Substance Abuse : Nursing Issues

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Substance Abuse Nursing Issues

• German Molina, M.D.
• Assistant Professor of Clinical Psychiatry
• University of Miami

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I. Introduction

• Substance abuse vs. use
• Epidemiology
• DSM Criteria

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A. DSM IV Criteria

• Dx Substance Abuse
• Dx Substance Dependence
• Dx Polysubstance Dependence

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II. Risk Factors

• Some risks are unique to the substance
• Commonly associated drugs
• Consequences of the use
• Psychiatric symptoms
• Axis I
• Axis II

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III. Most commonly associated drugs

• Ethanol
• Marijuana
• Methamphetamine
• Cocaine
• Ecstasy

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Cont. Most associated drugs

• Ketamine
• GHB (Gamma-hydroxybutyrate)

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A. Ethanol

• Effects
• Overdose
• Interactions

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B. Marijuana

• Grass, weed, pot, ganja
• Effects
• Overdose
• Interactions

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C. Methamphetamine

• Speed, crystal, meth, crystalmeth
• Effects
• Overdose
• Interactions

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D. Cocaine

• coke, Snow, crack
• Effects
• Overdose
• Interactions

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E. Ecstasy

• X, E, Adam
• Effects
• Overdose
• Interactions

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F. Ketamine

• K, Special K, KitKat
• Effects
• Overdose
• Interactions

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G. GHB

• Liquid X, Scoop, Organic Quaalude
• Effects
• Overdose
• Interactions

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IV. Issues relevant to IDU

• HIV disease stage
• Fragmentation of continuity of services
• Adherence
• Physical complications

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V. Medical Care

• On-site medical care vs. referral
• Med/Psych available in methadone clinic
• Intensive case management
• Pain management

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VI. Psychopathology

• In MMT
• Antisocial Personality D/o
• Secondary psychiatric symptoms

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VII. Medical evaluation

• Physical assessment
• Short/long term use of substance
• Withdrawls
• Neurotoxicities of medications prescribed

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Cont. Medical

• Head trauma
• Metabolic encephalopathies
• Neurosyphilis
• Cva
• Seizures

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Cont. Medical

• Opportunistic infections
• Minor Cognitive Motor Disorder
• HIV-associated Dementia

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VIII. Treatment Considerations

• Settings
• Medication treatment efficacy, safety, abuse
  liability, adherence
• Risk reduction intervention
• To be individualized