Addiction: Substance Use and Addictive Disorders Flashcards
Opioid Crisis
130 deaths occur daily in the U.S. from an opioid overdose
5 Point Program to Assess Crisis
- Assess
- Data
- Pain
- Overdose
- Research
5 Point Program: Assess
better prevention, treatment, and recovery plan
5 Point Program: Data
better data on the epidemic
5 Point Program: Pain
better pain management
5 Point Program: Overdoses
better targeting of overdose
-reversing drugs
5 Point Program: Research
better research on pain and addiction
Polysubstance Abuse
abuse of more than one substance
Types of Substances Abused: Categories
- alcohol
- sedatives, hypnotics, and anxiolytics
- stimulants
- cannabis
- opioids
- hallucinogens
- inhalants
Designer Dugs
synthetic substances made by altering existing meds or formulating new ones not yet controlled by the FDA
-amphetamine-like effects, some also have hallucinogenic effects called club drugs
Club Drugs
designer drugs that have a hallucinogenic effect
Intoxication
use of a substance that results in maladaptive behavior
Withdrawal Syndrome
negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases
Detoxification
process of safely withdrawing from a substance
-removal of toxic substances from the body
Substance Abuse
using a drug in a way that is inconsistent with medical or social norms and despite negative consequences
Blackout
phenomenon caused by alcohol in which long-term memory creation is impaired
- inability to later recall any memories from the intoxicated period, even when prompted
- continues to function but has no conscious awareness of his/her behavior at the time or any later memory of their behavior
- easily recall things that have occurred within the last 2 minutes, yet inability to recall anything prior
Tolerance
need for increased amount of a substance to produce the same effect
Tolerance Break
very small amounts of a substance will produce intoxication; very small amounts intoxicate the person
Spontaneous Remission
natural recovery that occurs without treatment of any kind
-response to a crisis or a promise to a loved one and was accomplished by engaging in alternative activities, relying on relationships with family and friends, avoiding alcohol and alcohol users, and social cues associated with drinking
Delirium Tremens
acute episode of delirium usually caused by withdrawal or abstinence from alcohol following habitual excessive drinking
- only occurs in individuals with a history of constant, long-term alcohol consumption
- the DT’s, “The horrors”, “The shakes” literally, “Shaking delirium”, or “trembling madness”
Codependence
someone who exhibits too much, and often inappropriately, caring for persons who depend on him/her
Sobriety
solemn or dignified personal behavior, in particular moderation or abstinence with regard to (typically) the consumption of alcoholic beverages or illicit drugs
Delirium
an acute and relatively sudden (developing over hours to days) decline in attention-focus, perception, and cognition
-associated with disturbance of consciousness, change in cognition, or the development of a perceptual disturbance, must be one that is not better accounted for by a preexisting, established, or evolving dementia
Delirium Diagnosis
- because it represents a change in cognitive function, the diagnosis cannot be made without knowledge of the persons baseline level of cognitive function
- rapid fluctuating time course of delirium is used to help in the later distinction
- confused with other psychiatric disorders because of the signs and symptoms
- most common symptomatic manifestation of early brain or mental dysfunction
Confabulation
is not lying; making up answers to fill in memory gaps; most commonly seen in dementia but also seen in chronic alcoholics
-symptoms of Wernicke Korsakoff syndrome
Agonist
chemical that binds to a receptor of a cell and triggers a response by that cell
- often mimic the action of a naturally occurring substance
- causes action
Antagonist
blocks the action of the agonist and causes an action opposite to that of the agonist
Wernicke-Korsakoff Syndrome
brain disorder due to Thiamine (Vitamin B1) deficiency
Dual Diagnosis
co-occurring disorders
-co-morbidity, co-curring illness, concurrent disorders, comorbid disorders, co-curring disorder, dual disorder
Wernicke Encephalopathy
confusion and loss of mental activity that can progress to coma and death
- loss of muscle coordination (ataxia) that can cause leg tremor
- vision changes such as abnormal eye movements (back and forth movements called nystagmus)
- double vision
- eyelid drooping
Ataxia
loss of muscle coordination
-symptom of Wernicke encephalopathy that can cause leg tremor
Nystagmus
abnormal eye movement; back and forth movements
-symptom of Wernicke Encephalopathy
Symptoms of Wernicke Korsakoff Syndrome
Deficiency in Thiamine (Vitamin B1)
- inability to form new memories
- loss of memory; can be severe
- making up stories (confabulation)
- seeing or hearing things that are not really there (hallucinations)
Addiction: Substance Use and Addictive Disorders Background Information
- maladaptive pattern of substance use
- remissions and exacerbations
- substance used poses a hazard to health
- known as addiction
- tolerance to a substance is examined
- withdrawal when the substance is eliminated or significantly reduced is common
- an altered physical or mental state due to use of the substance
Classes of Psychoactive Substances
- alcohol
- caffeine
- cannabis
- hallucinogens
- inhalants
- opioids
- sedatives/ hypnotics
- stimulants
- tobacco
Etiology
Theoretical causes
- biologic
- neurochemical
- psychologic
- social and environment
Risk Factors
- unemployment
- poor social coping skills
- history of emotional, physical, or sexual abuse
- chaotic home environment
- history of mental illness
- untreated physical pain
- family history of addiction
- peer pressure
- recent incarceration
Diagnostic Work-Up
- diagnosis of substance abuse/ dependency is made by detailed subjective history (patient says)
- blood or urine screening for substance (s) and assessment skills
Initial Assessment
- medical history and examination
- psychiatric history and examination
- family and social history
- detailed history of past and present substance use, tolerance, and withdrawal
- how did substance affect patient mentally and physically?
