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PSYCHOLOGY > Substance Abuse and Addictive Disorders > Flashcards

Substance Abuse and Addictive Disorders Flashcards

1
Q

what are risk factors for substance abuse?

A
  1. 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
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2
Q

assessment guidelines for acute chemical impairment

A
  1. 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
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3
Q

signs of alcohol poisoning

A
  1. 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
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4
Q

Interventions for substance abuse

A
  1. Substance abuse intervention 2. Motivational interviewing 3. Pharmacological interventions
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5
Q

What is substance a use intervention?

A

“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

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6
Q

What is motivational interviewing

A

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

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7
Q

4 C’s

A

Control Compulsion Cravings Continued use

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8
Q

Substance abuse

A

Continued despite problems related to use of drugs or alcohol

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9
Q

Concurrent disorder

A

“Concurrent Disorders […describes] a situation in which [an individual] experiences a psychiatric disorder and either a substance use disorder and/or a gambling disorder”

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10
Q

Why do not many people seek treatment

A

Stigma Acceptance of youthful experience Folder emcee and media promotion Powerful tobacco and ETOH industries

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11
Q

Screen tool: CAGE

A
  1. 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
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12
Q

What is delirium tremons (DTs)

A

Acute phase of withdrawal Symptoms: Severe mental/ neuro changes Infections, actue delirium

“shaking frenzy”

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13
Q

What is korsakoffs sydrome? (Looks similar to dementia)

A

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

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14
Q

Prevalence of substance abuse

A

-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

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15
Q

Process of Addiction

A
  1. no use 2. use 3. misuse 4. abuse 5. dependency
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16
Q

when is it an addiction?

A
  • 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
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17
Q

what is substance dependence?

A

severe condition or disease with physical problems and serious disruptions in work, family, social life

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18
Q

what is addiction?

A

persistent, compulsive dependence on substance or behaviour

19
Q

what is concurrent disorder?

A

co-existing mental illness and substance abuse, dependence or addiction

20
Q

what are some abused substances

A

CNS depressants Stimulants - methamphetamine Marijuana (cannabis) Hallucinogens (LSD) Nicotine Phencyclidine (PCP) Opiates Inhalants

21
Q

For patients in withdrawal what is the highest priority nursing intervention?

A

highest priority is patient safety (stabilization of patient’s physiological status until crisis of withdrawal subsides)

22
Q

withdrawl symptoms

A
  • Irritability
  • Anxiety
  • Insomnia
  • Mood instability
  • Drug cravings
  • Anorexia
  • Weakness
  • Flushing
  • Hypersensitivity to stimuli
  • Paresthesias
  • Perceptual distortion
  • Muscle pains/spasms Tension
  • Abdominal pain
  • Seizures
23
Q

consequences of substance abuse

A

Accidents Violence Self-neglect Fetal abnormalities and fetal substance dependence Infection with blood-borne pathogens Hepatitis AIDS

24
Q

questions for their coping

A

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

25
Q

what are destructive coping mechanisms?

A

minimization, denial, projection, rationalization

26
Q

what is delirium tremens?

A

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

27
Q

symptoms of delirium tremens

A

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

28
Q

nursing care for delirium tremens

A

Nursing care  ensure pt safety, adequate hydration, attention to physiologic needs VS Medications - benzo Monitoring

29
Q

Nursing care for detox

A

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

30
Q

what is the drug of choice for ETOH detox?

A

long acting benzos, help with symptoms and siezures

31
Q

which ETOH detox why do we give thiamine and B12?

A

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

32
Q

what kind of environment should you make for detoxing patient

A

Quiet, calm environment to decrease CNS irritability, promote relaxation Reassurance in calm, quiet voice Reorientation Comfort, support…always treat patient with dignity and respect

33
Q

what are the 5 principles to the motivational approach?

A

1.Express empathy 2. Avoid argument 3. Support self-efficacy 4. Discuss discrepancy 5. Roll with resistance

34
Q

what are the 8 steps to motivational interviewing?

A
  1. 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
35
Q

4 Types of Motivational Statements

A

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.”)

36
Q

what are some long term goals for quitting a substance?

A

Abstinence or reduced substance use, effects Reduced frequency and severity of relapse Improved psychological and social functioning

37
Q

Recovery and Relapse: Health promotion & illness prevention

A

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

38
Q

Prochazka Change Model

A

..

39
Q

summary of Change model

A

žPrecontemplation - “people are not intending to take action in the foreseeable future, usually measured as the next 6 months”
žContemplation - “people are intending to change in the next 6 months”
žPreparation - “people are intending to take action in the immediate future, usually measured as the next month”[nb 1]
žAction - “people have made specific overt modifications in their life styles within the past 6 months”
žMaintenance - “people are working to prevent relapse,” a stage which is estimated to last “from 6 months to about 5 years”
žTermination - “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

40
Q

motivational Approaches

A
  • 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
41
Q

Psychosocial interventions

A

•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)

42
Q

How does recovery and relapse turn out with substance abusers?

A
  • 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
43
Q

treatment for dual-diagnosed patients

A
  • 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

PSYCHOLOGY (17 decks)

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