Substance Abuse Chapter 11

Substance Abuse  Self-administration of a drug in a manner that does not conform to the norms within the patient’s own culture and society  Drugs all have in common the ability to impact the brain and central nervous system

Substance Dependence  Overwhelming desire to take a drug  Cannot stop taking drug  Two categories  Physical dependence  Psychological dependence

Withdrawal Syndrome  Prescription drugs may be used to reduce severity  May be particularly severe for those who are dependent on alcohol or sedatives  Abusers often associate use of substance with their conditions and surroundings  Counselors encourage distance from past social contacts

Opioid Withdrawal Symptoms  Excessive sweating, restlessness, and dilated pupils  Agitation, goose bumps, tremor, and violent yawning  Increased heart rate and blood pressure  Nausea/vomiting and abdominal cramps and pain  Muscle spasms and weight loss

Alcohol Withdrawal Symptoms  Tremors, fatigue, and anxiety  Abdominal cramping and hallucinations  Confusion, seizures, and delirium

Nicotine Withdrawal Symptoms  Irritability, anxiety, and restlessness  Headache, increased appetite, and insomnia  Inability to concentrate  Decrease in heart rate and blood pressure

Tolerance  Body adapts to repeated administration of a drug  Requires higher doses of drug to produce initial effect  Common in substances that affect nervous system  Does not indicate addiction or substance abuse

CNS Depressants  Cause patients to feel sedated or relaxed  Barbiturates  Nonbarbiturate sedative–hypnotics  Benzodiazepines  Alcohol  Opioids

Opioids Prescribed for Severe Pain  Also known as narcotic analgesics  Range of CNS effects  Addiction can occur rapidly  Intense withdrawal symptoms  Not life threatening, as with barbiturate withdrawal  High psychological dependence

Ethyl Alcohol  One of most commonly abused  Effects directly proportional to amount consumed  Psychological and physical dependence can occur  Withdrawal can be severe to life-threatening

Ethyl Alcohol  Symptoms recognizable, but nurse must take care not to assume alcohol is only drug in system  Food in stomach slows onset of absorption  Metabolism occurs at slow, constant rate  Benzodiazepines are the preferred drug class for treatment of acute withdrawal

Adverse Effects of Chronic Alcohol Consumption  Large number of adverse health effects  Liver failure - cirrhosis  Delirium tremens (DT) may occur with very long- term consumption  hallucinations, confusion, disorientation  Withdrawal can be combated with antiseizure medications  Disulfiram can discourage relapses

Nicotine  Affects nervous, cardiovascular, and endocrine systems  stimulates the CNS directly  Psychological and physical dependence occurs quickly  Patients tend to continue their drug use for many years

Nurse Serves Key Role in Substance Abuse  Prevention, Diagnosis, Treatment  Thorough medical history must include substance abuse if present  Be firm in disapproving of substance abuse, yet compassionate in trying to help the patient receive treatment  Attempt to involve family members when possible

With IV-Drug Users Nurse Must Consider  HIV infection  Hepatitis  Tuberculosis