Substance Use Disorders: Exam 3

Question 1

If you drink coffee on a regular basis, your body adjust and you wont get the ________ stimulatory effect. You’ll need higher quantities of caffeine to receive the same initial effects. This phenomenon is called _________. Clients frequently develop this to chemical substances. This does not mean they have an addiction.

Answer 1

Same
Tolerance

Question 2

Once your body gets use to a chemical substance, you may feel __________ if you stop using them. This phenomenon is called __________. Clients frequently become this on chemical substances. That does not mean they have an addiction.

Answer 2

Discomfort
Dependence

Question 3

When you abruptly stop using medication you have a dependency to, you go through a ___________ syndrome. These unpleasant symptoms are often ___________ of the normal effects of the medication. For example, clients going through this with CNS depressants may feel overstimulated, nervous, and may even have seizures.

Answer 3

Opposite
Withdrawal

Question 4

_____________ is a disease in which a person compulsively seeks out a drug and uses it despite the ___________ consequences it causes to the person and those around them.

Answer 4

Addiction
Harmful

Question 5

Many clients with an addiction no longer achieve the euphoria they once enjoyed; they only have the illicit substance to feel ___________. For these individuals, withdrawal may seem too great an obstacle for them to overcome. In addition, some withdrawal syndromes (ex: alcohol) can be dangerous. A common treatment strategy is to remove the original substance and replace it with a similar substance. These similar meds reduce many of the terrible withdrawal effects. Some will also abuse the substance ________ pleasurable. In other works, clients won’t get a buzz or high from the substance if they break their abstinence. This is called?

Answer 5

Normal
Less
Substitution therapy

Question 6

Many clients who have an addiction have another mental disorder (e.g., anxiety disorders, depressive disorders, bipolar disorder). Often times these clients use the illicit substance to treat some of the symptoms of their disorder (self-medication). When they try to abstain from the substance, the other disorder is likely to worsen, further increasing their urge to self-medicate. This creates a self-reinforcing ___________ that’s hard to break. These clients have a harder time recovering from addiction. What is this called?

Answer 6

Cycle
Dual Diagnosis

Question 7

Clients who have a substance use disorder often have complicated ______________. These individuals undergo a great deal of distress, tend to neglect to care for themselves, and may struggle with guilt. Dysfunctional relationships tend to increase clients’ drug abuse. The term codependency is sometimes used to describe these relationships.

Answer 7

Relationships

Question 8

Although the concept of codependency can provide helpful insights, it can also do harm. The term has a negative connotation and can make families feel like they’re being labeled and blamed for the client’s behavior. In addition, most recovery programs emphasize that clients should take full __________________ for their actions. At the same time, involving family members in a client’s recovery is extremely helpful and it should be encouraged. These family members also deserve attention to their own needs and struggles. Groups like Al- Anon can greatly benefit these individuals. What is this called?

Answer 8

Responsibility
Codependency

Question 9

What are some addictive substances?

Answer 9

CNS Stimulants
CNS Depressants
Hallucinogens

Question 10

__________ stimulants _______________ alertness and energy. Excessive stimulation, however, can produce anxiety, paranoia, hallucinations, and seizures. CNS stimulants usually increase heart rate and blood pressure. Most cause pupillary dilation (mydriasis). They suppress the appetite. High doses of CNS stimulants also active the brain’s reward circuitry, creating a sense of euphoria.

Answer 10

CNS
Increase

Question 11

_________ depressants ____________ alertness and energy. These drugs reduce anxiety and can induce sleep. This sleep, however, is not always restorative (i.e., they disrupt the REM phase of sleep). High doses of CNS depressants activate the brain’s reward circuitry, creating a sense of euphoria. CNS depressants lower clients’ respiratory rate and blood pressure. Respiratory failure and death can occur.

Answer 11

CNS
Descrease

Question 12

_________________ induce ______________ states of consciousness. These drugs are highly unpredictable in their effects. Some episodes will induce strong dysphoria (“bad trips”). Most hallucinogens have stimulatory effects; they increase heart rate, blood pressure, and cause pupillary dilation. Physical dependence and withdrawal are usually minimal with these drugs.

Answer 12

Hallucinogens
Altered

Question 13

What are some examples of CNS stimulants?

Answer 13

Caffeine
Nicotine
Cocaine
Amphetamines
Diet pills
Low doses of MDMA (Ecstasy)

Question 14

Do CNS stimulants increase or decrease VS and does it increase or decrease appetite?

Answer 14

Increase VS
Decrease appetite

Question 15

What effects the eyes when using CNS stimulants?

Answer 15

Cocaine and amphetamine cause pupillary dilation (Mydriasis)

Question 16

What are some examples of CNS depressants?

Answer 16

Alcohol, Benzodiazepines, barbiturates, opioids (ex: morphine, heroin, fentayl, hydrocodone), marijuana, many inhalants

Question 17

What do CNS depressants do to VS and to appetite?

