Substance Use Disorder Flashcards
predisposing factors for child addiction
–genetic
–brain chemistry
–psych factors (stress, impulsive, eating disorders)
–environmental (trauma, substance use)
–starting addictive substance at young age
social components of addiction
–social stigma
–environmental
–peer influence
–dysfunctional family dynamics
–abuse hx
–social maladaptation
–family hx of addiction
–peer pressure
–lack of family involvement
psych aspects of addiction
–stress
–depression
–low self-esteem
–increased need for success/power
–inability to cope
–anxiety
–loneliness
biological aspects of addiction
–genetics
–increased extracellular dopamine
–immature brain development
–acetate
–having another mental health disorder
–being male
cocaine and dopamine
stops molecules that usually mop up excess dopamine
amphetamines and dopamine
push dopamine out of sacs where it is stored
heroin and dopamine
makes dopamine-containing neurons fire more
alcohol and dopamine
helps release more dopamine
back of areas of brain are responsible for what?
areas of emotion, memory, impulse, psychomotor activity
front areas of brain are responsible for what?
areas of executive function, planning, problem solving, judgment, impulse control, organization
difference on brain area between adults and teen decision making
adults=frontal cortex
teens=amygdala
what does alcohol break down into?
acetate
how is acetate digestion different between addicts and non-addicts?
non-addicts: acetate moves through system quickly and exits
addicts: acetate barely processed out so, by staying in the body, it triggers a craving for more acetate, which causes the addict to drink more and more
how does repeated alcohol use lead to tolerance and withdrawal?
–fundamental changes in neurotransmitters
–decreased D2 receptors and decreased dopamine release
what does an addicted brain result in?
–compulsive behaviors
–decreased inhibitory control
–increased impulsivity
–impaired regulation of intentional action
define addiction
a pattern of problematic alcohol use that causes distress and significant impairment
substance intoxication
recent overuse/excessive use of a substance, such as an acute alcohol intoxication, that results in a reversible substance-specific syndrome
physiological changes with alcohol intoxication
–slurring of speech
–poor coordination
–impaired memory
–stupor
–coma
substance withdrawal
symptoms develop when a substance is discontinued abruptly after frequent, heavy, and prolonged substance use
symptoms of substance withdrawal
–anxiety
–irritability
–restlessness
–insomnia
–fatigue
symptoms appearing 6-12 hours after alcohol intake
–minor withdrawal symptoms
–insomnia
–tremulousness
–mild anxiety
–GI upset
–headache
–diaphoresis
–palpitations
–anorexia
symptoms appearing 12-24 hours after alcohol intake
–alcoholic hallucinosis: visual, auditory, or tactile hallucinations
symptoms appearing 24-48 hours after alcohol intake
withdrawal seizures: tonic-clonic
symptoms appearing 48-72 hours after alcohol intake
–alcohol withdrawal delirium (delirium tremens)
symptoms of delirium tremens
–hallucinations
–disorientation
–tachycardia
–hypertension
–low-grade fever
–agitation
–diaphoresis
CIWA components
–N/V
–tremors
–anxiety
–agitation
–paroxysmal sweats
–orientation
–tactile disturbance
–auditory disturbance
–visual disturbance
–headache
CIWA score 0-9
minimal withdrawal
CIWA score 10-19
mild-moderate
CIWA score > 20
severe
meds given for CIWA scoring 8-10+
–chlordiazepoxide
–diazepam
–lorazepam
–thiamine
–phenobarb
–inderal
–clonidine
–mag sulfate
–MVI
–antipsychotics
when should thiamine be given to withdrawal patients?
daily, prior to IV dextrose to prevent Wernicke’s
difference between CIWA and COWS
CIWA = alcohol
COWS = opioids
components of COWS
–resting pulse rate
–sweating
–restlessness
–pupil size
–bone or joint aches
–runny nose or tearing
–GI upset
–tremor
–yawning
–anxiety or irritability
–goosebumps
COWS score 5-12
mild
COWS score 13-24
moderate
COWS score 25-36
moderately severe
COWS score > 36
severe
when should nonpharm measures be implemented on opioid withdrawal patients?
