substance abuse

Psychoactive Substance Disorders

By:Bryan Mae H. Degorio, BSN, RN

SUBSTANCE ABUSE- Misuse of substance with

significance and recurrent adverse consequences related to the repeated use.

- refers to the continued use despite the recurrence of the related problem

Substance or chemical dependence- cluster of cognitive and behavioral

and physiologic symptoms indicating continued use of the substance despite of the significance

Characteristics of Substance Abuse

1. tolerance- increased amount of the substance to obtained

desired effect2. Withdrawal- behavioral, physiologic

and cognitive symptoms occuring when blood or tissue concentration of substance abruptly decline

3. Compulsive drug taking behavior

Intoxication- is use of substance that results in maladaptive behavior

Detoxification- is the process of safe withdrawal

Habituation- a psychological dependence on the use of drug

Addiction- the physical dependence on a substance

Concepts of Substance Abuse1. The most common abuse substance is

the alcohol2. About one in five nurses is a substance

abuser3. Substance abuse is a family problem4. Common personality traits are

associated with substance abuser5. Polysubstance abuse involves

concurrent use of two or more substance

Etiology of Substance Abuse1. Exact cause of substance abuse remains

unclear2. Biologic theories:

a. genetic factorb. biochemical

3. Sociocultural Theorya. hopelessness and defeat of living

conditionb. peer pressurec. easy availability of the substanced. social ambivalence about the use

of substance.

4. Family theory- implicates dysfunctional

family pattern5. Behavioral Pattern

- substance abuse is a response to stressful stimuli because substance provide temporary relief of anxiety

6. Psychoanalytic theory- maladaptation in the early

stage of development

Management:1. Detoxification followed by residual

or outpatient program2. Self-help 12 step program designed

to help members achieve and maintain sobriety one day at a time

3. Psychotherapy on reality orientation focusing on coping without the use of the drug

4. Family therapy- improves communication by encouraging the family members

to define and maintain family functioning

5. Alcoholic determinant therapy with disulfiram

6. Methodone treatment as a substitute for opioid

7. Family support such as self helping organizations

COMMONLY ABUSE SUBSTANCESAlcohol

- immediate effect due to action to the brain manifested by slurring of speech, incoordination and unsteady gait, impaired attention and memory

- withdrawal symptoms:Stage 1- minor withdrawal

characterized by sleeplessness, restlessness, agitation, diaphoresis, tachycardia, hypertension and tremorss

Stage 2- major withdrawal - stage 1 + visual and auditory

hallucinationStage 3- delerium tremens as

anifested by elevation of temperature, disorientation + stage 1 and 2

manifestations- Physiologic Effect of Chronic Alcohol Smoking

1. Cardiac myopathy

2. wernicke’ encephalopathy- thiamine deficiency

3. Korsakoff psychosis- associated with thiamine

and vitamin b 12 deficiency4. pancreatitis, hepatitis, cirrhosis and

ascitis5. Fetal alcohol syndrome

- occurs to infant born to an alcoholic mother

- Treatment of Withdrawal1. Anxiolytic- prevent withdrawal

manifestations2. Anticonvulsant- can be use for

seizure prevention3. Diet/Promotion of adequate

nutrition- vitamin

supplementation including multivitamins, vit. B12, B, folic acid

CNS DepressantCLASSIFICATIONSA.Barbiturates, other sedatives,

hypnotics and anxiolytic- it is a CNS depressant that

have the same effect like alcohol

- chronic use can lead to depression and paranoia

- commonly abuses types:a. Barbiturates- secobarbital,

pentobarbitalb. Sedative/hypnotics-

methoquolone, chloral hydrate

c. Anxiolytic- lorazipam, diazepam, alprazolam, valium

- Withdrawal:- occurs within 24-72

hours after the last use- manifested by nausea,

vomiting, seizure, depression,

tachycardia and orthostatic hypotension

- Treatment of Withdrawal1. tapering of the anxiolytic2. narcoleptic for psychotic manifestations