Answer 17

Alcohol increase VS, the rest decrease VS
Marijuana increase appetite

Question 18

What does CNS depressants do to the eyes?

Answer 18

Alcohol and Benzos cause nystagmus. Opioids cause pupillary constriction (Miosis). Marijuana causes reddened eyes.

Question 19

What are some examples of Hallucinogens?

Answer 19

LSD, PCP, Ketamine, high doses of MDMA (Ecstasy)

Question 20

What do Hallucinogens do to VS and appetite?

Answer 20

Increases VS
There is no effect to appetite

Question 21

What do Hallucinogens do to the eyes?

Answer 21

Most cause pupillary dialation (Mysriasis). PCP causes vertical and horizontal nystagmus.

Question 22

What is the etiology of addictive substances?

Answer 22

Genetics, environmental influences (e.g., peer pressure), and the presence of other mental disorders can each increase clients’ risk of developing a substance use disorder.

Question 23

Neurological factors: Pleasurable activities activate the brain’s reward circuitry. In short, neurons that originate in the ventral tenemental area transmit a signal to the nucleus accumbens and prefrontal cortex. These neurons utilize the neurotransmitter ____________________. Everyday activities produce moderate activation of this reward system. Illicit drugs, however, flood this system with dopamine.

Answer 23

Dopamine (pleasure hormone)

Question 24

Eventually, the brain must adapt to overstimulation of the reward circuit. First, neurons decrease their production of dopamine. Second, fewer dopamine receptors are produced. This means natural stimulation of the reward system is severely _______________. This creates a painful situation. Such clients no longer enjoy the drug; they “need” the drug just to function. They feel compelled to find more of the drug, no matter the cost. Many clients desperately want to quit but feel trapped. In short, what starts as some poor personal decisions, quickly evolves into a real, _____________ illness.

Answer 24

Reduced
Neurobiological

Question 25

What is the nursing diagnoses for addictive substances?

Answer 25

Relevant nursing diagnoses for this lesson include acute confusion, anxiety, chronic low self-esteem, compromised/disabled family coping, defensive coping, dysfunctional family process, imbalanced nutrition: less than body requirements, ineffective denial, ineffective impulse control, risk-prone health behavior, risk for injury, risk for loneliness, risk for other-directed violence, risk for self-directed violence, and spiritual distress.

Question 26

Alcohol use disorder is a broad diagnostic category. It includes clients who intermittently _________________ alcohol in ways that cause clinically significant distress (e.g., fighting, trouble at work, arrests for driving while intoxicated). These clients have not developed a significant tolerance for alcohol, do not experience a withdrawal syndrome, and are not strongly compelled to use it.

Answer 26

Abuse

Question 27

Alcohol use disorder also includes clients who have become ______________ on alcohol. They need increasing amounts of alcohol to experience the same effects (tolerance). When they abstain from drinking they experience painful physical and psychological effects (withdrawal). They feel a strong urge to drink, despite the devastation it is causing to their lives (compulsive use).

Answer 27

Dependent

Question 28

In lower amounts, alcohol primarily depresses ________ lobe activity, causing euphoria, disinhibition, and impaired judgment. As blood levels rise, ______________ lobe activity is depressed, causing impaired speech and motor function (ataxia). Further drinking impairs the occipital lobe and cerebellum, causing impaired _____________ and problems with ____________ . Eventually, the brain stem is affected, causing coma and respiratory __________________. (How the patient can die)

Answer 28

Frontal
Parietal
Vision
Balance
Depression

Question 29

Alcohol withdrawal can occur within a few __________ of cessation. Common symptoms include course hand tremors, nausea, vomiting, headache, malaise, autonomic activation (tachycardia, hypertension, hyperthermia, diaphoresis), anxiety, insomnia, and irritability. Some clients experience seizures. More rarely, some clients experience hallucinations (alcoholic hallucinosis). These hallucinations are usually _________. Clients recognize that they are hallucinating and are often distressed by them.

Answer 29

Hours
Visual

Question 30

About ____ % of clients who experience withdrawal go onto develop DTs. These develop two to four days after drinking cessation. DTs are characterized by extreme _______________ , hallucinations (usually visual), and autonomic activation. Electrolytes and blood gases abnormalities are common.
Modern medical treatment has substantially reduced the mortality rate of DTs. With proper treatment, the risk of death is less than 5%.

Answer 30

5%
Confusion

Question 31

Heavy drinkers sometimes have a poor intake of ________________ (vitamin B1). Making matters worse, alcohol inhibits absorption of this essential nutrient. Thiamine deficiency causes two serious conditions:

Answer 31

Thiamine

Question 32

Wernicke’s encephalopathy - a serious neurological disorder characterized by abnormal eye movements, ataxia, confusion, and stupor. Left untreated, clients will die.
Korsakoff’s psychosis - a serious neurological disorder characterized by an inability to convert short-term memory into long-term memory. Clients with this condition often ___________ .

