SUBSTANCE ABUSE

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SUBSTANCE ABUSE

• Mercedes A Perez-Millan MSN, ARNP

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D E F I N T I O N S

• DRUG ABUSE- The maladaptive and consistent use of
  a drug despite social, occupational,
  psychological, or physical problems exacerbated
  by the drug or recurrent use in situations that
  are physically hazardous, such as driving while
  intoxicated (APA 1994)

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D E F I N T I O N S ( CONT..)

• DRUG DEPENDANCE- Impaired control of drug use
  despite adverse consequences, the development of
  a tolerance to the drug, and the occurrence of
  withdrawal symptoms when drug intake is reduced
  or stopped

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PHYSICAL DEPENDENCE

• CONSUMES MORE THAN INTENDED
• UNABLE TO CONTROL USE
• PREOCCUPIED WITH OBTAINING SUBSTANCE
• INTERFERES WITH A.D.L..
• USES DURING HAZARDOUS ACTIVITIES
• USES RATHER THAN PARTICIPATES IN USUAL ACTIVITIES

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PHYSICAL DEPENDENCE (CONT.)

• USES DESPITE KNOWLEDGE THAT A PROBLEM EXISTS
• SIGNIFICANT TOLERANCE DEVELOPS
• W/D SYMPTOMS DEVELOP WITH CESSATION OR REDUCTION
• SUBSTANCE TAKEN TO RELIEVE OR AVOID W/D SYMPTOMS

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CLASSES OF PSYCHOACTIVE SUBSTANCES

• ALCOHOL
• NARCOTICS (Opioids, synthetics)
• SEDATIVES- HYPNOTICS
• STIMULANTS- Caffeine, Nicotine
• Cocaine,
  Amphetamine

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CLASSES OF PSYCHOACTIVE SUBSTANCES

• HALLUCINOGENS
• CANNABIS
• INHALANTS
• RAVE AND TECHNO DRUGS Designer drugs

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ALCOHOL STATISTICS 2001

• 14 million Americans considered themselves to be
  alcoholics (1 out of every 10)
• USA- 53 of those surveyed stated they had one
  or more relatives with an alcohol problem
• Costs - 100 billion/year
• 30 of all traffic related fatalities
• 35 of suicides
• 3rd leading cause of death in the USA

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ALCOHOL

• LEGAL INTOXICATION
• BLOOD ALCOHOL LEVEL 0.08
• DEFENSE MECHANISMS
• DENIAL, PROJECTION, RATIONALIZATION
• BEHAVIOR
• MANIPULATIVE

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ALCOHOL ( CONT..)

• WITHDRAWAL
• EARLY 6-8 HOURS AFTER LAST DRINK
• DTS IN 72 HOURS
• ANXIETY, ANOREXIA, INSOMNIA, NV TREMOR, SHAKY,
  DELIRIUM, ALTERED L.O.C., PULSE B.P.,
  DIAPHORESIS
• POSSIBLE SEIZURES
• VISUAL, TACTILE HALLUCINATIONS

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Nursing Diagnosis Substance Abuse

• Risk for injury. (withdrawal)
• Risk for violence to self (withdrawal)
• Ineffective denial related to weak ego
• Ineffective coping related to inadequate coping
  skills
• Low self-esteem related to a weak ego
• Risk for infection related to altered immunity
  and poor nutrition
• Imbalanced nutrition less than body requirements/
  fluid volume deficit related to not eating or
  drinking.

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TREATMENT OF ALCOHOL WITHDRAWAL

• SEDATIVES (Librium, Valium or Phenobarbital)
• THIAMINE
• MAGNESIUM SULFATE
• MULTIVITAMINS
• ANTIEMETICS
• --------------------------------------------------
  ------
• ANTABUSE Used only during rehabilitation phase

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NURSING CARE

• FLUID-ELECTROLYTE REPLACEMENT
• MONITOR VITAL SIGNS
• SAFETY-ONE-TO ONE
• PRESENT REALITY, DECREASE ANXIETY
• SEIZURE PRECAUTIONS
• SUPPORTIVE LIMIT-SETTING
• REINFORCE DISEASE CONCEPT
• CONSISTENCY
• REFER TO ALCOHOLICS ANONYMOUS
• EDUCATION PROGRAM AFTER DETOX.

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SEDATIVE, HYPNOTIC OR ANXIOLYTIC

• INTOXICATION
• LABILITY
• DECREASED CONTROL OF IMPULSES/INHIBITIONS
• IRRITABLE
• SLURRED SPEECH
• INCOORDINATION/UNSTEADY GAIT
• IMPAIRED ATTENTION AND JUDGEMENT
• CAN LEAD TO COMA AND DEATH

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SEDATIVE, HYPNOTIC OR ANXIOLYTIC ( CONT..)

• WITHDRAWAL
• POTENTIAL FOR SEIZURES
• MUST BE W/D GRADUALLY

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AMPHETAMINES

• INTOXICATION
• INCREASED PULSE AND B.P.
• DILATED PUPILS
• N /V
• TWITCHING, ASSAULTIVE
• GRANDIOSE/EUPHORIC
• PSYCHOSIS
• CONVULSIONS, COMA AND DEATH

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AMPHETAMINES ( CONT..)

