SUBSTANCE ABUSE

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SUBSTANCE ABUSE

• USE, ABUSE AND DEPENDENCE
• Mary Vercoutere, RN Instructor

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Topics

• Historical Factors
• Risk Factors/Poly drug abuse
• Theory for cause
• Predisposing factors
• Addition in the Health Care Professions

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Historical Aspects

• Neolithic Age 6400 B.C.
• Distillation introduced by the Arabs in the
  Middle Ages.
• Alchemists alcohol was the cure for all
  ailments.
• Whiskey means water of life

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A Disease and an Addiction

• Early 1800s Dr. Benjamin Rush, a well respected
  Physician of the time, identified the widespread
  excessive use.
• Strong religious beliefs of the time forced
  prohibition.
• Mid-19th century 13 states prohibited the sale of
  alcohol.

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Prohibition

• Major effect in the USA was 1920-1933.
• Profit in the underground
• Millions of dollars lost due to Federal and State
  Taxes
• Human devastation and social costs unmeasurable.

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Alcohol Use in Todays World

• Alcohol consumption effects 2/3 of the USA
  population.
• Acceptance culturally of college-age use and
  abuse as a rite of passage.
• Stigma of admitting a problem with alcohol.

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History of Opium

• Opiumthe Greek word for juice
• References to the use date back to 3000 B.C. in
  Egyptian, Greek and Arabian cultures.
• Widely used 16th, 17th century in Europe
  medicinally/ recreationally.
• 1803 Morphine isolated

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Opiate Abuse

• Development of hypodermic syringe in 1853.
• Self-administration
• Chinese immigration introduced opium smoking late
  19th century.
• Harrison Narcotic Act 1914 due to widespread
  addiction.

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Hallucinogens

• Carbon dating show use has been in practice by
  Native American Indians for 7000 years.
• The Peyote cactus has been used for rituals and
  in religious practices
• Shamen would use it to induce a trance lasting
  days for healing purposes.

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Synthesized

• LSD was synthesized 1938 by Dr. Albert Hoffman.
• Used as a clinical research tool on the mind and
  behavior for diseases such as schizophrenia and
  to investigate the unconscious mind.
• The abuse on the illicit market.

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• Substance use is simply the ingestion of a
  chemically active agent, prescription or illicit
  drug, alcohol or tobacco
• Substance abuse suggests a maladaptive pattern of
  substance use leading to significant difficulties
  in meeting major role obligations at home, work
  or school

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DSM IV-TR CRITERIA FOR SUBSTANCE ABUSE

• A maladaptive pattern of substance use leading to
  a clinically significant impairment or distress,
  as seen by one or more of the following within a
  12 month period.
• Inability to fulfill major role obligations at
  work, school or home.

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Risks

• Participation in physically hazardous situations
  while impaired.driving a car, operating a
  machine
• Recurrent legal or interpersonal problems
• Continued use despite recurrent social and
  interpersonal problems caused or exacerbated by
  the effects of the substance

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DSM IV- TR CRITERIA FOR SUBSTANCE DEPENDENCE

• Maladaptive pattern of substance use leading to
  clinically significant impairment or distress,
  manifested by three or more of the following
  within a 12 month period
• 1. Presence of tolerance of the drug
• 2. Presence of withdrawal syndrome due to the
  cessation or reduction of substance use that has
  been heavy and prolonged

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Criteria

• 3. Substance is taken in larger amounts for
  longer periods than intended
• 4. Unsuccessful or persistent desire to cut down
  or control use
• 5. Increased time spent in getting, taking, and
  recovering from the substance. May withdraw from
  family and friend

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Criteria

• 6. Reduction or absence of important social,
  occupational or recreational activities
• 7. Substance use despite knowledge of recurrent
  physical or psychological problems

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CAUSATIVE THEORIES

• Biological Factors
• Neurobiological theory-craving for drug is a
  cardinal feature of addictive disorders. Effects
  neurotransmitters, areas of the brain.
• Opioid,dopamine, GABA systems.

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Theory

• Psychological Factors
• Behavioral theory
• Sociocultural Theory Asians, lack of enzyme that
  breaks down ETOH.
• Aamerican Indians break down ETOH at faster rate.

