Addictions/Substance Use Disorders Flashcards
What is ‘addiction’
a condition where a person becomes dependent on a substance (like drugs or alcohol) or a behavior (like gambling) and feels a strong urge to use it or do it, even when it causes harm to themselves or others.
Repeated use of these substances or frequent substance intoxication can develop into a long-term problem known as
substance abuse
Abuse typically occurs when an individual consumes the substance for an extended period and develops a__ to the ingested substance
tolerance
A substance use disorder (SUD) occurs when
an individual continues using substances despite cognitive, behavioral, and physiologic symptoms
Define:
Abuse of more than one substance
Polysubstance abuse
4 Key feature of Substance Use Disorder (SUD)
- Impaired control: Struggling to limit how much or how often you use a substance
- Social impairment: Neglecting responsibilities at work, school, or home due to substance use.
- Risky use: Continuing substance use in dangerous situations (e.g., driving)
- Physical effects: intoxication, tolerance, and withdrawal
What is the purpose of the DSM-5 in relation to Substance Use Disorders?
Outlines specific criteria for diagnosing Substance Use Disorders (SUDs).
A nurse is reviewing the DSM-5 criteria for diagnosing substance use disorders. How many criteria must an individual meet within a 12-month period to be diagnosed with a substance use disorder?
A) One
B) Two
C) Three
D) Four
B) Two
(if meet 2-3 criteria = mild)
DSM-5 Criteria:
Moderate diagnoses is considered
if meet 4-5 criteria
DSM-5 Criteria:
SEVERE diagnoses is considered
if meet 6 or more criteria
Substance withdrawal symptoms are specific to
the substance used
Biological factors:
What role does genetics play in substance use disorders?
Some people have a genetic tendency to become addicted to alcohol.
( certain individuals may inherit genes from their parents that make them more vulnerable to addiction)
Withdrawal symptoms develop upon __
ABRUPT reduction or discontinue of substance that has been used.
One of the leading causes of irreversible mental retardation
Fetal Alcohol Syndrome (FAS)
What impact do parents who model substance use have on their children?
children (adolescents) are more likely to use substances if they have parents who provide a model for substance use.
What is the primary goal for individuals who have experienced substance abuse?
Recover from the abuse
Treatment and Recovery of Substanace Use:
Recovery involves a partnership between
List 3 individuals
- health care provider
- the individual and
- family
A nurse is educating a group of nursing students about the withdrawal process from substance use. Which statement accurately describes the process?
A) Withdrawal symptoms are always life-threatening and require immediate intervention.
B) Detoxification is the first step, followed by the beginning of the recovery process.
C) Recovery can begin without detoxification if the individual is motivated.
D) The withdrawal process does not require medical supervision in all cases.
B) Detoxification is the first step, followed by the beginning of the recovery process.
A nurse is providing education to a patient in recovery from substance use disorder. Which of the following statements regarding relapse should the nurse emphasize?
A) Relapse is uncommon and indicates that treatment has failed.
B) Relapse is an expected part of the chronic disease of addiction and may occur multiple times throughout recovery.
C) Once a patient achieves sobriety, they will not experience cravings or relapse.
D) Relapse only happens if the individual does not follow the treatment plan strictly.
B) Relapse is an expected part of the chronic disease of addiction and may occur multiple times throughout recovery.
(relapse is the PRIMARY concern)
A nurse is admitting a patient with a history of alcohol use disorder to the hospital. What is the nurse’s first priority during the initial assessment?
A) Assess the patient’s vital signs and mental status.
B) Determine whether the patient is ready to begin the withdrawal process.
C) Evaluate the patient’s nutritional status and hydration levels.
D) Initiate a referral to a substance use counselor for treatment options.
B) Determine whether the patient is ready to begin the withdrawal process.
What is the nurse’s next step after a patient is no longer in danger of withdrawal symptoms?
The nurse can discuss the use of substance and encourage the individual to seek help for the addiction
- After ensuring the patient is stable, nurses play a crucial role in facilitating discussions about substance use, helping the individual understand their situation, and encouraging them to seek help. This holistic approach is essential for effective recovery and long-term well-being.
Substance Use:
Can a patient be in denial?
Yes. It is commen and often a priority
The 7 categories of addicting Drugs
- alcohol
- sedatives/hypnotics
- stimulants
- opioids
- hallucinogens
- inhalants
- cannabis
Alcohol contributes to what 3 chronic diseases?
- Heart disease
- cancer
- Cerebralvascular Accident (CVA): brain attack
What is the nutritional impact of ethanol (ETOH) in food
ETOH contains calories but has no nutritional value.
