Substance Use Flashcards
What is the difference between substance use and abuse?
Substance use can refer to the use of substances but within moderation, with possible benefits (ex. glass of wine with dinner, pharmaceuticals), does not interfere with daily living; substance abuse is the misuse of substances that can produce harmful, disruptive effects to an individuals life (ex. binge drinking)
What is the spectrum of psychoactive substances?
- Beneficial: use that has positive health, spiritual or social impact (ex. coffee to increase alertness, pharmaceuticals)
- Non-problematic: recreational, casual or other use that has negligible health or social impact
- Problematic: use that begins to have negative health consequences for individual, friends/family or society (ex. impaired driving, binge consumption, harmful routes of administration)
- Dependent: use that has become habitual and compulsive despite negative health and social impacts
What is tolerance?
The body’s ability to process a certain amount of a drug.Low tolerance = body can only process a small amount of a drug. Increased tolerance = body has learned how to process increased amounts of the drug (i.e., it takes more drugs to feel the effects). I.e. it is the speed at which the body can metabolize the drug.
What is withdrawal?
The body’s response to cessation of drug use. Many people continue to use drugs so as to avoid withdrawal or “getting sick”.
What is addiction?
- Drug use that has become habitual and compulsive despite negative health and social impacts
- Increases in amount for longer period than intended
- Cannot stop
- Intoxication vs. maintenance
Explain the etiology of addiction:
- BIO: Genetics and neuro-chemical reward pathways
- PSYCHO: individual experience
- SOCIAL: disintegration from community and society
- SPIRITUAL: a disconnection from spirit
- ENVIRONMENTAL: poverty, housing
How do we assess patients with substance abuse?
- Non-judgmental interactions and rapport building
- Multiple medical problems are associated with drug use
- Drug hx and patterns of use
- Withdrawal hx
- Medical and medication history
- Physical exam (ex. intoxication symptoms)
- UDS (urine drug screen)
- Blood alcohol or drug screen
- Neurologic evaluation
- Stage of change (pre-contemplative; contemplative; maintenance; change)
What are some potential nursing diagnoses for addiction?
- Ineffective coping
- Self-care deficits
- At-risk for violence/self-harm
- Pain
- Denial
- Powerlessness
- Altered nutrition
- Low self-esteem
- Limited social supports
- Altered family processes
- Altered sexual functioning
- Deficient knowledge
How do we plan care?
- Use a non-judgmental, patient-centered, holistic approach
- Relapse is part of recovery
What are some interventions we can use for patients with addictions?
- Patient Safety
- Nutritional support
- Withdrawal management
- Medication management
- Social support
- Discharge planning based on patient’s expressed needs
(e. g. housing, financial assistance, outpatient support groups like AA/NA, social/family supports) - Harm Reduction
What is harm reduction?
- Reducing harmful effects without requiring cessation of use
- Needle exchange
- Empower healthy behaviours within context of drug use
- Non-judgemental, accepting, stigma reducing
- Celebrate successes
- Harm Reduction as treatment
- ETOH Maintenance
- War on Drugs
What are the benefits of supervised injection sites?
- Decreased spread of disease
- Decreased infection
- Increased dissemination of knowledge
- Overdose intervention
- Increased uptake of health and addiction services/referrals
- Harm reduction education
- Morals and ideology
- Support by HCP’s (ex. nurses)
Where does tax payer money go in regards to addictions?
- Coordination and research (7%)
- Prevention (4%)
- Treatment (17%)
- Harm reduction (2%)
- Enforcement (70%)
Describe alcohol-related disorders:
1: Alcohol use disorders
Dependence
abuse
2: Alcohol-induced disorders: Intoxication Withdrawal Delirium Dementia and amnestic disorders Depression and anxiety Sexual dysfunction Sleep disorders
What are the complications of alcohol use?
- High tolerance, intoxication and blackouts
- Social functioning (miss work, school, appointments)
- Physical: fatty liver, hepatitis, ulcers, pancreatitis, cardiomyopathy, anemia, low immunity, brain damage, peripheral neuropathy, vasodilation, low hematocrit
Psychological: depression, hostile, denial, irritable, isolative, low inhibitions, low self esteem
Describe minor alcohol withdrawal:
- 1-8 hours
- Anxiety, anorexia, insomnia, tremors, N/V, depression, headache, weak, high BP, tachycardia, diaphoresis
Describe moderate alcohol withdrawal:
- 8-12 hours
- Confusion, gross tremor, nervous, hyperactive, disoriented, tachycardia, night hallucinations
Describe acute alcohol withdrawals:
- 12-48 hours
- All symptoms of minor and moderate withdrawal, plus severe hallucinations and seizures
Describe major alcohol withdrawals:
- Medical emergency, requiring immediate tx
- Delirium tremons
Describe the CAGE questionare (know for exam!):
- Have you ever felt you needed toCUT down on your drinking?
- Have peopleANNOYED you by criticizing your drinking?
- Have you ever feltGUILTY about drinking?
- Have you ever felt you needed a drink first thing in the morning (EYE-OPENER) to steady your nerves or to get rid of a hangover?
How do we treat alcohol withdrawal?
- Seizure precautions - Diazepam, thiamine, Librium/Phenobarbital
- Hydration
- Antabuse - Refrain from anything containing alcohol
- Acamprosate/Campral – treats cravings
- Naltrexone – opioid antagonist
- Harm Reduction – Wet houses/Alcohol maintenance
- Trauma Informed Care
Describe the effects of cocaine (aka. crack), a stimulant:
- A dopamine agonist
- Can be administered by snorting, injecting and smoking, but all short-acting
- Withdrawal a result of dopamine depletion. Causes fatigue, depression, intense cravings and agitation, increasing risk of MI and dependence.
- Tx by psychosocial supports and cravings **
Describe the effects of crystal meth, a methamphetamine:
- Long-acting
- Destruction of neurons that produce dopamine, causing long-term and permanent effects
- Self-medication (ADHD)
- Psychosis common, especially feeling of bugs
- Treated by psychosocial supports, cravings, medical tx
Describe the effects of cannabis:
- THC is the active ingredient
- Can be inhaled/ingested
- Causes euphoria, laughter, lethargy, appetite, blood-shot eyes, dry mouth
- Treated by motivation and encouragement, psychodynamic and interpersonal therapy, relapse prevention; no meds
- Clinical benefits include tx of chronic pain (ex. cancer), neurodegenerative disease, glaucoma
