SUBSTANCE ABUSE • Peer pressure, especially during adolescence when

individual is most vulnerable to pressure from peer group

DEFINITION OF TERMS:
• Use – when a person drinks alcohol or swallows, smokes,
sniffs, or injects a mind-altering substance
D. Behavioral Theory
• Abuse – when a person is using alcohol or drugs for the
purpose of intoxication or, in the case of prescription drugs,
for the purpose beyond their intended use (excessive use of
substance that differs from societal norms)
• Easy availability of substances combined with attitude that
substance use is viable method of stress relief
• Societal ambivalence about use of substances, partially
validating message that medicine solves problems
• Substance use is a response to stressful stimuli; use is
reinforced because substances effectively provide temporary
relief of anxiety

Common Personality Traits are Associated with

• Dependence – the continuing use of alcohol or drugs Substance Abusers:
despite adverse consequences to one’s physical, social and a. Dominant and critical behavior toward others (masks self-
psychological well-being doubt and passivity)
b. Personal insecurity, decreased self-esteem
• Addiction – describes that state when the person c. Rebellious attitude towards authority
experiences severe psychological and behavioral d. Difficulty with intimate relationships, tendency toward
dependence on drugs or alcohol narcissism
e. Use of defense mechanisms including denial,
• Intoxication – use of substance that results in maladaptive rationalization, and projection
behavior
• Withdrawal – is the adverse physical and psychological
symptoms that occur when the person ceases using a
substance
Commonly Abused Substances and Effects:
• Tolerance – the need for greatly increased amounts of
substance to obtain desired effect A. Alcohol
1. Central Nervous System (CNS) Depressant
a. Immediate Effects due to action on brain (acute
• Detoxification – the process of safely and effectively intoxication) – causes slurred speech,
withdrawing a person from an addictive substance, usually incoordination, unsteady gait, impaired attention
under medical supervision and memory. High doses may cause stupor and
coma
• Spontaneous Remission – natural recovery b. Overdose: respiratory depression and cardiac
arrest
• Relapse – the recurrence of alcohol – or drug-dependent c. Chronic use causes multisystem dysfunction
behavior in an individual who has previously achieved and
maintained abstinence for a significant time beyond the • Intoxication: blood alcohol level 0.15 (150 mg
period of detoxification alcohol/100cc blood)
• Legal level: 0.08 – 0.10
TYPES OF SUBSTANCE ABUSE:
• Alcohol
• Amphetamine
1. Withdrawal symptoms related to CNS excitation -
• Cannabis a. Early phase (6-12 hours after last drink): anxiety
• Hallucinogen and agitation, tremors, tachycardia, and
• Inhalant hypertension, diaphoresis, nausea and vomiting
• Opioid
• Phencyclidine (PCP)
b. Delirium Tremens:
• Sedatives, hypnotics, anxiolytics • Occurs 48 to 72 hours after the last
drink
DIAGNOSTIC CRITERIA: • increased temperature, profuse
• Maladaptive pattern of substance use leading to clinically diaphoresis, hypertension and
significant impairment or distress tachycardia, seizures, perceptual
• Impairment manifested by three or more of the following disturbances such as illusions and
occurring within a 12 month-period hallucinations
A. Failure to fulfill major role obligations at work, school, or • resolves within 12-24 hours after
home onset
B. Recurrent substance use in hazardous situations ➢ Most serious form of alcohol
C. Recurrent substance-related legal problems withdrawal
D. Continued substance use despite problems ➢ Drug of choice: benzodiazepine
• Symptoms never met criteria for substance dependence 1. Fetal Alcohol Syndrome
a. Can occur in infants born to alcoholic mothers
b. Causes intellectual deficits, physical abnormalities
ETIOLOGY: c. Requires infant withdrawal from alcohol
A. Biological theory
• Genetic factors: incidence of alcohol abuse in the children 2. Alcohol-induced Amnestic Disorders
of alcoholics is four times greater than in the general a. Wernicke’s syndrome: caused by thiamine
population deficiency (Vit. B1); wernicke’s encephalopathy
presents with oculomotor dysfunctions (involuntary
• Biochemical factors rapid eye movements), ataxia, confusion, palsy of
the 6th cranial nerve leading to nystagmus, lack of
muscular coordination and decreased mental
B. Psychological Theory function.
• Family dynamics: children of alcoholics are four times as
likely to develop alcoholism b. Korsakoff’s psychosis: characterized by both
• Inconsistent parental behavior, poor role modeling, and lack retrograde and anterograde amnesia with sparing
of nurturing of intellectual function; confabulation, chronic
• Maladaptation in early stage of development leads to oral irreservible disorder following wernicke’s