At what blood alcohol level are individuals considered legally intoxicated in most states?
0.08 - 0.10
What type of effect does alcohol exert on the central nervous system (CNS)?
depressant effect on the CNS
Which 2 tools are commonly used to screen for alcohol use disorders and drinking patterns?
- CAGE Questionnaire
- Alcohol Use Disorders Identification Test (AUDIT)
What is the INITIAL effect of ethanol (ETOH), and how does it act on the body?
ETOH is a sedative but initially creates a feeling of euphoria.
Is alcohol digested?
No.
Where does alcohol enter FIRST?
BLOODSTREAM, then travels to every part of the body.
What organ does alcohol affect FIRST?
BRAIN
(then kidneys, lungs, and liver)
What are some physical and mental health risks for older adults who drink excessive amounts of alcohol?
- Stroke
- Heart disease
- Cancer
- Depression
- Confusion
- Dementia
What does alcohol do to your blood vessels?
Widens (vasodilates)-
* causing blushing, heat loss, decrease in body temp and drop in BP
What does receiving 2 “yes” responses on the CAGE screening indicate?
the possibility of alcoholism should be investigated further.
What are the potential consequences of alcohol overdose?
Can cause permanent brain damage or death.
What cardiovascular effects can ACUTE alcohol intoxication cause?
- Hypotension
- tachycardia
(due to peripheral vasodilation or fluid loss)
What S/S are commonly associated with a blood alcohol level of 0.08 - 0.1?
- Impaired driving
- Slurred speech
- Ataxia
- Reduced sensory function
S/S of alcohol blood level of 0.2-0.3
All sensory motor function impaired
S/S of alcohol blood level of 0.3 and up
- Increase potential cardiovascular and respiratory COLLAPSE
- coma
- death
Q: When do symptoms of alcohol withdrawal usually begin?
A: Symptoms usually start 6-12 hours AFTER stopping or cutting back on drinking.
S/S of alcohol withdrawal
- tremors
- sweating
- anxiety
- hyper alertness
- elevated pulse and B/P
- insomnia
- anxiety
- restlessness
- N/V
Q: What is required for safe alcohol withdrawal?
A: Alcohol withdrawal needs to be accomplished under medical supervision.
During alcohol withdrawal, VS should be monitored every
Q 4 hrs.
Medications to suppress withdrawal symptoms include:
benzodiazepines: Valium, Ativan, Librium
- REMEMBER: Benzo and VAL
What assessment tool is used to determine the amount of medication for alcohol withdrawal?
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar).
What can complicated alcohol withdrawal syndrome PROGRESS to?
May progress to alcohol withdrawal delirium.
- Usually happens 48 to 72 hours after the last drink and can cause confusion, hallucinations, severe agitation, tremors, and changes in heart rate and blood pressure. This condition requires immediate medical attention
What is CIWA?
Clinical Institute Withdrawal Assessment for Alcohol
* It is a tool used to assess the severity of alcohol withdrawal symptoms in patients.
* It evaluates symptoms such as nausea, tremors, sweating, anxiety, agitation, hallucinations, and orientation.
* Each symptom is rated, and the total score helps guide treatment decisions.
* A higher score indicates more severe withdrawal symptoms.
CIWA:
Mild withdrawal symptoms can be treated with
(score of 7 or below)
Supportive care such as: IV fluids and close monitoring
CIWA:
Moderate withdrawal symptoms can be treated with
(score of 8-15)
more intensive interventions such as: IV meds or sedation
CIWA:
SEVERE withdrawal symptoms may require
(score of 16 or more)
intensive tx such as an ICU care
What nutritional deficiencies can occur with alcohol abuse?
List 3
- Vit. B12
- folic acid
- Thiamine (Vit. B1)
What is the purpose of administering a “banana bag” to a patient during alcohol withdrawal?
- To treat electrolyte imbalances and nutritional deficiencies in alcohol withdrawal.
- It typically contains thiamine (B1), folic acid, magnesium, and a multivitamin
Which medications are commonly prescribed to suppress ALCOHOL withdrawal symptoms?
Benzodiazepines:
* Diazepam (Valium)
* Chlordiazepoxide (Librium)
* Lorazepam (Ativan)
What is the common protocol for treating a patient experiencing alcohol withdrawal?
- Thiamine 100 mg IV initially and daily (qd)
- Folic acid (Folate) 1 mg daily (qd)
- Multivitamin (MVI) daily (qd)
- Assess current withdrawal state using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale- then move forward based on score
Define:
Delirium Tremens (DTs)
- SEVERE form of alcohol withdrawal characterized by confusion, severe agitation, hallucinations, and autonomic instability
- require prompt medical treatment due to the risk of complications, including seizures and death.
