Substance use Disorders

Immediate Treatment in Detoxification

- A complete medical workup is important. Blood work determines liver, kidney, and thyroid function. Blood chemistry levels indicate vitamin deficiencies, lipid (fat) levels, uric acid levels, and enzyme levels that might indicate physical (especially muscle) damage. Urine toxicology reveals which common drugs the client has used. In some cases, blood tests are also done to determine more exact drug levels. - Before administering medications (e.g., benzodiazepines), the client is evaluated for severity of withdrawal symptoms. The decision to administer or withhold medications is based on the presence or absence of specific factors. - There are several formal rating scales used to determine the severity of withdrawal symptoms. One such scale is the CIWA (Clinical Institute Withdrawal Assessment). This scale systematically itemizes and quantifies the most common alcohol withdrawal symptoms and allows healthcare staff to determine if medications are needed. S/S: Nausea, vomiting, internal and/or external tremors, diaphoresis (excessive sweating), tactile disturbances, auditory hallucinations, visual hallucinations, anxiety, agitation .. - rated on a scale on 0 - 7. Max score is 67

The Detoxification Center

- A person with a substance use disorder may initially be admitted to a detoxification center. - Often, the person is transported to "detox" by police. Here, detoxification is supervised. - The emphasis is on supportive care and • referral to continuing therapy after detoxification, so the person can deal with the underlying motivations that led to the condition.

GHB (Gamma Hydroxybutyrate)

- A very dangerous street drug showing increasing abuse is GHB, also known as "the date-rape drug," "G," and "liquid ecstasy" (it is not the same as "ecstasy"). - GHB is colorless, odorless, and tasteless. It is available alone and is also contained in a number of dietary supplements, many of which are marketed on the Internet. (The active ingredient may be listed as furanone or lactone.) - GHB causes a decrease in inhibitions and often amnesia. However, death may occur, even with first-time use. - Precursors of GHB are marketed on the Internet as "cleaning products," but are used as drugs of abuse. - The sale, manufacture, or possession of GHB is illegal, but Internet sales are nearly impossible to monitor

Classifications related to recovery include:

- Active - In remission (not currently active) • On agonist/blocking therapy - In a controlled environment

Symptoms of GHB Overuse

- Acute toxicity symptoms are highly variable and unpredictable. - The person may be extremely labile, alternating abruptly between combativeness and somnolence (the characteristic presentation.) Other signs and symptoms exist, demonstrating lack of control. - Many GHB abusers come to the ED following an MVA or rape. Other trauma, such as a fracture, can occur as a result of sudden loss of muscle control ("head-snap") or collapse ("carpeting-out"). - A number of fatalities have been documented, particularly when GHB is combined with alcohol or other depressants.

S/S of Alcohol Disorders

- Alcohol is a CNS depressant. - Signs and symptoms that a person is under its influence include slurred speech, unsteady gait, confusion, and behavioral changes, including aggression. - The chronic alcohol user may have a swollen nose, prominent or spidery veins (spider angiomas) on the nose and/or cheeks, and thickened and reddened palms (palmar erythema). - Chronic alcohol use disorder can also lead to impaired attention, confusion, dementia, amnesia, sleep disorders, and psychotic symptoms, including delusions and hallucinations. - These people are at major risk for suicide.

Family consideration

- Alcohol use disorder involves the entire family. In addition to the client, the people most affected are the spouse or significant other and children, or the client's parents, particularly if the client lives with them. - The following are characteristics of the family of the alcohol abuser (many of these characteristics are also present in families of persons with other substance use disorders as well): • Control—The alcohol-abusing person often attempts to control the rest of the family. • Rigidity or perfectionism (or both)—Everyone tries too hard to avoid angering the substance abuser. Everyone is afraid of the person's sudden rages and mood swings. • Mistrust of others on the part of the client and family. • Tension, or overly cheerful and social behavior by the family, that seems forced—Constant coverup, hiding of real feelings, and denial of the abuser's inappropriate behavior. • Abuse of family members by the alcohol abuser (particularly psychological abuse). • Overuse of certain defense mechanisms, particularly projection, rationalization, and denial, by the family and the client. - Young people raised in the family of a person with a substance use disorder have special problems, including low self-esteem, feelings of failure, and a sense of responsibility to take care of everyone else. Many of these children falsely believe that they somehow caused their loved one's disorder.

Steroid Use Disorder

- Anabolic-androgenic steroids (AAS) ("Arnolds, juice, stockers") derive synthetically from the male hormone, testosterone, and are available (usually illegally) in many forms, including tablets, liquid, and transdermal or injectable forms. - The most frequently misused are testosterone, nandrolone, stanozolol, methandienone, and boldenone. - They promote growth of skeletal muscles and increase lean muscle mass in the body. - They may be abused by athletes in an effort to increase strength and athletic performance and to improve physical appearance. - Users usually take steroids intermittently (cycling), often combining several types. - Undesired side effects include liver damage and cancer, endocrine and sexual dysfunction, impaired judgment, electrolyte imbalance, acne, edema, headache, fatigue, and insomnia. - Withdrawal can be very difficult and uncomfortable. Relapse is common.

The nursing process

- Assessment Priorities (Behavior Changes, Physical Signs, Complications with Overdose), Possible Nursing Diagnoses Planning, Implementation, Evaluation ASSESSMENT PRIORITIES (Behavior Changes) - Erratic or inappropriate behavior: sudden changes in mood - Poor school or job attendance or performance - Illegal acts, such as stealing, embezzling, prostitution, or selling drugs - Declining social status or an incongruent economic situation - Avoidance of previously enjoyed activities - Frequent visits to an emergency department for depression or suicide threats; anhedonia Physical signs - Withdrawal symptoms - Needle tracks, often covered by long sleeves - Chronic nasal congestion and cold symptoms with drug snorting; after heavy use, the septum may perforate - Dilated pupils (mydriasis), often masked by sunglasses - Unkempt appearance (unusual for this client) - Unexplained weight loss - Abnormal electrolyte levels, anemia, extreme weight loss Complications with Overdose - Cerebrovascular spasm, as shown by hemorrhage, seizures, hypertensive or hypotensive crisis; angina; myocardial infarction; dysrhythmias; abnormal respirations (e.g., Cheyne-Stokes, hyperpnea); hyperthermia; tachycardia or bradycardia - Use urine or blood toxicology studies to identify drugs of abuse *** POSSIBLE NURSING DIAGNOSES - Anxiety - Ineffective Individual Coping - Altered Growth and Development (fetal) - Altered Health Maintenance - High Risk for Infection - High Risk for Injury - Knowledge Deficit (specify) - Altered Nutrition: Less than Body Requirements - Altered Parenting - Powerlessness - Self-Care Deficit - Self-Esteem Disturbance - Sensory/Perceptual Alterations - Impaired Social Interaction - Altered Thought Processes - High Risk for Violence: Self-Directed or Directed at Others PLANNING - A plan of care is designed with the client to achieve may be required. general goals including those in the following list. The person: • Safely detoxifies • Admits that use of substances has been a problem and that he or she needs help to stop using • Agrees to participate in a treatment program • Shows behavior and physical signs demonstrating decreased or discontinued substance use • Tests drug free (urine tests, toxicology screening) • Agrees to continue with after-care IMPLEMENTATION - Refer the client to a psychiatric liaison nurse or drug treatment counselor. • Support the client's family; encourage them to seek help by contacting a support group, such as Al-Anon. - sometimes, interventions and forced treatments are required - Strongly recommend client follow-up in a support person: group, such as AA or NA. EVALUATION - evaluating the client's achievement of stated goals.

LSD, Mescaline, and "Mushrooms"

- Between LSD, mescaline/peyote ("buttons, cactus"), and psilocybin ("mushrooms"), LSD is the most potent. - Tolerance to such drugs is highly variable. Their most characteristic effects are altered perceptions of time and space, auditory hallucinations and intense visual hallucinations (e.g., vivid colors, light flashes, or geometric shapes). - The person may see "trails of light" or "halos" around objects. Objects may appear larger (macropsia) or smaller (micropsia) than normal. Medications are not usually used in detoxification. - Major problems associated with hallucinogens are "flashbacks" (hallucinogen persisting perception disorder [HPPD]), sometimes years later, causing severe panic attacks. - The abuser also may injure himself or herself by thinking that they can fly, walk on water, or stop traffic on a busy freeway. - Providing a safe, controlled environment is essential. If a person has a "bad trip," speak calmly and quietly; give reassurance. - This person can also have permanent brain damage, especially if several drugs are combined.

