Ohia-Nwoko_2016_Animal Models and Vaccines for Substance Abuse Disorders
9.substance abuse disorders
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Transcript of 9.substance abuse disorders
SUBSTANCE ABUSE DISORDERS
Why do we need to know about chemical dependency?
Many M/S patients are chemically dependent
Your chances of being in a close relationship with someone who is chemically dependent is great
Our profession holds statistically high users of drugs and alcohol
Substance abuse is not a one person illness.
It affects personal and professional relationships with those associated with the user.
We need to treat user and family and significant other.
SUBSTANCE ABUSE:
Repeated use of chemical substances leading to clinically significant impairment over 12 month period manifested by 1 or more of the following: Inability to fulfill major role obligations at work,
school, or home; Recurrent legal or interpersonal problems; Continued use despite social and interpersonal
problems; and Participation in physically hazardous situations
while impaired such as driving
ADDICTION:
Physical dependence on a substance Repeated compulsive use of substance that
continues in spite of negative consequences physical, social or legal
Characterized by loss of control due to participation in the dependency, whether that dependency is to a substance or to a process
A tendency to relapse into dependency Denial (a defense mechanism) is commonly
used by patients who have problems with abuse and dependency
TOLERANCE:
Increased amounts of substance are needed over period of time to achieve same effect as obtained previously with smaller amounts
CROSS TOLERANCE:
Tolerance to one drug causes tolerance to another drug or class of drugs
WITHDRAWAL:
Unpleasant physical, psychological or cognitive effects resulting from decreasing or stopping use of chemical after regular use for extended period of time.
DEPENDENCY:
Condition in which person has several of the following symptoms for a single 12 month periodNeeds more of substance and more
frequent intervals to achieve same high or desired effect of the substance
Spends significant time obtaining substanceGive up important social or professional
functions to use substance
DEPENDENCY continued:
Has tired at least once to quitExperience difficulty with job, family or
social activities because of use or withdrawal symptoms
Uses substance regardless of problem it causes
Uses substance to avoid withdrawal symptoms
Usually has unsatisfied emotional needs
DUAL DIAGNOSIS:
Means that an individual has both a mental illness, such as depression, as well as a problem with substance abuse
Patients with serious mental illness often have a dual diagnosis of some type of substance abuse
DYSFUNCTIONAL:
Often used to refer to relationships within alcoholic family or work environment
Characterized by dishonesty inability to discuss situation, and covering up for users behaviors
CODEPENDENCE:
Members of a family group or relationship begin to lose own sense of identity and purpose and exist solely for the abuser
Enable abuser by taking responsibility for own actions away from abuser
NON-SUBSTANCE RELATED DEPENDENCY / ADDICTIVE PERSONALITY:
Includes all kinds of addictive behavior May include addiction to food, sex, gambling.
Shopping / spending, or internet use
ETIOLOGICAL THEORIES:
Some believe in existence of addictive personality
Biological theories – some sort of genetic metabolic disorderA person who is alcohol dependent is 3-4
times as likely to come from parents who abused alcohol than a person who did not abuse alcohol
ETIOLOGICAL THEORIES:
Cognitive behavioral theorists – suggest way person perceives high may influence act of becoming high, another word, may start out very innocent, just want to repeat that good feeling!
Psychological theories – the person who abuses substances / processes may have certain personal tendencies including: lower self esteem, lower tolerance for pain or frustration.
SOCIO-CULTURAL THEORIES:
Certain cultures within US, such as:Native American have a high percentage of
members with alcohol dependencyAsian’s have low percentage of dependency
Peer pressure and other sociologic factors can increase likelihood of substance use
SELECTED SUBSTANCES OF ABUSE
ALCOHOL
Use and abuse are present in all walks of life, on all economic levels and in both men and women
Differentiation between social drinker and abuser is the degree of need or compulsion to drink
Decreases a persons life
expectancy an 10-12 years
DELIRIUM TREMENS (DT’S)
Visual hallucinations Tremors Possibly tonic-clonic seizures Elevated blood pressure Elevated heart rate Cardiac dysrhythmias Symptoms 4 – 12 hrs after patient has stopped
drinking and will peak in 24 – 48 hours
FETAL ALCOHOL SYNDROME
Leading known preventable causes of mental retardation and birth defects
Lifelong condition that causes physical and mental disabilities
Abnormal facial features, growth deficiencies, and central nervous system problems
Problems learning, memory, attention span, communication, vision, hearting or a combination of these
What are the symptoms of FAS?
