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Chapter 18
Addictive Disorders
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Tolerance and Withdrawal
Tolerance
• Person’s physiological reaction to drug
decreases with repeated administration
of same dose
Withdrawal
• Psychological changes occur when
blood and tissue concentrations of
drug decrease after heavy prolonged
use of substance
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Synergistic and Antagonistic
• Synergistic effect – when drugs are
taken together, effect of either or both
is intensified or prolonged
• Antagonistic effects – when drugs are
taken together, effect of one is
inhibited or weakened
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Comorbidity
• Psychiatric comorbidity – 6 out of 10
people affected by substance-abuse
disorder also affected by mental health
disorder
• Medical comorbidity – alcohol-related
medical problems are the comorbidities
most commonly seen in medical
settings
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Etiology
• Biological factors
– Specific effects on neurotransmitter systems
• Psychological factors
– Lack of tolerance for frustration and pain
– Lack of success in life
– Lack of affectionate and meaningful relationships
– Low self-esteem, lack of self-regard
– Risk-taking propensity
• Sociocultural factors
– Social and cultural norms
– Socioeconomic stress
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General Assessment
•
Two questions of importance
1. In the last year, have you ever drank or used
drugs more than you meant to?
2. Have you felt you wanted or needed to cut down
on your drinking or drug use in the last year?
•
Details include
– Drugs used
• Route
• Quantity
• Time of last use
• Usual pattern of use
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Psychological Changes
• Denial
• Depression
• Anxiety
• Dependency
• Hopelessness
• Low self-esteem
• Various psychiatric disorders
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Signs of Intoxication
and Withdrawal
• Alcohol poisoning
– Large amounts of alcohol consumed quickly or
over time
• Alcohol withdrawal
– Signs develop within a few hours after cessation
– Peaks at 24 to 48 hours
• Alcohol withdrawal delirium
– Medical emergency
– Can result in death, even if treated
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• A nurse is assigned the care of four
patients detoxifying from alcohol. The
patient with which symptom would be
the nurse’s highest priority?
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a. Fine-motor tremors
b. Diaphoresis
c. Diarrhea
d. Hallucinations and delusions
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Central Nervous System
Stimulants
Common signs of stimulant abuse
– Dilation of the pupils
– Dryness of the oronasal cavity
– Excessive motor activity
Cocaine and crack
Caffeine and nicotine
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Cocaine and Crack
• Extracted from leaf of coca bush
• When smoked, takes effect in 4 to 6 seconds; a
5- to 7-minute high follows, then a deep
depression
• Two main effects on body
– Anesthetic
– Stimulant
• Produces imbalance in neurotransmitters
• Withdrawal symptoms include
– Depression, paranoia, lethargy, anxiety, insomnia,
nausea, vomiting, sweating, chills
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Opiates
• Morphine
• Heroin
• Codeine
• Fentanyl
• Methadone
• Meperidine
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Marijuana (Cannabis sativa)
• Indian hemp plant
• Tetrahydrocannabinol (THC) is active
ingredient
• Depressant and hallucinogenic properties
• Usually smoked
• Desired effects – euphoria, detachment,
relaxation
• Long-term effects – lethargy, anhedonia,
difficulty concentrating, loss of memory
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Hallucinogens
• Lysergic acid diethylamide (LSD or acid)
• Mescaline (peyote)
• Psilocybin (magic mushroom)
• Phencyclidine piperidine (PCP, angel
dust, horse tranquilizer, peace pill)
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Inhalants
• Volatile solvents
– Spray paint
– Glue
– Cigarette lighter fluid
– Propellant gases used in aerosols
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Club Drugs
• Common drugs
– Ecstasy - also called MDMA, Adam, yaba,
XTC
– MDA – “love”
– MDE – “Eve”
• Produce subjective effects resembling
stimulants and hallucinogens
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Date Rape Drugs
• Flunitrazepam (Rohypnol or “roofies”)
• Gamma hydroxybutyric acid (GHB)
• Rapidly produce
– Disinhibition
– Relaxation of voluntary muscles
– Anterograde amnesia
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Assessment Guidelines
for the Chemically Impaired
• Assess for withdrawal syndrome
• Assess for overdose that warrants medical attention
• Assess for suicidal thoughts or other self-destructive
behaviors
• Evaluate for physical complications related to drug
abuse
• Explore interests in doing something about drug or
alcohol problem
• Assess patient and family for knowledge of
community resources
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Potential Nursing Diagnoses
• Imbalanced nutrition: less than body
requirements
• Disturbed thought processes
• Disturbed sleep patterns
• Ineffective health maintenance
• Hopelessness
• Risk for suicide
• Risk for other-directed violence
• Ineffective airway clearance
• Ineffective breathing pattern
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Outcomes Identification
• Withdrawal
– Fluid balance
– Neurological status: consciousness
– Distorted thought self-control
• Initial and active drug treatment
– Risk control – alcohol use
– Risk control – drug use
– Substance addiction consequences
• Health maintenance
– Knowledge: substance abuse control
– Family coping
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Implementation
• Aim of treatment – self-responsibility
• Challenge – matching patients with
types of treatment related to various
needs
– Physiological
– Psychological
– Sociocultural processes
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Health Teaching and
Health Promotion
• Primary prevention – health teaching
FRAMES
– Feedback of personal risk
– Responsibility of the patient
– Advice to change
– Menu of ways to reduce substance use
– Empathetic counseling
– Self-efficacy or optimism of the patient
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Intervention Strategies
Continued
• Relapse prevention
• Self-help groups for patient and family
• 12-Step programs
• Residential programs
• Intensive outpatient programs
• Outpatient drug-free programs and
employee assistance programs
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Pharmacological Interventions
Treatment of Alcoholism
• Naltrexone (ReVia)
– Reduces or eliminates alcohol craving
• Acamprosate (Campral)
– Helps client abstain from alcohol
• Topiramate (Topamax)
– Works to decrease alcohol cravings
• Disulfiram (Antabuse)
– Alcohol-disulfiram reaction causes unpleasant
physical effects
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Pharmacological Interventions
Treatment of Opioid Addiction
• Methadone (Dolophine)
– Synthetic opiate blocks craving for and effects of heroin
• LAAM (l-α-acetylmethadol)
– An alternative to methadone
• Naltrexone (ReVia)
– Antagonist that blocks euphoric effects of opioids
• Clonidine (Catapres)
– Effective somatic treatment when combined with
naltrexone
• Buprenorphine (Subutex)
– Blocks signs and symptoms of opioid withdrawal
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Evaluation
• Increased time in abstinence
• Decreased denial
• Acceptable occupational functioning
• Improved family relationships
• Ability to relate comfortably to other
individuals
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