Caffeine

- Caffeine is found not only in coffee, but also in tea, chocolate, some alcoholic beverages, and soft drinks. - Caffeine is also a component of many OTC and prescription analgesic preparations such as Anacin, Excedrin Extra-Strength, and Fiorinal. Ergotamine and caffeine are combined in Cafergot, and caffeine is combined with other drugs, for the treatment of migraines and sold OTC as NoDoz and other trade names ("stay awake pills"). - Caffeine is available as tablets capsules, lozenges, oral solution, or injection. Caffeine may be used medically as a respiratory stimulant, particularly in an overdose of a CNS depressant, and to treat newborn apnea. - Caffeine acts directly on blood vessels, causing them to dilate. It is effective as a mild stimulant and diuretic. • Evidence shows that 200 to 300 mg will partially offset fatigue, may enhance a person's capacity to function, and increase attention span. - Symptoms of overuse include restlessness, nervousness, agitation, insomnia, flushed face, and GI discomfort. Caffeine does not reverse alcohol's intoxicating or depressant effects and may actually add to depression. (A person may temporarily become more alert, but the overall effect is that of general physical and mental depression.) - Caffeine is not without dangerous side effects. At levels of 500 mg or higher, heart rate increases and may become irregular. In a person with limited tolerance, even a small amount of caffeine makes falling asleep difficult and interferes with normal sleep patterns. Aggravation of cystic breast disease is also related to caffeine use. Caffeine

NURSING CARE MEASURES for pts dealing c substance abuse

- Caring for clients dealing with substance use disorders occurs in various settings, including outpatient treatment, extended-care facilities, specific treatment centers and clinics, and hospitals. - Because many insurance plans no longer cover inpatient treatment for substance use disorders, many of these people are admitted under another diagnosis, either associated with or directly resulting from substance use. These diagnoses include depression and suicide attempts; pancreatitis, diabetes, cirrhosis, and other liver problems; gastrointestinal (GI) disorders; headaches; and cardiovascular disorders, such as suspected heart attack and hypertension. - In addition, motor vehicle accidents (MVAs) are often directly attributable to substance use.

Cocaine and Related Drugs

- Cocaine HCl ("coke, snow, flake, blow") is an alkaloid derived from the coca plant or manufactured synthetically; it can be absorbed by all mucous surfaces and stimulates the release of dopamine. (Cocaine combined with heroin is called a "speedball.") - Two types of cocaine are abused: water-soluble HCl salt, injected or snorted, and the water- insoluble form ("freebase, crack"), which can be smoked, and is even more dangerous and addictive. - Cocaine is one of the most widely used drugs across all socioeconomic groups in the United States. Since it directly affects the brain, it is very addictive; dependence occurs quickly and may occur with first use. - Derivatives such as "crank" and "rock" continue to emerge. "Other than (closely) supervised medical use, there is no safe way to use cocaine." - The use of cocaine and related drugs is particularly dangerous in pregnancy; it often leads to premature birth, low birth weight, and often, later cognitive impairment of the child. - Child Protection often is involved if a pregnant woman is identified as a cocaine user. - These mothers usually are not allowed access to their babies until they have detoxified and entered a long-term treatment program. - A cocaine habit is very expensive, because its effects rapidly disappear, requiring constant dosing. - This person often must resort to illegal means, such as burglary or prostitution, to support the habit. - Many violent crimes are related to cocaine, crack, and crank activity.

Genetic Theory

- Considerable research has been conducted to target genetic causes. - It has yet to be determined whether overuse of alcohol and other drugs is based on direct biologic transmission or is a learned behavior in children who constantly interact with family members with substance use issues. - accounts for 50% of the chance for alcoholism

Pregnant women as drug abusers

- Drug, alcohol, or nicotine use greatly complicates pregnancy, labor, and delivery, with profound effects on both mother and fetus. Babies born to mothers who overuse drugs or alcohol are often of low birth weight, with many related problems. Preterm labor is common. Heroin withdrawal symptoms in a newborn may occur within hours after delivery; most affected babies demonstrate symptoms within 24 hours. The number of cocaine- and crack-dependent babies continues to increase. Many babies born to mothers with chemical use disorders have permanent physical and/or mental disorders, including birth defects. Long-term adverse effects on the child (e.g., fetal alcohol syndrome [FAS]) are particularly evident if the mother abuses alcohol during pregnancy. In addition, many of these mothers lack parenting skills because of their drug or alcohol use. Sometimes, children born to mothers with substance use disorders are cared for in foster homes until the mother can properly care for them.

