Substance Use

Question 1

User related factors:
Environmental Factors:
Drug Related Factors:

Answer 1

User related factors: genetics, personality, disorders that require pharmaceuticals, prior experience with drugs

Environmental Factors: role models, peer influences, educational level, societal and community norms

Drug Related Factors: availability, price, dose, mode of administration, speed of onset, the type of substance

Question 2

Risk factors
Biology
Environmental
Drug

Answer 2

Biology:
-genetic risk: if bio parents have a substance use disorder or mental illness they have at an increased risk
-gender: Males at higher risk for substance use, but female at risk for developing into severe category mush faster when it hits moderate.
-mental disorder

Environment:
-chaotic home and abuse
-parents use and attitudes
-peer influences
-community attitudes: ex. In rural places kids start drinking at 13 with parents or inversely footloose where tou ban it. Any extreme attitudes towards substance use
-poor school achievement

Drug
-early use: the younger someone is when they start using the more at risk to develop substance use
-availability
-route of administration: inhaled, mouth, lungs, mucus membrane, injection
-effect of drug itself: how strong, quick acting, how it makes people feel

Question 3

The 4 C’s

Answer 3

Craving
Compulsion: acting on the thoughts
Continued used despite negative consequences
Cognitive changes, cognitive distortions: mental gymnastics, rationalization to justify the use

Question 4

CAGE

Answer 4

CAGE Questions Adapted to Include Drug Use (CAGE-AID)
Have you ever felt you ought to cut down on your drinking or drug use?
Have people annoyed you by criticizing your drinking or drug use?
Have you felt bad or guilty about your drinking or drug use?
Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hang

Question 5

CRAFFT

Answer 5

Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?  

Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?  

Do you ever use alcohol or drugs while you are by yourself, or ALONE?  

Do you ever FORGET things you did while using alcohol or drugs?  

Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?  

Have you ever gotten into TROUBLE while you were using alcohol or drugs?

Question 6

To vs For - Attachment

Answer 6

We see what the substance does to the person, they see what it does for them.

Question 7

Critical period of risk in alcohol withdrawl

Answer 7

24-72hrs. Needs very regular monitoring in this time period.
**Can be fatal if untreated

Question 8

Alcohol Withdrawal Symptoms

Answer 8

Increased blood pressure, temperature and pulse
Diaphoresis
Increased hand tremor
Insomnia
Nausea or vomiting
Psychomotor agitation
Anxiety
Generalized tonic-clonic seizures
Delirium tremens
Transient visual, tactile, or auditory hallucinations or illusions

Stage 1: 8hrs
Anxiety insomnia, nausea, abdominal pain

Stage 2: 1-3days
-high bp, increased temp

Stage 3: 1week
-hallucinations, fever, seizure, agitation

Question 9

MINDS

Answer 9

Minneapolis Detox Scale (MINDS) – Alcohol Withdrawal

Question 10

CIWA

Answer 10

The Clinical Institute Withdrawal Assessment for Alcohol

Question 11

Benzodiazepines Intoxication

Answer 11

Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impaired coordination
Stupor
Coma

Question 12

Benzodiazepines Withdrawl

Answer 12

(basically the same as alcohol)
High blood pressure, pulse, temp
Tremor
Insomnia
Nausea and vomiting
Visual, tactile, or auditory hallucinations
Agitation
Anxiety
Grand mal seizures

Question 13

Opioid Intoxication

Answer 13

Euphoria followed by apathy, psychomotor agitation or retardation, impaired judgement
Pupillary constriction
Drowsiness or coma
Slurred speech
Impaired attention or memory
*Respiratory depression (can be fatal)

Question 14

Opioid Withdrawal

Answer 14

Withdrawal symptoms typically last for approximately 1 week

Symptoms gradually decrease in intensity
Dysphoric mood
Nausea or vomiting
Muscle aches
Lacrimation (teary eyes)
Rhinorrhea (running nose)
Pupils dilate
Piloerection (goosebumps)
Sweating

Not physically life threatening

Question 15

COWS

Answer 15

Clinical Opiate Withdrawal Scale

Question 16

Clonidine

Answer 16

antihypertensive that assist with reducing uncomfortable symptoms of opiate withdrawal
sweating
hot flashes
watery eyes
anxiety
Clonidine may also help expedite recovery
Due to antihypertensive properties a nurse MUST take the clients blood pressure prior to administering clonidine
*Do not administer if client is hypotensive

