Addictions and Mental Health Flashcards
Define addiction.
The persistent, compulsive dependence on or use of a substance or behaviour despite its negative consequences and the increasing frequency of those consequences.
What is alcohol withdrawal?
A physical reaction to the cessation or reduction of alcohol (ethanol) intake that develops within a few hours of the last intake.
What is a blood alcohol level?
A measure (by urinalysis or Breathalyzer) of the level of alcohol in the blood.
What three elements must addiction have for it to be an addiction?
biological, psychological, and social
What are biological factors?
neurotransmitter involvement. Physical withdrawal s/s.
What are psychological factors?
the substance becomes so important to all aspects of a person’s life they believe they cannot manage without. 4 theories.
What are sociocultural factors?
We are a reflection of who and where we were raised
What factors do compulsive behaviours have?
psychological and social, but not biological
Define tolerance.
A physiological experience that occurs when a person’s reaction to a substance decreases with repeated administrations of the same dose.
What are the etiology and characteristics of an addiction?
Characterized by use, abuse, and physical and psychological dependence, and also by certain behaviours:
Loss of control of substance consumption
Continued substance use despite associated problems
Cravings and a tendency to relapse after efforts to change behaviour
What are the stages in the process of addiction development?
No contact
Experimentation
Integrated use
Excessive use: Intervention here.
Addiction (with features of tolerance and withdrawal)
What occurs in the no contact stage?
- No use, therefore no risk
- Many protective factors for not using drugs: culture, family, other positive social supports, and faith, as well as fear of legal consequences
What occurs in the experimentation phase?
People (often adolescents) begin to experiment with drugs for a rnage of reasons:
* feel the effects
* fit in with peers
* reduce the anxiety of intimacy
* escape from issues of stress, violence, trauma and oppression
What occurs during the integration phase?
- may use a substance to enhance an already pleasurable and ongoing experience, making it a social habit and integrating it into their lives
- marijuana at a concert
- few negative consequences
What occurs at the excessive use phase?
- misuse causes problems for the user and often those around them
- lapse in memory, conflict, and engage in acts they otherwise wouldn’t
- Treatment intervention becomes appropriate here
What happens during the addiction stage?
Person has reached the phase where they are physically and psychologically dependent,
Person has lost the ability to choose and the drug has become the central organizing principle in the person’s life.
What is the epidemiology of addiction in Canada?
- Substance use is common in Canada
*** Prevalence of alcohol use **for Canadians over age 15 years is 78% - Drug use by youth 15 to 24 years of age is higher than for adults 25 years and over
- Binge drinking among Canadian men is ranked as the highest in the world
- Of the three categories of pharmaceuticals, **opioid pain relievers **were the most commonly used in 2017
- Overall smoking prevalence has fallen to 15% of the population
- The** rate of death due to alcohol for Indigenous people **in Canada is twice that of the general population
List the percentages of concurrent disorders.
Of those with Anxiety Disorders, 24% have concurrent substance use disorders
27% of people with Major Depressive Disorder have concurrent disorders
47% of those with Schizophrenia have concurrent disorders
56% of those with Bipolar Disorders experience a concurrent disorder
What does the CAGE questionnaire ask?
- Have you ever felt you needed to Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
What is Wernicke’s encephalopathy?
an acute and reversible condition brought on by alcoholism; reversed by high IV thiamine
What are medical comorbidities of alcohol abuse?
- Wernicke’s encephalopathy
- Korsakoff’s syndrome
- Fetal Alcohol Spectrum Disorder
- esophagitis, gastritis, pancreatitis, alcoholic hepatitis, cirrhosis of the liver
- associated with tuberculosis, cancer, accidents, suicide and homicide
What is Korsakoff’s syndrome?
a chronic condition with a recovery rate of only about 20%; a serious progression of Wernicke’s encephalopathy
What are substances that lead to use disorders?
Alcohol
Caffeine
Cannabis
Hallucinogen
Inhalant
Opioid
Sedative–hypnotic
Stimulant
Tobacco
What are the levels of prevention related to addictions?
Primary – eg., alcohol labelling policy; cigarette taxation, education, taxing use heavily
Secondary – eg., harm reduction practices (supervised injection sites, managed alcohol program); relapse prevention support
Persons who use IV drugs have increased risk of HIV, hepatitis. Harm reduction measures play an important role in preventing transmission and spread.
Tertiary – detox and recovery/rehabilitation programs
What level of prevention does harm reduction fall into?
Secondary prevention
What is a hallmark of an addiction diagnosis?
Interference in daily functioning (hallmark of addiction diagnosis)
Even when you can acknowledge problems, you continue to use
What is the most prevalent of the substance abuse disorders?
Alcohol abuse
Why would we not do an MSE on a patient who is intoxicated?
1-2 drinks BAL 0.05 (altered mental status, impaired judgment)
5-6 drinks BAL 0.10 (clumsy, involuntary motor activity)
15-18 drinks BAL 0.30 (confusion, stupor)
25-30 drinks BAL .50 (death due to respiratory distress)
What is the blood alcohol level and impact after 1-2 drinks?
BAL 0.05 (altered mental status, impaired judgment)
What is the blood alcohol level and impact after 5-6 drinks?
BAL 0.10 (clumsy, involuntary motor activity)
What is the blood alcohol level and impact after 15-18 drinks?
BAL 0.30 (confusion, stupor)
What is the blood alcohol level and impact after 25-30 drinks?