Nurses as drug abusers

- Drugs are readily available in healthcare facilities; nurses are at high risk for substance use disorders. This is a serious problem. - Research indicates that nurses are often more likely to overuse drugs than the general population, partially because of stress and overwork. - Nurses are bound by law, the nursing code of ethics, and the pledge taken on entering nursing, to report any staff person suspected of abusing drugs or alcohol. - Reporting is necessary to assist others to get help and to protect clients with whom these people might come in contact. - The safe care of all clients rests in each nurse's hands. Not reporting can be prosecuted as a crime.

Symptoms of Overuse Disorders

- Drugs in these groups are processed by the liver, as is alcohol. - These drugs cause symptoms of generalized body depression, coma, or extreme lability. - a particular danger of overdose with these depressants is life- threatening respiratory depression and cardiopulmonary arrest. - Many of these drugs also have serious side effects. - All such drugs have a potential for physical and psychological dependence. Effects of many of these drugs are potentiated when combined with alcohol, which can speed the progress of liver damage.

After-care

- Following detoxification and/or intensive treatment, after-care is often the most important factor in maintaining sobriety. - The client needs to work with AA or another specific program, for at least 2 years, and sometimes for life, after completing intensive treatment

Hallucinogen use disorders

- Hallucinogenic drugs are found in plants or produced synthetically. They are not believed to cause actual physical dependence, but do produce psychological dependence and mild tolerance. - There are several types of hallucinogens, including traditional psychedelics (e.g., lysergic acid diethylamide [LSD, "acid"]; phencyclidine hydrochloride [PCP]; and mescaline). - Other amphetamine-like drugs (including DOM, MDA/MDMA, GBA ["ecstasy," XTC] (and sometimes Khat), and anticholinergics (e.g., belladonna, methantheline bromide [Banthine], and scopolamine [Hyoscine]) produce similar effects and symptoms.

recurrent use of alcohol or drugs causes clinically and functionally significant impairment," as evidenced by:

- Health problems • Disability - Failure to meet major responsibilities and obligations in work, school, social, or family life - Impaired control, resulting in social impairment, risky behaviors (e.g., driving or using heavy machinery), and specific pharmacologic criteria - Other factors, such as legal problems and arrests; or continued use, despite related problems.

Health realization

- Health realization (HR) is a psychological/spiritual therapy model. - HR is based on the theory that each person possesses inborn or innate (inner) health and has the capacity or ability to lead a healthy life. - HR helps the person learn to do this. - This therapy draws on the natural resiliency (recuperative powers) of all people and teaches them to gain awareness and insight, to bring about positive change. - As the person gains insight, he or she begins to view life from a healthier perspective and is able to make better life choices and thus, to have a more positive impact on others. - The person changes from the "inside out," learns to stop living life "reactively," and learns to be more self-directed. An ultimate goal of HR therapy is to help the client gain self-esteem.

Nutrition and General Health

- Healthcare must address the client's nutritional status and general health. - Many clients are seriously malnourished as a direct result of substance use. - Usually liver function tests (to rule out cirrhosis and other disorders) and evaluation of GI function (to rule out conditions such as ulcers, diverticulitis, esophageal varices, or colon cancer) are necessary. - if the client is severely malnourished, weight gain is carefully supervised (see later discussion of refeeding syndrome). - Supplemental vitamins are often given. - Any coexisting conditions, such as injuries, skin rashes, hypertension, and diabetes mellitus, are treated. - Many times, physical disorders require immediate medical attention. - Some clients require long-term treatment for generalized infections, including tuberculosis and AIDS, which often relate directly to misuse of drugs.

