Download Substance Abuse (CC)

Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
CHAPTER 17
SUBSTANCE USE AND
ADDICTIVE DISORDERS
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Objectives
 Discuss disorders affecting a patient’s mental/emotional
health
 Categorize drugs used for mental health disorders based
on their classifications and drug actions
 Discuss nursing management for clients with identified
mental health issues utilizing the nursing process.
 Formulate a teaching plan for a client with a mental
health condition
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Substance Abuse and Dependence
 No longer considered two distinct diagnoses
 Now gradient of mild, moderate, and severe
substance use disorder is preferred terminology
 Substance can be any mood- or mind-altering
drug or alcohol
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Key Terms
 Addiction: a chronic brain disease characterized
by compulsive and maladaptive use of a
substance or behavior (e.g., gambling)
 Alcoholism: a complex progressive disease
characterized by significant physical, social,
and/or mental impairment directly related to
alcohol dependence and addiction
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Key Terms (cont’d)
 Codependency: maladaptive coping behaviors
that reinforce another person’s addictive
behavior by allowing that person to avoid
consequences of his/her actions
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Co-occurring Disorders
 Many people with drug and/or alcohol disorders
have co-existing psychiatric disorders (or dual
diagnosis)
 Substance may be used to treat uncomfortable
symptoms (e.g., anxiety, depression)
 This makes treatment more complicated
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Signs of Substance Use Disorder
 A need for markedly increased amounts of the substance
to achieve intoxication or desired effect (tolerance)
 Markedly diminished effect with continued use of the
same amount of the substance
 Recurrent substance-related problems including legal,
relationship, work, social
 Substance use continues despite knowledge of the
problems being created by it
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Clicker Question
1. Which statement is most true regarding early
signs of Substance Use Disorder?
A. Uses substance weekly as stress reliever
B. Amnesia after last night’s drinking binge
C. Car accident after using drugs with friends
D. Days of intoxication followed by drying out
period
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Answer
Correct answer: A
Rationale: Regular use of substance to relieve
stress is one of the early signs of a potential
problem developing. Other choices indicate more
advanced disorder.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Substance Use Disorder
 Generally substance use becomes a problem
when it
 Interferes with normal functioning
 Continues despite negative consequences
 Hurts others
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Theoretical Causes
 Brain disorder/genetics
 Oral gratification (Freud)
 Perception of being high is pleasant and
person becomes addicted to this pleasure
 Learned behavior
 Use of substance relieves anxiety, depression
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Alcoholism
 A complex progressive disease characterized
by significant physical, social, and/or mental
impairment directly related to alcohol
dependence and addiction





Daily use is common; cannot “cut down”
Binges last two days or more
“Blackouts” (amnesia while intoxicated)
Social functioning impaired
Denial is used extensively
 Alcohol is a depressant
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Alcohol Contributes to Many Chronic
Illnesses






Heart disease
Liver disease
Diabetes
Falls
Accidents
Dementia
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Treatments for Alcohol-Related Conditions
 Treatment is usually a slow process
 Usually refer to being in recovery rather than ever
being recovered
 Alcoholics Anonymous (AA)




12-step program with reported high success rate
Cost-free
Meetings for the user
Separate meetings for codependents/teens/
children
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Clicker Question
2. Alcohol is a
A. Stimulant
B. Depressant
C. Neither
D. Both
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Answer
Correct answer: B
Rationale: Though initial effects may appear to
stimulate, this is caused by reduction of inhibitions
not stimulation when someone gets “buzzed” from
a few drinks.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Pharmacological Treatments
 Medications




Inconsistent success
Side effects can be unpleasant
Disulfiram (Antabuse) is controversial
Antidepressants
 Newer medications
 Acampresate
 Naltrexone (Revia)
 Campral
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Other Treatments for Alcoholism
 Detoxification for safe withdrawal
 Family and individual therapy for all involved to
learn new coping skills without the presence of
the alcohol
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Nursing Care: Alcohol-Related Conditions





Maintain honesty
Observe patient for use of defense mechanisms
Support patient; use positive reinforcement
Promote safety
Demonstrate “tough love”; encourage patient to
be self-responsible
 Challenge denial
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Other Substances
 Symptoms can look similar to those of alcoholrelated conditions
 Other symptoms may include






Red, watery eyes
Runny nose
Hostility
Paranoia
Deviant behavior
Needle tracks on arms/legs
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Medical Treatments for Drug-Related
Disorders
 Narcotics Anonymous (NA) uses 12-step
approach
 Group therapy
 Individual psychotherapy
 Detoxification required for some drugs
 Drug-specific programs based on substance
abused [e.g., Methadone programs (heroin) or
Suboxone (opioids)]
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Nursing Interventions for Drug-Related
Conditions
 Similar to those for alcohol-related conditions
 Caution: Nurses and others in the medical
professions are high-risk groups for becoming
chemically dependent. Be a role model and
seek help if you or a coworker is at risk.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Clicker Question
3. Which defense mechanism is generally most
common in someone abusing
methamphetamines?
A. Denial
B. Alteration in coping
C. Manipulation
D. Avoidance
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Answer
Correct answer: A
Rationale: Even though any of these responses
may be utilized, denial remains the most common
used by those with substance use disorders.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
 You are working in a holistic medicine clinic. LW
has a habit of “having a few beers” several nights a
week to relieve stress. LW’s coworkers have
suggested a visit to your clinic for some “help” with
stress. What alternative forms of treatment might be
prescribed for LW’s beer consumption and stress
(select all that apply)?
 A. Thiamine-rich foods
 B. Milk thistle
 C. Chocolate
 D. Biofeedback
Copyright © 2014. F.A. Davis Company