copyright © 2014. f.a. davis company substance-related and addictive disorders chapter 23

Copyright © 2014. F.A. Davis Company

Substance-Related and Addictive DisordersSubstance-Related and Addictive DisordersChapter 23Chapter 23


Substance-Related DisordersSubstance-Related Disorders

• Substance-Use Disorders– Addiction

• Substance-Induced Disorders– Intoxication– Withdrawal– Others discussed in chapters with which they

share symptomatology


Substance-Use DisorderSubstance-Use Disorder

Substance Addiction• Physical Dependence

– Need for increasing amounts to produce the desired effects

– Syndrome of withdrawal upon cessation• Psychological Dependence

– Overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort


Substance Addiction (cont.)– Use of the substance interferes with ability to

fulfill role obligations– Attempts to cut down or control use fail– Intense craving for the substance– Excessive amount of time spent trying to

procure the substance or recover from its use

Substance-Use Disorder Substance-Use Disorder (cont.)(cont.)


Substance Addiction (cont.)– Use of the substance causes the person difficulty

with interpersonal relationships or to become socially isolated

– Engages in hazardous activities when impaired by the substance

– Tolerance develops and the amount required to achieve the desired effect increases

– Substance-specific symptoms occur upon discontinuation of use

Substance-Use Disorder Substance-Use Disorder (cont.)(cont.)


Substance Intoxication– Development of a reversible syndrome of

symptoms following excessive use of a substance– Direct effect on the central nervous system– Disruption in physical and psychological

functioning– Judgment is disturbed and social and occupational

functioning is impaired

Substance-Induced DisorderSubstance-Induced Disorder


Substance-Induced Disorder Substance-Induced Disorder (cont.)(cont.)

Substance Withdrawal– Development of symptoms that occurs upon

abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period of time

– The symptoms are specific to the substance that has been used.

– There is a disruption in physical and psychological functioning, with disturbances in thinking, feeling, and behavior.


Classes of Psychoactive SubstancesClasses of Psychoactive Substances

• Alcohol• Caffeine• Cannabis• Hallucinogens• Inhalants• Opioids• Sedatives, Hypnotics, Anxiolytics• Stimulants• Tobacco


Predisposing FactorsPredisposing Factors

Biological Factors

• Genetics: apparent hereditary factor, particularly with alcoholism

• Biochemical: alcohol may produce morphine-like substances in the brain that are responsible for alcohol addiction


Psychological Factors

• Developmental influences:– Punitive superego– Fixation in the oral stage of psychosexual development

S. Freud

Predisposing Factors Predisposing Factors (cont.)(cont.)


Psychological Factors (cont.)

• Personality factors: Certain personality traits are thought to increase a tendency toward addictive behavior. They include:

– Low self-esteem– Frequent depression– Passivity– Inability to relax or defer gratification– Inability to communicate effectively



Sociocultural Factors

• Social learning: children and adolescents more likely to use substances with parents who provide model for substance use

• Use of substances may also be promoted within peer group



Sociocultural Factors (cont.)

• Conditioning: Pleasurable effects from substance use act as a positive reinforcement for continued use of substance.

• Cultural and ethnic influences: Some cultures are more prone to substance abuse than others.



1. Which of the following has been implicated in the predisposition to substance abuse?

A. Hereditary factorB. Fixation in the adolescent stage of

psychosexual developmentC. Punitive egoD. Narcissistic and dependent personality traits



• Correct answer: A– Research has indicated that an apparent

hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism.



Dynamics of Substance-Related Dynamics of Substance-Related DisordersDisorders

Alcohol Use Disorder• Patterns of Use

– Phase I. Prealcoholic phase: Characterized by use of alcohol to relieve everyday stress and tensions of life.

– Phase II. Early alcoholic phase: Begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person.


• Patterns of Use (cont.)– Phase III. The crucial phase: Person has lost

control; physiological dependence is clearly evident.

– Phase IV. The chronic phase: Characterized by emotional and physical disintegration. The person is usually intoxicated more often than sober.

