Chapter 22 Substance-related and Addictive Disorders Flashcards
ADDICTION/Substance Abuse
Define
“Primary, chronic disease of brain reward, motivation, memory and related circuitry.”
“Chronic medical condition with roots in the environment, neurotransmission, genetics and life experiences.”
American Society of Addiction Medicine
A disease of dysregulation in the hedonic or reward pathway of the brain.
ALCOHOL?
Most common abuser
Men
Young people
Whites
Single
ALCOHOL?
What % of US population consumes regularly
2/3
ANTAGONISTIC EFFECTS OF DRUGS
When drugs are taken together and the effect of one is inhibited or weakened
IE cocaine with heroin (speedball)
CNS depressant Heroin softens the withdrawal from cocaine
Narcan (Naloxone) give to OD opiates reverses respiratory and CNS depression
Behavioral Addictions
Do they have clear identifiable intoxication or withdrawal symptoms?
Is Tolerance an ISSUE?
Behavioral addictions NO clear intox or withdrawal symptoms
Tolerance NOT an issue
Behavioral Addictions
How are they assessed?
Patterns of behavior and consequences
Co-occurring disorders. COMORBITIY
Two or more disorders occurring in the same person at the same time with potential interactions and exacerbation of symptoms. Can be SUD or Psychiatric Disorders from DSM-5
Codependence
Cluster of behaviors
client id’s self-worth in terms of caring for others to the exclusion of their own needs
nursing attracts people who are codependent (care for people’s fundamental needs)
COMMORBIDITY
ETOH affects _____
Liver, esophageal varies gastritis CA Whole body nutrition ecteric edema from cirrhosis/ascites
COMORBITITY
name two types
Psychiatric 6/10 that have SUD also affected by mental health d/0
Medical (most common ETOH)
COMORBITIY
Having more than two disorders at the same time.
Drug Schedules
I - high potential for abuse, no acceptable medical use (heroin, LSD)
II - high potential for abuse, dangerous, by RX only, methadone, meperidine (demerol) and methylphenidate (ritalin)
III - low to moderate potential for abuse, by RX only, testosterone, acetaminophen/Codeine/Tylenol with codeine, buprenorphine (Suboxone)
IV - low-risk for abuse, by RX only, alprazolam (Xanax), lorazepam (ativan), propoxyphene/acetaminophen (darvocet)
V - contain limited amount of narcotics for treatment of diarrhea, coughing, and pain. atropine/diphenoxylate (lomotil), guaifenesin and codeine (robitussin AC), and pregabalin (Lyrica), available over the counter.
Substance abuse + Substance disorder =
Substance Use Disorder (SUD). DSM-5
FLASHBACKS
Transitory recurrences of perceptual disturbance caused by a person’s earlier hallucinogenic drug use when they are in a drug free state.
Examples visual time expansions loss of ego boundaries intense emotions mild/pleasant to frightening images or thoughts.
Fragmented Care Began To Change in 20__
2001
with federal initiative to address mental health and SUD treatment systems
-cross training of mental health professionals
-integrated screenings
-early intervention
Fragmented Care Began To Change in 20__
2001
with federal initiative to address mental health and SUD treatment systems
-cross training of mental health professionals
-integrated screenings
-early intervention
INTOXICATION
INTOXICATION
when person using a substance to excess.
-under the influence, intoxicated or high
“STATE OF EXPERIENCING ACUTE EFFECTS OF A SUBSTANCE” -NG
may be different terms -alcohol - drunk. Weed -high, stoned
ADDICTIONS IN USA
what is the most common
ALCOHOL
TOLERANCE
with RX meds
Considered abuse for addiction?
what drugs?
No Antidepressants beta-blockers Analgesics anti-anxiety meds
Substance Use Disorders (SUD’s) are represented by three actions-
CRAVING
SEEKING
USING (regardless of consequences)
Substance Use Disorder
Pathological use of a substance that leads to a disorder of use, intoxication, and often withdrawal if the substance is taken away.
Can be swallowed, injected, rectal, IV, smoke, skin pop, or inhaled.
From caffeine to LSD
SUD - continuous can do what to the brain structure?
Actual change to the Brain structure and to
the function of the limbic (reward and pleasure) system
Mood disorder and self medicated - SUD
Drugs and then mood disorders - SUD
SUD
How long to have brain chemistry revert back with some drugs?
Up to 5 years.
SYNERGISTIC EFFECT of DRUGS
When drugs are taken together, the effect of either or both is intensified or prolonged
IE ETOH with BZO’s
TOLERANCE
SUD experience TOLERANCE to effects of the substance.
They need a higher dose to achieve the same response as initially.