Question 17

Opidio withdrawl Maintenance Options
(3 drugs)

Answer 17

Naltrexone - educing cravings and feelings of euphoria associated with substance use disorder

Suboxone (Buprenorphine with Naloxone) - relieves cravings to use and withdrawal symptoms

Methadone Maintenance - liminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brain

Question 18

Methadone

Answer 18

Methadone is a controlled substance
In acute care settings – typically requires are 2 nurse check prior to administration
Not all psychiatrists/physicians can prescribe methadone
Long lasting effects (24-36 hours)
Comes in liquid form
Administered with orange juice

All opiates have a risk of overdose – methadone is relatively safe when taken as prescribed

Acts on the receptors but without the high

Question 18

Methamphetamines

Answer 18

• Highly addictive stimulant that affects the CNS
• People experience a rush of euphoria
• Pleasurable effects of methamphetamine disappear before the drug concentration in the blood falls significantly
• High incidence of methamphetamine induced psychosis. High conversion rates to schizophrenia with continued use.
• People who have prolonged use may exhibit symptoms that can include:
  – Anxiety
  – Confusion
  – Insomnia
  – Mood disturbances
  – Psychotic features: paranoia, hallucinations, & delusions
• Psychotic symptoms can sometimes last for months or years after a person has abstained
• Stress may precipitate spontaneous recurrence of methamphetamine psychosis
• People start taking things apart and putting them back together again. This is generally due to paranoia about bugs/cameras in the electronics
• Cycle of use is in the 7 day window (they say “oh I’ve replased after 7 days of being clean” but that’s not really true as they never had to deal with the hard withdrwal sysmptoms they are just in a cycle or use instead.)

Question 19

Treatment and Interventions for Methamphetamine/Stimulant Psychosis

Answer 19

• Mirtazapine and Bupropion have demonstrated promise for treatment.
• Prescribed stimulants as a harm reduction strategy
• Olanzapine and Clopixol are regularly used to treat this type of psychosis and have been found to be fairly effective.
• May be prescribed for acute and/or chronic experiences of psychosis
• Contingency management (CM)
• Exercise
• Cognitive Behavioural Therapy, Motivational Interviewing
• Clopixol is affordable and comes in injectable form, this is useful for people who may continue to use.
• Exercise helps to produce endorphins and also the rush of physical heart pounding sensation

Question 20

tobacco withdrawal

Answer 20

Irritability
Restlessness
Anxiety
Insomnia
Fatigue
Increased hunger

Contingency management can be finding ways to engage in the reward pathways without using (ex. Getting a freezie if you don’t use but want to)

Olanzapine, clozapine, and Haldol. If they’re on this meds and not smoking then potentially they need to be o a lower dose (review this section)
Nicotine relationment therapy is needed to figure out their meds doses if we know they’re going to keep smoking when they go outside
Nicotine gum, they chew it, makes a tingly sensation and they park it in the mucus membrane. It’s absorbed through the membrane not through swallowing. Noramlly meds gum lasts about 15min

Question 21

Cannabis Withdrawal

Answer 21

Anger, anxiety, restlessness, low mood, sleep disturbance (disturbing dreams, insomnia)
Pharmacotherapy – targeting sleep, anxiety
Psychotherapeutic interventions, MI

Question 22

Medical Cannabis

Answer 22

An employee of a hospital, such as a nurse, may administer medical cannabis to a client who is under treatment as an in-patient or out-patient in hospital as long as the following criteria are met:
this role is authorized for the nurse by the administration of the hospital, for example, in the form of a written policy that support’s the practice,
the client has a valid medical document or written order that authorizes their access to medical cannabis, and
the medical cannabis is received from either a holder of a license for sale or a holder of a license for processing.

Question 23

Diversion Signs
(Problematic Substance Use by Nurses)

Answer 23

failing to ask for cosigners for meds that need cosigning. Volunterring to hold narcotic keys. Doing narcotic count alone and then asking for a signature after.
Never sign for something you never witnessed
If the client reports missing doses
Asking to cover breaks then gving out the meds to your patient that has narcotics