Dynamics of Substance-Related Dynamics of Substance-Related Disorders Disorders (cont.)(cont.)


Effects of Alcohol on the Body• Peripheral neuropathy is characterized by:

– Peripheral nerve damage– Pain– Burning– Tingling– Prickly sensations of the extremities



Effects of Alcohol on the Body Effects of Alcohol on the Body

• Alcoholic myopathy: thought to result from the same B vitamin deficiency that contributes to peripheral neuropathy

– Acute: sudden onset of muscle pain, swelling, and weakness; reddish tinge to the urine; and a rapid rise in muscle enzymes in the blood

– Chronic: gradual wasting and weakness in skeletal muscles


• Wernicke’s encephalopathyMost serious form of thiamine deficiency in alcoholic patients

• Korsakoff’s psychosisSyndrome of confusion, loss of recent memory, and confabulation in alcoholic patients

Effects of Alcohol on the Body Effects of Alcohol on the Body (cont.)(cont.)


• Alcoholic cardiomyopathyEffect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition.



• EsophagitisInflammation and pain in the esophagus occurs because of the toxic effects of alcohol on the esophageal mucosa and also because of frequent vomiting associated with alcohol use.



• GastritisEffects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention.



• Pancreatitis– Acute: usually occurs 1 or 2 days after a

binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain, nausea and vomiting, and abdominal distention.



• Pancreatitis (cont.)– Chronic: leads to pancreatic insufficiency

resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus



• Alcoholic Hepatitis– Caused by long-term heavy alcohol use– Symptoms: enlarged, tender liver; nausea and

vomiting; lethargy; anorexia; elevated white cell count; fever; and jaundice. Also ascites and weight loss in severe cases.



• Cirrhosis of the LiverCirrhosis is the end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue.



• Cirrhosis of the Liver (cont.)– Portal hypertension: Elevation of blood pressure

through the portal circulation results from defective blood flow through cirrhotic liver.



• Cirrhosis of the Liver (cont.)– Ascites: a condition in which an excessive amount

of serous fluid accumulates in the abdominal cavity; occurs in response to portal hypertension



• Cirrhosis of the Liver (cont.)– Esophageal varices: veins in the esophagus

become distended because of excessive pressure from defective blood flow through the cirrhotic liver.



• Cirrhosis of the Liver (cont.)– Hepatic encephalopathy: occurs in response to

the inability of the diseased liver to convert ammonia to urea for excretion; the continued rise in serum ammonia, if allowed to progress, leads to coma and eventual death.



• LeukopeniaImpaired production, function, and movement of white blood cells

• ThrombocytopeniaPlatelet production and survival are impaired as a result of the toxic effects of alcohol.



• Sexual Dysfunction– In the short term, enhanced libido and failure of

erection are common.– Long-term effects include gynecomastia,

sterility, impotence, and decreased libido.



2. A client is brought to the ED. The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dl. Among the physician’s orders is thiamine. Which is the rationale for this intervention?

A. To prevent nutritional deficitsB. To prevent pancreatitisC. To prevent alcoholic hepatitisD. To prevent Wernicke's encephalopathy



• Correct answer: D– Wernicke’s encephalopathy is the most serious

form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.



• Alcohol use during pregnancy can result in fetal alcohol spectrum disorders (FASDs):– Fetal alcohol syndrome (FAS): problems with

learning, memory, attention span, communication, vision, and hearing

– Alcohol-related neurodevelopmental disorder– Alcohol-related birth defects



• No amount of alcohol during pregnancy is considered safe.

• Alcohol can damage a fetus at any stage of pregnancy.



Characteristics of FAS:• Abnormal facial features• Small head size• Shorter-than-average

height• Low body weight• Poor coordination• Hyperactive behavior• Difficulty paying attention• Poor memory• Difficulty in school

• Learning difficulties• Speech and language delays• Intellectual disability• Poor reasoning skills• Sleep and sucking problems

as a baby• Vision or hearing problems• Problems with the heart,

kidneys, or bones



• Alcohol IntoxicationOccurs at blood alcohol levels between 100 and 200 mg/dl.