Or the same amount over time is decreased effect
Tolerance
What drug increases tolerance RAPIDLY?
Cocaine
What % of adults in USA during the year will abuse alcohol?
What % will be alcohol dependent>
5% Abuse
4% Dependent
What question do you ask a SUD
What do they use?
How do they use it? This is important. Withdrawal need to know.
What amount?
When did they last use?
TOLERANCE
What drug is a slow tolerance?
prescription pain meds
WITHDRAWAL
Physiological and or psychological symptoms when substance is stopped.
Blood and tissue concentrations decrease after heavy and prolonged use of substance.
Specific to the drug, can be mild or life-threatening.
the more intense the symptoms, more likely to use again
Withdrawal to behavioral addictions
symptoms
cravings sleep disruption anxiety depression ie gambling
Alcohol
Most common drug of abuse in USA
Greatest danger for withdrawal - Seizures Deliriums fatality
NEED to find out when they last drank and how much?
ANTABUSE (Disulfiram)
Used with motivated patients to remain sober. Take daily. Only w patient consent.
RX if have any alcohol Handsanitizer
CNS Stimulants
signs
Pupils dilated oronasal cavity - dry HR - tachycardia N and V insomnia excessive motor activity Cardiac problems prev - ER
Cocaine and crack
how long does it last?
4-6 seconds will feel it
lasts 5-7 minutes
Crack Cocaine
Withdrawal
Depression Paranoia Suicide Lethargy Anxiety Insomnia Nausea and Vomiting Sweat and Chills
OPIATES
list
Morphine Heroin Codeine Fentanyl Methadone Meperidine (Demerol HCL)
Opiates
What do they affect?
CNS and ANS
Opiates
medical use
analgesic - pain killer may be RX
Ask when, what, how,
know what does under the influence look like
and know what withdrawal looks like
Opiates
most common?
Heroin
Opiates
Withdrawal
Yawning Irritability Runny nose rhinorrhea panic Diaphoresis Cramps N and V Muscle aches - bone pain Fever, Chills Lacrimation (teary) Diarrhea Like a very bad FLU not life threatening
OPIATES
INtoxication
Pupils - constricted RR - decreased BP - decreased Drowsy Slurred speech Psychomotor retardation initial euphoria followed by dysphoria and impairment of attention, judgement and memory
OPTIATES
OD
pupils - dilations RR depression or arrest coma shock convulsions death
Opiates
OD treatment
Narcotic antagonist
naloxone narcan
reverses depression of CNS
OPIATE
withdrawal treatment
Methadone tapering
Clonidine
Naltrexone
Buprenorphine
Behavior Addictions
Gambling Internet gaming Use of social media shopping Sexual activity
TRIGGER THOUGHT CRAVING USING
Treatment
stop before the craving
Marijuana (Cannabis sativa)
Indian hemp plant
What is the active ingredient?`
Tetrahydrocannabinol (THC)
Marijuana
category
Depressant
hallucenogen
Marijuana
how is it used?
Smoked
ingested. baked
oils
Marijuana
desired effects?
euphoria
detachment
relaxation
medical use
Marijuana
long term effects
lethargy
anhedonia
difficulty concentrating
loss of memory
Marijuana
intoxication symptoms
giddy tired red eyes increase appetite cotton mouth giggly
Marijuana
withdrawal symptoms and overdose symptoms
Rarely OD and withdrawal
symptoms - cravings
Marijuana
Indications for Medical use
Chemo - control nausea
glaucoma - reduce intraocular pressure
AIDS wasting syndrome - stimulates appetite
many more
Hallucinogens
name 4
LSD lysergic acid diethylamide
Mescaline - peyote - cactus
Psilocybin - magic mushrooms
Phencyclidine piperidine - PCP, angel dust, horse tranquilizer, peace pill
religions rites by native americans
Hallucinogens
Intoxication symptoms
psychotic
hallucinations - auditory, tactile
bad trip - paranoia - can be at risk for danger,
PCP - very aggressive, super human powers.
PCP
onset
Ingested - 1 hour
Intranasal or inhaled (smoked) - 5 minutes
PCP
intoxication signs
acute anxiety to acute psychosis
PCP
chronic use.
