ADDICTIVE BEHAVIOUR

Define Addictive Behaviour The effect of habitual ingestion of drugs or alcohol in increasing amounts to the point of dependency - implicated in many car accidents, crime (B+E), drowning, suicides, homicides, etc - costs billions in medical bills, lost work days - impact on family, roles, relationships (ruins many families) - rehabilitation is very important e.g. AA (12 step program) - The most frequent stimulus for helping a client recognize when he/she has a problem with addictive behaviour is social pressure. Therapeutic Role and Self-Awareness In Developing Nursing Interventions nurses must have self-awareness; be non-judgemental Manifestations/Assessment: Patient is admitted with one of these three: - Acute Intoxication - Withdrawal Syndrome - Chronic Alcoholism Acute Intoxication: Usually person brought to hospital or Detox Centre by family or police due to a physical problem e.g. fall, passed out, etc. aim of treatment: - let patient sleep it off (takes several hours) - have the patient ambulatory ASAP - follow up care Nursing Interventions - take any substances containing alcohol away - monitor patient closely may have suffered from injuries e.g. head injury, broken bones, internal bleeding - monitor VS (may go into respiratory arrest) - keep patient on side - monitor urinary output (if internal bleeding, output will decrease) - monitor LOC - monitor for depression often seen with alcoholism/substance abuse - when patient fully conscious and medically cleared, they are discharged. Encourage follow up care! Withdrawal Syndrome: - when alcohol intake has stopped, can occur any time from several hours to four days after last drink - important for nurses to recognize signs and symptoms of alcohol withdrawal could happen in any area of nursing (e.g. patient admitted for emergency surgery Minor Symptoms: hangover, insomnia, vivid dreams, anxiety, agitation, tremors, tachycardia may disappear within 48 hours or progress to moderate symptoms Moderate Symptoms : all above plus: coarse tremors, nausea and vomiting, diarrhea, increased BP, P, diaphoresis, headache, tactile, visual hallucinations, illusions, nightmares, high anxiety, seizures Medications: Treat with librium or valium to prevent patient from having seizures and progressing to DTs Major Withdrawal Symptoms Delirium Tremens: Occurs in only 5% of alcoholics signs and symptoms appear 3 7 days after alcohol make has stopped (need 5 15 years heavy drinking). A toxic reaction

Signs and symptoms: all mild and moderate symptoms plus: confusion, delirium, delusions, fever, may be suicidal/homicidal, seizures, lasts 2 days to 1 week, life threatening, 5% die even if treated (pneumonia, liver or renal disease, heart failure, medical illnesses), If untreated, 20% die untreated Nursing interventions used in caring for clients: - maintain optimal level of fluid and electrolyte balance (up to 3000 ml/day): I & O, IV prn, frequent small amount of fluids, push fluids, antiemetics as ordered, check lab results daily, observe for possibility of GI bleed - maintain adequate nutritional intake: antiemetics, multivitamins, thiamine and vitamin B - very important!, assist prn, small frequent feeds, 3000 calorie diet - engage in activity to patients tolerance: rest is a priority, assist with ambulating prn - achieve improved sleep pattern: quiet environment, single room, restrict visitors, administer sedatives as ordered - effective coping with anxiety: remain with patient if extremely anxious, comfort measures, stimulation, calm soft voice, short simple statements, assess for hallucinations/illusions, present reality, assure patient of safety, assess cognitive status - maintain skin integrity: assess, sheepskin, improve nutrition (story re: 24 yr old with pressure ulcers) - maintain patient safety: side-rails up / padded, bed in lowest possible position, call bell close, supervise smoking, remain with patient when acutely ill, may need constant care if very agitated or confused, comfort and assure of safety, orient frequently, suicide precautions, seizure precautions - medications: antabuse taken daily health teaching, verbal and in writing, regarding use, rationale and effects including the avoidance of alcohol containing substances, e.g. mouthwash, cough syrup, etc. General Hospital Clients: Be aware of the possibility of substance withdrawal in individuals admitted to acute care for other health issues in order to begin appropriate treatment and modify nursing care plan accordingly Recovery and Relapse: Anticipatory guidance for potential and strategies to avoid relapse (avoiding situations of high risk) Assess for signs of substance abuse Assess for signs leading to relapse: depression, complacency, not adhering to planned actions e.g. attendance at AA meetings, having just one drink Present behavioural facts and consequences Foster capacity, resilience and self-efficacy: e.g. journaling thoughts, feelings and behaviours relative to substance avoidance to increase self-awareness (mindfulness) of the effectiveness of strategies - lifestyle changes avoiding persons and situations associated with substance abuse - psychoeducation with culturally relevant methods and resources - establish a contract, e.g. actions to take when urge to take substance is strong - develop new interests to increase capacity and coping strategies Refer to Community Resources: Support groups: AA, Al Anon, Alateen (http://www.aatoronto.org/program.php); Narcotics Anonymous (NA), Gamblers Anonymous (GA), etc. Rational Recovery or Secular Organizations for Sobriety www.camh.net Professional Resources: www.camh.net http://www.hc-sc.gc.ca/hl-vs/pubs/adp-apd/index_e.html - broad range of resources related to substance abuse and includes determinants such as age, culture, poverty, developmental transitions, etc. http://www.rnao.org/Storage/29/2338_Final_-_revised_smoking.pdf - smoking cessation