- how does the substance use affecting patients occupational, family or social life?
- reliable and valid screening tools; CIWA, Clinical Institute Withdrawal Assessment for Alcohol
Clinical Presentation
will vary depending on substance being used
- sudden weight loss/ gain
- excessive sleep or inability to sleep
- periods of excessive energy
- chronic nosebleeds
- chronic cough or bronchitis
- pancreatitis
- ascites
- increased periods of agitation, irritability, or anger
- slurred speech
- impaired concentration
- stupor or coma
- pupil changes
- temporary psychosis
Types of Substances: Alcohol
central nervous system depressant that is absorbed rapidly into the bloodstream
-Effects: relaxation and loss of inhibition
Alcohol: Intoxication
slurred speech, unsteady gait, lack of coordination, and impaired attention, concentration, memory, and judgment
- some become aggressive or display inappropriately sexual behavior
- may experience black out
Alcohol: Overdose
vomiting, unconsciousness, respiratory depression; this combination can cause aspiration pneumonia or pulmonary obstruction
-alcohol induced hypotension can lead to cardiovascular shock and death
Alcohol: Treatment of Overdose
gastric lavage or dialysis to remove the drug, and support respiratory and cardiovascular functioning in an intensive care unit
Alcohol: Withdrawal
- symptoms begin 4 to 12 hours after cessation
- course hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting
- severe or untreated withdrawal can progress to transient hallucinations, seizures, or delirium tremens
- if symptoms are mild; can be treated at home
- withdrawal peaks on to the second day and is over in about 5 days. Can vary; may take 1-2 weeks
Alcohol: Detoxification
needs to be accomplished under medical supervision
- safe withdrawal is accomplished by administration of benzodiazepines; Lorazepam (Ativan), Chlordiazepoxide (Librium), and Diazepam (Valium) to suppress withdrawal symptoms
- withdrawal can be accomplished by fixed-scheduling dosing, known as tapering, or symptom-triggered dosing
Types of Substances: Sedatives, Hypnotics, and Anxiolytics
includes all CNS depressants; barbiturates, nonbarbiturate hypnotics, hypnotics, and anxiolytics (benzodiazepines)
- benzodiazepines and barbiturates most frequently abused
- intended purpose of these drugs is to cause drowsiness and reduce anxiety
Sedatives, Hypnotics, and Anxiolytics: Intoxication Symptoms
slurred speech, lack of coordination, unsteady gait, labile mood, impaired attention or memory, even stupor or coma
-benzodiazepines alone in overdose, are rarely fatal, but person is lethargic and confused
Sedatives, Hypnotics, and Anxiolytics: Treatment for Intoxication
gastric lavage followed by ingestion of activated charcoal and a saline cathartic; dialysis can be used if symptoms are severe
-confusion and lethargy improve as drug is excreted
Sedatives, Hypnotics, and Anxiolytics: Overdose
- benzodiazepines are rarely fatal, but person is lethargic and confused
- barbiturates can be lethal
- cause: coma, respiratory distress, cardiac failure and death
Sedatives, Hypnotics, and Anxiolytics: Overdose Treatment
lavage or dialysis to remove drug from system and to support respiratory and cardiac function in ICU
Sedatives, Hypnotics, and Anxiolytics: Withdrawal
- onset depends on half-life of the drug
- longer acting medicines like diazepam may not produce symptoms for 1 week
- Symptoms: autonomic hyperactivity (increased pulse, BP, respirations, and temperature), hand tremor, insomnia, anxiety, nausea, and psychomotor agitation
- seizures and hallucinations occur rarely in severe benzodiazepine withdrawal
Sedative, Hypnotics, and Anxiolytics: Detoxification
medically managed by tapering the amount of drug the client receives over a period of days or weeks, depending on the drug and amount the client has been using
Tapering
administering decreasing dosages
Type of Substances: Stimulants
drugs that stimulate or excite the CNS and have limited clinical use
ex: amphetamines, cocaine, methamphetamine
Stimulants: Intoxication
develops rapidly
- high or euphoric feeling, hyperactivity, hypervigilance, talkativeness, anxiety, grandiosity, hallucinations, stereotypic or repetitive behavior, anger, fighting, and impaired judgment