Answer 32

Confabulate

Question 33

The ____________ tool is a simplification of the original, longer version (AUDIT). It reliably identifies clients who
engage in unsafe drinking

Answer 33

AUDIT-C

Question 34

The _________ questionnaire utilizes four screening questions. Two positive answers are highly indicative of a drinking problem.
Have you ever felt you should _______ down on our drinking?
Have people _________ you by criticizing your drinking?
Have you felt ___________ about your drinking?
Have you ever needed a drink first thing in the morning ( _____ -opener) to calm your nerves or get rid of a hangover?

Answer 34

CAGE
cut
annoyed
guilty
eye

Question 35

What is the epidemiology for Alcohol Use Disorder?

Answer 35

The lifetime prevalence of alcohol use disorder is around 30%. Rates are highest among young adults and men.

Question 36

What is the etiology for alcohol use disorder?

Answer 36

Like all substance addictions, genetics, environmental influences (e.g., peer pressure), and the presence of other mental disorders can each contribute to the development of this disorder.

Question 37

Psychotherapy:
Effective treatments of alcohol use disorder include CBT, motivational interviewing, and group therapy (e.g., Alcoholic Anonymous).
Pharmacotherapy for Withdrawal
The key to treating alcohol withdrawal syndromes is to _____________ them. Clients presenting with symptoms of alcohol withdrawal are given benzodiazepines (substitution therapy). Benzodiazepines with a long half-life (e.g., chlordiazepoxide) are a good choice for most clients.
Clients are also given intravenous fluid containing thiamine, folate, a multivitamin, and dextrose. This mixture has a yellow color and is colloquially called a ___________ bag.

Answer 37

Prevent
Banana

Question 38

Acamprosate helps reduce some of the unpleasant feelings abstinence produces. It works by restoring the balance of ________ and glutamate in the brain.
Naltrexone, an opioid antagonist, blocks the ____________ effects of alcohol, making it less desirable. This drug can assist clients who want to abstain from alcohol.
Disulfiram, creates an extremely unpleasant reaction when a client consumes alcohol (e.g., headache, dyspnea, nausea, sweating). Clients taking this drug must be careful not to accidentally consume alcohol. This treatment is an example of ___________therapy.

Answer 38

GABA
Euphoric
Adversion

Question 39

Sometimes it’s difficult to overcome judgmental feelings toward clients who abuse substances—especially if you’ve been personally affected by substance abuse. Examine these attitudes, work to show unconditional ______________ regard, and watch out for countertransference.

Answer 39

Positive

Question 40

Maintain the attitude that it is not the person but his or her _____________ that is unacceptable. Provide a low stimuli environment for clients who are withdrawing; a private room is best.
Clients who are withdrawing from alcohol have an increased seizure risk. Pad the headboard and bed rails. Make sure oxygen and suction are ready for use.

Answer 40

Behavior

Question 41

Clients who have a substance use disorder sometimes misuse the ego defense mechanisms _________ and ___________________ . Arguing with clients is not likely to halt their use of these defense mechanisms.
Give immediate, positive reinforcement when clients recognize their problems with alcohol and take responsibility for their actions.
Nurses and student nurses can have problems with substance abuse and addiction. Be alert to the signs of chemical impairment (e.g., absenteeism, narcotic count discrepancies, signing out drugs for other nurses, volunteering to give drugs to other nurses’ clients, elaborate excuses, poor coordination, slurred speech, poor performance). Report concerns to your supervisor.

Answer 41

Denial
Rationalization

Question 42

_______________ _______________ is a popular counseling technique developed by psychologist William Miller. Motivational interviewing began as a method for helping clients with drug addictions, but it has proven useful in many other practice areas. Today, many providers are trained to use this powerful technique when trying to encourage positive health practices in their clients.

Answer 42

Motivational interviewing

Question 43

Clients who have an addiction tend to be very _______________ . Part of them enjoys the addiction. It may relieve stress or bestow some other benefit. However, the client also dislikes the addiction. It impairs their relationships with others, harms their health, interferes with work, etc.
The goal of motivational interviewing is not to argue or overpower clients. Rather, the goal is to help clients _____________ and ________________ their ambivalence.

Answer 43

Ambivalent (feel 2 opposite ways)
Explore
Resolve
Work on strategies to make it resolved, works better then pointing fingers

Question 44

Motivation to change is elicited from the __________ , not the counselor.
It’s the client’s task, not the counselor’s, to articulate and resolve _______________. Direct persuasion is not an effective method for resolving ambivalence.

Answer 44

Client
Ambivalent

Question 45

The counseling style is generally a quiet and eliciting one.
The counselor is _____________ in helping the client examine and resolve ambivalence. Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction. The therapeutic relationship is more like a _________________ than expert/recipient roles.

Answer 45

Directive
Partnership

Question 46

“To a counselor accustomed to confronting and giving advice, motivation interviewing can appear to be a hopelessly slow and passive process. The proof is in the _______________ ” (Rollnick & Miller, 1995, p. 327).

Answer 46

Outcome