Download Chapter 25

Chapter 25Substance-Related
Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Substance abuse and addiction can negatively
impact health, relationships, finances, school, and
employment. Some people hit bottom and seek
treatment in an effort to recover. Treatment involves
helping the individuals become and remain free from
substances, ideally for the rest of their lives.
London, 2009
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
After studying this chapter, you should be able to
•
Explain the disease concept of alcoholism and the following
theories of addiction: biologic, genetic, behavioral and
learning, sociocultural, psychodynamic, and the disease
concept of alcoholism
•
Differentiate the following terms: substance use, addiction,
psychological dependence, tolerance, and physiologic
dependence
•
Discuss the dynamics of enabling and codependency
•
Articulate the difference between alcohol dependence and
alcohol abuse
•
Recognize the more common physiologic effects of
alcoholism
•
Identify the common medical problems associated with
illicit abuse of substances (drugs)
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Learning Objectives (cont.)
•
Describe the rationale for the use of substance abuse
screening tools during the initial assessment of a client
with a substance-related disorder
•
Articulate the rationale for the use of the Stages of Change
Model when planning interventions for a client with a
substance-related disorder
•
Evaluate the treatment measures, including nursing
interventions, for a client with a substance-related
disorder
•
Formulate a list of nursing interventions for a client with
clinical symptoms of acute substance intoxication
•
Develop a list of services available to clients who abuse
substances
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Substance-related disorders refer to the use
and abuse of alcohol, illicit drugs, or
substances such as over-the-counter or
prescription drugs. When substance use
creates difficulties for the user or ceases to
be entirely volitional, it becomes the concern
of all the helping professions, including
nursing.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Epidemiology of Substance-Related
Disorders
• Alcohol use and abuse
– World Health Organization
• Approximately 76.3 million individuals have
been diagnosed with alcohol use disorder.
– National Institute on Drug Abuse
• Approximately 20 million individuals commonly
abuse drugs.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Specialty Practice: Addictions Nursing
Practice
• Addictions nursing was defined as an area of
specialty practice concerned with care related to
dysfunctional patterns of human response that have
one or more of the following key characteristics:
some loss of self-control capacity, episodic or
continuous maladaptive behavior or abuse of some
substance, and development of dependence patterns
of a physical and/or psychological nature.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Etiology of Substance-Related Disorders
• Biologic theories
• Genetic theories
• Behavioral and learning theories
• Sociocultural theories
• Psychodynamic theories
• Disease concept of alcoholism
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Alcohol-Related
Disorders
• Alcohol use disorders
– Alcohol dependence
– Alcohol abuse disorder
• Alcohol-induced disorders
– Alcohol intoxication
– Alcohol withdrawal
– Alcohol withdrawal delirium
– Alcoholic-induced persisting dementia
– Alcoholic-induced persisting amnestic disorder
– Other alcohol-induced disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Other SubstanceRelated Disorders
• Sedative-, hypnotic-, or anxiolytic-related disorders
• Opioid-related disorders
• Amphetamine-related disorders
• Cocaine-related disorders
• Cannabis-related disorders
• Hallucinogen- and phencyclidine-related disorders
• Inhalant-related disorders
• Caffeine- and nicotine-related disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Other SubstanceRelated Disorders: Designer Drugs, Club
Drugs, and Anabolic Steroids
• Designer drugs
• Club drugs
• Anabolic steroids
• Prescription drug abuse
• Internet addiction disorder
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The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment
• Assessment of the client who abuses alcohol:
– General description
– Behavior
– Screening tools for alcohol use or abuse
– Diagnostic tests
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment (cont.)
• Assessment of the client who abuses substances other
than alcohol:
– General description
– Behavior
– Screening tools
– Diagnostic tests
• Transcultural considerations
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses
• Anxiety
• Ineffective denial
• Ineffective health
maintenance
• Ineffective coping
• Imbalanced nutrition: less
than body requirements
• Hopelessness
• Impaired verbal
communication
• Impaired social interaction
• Deficient knowledge
regarding illness
• Risk for injury
• Risk for other-directed
violence
• Disturbed sleep pattern
• Spiritual distress
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcome Identification
Outcomes focus on the following:
• Providing a safe environment to prevent injury
• Stabilizing existing medical complications secondary to
substance use or abuse
• Improving impaired cognition and communication
• Establishing nutritious eating patterns
• Establishing a balance of rest, sleep, and activity
• Establishing alternative coping skills
• Resolving any personal or family issues related to the
client’s disorder
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Planning Interventions
Planning focuses on the following:
• Psychobiological, social, and pharmacological aspects of
the client’s substance abuse
• Involves the client and family
• Includes a multidisciplinary approach
– Stages of Change Model
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Implementation
• Provision of a safe environment
• Assistance in meeting basic needs
• Stabilization of medical condition
• Stabilization of behavior
• Medication management
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Implementation (cont.)
• Detoxification
• Disulfiram and naltrexone therapy (alcohol aversion
therapy)
• Harm avoidance
• Pain management of clients with substance-related
disorders
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Implementation (cont.)
• Intervention strategy
• Interactive therapies
• Individual and cognitive–behavioral psychotherapy
• Group therapy
• Family therapy
• CRAFT reinforcement and family training program
• Client education
• Smoking-cessation program
• Support and self-help groups
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation
• The ultimate outcome is complete freedom from drug use and
abuse. However, the potential for relapse is ever present.
• Services available to clients who relapse are the following:
– “28-day” inpatient program
– Short-term residential rehabilitation for 3 months
– Long-term therapeutic community programs for 6 to 18
months
– Day-treatment centers
– Reentry programs
– Outpatient or aftercare programs
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Possible Signs of an Impaired Nurse
• Volunteers to work overtime frequently especially on weekends
when staffing ratios are less than during the weekdays
• Leaves the floor or unit frequently or spends a considerable
amount of time in the bathroom
• Is frequently involved in incidents in which clients report they
haven’t received relief for pain (narcotic analgesics), insomnia
(sedative hypnotics), or anxiety (benzodiazepines) although
documentation indicates that they have received prescribed
medication
• Exhibits lapses in memory, changes in personal appearance, and
appears preoccupied
• Is on duty when the inaccurate drug counts occur
• Gives questionable explanations regarding drug wastage and
discrepancies in documentation
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Key Terms
• Addiction
• Enabling
• Addictions nursing
• Habituation
• Addictive personality
• Harm avoidance or reduction
• Alcohol intoxication
• Impaired nurse
• Alcohol withdrawal
• Intervention
• Aversion therapy
• Korsakoff’s psychosis
• Behavioral dependence
• Physiological dependence
• Codependency
• Psychological dependence
• Delirium tremens
• Stages of Change Model
• Detoxification
• Substance use
• Drug dependence
• Tolerance
• Wernicke’s encephalopathy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflection
Reflect on the chapter-opening quote.
• Compare and contrast the serious medical and social
consequences of alcohol abuse and drug abuse. Which
abuse do you think is more detrimental to a client’s
quality of life? Why? Which abuse do you think is more
detrimental to a client’s family?
• Explain your answers.
?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins