Substance Abuse and Addictive Disorders Flashcards
what are risk factors for substance abuse?
- lack of tolerance for frustration and pain 2. lack of success in life 3. lack of affectionate and meaningful relationship 4. low self esteem and lack of self regard 5. risk taking propensity 6. impulsivity
assessment guidelines for acute chemical impairment
- assess for a severe or major withdrawal syndrome 2. assess for an overdose of a drug or alcohol that needs immediate attention 3. assess for suicide or self harm 4. any physical complication because of the substance 5. explore their interest in solving it 6. assess family’s knowledge on community resources
signs of alcohol poisoning
- inability to rouse individual 2. severe dehydration 3. cool or clammy skin 4. resp less than 10/min 5. cyanosis of gums and finger nails 6. emesis
Interventions for substance abuse
- Substance abuse intervention 2. Motivational interviewing 3. Pharmacological interventions
What is substance a use intervention?
“An intervention” when signifanct others meet with the person experiencing the abuse and point out issues and treatment alternatives - don’t do it when the person is using - do t react to defensiveness
What is motivational interviewing
Having an approach that is motivational, empathetic and hopeful Steps 1. Build rapport 2. Setting an agenda 3. Assessing readiness to change 4. Sharpening focus 5. Identifying ambivalence 6. Eliciting self motivating statements 7. Handling resistance 8. Shifting focus and transition
4 C’s
Control Compulsion Cravings Continued use
Substance abuse
Continued despite problems related to use of drugs or alcohol
Concurrent disorder
“Concurrent Disorders […describes] a situation in which [an individual] experiences a psychiatric disorder and either a substance use disorder and/or a gambling disorder”
Why do not many people seek treatment
Stigma Acceptance of youthful experience Folder emcee and media promotion Powerful tobacco and ETOH industries
Screen tool: CAGE
- Have you thought you ought to CUT DOWN on your drinking? 2. Have people ANNOYED you by criticizing your drinking? 3. Have you felt GUILTY about your drinking? 4. Have you had a drink first thing in the morning to steady your nerves? (EYEOPENER) Scoring 2 yes answers indicates probable alcohol abuse and warrants further assessment
What is delirium tremons (DTs)
Acute phase of withdrawal Symptoms: Severe mental/ neuro changes Infections, actue delirium
“shaking frenzy”
What is korsakoffs sydrome? (Looks similar to dementia)
is a neurological disorder caused by a lack of thiamine (vitamin B1) in the brain. Its onset is linked to chronic alcohol abuse or severe malnutrition, or both
amneisa, lack of insight, inability to form new memories
Prevalence of substance abuse
-At least half of adults arrested for major crimes test positive for drugs at time of their arrest -Alcohol plays role in domestic violence, affecting married and unmarried couples -Intoxication increases risk for self-inflicted injury, suicide
Process of Addiction
- no use 2. use 3. misuse 4. abuse 5. dependency
when is it an addiction?
- Substance abuse is a maladaptive behavioural response affecting relationships/functioning leading to: 1. Overwhelming sense of lack of control 2. Failure to meet role obligations at home, work, school, or in recreational activities 3. Creation of hazardous situations, health risks, legal problems
what is substance dependence?
severe condition or disease with physical problems and serious disruptions in work, family, social life
what is addiction?
persistent, compulsive dependence on substance or behaviour
what is concurrent disorder?
co-existing mental illness and substance abuse, dependence or addiction
what are some abused substances
CNS depressants Stimulants - methamphetamine Marijuana (cannabis) Hallucinogens (LSD) Nicotine Phencyclidine (PCP) Opiates Inhalants
For patients in withdrawal what is the highest priority nursing intervention?
highest priority is patient safety (stabilization of patient’s physiological status until crisis of withdrawal subsides)
withdrawl symptoms
- Irritability
- Anxiety
- Insomnia
- Mood instability
- Drug cravings
- Anorexia
- Weakness
- Flushing
- Hypersensitivity to stimuli
- Paresthesias
- Perceptual distortion
- Muscle pains/spasms Tension
- Abdominal pain
- Seizures
consequences of substance abuse
Accidents Violence Self-neglect Fetal abnormalities and fetal substance dependence Infection with blood-borne pathogens Hepatitis AIDS
questions for their coping
What is patient’s motivation to change? What are patient’s social supports? What is patient’s health status? What are patient’s social skills? Patients need intellectual skills, personality traits for positive change
what are destructive coping mechanisms?
minimization, denial, projection, rationalization
what is delirium tremens?
Severe form of ETOH withdrawal Severe mental/neuro changes After heavy drinking or other triggers (HI, infection) Usually up to 72 hrs after but can be several days after
symptoms of delirium tremens
Body tremors - seizures Mental status changes Agitation, irritability Confusion, disorientation , decr attention span Decreased mental status Deep sleep x day or longer , Stupor, sleepiness, lethargy Delirium (severe, acute loss of mental functions) Excitement or Fear - hallucinations Highly sensitive to light, sound, touch Mood changes rapidly
nursing care for delirium tremens
Nursing care ensure pt safety, adequate hydration, attention to physiologic needs VS Medications - benzo Monitoring
Nursing care for detox
Give fluids if dehydrated, encourage eating Frequent sips of milk or meds for GI distress, antidiarrheal or analgesic meds PRN Take seizure precautions Cool cloth on forehead can help if patient too warm or diaphoretic
what is the drug of choice for ETOH detox?
long acting benzos, help with symptoms and siezures
which ETOH detox why do we give thiamine and B12?
alcoholics are deficient in B 12 (folic acid) and Thiamine, so it should be administered. Insufficiency of these vitamins puts them at risk of developing Wernicke Encephalopathy and Korsakoff psychosis
what kind of environment should you make for detoxing patient
Quiet, calm environment to decrease CNS irritability, promote relaxation Reassurance in calm, quiet voice Reorientation Comfort, support…always treat patient with dignity and respect
what are the 5 principles to the motivational approach?
1.Express empathy 2. Avoid argument 3. Support self-efficacy 4. Discuss discrepancy 5. Roll with resistance
what are the 8 steps to motivational interviewing?
- Establishing Rapport 2. Setting the Agenda 3. Assessing Readiness to Change 4. Sharpening Focus 5. Identifying Ambivalence 6. Eliciting Self-motivating Statements 7. Handling Resistance 8. Shifting the Focus
4 Types of Motivational Statements
Cognitive Recognition of the problem (e.g., “I guess this is more serious than I thought.”) Affective Expression of concern about the perceived problem (e.g., “I’m really worried about what is happening to me.”) A Direct or Implicit Intention to change behavior (e.g., “I’ve got to do something about this.”) Optimism about one’s ability to change (e.g., “I know that if I try, I can really do it.”)
what are some long term goals for quitting a substance?
Abstinence or reduced substance use, effects Reduced frequency and severity of relapse Improved psychological and social functioning
Recovery and Relapse: Health promotion & illness prevention
Anticipate and address likelihood of relapses Support return to treatment promptly after relapses – one day at a time… Psycho-education and learning assist relapse prevention in the future
Prochazka Change Model
..
summary of Change model
Precontemplation - “people are not intending to take action in the foreseeable future, usually measured as the next 6 months”
Contemplation - “people are intending to change in the next 6 months”
Preparation - “people are intending to take action in the immediate future, usually measured as the next month”[nb 1]
Action - “people have made specific overt modifications in their life styles within the past 6 months”
Maintenance - “people are working to prevent relapse,” a stage which is estimated to last “from 6 months to about 5 years”
Termination - “individuals have zero temptation and 100% self-efficacy… they are sure they will not return to their old unhealthy habit as a way of coping
motivational Approaches
- Express empathy through reflective listening
- Discuss discrepancies if noted
- Avoid argument; roll with resistance (arguing, interrupting, denying , ignoring)
- Support self-efficacy to increase optimism
- explore pros and cons of old and new behaviors to promote positive change
- Hypothetical / Future oriented questioning
Psychosocial interventions
•Identify high-risk situations & thoughts and feelings triggers for drug, alcohol use
•Promote family counseling, group therapy
•Self-help groups
–Alcoholics Anonymous (AA)
–Women for Sobriety (WFS)
–Rational Recovery (RR)
–Narcotics Anonymous (NA)
How does recovery and relapse turn out with substance abusers?
- Rare for addicted person to suddenly stop substance use forever
- Most addicted people try at least once and usually several times to use drug in controlled way
- Tell patient to return to treatment promptly after relapses
- Patients can learn from what they did to try to prevent further relapses
treatment for dual-diagnosed patients
- Integrated approach; both services offered by program staff qualified in both areas
- Need coordination of community services
- Avoid parallel treatment by two different clinicians with different approaches
- Treat in sequence (first psychiatric, then substance abuse can be vice versa)
- Combine pharmacological, psychosocial treatment with supportive services