• Alcohol WithdrawalOccurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use.



Sedative-, Hypnotic-, or Anxiolytic Use Disorder

• A Profile of the Substance– Barbiturates– Nonbarbiturate hypnotics– Antianxiety agents– Club drugs



• Patterns of Use• Effects on the Body

– Effects on sleep and dreaming– Respiratory depression– Cardiovascular effects– Renal function

Sedative-, Hypnotic, or Anxiolytic Use Sedative-, Hypnotic, or Anxiolytic Use DisorderDisorder


• Effects on the Body (cont.)

– Hepatic effects– Body temperature– Sexual functioning

Sedative-, Hypnotic, or Anxiolytic Use Sedative-, Hypnotic, or Anxiolytic Use Disorder Disorder (cont.)(cont.)


• Intoxication– With these CNS depressants, effects can range

from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug).

• Withdrawal– Onset of symptoms depends on the half-life of

the drug from which the person is withdrawing.

– Severe withdrawal from CNS depressants can be life threatening.

Sedative-, Hypnotic, or Anxiolytic Use Sedative-, Hypnotic, or Anxiolytic Use Disorder Disorder (cont.)(cont.)


Stimulant Use Disorder•A Profile of the Substance

– Amphetamines– Synthetic stimulants– Nonamphetamine stimulants– Cocaine– Caffeine– Nicotine



Stimulant Use Disorder (cont.)•Patterns of Use •Effects on the Body

– CNS effects– Cardiovascular effects – Pulmonary effects– Gastrointestinal and renal effects– Sexual functioning



Stimulant Use Disorder (cont.)•Intoxication

– Amphetamine and cocaine intoxication produce euphoria, impaired judgment, confusion, changes in vital signs (even coma or death, depending on amount consumed).

– Caffeine intoxication usually occurs following consumption in excess of 250 mg. Restlessness and insomnia are the most common symptoms.



Stimulant Use Disorder (cont.)•Withdrawal

– Amphetamine and cocaine withdrawal may result in dysphoria, fatigue, sleep disturbances, and increased appetite.

– Withdrawal from caffeine may include headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting.

– Withdrawal from nicotine may include dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite.



Inhalant Use Disorder•A Profile of the Substance

– Aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners



Inhalant Use Disorder (cont.)•Patterns of Use/Abuse•Effects on the Body

– CNS effects– Respiratory effects– GI effects– Renal system effects



Inhalant Use Disorder (cont.)•Intoxication

– Develops during or shortly after use of or exposure to volatile inhalants

– Symptoms include:• Dizziness, ataxia, muscle weakness• Euphoria, excitation, disinhibition, slurred speech• Nystagmus, blurred or double vision• Psychomotor retardation, hypoactive reflexes• Stupor or coma



Opioid Use Disorder• A Profile of the Substance

– Opioids of natural origin– Opioid derivatives– Synthetic opiate-like drugs



Opioid Use Disorder (cont.)•Patterns of Use or Abuse•Effects on the Body

– Central nervous system– Gastrointestinal– Cardiovascular– Sexual functioning



Opioid Induced Disorder•Intoxication

– Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours.

– Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment.

– Severe opioid intoxication can lead to respiratory depression, coma, and death.



Opioid Induced Disorder (cont.)•Withdrawal

– From short-acting drugs (e.g., heroin):• Symptoms occur within 6 to 8 hours, peak within 1 to 3

days, and gradually subside in 5 to 10 days– From long-acting drugs (e.g., methadone):

• Symptoms occur within 1 to 3 days, peak between 4 and 6 days, and subside in 14 to 21 days

– From ultra-short-acting meperidine:• Symptoms begin quickly, peak in 8 to12 hours, and

subside in 4 to 5 days



Opioid Induced Disorder (cont.)•Symptoms of Opioid Withdrawal

– Dysphoria, muscle aches, nausea and vomiting, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal cramping, diarrhea, yawning, fever, and insomnia



Hallucinogen-Induced Disorder •A Profile of the Substance–Naturally occurring hallucinogens–Synthetic compounds

•Patterns of Use–Use is usually episodic



Hallucinogen-Induced Disorder (cont.)• Intoxication–Occurs during or shortly after using the drug–Symptoms include perceptual alteration, depersonalization, derealization, tachycardia, palpitations



Hallucinogen-Induced Disorder (cont.)• Symptoms of PCP intoxication include

belligerence and assaultiveness and may proceed to seizures or coma.



