Addictive Behaviors Flashcards
Substance Abuse and their classification
- CNS depressants: alcohol, benzodiazepines, barbiturates, sedatives
- Opiates: opium, heroin, morphine, codeine
- CNS stimulants: amphetamines, cocaine, crack, caffeine, nicotine(tobacco), MDMA(xo), (meth), “bath salts”
- Hallucinogens: LSD, psilocybin(mushroom), PCP (mescaline)
- Marijuana: includes all cannabis by-products and synthetic cannabinoids (“spice”)
- Inhalants: gasoline, butane, paint thinner, propellant gases, spot remover, amyl nitrate (poppers)
Etiology
Biological factors (neurophysiological)
\>predisposed to addiction from gen to gen.
Sociocultural factors
\>cultures may be custom to perform addictive **behaviour (alcohol, opiates, smoking)**
\> becomes a habit and part of the culture
Environmental factors
\> Access to the substances: weed, opium
Psychological factors
\> Psychiatric addiction: reason on why they use substances
Uses
- Religious & sociocultural uses
- Relatively safe in moderation (antiplatelets properties)
- Mood- & mind- altering properties are relative to amts ingested and individual tolerance
- Can be a “social lubrication”
Tolerance vs Cross Tolerance
- *Tolerance**: more of a substance is required to reach the desired effect or decreased effect from same amount
- taking more of the substances in order to produce the same effect that was previously experienced from the past
- *Cross-tolerance:** tolerance to substances in related class (e.g. CNS depressants – ETOH and benzo)
Intoxication Criteria
- Recent ingestion
- Clinically significant, maladaptive beh/ psychological changes (sexual, aggression, mood and judgement)
- At least- one of the following**
- Recent ingestion
- Slurred speech,
- incoordination
- Unsteady gait
- Nystagmus
- Impairment in attention or memory,
- stupor or coma
Alcohol withdrawal
- Cessation (reduction of alcohol use that has been heavy or prolonged)
- hospitalized, trauma accident, imprisoned, run out of money, limit supply, etc
**2. Two (or more) of the following **
- N +V
- Anxiety
- Transient visual, tactile or auditory hallucination or illusion
- Autonomic hyperactivity (sweating, increase pulse over 100bpm; tachycardia)
- Psychomotor agitation - Insomnia - Grand mal seizures - Increase hand tremor
Alcohol Withdrawal delirium
(Delerium tremens – DTs)
- Late stage severe alcohol withdrawal
- Life threatening cond
- Onset 2 days a/f last drink
- Characteristics: autonomic hyperactivity: tremors, htn, risk for grand mal seizure, high fever, diaphoretic
- At risk for.. seizure, falls
- Treatment: benzo for calming effect, anti-convulsant to prevent seizure, treat fever, IV for replenish fluid, thiamine d/t risk for thiamine deficiency, multi-vit for supplments, any medication for his condition
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Alcohol Widrawal Syndrome vs Alcohol Delirium
AWS
- ** Onset** →hours
- Peak →days
- Duration →weeks
Behaviours
Autonomic hyperactivity, transient hallucinations, seizures, provide low stimulations
DTs
- Onset 2 days
- Peak 4 days
- Duration 2 days -1 week
Behaviours
Profound autonomic hyperactivity incl. fever, agitation → lethargy, confusion ++, hallucinations (total break from reality)
Addiction or dependence characterized by one or more of the following 4 C’s
- Impaired Control over drug use
- Compulsive use
- Continued use despite harmful Consequences
- Craving
CAGE questionnaire
- Have you ever felt you should CUT down on your drinking?
- Have people ANNOTWS you by criticizing your drinking?
- Have you ever felt bad or GUILTY about your drinking
- Have you ever had a drink first thing in the morning (EYE opener) to steady your neverves or to get rid of a hangover?
Assessment
- Rx, OTC drugs & homeopathic preparations, caffeine intake, nicotine intake, ETOH intake
- Nutrition, social situation
- Other drugs: marijuana, cocaine, heroin, etc.
- Use of drugs/ETOH prior to hospitalization
- Quantity
- Route of taking substances
- Last dose
- How long
- How often
- Identify problems associated with use (family, friends, job, health, $$, law)
Principles of treatment for alcoholism
_Total abstinence (typical AA approach) _
**Steps **
- Prevention of complications during detoxification
- Achievement of abstinence during rehabilitation
- Consolidation of abstinence & reduced craving during longer-term treatment (relapse prevention
Treatment must address: occupational, family, psychiatric, medical problems
Comprehensive treatment package includes:
- Meds for withdrawal (+/- medical supervision)
- May include negative reinforcers or aversion therapy
- Groups, psychotherapy, A.A. (group support), vocational rehab
The impaired colleague: Behavior
- Job performance changes
- Controlled drug handling/Records (potential drug diversion); preoccupied with narcotic key
- General performance (either over efficient [hyperactive] or decreased performance and quality [poor concentration])
- Behaviour/personality changes (isolated, quiet)
- Signs of use (smell of alcohol, freq gums, long sleeves to cover injection side)
- Signs of withdrawal
- Not limited to alcohol use
Intervention
- What you must not do: enable ( provide excuses and covering for the impaired colleagues)
- You have an ethical and legal responsibility (nurses are pt guadians) to report
- Report your suspicions to your superior
- Be accurate in your reporting of behaviours observed, incidences
- Review OIIQ Code of Ethics Sections 13, 16, 42 (see also provisions according to CNA)
