SUBSTANC

E ABUSE
Kim Faye Quimson
Shannon Boyle
Frandelle Dagalea
Glen Garcia
Rica May Maniri
Fatima Hyghia Himpon

SUBSTANCE ABUSE

Use of drug in a way that is

inconsistent with medical or social
norms
and
despite
negative
consequence.
It denotes problem in social, vocational
or legal areas of the persons life.
SUBSTANCE DEPENDENCE

Includes problem associated with

addiction such as tolerance, withdrawal
and unsuccessful attempts to stop sing
the substances.

TYPES OF SUBSTANCE ABUSE

Poly Substance Abuse abuse of more than one
substance
DSM-IV-TR
11
diagnostic
classes
of
substance abuse:
Alcohol
Amphetamines
or
similarly
acting
sympathomimetics
Caffeine
Cannabis
Cocaine
Hallucinogens
Inhalants
Nicotine
Opioids

TWO GROUP CATEGORIES OF

SUBSTANCE-RELATED DISORDER
1.Those that include disorders of abuse and

dependence
2. Substance-induced disorders such as:
Intoxication
Withdrawal
Delirium
Dementia
Psychosis
Mood disorder
Anxiety sexual dysfunction
Sleep disorder

Intoxication
use of a substance that results in
maladaptive behavior.
Withdrawal Syndrome
refers to the negative psychological and
physical reactions that occur when use
of a substance ceases or dramatically
decreases.
Detoxification
the process of safely withdrawing from
a substance.

ALCOHOLISM
The early course of alcoholism typically

begins with the first episode of intoxication

between the 15 and 17 years of age.
A pattern of more severe difficulties for
people with alcoholism begins to emerge in
the middle 20s to the middle 30s; these
difficulties can be:
Breakup of a significant relationship
An arrest for public intoxication or driving while

intoxicated
Evidence of alcohol withdrawal
Early alcohol-related health problems
Significant interference with functioning at work
or school.

Blackout
an episode during which the person continues
to function but has no conscious awareness of
his or her behavior at the time nor any later
memory of the behavior
Tolerance
the person needs more alcohol to produce the
same effect
Tolerance Break
very small amounts of alcohol will intoxicate
the person
Spontaneous Remission/Natural Recovery
Alcohol problem can modify or quit drinking
on their own without a treatment program

RELATED DISORDERS
Substance-induced disorders such
as anxiety, mood disorders, and
dementia are present. Delirium may
be seen in severe alcohol withdrawal.

ETIOLOGY
The exact causes of drug use, dependence, and

addiction are not known, but various factors are

thought to contribute to the development of
substance-related disorders.
Factors:
Biological Factors
Psychological Factors
Social and Environmental Factors

BIOLOGICAL FACTORS

Children of alcoholic parents are at higher risk for

developing alcoholism and drug dependence than

children of non-alcoholic parents.
Several studies of twins have shown a higher rate of
concordance (when one twin has it, the other twin gets
it) among identical than fraternal twins.
Adoption studies have shown higher rates of alcoholism
in sons of biologic fathers with alcoholism than in those
of nonalcoholic biologic fathers.
50% to 60% of the variation in causes of alcoholism
was the result of genetics, with the remainder caused
by environmental influences.
The ingestion of mood-altering substances stimulates
dopamine pathways in the limbic system, which
produces pleasant feelings or a high that is a
reinforcing, or positive, experience.

 PSYCHOLOGICAL FACTORS
Children of alcoholics are four times as likely to

develop alcoholism.
Inconsistency in the parent's behavior, poor
role modeling, and lack of nurturing pave the
way for the child to adopt a similar style of
maladaptive coping, stormy relationships, and
substance abuse.

Some people use alcohol as a coping

mechanism or to relieve stress and tension,
increase feelings of power and decrease
psychological pain. High doses of alcohol,
actually
increase
muscle
tension
and
nervousness.

 SOCIAL AND ENVIRONMENTAL FACTORS

Younger experimenters use substances that

carry less social disapproval such as alcohol

and cannabis, whereas older people use
drugs such as cocaine and opioid that are
more costly and rate higher disapproval.
Alcohol consumption increases in areas
where availability increases and decreases in
areas where cost of alcohol are higher
because of increased taxation.

ALCOHOL
Intoxication and Overdose
Alcohol is a CNS depressant that is absorbed rapidly

into the blood stream.

Initial Effects

Relaxation
Loss of inhibition
Intoxication Symptoms

Slurred speech
Unsteady gait
Lack of coordination
Impaired attention
Concentration
Memory
Judgment

 Some people become aggressive or display

inappropriate sexual behavior when intoxicated.