Hallucinogens: Effects on the BodyHallucinogens: Effects on the Body

• Physiological– Nausea/vomiting– Chills– Pupil dilation– Increased BP, pulse– Loss of appetite– Insomnia– Elevated blood sugar– Decreased respirations

• Psychological– Heightened response to

color, sounds– Distorted vision– Sense of slowed time– Magnified feelings– Paranoia, panic– Euphoria, peace– Depersonalization– Derealization– Increased libido



Cannabis Use Disorder• A Profile of the Substance

– Marijuana– Hashish

• Patterns of Use


Cannabis Use Disorder•Effects on the Body

– Cardiovascular – Respiratory – Reproductive – Central nervous system– Sexual functioning



Cannabis Use Disorder•Intoxication

– Symptoms include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment.

– Physical symptoms include conjunctival injection, increased appetite, dry mouth, and tachycardia.

– Impairment of motor skills lasts for 8 to 12 hours.



Cannabis Use Disorder•Withdrawal

– Occurs upon cessation of cannabis use that has been heavy and prolonged.

– Symptoms occur within a week following cessation of use.

– Symptoms include irritability, anger, aggression, anxiety, sleep disturbances, decreased appetite, depressed mood, stomach pain, tremors, sweating, fever, chills, or headache.



Application of the Nursing ProcessApplication of the Nursing Process

• Nurses must begin relationship development with an individual who abuses substances by examining own attitudes and personal experiences with substances.


Nursing Process: AssessmentNursing Process: Assessment

• Various assessment tools are available for determining the extent of the problem a client has with substances.– Drug History and Assessment– Clinical Institute Withdrawal Assessment of

Alcohol Scale– Michigan Alcoholism Screening Test (MAST)– CAGE Questionnaire


• CAGE Questionnaire– Have 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 to steady your nerves (Eye-opener)?

Nursing Process: AssessmentNursing Process: Assessment


Dual DiagnosisDual Diagnosis

• Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis.

• Program combines special therapies that target both problems.


• Ineffective denial related to weak, underdeveloped ego

• Outcome: Client will demonstrate acceptance of responsibility for own behavior and acknowledge association between personal problems and use of substance(s).

Nursing Diagnosis/Outcome Nursing Diagnosis/Outcome IdentificationIdentification


• Ineffective coping related to inadequate coping skills and weak ego

• Outcome: Client will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances).

Nursing Diagnosis/Outcome Nursing Diagnosis/Outcome Identification Identification (cont.)(cont.)


• Imbalanced nutrition less than body requirements/fluid volume deficit related to drinking or taking drugs instead of eating

• Outcome: Client will be free from signs or symptoms of malnutrition/dehydration.



• Risk for infection related to malnutrition and altered immune condition

• Outcome: Shows no signs or symptoms of infection.



• Chronic low self-esteem related to weak ego, lack of positive feedback

• Outcome: Exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others.



• Deficient knowledge (effects of substance abuse on the body) related to denial of problems with substances evidenced by abuse of substances

• Outcomes: Verbalizes importance of abstaining from use of substances to maintain optimal wellness



• For the client withdrawing from CNS depressants:– Risk for injury related to CNS agitation

• For the client withdrawing from CNS stimulants:– Risk for suicide related to intense feelings of

lassitude and depression, “crashing,” suicidal ideation



Planning/ImplementationPlanning/Implementation

• Detoxification– Provide safe and supportive environment.– Administer substitution therapy.