BEFORE PRN meds
nonpharm interventions for nausea for COWS pt
crackers, ginger ale, tea, flat warm coke
nonpharm interventions for muscle aches for COWS pt
hot showers, warm compresses
nonpharm interventions for anxiety reduction for COWS pt
distraction, relaxation therapy, talk therapy
pharm interventions for nausea in COWS pt
–ondansetron
–promethazine
pharm interventions for anxiety, lacrimation, rhinorrhea in COWS pt
–hydroxyzine
–avoid benzos
pharm intervention for insomnia in COWS pt
trazadone
pharm interventions for aches and pains in COWS pt
–tylenol
–nsaids
pharm interventions for diarrhea in COWS pt
–kaopectate
–avoid loperamide (sedation)
medication interventions for substance use disorder
–naltrexone
–antabuse
–clonidine
–campral
–methadone/suboxone/subutex
methadone and pregnant women
–decreases variability of illicit drug use on fetus
–limits exposure to health risk for mom and fetus
–dosage may need to be increased throughout pregnancy
fetus experiences symptoms of withdrawal that may be 2-3x intense as mother’s symptoms
action of methadone
–full agonist at opioid receptor sites to decrease craving and withdrawal
–lower likelihood of resp. depression
–blocks effects of other opioids
tolerance
using increasing amounts of a substance over time to achieve the same effect and a markedly diminished effect occurs with continued use
etiology of Wernicke’s encephalopathy
thiamine (vitamin B1) deficiency that directly interferes with glucose production
effect of chronic alcoholism on thiamine absorption
chronic alcoholism can decrease intestinal absorption of thiamine by 70%
other possible causes of thiamine deficiency
–gastric carcinomas
–starvation
–chronic gastritis
–hemodialysis
classic symptoms of Wernicke’s
–mental confusion
–ataxia
–mental status changes (short and long-term memory)
–ophthalmoplegia
ophthalmoplegia
paralysis or weakness of one or more of the muscles that control eye movement
treatment of Wernicke’s
–reversible with thiamine replacement
–improve nutritional status
outcomes of Wernicke’s
–symptom improvement
–without treatment –> Korsakoff Psychosis
Korsakoff Psychosis
–NOT REVERSIBLE
–persistent learning and memory problems
–ataxia
–disorientation
–delirium/psychosis
–confabulation
–neuropathy
confabulation
filling in memory gaps with fabricated or imagined data
symptoms of Wernicke-Korsakoff
–BP and temp low
–pulse rate elevated
–symptoms may mirror intoxication
NIDA principles of treatment
–no single treatment is appropriate for all individuals
–readily available
–attend to multiple needs of patient, not just drug use
–multiple courses of treatment may be necessary
–adequate time for treatment
environmental/community strategies for SUD prevention
–change norms
–reduce access
–limit exposure
–family involvement
–role modeling
–social-emotional development
–access to behavioral health services
CAGE questionnaire
asks about alcohol
CAGE-AID
asks about alcohol and drugs
“not detected or none detected” on UDS
the drug or drugs are not present or are below the established cutoff
UDS result timing
–shows drug use over last 2-3 days for amphetamines, cocaine, and opiates
–marijuana and metabolites may be detectable for several weeks
KY DUI threshold
–>0.02 for under 21
–> 0.08 for over 21
what BAC level can equal death?
0.5 and greater
typical symptoms of .08 BAC
–poor muscle coordination
–harder to detect danger
–judgment, self control, reasoning, and memory are impaired
predictable effects of alcohol on driving
–concentration
–short-term memory loss
–speed control
–reduced information processing capability
–impaired perception
blackout
–not same as syncope
–clients function normally but don’t remember
relapse
recurrence of alcohol or drug dependent behavior in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detox
dual diagnosis
co-occurring mental illness and substance use or addictive disorder
signs of denial
–refusing
–minimizing
–rationalizing
–intellectualizing
–blaming/projecting
–bargaining
–passivity
–hostility
priority care needs for SUD
–provide support for decision to stop
–strengthening individual coping skills
–facilitate learning of new ways to reduce anxiety/stress
–promote involvement of significant others in rehab program
–provide info about condition, prognosis, and treatment
nursing interventions for SUD
–encourage honesty of feelings
–listen to individual
–express caring
–monitor own reactions
–hold individual responsible for behavior
–communicate treatment plan to patient and others on treatment team
planning responsibilities for rehab/recovery
–promote participation in outpatient support system
–assist client to identify alternative sources of satisfaction
–provide support for health promotion and maintenance
planning responsibilities for relapse prevention
–recognize the danger signs leading to relapse
–develop a relapse prevention plan
components of recovery
–hope
–self-responsibility
–setting life goals
–adherence to treatment plan
–improving coping skills
–therapies
–peer support programs
–harm-reduction strategies
–patient specific interventions
–life long commitment
components of client/family education for SUD
–nature of the illness
–management of the illness
–problem solving skills
–essentials of good nutrition
–relaxation techniques
nature of the illness (SUD)
–effects of substance on the body
–ways in which use of substances affects life
management of the illness (SUD)
–activities to substitute for in times of stress
–increase coping skills
relaxation techniques (SUD)
–progressive relaxation
–tense and relax
–deep breathing
–mindful meditation
–imagery
–yoga
definition of evaluation
reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care
CARA addiction
Comprehensive Addiction and Recovery Act of 2016 (Obama)
What is CARA?
authorizes 181 million each year in new funding to fight addiction, engaging SUD through evidence-based practices (medication assisted and individualized treatment and recovery)