fixation in dependent personality – relief from guilt and encephalopathy, ataxia, confusion. Irreversible.
shame is sought by taking substance
3. Alcohol-deterrent therapy with disulfiram (Antabuse) –
C. Sociocultural theory aversion therapy
• Hopelessness and defeat of living conditions (poverty and
related problems) leading to the use of substances for relief a. Inhibits breakdown of alcohol in the body
(specifically inhibits the breakdown of
Ma. Elena I. Momongan, R.N., 2/10/10
 acetaldehyde
dehydrogenase)
by the enzyme aldehyde 2. Withdrawal is characterized by: severe depression, fatigue,
vivid dreams and hypersomnia or insomnia, psychomotor
b. Inhibits hepatic enzymes from normal metabolic agitation
breakdown of alcohol resulting in high levels of 3. Treatment of Withdrawal
acetaldehyde, leading to disulfiram alcohol a. Anxiolytics to treat psychomotor agitation
reactions (flushing, sweating, throbbing headache, b. Antidepressants to counteract depression
copious vomiting, tachycardia, hypotension, c. Beta-adrenergic blockers to treat hypertension and
blurred vision, weakness, tremor to death)
tachycardia
c. Produces hypersensitivity reaction following
d. Dopamine receptor agonist such as bromocryptine
alcohol ingestion
(Parlodel) to decrease cocaine craving from
d. Client should abstain from alcohol at least 12
dopamine depletion
hours before initial dose.
e. Purpose: to discourage individual from taking
4. Crosses placental barrier causing fetal addiction
possibly brain damage, and seizure disorders in infants
alcohol
f. Avoid alcohol, including ingestion of elixirs
A. Cannabis – pot or hashish
(drug preparation that use alcohol), topical
application (mouthwash, lotions, liniment, 1. Alters sensory perception due to active ingredient,
shaving cream) and inhalation (paints and tetrahydrocannibol (THC), which is a psychoactive
varnishes) substance
g. Nursing Responsibilities:
• Teach the client the nature of
a. Immediate effects: euphoria, sensation of slowed
time, impaired motor coordination, social
severe reaction and importance of
withdrawal, conjunctival irritation(red eyes),
avoiding all alcohol
increased appetite, dry mouth, tachycardia
• Teach the client to carry an
identification card in case of b. Chronic can cause decreased testosterone levels
accidental alcohol ingestion in males; may also cause a chronic lung disease
(emphysema and lung cancer)
4. Naltrexone: an opioid antagonist has been used with 1. Commonly abused drug forms include marijuana and
hashis
success for the treatment of alcoholism
2. Possible symptoms of withdrawal: irritability and anxious
mood accompanied by physiologic changes such as
5. Treatment of withdrawal
tremor, perspiration, nausea, and sleep disturbance
a. Anxiolytics such as chlordiazepoxide (Librium) and 3. Crosses placental barrier – increases risk of low birth
oxazepam (Serax) administered over 5 to 7 days weight and smaller head circumference in infant
in gradually decreasing doses
b. Anticonvulsant such as phenytoin (Dilantin) or A. Barbiturates, Other sedatives and hypnotics
carbamezapine (Tegretol) for seizure prevention. and anxiolytics
Magnesium sulfate can also be used for seizure 1. CNS depressants
prevention caused by magnesium deficiency a. Immediate effects due to action on CNS. Causes
c. Use of measures to promote adequate
drowsiness, slurred speech, motor incoordination,
nutrition and fluid and electrolyte balance
mood lability, talkativeness, postural hypotension
• Vitamin supplementation including
b. At high doses: respiratory depression, coma,
multivitamin preparation , vitamin B1
death
(Thiamin) and folic acid
c. Chronic use: depression and paranoia
• Balanced diet with supplements as
necessary
• Symptomatic treatment of nausea
2. Commonly abused types
and vomiting
a. Barbiturates: secobarbital (Seconal), pentobarbital
• Increased fluid intake
(Nembutal)
b. Sedative/hypnotics: methaqualone (Quaalude),
A. Amphetamines – crack or speed chloralhydrate (Noctec)
1. CNS Stimulant c. Anxiolytics: lorazepam (Ativan), alprazalone
a. Immediate effects due to action on the CNS: causes (Xanax), diazepam (Valium), chlordiazepoxide
(Librium)
increased energy and euphoria; extreme vigilance,
3. Withdrawal
hostility and impaired judgment; elevated blood
a. Occurs within 24 hours to 72 hours after last dose
pressure, tachycardia, dilated pupils, nausea and
vomiting b. Characterized by: nausea, vomiting,
b. Chronic use can lead to psychosis with paranoid hypertension, tachycardia, anxiety, depression,
ideation irritability, seizures (which may occur after 2
weeks of withdrawal), possibly respiratory failure
1. Commonly abused drugs: dextroamphetamine 4. Treatment of Withdrawal
a. Anxiolytics
(Dexedrine), metamphetamine
b. Neuroleptics for psychotic-like symptoms
2. Withdrawal is characterized by severe depression, vivid c. Anticonvulsants to prevent and/or treat seizures
dreams, insomnia or hypersomnia, and psychomotor