• Intermediate Care– Provide explanations of physical symptoms.– Promote understanding and identify causes of

substance dependency.– Help client accept use of substance as a problem.– Provide education and assistance to client and

family.

Planning/Implementation Planning/Implementation (cont.)(cont.)


• Rehabilitation– Encourage continued

participation in long-term treatment.

– Promote participation in outpatient support system.

– Assist client to identify alternative sources of satisfaction.

– Provide support for health promotion and maintenance.

Alcoholics Anonymous

Planning/Implementation Planning/Implementation (cont.)(cont.)


Client/Family EducationClient/Family Education

Nature of the Illness• Effects (of Substance) on the Body

– Alcohol– Other CNS depressants– Hallucinogens– Inhalants– Opioids– Cannabinols

• Ways in Which Use of Substance Affects Life


Management of the Illness • Activities to substitute for (substance) in

times of stress• Relaxation techniques

– Progressive relaxation– Tense and relax– Deep breathing– Autogenics

Client/Family Education Client/Family Education (cont.)(cont.)


Management of the Illness (cont.)• Problem-solving skills• Essentials of good nutrition



Support Services

• Financial assistance• Legal assistance• Alcoholics Anonymous (or other support group specific to another substance)• One-to-one support person



Nursing Process: EvaluationNursing Process: Evaluation

• Evaluation involves reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care.


The Chemically Impaired NurseThe Chemically Impaired Nurse

• It is estimated that 10 to 15 percent of nurses suffer from the disease of chemical addiction.

• Alcohol is the most widely abused drug, followed closely by narcotics.


• Clues for recognizing substance impairment in nurses vary according to the substance being used.

• High absenteeism may be present if the person’s source is outside the work area.

• Or the person may rarely miss work if the substance source is at work.

The Chemically Impaired Nurse The Chemically Impaired Nurse (cont.)(cont.)


• Increase in “wasting” of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs compared to other nurses may be present.

• Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall

• Problems with relationships• Irritability, tendency to isolate, elaborate

excuses for behavior



• Unkempt appearance, impaired motor coordination, slurred speech, flushed face

• Patient complaints of inadequate pain control, discrepancies in documentation



State Board Response• May deny, suspend, or revoke a license based

on a report of chemical abuse by a nurse• Diversionary laws allow impaired nurses to

avoid disciplinary action by agreeing to seek treatment



During the Suspension Period • Successful completion of an inpatient,

outpatient, group, or individual counseling treatment program



• Evidence of regular attendance at nurse support groups or 12-step programs

• Random negative drug screens• Employment or volunteer activities



• Peer assistance programs serve to assist impaired nurses to:

– Recognize their impairment – Obtain necessary treatment – Regain accountability within profession



CodependencyCodependency

• Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions


• Codependent people sacrifice their own needs for the fulfillment of others to achieve a sense of control.

• Derive self-worth from others• Feel responsible for the happiness of others• Commonly deny that problems exist

Codependency Codependency (cont.)(cont.)


• The person keeps feelings in control, and often releases anxiety in the form of stress-related illnesses, or compulsive behaviors such as eating, spending, working, or use of substances.



• May have experienced abuse or emotional neglectas a child

• Are outwardly focused on others and know very little about how to direct their lives from their own sense of self



The Codependent NurseThe Codependent Nurse

• Classic Characteristics – Caretaking– Perfectionism– Denial– Poor communication


Treating CodependenceTreating Codependence

• Recovery Process– Survival stage– Reidentification stage– Core issues stage– Reintegration stage


Treatment Modalities for Substance-Treatment Modalities for Substance-Related DisordersRelated Disorders

• Alcoholics Anonymous– Is a major self-help organization for the treatment of alcoholism– Based on the concept of:

• Peer support• Acceptance• Understanding from others who have

experienced the same problem


• Alcoholics Anonymous (cont.)– The 12 steps that embody the philosophy of AA

provide specific guidelines on how to attain and maintain sobriety.

– Total abstinence is promoted as the only cure; the person can never safely return to social drinking.

Treatment Modalities for Substance-Treatment Modalities for Substance-Related Disorders Related Disorders (cont.)(cont.)