The person who is intoxicated may experience a
blackout.
Overdose
Vomiting
Unconscious
Respiratory depression
Treatment
Gastric lavage or dialysis to remove drug
Support for respiratory
Cardiovascular functioning in an ICU

Withdrawal and Detoxification

Symptoms of withdrawal usually begins 412hrs after cessation. Symptoms include:
Coarse hand tremors
Sweating
Elevated blood pressure and pulse
Insomnia
Anxiety
Nausea and vomiting
Severe or untreated withdrawal may progress
to transient hallucination, seizure or delirium
called Delirium Tremors ( DTs)
Safe withdrawal usually is accomplished with
the administration of benzodiazepines such
as lorazepam (Ativan), chlordiazepoxide
(Librium), or diazepam (Valium) to suppress

PHYSIOLOGIC EFFECTS OFLONGTERM ALCOHOL USE

Cardiac myopathy
Wernickes encephalopathy
Korsakoffs psychosis
Pancreatitis
Esophagitis
Hepatitis
Cirrhosis
Leukopenia
Thrombocytopenia
Ascites

SEDATIVES, HYPNOTIC AND ANXIOLYTICS

INTOXICATION AND OVERDOSE
Intoxication Symptoms
Slurred speech
Lack of coordination
Unsteady gait
Labile mood
Impaired attention/ memory
Stupor and coma
Treatment
Include gastric lavage followed by ingestion
of active charcoal and a saline cathartics
dialysis can be used if symptoms are severe.

WITHDRAWAL AND DETOXIFICATION

Lorazepam action typically last about 10; hrs produce
withdrawal symptoms in 6-8 hours; longer acting
medications such as diazepam may not produce
withdrawal symptoms for 1 week
Withdrawal Syndrome characterized by symptoms
opposite of the acute effects of drug.
Autonomic hyperactivity (Increased Vital Signs)
Hand tremor
Insomnia
Anxiety
Nausea
Psychomotor agitation
Seizures and hallucinations occur only rarely in severe

benzodiazepine withdrawal.
Tapering, or administering decreasing doses of a

medication, is essential with barbiturates to prevent

STIMULANTS
(AMPHETAMINES, COCAINE, OTHER)
Amphetamines are drugs that stimulate
or excite the CNS; used by people who
wanted to lose-weight or to stay awake.
Cocaine highly addictive and a popular
recreational drugs because of the intense
and immediate feeling of euphoria it
produces.
Methamphetamine it is particularly
dangerous. It is highly addictive and
causes psychotic behavior.

Intoxication and Overdose

Intoxification Effects
Euphoric feeling
Hyperactivity
Hyper vigilance
Talkativeness
Anxiety
Grandiosity
Hallucination
Stereotypic/ repetitive behavior
Anger
Fighting
Impaired judgment

Physiologic Effects
Elevated Blood Pressure
Tachycardia
Dilated pupils
Perspiration/ chills
Nausea
Chest pain
Confusion
Cardiac Dysrrhythmias
Overdose can result seizures and/or coma
Deaths are rare

Treatment
Chlorpromazine
(Thorazine)
control hallucination, lower
relieves nausea.

antipsychotic,
Blood Pressure,

Withdrawal and Detoxification

Occurs with in the few hours to several days after
cessation of the drugs and is not life-threatening.
Symptoms include:
Dysphoria
Fatigue
Vivid
Unpleasant dreams
Insomnia/ Hypersomnia
Increase appetite
Psychomotor retardation/ agitation

CANNABIS (MARIJUANA)
Cannabis Sativa is the hemp plant that is
widely cultivated for its fiber used
to make rope and cloth and for oil
for its seeds
Marijuana refers to the upper leaves, flowering
tops and stems of the plant
Two Cannabinoids used to treat
N/V from cancer chemotheraphy:
1. Dronabinol (Marinol)
2. Nabilone ( Cesamet)

Intoxication and Overdose

Cannabis begins to act less than 1minute after
inhalation. Effects usually occur in 20-30min.
And last at least 2-3hours.
Symptoms of Intoxication
Impaired motor coordination
Inappropriate laughter
Impaired judgment
Short term-memory
Distortion of time and perception
Anxiety
Dysphoria
Social withdrawal

Physiologic Effects
Increased appetite
Conjunctival injection (Bloodshot Eyes)
Dry mouth
Hypotension
Tachycardia
Withdrawal and Detoxification
Withdrawal Symptoms
Muscle ache
Sweating
Anxiety
Tremors

OPIOIDS
Popular drugs of abuse because they desensitize the user

to both physiologic and psychological pain and induce the

sense of euphoria and well-being. Opioids compounds
include both potent prescription analgesic such as:
Morphine
Meperidine (Demerol)
Codeine
Hydromorphone
Oxycodone
Methadone
Oxymorphone
Hydrocodone
Propoxyphene and illegal substance such as
Heroin
Normethadone

Intoxication and Overdose

It may develops soon after the initial euphoria

feeling;

symptoms includes:
Apathy
Lethargy
List lessens
Impaired judgment
Psychomotor retardation/ agitation
Constricted pupils
Drowsiness
Slurred speech
Impaired attention and memory

Severe intoxication can lead to:

Coma
Respiratory depression
Papillary constriction
Unconsciousness
Death
Administration of Naloxone (Narcan) opioid
antagonist is the treatment of choice because it
reverses all signs of opioid toxicity.

