1. Substance-Related Disorders Part II
Chapter 13
Substance-Related Disorders
Part II

2. Application of the Nursing Process
Nurses must begin relationship development with a substance abuser by examining own attitudes and drinking habits

3. Nursing Process
Various assessment tools are available for determining the extent of the problem a client has with substances
Michigan Alcoholism Screening Test (MAST)
CAGE Questionnaire
Drug History and Assessment
Clinical Institute Withdrawal Assessment of Alchohol Scale

4. Nursing Process Assessment
CAGE Questionnaire**
Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt bad or Guilty
about your drinking?
Have you ever had a drink first
thing in the morning to steady
your nerves (Eye-opener)?

5. Dual Diagnosis
Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis
Program combines special therapies that target both problems

6. Nursing Diagnosis
Ineffective Denial related to weak, underdeveloped ego
Outcome: client will demonstrate acceptance of responsibility for own behavior and acknowledge association between personal problems and use of substance(s)

7. Nursing Diagnosis (cont.)
Ineffective Coping related to inadequate coping skills and weak ego
Outcome: client will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking
substances)

8. Nursing Diagnosis (cont.)
Imbalanced Nutrition less than Body Requirements/Deficient fluid volume
related to drinking or taking drugs instead of eating
Outcome: client will be free from signs or symptoms of malnutrition

9. Nursing Diagnosis (cont.)
Risk for Infection related to malnutrition and altered immune condition
Outcome: shows no signs or symptoms of infection

10. Nursing Diagnosis (cont.)
Low Self-Esteem related to weak ego,
lack of positive feedback
Outcome: exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others

11. Nursing Diagnosis (cont.)
Deficient Knowledge (effects of substance abuse on the body) related to denial of problems with substances evidenced by abuse of substances
Outcome: verbalizes importance of abstaining from use of substances to maintain optimal wellness

12. Planning/Implementation
Detoxification (FYI, this will occur in an acute facility)
Provide safe and supportive environment
Administer substitution therapy

13. Planning/Implementation (cont.)
Intermediate care
Provide explanations of physical symptoms
Promote understanding and identify causes of substance dependency
Provide education and assistance to client and family

14. Planning/Implementation (cont.)
Rehabilitation
Encourage continued participation in long-term treatment
Promote participation in outpatient support system
Assist client to identify alternative sources of satisfaction
Provide support for health promotion and maintenance
Alcoholics Anonymous

15. Client/Family Education
Nature of the illness
Effects of (substance) on the body
Alcohol
Other CNS depressants
Hallucinogens
Inhalants
Opioids
Cannabinols
Ways in which use of substance affects the individual’s life

16. Client/Family Education (cont.)
Management of the illness
Activities to substitute for (substance) in times of stress
Relaxation techniques
Progressive relaxation
Tense and relax
Deep breathing
Autogenics
Problem-solving skills
Essentials of good nutrition

17. Client/Family Education (cont.)
Support services
Financial assistance
Legal assistance
Alcoholics Anonymous (or other support group specific to another substance)
One-to-one support person

18. Nursing Process Evaluation
Evaluation involves reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care

19. Treatment Modalities Alcoholics Anonymous
Is a major self-help organization for the treatment of alcoholism
Based on the concept of
Peer support
Acceptance
Understanding from others who have experienced the same problem
Alcoholics Anonymous

20. Treatment Modalities (cont.)
Alcoholics Anonymous (cont.)
The 12 steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety
Total abstinence is promoted as the only cure; the person can never safely return to social drinking
Alcoholics Anonymous

21. Treatment Modalities (cont.)
Various support groups patterned after AA but for individuals with problems with other substances
Disulfiram (Antabuse)
Other medications for treatment of alcoholism
Counseling
Group therapy

22. Treatment Modalities (cont.)
Psychopharmacology for substance intoxication and substance withdrawal
Alcohol
Benzodiazepines
Anticonvulsants
Multivitamin therapy
Thiamine

23. Treatment Modalities (cont.)
Psychopharmacology for substance intoxication and substance withdrawal (cont.)
Opioids
Narcotic antagonists
Naloxone (Narcan)
Naltrexone (ReVia)
Nalmefene (Revex)
Methadone
Buprenorphine
Clonidine

24. Treatment Modalities (cont.)
Psychopharmacology for substance intoxication and substance withdrawal (cont.)
CNS depressants
Phenobarbital (Luminal)
Long-acting benzodiazepines

25. Treatment Modalities (cont.)
Psychopharmacology for substance intoxication and substance withdrawal (cont.)
CNS stimulants
Minor tranquilizers
Major tranquilizers
Anticonvulsants
Antidepressants

26. Treatment Modalities (cont.)
Psychopharmacology for substance intoxication and substance withdrawal (cont.)
Hallucinogens and cannabinols
Benzodiazepines
Antipsychotics