7 S/S OF DELIRIUM TREMENS (DT)
- Tachycardia: fast HR
- tachypnea: fast breathing
- Increase BP
- diaphoresis
- Marked tremors: noticeable, rhythmic shaking movements
- Hallucinations
- Paranoia
- Grand Mal seizures (possible): seizure that involves a loss of consciousness and body convulsions
Delirium Tremens (DT) may appear
12 to 36 hours AFTER the last drink
(can last from a few hours to several weeks)
3 types of alcohol-induced amnestic disorders (memory impairment)?
- Wernicke encephalopathy
- Korsakoff’s amnestic syndrome
- Wernicke–Korsakoff syndrome
What is Wernicke encephalopathy?
- degenerative brain disorder caused by thiamine deficiency
- often associated with alcohol misuse
5 S/S of Werniche’s Encephalopathy
- confusion
- ataxia: poor muscle control
- vision impairment
- hypotension
- coma
What is Korsakoff’s Amnestic Syndrome?
- Chronic condition resulting from UNTREATED Wernicke encephalopathy.
S/S of Korsakoff syndrome
- memory deficits
- confabulation (fabricating stories)
- difficulty with learning new information
What is Wernicke–Korsakoff syndrome?
- They are 2 different disorder- they are generally considered to be different stages of the same disorder
- Refers to the combined effects of Wernicke encephalopathy and Korsakoff’s amnestic syndrome.
- Wernicke encephalopathy representing the acute phase
- Korsakoff amnestic syndrome the chronic phase
What is the prognosis of Wernicke–Korsakoff syndrome
- Early symptoms can be reversed
- But without long-term treatment, the prognosis is poor
How does heavy alcohol use affect the stomach lining and vitamin absorption?
- Causes inflammation of the stomach lining and digestive tract (gastritis), which reduces the body’s ability to absorb essential vitamins and nutrients.
- This can lead to nutritional deficiencies, including thiamine (B1), folate, and vitamin B12, contributing to conditions such as Wernicke-Korsakoff syndrome.
Drug used to reduce or eliminate alcohol craving
(used for narcotic dependents)
Naltrexone (ReVia)
Is Naltrexone a narctoic?
NOPE- works by blocking the effects of narcotics
2 benefits of Naltrexone
- It will NOT produce any narcotic-like effects or cause mental or physical dependence.
- It will NOT prevent you from becoming impaired while drinking alcohol.
- DRUG that is used to help OVERCOME your drinking problem.
- It is not a cure for alcoholism, but rather will help you maintain abstinence.
Acamprosate
- DRUG used to DECREASE alcohol cravings
- Also used for seizures & migranes
Topiramate
- will NOT CURE epilepsy and will only work to control seizures for as long as you continue to take it
Drug that disrupts the metabolism of alcohol, leading to unpleasant reactions when alcohol is consumed.
Disulfiram (Antabuse)
physical reaction of Disulfiram + Alcohol can include
- nausea
- flushing
- heart palpitations
MOST effective way to treat alcohol use disorder
Alcoholics Anonymous program
Important teaching when taking Disulfiram (antabuse)
- Teach to avoid products such as cough syrups, lotions, colognes, mouthwash
- ANY product with ETOH in its ingredient.
3 Non pharmacological Treatment for Alcohol abuse
- 12 Step Programs (Support Groups- AAA)
- Residential treatment centers
- Cognitive behavior therapy
A client is brought to the emergency department. The client is aggressive, has slurred speech, and has impaired motor coordination. Blood alcohol level is 347 milligrams per deciliter. Among the physician’s orders is thiamine. Which is the rationale for this intervention?
A. To prevent nutritional deficits
B. To prevent pancreatitis
C. To prevent alcoholic hepatitis
D. To prevent Wernicke’s encephalopathy
D. To prevent Wernicke’s encephalopathy
-Wernicke’s encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.
What is one potential danger of alcohol overdose?
choking on one’s vomit, which can lead to death from lack of oxygen.
How does high alcohol intake affect the gag reflex and airway protection?
- High levels of alcohol intake can hinder the gag reflex, resulting in the inability to protect the airway.
- This impairment increases the risk of choking and aspiration
Pt’s passed out due to alcohol misues should NEVER __.
be left alone.
What position should a patient who has passed out due to alcohol use be placed in to ensure safety?
Partially upright position
OR
Rolling them onto one side with an ear toward the ground.