Fetal Alcohol Syndrome symptoms include Small head, small jaw, and small, flat cheeks Malformed ears Small eyes, poor development of optic nerve,
crossed-eyes Upturned nose, low bridge Small upper mouth structure and teeth Umbilical or diaphragmatic hernia Caved-in chest wall Heart murmurs, heart defects, abnormalities of
large vessels
How is FAS diagnosed?
Based on mother’s history and the appearance of the baby, based on a physical examination by a physician
Treatment for FAS?
Specific drugs for treating the symptoms of withdrawal from alcohol in babies
No treatment for life-long birth defects and retardation
Damage often need developmental follow-up and possibly, long-term treatment and care
Prevention of FAS?
100° preventable – however, requires the followingMother to stop using alcohol before
becoming pregnantWomen should stop drinking immediately if
pregnancy is suspected
KORSAKOFF’S PSYCHOSIS:
Form of amnesia often seen in chronic alcoholics that is characterized by a loss of short-term memory and an inability to learn new skills
Usually disoriented, may present with delirium and hallucinations, and confabulates to conceal the condition
Often traced to degenerative changes in the thalamus as a result of a deficiency of B complex vitamins, especially thiamine and B12
Therapeutic Interventions for Alcohol Abuse and Dependence
Treatment is a slow processSingle most effective treatment is
Alcoholics Anonymous, 12-step program that offers support through others who have stopped drinking
Cognitive behavioral therapy and psychotherapy are also sometimes used
Family therapy
ANTABUSE
Medication that is sometimes prescribed as a deterrent to alcohol
Need full informed consent to start antabuse therapy
Severe reaction will occur if ingest alcohol, chest pain, nausea, vomiting, confusion and other symptoms
Effects last 2-3 weeks after last dose
CAMPRAL
New drug that works on neurotransmitters to alter functions of other brain chemicals that have been affected by long term drinking
REVIA
May decrease alcohol cravings (and opoid drugs) and impulsive behavior
VALIUM AND ATIVAN
Can help prevent symptoms of DT’s during acute withdrawal but are not used long term
Hospitalization may range from in house of 2 weeks or more to step down to halfway houses
To eventual independenceIs typical for patients to seek treatment
multiple times
Assessment of Patient with Alcohol Abuse
CAGE questionnaireHave you ever felt you should Cut down on
your drinking?Have people Annoyed you by criticizing
your drinking?Have you ever felt bad or Guilty about your
drinking?Have you ever had a drink first thing in the
morning as an Eye opener to steady your nerves or get rid of a hangover?
Assessment of Patient with Alcohol Abuse continued:
Objective, nonjudgmental approach by nurse is imperative
Self assess your own feelingsUse open ended questions
“when was your last drink” “how much do you drink”
Ask about each substance or behavior separately
Assessment of Patient with Alcohol Abuse continued:
Type of substance Type of compulsive behavior Pattern and frequencyAmountAge of regular useChanges in use patterns Previous withdrawal symptoms
NURSING INTERVENTIONS:
SafetyClosely observe for withdrawal, possibly
even 1-1 observationReorient patientAdequate nutrition and fluid balanceLow stimulation environmentAdminister withdrawal meds PRNEmotional support to patient and family
WHAT IS DETOXIFICATION?Removal of poisonous effects of a substance
ALCOHOL DETOXIFICATION
Process which a heavy drinker’s system is brought back to normal after being used to having alcohol in the body on a continual basis
Precipitous withdrawal from long-term addition without medical management can cause severe health problems and can be fatal
Treatment must be undergone to deal with underlying addiction that caused the alcohol use
DRUG DETOXIFICATION
Used to reduce or relieve withdrawal symptoms while helping the addicted individual adjust to living without drugs
Not meant to treat addition – early step in long-term treatment
Treatment occur in a community program that lasts sever months and takes place in residential atmosphere rather than medical center
WHAT IS REHABILITATION?