*** Refeeding Syndrome

- If a person using drugs is severely malnourished or starving, careful dietary management is vital. - These clients should be rehydrated very slowly, with small and carefully planned fluids and feedings. - Carbohydrates, such as dextrose intravenous (IV) solutions, tube-feeding mixtures, and liquid dietary supplements, must be given very carefully. - The sudden influx of carbohydrates stimulates insulin production and other events that may seriously upset electrolyte balance. This refeeding syndrome can also cause cardiac failure, hypertension, peripheral edema, neurologic complications (including seizures or coma), respiratory failure, and death.

Diagnosis

- It is important to note that drug use (including alcohol) within 4 to 12 hours can be determined with blood and breath testing. - Urinalysis can identify substance use, other than alcohol, within the past 24 to 72 hours. - Saliva testing is becoming more commonly used, because it is convenient. - Other tests, such as microscopic hair examination, for chronic, long-term use are available - It is important to know blood alcohol levels (BAL) for detoxification. **** The maximum legal blood alcohol level for driving varies among states, but generally it is 0.08 to 0.10 grams per deciliter (g/dL). - This represents approximately 4 drinks in 2 hours for a woman or 5 for a man. - person with a level of 0.3 g/dL will usually be vomiting and incoherent, aggressive, or in a stupor. - Coma usually occurs at about 0.4 g/dL, and severe respiratory depression and death can occur at 0.5 g/dL.

Identification of the Person with a Substance Use Disorder

- Many of these people routinely use defense mechanisms. They often convince healthcare professionals that their medical disorder is not related to any form of substance use; therefore, the underlying disorder goes undetected. - Be aware of stereotypes; it is not possible to identify a person with a substance use disorder by appearance. - Be alert for signs and symptoms of substance overuse or withdrawal in all clients. Many people are admitted for non-chemical-related problems. - Clients in the healthcare facility who are deprived of their substance of choice may suddenly begin having serious or life-threatening withdrawal symptoms. - Remember: Clients in the Emergency Department, Day Surgery, Labor and Delivery, or any other area may experience withdrawal symptoms. Also, be alert to cross-dependence: abusers of one substance often have built up tolerance to related drugs. (This includes prescription drugs, such as pain killers, tranquilizers, and sleeping pills.)

Older adults as substance abusers

- Many older adults take large amounts of prescribed and OTC medications. The senior client may be confused and accidentally take a double dose of medications or may intentionally take extra sleeping pills or tranquilizers to counteract loneliness, depression, worries about health problems or financial status, or feelings of loss and hopelessness. - Alcohol use disorder is fairly common among seniors and is a rapidly growing national health problem. Alcohol is particularly dangerous when combined with sleeping pills or tranquilizers. Because many seniors live alone, problem use may not be recognized until it has become very serious. - Suicide attempts with medications and/or alcohol are also fairly common. Many seniors also overuse medications such as cathartics and antacids. In addition, it is not unusual for older people to change their own medication dosages without consulting a healthcare practitioner. - It is important to remember that older people often have a paradoxical reaction to drugs or alcohol. For example, they may become very agitated, confused, or assaultive when given a benzodiazepine, instead of becoming sedated. An understanding counselor allows a client to express his or her specific concerns on a one-to-one basis. - Remember that an accurate drug history is an important part of data collection in nursing

Symptoms of Cocaine Use Disorder

- Many symptoms of cocaine intoxication are similar to those of amphetamines. - Cocaine frequently causes delirium and mood and anxiety disorders. - Even small amounts of cocaine can cause permanent brain damage, causing psychosis. This organic brain syndrome (OBS) cannot be reversed. - Many clients experience vivid hallucinations and grandiose delusions, with paranoia. Seizures, coma, and death may follow. - Acute detoxification from many of the stimulants takes 4 to 5 weeks; approximately the fourth week, intense craving occurs; now there is high risk for relapse.

The Codependent or Enabler

- Most persons with alcohol use disorder have one or more codependents, also called an enabler, as "one who has let someone else's behavior affect him or her. - The codependent is obsessed with controlling (the user's) behavior." - The codependent (often the user's spouse or partner) tries to keep the family together, fends off creditors, maintains a full-time job, drives the intoxicated person home after a party, and helps while he or she vomits the next morning. - The codependent calls in sick for the person and tells the children that "Mother can't cook tonight, because she has a headache" or "Daddy doesn't feel well, so don't bother him." - The codependent, however, is often the person the user blames for the entire problem; in turn, the codependent accepts that blame, thinking, "Maybe if I took better care of myself and looked better, he or she wouldn't have this problem."