Dulled thinking Poor memory Lethargy Poor impulse control Depression
Inhalants
% of adolescents in USA
19%
Inhalants
what are they?
spray paint glue cigarette lighter fluid propellant gases used in aerosols dust offfuels early marker for SAD long island - heroin
Inhalants
harmful effects
permanent brain damage hearing loss nose bleeds loss of smell suffocation sudden death irregular HR, Heart attack, death N and V Kidney and Liver damage Muscle weakness and cramping abdominal pain involuntary passing of urine and feces bone marrow depression could be a co-occuring disorder cmp fbs, cbc nutrition
Inhalants
neuropathy treatment
gapapentin
B12
Inhalants
Organic solvents
symptoms
alchohol-like effects eurphoria impaired judgement slurred speech flushing CNS depression Visual hallucinations and disorientation
Inhalants
VOLATILE NITRATES
Room deodorizers
other products
Inhalants
Gas esp nitrous oxide
intoxication
giggling
laughter
euphoria
Date Rape Drugs
name 2
Flunitrazepam = Rohypnol - roofie
Gamma hydroxybutyric acid - GHB
Date Rape Drugs
intoxication symptoms
disinhibition
relaxation of voluntary muscle
lasting anterograde amnesia - blank slate that period of time when under the influence
Self-Assessment
examine your own attitudes
attend to personal feelings that arise
Chemically Impaired Nurse
what % abuse ETOH or drugs ___
What % have a serious problem that interferes with safe care
10%
6%
Chemically Impaired Nurse
what % abuse ETOH or drugs ___
What % have a serious problem that interferes with safe care
10%
6%
Chemically Impaired Nurse
warming signs
Offering to go in to medicate patients with opiods
If your patients meds not effective
after break - hyped up sedated
frequent absences, excues
Chemically impaired Nurse
responsiblity
must report
Chemically Impaired- Substance abuse
Assessments
Assessments-
withdrawal overdose suicidal or self-destructive behaviors physical complications explore interest in treatment knowledge of community resources
Nursing DX
SAD Symptoms: V/ diarr., poor nutrition and fluid intake
Imbalanced nutrition, less than body requirements
Nursing DX
SAD Symptoms: Halluc. impaired judgement, memory deficits, cog. impairments
disturbed/impaired thought process
Nursing DX
SAD Symptoms: changes in sleep/wake, interference with stage 4 sleep, inability to sleep or long sleep periods
disturbed sleep patterns
Treatment Goal for SUD
abstinence
12 step one day at a time
relapse - no shame happy you are back for help
Treatment SUD
CONSIDERATIONS
Social status, income, ethnic background, gender, age, culture
SUD history
current condition
Treatment
Goals
self-responsibility
need to match patient with treatment
Treatment
relapse prevention
self-help groups patient and familyl sponsor residential programs outpatient intensive outpatient employee assistance
Alcoholism
Pharmacological interventions
Naltrexone (ReVia) - reduces or eliminates alcohol craving
Acamprosate (Campral) -Helps client abstain from alcohol
Topiramate (Topamax) - Works to decrease alcohol cravings
Disulfiram (Antabuse) Alcohol-disulfiram reaction causes unpleasant physical effects MUST CONSENT, MUST KNOW SYMPTOMS, CANNOT BREAK DOWN ETOH, WILL keep very sick if ingest any ETOH, BAD Rx. Stays in system for 2 weeks. Repeat offenders remaining sober.
OPIOID ADDICTION
Pharm Treatments
*Methadone (Dolophine)
Synthetic opiate blocks craving for and effects of heroin
LAAM (l-α-acetylmethadol)
An alternative to methadone. Not commonly used.
*Naltrexone (ReVia)
Antagonist that blocks euphoric effects of opioids
*Clonidine (Catapres)
Effective somatic treatment when combined with naltrexone
*Buprenorphine (Subutex)
Blocks signs and symptoms of opioid withdrawal
OPIOID
evaluation
Increased time in abstinence. cravings? meeting?
Decreased denial - starting to own their cravings?
Acceptable occupational functioning - are they back to work, training?
Improved family relationships?
Ability to relate comfortably to other individuals
OPIOID
evaluation
Increased time in abstinence. cravings? meeting?
Decreased denial - starting to own their cravings?
Acceptable occupational functioning - are they back to work, training?
Improved family relationships?
Ability to relate comfortably to other individuals? assess anxiety, depression
12 step program
Effective AA, alcohol NA, narcotics CA, cocaine SA, sex anon. GA gambling anon. OA overeaters Al-Anon Al-Ateen- families
Residential Programs
for individual who have a long history of antisocial behaviors, or other..lack housing
effects lifestyle change
According to the AA glossary, the phrase “Stinking Thinking” refers to an alcoholic’s reversion to old thought patterns and attitudes. Stinking thinking may include, blaming others, alcoholic grandiosity, fault-finding, self-centeredness, and skipping meetings.
Outpatient Drug Free Programs
Employee Assistance Programs (EAP)
EAP: provide the delivery of MG services in occupational settings. Many hospitals and corporations offer their employees counseling and support as an alternative to job termination when the employee’s work performance is negatively affected by impairment.
