Broadway doesn't go for BOOze and DOPE!

Question 1

Substance Abuse – or chemical dependency
*
use of a substance(s) in an
UC-PHM

Answer 1

use of a substance(s) in an uncontrolled, compulsive, and potentially harmful manner

Question 2

Criteria for diagnosis of substance abuse includes a
maladaptive pattern of substance use during a 12 month period that results in impairment of at least one of the following:
LOLR

Answer 2

• Lack of fulfillment of role obligations
• Ongoing interpersonal problems as a result of or exacerbated by use
• Legal problems
• Risk of physical danger because of use

Question 3

Physical dependency
refers to?
is accompanied by?

Answer 3

Refers to development of a withdrawal syndrome
following abrupt cessation
*
Accompanied by tolerance to a substance – increasing dosage is req to sustain same effects

Question 4

Addiction is characterized by (3)

Answer 4

psychological dependence and preoccupation
with obtaining or using a substance
*
loss of control over the use of a substance
*
continued use despite adverse consequences.

Question 5

How people with substance abuse problems have

other mental health problems.

Answer 5

 6 out of 10

Question 6

Patients with mood disorders and anxiety disorders

are how much more likely to have substance abuse problems and vise versa.

Answer 6

Twice as likely

Question 7

Screening Tools for Identification of
Substance Abuse in the Older Adult
REMEMBER!!!

Answer 7

– A complete comprehensive assessment is important.

Patient history and medical record contribute to the picture – often overlooked….

Question 8

Screening Tools for Identification of
Substance Abuse in the Older Adult
*
CAGE Questionnaire

Answer 8

1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had an Eye opener (drink) first thing in the morning to steady your nerves?

Question 9

Screening Tools for Identification of
Substance Abuse in the Older Adult
*
Second test mentioned + how does it work?

Answer 9

Michigan Alcoholism Screening Test – Geriatric – 24 questions - 5 or more yes answers are positive –

Question 10

Shortened MAST protocol?

Answer 10

Shortened MAST – 10 questions – 2 or more yes answers are positive, focus is alcohol,
not drug abuses.

Question 11

When should screening be considered?

Answer 11

If the older adult is going through life transitions, such as retirement, taking on caregiver role, or death of a spouse.

Question 12

What should prompt screening?

Answer 12

Physical signs should prompt screening –

Question 13

Examples of physical signs that should prompt screening.
SAD BUG FIN

Look for how many of these cues?

Answer 13

Sleep complaints
Anxiety
Depression

Bruising
Unexplained physical complaints
Gait disturbance

Frequent falls
Irritability persistent
Neglect of hygiene

All have been identified as clues to substance abuse. Look for several, not just one….

Question 14

Just a bunch of Frannyisms
Be...
Engage from...
Seek...
Do...

Answer 14

Be respectful and non-judgmental
Engage from concern
Seek to understand the individual.

Question 15

As often as we miss the cues, we…

Answer 15

hypothesize incorrectly!

Question 16

When does late onset alcohol abuse occur?

Answer 16

After 60

Question 17

Late Onset Alcohol Abuse occurs as a result of

Answer 17

the stress of aging and related situations

Question 18

Late Onset Alcohol Abuse occurs as a result of the stress of aging and related situations, such as?
L L–3 RR

Answer 18

Loneliness and isolation
Loss
– social/emotional support
– sensory capabilities
– full mobility
Reactive depression
Reduced ability of aging body to handle alcohol

Question 19

Elderly recovery rate from alcohol abuse

Answer 19

75%

Question 20

System changes (aging plus alcohol): (5)
NG RIM

Answer 20

Neurological – memory loss
GI – gastritis, cirrhosis
Renal and pharmacokinetics
Immune – increased infx
Musculoskeletal – muscle atrophy

Question 21

Pharmacological agents used in conjunction with an

overall program of couselling support, self-help groups, and medical monitoring.

Answer 21

Benzodiazepines – shorter acting used for alcohol
withdrawal (lorazipam, oxazipam) 1/2 to 1/3 dosage
Antismoking Medications
Antibuse

Question 22

Alcohol detoxification and older adults?

Answer 22

riskier

Question 23

Alcohol detoxification minor withdrawal?

Answer 23

6-12 hours

Question 24

Alcohol detoxification major withdrawal?

Answer 24

10-72 hours

Question 25

S/S of alcohol detox? (4)

Answer 25

vomiting, diaphorisis, hallucinations, seizures

Question 26

When may delirium tremens occur?

Answer 26

24-72 hours up to 10 days after last drink

Question 27

Nursing Interventions

to Address Substance Abuse

Answer 27

Be adept at assessment, recognition, intervention, and referral
*
Facilitate safe arena for discussion
Blend of compassion/respect
Build therapeutic r'ship
*
Initiate health promotion to improve QOL
*
Assess safety/suicide thoughts/plans
Focus on psychosocial aspects in recovery, education, quality of life, social supports such as AA or Alanon.