3. anticonvulsant to prevent and treat seizure

B. Narcotics- a CNS depressant that are

use medically to relieve moderate and severe pain

- morphin, heroin and cocain- derivatives of opium

- demerol and methadone- are synthetic substitutes

- manifestations:- euphoria, well being, impaired attention,

apparent sedation, complete relaxation and PINPOINT or constricted pupil

and scattered pigment of hypodermic needle

- Withdrawal:- occurs within few hours after last dose of short

acting opiates

- begins 2-3 days after the last dose of long acting opioids

- manifested by:a. Dilated pupil, tearing,

runny nose and restlessness

b. Heroin- coryza, tears, yawning, sneezing, restlessness and irritability

- Treatment for Withdrawal:1. use of Methodone for the first 3-5 days2. Clonidine hydrochloride to block the

withdrawal manifestations and maybe given for 14 days

CNS StimulantA. Cocain- a CNS stimulant and causes

dopamine depletion- can cause euphoria, anxiety, anger, tachycardia and

DILATION OF PUPIL

- Common Drugs:1. Cocaine powder- snorted or injected2. Crack crystals- usually smoked- Withdrawal:

- severe depression, fatigue, hypersomnia and psychomotor agitation

- Treatment:1. anxiolytic to treat psychomotor agitation2. antidepressant to counteract depression

3. Betacholinegic blockers to treat hypertension and tachycardia

4. Dopamine receptor agonist or dopaminergic

B. Amphetamines- medically use to treat ADHD

and to loss weight or stay awake- Physiologic Effect:

- raise of BP, increase of energy level, euphoria,

tachycardia, nausea and vomiting and dilated pupil

- withdrawal Manifestations:-severe depression, vivid

dreams, insomnia, hypersomnia and psychomotor agitation

- treatment:1. anti depressant- to counteract

depression2. neuroleptic- to treat paranoia

and psychosis3. Anxiolytic- to treat psychomotor

agitation

Cannabinol/ marijuana- the most common type of

cannabis composed of dried leaves, stems and flowers of a plant cannabis sativa that can be smoked of added to food

- it alters sensory percepion due t active ingredients TETRAHYCANNABINOL ( THC )

- immediate affect:- euphoria, sensation of

slowed time, impaired motor coordination, conjunctivitis, increased appetite, dry

mouth and tachycardia- chronic use:

- decrease testosterone level and chronic lung disease

- reverse tolerance

- common drugs:a. Marijuana b. Hashish

Nicotine- is found in tobacco in 1-2

percent concentration - manifestations:

- reduce appetite- Physiologic effect:

a. Respiratory- COPD,

b. Cardiovascular- ischemic heart disease, CVA and peripheralvascular disease- Withdrawal:- increase appetite along with intense craving for tobacco that may persist for 6 months or longer- Treatment:1. Nicotine Replacement Therapy- use of nasal patch, nasal spray or inhaler

- use of non- nicotine prescription such as

BUPROPION ( zyban)2. developing of support system

- relapse is highest during the first few weeks and diminishes considerably

Hallucinogen / LSD or Acids- refer to the group of naturally

occurring and synthetic agent that produce essentially the same altering mind effect

- manifestations:1. similar to psychosis and

depersonalization2. presence of mystical experience3. intensified perception - dangerous due to the following:1. makes the individual believe that they have supernatural power and more than one person has been killed in an attempt to fly

2. panic reaction occurring for the first user and is referred to as BAD TRIP.3. Flashback as manifested by

hallucinationSTEROIDS

- are synthetic derivatives of testosterone

- can cause androgenic and anabolic effect

- Associated problem1. cholestatis2. hepatoadenoma3. hepatocarcinoma4. gynecomastia

- ttt- manifestation subside upon withdrawal

Inhalant- are inexpensive and easy to

obtain substances

- examples:- gasoline, kerosene, isopropyl alcohol, thinner, acetone,

nitrous oxide, fluorocarbons- effects:

- euphoria, hallucination and unsteady gait

- problem:- COPD and acidosis

- treatment: O2 and resp support