Tobacco Use Disorder

- Nicotine is contained in cigarettes and in chewing and other tobaccos (smokeless tobacco). - Approximately one fourth of Americans smoke cigarettes; this percentage is higher in persons with mental illness. - Nicotine and other additives in tobacco are considered to be the most addicting drugs available. - Nicotine contributes to or causes cancer, particularly of the lungs, lips, mouth, throat, esophagus, or larynx and smokers also have a higher than normal risk of cancer of the stomach, kidney, pancreas, bladder, or skin. - Nicotine also contributes to heart and blood vessel disorders (hypertension, narrowing of blood vessels, tachycardia, increased blood clotting, arteriosclerosis, increased incidence of stroke, and heart attack), and congenital disorders. - Coughing, dizziness, and burning of the eyes and respiratory tract are early signs that smoking is causing physical damage. (It is important to note that the use of smokeless tobacco can cause many of the same physical reactions and disorders as smoked tobacco. This includes cancers of the mouth, throat, esophagus, or stomach, as well as other system disorders.) - Smoking particularly increases health risks in persons with diabetes, hypertension, or high cholesterol. (More than 480,000 people in the United States die yearly from illnesses caused by smoking [CDC, 2014].)

Nicotine withdrawal

- Nicotine withdrawal causes dysphoria and depression, as well as insomnia, irritability, restlessness, and anxiety. - Heart rate decreases (bradycardia), and the person often feels hungry and gains weight. - The relapse rate is high and "cutting down" usually is not effective. - Many smoking cessation materials are available, such as nicotine patches, lozenges (troches), nasal spray, inhalers, or nicotine gum. - The client may need assistance with calorie control. - Hypnosis/acupuncture may be helpful.

Defense Mechanisms

- Of the many defense mechanisms people use, denial, rationalization, and projection are commonly used and the most pertinent to substance use disorders. - Denial - The user denies difficulty in controlling intake or denies that drug use is causing problems long after others realize that the person is out of control. - Rationalization - Many users argue that they could not possibly have a problem and they offer rationalizations, such as "I cannot have an alcohol problem, because ..." - Projection - Whether or not the person admits to having a problem, he or she often blames others. A typical complaint is projected onto the family: "If you were a better parent or spouse, I would not have to drink,"

Opiate Withdrawal

- Opiate withdrawal, although uncomfortable, is less dangerous than barbiturate or alcohol withdrawal. - Symptoms resemble those of a cold or an allergic response, with sore throat, rhinorrhea, lacrimation (tearing of eyes), diaphoresis, and insomnia. Yawning and mydriasis are specific signs. - Nausea, vomiting, severe abdominal cramping, diarrhea (sometimes explosive), anorexia - Tremors, weakness, muscle/joint pain - Depression or irritability and hyperactivity - Confusion, disorientation, delusions, hallucinations - Insomnia, sleep disturbances, sexual dysfunction - Fast, weak, irregular pulse; mild hypertension - Overdose: pinpoint pupils, cold, clammy skin; seizures; depressed respirations and heart rate; extreme drowsiness; coma and possible death

Agonist and Drug Replacement Therapy

- Opiates, such as heroin, are very addictive; withdrawal is difficult. - Outpatient therapy alone is often ineffective. - Inpatient therapy accomplishes detoxification, but clients often relapse when released from the controlled environment. - Several drugs, some without pharmacologic effects of their own, are used as adjunct therapy in selected cases. - They act in differing ways. - Some "take over" or occupy opioid receptors, blocking the opioid's effects (agonist therapy); some displace previously administered opioids (opioid blockers)

Over-the-Counter Drugs and Herbals

- Over-the-counter (OTC) drugs are those available without a prescription. Many medications, dietary supplements, and herbal preparations can be purchased OTC at local stores or on the Internet. - In some cases, self-medication is dangerous, especially if used to excess. - Some supplements adversely interact with prescribed medications and can also cause or aggravate medical conditions. - Herbal supplements can inhibit blood clotting, increase hypertension, adversely affect diabetes, or cause kidney/liver damage. - Many of these products also have adverse effects when combined with certain prescribed drugs. - Nurses have many opportunities to teach clients about dangers related to self- medication.

