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Chapter 16

Chapter 16. Addictive Disorders. Substance abuse. Abuse Use of a substance that falls outside of medical necessity or social acceptance resulting in adverse effects to the abuser or others Dependence or Addiction

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Chapter 16

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  1. Chapter 16 Addictive Disorders

  2. Substance abuse • Abuse • Use of a substance that falls outside of medical necessity or social acceptance resulting in adverse effects to the abuser or others • Dependence or Addiction • Occurs when a tolerance to the drug occurs and the person has to take more and more of the drug to prevent withdrawal • Operational Definition of Addiction • The 3 C’s • Craving to Compulsive spectrum • Continued use despite adverse consequences • Loss of Control

  3. Prevalence • Lifetime prevalence for substance use disorders in US is 14.6% • Alcohol • Most common substance abused (17.6 million US • Illicit Drugs • Club drugs, cannabis, methamphetamines, heroin, opiates, cocaine • Anabolic Steroids • Increased use 1-6% in athletes • Nicotine: 46 million in US

  4. Comorbidity • Psychiatric • 50% with mental disorder also have substance use disorder • High rate of suicide • Medical • Cardiovascular • Seizures/ Stroke • MI • Infections • Sclerotic veins

  5. Theory • Addiction • Characterized by • Loss of control of substance consumption • Substance use despite associated problems • Tendency to relapse • Biological • Genetic and all drugs affect the limbic system in brain (reward center) • Psychological • Lack of tolerance for frustration, pain, impulsiveness, lack affection, lack of self regard lack of self esteem

  6. Cultural considerations • Asian cultures: Low incidence alcohol abuse • Native Americans and Alaska Natives • 70% as compared to other cultures • Women: Lower rate than men but get hooked quicker • Pregnant women & their partners Alcohol is neurotoxic, baby develops fetal alcohol syndrome • Impaired professionals • Inability to practice due to substance use • Nurses have higher rate of chemical dependency than general population • Referral or self report: RAMP or Dr Baxter group for impaired professionals • Must be truthful when renewing license

  7. Clinical picture • Tolerance: need for higher doses to achieve effect • Withdrawal: occurs after using for long period so that stopping causes physical and psych S&S • Flashbacks: transient recurrences of perceptual disturbances caused by earlier hallucinogenic use • Codependence: behaviors involving family of substance abuse patients • Synergistic Effects: Intensified or prolonged effects produced when drugs taken together • Antagonistic Effects: Combining drugs to weaken or inhibit the effect of one of the drugs

  8. Application of nursing process • Assessment • The complex due to polysubstance abuse (simultaneous use of many substances) and comorbidity (coexistence of psychiatric illness) define the dual diagnosis • Initial Interview Guidelines-use of drugs/alcohol and the need or want to cut down on use • Further assessment- Urine drug screen and BAL • Psychological Changes- Predictable defensive style (denial, projection, rationalization) • Signs of Intoxication and Withdrawal • Assessment Guidelines

  9. Aplication of nursing process • Signs of Intoxication & Withdrawal • CNS Depressants: alcohol, benzos, barbiturates • Can result in severe morbidity and mortality • CNS Nervous System Stimulants: cocaine, crack, methamphetamines, nicotine • Opiates: morphine, heroin, fentanyl, methadone • Marijuana: Cannabis • Hallucinogens : LSD, PCP • Inhalants: paint, glue, lighter fluid • Rave & Techno drugs: Ecstasy (MDMA)

  10. Application of nursing process • Diagnosis • Numerous nursing dx associated with physical & psychiatric comorbidities • Outcomes Identification • Factor in culture and values in plan of care • Planning • Social status, income, ethnicity, gender, age, substance hx and current condition • Implementation • Aim of tx is self-responsibility, not compliance • Communication Guidelines • Health teaching and promotion • Relapse & Prevention

  11. Application of nursing process • Psychotherapy & Therapeutic Modalities • Assist pts in identify & using alternative coping mechanisms to reduce reliance on substances • Self Help Groups for Patients and Family • 12-Step program • Residential Program • Intensive Outpatient Program • Outpatient Drug Free Program • Employee Assistance Program

  12. Application of nursing process • Pharmacological, Biological & Integrative Therapies • Alcohol Withdrawal Treatment • Help patient achieve safe detox • Enhance patients’ motivation for abstinence and motivation • Evaluation • Favorable treatment outcomes judged by increased lengths of time in abstinence, decreased denial, acceptable occupational functioning, improved family relationships, and ability to relate to normally to other human beings

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