Substance Abuse Flashcards
What is addiction?
A strong need to use a substance
Phases of Addiction
- The Prealcoholic Phase
- The Early Alcoholic Phase
- The Crucial Phase
- The Chronic Phase
The Prealcoholic Phase
- Characterized by using alcohol to relieve everyday stress and tensions of life
- Parents may have provided modeling to the person as a child
- Tolerance develops, therefore the amount desired to achieve the desired effects steadily increases
- The first phase of addiction
The Early Alcoholic Phase
- Begins with blackouts (anterograde amnesia)
- Drinking is no longer a sense of pleasure, but a requirement
- Behaviors: secret drinking, hiding the alcohol, rapid consumption of drinks
- Feels an overwhelming sense of guilt, and defensiveness about his/her drinking
- Defense Mechanism: Denial and Rationalization
- The second phase of addiction
The Crucial Phase
- Loss of control. Can no longer make the choice whether or not to drink
- The person is very ill. Have episodes of sickness, loss of consciousness, squalor, and degradation
- Drinking is the total focus and is willing to risk losing everything to maintain the addiction
- Defense Mechanism: Anger and Aggression
- The third phase of addiction
The Chronic Phase
- Emotional and physical disintegration
- Person is intoxicated more than sober
- Evidenced by a deep helplessness and self-pity; may result in psychosis
- Physical manifestations can be life-threatening (as it effects every system of the body)
- Abstaining results in hallucinations, tremors, convulsions, severe agitation, and panic
- Depression and suicidal thought are not unusual
- The fourth phase of addiction
Cultural Influences on Alcohol
One’s culture helps to establish patterns of substance abuse. This is done by molding attitudes, influencing patterns of consumption based on cultural acceptance, and the availability of the substance
Alcohol’s Effects: Italians and French
- Have a low dependency of alcohol
- Tend to have a “healthier” perception
- Exposure at an early age and the influence of moderation by parents at an early age are believed to be the reason of low dependency
Alcohol’s Effects: Native-Americans
- Have a high dependency rate of alcoholism
- Due to social and cultural influences, genetics, and personal attitudes
- Death rate is seven times higher than non-Native Americans
Alcohol’s Effects: Northern Europeans vs Southern Europeans
- Northern Europeans have a higher incidence of alcoholism than Southern Europeans
- Example: Irish - influence of Pubs, holidays that encourage drinking (St. Patrick’s Day)
Alcohol’s Effects: Asians
- Asians have a low incidence of alcoholism
- Recent research indicates that it may be related to genetics and how alcohol is consumed
- Many experience unpleasant symptoms when alcohol is consumed
Alcohol’s Physical Effects on the Body (chronic use)
- Peripheral neuropathy
- Alcoholic myopathy
- Wernicke’s encephalopathy
- Korsakoff’s Psychosis
- Alcoholic Cardiomyopathy
- Cirrhosis
Chronic Alcohol Use: Peripheral Neuropathy
- Pain, burning, tingling, or prickly sensations of the extremities
- Believed to be a lack of B-vitamins (particularly thiamine B1)
Chronic Alcohol Use: Alcoholic Myopathy
Thought to be a result of vitamin B deficiency - especially thiamine
Alcoholic Myopathy Treatment
- Abstain from alcohol
- Vitamin supplements
- Nutritious diet
Chronic Alcohol Use: Wernicke’s encephalopathy
- Most serious form of thiamine deficiency
It causes brain damage in lower parts of the brain (thalamus and hypothalamus). If not replaced quickly, will result in death
Wernicke’s Encephalopathy Symptoms
- Paralysis of ocular muscles
- Diplopia
- Ataxia
- Somnolence
- Stupor
Chronic Alcohol Use: Korsakoff’s Psychosis
- This tends to develop as Wernicke’s symptoms disappear
- Korsakoff’s psychosis results from damage to the area of the brain involved with memory
- Wernicke’s encephalopathy and Korsakoff’s psychosis are usually paired together and known as Wernicke-Korsakoff syndrome
Chronic Alcohol Use: Alcoholic Cardiomyopathy
Due to an accumulation of lipids in the myocardial cells, causing enlargement and weakened heart
Chronic Alcohol Use: Cirrhosis
It occurs at the end of alcoholic liver disease resulting from long-term chronic alcohol abuse. There is wide spread destruction of liver cells which are replaced by fibrous scar tissue
Complicated Withdrawal Syndrome
- Also known as Delirium Tremors (DTs)
- May progress to alcohol withdrawal delirium, which usually occurs on the 2nd or 3rd day following cessation or reduction
- These symptoms may last 48-72 hours and is considered a medical emergency
- This type of withdrawal may progress to death
Symptoms of Alcohol Withdrawal
- Coarse tremor of hands, tongue, or eyelids
- N/V
- Malaise or weakness
- Tachycardia
- Sweating
- Increased blood pressure
- Anxiety, depressed, or irritable mood
- HA
- Insomnia
Symptoms of Complicated Withdrawal Syndrome
- Symptoms of alcohol withdrawal
- Hallucinations
- Seizures
- Stroke level blood pressure
- Delirium (confusion, excitement, disorientation, clouding of consciousness)
Screening for Alcohol Abuse
CAGE
C - Have you ever felt life you should cut down on your drinking
A - Have people annoyed you by criticizing your drinking?