Alcohol use Disorder

- Overuse of alcohol (ETOH, EtOH) is a major public health problem, causing or contributing to over 88,000 deaths (5% of all deaths) yearly in the United States, many of which are alcohol-related MVAs (1/3 of all traffic fatalities). - Groups such as MADD (Mothers Against Drunk Driving) have initiated programs strongly encouraging people not to drive while drinking or using drugs. - They have lobbied for stricter laws; severe penalties for DUI are in place in most states. - Groups also sponsor designated driver programs and offer free taxi rides on holidays such as St. Patrick's Day and New Year's Eve. - A program sponsored by law enforcement, DARE (Drug Abuse Resistance Education), encourages school-age people to avoid alcohol and drugs. - The U.S. Public Health Service (PHS) and National Safety Council estimate that at least 15 million Americans, including many young people, have problems with alcohol. - Palcohol, powdered alcohol, is being introduced, although several states have opposed it. One ounce of Palcohol contains 80 calories and the same amount of alcohol as one drink. Sale of this product follows the same regulations as sale of any other alcohol product

OTHER SUBSTANCE USE DISORDERS

- Overuse of substances other than alcohol ranges from common drugs found in the home medicine cabinet to illegal "street" drugs, including methamphetamine, crack, or heroin. - Many people also overuse substances such as nicotine and caffeine. - It is also very common that more than one substance is overused (polysubstance use disorder). - Alcohol in particular is often combined with other mood-altering chemicals, such as cocaine and/or marijuana. - There are many commonalities between persons with alcohol use disorders and those with polysubstance use disorders.

Antihistamine withdrawal

- People in withdrawal from amphetamines are highly unpredictable and can be very dangerous. - Amphetamine users often alternate amphetamines with sedatives, such as barbiturates or alcohol. - They take sedatives to "even out" the high and avoid the "crash" of stimulant withdrawal or to help them sleep. - Then they must take amphetamines to wake up. This necessitates simultaneous withdrawal from several drugs. - These alternating "highs" and "lows" are life threatening, if continued. - It is important to prevent these clients from injuring themselves or others.

Phencyclidine Hydrochloride

- Phencyclidine hydrochloride (PCP, "angel dust") is a hallucinogen that was originally developed as an animal anesthetic. It has been abused for about 40 years, because of its low cost and fairly easy availability. - Because it has a simple chemical structure, it is believed that most PCP on the streets is illegally manufactured. - Its effects are similar to those of hallucinogens and CNS stimulants; the person becomes overwhelmed by environmental stimuli. The drug's most characteristic effect is an alteration in body image, frequently accompanied by uncomfortable feelings of unreality. - Some individuals experience intense feelings of loneliness and isolation. It can result in permanent brain damage. - The most effective way to assist a person on a "bad trip" caused by PCP or another hallucinogen is to provide a quiet environment, with reduced stimuli. - Verbal reassurance will not benefit the person on PCP; do not talk at all (an approach that differs from the treatment of withdrawal from other hallucinogens

causative factor of substance abuse theories

- Physical Factor Theory - Genetic Theory - Emotional and Psychological Theories - Dual Disorders

Rational recovery

- Rational emotive therapy (RET or rational emotive behavior therapy [REBT], rational recovery). - REBT is built on the premise that an individual's values and beliefs control behavior. - A person's illogic beliefs influence irrational - For example, a person who overuses substances may believe he or she is weak, worthless, or unworthy of happiness. Therefore, the person continues harmful behavior, even though he or she knows it is dangerous, because of their derogatory self- perceptions and low self-esteem. - The treatment premise in REBT is helping the person recognize that "I am the only one who can control my behavior and I need to reject irrational behavior."