• WITHDRAWAL
• DEPRESSION
• AGITATION
• SLEEPINESS
• DISORIENTATION
• APATHY

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NURSING CARE FORAMPHETAMINE O/D AND W/D

• OVERDOSE
• MANAGEMENT FOR
• INCREASED TEMP
• CONVULSIONS
• RESPIRATORY DISTRESS
• CV SHOCK
• WITHDRAWAL
• ANTIDEPRESSIVE THERAPY

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COCAINE / CRACK

• INTOXICATION
• INCREASED PULSE AND B.P.
• DILATED PUPILS
• INSOMNIA
• ANOREXIA
• OVERDOSE
• SEIZURES
• CARDIAC ARREST
• CONVULSIONS DEATH

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COCAINE / CRACK ( CONT..)

• WITHDRAWAL
• FATIGUE
• DEPRESSION
• APATHY
• ANXIETY

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NURSING CARE FORCOCAINE / CRACK O/D AND W/D

• SAME AS FOR
• AMPHETAMINES

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OPIODS / NARCOTICS

• INTOXICATION
• DECREASED B.P. AND RESPIRATIONS
• CONSTRICTED PUPILS
• DROWSINESS
• SLURRED SPEECH
• PSYCHOMOTOR RETARDATION
• EUPHORIA/DYSPHORIA
• IMPAIRED MEMORY/JUDGEMENT

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OPIODS / NARCOTICS ( CONT..)

• OVERDOSE
• PUPILS CONSTRICTED, BUT CAN BE DILATED
• RESPIRATORY DEPRESSION/ARREST
• COMA
• SHOCK
• CONVULSIONS AND DEATH

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OPIODS / NARCOTICS ( CONT..)

• WITHDRAWAL
• YAWNING
• ANOREXIA
• INSOMNIA
• RUNNY NOSE
• CRAMPS
• CHILLS
• NAUSEA
• PILORECTION OF SKIN

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NURSING CARE FOR O/D AND W/D NARCOTICS

• OVERDOSE
• NARCAN
• WITHDRAWAL
• SUPPORTIVE MEASURES, IF NOT LIFE THREATENING
  (COLD TURKEY)
• (METHADONE MAY BE USED IN SEVERAL SITUATIONS)

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HALLUCINOGENS- LSD / PCP

• INTOXICATION/OD
• INTENSIFIED PRECEPTIONS
• PCP, LSD- DILATED PUPILS AND TACHYCARDIA,
  TPR. AND BP
• ANXIETY/DEPRESSION
• ILLUSIONS AND HALLUCINATIONS
• DEPERSONALIZATION
• PANIC REACTION GRANDIOSITY, PARANOIA
• PCP ASSAULTIVENESS JERKING SEIZURES
• LSD TRIPS AND FLASHBACKS

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HALLUCINOGENS- LSD / PCPNURSING CARE

• BENZODIAZAPINES (eg, diazepam, lorazepam)
• ANTIPSYCHOTICS (eg, haloperidal)
• ROOMS WITH LOW STIMULATION
• LSD- STAY WITH THE PATIENT TALK DOWN
• PCP- SPEAK SLOWLY, CLEAR. DO NOT ATEMPT TO TALK
  DOWN
• MEDICAL INTERVENTION FOR- HYPERTENSION,
  HYPERTHERMIA, RESPIRATORY DISTRESS

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CANNABIS (CNS DEPRESSANT AND HALLUCINOGEN)

• ALTERED SENSORY PERCEPTIONS
• EUPHORIA, IMPAIRED COORDINATION
• SOCIAL WITHDRAWAL
• RED EYES EYE IRRITATION
• INCREASED APPETITE

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INHALANTS

• Paints, glue, cigarette lighter fluid, and
  propellant gases used in aerosols. (e.g. hair
  spray)
• Nitrates, Anesthetics (nitrous oxide)
• Sniffing result in intoxication disinhibition,
  staggering, lightheadness agitation, euphoria.
• Damage to the nervous system and polyneuropathy
  and myelopathy in chronic users
• Treatment Support affected systems, B12 and
  folate.

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Rave and Techno Drugs, Club Drugs, Date Rape drugs

• Rave (dance parties) usingdrugs such as Ecstacy
  (meth-amphetamine) (MDMA, Adam, yaba, XTC) and
  other amphetamines-like recreational drugs
  producing effects resembling stimulants and
  hallucinogens.
• Effects include increased energy, euphoria,
  self-confidence, feelings of closeness to people.
• Use results in depression, anxiety and sleep
  disorders.
• Rohypnol roofies used for sexual assault. Fast
  acting benzodiaxepine resulting in relaxation and
  amnesia.

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PSYCHOPHARMACOLOGY ADDICTION

• ADDITIONAL MEDICATIONS USED
• TREXAN, REVIA
• ANTABUSE
• ZYBAN
• METHADONE
• CATAPRESS
• SUBUTEX
• NICOTINE PATCH