Restore to health or normal life by training and therapy – restore to a former condition
Getting back on your feet, finding your old self again, learning to live a normal life, the way – before alcohol took over
Need to be strong to stay off the booze of course – always about changing life
SIGNS & SYMPTOMS OF ALCOHOL INTOXICATION
Glazed eyesSmell on breath PupilsUnsteady gaitUnusual behavior for the patient, passive
aggressive, violent
NICOTINE:
Cigarettes, cigars, and smokeless tobacco
Experts believe the single most difficult addition to overcome
OPIOIDS:
Heroin Prescription opiodsCan be injected, smoked or inhaled
BARBITURATES:
Ingested orally and injectedPentathol, phenobarbitalSedatives, hypnotics
BENZODIAZEPINES:
ValiumMany have replaced earlier used
barbituratesCan be taken orally or injected
AMPHETAMINES:
Crystal meth which is a growing substance use / abuse problem affecting families and society
Can be taken orally, injected IV or smoked
COCAINE:
Can be injected, smoked or inhaled nasally
CANNABIS:
Marijuana or hashishCan be smoked or eaten
INHALANTS
Nitrous oxide and solvents that are sniffed, huffed or bagged
Often young teenagers or young children to use lighter fluid, paint, paint thinners, and gasoline (or other easily accessed household substances) to get high
Highly toxic substances that are potentially lethal
PSYCHEDELICS: LSD
Usually ingested orally, can be injected or smokedSymptoms include:
Sleeplessness Increased heart rate Increased blood pressure Loss of appetite Powerful hallucinogenic
Very addictive- Provides a mental escape
Bath Salts
A synthetic, stimulant powder product that contains amphetamine-like chemicals, including mephedrone, which may have a high risk for overdose.
"Agitation, paranoia, hallucinations, chest pain, suicidality”
Signs and Symptoms of drug abuse and dependence
Very similar as those s/s of alcohol abuse
Read, watery eyesRunny noseHostile behaviorParanoiaNeedle tracts on arms or legs
Therapeutic interventions for drug abuse and dependence
Narcotics anonymous
Group therapy
Psychotherapy
Meth programs
Nursing interventions for drug abuse and dependence
Essentially the same as for those who are alcohol dependent
Remember nurses and doctors can not “fix” the patient who is chemically dependent
Desire to be chemically free needs to come from within the patient themselves
The chemically impaired nurse
Nurses have 32 – 50% increased rate of chemical dependency than general population. Access! When clinically impaired nurse is on duty patient may have increase complaints of pain, with little relief of pain meds, patients may ask more often for pain med. You may also see inaccurate narcotic counts, frequent vial breakage may also occur.
Indication evident in the chemically impaired nurse
Changing life style to focus activities that encourage substance use
Inconsistency between statements and actions Increase irritability Projecting blame Isolating self from social contacts Deteriorating physical appearance Tardiness or absences Depression
PRIORITIES OF NURSE
WHO IS A WITNESS OR SUSPECTS CHEMICALLY IMPAIRED COLLEAGUE
Ethically and legally remove nurse from patient care
Clear accurate documentation by co-worker is vital
Report to nurse managerImpaired nurse should be allowed
referral to treatment programReport to state board of nursing
Withdrawal Symptoms
Alcohol-increase in VS, psychosis, seizures LSD-no withdrawal symptoms Crystal Meth-increased sleeping, depression Heroin-muscle pain, cramps in abdomen,
increased yawning Cigarettes-craving, nervous/anxious,
increased appetite, irritable Caffeine-irritability, headache, jittery Marijuana-no withdrawal symptoms