- physiological effects: tachycardia, elevated BP, dilated pupils, perspiration or chills, nausea, chest pain, confusion and cardiac dysrhythmias
Stimulants: Overdoses
seizures and coma; deaths are rare
Stimulants: Intoxication and Overdose Treatment
Chlorpromazine (Thorazine) an anti-psychotic controls hallucinations, lowers BP, and relieves nausea
Stimulants: Withdrawal
occurs within a few hours to several days after cessation of drug and is not life threatening
- dysphoria, fatigue, vivid and unpleasant dreams, insomnia, hypersomnia, increased appetite and psychomotor retardation or agitation
- symptoms referred to as “crashing”
- may experience depressive symptoms
Stimulants: Detoxification
stimulant withdrawal not treated pharmacologically
-Chlorpromazine is an anti-psychotic that controls hallucinations, lowers BP and relieves nausea
Types of Substances: Cannabis
hemp plant cultivated for its fiber used to make rope and cloth
- short-term effects of lowering intraocular pressure, relieves nausea and vomiting in chemotherapy, and anorexia and weight loss in AIDs
- control seizures
Cannabis: Intoxication
- begins in less than 1 minute; peak in 20-30 minutes
- lasts 2 to 3 hours
- high feeling similar to alcohol, lowered inhibitions, relaxation, euphoria, increased appetite
- impaired motor coordination, inappropriate laughter, impaired judgment and short-term memory and distortions of time and perception
- anxiety, dysphoria and social withdrawal may occur
- bloodshot eyes (conjunctival injection), dry mouth, hypotension, tachycardia
- excessive can produce deilrium
Cannabis: Intoxication Treatment
symptomatically; overdoses do not occur
Cannabis: Withdrawal and Detoxification
even though some report muscle aches, sweating, anxiety, tremors; no clinically significant withdrawal symptoms
Types of Substances: Opioids
desensitizes both physiological and psychological pain and induce a sense of euphoria and well-being
- Opioid Compounds: potent prescription analgesics; morphine, meperidine, codeine, hydromorphone, oxycodone, methadone, oxymorphone, hydrocodone, and propoxyphene
- Illegal Substances: heroin, illicitly produced fentanyl, and normethadone
- fentanyl used for anesthesia
Opioids: Intoxification
develops soon after initial euphoric feeling
-apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech
Opioids: Overdose
coma, respiratory depression, pupillary constriction, unconsciousness and death
Opioid: Intoxication and Overdose Treatment
- Naloxone (Narcan) reverses all signs of opioid toxicity
- given every few hours until opioid levels drop to non-toxic
Opioids: Withdrawal
develops when drug intake ceases or decreases markedly or can be precipitated by the administration of opioid antagonist
- short-acting drugs such as heroin produce withdrawal symptoms in 6 to 24 hours; peak in 2 to 3 days; subside in 5-7 days
- longer acting; methadone for 2 to 4 days; take 2 weeks to subside
Opioids: Withdrawal Symptoms
anxiety, restlessness, aching back and legs, cravings for more opioids
-symptoms that develop as withdrawal progresses: nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, insomnia
Type of Substance: Hallucinogen
substances that distort the users perception of reality and produce symptoms similar to psychosis, including hallucinations and depersonalization
ex: mescaline, psilocybin, lysergic acid diethylamide, and “designer drugs” such as ectasy
- Phencyclidine (PCP) developed as a anesthetic included
- increases pulse, blood pressure and temperature; dilated pupils, hyperreflexia
Hallucinogen: Intoxication
marked by several maladaptive behavioral or psychological changes
- anxiety, depression, paranoid ideation, ideas of reference, fear of losing one’s mind, dangerous behaviors; such as jumping out of a window in belief that one can fly
- sweating, tachycardia, palpitations, blurred vision, tremors, lack of coordination
- PCP toxicity: belligerence, aggression, impulsivity, and unpredictable behavior
Hallucinogen: Overdoses
do not occur
-not a direct cause of death; but fatalities have occurred from related accidents, aggression, and suicide
Hallucinogens: Treatment
supportive
- psychotic reactions managed best by isolation from external stimuli; physical restraints may be necessary