- This position helps prevent choking in case of vomiting and ensures that the airway remains clear
Class of medications that depress the central nervous system (CNS) to induce sedation or sleep
(from tranquilizing relief of anxiety to anesthesia, coma, and even death)
Sedative/hypnotic/anxiolitics compounds
Sedative/hypnotics are generally categorized into 3 main groups:
- barbiturates
- nonbarbiturate hypnotics
- antianxiety agents
What organ is primarily affected by the use of sedative/hypnotics?
LIVER (hepatic damage- jaundice)
Sedative/hypnotic drugs:
What factor influences the ONSET of withdrawal symptoms?
depends on the half-life of the drug from which the person is withdrawing.
- short-acting sedative/hypnotics can lead to rapid onset of withdrawal symptoms within hours, while long-acting ones may result in delayed onset, occurring days after the last dose.
What is the reversal agent for Benzodiazepines
Flumazenil
____ may occur SECONDARY to administering Flumazenil.
Seizures
If seizures are induced by flumazenil administration, patients may require
larger doses of benzodiazepines to control seizures effectively.
9 S/S of Benzo Withdrawal
- Anxiety
- Weakness
- Elevated heart rate (tachycardia)
- Tremors
- Sweating
- Hyperreflexia (increased reflexes)
- Oversensitivity to stimuli
- Confusion
- Konvulsions (seizures)
‘A WET SHOCK’
Abrupt stoping of barbituates can cause
death.
know
How do we SAFELY get patients off of Sedative/Hypnotic drugs?
TAPER THEM- slowly decrease
6 TYPES OF STIMULANTS
- Amphetamines- increase dopamine & Norepi
- Synthetic stimulants: man-made substances designed to mimic the effects of natural stimulants, such as amphetamines or cocaine
- Nonamphetamine stimulants
- Cocaine
- Caffeine
- Nicotine
Stimulants-
5 Effects on the body
- Central nervous system effects
- Cardiovascular effects
- Pulmonary effects
- GI and renal effects
- Sexual functioning
At what level of caffeine consumption does intoxication usually occur?
250 milligrams
2 most common caffeine intoxication symptoms
- Restlessness
- insomnia
What two S/S receive TOP PRIORITY in Stimulant-Induced Disorders?
- Agitation
- Hyperthermia
S/S of Cocaine Intoxication
- Rapid heart rate (tachycardia)
- Sweating (diaphoresis)
- Pupil dilation (mydriasis)
- Teeth grinding
- dry mouth
- nosebleeds
- rapid speech
- weight loss
The withdrawing from Stimulants is called
Crashing.
(feel very high and suddenly feel very low)
When crashing occurs during stimulant withdrwal, #1 thing we need to monitor for is
Suicide
Pts may sleep for ___ when use of Stimulants is discontinued
12-18 hrs
(pts are excessively sleepy)
NCLEX
Opioids:
Fentanyl is __ stronger than Heroin
50 times stronger
Fentanyl > heroin
Opioids:
Fentanyl is __ stronger than Morphine
100 times stronger
Fentanyl > heroin > morphine
S/S of Opioid Intoxication
- euphoria followed by:
- apathy
- dysphoria
- psychomotor agitation or retardation
- impaired judgment.
Opioid antagonist
Naloxone
9 Symptoms of OPIOID withdrawal
- Dysphoria
- muscle aches
- nausea/vomiting/diarrhea
- lacrimation or rhinorrhea **
- pupillary dilation,
- sweating, abdominal cramping,
- yawning**
- fever
- insomnia
-bold is specific to opioid withdrawals
Withdrawal from short-acting drugs (for example, heroin) occur, peak and subside in:
- Symptoms occur within 6 to 8 hours
- peak within 1 to 3 days
- gradually subside in 5 to 10 days.
Withdrawal from long-acting drugs (for example, methadone) occur, peak and subside in:
- Symptoms occur within 1 to 3 days
- peak between days 4 and 6
- subside in 14 to 21 days.
Withdrawal from ultra-short-acting meperidine occur, peak and subside in:
- Symptoms begin quickly
- peak in 8 to 12 hours
- subside in 4 to 5 days
How do we get patients off of Opioids>
Taper- gradual decrease of drug
S/S of Opioid OVERDOSE
- Unconsciousness or inability to awaken
- Pinpoint pupils
- Slow, shallow breathing: choking sounds or a gurgling/snoring noise from a person who cannot be awakened
- Fingernails or lips turning blue or purple
If opioid overdose is suspected, how will you stimulate the person to wake them up?
2 ways
- calling their name or vigorously
- grinding one’s knuckles into their sternum.
