Week 5 - Substance use disorders Flashcards
Define Substance Use Disorder
Substance use disorder is the harmful and hazardous use, addiction and dependence on a substance, and is characterised by continued use and impaired control of the substance use, despite significant health consequences
Differentiate between harmful and hazardous substance use
Hazardous - has the potential for physical, psychological and social consequences
* MVA
* violence
Harmful - a pattern of substance use that is dangerous to health
* hepatitis from injecting
* liver disease
* depression
Differentiate between addiction and dependence
Addiction - use which causes changes to brain circuitry that persists after detoxification. These changes lead to chronic compulsive drug seeking and use
relates to a compulsion to use
Dependence - A behavioural, psychological and cognitive controlling urge to use substances after repeated use
relates to the bodys adaptation to long term misuse
*leads to withdrawal syndrome and tolerance
Alcohol
Depressant - decreases CNS activity
Physiological
* impaired coordination
* slurred speech
* N+V
* drowsiness
* blackouts
Psychological
* impaired decision making
* increased confidence
* impaired memory
Cannabis
Depressant - decreases CNS activity
Physiological
* tachycardia
* bloodshot eyes
* diminished psychomotor performance
Psychological
* relaxation
* euphoria
* drowsiness
* enhancement of senses
* pain relief
* increased appetite
Stimulants
Stimulants - stimulate CNS activity
Physiological
* overstimulation
* tachycardia and hypertension
* increased RR
* dry mouth
* jaw clenching and teeth grinding
Psychological
* euphoria
* confidence
* energy
* alertness
* talkative
Opioids
Depressant - decreases CNS activity
Physiological
* drowsiness
* sedation
* decreased RR
* nausea and vomiting
* high risk of overdose due to resp depression
Psychological
* euphoria
* tranquility
* apathy
* memory impairment
The spectrum of substance use
abstinent -> experimental -> recreatonal -> regular -> dependent
Physiology of addiction
- The potency of substances stimulates the dopaminergic and endorphin reward pathways in the brain
- creates euphoria and motivation
- faster and more intense reward than other behaviours -> positive reinforcement of this behaviour -> excessive use
Explain dependence
Suggestive of more severe SUD
However
important to consider dependence without an SUD
* dependence on morphine for pain management
* they will experience withdrawal if abruptly ceased, but do not experience a compulsion
Explain tolerance
repeated chronic use of an illicit substance overstimulates the reward pathway
after a while, the body adjusts to excessive dopamine production and decreased high
person now requires increased dose to achieve same effect
tolerance may extend from a decreased pleasure in substance use to decreased pleasure in other areas eg. sex, eating
Explain withdrawal
refer to withdrawal syndrome
Biological causes of substance use disorders
Genetic vulnerability
Men
* brain development means they are more likely to develop AUD
Women
* more likely to experience harm from alcohol use
* reduced ability to metabolise alcohol
* vulnerability to sexual assault
Adolescence
* substance use in adolesence can compromise pre-frontal cortex development (last part of the brain to develop)
* responsible for executive functioning
Environmental causes of substance use disorders
Adolescence
* parents substance misuse
* increased risk taking behaviour, criminality, relationships
* peer pressure
* family dynamic
* abuse and trauma
Exposure to stress
cultural norms
SES
* employment
* education
* where you live
* your own relationships
* availability of substances
High risk populations
culture, high risk aus populations, religion, SES
Aboriginal and torres strait islander people, people living in rural and remote communities, and LGBTQI+ communities are more likely to consume more substances and experience substance related harm
Alcohol use disorder and consequences
A problematic pattern of alcohol usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Consequences include
* CV disease
* liver disease
* obesity
* Wernickes encephelopathy
* mood disorderws
* suicide and violence
Cannabis use disorder and consequences
A problematic pattern of cannabis usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Consequences include
* Chronic resp symptoms and lung cancer