BAL .50 (death due to respiratory distress)
When does alcohol withdrawal normally begin?
Usually begins a few hours after drinking and disappear within a day or 2.
The amount of alcohol and the frequency of drinking affects withdrawal picture.
How does the amount of alcohol and the frequency of drinking affects withdrawal picture?
Someone who drinks infrequently will have minor withdrawal symptoms.
Someone who drinks large amounts frequently will need closer monitoring.
Feel “shaky inside”
Risk of seizure
CIWA assessment to avoid seizure and progressing to DTs. CIWA Simulation
Therapeutic nurse - patient relationship essential.
What are delirium tremens?
Also known as alcohol withdrawal delirium, it is a medical emergency that can result in death in 20% of untreated patients. It is an altered level of consicousness that presents with seizures following acute alcohol withdrawal. Death is usually due to cardiopathy, cirrhosis, or other coomrbidities requiring mechanical ventilation.
What is the onset of delirium tremens and what is the clinical picture?
Onset is usually 2-3 days after last drink.
Sweating, disorientated, hallucinations, delusions, agitated, Fever, Insomnia. (note these are what we monitor when doing the CIWA)
What is alcohol poisoning?
A state of toxicity that results when an individual has consumed large amounts of alcohol either quickly or over time. It can produce death from aspoiration of emesis or a shutdown of body systems due to severe CNS depression.
What are signs of alcohol poisoning?
Cool, clammy skin
Respirations less than 10 a minute
Cyanosis of gums/fingernails
Emesis while semiconscious or unconscious
Why are people dying from opioid use?
*Prescribing issues
* Mis-understanding of how addictive
*Risk Factors: mental health, trauma, poverty, other social determinants of health
* Stigma
* Illegal drugs laced with fentanyl
* Lack of comprehensive care to respond
What are opioids?
A distinct family of CNS depressants that includes morphine, heroin, codeine, oxycodone, methadone, meperidine, fentanyl. Medically, it is used primarily as an analgesic.
What does Opioid Intoxication Look Like?
- Initial feeling of euphoria. Impaired judgement and memory.
- Pupils constricted, decreased respiration, drowsy, decreased blood pressure, slurred speech, psychomotor retardation.
- Effects can last several hours. Withdrawal from opioids is painful and the user will seek more drug to avoid going into withdrawal.
Why is the term opioid poisoning preferred over overdose?
- Often not intentional
- Non-uniform substances; same physical amount can have vastly different effects
How to Reverse an Opioid Overdose?
An opioid antagonist: Naloxone (injection or nasal spray)
How Can We Help Someone Through Opioid Withdrawal?
If someone chooses to detox they often require opioid replacement therapy for an extended period of time. We are unable to determine how long. It is on a case by case basis.
First Line: Suboxone
Other Choice: Methadone
What are the guidelines for initiating suboxone?
Suboxone must be initiated when client is in moderate or > withdrawal. Most initiations start 12- 24 hours after last dose of opioid.
If you give it too soon you will put the person in precipitated withdrawal which means they will experience severe withdrawal symptoms.
How do We Know When A Client is in Moderate Withdrawal?
we use a tool called COWS (clinical opiate withdrawal scale) to determine level of withdrawal and subsequent suboxone dose.
Monitoring of withdrawal symptoms and dosing is crucial for the first 24- 48 hours after initiation of suboxone to ensure the person does not experience withdrawal. Initiation is usually complete by Day 2, meaning they have reached a dose of suboxone that keeps them stable and not experiencing withdrawal symptoms.
What tool do we use to assess alcohol withdrawal?
CIWA-AR
What does the Clinical Opiate Withdrawal Scale (COWS) assess for?
- resting pulse rate
- sweating
- restlessness
- pupil size
- Bone or joint ache
- runny nose or tearing
- GI upset
- tremor
- yawning
- Anxiety or irritability
- gooseflesh skin
What is the Nurse Responsibility when Suboxone treatment is initiated?
Suboxone can be initiated on an outpatient basis, at detox, in ER or on a hospital unit.
Nurses need to know how to complete a COWS and interpret the results.
Score:
5-12 = mild;
13-24 = moderate;
25-36 = moderately severe;
more than 36 = severe withdrawal
How Can We Help Someone Use Safe?
When we use a harm reduction approach we let the patient lead. If they tell us they are not ready to stop using we hear this, we understand this and we recognize the most important thing we can do is make sure they use safe.
List examples of central nervous system stimulants..
- cocaine
- crack
- amphetamines such as crystal meth,
- caffeine
- nicotine
What are the stages of the transtheoretical model of change?
- precontemplation: resistant to change and typically has no intention of altering behaviour in the near future
- contemplation: patients become aware that they are stuck in a situation and must decide whether they wish to change or remain where they are.
- preparation: involves some commitment form the patient that changing the drug-using behaviour is being considered along with anticipation of what this future action might look like
- action: when the work and behavioural change begin; involves changing awareness, emotions, self-image, and thinking
- maintenance/asaption: supporting and consolidating gains
- evaluation/termination: focus on relapse prevention and dealing with the reality of sobriety
What is harm reduction?
A range of programs, policies, and interventions designed to reduce or minimize the adverse consequences, such as overdose, infections, and spread of communicable diseases, associated with drug use.
What are examples of harm reduction programs?
- needle exchange programs
- methadone treatment and methadone maintenance
- heroin assisted treatment
- supervised injection sites
- controlled drinking
- managed alcohol programs