G - Have you ever felt bad or guilty about your drinking?
E - Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)?
What is a very important thing to remember about the treatment of alcoholism?
Not only is the client responsible for this, but the client must also address issues with self-esteem. Self-esteem issues are just as important as accepting responsibility and accepting one’s own actions.
Alcoholics Anonymous
Is the original 12-step program which was built on the foundation that support and encouragement from others with alcoholism provides support and reinforcement to those on the road to recovery. It is considered the most effective treatments of alcoholism. AA provides members with patience, empathy, and understanding. Members have their dependent needs met while helping others.
* AA promotes that total abstinence is the only cure
Other Treatment Groups for Alcoholism
- Al Anon
- Al-a Teen
- ACOA (Adult Children of Alcoholics)
Al-Anon
Support group for spouses and friends of individuals with alcoholism
Al-a Teen
A nationwide support group for teens (children over 10 years of age) who have alcoholic parents
ACOA
Adult Children of Alcoholics
Support group for adults who were raised in alcoholic homes
Medications for Alcohol Detoxification
- Chlordiazepoxide
- Lorazepam
- Diazepam
Chlordiazepoxide Classification
Anxiolytic, Benzodiazepine
** Used for alcohol detoxification
Chlordiazepoxide Route
PO
Chlordiazepoxide Dosages
5, 10, 25 mg
Chlordiazepoxide Contraindications
- Glaucoma or a predisposition for glaucoma
- COPD or other respiratory problems
- Muscle problems
- Depression
- Suicidal tendencies
- Porphyria (hematological disorder)
- Pregnancy (can cause harm to fetus)
Lorazepam Classification
- Anxiolytic
- Benzodiazepine
- Sedative-Hypnotic
* * Used for alcohol detoxification
Lorazepam Route
PO, IM, IV
Lorazepam Dosages
PO: 0.5, 1, 2 mg
IM/IV: 2, 4 mg/mL
Lorazepam Contraindications
Do not give with alcohol, with depressed vital signs, or pregnancy
Diazepam Classification
- Benzodiazepine
- Antiepileptic
- Skeletal muscle relaxant
Diazepam Route
PO, Rectal, IM, IV
Diazepam Dosages
PO: 2.5, 10, 20 mg
Rectal: 2.5, 5, 10, 20 mg
IM/IV: 5 mg
Diazepam Contraindications
- Pregnancy (can cause cleft lip, cleft palate)
- Glaucoma
- Asthma, or other respiratory problems
- Kidney problems
- Myasthenia gravis.
- Also do not use ETOH with diazepam (can increase the effects)
Medications Following Alcohol Detoxification
- Naltrexone
- Disulfram
- MVI and thiamine (B1) and folic acid (B9) replacement
Naltrexone
A pure opioid antagonist that suppresses craving and pleasurable effects of alcohol
Naltrexone: Side Effects
- Insomnia
- Anxiety
- Muscle aches
- Abdominal pain
- Suicidal thoughts
- Depression
- Hepatoxicity
Naltrexone: Nursing Interventions
- Assess patient’s history to see if patient is also dependent on opioids
- Inform patient to take with meals (as it causes GI distress)
- IM injections can be administered if patient has difficult adhering to medication regimen
Disulfram
- This is a daily p.o. medication that is a type of aversion (behavioral) therapy.
- Should only be prescribed after the patient has detox’d d/t there is a severe hypersensitivity to alcohol.
- Patient should not have had anything containing ETOH (aftershave, mouthwash) within 12 hours. Makes the patient SEVERELY ILL (nausea, vomiting, weakness, palpitations, sweating, and hypotension).
- Med should not also be taken with metronidazole.
Disulfram Dosage
500 mg for 1-2 weeks; maintenance dose is 250 mg/day
Disulfram Side Effects
- Severe headache
- Sweating
- Dry mouth
- Flushing
- Impotence
- Metallic taste
- Peripheral neuropathy
* ** Severe effects can include: - Optic neuritis
- Arrhythmias
- Seizures
- Psychosis
- Acute MI
- Hepatitis
Disulfram Nursing Interventions
- Inform the patient of the potential dangers of drinking alcohol
- Advise to avoid any products that contain alcohol (cough syrups, aftershave lotion)
- Encourage to wear a medical alert bracelet
- Encourage the patient to participate in a 12-step program