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ALCOHOL

• Alcohol can be classified technically as a food,
  due to its high caloric content, but it does not
  require any digestive process in order to be
  metabolized by the body in most European decent
  peoples.
• The rate of absorption of alcohol from the
  stomach and duodenum is effected by 4 variables

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Alcohol

• 1. The alcohol concentration in a drink
• 2. The amount of food in the stomach
• 3. Body weight
• 4. Drinking experience - tolerance

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Alcohol Abuse

• Taking large amts of alcohol
• Binge drinking
• Withdrawal syndrome.hangover
• NV, Gastritis, Headache,Fatigue, Sweating and
  thirst,Restlessness, Irritability,The
  shakesVasomotor instability

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Alcohol

• Time frame for withdrawal symptoms may begin
  within 12-24 hours following last drink. Symptoms
  may last 48-72 hours. Major withdrawal symptoms
  may appear within 2-3 days following last drink
  and may last 3- 5 days

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DANGERS AND COMPLICATIONS

• Car accidents
• Physical injury
• Malnutrition
• Hepatitis
• Cirrhosis
• Suicide

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Effects of Alcohol on the Body

• Reproductive effects fetal alcohol syndrome.
• Cardiovascular effects, caardiomyopaathy.
• Pancreatitis.
• GI bleeding, esophageal bleeding.
• Wernickes encephalopathy thiamine deficiency
  that causes paralysis and death if not corrected.

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Effects of Alcohol on the Body

• Korsakoffs psychosis confusion, loss of memory,
  confabulation.
• Both Wernickes and Korsakoffs are treated the
  same.
• Peripheral Neuropathy nerve dammage due to poor
  nutrition
• DTsDelirium Tremens

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Withdrawal

• Withdrawal delirium a medical emergency MI, PV
  collapse, electrolyte imbalance, aspiration
  pnemonia, suicide.
• Orinda Center a social model of de-toxicitation

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MAJOR WITHDRAWALMEDICAL TREATMENT

• Major withdrawal is the most advanced potentially
  life-threatening stage of alcohol withdrawal,
  develops within 72 hours after last drink
• Symptoms autonomic hyperactivity elevated temp,
  diaphoresis, hypertension, tachycardia
• Behavioralconfusion, agitation, tremors and
  alterations in sensory perceptions, auditory and
  visual hallucinations

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Treatment

• Monitoring the fluid status
• Administering magnesium sulfate to decrease
  irritability caused by low magnesium levels to
  prevent seizure
• Prescribing detoxification protocol accepted at
  the facility.

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TREATMENT

• QUIET NON STIMULATING ENVIRONMENT
• Vitamins - thiamine and b-complex, usually 200mg
  thiamine every day for three days.
• Aversion therapy - Antabuse- can be fatal if
  patient drinks while on this drug. ReVia,
  Trexandeveloped 1984 for treatment in heroin
  abuseseems to work for craving with alcohol

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Treatment

• Psychotherapy
• AA - support groups
• Supportive life changes

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NURSING ASSSESSMENT

• Nurse must begin relationship development with a
  client with a substance abuse problem by
  examining his or her own attitudes and personal
  experiences with this area of caring and
  treatment.
• Help client to find ways to cope.
• Family intervention.
• Need open, accepting, trusting relationship.

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Client Centered Hope

• Lifetime problem.DENIAL is biggest problem

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OTHER DRUGS

• Marijuana
• Cocaine
• Amphetamines
• Heroin and the Opiates
• Opioid Analogs called designer drugs

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Other Drugs

• Semisynthetic narcotic, oxycodone (percodan)
  OxyContin,unfortunately street users of the drug
  are attracted to its euphoric high that is
  similar to heroin
• Hallucinogens
• Club drugs
• Rohypnol.date rape drugs, alcohol-69,
  marijuana-18, cocaine 5

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Chemical Dependency in the Health Professional

• 1983 California State Legislature revised the
  Nurse Practice Act to require that all RNs have
  training in detection of substance abuse.
• Caregivers with a substance problem.
• Chemical dependency is a primary disease
  chronic, progressive.

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Occupational Hazard

• Loss of control
• Compulsive
• Continued despite adverse consequences.
• Genetics
• Nurses and physicians knowledge about
  pharmaceuticals
• Access

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Signs/Symptoms

• Difficulty concentrating
• Impaired judgment
• Undependable
• Moodiness, runny nose
• Daydreaming
• Constantly wearing long sleeves

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Interventions

• Individuals
• Families
• Conclusions
• Questions