- PCP toxicity: seizures, hypertension, hyperthermia, and respiratory depression–> medications to control BP and seizures, cooling blanket, mechanical ventilation
Hallucinogens: Withdrawal
no withdrawal symptoms
-can produce flashbacks
Types of Substance: Inhalants
diverse group of drugs; anesthetics, nitrates, and organic solvents that are inhaled for their effect
- Substances: aliphatic and aromatic hydrocarbons in gas, glue, paint thinner, and spray paint
- Less Used: cleaners, correction fluid, spray can propellant, compounds containing esters, ketones, and glycols
- inhaled from soaked rags, directly from container, plastic bags
- brain damage, peripheral nervous system damage, and liver diease
Inhalants: Intoxications
dizziness, nystagmus, lack of coordination, slurred speech, unsteady gait, tremor muscle weakness, blurred vision, stupor or coma can occur
- Behavioral: belligerence, aggression, apathy, impaired judgment, inability to function
- Acute Toxicity: anoxia, respiratory depression, vagal stimulation, dysrhythmias
Inhalants: Treatment
death may occur from bronchospasm, cardiac arrest, suffocation or aspiration of compound or vomitus
- supporting respiratory and cardiac functioning until substance is removed from the body
- no antidotes or specific medications to treat inhalant toxicity
Pharmacologic Treatment
Substance Specific
- Lorazepam (Ativan)
- Chlordiazepoxide (Librium)
- Disulfiram (Antabuse)
- Methadone
- Naloxone
- Naltrexone
- Thiamine (Vitamin B1)
Lorazepam (Ativan)
Benzodiazepine
- Uses: alcohol withdrawal
- Nursing Considerations: monitor vital signs and global assessment for effectiveness; may cause dizziness or drowsiness
Chlordiazepoxide (Librium)
Benzodiazepine
- Uses: alcohol withdrawal
- Nursing Considerations: monitor vital signs and global assessment for effectiveness; may cause dizziness or droswiness
Disulfiram (Antabuse)
Uses: maintains abstinence from alcohol
Considerations: teach client to read labels to avoid products with alcohol
Methadone
Uses: maintains abstinence from heroin
Consideration: cause nausea or vomiting
Naloxone
Uses: maintains abstinence from opiates; decrease opiate cravings
(treatment choice for opiates)
Considerations: cause orthostatic hypotension, sedation; avoid CNS depressants
Naltrexone
Uses: blocks the effects of opiates; reduces alcohol cravings
Considerations: may not respond to narcotics used to treat cough, diarrhea, or pain; take with food or milk, may cause headache, restlessness, or irritability
Thiamine (B1)
Uses: prevents or treats Wernicke-Korsakoff syndrome in alcoholism
Considerations: teach client about proper nutrition
Physiological Considerations
- poor nutrition
- sleep disturbances that persist beyond detoxification
- liver damage
- hepatitis or HIV infection from IV drug use
- lung or neurologic damage from inhalants
Nursing Interventions
- pharmacologic management
- physiological consequences
- self-help groups
- treatment of co-morbid conditions
- medications for relapse prevention
- focus on here and now
- dispel myths surrounding substance abuse
- decrease co-dependence behaviors among families and friends
- role-play potentially difficult situations
- set realistic goals
3 Most common Defense Mechanisms Used
- Denial
- Rationalization
- Projection
Projection
a defense mechanism in which the individual attributes to other people impulses and traits he himself has but cannot accept. It is especially likely to occur when the person lacks insight into his own impulses and traits
-ex: an aggressive man accuses other of being aggressive
Rationalization
falsifying experiences by contrived, socially acceptable, and logical explanations
-ex: “sure i got a little angry with my boss. Everyone comes in late to work, s why does he have to pick on me all the time?”
Denial
escaping unpleasant realities by ignoring their existence
What type of therapy is used with chemically dependent clients?
group therapy
-ex: alcoholics anonymous
What basic needs have priority with chemically dependent clients?
Physiological and Psychological needs
-alcohol and drug intake has superseded the intake of food
What medications can the nurse expect to administer to a patient in alcohol withdrawal?
- Lorazepam (Ativan)
- Chlordiazepoxide (Librium)
- Haloperidol
- Disulfiram (Antabuse) as a deterrent to drinking alcohol
