substance use and addiction disorders Flashcards
substance addiction
strong craving of substance, persistent desire to cut down w/o success increased social isolation
impact social, occupational and recreational and unable to fulfill role obligations
result in hazardous activities, continue despite harmful consequences, excessive time spent trying to procure substance or recover from use
may result in tolerance or withdrawal
chronic, env and NT and genetics and life experiences
specific substances have own disorders
stigma
biggest barrier to tm
moral weakness
lang: addict, alcoholic, drunk, substance or drug abuser, drug habit, dirty
“substance use disorder”
+/- drug screening
countertransference
unconscious feelings that hcp has toward pt, unconsciously displace feelings r/t significant figure in nurses past onto pt, overinvolvement, impairs therapeutic relationship
examine own attitudes, past experiences may impact perceptions and influence how they treat
rf
bio = genetic predisposition
neuro bio = NT (dopamine)
env = chronic stress, anx, abuse, trauma, around others with abuse, access, lack of coping or effective coping
starting early
biological aspects
genetic, increased extracellular dopamine, immature brain (adolescents), acetate function
another MH disorder (dual dx): dep, ADHD, PTSD -> self medicate to decrease s/s and mask feelings
male more freq but progress faster in F
dopamine
feel good NT, excess gives high feeling, relapse v common
all drugs increase extracellular dopamine
cocaine: stops reuptake
amphetamines: push dopamine out of sacs
heroin: fire more dopamine neurons
OH: release more dopamine
immature brain dev
early experience affect brain dev, early stress and trauma affect brain dev, brain dev until 24
brain matures from back to front
back = amygdala: emotions, mem, impulse, psychomotor activity -> making decisions in adolescent brains
front = executive function, planning, problem solve, judgement, impulse control, organization -> make decisions in adults
est pathways and patterns
reasons for continued use
repeated use leads to tolerance and withdrawal
NT change, less D2 receptors and decreased dopamine release -> need to drink more to get same effect
causes compulsions, decreased impulse control, increased impulsivity, impaired reg of intentional actions
PET
monitor response to drugs -> short and long term effects
OH and acetate
OH (and nicotine) breaks down into acetate, triggers craving for more
normally moves through body fast; in chronic addict, liver and pan take longer
lose control, craving cycle, acetate accumulates
substance intoxication
recent overuse/excessive use that results in reversible substance specific syndrome
s/s are drug specific
impaired judgement, may have inappropriate/maladaptive behavior and imapired social/occupational funcitoning
CNS change, disrupt physiological and psychological funcitoning
can happen with 1 time use
BAC
0.08%
poor muscle coordination: balance, speech, vision, rxn time, hearing
hard to detect danger, judgement, self control, reasoning, mem
driving: [], short term mem loss, speed control, decreased info processing capacity (signal detection, visual search, impaired perception)
tolerance
person no longer repsonds to drug or substance as they initially did, need increasing amounts
happens at different times with different substances: cocaine = fast, rx pain meds = slow
blackouts
not passing out
excessive OH and amnesia, engage in behaviors, perform complicated tasks, appear normal
relapse
recurrence of dependent behavior in one that previously achieved and maintained abstinence for significant time beyond period of detox
screening tools
SBIRT, CRAFT, AUDIT, CAGE-AID
felt you should cut down, annoyed with criticism, felt guilty, had eye opener drink
nurse role: most ok with being screened, open to quality advice, ready to change
assess
background, pattern of use, MH s/s, trauma hx, fam hx of SA or MS, strengths + willingness to change
BAC
planning
rehab: participate in output support system, alternative coping, health promo and maint
relapse prevention: danger s, prevent plan
intervention
safety and sleep, nutrition (gradually reintroduced, hydrate), VS, therapeutic relationship, meds, assess, self care (self esteem), coping, goal setting (hope, see beyond current), health teaching + promo
recovery
hope, self responsibility, setting life goals, adherence to agreed upon treatment plan, improve coping skills, therapies, peer support, harm of strategies, pt specific, life long commitment
meet the patient where they are
fam involvement
decrease relapse SE
pt and fam education
nature of illness: effects on body and life
management: sub activities, increase coping
problem solving skills
essentials of good nutrition
relaxation techniques: progressive, dense and relax, deep breathing, mindful meditation, imagery, yoga
other support services
financial, legal, 1:1 support person, alanon-alateen -> children of parents with addiction
instill hope as nurse
SBIRT
public health approach, delivery of early intervention and treatment services for those with and at risk of SUD
goal = decrease and prevent health consequences, disease, accidents, injuries, costs, hc utilization
screening
severity of use, appropriate level of treatment
brief intervention
more insight and awareness and motivation
referral to tm
more specialty tm get access to care prn
SBIRT: brief negotiated interview - step 1
rapport
ask to screen
SBIRT: brief negotiated interview - step 2
pros and cons of OH use discussed and summarized
background, patterns of use, MH s/s, trauma, fam hx, disabilities, strengths, willingness to change
SBIRT: brief negotiated interview - step 3
info and feedback: ilicit provide ilicit
risky drinking: preg, drive, certain meds, certain conditions, in recovery, unable to control
hazardous = increased r/o adverse consequences
harmful = negative consequences have already occured
SBIRT: brief negotiated interview - step 4
discuss and interpret score
range: give possible score range
ask what they think they got
give normal range
give score
elicit rxn -> feelings about score
SBIRT: brief negotiated interview - step 5
motivation for change
importance, confidence, readiness
reinforce positives, ask about lower #
SBIRT: brief negotiated interview - step 6
negociate action plan -> motivaitonal interviewing: impathy, discrepancy, avoid argue, roll with resistance, support self efficacy
open ended Q: safe, rapport, trust, explore, clarify, past, gather info, help make informed decisions -> strengths and support
reflective listening, summarizing
effects of OH on body
cancer of throat and mouth, pancreatitis, premature aging, painful nerves, numb and tingle in toes
referral to services
out pt counseling, acute tm (detox), clinical stabilization, peer support group
nursing actions
honest feelings, listen, care, monitor own rxn, hold individual responsible, comm tm plan, set realistic goals, prioritize care needs (support, coping, fam/friends, provide info
