Substance misuse/Dependence/Addition Flashcards
What is a substance?
“Any chemical entity that is used non- medically and is (generally ) self – administered, through any route of administration for its positive psychoactive effect”
-WHO 2008
What could a substance be?
Legal:
Alcohol
Tobacco
Illegal:
Heroin
Controlled for use by licensed prescribers for medical purposes.
What are the classifications substances are divided into?
Nicotine — cigarettes, vapor-cigarettes, cigars, chewing tobacco
Alcohol —beer, wine, and distilled liquors
Cannabinoids — Marijuana, hashish, hash oil, and edible cannabinoids
Opioids — Heroin, methadone, buprenorphine, Oxycodone,
Depressants — Benzodiazepines (e.g., Valium) and Barbiturates (e.g., Seconal)
Stimulants —amphetamine, methamphetamine, methylphenidate (e.g., Ritalin),
Hallucinogens — LSD, mescaline, and MDMA (e.g., Ecstasy)
What is substance misuse?
Using any of these substances at high doses or in inappropriate situations can cause a health or social problem — immediately or over time. This is called substance misuse. Such as binge drinking. Drinking more than the recommended standard alcoholic drinks in one sitting (a few hours).
What can substance misuse and dependence impact?
Health - Physical:
Dental neglect
Lack of fitness
Tiredness
Hangovers
vomiting
Ulcers
Liver disease
Weight loss
Weight gain
Blackouts
Memory Loss
Injuries
Premature Aging – females
R/ships - Effects:
Self
Partner
Children
Parents
Siblings
Friends
Workmates
Lack of trust
Fear
Instability
Violence
Unfaithfulnes
Cruelty to pets
Denial of feelings
Economics:
Drugs
Debts
Bad priorities
Fines
Lawyers fees
Selling Possessions
Gambling
Credit cards
Car crashes
No holidays
No good clothes
No extras/treats
Legal:
Lawyers
Separation/Divorce
Traffic crimes
Law crimes
Jail/PD
Probation
Periodic/ Home detention
Nonviolence/ non – molestation orders
Spirituality:
Morals
Conscience
Faith
No inner peace or serenity
Forgiveness issues
————–
Mental:
Lack of motivation
Paranoia
Hopeless
Poor concentrate
Resentfulness
Anger
Dishonesty
Employment:
Lateness
Missed days
Poor quality of work
Missed promotion
Danger to self and others
Unemployment
Lack of motivation
Job Loss
What are some screening tools?
AUDIT
CAGE
ASSIST V3
SACCS (young people)
What is the screening for?
The screen is for you, the nurse, to decide to refer to specialist services (dependence) or conduct a Brief Intervention (Substance misuse/hazardous/problem use)
What are the different types of substance dependence/addiction?
Dyscontrol – Substance used more times than intended
Salience – Much time is spent in substance use
Compulsion of use – Continued use despite knowledge of problems
Physiological features – acquired tolerance, withdrawal symptoms
What does ASEAN stand for?
A = assessment (brief assessment)
S = Summary (Feedback to client current risks/harms i.e.: sexual activity, work performance)
E = Education (ALAC guidelines drinking, risks of drinking for them)
A = Advice (To reduce this risk, it is medically advised to lower/ reduce your substance use)
N = Negotiate a plan (This weekend = movie night
What are some key features of brief intentions?
Time limited
“ teachable moments ”
Need to be considered in the context of ongoing relationship with patient and family
Can improve other health outcomes for the person - reduce anxiety, improve sleep.
Increase self management skills/ resilience
Enhance self efficacy
Clearly defined goals ( link goals to persons values and beliefs)
What are some interviewing skill to imbed the chosen brief intervention?
Roll with resistance:
- Its okay if you don’t think any of these ideas will work for you, perhaps you’ve been thinking about something that might work instead?
Ultimately, it is your decision. -So, what would you like to try?
- You are right. I am concerned about your _______, but you are the one in control.
- I don’t understand everything you are going through, but if you share what you’ve tried, maybe together we can find something that could work for you.
- Would you like to talk about some ideas that have worked for other people and use what works for you?
Self – efficacy:
- How important is this to you?
- How much do you want to_____?
-How confident are you that you can make this change?
- It sounds like you want to continue to ______. What personal strengths do you have that will help you succeed?
- Who could offer helpful support so you can continue
Reinforcing Positive Change-talk:
- That sounds like a good idea
- That’s a good point
- You are very considerate of how your decisions effect other people
- I can see that it’s important to you to be a good parent.
Developing Discrepancy:
- What is it about your________ that others may see as reasons for concern?
- How has ________ stopped you from doing what you want to do?
- The fact you are sharing with me indicates that you are interested in learning about ______. Why do you want to learn about ________?
- What makes you think you need to make a change?
If things worked out exactly as you like, what would be different?
- If you decided to change, what do you think would work for you?
- What concerns you about making changes?
- So, on the one hand you use ________ to help with anxiety/fear, and on the other
What is health literacy?
The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions -WHO 2010
What can you do if someone is not willing to change?
Don’t be discouraged - theperson may become willing towork on this in the future.Communicate your concern andwillingness to help.Continue to monitor use andrecommend change at futurevisits.
What is the Nursing process?
