chapter 17: substance use and addictive disorders Flashcards
substance abuse and dependence
- no longer considered two distinct diagnoses
- new gradient of mild, moderate to severe substance use disorder is preferred terminology
- substance can be any mood or mind alerting drug or alcohol
addiction
- a chronic brain disease characterized by compulsive and maladaptive use of a substance or behavior
alcoholism
a complex progressive disease characterized by significant physical, social, and/or mental impairment directly related to alcohol dependence and addiction
codependency
- maladaptive coping behaviors that reinforce another person’s addictive behavior by allowing that person to avoid consequences of their actions
co-occurring disorders
- many people w/ drug and/or alcohol disorders have co-existing psychiatric disorders (or dual diagnosis)
- substance may be used to treat uncomfortable symptoms. this makes the treatment more complicated
- can start w/ a patient self medicating to treat symptoms of a psychiatric diagnoses or the substance abuse can be the initial diagnosis that leads to other psychiatric disorders as a complication
signs of substance use disorder often include the following:
- a need for markedly increased amounts of the substance to achieve intoxication or desired effect (tolerance)
- markedly diminished effect with continued use of the same amount of the substance
- recurrent substance related problems including legal, relationship, work, social
- substance use continues despite knowledge of the problems being created by it
generally, substance use becomes a problem when it…
- interferes w/ normal functioning
- continues despite negative consequences
- hurts others
theoretical causes of substance misuse
- brain disorder/genetics
- oral gratification (Freud)
- perception of being high is pleasant and person becomes addicted to this pleasure
- learned behavior
- use of substance relieves anxiety, depression
alcoholism often includes…
- daily use; cannot “cut down”
- binges lasting 2 days or more
- “blackouts” (amnesia while intoxicated)
- social functioning impaired
- denial used extensively
alcohol contributes to many chronic illnesses
- heart disease
- liver disease
- diabetes
- falls
- accidents
- dementia
treatments for alcohol-related conditions
- treatment is usually a slow process
- usually refer to being in recover rather than ever being recovered
- treatment approaches include Alcoholics Anonymous (12-step program), individual, and family therapy
- pharmacologic treatment
pharmacologic treatments for alcoholism: medications
- inconsistent success
- side effects can be unpleasant
- disulfiram (antabuse): controversial
- antidepressants
newer medications for alcoholism
- acampresate
- naltrexone
- topiramate
other treatments for alcoholism
- detoxification for safe withdrawal
- family and individual therapy for all involved to learn new coping skills without the presence of alcohol
nursing care for alcohol-related conditions
- maintain honesty
- observe patient for use of defense mechanisms
- support patient/use positive reinforcement
- promote safety
- demonstrate ‘tough love’; encourage patient to be self responsible
- challenge denial
other symptoms: symptoms that can looksimilar to those of alcohol related conditions
- red, watery eyes
- runny nose
- hostility
- paranoia
- deviant behavior
- needle tracks on arms/legs
medical treatments for drug related disorders
- narcotics anonymous using 12 step approach
- group therapy
- individual psychotherapy
- detoxification required for some drugs
- drug specific programs based on substance abused
nursing interventions for drug related conditions
- similar to those for alcohol related conditions
- caution: nurses and others in the medical professios arhigh risk groups for becoming chemically dependent.