agitation A. Opioids
3. Treatment of withdrawal is symptomatic 1. CNS depressants
a. Antidepressants to counteract severe depression
b. Neuroleptics to treat any paranoia or psychosis
a. Immediate effects due to action on brain: causes
c. Anxiolytics to treat psychomotor agitation euphoria, impaired attention and memory,
apparent sedation, psychomotor retardation,
increased sensitivity to pain, apathy, pinpoint
A. Cocaine
constricted pupils, slurred speech, hypothermia,
1. CNS Stimulant and dopamine depletion
a. Immediate Effects due to action on CNS causes
b. At high doses: respiratory depression
c. Chronic use: multiple infectious disease related to
euphoria, anxiety, anger; impaired judgment and
intravenous drug use
paranoid thinking, tachycardia, dilated pupils; elevated
blood pressure; insomnia
b. Chronic use can lead to tolerance with need for 2. Commonly abused types: heroin(most addictive),
increased amount of drug morphine(major pain killer), hydromorphone, codeine (found
c. Can also cause chronic fatigue, irritability, anxiety, in cough syrups), methadone, opium
mental confusion, paranoia, suicidal depression, 3. Withdrawal
infectious disease related to intravenous use a. occurs within a few hours after last dose of short-
d. Can cause symptoms of runny nose or damaged acting opioids; begins 2-3 days after last dose of
mucous membranes from chronic snorting cocaine longer-acting opioids
1. Commonly abused drug forms include: cocaine powder b. characterized by: dilated pupils, tearing, runny
(snorted or injected), and crack crystal a cocaine derivative nose, sweating, diarrhea, fever, insomnia,
(smoked) tachycardia, mild hypotension, restlessness,
piloerection, yawning
Ma. Elena I. Momongan, R.N., 2/10/10
 4. Treatment of Withdrawal 11. We sought trough prayer and meditation to improve our
a. methadone for first 3-5 days conscious contact with God as we understood Him, praying only
b. clonidine hydrochloride (Catapres) to block for knowledge of His will and the power to carry that out.
withdrawal symptoms, may be given for 14 days 12. Having had the spiritual awakening as a result of these steps, we
tried to carry this message and to practice these principles in all
A. Hallucinogens our affairs.
1. Mind-altering drugs affecting sensory perceptions
Principles of Addiction Treatment
a. Immediate effects: intensified perception;
depersonalization, heightened response to color, 1. NO single treatment s appropriate for all individuals.
textures, sounds; illusions and hallucinations; 2. Treatment needs to be readily available.
anxiety and depression; dilated pupils, 3. Effective treatment attends to multiple needs of the individual,
tachycardia, and sweating not just his or her drug use.
b. Chronic use: paranoia. “Bad trips” may occur 4. An individual’s treatment and services plan must be assessed
which can cause panic attacks. Flashbacks can continually and modified as necessary to ensure that the plan
occur at unpredictable times meets the person’s changing needs.
c. Phencyclidine (PCP) dependence may be 5. Remaining in treatment for an adequate period of time is critical
marked by extreme violent behavior followed by for treatment effectiveness.
unresponsiveness 6. Counseling and other behavioral therapies are critical
components of effective treatment for addiction.
2. Commonly abused drug types: PCP, lysergic acid (LSD), 7. Medications are an important treatment for many patients,
mescaline, peyote especially when combined with counseling and other behavioral
3. No withdrawal symptoms described therapies.
8. Addicted or drug-abusing individuals with coexisting mental
MANAGEMENT: disorders should have both disorders treated in an integrated
ways.
f.r.a.m.e.s – Effective Elements of Brief Intervention 9. Medical detoxification is only the first stage of addiction
treatment and by itself does little to change long-term drug use.
FEEDBACK – about patient’s individual status (personal 10. Treatment does not need to be voluntary to be effective.
alcohol and other drug consumption relative to norms, 11. Possible drug use during treatment must be monitored
information about elevated liver enzyme values) continuously.
12. Treatment programs should provide assessment for HIV/AIDS,
RESPONSIBILITY Hepatitis b and c , tuberculosis and other infectious diseases and
Emphasize the individual’s freedom of choice counseling to help patients modify or change behaviors that
and personal responsibility for change. General themes place themselves and others at risk for infection.
are as follows: 13. Recovery from addiction can be a long-term process and
a. It’s up to you; you’re free to decide to frequently requires multiple episodes of treatment.
change or not
• Psychotherapy
b. No one else can decide for you or force
you to change • Family therapy
c. You’re the one who has to do it if it’s • Family support groups (Al-Anon, Alateen)
going to happen