Screening
Brief assessment
Continumm
Stages of change model
Brief intervention
FRAMES (ASEAN)
Motivational interviewing skills
What is ‘Pre-contemplation’ in the change model?
Pre-contemplation: no intention of changing behaviour in the near future (6 months approx), generally appearing unmotivated and resistant to change
What are the tasks of ‘Pre-contemplation’
Tasks: Increase awareness of need for change and concern about the current pattern of behavior; envision possibility of change
What is ‘Contemplation’ in the change model?
Contemplation: individual state their intent to change in the near future but are ambivalent about change
What are the tasks of ‘Contemplation’?
Tasks: Analysis of the pros and cons of the current behavior pattern and of the costs and benefits of change. Decision-making.
What is ‘Preparation” in the change model?
Preparation: individual intend to actively change, within the next month or so, and preparation is therefore a transition from contemplation to action rather than a stable state
What are the tasks of ‘Preparation’?
Tasks: Increasing commitment and creating a change plan.
What is ‘Action’ in the change model?
Action: the individual is making changes, or has done so recently
What is the tasks of ‘Action’?
Tasks: Implementing strategies for change; revising plan as needed; sustaining commitment in face of difficulties
What is ‘Maintenance, relapse, and recycling’ in the change model?
Maintenance, relapse and recycling: individuals maintain the gains made and prevent relapse
What are the tasks of ‘Maintenance, relapse, and recycling’?
Tasks: Sustaining change over time and across a wide range of situations. Avoiding going back to the old pattern of behaviour
What are the stages of regression, relapse and recycling?
Regression: represents movement backward through the stages
Slips: are brief returns to the prior behavior that represent some problems in the action plan
Relapse: is a return or re-engaging to a significant degree in the previous behavior after some initial change
After returning to the prior behavior, individuals Recycle back into pre-action stages (pre-contemplation, contemplation, or preparation).
What are the stages of the change model?
Contemplation
Preparation
Action
Maintenance
relapse
What is a Brief intervention?
Brief Intervention is defined by any interaction with a client where the clinician is attempting to promote changes to at risk health behaviours….
Brief Intervention is mostly defined by the delivery style of the clinician. An empathetic and non-judgemental approach during assessment and discussion is the most remembered feature of the session by clients, above any information received.
What are the six common elements of effective brief interventions (FRAMES)?
Feedback of personal risk of impairment
Responsibility for change
Advice to change
Menu of alternative change options
Empathy as a counselling style
Self-efficacy or optimism
What does a Brief intervention involve?
A Assessment (brief assessment of current use)(CAGE)(AUDIT)
S Summarisation of findings to client (feedback of clients risk)
E Education
A Advice
N Negotiation of a plan / strategy to attempt
What is the CAGE framework?
c- Have you ever felt you ought to Cut down on your drinking?
a- Have people Annoyed you by criticising 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 get rid of a hangover? (Eye-opener)
List some intoxicating or addictive substances below
- Alcohol
- Cannabis
- Opiates
- Amphetamines
- Benzodiazepines
Why do you think people are reluctant to admit they have a substance-related disorder
shame
fear of stigma, judgement or discrimination
Brief Intervention
Components include: assessment, feedback, listening and advising, strategies, defining treatment goals, discussing strategies
Motivational interviewing
Precontemplation - no intent of changing
Contemplation- is aware of problem but reaims ambivalent thinking about changing. therapist must acknowledge this works on tipping, offers support/ client responsibility
Preparation- client intends to change but is confused, looking for advice and support, therapist inspires hope and choice while demystifying the change process
Action- behaviour changes commence
Maintenance- Change has been achieved, vigilance required to avoid relapse and may slip back and have to work their way back through the cycle.
Relapse prevention
Relapse - this is an expected part of this process and care must be taken to ensure the client understands this to avoid a sense of guilt of failure
Harm minimisation and harm reduction
Needle exchange programmes
Methadone programmes (opioid recovery service)
Nicotine replacement therapy (NRT)
AA (alcoholic anonymous)
NA (narcotics anonymous)
Controlled drinkings ideas
Alcohol withdrawal
Common symptoms- temor, hypertension ,restlessness, sweating diarrhoea, readachem difficulty breathing, decreased, appetite, anxiety
nursing management- reduce agitation, remain calm, observe airways and breathing, monitoring vital signs and assess for head injury, keep client calm and reduce exhaustion and increase hydration
substance withdrawal and detoxification (five main areas)
- minimise progression to severe withdrawal
- decrease risk of injury
- elimination risk of dehydration, electrolyte and nutrition imbalance
- reduce risk of seizure
- identify presence of concurrent of different diagnosis
What is a substance
Any chemical entity that is used non-medically and is generally self-administered, through any route of administration for its positive psychoactive effect
Psychoactive (mind altering) compound with the potential to cause potential health and social problems (including addiction)
Nicotine
cigarettes, vapor-cigarettes, cigars, chewing tobacco
Alcohol
beer, wine, liquors
Cannabinoids
marijuana, hashish, hash oil, edibles
Opioids
heroin, methadone, buprenorphine, oxycodone
Depressants
benzodiazepine (valium), barbiturates (seconal)
Stimulants
amphetamine, methamphetamine, methylphenidate (ritalin)
Hallucinogens
LSD, mescaline and MDMA (ecstasy)
