Chapter 16

Addictive Disorders

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

Substance abuse

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

Psychiatric 50% with mental disorder also have substance use

disorder High rate of suicide

Medical Cardiovascular Seizures/ Stroke MI Infections Sclerotic veins

Comorbidity

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

Theory

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

Cultural considerations

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

Clinical picture

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

Application 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)

Aplication 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

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

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

Application of nursing process