WITHDRAWAL AND DETOXIFICATION

Initial Symptoms
Anxiety
Restlessness
Aching back and legs
Symptoms develop as withdrawal progress
includes:
Nausea
Vomiting
Dysphoria
Lacrimation
Rhinorrhea
Sweating
Diarrhea
Yawning
Fever
Insomnia

Short-acting drugs such as heroin produce

withdrawal
symptoms
in
6-24
hrs;
symptoms peak in 2-3days and gradually
subside in 5-7days.

Longer-acting
substances
such
as
methadone may not produce significant
withdrawal symptoms for 2-4days and the
symptoms may take 2weeks to subside

Methadone used as replacement for the

opioid and the dosage is decreased aver

2weeks.

HALLUCINOGENS

Substances that distort the users

perception of reality and produce

symptoms similar to psychosis including
hallucinations (usually visual) and
depersonalization.
Causes:
Increased pulse
Blood pressure
Temperature
Dilated pupils
Hyperreflexia

INTOXICATION
Marked by several maladaptive behavioral

Psychological Changes:
Anxiety
Depression
Paranoid ideation
Ideas of reference
Fear losing ones mind
Physiologic symptoms
Sweating
Tachycardia
Palpation
Blurred vision
Tremors
Lack of coordination

WITHDRAWAL AND DETOXIFICATION

No withdrawal syndrome has been identified foe hallucinogen.

INHALANTS
Are

a diverse group of drugs including

anesthetics, nitrates, and organic solvents
that are inhaled for their effects. Most
common substances:
Aliphatic and aromatic hydrocarbons
Glue
Paint thinner
Spray paint

It can cause:
Brain damage
Peripheral nervous system damage
Liver disease

INTOXICATION AND OVERDOSE

Inhalants intoxication involves:
Dizziness
Nystagmus
Lack of coordination
Slurred speech
Unsteady gait
Tremor
Muscle weakness
Blurred vision

Behavioral symptoms:
Belligerence
Aggression
Apathy
Impaired judgment
Inability to function
Acute toxicity causes:
Anoxia
Respiratory depression
Vagal stimulation
Dysrrhythmias

Treatment - supporting respiratory and cardiac

functioning until the substance is removed from
the body.
WITHDRAWAL AND DETOXIFICATION
People who abuse inhalants may suffer from
persistent dementia or inhalant-induced
disorder such as psychosis, anxiety or mood
disorder even if the inhalant abuse ceases.

Treatment and Prognosis

Until 1970s, organized treatment programs and

clinics for substance abuse was scarce.

The user was advised to pull yourself together
and get control of your problem.
Founded in 1949, the Hazelden Clinic in Minnesota
is the noted exception; because of its success,
many programs are based on Hazelden model of
treatment.
Alcoholic Anonymous was founded in the 1930s by
alcoholics. This self help group developed the 12step program model for recovery which is based on
the philosophy that total abstinence is essential
and alcoholics need the help and support of others
to maintain sobriety.

Twelve Steps of Alcoholics Anonymous

We admitted we were powerless over alcohol - that our lives had become
unmanageable.
Came to believe that a Power greater than ourselves could restore us to
sanity.
Made a decision to turn our will and our lives over to the care of God as
we understood Him.
Made a searching and fearless moral inventory of ourselves.
Admitted to God, to ourselves and to another human being the exact
nature of our wrongs.
Were entirely ready to have God remove all these defects of character.
Humbly asked Him to remove our shortcomings.
Made a list of all persons we had harmed, and became willing to make
amends to them all.
Made direct amends to such people wherever possible, except when to
do so would injure them or others.
Continued to take personal inventory and when we were wrong promptly
admitted it.
Sought through prayer and meditation to improve our conscious contact
with God as we understood Him, praying only for knowledge of His will for
us and the power to carry that out.
Having had a spiritual awakening as the result of these steps, we tried to
carry this message to alcoholics and to practice these principles in all our
affairs.

Pharmacologic Treatment
Have two main purposes:
o To
permit
safe
withdrawal
from
alcohol,
sedative/hypnotics, and benzodiazepines
o To prevent relapse.
For clients whose primary substance is alcohol,
vitamin B1 (thiamine) often is prescribed to prevent
or treat Wernickes syndrome and Korsakoffs
syndrome, which are neurologic conditions that can
result from heavy alcohol use.
Cyanocobalamin (vitamin B12) and folic acid
often are prescribed for clients with nutritional
deficiencies.
Alcohol withdrawal usually is managed with a
benzodiazepine anxiolytic agent, which is used to
suppress the symptoms of abstinence. The most
common used benzodiazepines are lorazepam,
chlordiazepoxide, and diazepam.

