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Addiction
- - Addiction has been defined as an illness characterized by
- ◦Compulsion
- ◦loss of control
- ◦continued patterns of abuse despite perceived negative consequences
- ◦obsession with a dysfunctional habit (ANA, 1987).
}= term used to define a state of chronic or recurrent drug intoxication, characterized by psychological and physical dependence as well as tolerance.
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Stimulants
- }Nicotine
- }Cocaine
- }Amphetamines
- }Caffeine
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Nicotine
- }Characteristics
- ◦Cigarettes, chewing tobacco
- }Effects of use
- ◦stimulant that elevates BP & increases heart rate
- }Complications
- ◦Lung cancer, COPD, and others
- }Collaborative care
- ◦Prevention of tobacco use
- ◦Tobacco cessation
Nicotine- always assessed on admission!
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Cocaine
- }Characteristics
- ◦Powder form (snorted), IV, smoked (crack)
- }Effects of use
- ◦pupillary dilation; increased blood pressure, respirations, and temperature; less common effects: loss of appetite, insomnia, impaired thinking, agitation, panic attacks or cocaine psychosis.
- }Complications
- ◦Stimulant psychosis
- ◦Acute cocaine toxicity
Collaborative care
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Amphetamines
- }Characteristics
- ◦Poor man’s cocaine
- }Effects of use
- ◦“pep pills”; directly stimulate CNS
- ◦ Effects on the body: increased heart rate; elevated blood pressure; excitability; hand tremors; talkativeness; diaphoresis; dry mouth; abnormal heart rhythms; headaches; pallor; diarrhea; unclear speech.
- }Complications
- ◦“Overamping”Collaborative care
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Caffeine
- }Characteristics
- ◦Most widely used psychoactive substance
- }Effects of use
- ◦stimulant that elevates BP & increases heart rate.
}Complications
}Collaborative care
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Depressants
}Alcohol
}Sedative/Hypnotics
}Opiods
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Alcohol
- }Characteristics
- ◦Consumed by more than ½ Americans age 12 & >
- }Effects of use
- ◦Relaxation, emotional lability, hypotension, bradycardia, constricted pupils
- }Complications
- ◦Acute alcohol toxicity
- ◦Wernicke’s encephalopathy
- }Collaborative care
- ◦Detoxification
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Alcoholism
}= CNS depressant; produces relaxation, loss of inhibitions
- }Intoxication:
- ◦slurred speech, unsteady gait. lack of coordination; impaired attention, concentration, memory, and judgment
- }Overdose:
- ◦ vomiting, unconsciousness, respiratory depression, hypotension, death
- }Withdrawal can be life-threatening; detoxification under medical supervision is needed.
- ◦coarse hand tremors, sweating, elevated blood pressure and pulse, insomnia, anxiety, nausea or vomiting
- }Severe or untreated withdrawal:
- ◦transient hallucinations, seizures, delirium tremens (DTs)
}Safe withdrawal from alcohol includes use of vitamin B1 (thiamine) supplements to prevent or treat Wernicke-Korsakoff’s syndrome, folic acid, multivitamins, cyanocobalamin (vitamin B12) for nutritional deficiencies, sedation, calm well lit environment.
}Withdrawal can take 2 days to 2 weeks.
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Sedative-Hypnotics
- }Characteristics
- ◦Substances: benzodiazepines; barbiturates; hypnotics; prescription sleeping medication; and all anxiolytic medications.
- }Effects of use
- ◦Increased inhibition, impaired judgement, hypotension, bradycardia, bradypnea, constricted pupils
- ◦Rebound anxiety
}Complications
}Collaborative care
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Opioids
- }Characteristics
- ◦Resemble opium or alkaloid derivatives; opiate: any chemical derived from opium. Considered most addictive drugs.
- }Effects of use
- ◦Analgesia, euphoria, impaired judgment constricted pupils, nausea, decreased respirations
}Complications
}Collaborative care
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Other Drugs of Abuse
- }Cannabis
- }Characteristics
- - most widely used illicit drugs in U.S.
- - THC
- }Effects of use
- ◦Euphoria
- ◦Sedation
- ◦Hallucinations
- }Complications
- }Collaborative care
- }Psychedelic Agents
- ◦change in level of consciousness (hallucination, psychosis)
- ◦increased vital signs, dilated pupils, feeling of enormous strength
- ◦ Ex.-LSD, Ecstasy, PCP, mushrooms, and others
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Inhalants
- }Four main classes
- ◦Volatile solvents
- ◦Aerosols
- ◦Anesthetic agents
- ◦Nitrites
}Cause confusion, excitement, and hallucinations
}Commonly abused inhalants: glue, gasoline, lighter fluid, paint thinner, varnish, shellac, nail polish remover, aerosol-packaged products.
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Treatment of Addictions
}= based on the concept that alcoholism & drug addictions a medical illness: chronic, progressive, characterized by remissions and relapses
}Tx may be as out or inpatient depending on client’s circumstances & ability to abstain from alcohol or drugs (as well as insurance)
}Attitudes of the nurse can influence quality of care they provide.
- }Disulfiram (Antabuse) to help client abstain from alcohol;
- ◦methadone as a substitute for heroin
- ◦Naltrexone (ReVia) to block effects of opioids and reduce cravings for alcohol
- ◦Clonidine (Catapres) to suppress opiate withdrawal
- ◦Bromocriptine (Parlodel) to decrease cocaine cravings
- }12-step program developed by Alcoholics Anonymous (AA)
- ◦Focus is on group experiences involving education, problem-solving techniques, cognitive techniques to identify and modify faulty thinking, coping with life, stress, and other people without the use of substances
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Nursing process with substance abuse
- }Assessment
- ◦Michigan Alcoholism Screening Test (MAST)
- http://www.1016.org/MiAlcTst.html
- ◦Denial is a major component of substance abuse, so identifying clients can be difficult. Several screening devices are available. Detoxification is a priority.
- ◦History: chaotic family life, family history, crisis that precipitated treatment
- ◦General appearance and motor behavior: depends on physical health; likely to be fatigued, anxious
- ◦Mood and affect: may be tearful, expressing guilt and remorse; angry, sullen, quiet, unwilling to talk
- ◦Thought processes and content: users often minimize substance use, blame others for problems, rationalize their behavior, say they can quit on their own
- ◦Sensory & intellectual processes: usually alert and oriented; intellectual abilities intact (unless neurologic deficits from long-term alcohol or inhalants)
- ◦Judgment and insight: poor judgment while intoxicated and due to cravings for substance; insight usually limited
- ◦Self-concept: low self-esteem, feels inadequate at coping with life
- ◦Roles and relationships: strained relationships and problems with role fulfillment due to substance use
- ◦Physiologic considerations: may have trouble eating and sleeping; HIV risk if IV drug user
- ◦Other health problems associated with substance use
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}Assessment-Substances Other Than Alcohol
- Direct questions towards:
- substance identification
- amount and frequency of use
- duration of use
- route of administration
- history of suicidal ideation or attempts
- withdrawal symptoms
- longest drug-free period
- desire for treatment.
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