of alcohol abuse?

A

Cornerstone of treatment: Benzodiazepines

81
Q

Where are the setting of alcohol detoxification where Benzodiazepines are given?

A

Settings: outpatient, inpatient detox, hospital medical unit

82
Q

What route it benzodiazepines are given?

A

PO, IM, IV, depending on setting & severity

83
Q

How does tapering of benzodiazepines effect patient?

A

Clinical pearl: The slower the medication is tapered, the more comfortable the patient.

84
Q

Administer one of the following medications every hour based on the CIWA-AR score. / How often should the CIWA-AR test be repeated?

A

Chlordiazepoxide (Librium) 50-100mg*

Diazepam (Valium) 10-20mg

Oxazepam (Serax) 30-60mg

Lorazepam (Ativan) 2-4mg

Repeat the CIWA-AR after every dose to assess the need for further medication

85
Q

What medication is used to treat chronic alcoholism

A

Disulfiram (Antabuse) is used totreat chronic alcoholism.

86
Q

What does Disulfiram medication cause when taken to treat chronic alcoholism?

A

It causes unpleasant effects* when even small amounts of alcohol are consumed.

87
Q

How does disulfiram work?

A

Inhibits aldehyde dehydrogenase and prevents metabolism of acetaldehyde, alcohol’s main metabolite

88
Q

How does disulfiram work in the body?

A

Inhibits aldehyde dehydrogenase and prevents metabolism of acetaldehyde, alcohol’s main metabolite

89
Q

How long does disulfiram stay in the body?

A

Can stay in body up to 14 days after last dose*

90
Q

What should you be cautious of when taking disulfiram?

A

Caution in use with cologne or aftershave with alcohol, and foods with “Hidden alcohol” *

91
Q

Disulfiram three phases?

A
  1. Mild
  2. Moderate
  3. Severe
92
Q

Disulfiram- mild

A

Mild- facial flushing, sweating, headache

93
Q

Disulfiram- moderate

A

Moderate- nausea, tachycardia, palpitations, hyperventilation, hypotension, dyspnea

94
Q

Disulfiram- severe

A

Severe- vomiting, respiratory depression, CV collapse, arrhythmias, MI, CHF, coma, death

95
Q

When do symptoms of disulfiram occur? How do patients feel?

A

Symptoms start within 5 to 15 minutes and last 30 minutes to several hours.

Clients feel as if they are having a heart attack and are dying.

96
Q

Naltrexone

A

Naltrexoneblocks the euphoric of alcohol & opioidssuch as heroin, morphine, and codeine.

97
Q

How specifically does naltrexone work in the body?

A

Naltrexone binds and blocks opioid receptors, and reduces and suppresses opioid cravings.

98
Q

What is a benefit of naltrexone?

A

There is no abuse and diversion potential with naltrexone

99
Q

Who is naltrexone NOT to be given to?

A

Not to be given to people taking opioids*

100
Q

What does naltrexone reduce?

A

Can Reduce (Water Scenario)

Number of days spent drinking

Amount of alcohol consumed on drinking days

Excessive and destructive drinking

101
Q

Most common side effects of Naltrexone?

A

Most Common Side Effects :

Nausea, decreased appetite
Headache, fatigue

102
Q

Rare/Serious side effects of naltrexone?

A

Rare/Serious: Hepatotoxicity/monitor LFTs * Contraindicated in acute hepatitis or liver failure

103
Q

Who is naltrexone contraindicated in?

A
  • Contraindicated in acute hepatitis or liver failure
104
Q

When can patients start naltrexone?

A
  • Patient should be opioid free for 7-10 days prior to initiating treatment, as confirmed by a negative urine screen.
105
Q

Acamprosate

A

Maintains abstinence from alcohol in patients who are abstinent at treatment initiation

106
Q

How is Acamprosate similar to naltrexone?

A

Similar to naltrexone, reduces drinking by reducing craving

107
Q

Dosing of Naltrexone?

A

666 mg (two 333 mg tablets) TID (with food)
Do not cut or crush (EC)
Initiate after 7 days abstinence

108
Q

Acamprosate most common side effects

A

Most Common: Nausea & headache

109
Q

Who is Acamprosate preferred for?

A

Preferred for those with significant liver impairment*

110
Q

Who is Acamprosate contraindicated in?

A

Renal excretion: Contraindicated in renal failure

111
Q

What are the 2 other groups of meds used for abuse?

A
  1. Anxiolytic/ Benzodiazepines
  2. Hypnotics/Sleep Medications
112
Q

Anxiolytic/ Benzodiazepines include:

A

Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan), Clonazepam (Klonopin)

113
Q

Hypnotics/Sleep Medications include:

A

Eszopiclone (Lunesta), Zaleplon (Sonata), Zolpidem (Ambien)

114
Q

Hypnotics and Anxiolytiscs: What do they do to cause intoxication and overdose?