 Methadone, a potent synthetic opiate, is

used as a substitute for heroin in some

maintenance programs.
Levomethadyl is a narcotic analgesic
whose only purpose is the treatment of
opiate dependence.
Naltrexone
(ReVia)
is
an
opiod
antagonist often used to treat overdose.
Clonidine (Catapres) is an alpha-2adrenergic
agonist
used
to
treat
hypertension.
Odansentron (Zofran), a 5-HT3 antagonist
that blocks the vagal stimulation effects of
serotonin in the small intestine, is used as
an antiemetic.

Dual Diagnosis
Client with both substance abuse and another psychiatric illness is

said to have a dual diagnosis. It is estimated that 50% of people

with a substance abuse disorder also have a mental health
diagnosis. Traditional methods of treatment for major psychiatric
illness or primary substance abuse often have little success in
these clients for the following reasons:

Clients with a major psychiatric illness may have impaired abilities to

process abstract concepts; this is a major barrier in substance abuse
programs.
Substance use treatment emphasizes avoidance of all psychoactive
drugs. This may not be possible for the client who needs psychotropic
drugs to treat his or her mental illness.
The concept of limited recovery is more acceptable in the treatment
of psychiatric illnesses, but substance abuse has no limited recovery
concept.
The notion of lifelong abstinence, which is central to substance use
treatment, may seem overwhelming and impossible to the client who
lives day to day with a chronic mental illness.
The use of alcohol and other drugs can precipitate psychotic behavior;
this makes it difficult for professionals to identify whether symptoms
are the result of active mental illness or substance abuse.

Symptoms of Substance Abuse

Denial of problems
Minimizes use of substance
Rationalization
Blaming others for problems
Anxiety
Irritability
Impulsivity
Feelings of guilt and sadness or anger and
resentment
Poor judgment

Limited insight

Client and Family Teaching:

Clients with Substance Abuse
Substance abuse is an illness
Dispel myths about substance abuse
Abstinence from substances is not a matter of

willpower
Any alcohol whether beer, wine, or liquor, can be
an abused substance
Prescribed medication can be an abused
substance
Feedback from family about a return to previous
maladaptive coping mechanism is vital
Continued participation in an aftercare program is
important

NURSING INTERVENTIONS FOR

CLIENTSWITH SUBSTANCE ABUSE
Health teaching for the client and family
Dispel myths surrounding substance abuse
Decrease codependent behaviors among family
members
Make appropriate referrals for family members
Promote coping skills
Role-play potentially difficult situations
Focus on the here-and-now with clients
Set realistic goals such as staying sober today

Application of Nursing Process

GENERAL
APPEARANCE
AND
MOTOR
BEHAVIOR
Assessment of general appearance and
behavior usually reveals appearance and
speech to be normal. Clients may appear
anxious, tired, and disheveled if they have just
completed a difficult course of detoxification.
MOOD AND AFFECT
Wide ranges of mood and affect are possible.
Some clients are sad and tearful, expressing
guilt and remorse for their behavior and
circumstances. Others may be angry and
sarcastic or quiet and sullen, unwilling to talk
to the nurse. Irritability is common because

THOUGHT PROCESS AND CONTENT

During assessment of thought process and
content, clients are likely to minimize their
substance use, blame others for their
problems, and rationalize their behavior. They
may think they cannot survive without the
substance or may express no desire to do so.
SENSORIUM
AND
INTELLECTUAL
PROCESSES
Clients generally are oriented and alert unless
they are experiencing lingering effects of
withdrawal. Intellectual abilities are intact
unless clients have experienced neurologic
deficits from long-term alcohol use or inhalant
use.

JUDGMENT AND INSIGHT

Clients are likely to have exercised poor
judgment especially while under the influence
of the substance. Judgment may still be
affected: clients may behave impulsively such
as leaving treatment to obtain the substance
of choice. Insight usually is limited regarding
substance use.

SELF-CONCEPT
Clients generally have low self-esteem, which
they may express directly or cover with
grandiose behavior.
ROLES AND RELATIONSHIPS
Clients usually have experienced many
difficulties
with
social,
family,
and
occupational roles. Absenteeism and poor
work performance are common.
PHYSIOLOGIC CONSIDERATIONS
Many clients have a history of poor nutrition
(using rather than eating) and sleep
disturbances
that
persist
beyond
detoxification. They may have liver damage
from drinking alcohol, hepatitis or HIV
infection.