Steps in Treating Opioid OVERDOSE
- Recognize signs of Opioid Overdose
- Obtain Emergency Assistance: 911
- Provide Rescue Breathing, Chest Compressions, and Oxygen As needed
- Administer the First Dose of Naloxone- WAIT 2-3 mins
- Administer a Second Dose of Naloxone if the person does not respond
- Monitor the Person’s Response
Pt who is a chronic, long-term use of inhalants experiences ___ withdrawal symtpoms
mild
S/S of Inhalant withrawal
- restlessness
- nausea
- vomiting
- runny nose
- watery eyes
- poor attention
- concentration
Drug that is often used in isolated events or episodes rather than using them regularly or daily.
Halluciongens
The effects produced by hallucinogens are highly ____.
unpredictable
Hallucinogen intoxication occurs ___ after using the drug
shortly
Cannabis use decreases ___ count
sperm
S/S of Cannabis Intoxication
- impaired motor coordination
- euphoria
- anxiety
- sensation of slowed time
- impaired judgment.
Cannabis use impairs motor skills for
8-12 hrs
Cannabis withdrawal symptoms occur
within a week following cessation of cannabis use that has been heavy and prolonged
Withdrawal symptoms for Cannabis
- irritability
- anger/aggression
- anxiety
- sleep disturbances
- decreased appetite
- depressed mood
Which substance is the most widely misused among nurses, followed closely by narcotics?
A. Stimulants
B. Alcohol
C. Benzodiazepines
D. Hallucinogens
B. Alcohol
A nurse manager is evaluating staff attendance records for signs of substance misuse. Which of the following might indicate that a nurse’s source of substances is outside of the workplace?
A. High absenteeism
B. Volunteering for overtime
C. Frequently offering to medicate patients
D. Spending excessive time in medication rooms
A. High absenteeism
A nurse manager is concerned about a nurse’s possible substance misuse. Which behavior might suggest that the nurse is obtaining substances from the workplace?
A. Frequent absenteeism
B. Rarely missing work
C. Taking frequent sick days
D. Reluctance to work extra shifts
B. Rarely missing work
-feels a need to be present to access the drugs
Chemically impaired Nurses are ___ at masking their symptoms
good.
A nurse is discussing diversionary laws with a colleague. Which statement accurately reflects the purpose of diversionary laws regarding impaired nurses?
A. Diversionary laws require mandatory reporting of impaired nurses to law enforcement.
B. Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment.
C. Diversionary laws mandate that impaired nurses be immediately suspended without pay.
D. Diversionary laws prohibit any type of treatment for impaired nurses.
B. Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment.
- Diversionary laws provide a framework for impaired nurses to enter treatment programs and receive support instead of facing immediate disciplinary action.
What is required for successful completion of treatment during the SUSPENSION PERIOD for a nurse with substance use issues?
- Successful completion of an inpatient, outpatient, group, or individual counseling treatment program
- Evidence of regular attendance at nurse support groups or 12-step program
- Random negative drug screens
- Employment or volunteer activities
Peer assistance programs serve to assist impaired nurses to:
- Recognize their impairment
- Obtain necessary treatment
- Regain accountability within the profession
Who makes up the Peer Assistance Programs
Nurse members of the state associations as well as nurses who are in recovery themselves.
Treatment for Gambling disorders
- Behavior therapy
- Cognitive therapy
Psychopharmacology Treatment for Gambling
SSRI
Which of the following are effective ways to identify a substance-impaired nurse? Select all that apply.
- A nurse who frequently administers medications to other nurses’ clients.
- High absenteeism if the substance source is outside of the work area.
- Denial of substance abuse problems.
- A high incidence of incorrect narcotic counts.
- Poor concentration and difficulty in meeting deadlines
All of the above!
A client receives lorazepam because of a high Clinical Institute Withdrawal Assessment (CIWA) score. What is the rationale for this pharmacological intervention?
- Lorazepam is a medication that decreases cravings in clients who are experiencing alcohol-induced withdrawal.
- Lorazepam is a deterrent therapy that helps to motivate clients to maintain alcohol abstinence.
- Lorazepam is a substitution therapy to decrease the intensity of withdrawal symptoms.
- Lorazepam is a CNS stimulant that decreases the CIWA score.
- Lorazepam is a substitution therapy to decrease the intensity of withdrawal symptoms.
What does an increasing CIWA score indicate about a client’s condition?
- As the CIWA score increases, the client’s potential for serious complications from alcohol withdrawal also increases.
- CNS (central nervous system) depressant medications must be administered to manage withdrawal symptoms and prevent serious complications.