* cognitive problems
* appetite problems
* systemic problems in CV, immune, reproductive, neuromuscular systems
* exacerbation and emergence of a range of mental health issues eg. depression, anxiety, bipolar, psychosis, suicide
Stimulant use disorder and consequences
A problematic pattern of stimulant usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Complications include
* liver and kidley failure
* cardiopulmonary problems
* respiratory problems (snorting)
* blood borne viruses and infection (injecting)
* tooth decay
* development of other mental health issues eg. anger, anxiety/panic
Opioid use disorder and consequences
A problematic pattern of opioid usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Complications include
* nausea
* constipation
* amenorrhea
* CV and resp problems related to sedation
* Blood borne viruses, infections, and ‘track marks’ related to IV
Wernickes encephalopathy
excessive and prolonged alcohol misuse -> depletion of vitamin B1 which is essential for CNS function
results in necrotic lesions on the brain stem
Symptoms (only one required for diagnosis)
* confusional state
* ocular disturbance
* ataxia - wide based steps
Nursing management
* reverse condition with IM B1 injection
Delerium tremens
A severe form of alcohol withdrawal in heavy user. Medical emergency
1-5 days post withdrawal
Symptoms
* disorientation
* agitation
* labile blood pressure
* hallucinations
* nightmares
Nursing management
* manage agitation
* administer benzodaizepines to prevent seziures and death
* monitor vital signs
* assess withdrawal symptoms
* reorient person
* manage anxiety
* rehydrate
Overdose and opioids
Opioids cause CNS depression and affect the part of the brain that regulates breathing
Signs of overdose
* cyanosis
* vomiting
* pinprick pupils
* slow respiration
* loss of consciousness
* pale and limp
Nursing management
* Naloxone administration and resus
Overdose risk is increased when mixing with other drugs
Suicide
risk increases with substance use and again when in the presence of a mental health condition
Intentional and unintentional
Assessing for substance use in MSE and risk assessment is essential in deciding on risk of suicide
During pregnancy
- impacts foetal development
- impacts birth
- poor prenatal and postnatal care outcomes
- Mother at risk of PND or PPP
Define intoxication
The manifestation of significant behavioural and psychological changes which develop after substance consumption
Explain the stages of stimulant withdrawal
Crash - extreme fatigue and lethargy 1-3 days post
Acute - depression, fatigue, vivid unpleasant dreams, insomnia etc. until 7-10 days post
Sub-acute - more extended less intense symptoms
Nursing care
* re-establish sleep
* manage agitation
* promote nutrition
CAGE-AID
To screen for potential substance misuse
C - have you ever felt that you should cut down on your drinking and drug use
A - have people annoyed you by criticising your drinking/drug use
G - have you ever felt guilty about your drinking/drug use
E - Eye opener - have you ever had alcohol or drugs first thing in the morning to steady nerves or get rid of a hangover
3 pillars of harm minimisation
Harm reduction
* clean injecting sites - reduce infection
* brief interventions
* peer education
* protecting children from exposure
Supply reduction
* legal restrictions on consumption and sale
* regulating and patrolling for illicit exchanges and use
Demand reduction
* education on impacts of substances
* encouraging help seeknig
* treatment services and brief community intervention
Early intervention for SUD
- Education programs
- positive role modelling
- counselling for substance use
- clean injecting sites
Tertiary treatment for SUD
- SUD detox and withdrawal
- CBT
- relapse prevention and mindfulness based relapse prevention
- self-help programs
Nursing intervention and rationale for SUD
Comprehensive AOD assessment on admission and regularly throughout admission
* reduce mortality
* implement interventions eg. tapered withdrawal
MSE and risk assessment
Monitor for withdrawal symptoms
Monitor for symptoms of overdose
Build trusting relationship with consumer
Safe space for withdrawal to take place
discuss goals of recovery eg. harm minimisation or abstinence from substance and practice to achieve this
Support/encourage nutrition, sleep, personal hygeine
implement routine and stability
Psychoeducation
