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

Characteristics of Substance Abuse 2. tolerance- increased amount of the substance to obtained desired effect 3. Withdrawal- behavioral, physiologic and cognitive symptoms occuring when blood or tissue concentration of substance abruptly decline 4. 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 Abuse 2. The most common abuse substance is the alcohol 3. About one in five nurses is a substance abuser 4. Substance abuse is a family problem 5. Common personality traits are associated with substance abuser 6. Polysubstance abuse involves concurrent use of two or more

Etiology of Substance Abuse 2. Exact cause of substance abuse remains unclear 3. Biologic theories: a. genetic factor b. biochemical 6. Sociocultural Theory a. hopelessness and defeat of living condition b. peer pressure c. easy availability of the substance d. social ambivalence about the use of substance.

4. Family theory - implicates dysfunctional family pattern 5. 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: 2. Detoxification followed by residual or outpatient program 3. Self-help 12 step program designed to help members achieve and maintain sobriety one day at a time 4. 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 SUBSTANCES Alcohol - 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 hallucination Stage 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 deficiency 4. pancreatitis, hepatitis, cirrhosis and ascitis 5. Fetal alcohol syndrome - occurs to infant born to an alcoholic mother

- Treatment of Withdrawal 2. Anxiolytic- prevent withdrawal manifestations 3. Anticonvulsant- can be use for seizure prevention 4. Diet/Promotion of adequate nutrition - vitamin supplementation including multivitamins, vit. B12, B, folic acid

CNS Depressant CLASSIFICATIONS C.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, pentobarbital b. Sedative/hypnoticsmethoquolone, 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 Withdrawal 1. tapering of the anxiolytic 2. narcoleptic for psychotic

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 cocainderivatives of opium - demerol and methadoneare 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 days 2. Clonidine hydrochloride to block the withdrawal manifestations and maybe given for 14 days CNS Stimulant A. Cocain- a CNS stimulant and causes dopamine depletion - can cause euphoria, anxiety, anger, tachycardia and

- Common Drugs: 1. Cocaine powder- snorted or injected 2. Crack crystals- usually smoked - Withdrawal: - severe depression, fatigue, hypersomnia and psychomotor agitation - Treatment: 1. anxiolytic to treat psychomotor agitation

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

- withdrawal Manifestations: -severe depression, vivid dreams, insomnia, hypersomnia and psychomotor agitation - treatment: 1. anti depressant- to counteract depression 2. neuroleptic- to treat paranoia and psychosis 3. 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 peripheral vascular 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

- manifestations: 1. similar to psychosis and depersonalization 2. presence of mystical experience 3. 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 hallucination STEROIDS - are synthetic derivatives of testosterone - can cause androgenic and anabolic effect

- Associated problem 1. cholestatis 2. hepatoadenoma 3. hepatocarcinoma 4. 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