ADVICE
Include clear recommendation on the need for
change, in a supportive and concerned rather than in a
judgmental manner.

MENU
Provide a menu of treatment options, from
which patients may pick those that seem more suitable
or appealing

EMPATHETIC COUNSELING
Show warmth, support, respect and
understanding in communication with patients.

SELF-EFFICACY
Reinforce self-efficacy, or an optimistic feeling
that he or she can change.

• Detoxification followed by residential or outpatient

rehabilitation programs.
• Self-help 12-step programs designed to help members
achieve and achieve sobriety one day at a time.

The Twelve Steps

1. We admitted we were powerless, that our lives had become
unmanageable.
2. We came to believe that a Power greater than ourselves could
restore us to sanity.
3. We made a decision to turn our will and our lives over to the care
of God as we understood Him.
4. We made a searching and fearless moral inventory of ourselves.
5. We admitted to God, to ourselves, and to another human being
the exact nature of our wrongs.
6. We are entirely ready to have God remove all these defects of
character.
7. We humbly ask Him to remove our shortcomings.
8. We made a list of all persons we had harmed, and became
willing to make amends to them all.
9. We made direct amends to such people whenever possible, except
when to do so would injure them or others.
10. We continued to make personal inventory, and when we are
wrong, promptly admitted them.

Ma. Elena I. Momongan, R.N., 2/10/10