• Various support groups patterned after AA but for individuals with problems with other substances

• Counseling

• Group therapy



• Pharmacotherapy for Alcoholism– Disulfiram (Antabuse)– Other medications:

• Naltrexone (ReVia)• Nalmefene (Revex)• SSRIs• Acamprosate (Campral)



• Psychopharmacology for substance intoxication and substance withdrawal:– Alcohol

• Benzodiazepines• Anticonvulsants• Multivitamin therapy• Thiamine



• Psychopharmacology for substance intoxication and substance withdrawal (cont.):– Opioids

• Narcotic antagonists–Naloxone (Narcan)–Naltrexone (ReVia)–Nalmefene (Revex)

• Methadone• Buprenorphine• Clonidine



• Psychopharmacology for substance intoxication and substance withdrawal (cont.):– Depressants

• Phenobarbital (Luminal)• Long-acting benzodiazepines



• Psychopharmacology for substance intoxication and substance withdrawal (cont.):– Stimulants

• Minor tranquilizers• Major tranquilizers• Anticonvulsants• Antidepressants



• Psychopharmacology for substance intoxication and substance withdrawal (cont.):– Hallucinogens and cannabinols

• Benzodiazepines• Antipsychotics



3. A client, diagnosed with chronic alcoholism, says to the nurse, “I’m tired of using and I want to stop. Is there a medication that can help me maintain sobriety?” About which medication would the nurse provide information?

A. Carbamazepine (Tegretol)B. Clonidine (Catapres)C. Disulfiram (Antabuse)D. Folic acid (Folvite)



• Correct answer: C– Disulfiram is used as a deterrent to drinking.

Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol, are strictly prohibited when taking this drug.



Nonsubstance AddictionsNonsubstance Addictions

Gambling Disorder• Persistent and recurrent problematic gambling

behavior that intensifies when the individual is under stress.

• As the need to gamble increases, the individual may use any means required to obtain money to continue the addiction.


Gambling Disorder (cont.)•Gambling behavior usually begins in adolescence, although compulsive behaviors rarely occur before young adulthood.

•The disorder usually runs a chronic course, with periods of waxing and waning.

•The disorder interferes withinterpersonal relationships, social, academic, or occupational functioning.

Nonsubstance AddictionsNonsubstance Addictions


Predisposing Factors to Gambling Predisposing Factors to Gambling DisorderDisorder

• Biological Influences– Genetic

• Increased incidence among family members– Physiological

• Abnormalities in neurotransmitter systems


• Psychosocial Influences– Loss of a parent before age 15– Inappropriate parental discipline– Exposure to gambling activities as an adolescent– Family emphasis on material and financial

symbols– Lack of family emphasis on saving, planning, and

budgeting

Predisposing Factors to Gambling Predisposing Factors to Gambling Disorder Disorder (cont.)(cont.)


• Psychosocial Influences (cont.)– The psychoanalytical view suggests that gambling is used to release a buildup of tension.

S. Freud

Predisposing Factors to Gambling Predisposing Factors to Gambling Disorder Disorder (cont.)(cont.)


Treatment Modalities for Gambling Treatment Modalities for Gambling DisorderDisorder

• Behavior Therapy• Cognitive Therapy• Psychoanalysis• Psychopharmacology

–SSRIs–Clomipramine–Lithium–Carbamazepine–Naltrexone


• Gamblers Anonymous– Organization modeled after Alcoholics

Anonymous– Only requirement for membership is an expressed

desire to stop gambling– Reformed gamblers help others resist the urge to

gamble

Treatment Modalities for Gambling Treatment Modalities for Gambling Disorder Disorder (cont.)(cont.)


• Related Organizations

– Gam-Anon• For family and spouses

of compulsive gamblers– Gam-a-Teen

• For adolescent children of compulsive gamblers

Treatment Modalities for Gambling Treatment Modalities for Gambling Disorder Disorder (cont.)(cont.)

copyright © 2014. f.a. davis company substance-related and addictive disorders chapter 23

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