A

CNS depressants

115
Q

Intoxication symptoms of Hypnotics and Anxiolytics:

A

Intoxication symptoms: slurred speech, lack of coordination, unsteady gait, labile mood, stupor

116
Q

Onset of withdrawal symptoms for Hypnotics and Anxiolytics depend on what?

A

Onset of withdrawal dependent on half-life of drug

117
Q

How to detox from hypnotics and anxiolytics

A

Detoxification via drug tapering*

118
Q

Flumazenil

A

Flumazenil prescribed to reverse the sedative effects of benzodiazepines after sedation is produced for procedures or overdose*

119
Q

Stimulants include:

A

(Amphetamines, Cocaine)

120
Q

Stimulants are what kind of stimulants?

A

CNS stimulants

121
Q

Intoxification and overdose of stimulants lead to what symptoms:

A

High or euphoric feeling, hyperactivity, hypervigilance, anger; elevated blood pressure, chest pain, confusion

Seizures, coma with overdose

122
Q

How long does it take for onset of stimulant withdrawal to occur?

A

Onset within hours to several days

123
Q

Primary symptom of stimulant withdrawal

A

Primary symptom is marked dysphoria (unease).

124
Q

Other symptoms of withdrawal for stimulants

A

“Crashing” sleeping 12 to 18 hours

Not treated pharmacologically* Supportive in nature

125
Q

Cannabis (Marijuana)

A

Used for psychoactive effects and has medical applications

126
Q

Intoxication of Cannabis leads to:

A

Lowered inhibitions, relaxation, euphoria, increased appetite

127
Q

Symptoms of intoxication of cannabis include:

A

Symptoms of intoxication include impaired motor control*, impaired judgment

Delirium

128
Q

Delirium in cannabis

A

Delirium*, cannabis-induced psychotic disorder

129
Q

What is a big danger with marijuana?

A

Marijuana laced with fentanyl

130
Q

What are the withdrawal symptoms of cannabis

A

No clinically significant withdrawal syndrome

Possible symptoms of insomnia, muscle aches, sweating, anxiety, tremors

131
Q

Examples of opoids

A

Opium
Heroin
Fentanyl
Morphine
Codeine

132
Q

Classic triad of opioid overdose?

A
  1. Decreased respirations: <12/minute, shallow respirations
  2. Decreased level of consciousness…eventually coma
  3. Pinpoint pupils: Miosis
133
Q

Miosis

A

(excessive constriction of the pupil)

134
Q

What is the first line of treatment for opioid overdose?

A

First line treatment for overdose Naloxone (Narcan)*

135
Q

Symptoms of withdrawal of opioids:

A

Nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia

136
Q

Symptoms of opioids do not require…

A

Symptoms cause significant distress, but do not require pharmacologic intervention to support life or bodily functions

137
Q

What is the onset of short acting drugs? What is the peaking? When does it subside?

A

Short-acting drugs (e.g., heroin): onset in 6 to 24 hours;

peaking in 2 to 3 days and

gradually subsiding in 5 to 7 days

138
Q

Example of short acting drugs

139
Q

What is used to treat opioid disorder?

A

Methadone is used to treat opioid use disorder

140
Q

Where is methadone administered?

A

Only in licensed NTPs (narcotic treatment program) or while on a detox unit

141
Q

What does methadone do?

A

It blocks the high from drugs

142
Q

Risks of methadone?

A

Risks: physical dependence, abuse, diversion, overdose

143
Q

When can methadone use be safe and effective?

A

When taken as prescribed, safe & effective

144
Q

How is the overdose of methadone viewed?

A

Overdose can be fatal

145
Q

Methadone Adverse Effects

A

Dizziness
Sedation or paradoxic excitement
Nausea
Respiratory depression
Constipation
Miosis (pupils constrict)
Hypotension

146
Q

Nursing Considerations of Methadone

A

Administer in smallest effective dose.

Observe for development of dependence.

Monitor:
Respiratory status.
Vital signs.
Intake and output.

Encourage fluids and high-bulk foods.

147
Q

What should you monitoring for as a nursing consideration for pts using methadone?

A

Monitor:
Respiratory status.
Vital signs.
Intake and output.

148
Q

Monoproduct buprenorphine; Suboxone is a combination of what?

A

BUP +naloxone (diversion prevention as naloxone is not absorbed)

149
Q

How is Buprenorphine/ Suboxone similar to methadone?

A

Equal to methadone in:
Alleviating withdrawal, treatment retention & completion

150
Q

Risks of Buprenorphine/ Suboxone:

A

Risks (reduced): overdose; abuse; toxicity; diversion

151
Q

What other drug can be combined with Methadone or Buprenorphine?

A

Clonidine – Add On

152
Q

Why does Clonidine have to be combined with Methadone and Buprenorphine?

