Substance Use Disorders

Question 1

Addiction

Answer 1

repeated harm from use

pt needs our care, like w/ any other chronic medical conditions

relapsing and remitting pattern

chronic brain disease

Question 2

Urine Drug Testing

Answer 2

results may not be confirmed

interpret w/ caution

there are false positives (poppyseeds)

Question 3

Addiction: Etiology

Answer 3

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)

Question 4

Addiction: Cultural Considerations

Answer 4

attitudes/physiological differences to substances vary by culture by

ex: flushing reaction among people of asian ancestry

Question 5

Intoxication

Answer 5

use of a substance resulting in maladaptive behavior

Question 6

Withdrawal

Answer 6

is the physiological reactions that occur when a substance is stopped or dramatically tapered

Question 7

What Classes of Meds Require Detox?

Answer 7

alcohol
opioids
benzos

could be stimulants but usually there isn’t a life-threatening withdrawal

Question 8

Detoxification

Answer 8

referred to as medically supervised withdrawal

is the process for safely withdrawing from a substance

Question 9

Tolerance

Answer 9

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

Question 10

Dependence

Answer 10

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

Question 11

Co-Dependence

Answer 11

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

Question 12

Behavioral Addictions

Answer 12

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”

Question 13

Alcohol Intoxication (ethanol)

Answer 13

-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)

Question 14

Alcohol Intoxication/Overdose

Answer 14

risk of:

• vomiting
• unconsciousness
• respiratory depression (can cause aspiration pneumonia, pulmonary obstruction)

Question 15

Alcohol Withdrawal

Answer 15

onset: 4-12 hours after last drink
peak: 24 hours
duration: five days (variable) - 96 hours!

Question 16

Alcohol Withdrawal: Tx

Answer 16

• 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)

Question 17

CIWA-AR

Answer 17

Clinical Institute Withdrawal Assessment

• n/v
• tremor
• diaphoresis
• anxiety
• agitation
• tactile disturbances
• auditory distrubances
• visual disturbances
• headache
• sensorium (LOC)

Question 18

Alcoholic Hallucinosis

Answer 18

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)

Question 19

DT

Answer 19

delirium tremens

• hallucinations
• disorientation
• autonomic hyperactivity
• agitation
• diaphoresis
• 48-96 hours after last drink

Question 20

Alcohol Withdrawal: Seizure and DT

Answer 20

generalized tonic/clonic w/in 12-24 hours

day 3-4: at risk for DT

Question 21

Thiamine and Folate

Answer 21

Banana bag: IV infusion of thiamine, folate, MVI

prevention of wernicke encephalopathy

neurological symptoms caused by thiamine deficiency

Question 22

Physiological Effects of Long-Term Alcohol Ise

Answer 22

cardiac myopathy
pancreatitis
esophagitis
hepatitis
cirrhosis
leukopenia
thrombocytopenia
ascites

Question 23

Cannabis

Answer 23

Cannabis induced hyperemesis

cannabis and psychosis: transient acute psychosis

• substance induced psychosis
• exacerbation of sx w/ schizophrenia

Question 24

Synthetic Cannabis

Answer 24

spike, K2, spice

hallucinations, delirium, seizures

inhalation of adulterated herbs

won’t show up on a urine drug screen

Question 25

Vaping

Answer 25

Evali: form of acute lung injury (vaping associated lung disease)

Inhalation of aerosol created by a liquid or wax (Nicotine/THC)

Question 26

What are Opioids?

Answer 26

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

Question 27

How Opioids Cause Overdose

Answer 27

in OD, there is an excessive effect on the portion of the brain regulating respiratory rate, resulting in respiratory depression and death

Question 28

OD Risk Factors

Answer 28

• 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.)

Question 29

Signs of OD

Answer 29

• 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

Question 30

What is naloxone?

Answer 30

• 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

Question 31

Opioid Withdrawal: Sx

Answer 31

resting pulse
sweating
restlessness
pupil size - dilated
bone/joint aches
runny nose or tearing
GI upset
tremor
yawning
anxiety or irritability
piloerection (goosebumps)

Question 32

Clinical Opiate Withdrawal Scale

Answer 32

COWS

Question 33

Opioid Use Disorder: Tx

Answer 33

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”)

Question 34

Buprenorphine

Answer 34

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

Question 35

Buprenorphine: Pt Education

Answer 35

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

Question 36

Harm Education

Answer 36

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

Question 37

Hallucinogens/Inhalants

Answer 37

feeling of detachment from body

• mostly ingested
• dextromethorphan (paranoia), LSD, PCP, Ketamine

inhalant of chemical vapors that create an altered mental state

Question 38

Tobacco Use Disorder

Answer 38

Varenicline
NRT
Bupropion

Question 39

Why Use the 12-Steps?

Answer 39

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

Question 40

Motivational Interviewing

Answer 40

• 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

Question 41

Dual Diagnosis

Answer 41

substance use + another psychiatric illness

~50% of people w/ substance use disorder have a mental health diagnoses