Substance Use Disorders Flashcards
Addiction
repeated harm from use
pt needs our care, like w/ any other chronic medical conditions
relapsing and remitting pattern
chronic brain disease
Urine Drug Testing
results may not be confirmed
interpret w/ caution
there are false positives (poppyseeds)
Addiction: Etiology
unknown
biologic/genetic: family hx w/ alcohol use = higher risk
environmental: cultural factors, social attitudes, peer influence, laws, cost, and availability
psychological: family dynamics, poor role modeling
neurotransmitter: drugs increase dopamine in the brain (reward center specifically)
Addiction: Cultural Considerations
attitudes/physiological differences to substances vary by culture by
ex: flushing reaction among people of asian ancestry
Intoxication
use of a substance resulting in maladaptive behavior
Withdrawal
is the physiological reactions that occur when a substance is stopped or dramatically tapered
What Classes of Meds Require Detox?
alcohol
opioids
benzos
could be stimulants but usually there isn’t a life-threatening withdrawal
Detoxification
referred to as medically supervised withdrawal
is the process for safely withdrawing from a substance
Tolerance
the process that occurs when the body no longer responds to a drug the way they did when it was first started
it takes a higher dose of the drug to achieve the same effect
Dependence
not the same thing as addicted
it means that when a person stops using a drug, their body goes through a withdrawal
ex: life threatening withdrawal from alcohol, benzos, barbiturates
Co-Dependence
level of dependence exceeds what is healthy-learned behavior
characteristics: poor relationship skills, excessive anxiety, compulsive behaviors, resistance to change
type: enabling
- may seem helpful but it perpetuates the substance use
- calling the job to report sickness when person is hungover
Behavioral Addictions
gambling sex spending money overeating gaming food
the act is no longer a source of pleasure, it becomes ingrained so that the person continues to perform it despite negative consequences
*gambling disorder is the only condition in the DSM “Non-substance-related disorder”
Alcohol Intoxication (ethanol)
-CNS depressant
-blood alcohol test measures alcohol in the blood (BAL)
-absorbed in the bloodstream and processed by the liver
-process one drink per hour
(12oz beer, 5oz wine, 1.5oz whiskey)
Alcohol Intoxication/Overdose
risk of:
- vomiting
- unconsciousness
- respiratory depression (can cause aspiration pneumonia, pulmonary obstruction)
Alcohol Withdrawal
onset: 4-12 hours after last drink
peak: 24 hours
duration: five days (variable) - 96 hours!
Alcohol Withdrawal: Tx
- benzodiazepines (diazepam)
- anticonvulsant to decrease benzodiazepine load (Gabapentin - extra seizure precautions)
- seizure precautions
- fluids (dehydration, malnourished, etc.)
- electrolyte
- symptom triggered: providing meds when client has symptoms, CIWA (to help assess sx), schedule developed based on CIWA score, lorazepam, diazepam
- fixed-schedule dosing
- front loading approach (10mg qhr for 4 doses for the first day they are admitted)
CIWA-AR
Clinical Institute Withdrawal Assessment
- n/v
- tremor
- diaphoresis
- anxiety
- agitation
- tactile disturbances
- auditory distrubances
- visual disturbances
- headache
- sensorium (LOC)
Alcoholic Hallucinosis
not delirium tremens (DT)
-12-24 hours after incidence and are gone w/in 48 hours
visual clear sensorium (know they are hallucinating, are uncomfortable, not disoriented)
DT
delirium tremens
- hallucinations
- disorientation
- autonomic hyperactivity
- agitation
- diaphoresis
- 48-96 hours after last drink
Alcohol Withdrawal: Seizure and DT
generalized tonic/clonic w/in 12-24 hours
day 3-4: at risk for DT
Thiamine and Folate
Banana bag: IV infusion of thiamine, folate, MVI
prevention of wernicke encephalopathy
neurological symptoms caused by thiamine deficiency
Physiological Effects of Long-Term Alcohol Ise
cardiac myopathy pancreatitis esophagitis hepatitis cirrhosis leukopenia thrombocytopenia ascites
Cannabis
Cannabis induced hyperemesis
cannabis and psychosis: transient acute psychosis
- substance induced psychosis
- exacerbation of sx w/ schizophrenia
Synthetic Cannabis
spike, K2, spice
hallucinations, delirium, seizures
inhalation of adulterated herbs
won’t show up on a urine drug screen
Vaping
Evali: form of acute lung injury (vaping associated lung disease)
Inhalation of aerosol created by a liquid or wax (Nicotine/THC)
What are Opioids?