A

Combine with Methadone or Buprenorphine because not as effective stand alone treatment*

153
Q

Advantages of Clonidine add on:

A

Advantages: non-controlled, minimal diversion risk, provider comfort level

154
Q

Notable effects of Clonidine add on:

A

Notable side effects: dry mouth, dizziness, constipation, sedation

155
Q

Clonidine add on Amount given for opioid withdrawal

A

Opioid withdrawal: 0.1mg - 3 times daily (can be higher in a inpatient setting)

156
Q

Most commonly abused hallucinogens:

A

Most commonly abused:Mushrooms, LSD and MDMA (ecstasy)

157
Q

Symptoms of hallucinogens:

A

Reality distortion; symptoms similar to psychosis including hallucinations (usually visual), depersonalization

158
Q

Physical symptoms caused by hallucinogens:

A

Cause increased pulse, blood pressure, and temperature; dilated pupils; and hyperreflexia

159
Q

Hallucinogens overdose? A confusing slide….

A

No overdose; toxic reactions are primarily psychological (anxiety), paranoia, fear, depression

160
Q

What are the withdrawal symptoms of hallucinogens?

A

No withdrawal syndrome

Some report a craving for the drug

Flashbacks possible for few months up to 5 years

161
Q

Inhalants

A

Found in common household products that produce chemical vapors

162
Q

Acute toxicity of inhalants?

A

Acute toxicity
Anoxia (decreased oxygen), respiratory depression, dysrhythmias

Death possible from bronchospasm, cardiac arrest, suffocation, or aspiration

163
Q

Withdrawal or detoxification of inhalants?

A

No withdrawal or detoxification
Frequent users report cravings

164
Q

What is the treatment for inhalant use?

A

Symptomatic treatment

165
Q

Substance Abuse Treatment: Treatment models

A
  1. 12-step program of Alcoholics Anonymous
  2. Harm Reduction Strategies Goal is to reduce the potential harm associated with behavior
  3. Screening, brief intervention, and referral to treatment (SBIRT)
166
Q

12-step program of Alcoholics Anonymous

A

(peer led with aim toward sobriety)

167
Q

Harm Reduction Strategies

A

Goal is to reduce the potential harm associated with behavior

168
Q

History of someone with substance abuse?

A

chaotic family life, family history, crisis that precipitated treatment

General appearance and motor behavior

169
Q

Mood and affect of someone with substance abuse disorder

A

Mood and affect: tearful; expressing guilt, remorse; angry; sullen; quiet; unwilling to talk

170
Q

Thought process and content of someone with substance abuse disorder:

A

Thought process and content: minimize substance use; blaming others; rationalization

171
Q

Sensorium and intellectual processes: of someone with substance abuse disorder

172
Q

Judgment and insight of someone with substance abuse disorder

A

poor judgment; impulsivity; may still believe he or she can control substance use

173
Q

Self-concept: of someone with substance abuse disorder

A

low self-esteem; problems identifying and expressing feelings

174
Q

Roles and relationships: of someone with substance abuse disorder

A

Roles and relationships: often strained

175
Q

Physiological considerations of someone with substance abuse disorder

A

Physiological considerations: poor nutrition; sleep disturbances; liver damage; HIV infection; lung damage

176
Q

Outcome identification of substance abuse?

A

Outcome identification

Abstain from alcohol and drug use

Express feelings openly and directly

Accept responsibility for own behavior

Practice nonchemical coping alternatives

Establish an effective aftercare plan

177
Q

A client who abuses substances will commonly state that he or she can control his or her use of the substance. True or False

178
Q

Substance Abuse and Nursing Process Application: Interventions

A

Health teaching for client, family
Addressing family issues (codependence, shifting roles)
Promoting coping skills

179
Q

Elder Considerations of substance abuse: What percent of elders in treatment began drinking abusively after age 60?

A

Approximately 30% to 60% of elders in treatment began drinking abusively after age 60.

180
Q

Risk factors for late onset substance abuse include:

A

Risk factors for late-onset substance include chronic illness that causes pain, long-term use of prescription medication, life stress, loss, social isolation, grief, depression, and an abundance of discretionary time and money.

181
Q

How do physical problems develop with substance use?

A

Physical problems associated with substance abuse develop rather quickly.

182
Q

Substance Abuse in Health Professionals: What is the role of other providers noticing this?

A

Ethical and legal responsibility to report suspicious behavior to supervisor

183
Q

General warning signs of substance abuse in health professionals

A

Poor work performance/frequent absenteeism

Unusual behavior/slurred speech

Isolation from peers

May be involved in discrepancies in narcotics counts

Increased client reports
of unrelieved pain or poor sleep

Frequent trips to bathroom.

Offers to medicate co-worker’s clients.

184
Q

States treatment of substance abusers who are health professionals?

A

Most states have a non-disciplinary alternative-to-discipline program that can monitor and treat the nurse, assess for abstinence and help with returning to work.

185
Q

Self-Awareness Issues of substance abuse?

A

Examine own beliefs about alcohol and drugs.

History of substance use

Recognize that substance abuse is chronic illness with relapses and remissions.

Remain open and objective.

NURS 406 (29 decks)

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