an opiate is derived from the opium poppy plant, while opioids are substances that act on the opiate receptors/manmade
the poppy plant is the source of all natural opiates (morphine, diacetylmorphine), whereas synthetic opioids are made in a lab (oxycodone, methadone)
opioid receptors are located in the brain, spinal cord, and gut
How Opioids Cause Overdose
in OD, there is an excessive effect on the portion of the brain regulating respiratory rate, resulting in respiratory depression and death
OD Risk Factors
- reduced tolerance
- mixing drugs
- using alone
- fentanyl/adulterants
- injection or inhalation of the opioid
- prior overdose
- use w/ other CNS depressants (Gabapentin, ETOH, benzos, etc.)
Signs of OD
- over sedation is a sign of impeding OD
- OD is not always immediate
- Fentanyl related ODs can be fatal w/in minutes
- blue lips/nails
- dizziness/confusion
- choking/gurgling/snoring sounds
- slow/diminished/no breathing
- drowsiness/difficulty remaining awake
What is naloxone?
- it displaces opioids off the opioid receptor and blocks the receptor (antagonist)
- opioid receptor is blocked for 30-90 minutes
- given most often as nasal spray
- can be given as injection or IV
- restores breathing w/in 1-4 minutes
Opioid Withdrawal: Sx
resting pulse sweating restlessness pupil size - dilated bone/joint aches runny nose or tearing GI upset tremor yawning anxiety or irritability piloerection (goosebumps)
Clinical Opiate Withdrawal Scale
COWS
Opioid Use Disorder: Tx
naltrexone: pure opioid antagonist (vivitrol - like Nalaxone)
Buprenorphine: partial opioid agonist/antagonist (ceiling effect)
-special license to prescribe w/ restrictions
Methadone: full opioid agonist (very long duration of action)
-only available via OTP’s (opioid treatment programs “methadone clinic”)
Buprenorphine
brand names:
- suboxone (has naloxone) - usually prescribed
- subutex (no naloxone)
absorbed directly into the blood by the veins under the tongue
do not swallow or it will be destroyed by stomach acid
do not use nicotine products before use as it causes vasoconstriction, decreasing the surface area of blood vessels that absorb the med
continue while NPO
nursing: monitor the pt for the full 3 minutes that it takes for med to be absorbed
Buprenorphine: Pt Education
SE: HA, dizziness, nausea, constipation, sexual dysfunction, urinary retention
storage of the med: safe/locked box, careful w/ children
understand that discontinuing buprenorphine increases risk of accidental OD/death
not recommended to combine alcohol/benzos or other CNS depressants
plan for procedures
Harm Education
it’s not condoning use, rather it is valuing life w/o judgement
people have the right to continue using substances
Harm reduction strategies:
- don’t use alone
- fentanyl test strips
- naloxone
- peer support
Hallucinogens/Inhalants
feeling of detachment from body
- mostly ingested
- dextromethorphan (paranoia), LSD, PCP, Ketamine
inhalant of chemical vapors that create an altered mental state
Tobacco Use Disorder
Varenicline
NRT
Bupropion
Why Use the 12-Steps?
while meds are important in recovery, don’t teach and practice:
- responsibility
- honesty
- respect for others
- 12 step programs not only promote model recovery
- 12 step members from a new, sober, social group for guidance and support
- free
- available to help people stay sober
- meetings are currently easier than ever to access
Motivational Interviewing
- type of therapy utilized in substance use tx
- goal is to feel less frustrated and be more effective in helping people change
- guiding style of communication
- focus on the language of change
- evoking in the person their own reasons for change
Dual Diagnosis
substance use + another psychiatric illness
~50% of people w/ substance use disorder have a mental health diagnoses