E-cigarettes

- Recently, electronic cigarettes (personal vaporizers [PV], electronic nicotine delivery systems [ENDS], or vapor cigarettes) have been developed and are very popular. (Their use is known as "vaping".) - E-cigs are battery-powered vaporizers that simulate the feeling of smoking, without burning tobacco. Instead of inhaling smoke, the user inhales an aerosol, or vapor. - E-cigs are believed to contain about the same amount of nicotine as smokeless tobacco. In addition, users can vape other substances, such as marijuana. - Many people who vape also smoke cigarettes. The total health risks are unknown at this time

Medical Marijuana (THC)

- Several cannabinoids are used medically. - These have been tested for purity and freedom from mold, pesticides, and other harmful chemicals, and efforts have been made to reduce the "high" of street THC. - Besides medical THC, other forms currently used in the US include cannabidiol (CBD), dronabinol (Marinol), and Nabilone (Cesamet), a synthetic cannabinoid. (Sativex is a combination of THC and CBD and is approved in several European countries to treat disorders such as MS.) - New forms are in development and it is believed that medical THC will be used widely in the future. - Many states have approved the use of medical THC for disorders such as nausea and vomiting associated with cancer chemotherapy and to treat anorexia in AIDS. - it is used to treat intractable seizures and to reduce pain, spasticity, and inflammation. (THC may exacerbate bipolar illness, schizophrenia, hypertension, and heart disease.)

Nursing Data Gathering

- Several formal evaluation tools are used to identify a substance use disorder. In addition, the nurse gathers relevant information, to assist the provider in making a diagnosis. - It is important to know what items to include. The LV/LPN often assists with the admission and talks with the client and family. - Report pertinent observations to the person who is doing the written admission assessment and writing the nursing care plan. Initial data gathering regarding the client's use of mood-altering chemicals can be incorporated naturally into every nursing interaction. - Ask the person, "How much alcohol do you use? What other drugs do you use? How often? How much?" If the person responds negatively to these questions, ask him or her, "When was the last time you used alcohol or drugs?"

Adolescents as drug abusers

- Substance use disorders present a serious problem among adolescents and school-age children. Peer pressure and low self- esteem contribute to chemical use. Cigarette smoking and alcohol use are also on the increase among adolescents

Stimulant Use Disorders

- The CNS (cerebral) stimulants include amphetamines and cocaine-related drugs. - These drugs are taken orally, snorted, or injected and induce tolerance and psychological dependence. - Caffeine is considered a milder cerebral stimulant. Amphetamines - Amphetamines are mood elevators and appetite depressants and they combat fatigue. Caffeine potentiates the action of amphetamines. - A number of drugs in this class (or related drugs) are used medically. These include methylphenidate (Ritalin), amphetamine/dextroamphetamine (Adderall), and dextroamphetamine (Dexedrine, Dextrostat), which may be prescribed for narcolepsy or for children with ADHD. Any of these drugs may be abused. - Many of the drugs in this class are now illegal, but are sold as street drugs; these include benzphetamine ("Benzedrine," "bennies") and gamma butyric acid (GBA). Although it can be legally prescribed, this amphetamine is commonly abused and is becoming a serious public health problem. - Known by street names such as "meth, crank, speed, tweak, and STP" it is usually a white, crystalline powder taken orally, snorted, smoked, or injected. Crystal meth ("glass, crystal, ice") is produced from the powder and is typically smoked. Since crystal is very pure, its effects can last up to 12 hours. - Methamphetamine is a powerful, highly addictive CNS stimulant, causing a cascading release of norepinephrine, dopamine, and some serotonin. This causes an intense euphoria ("rush") and results in rapid dependence, requiring ever-higher doses to obtain a high. - Meth may cause permanent brain damage, heart disorders, tooth destruction ("meth mouth"), and skin lesions. - It may lead to very risky behaviors, may worsen the progression of HIV/AIDS, and may also cause memory loss, agitation, aggression, paranoia, hallucinations, and delusions. - The client may have the sensation of insects or snakes crawling on the skin (formications, "meth mites"). Meth abusers may stay awake for many days; the combination of the drug and sleep- deprivation exacerbates the drug's negative effects. - Prolonged sleeplessness and meth use may result in "tweaking." A "tweaker" is a meth user who has not slept for days and is in acute withdrawal. - He or she may appear normal, except for rapid eye movements or quick, jerky body movements. (Post- withdrawal syndrome may last for months.) - Another danger of meth is that it may be used by people who would not otherwise be abusing drugs. - For example, teen-aged girls may use the drug to promote weight loss. - Others may use the drug to stay awake. These people may be unaware of the drug's potency and may quickly become addicted. - Meth labs are also dangerous, in that they emit dangerous fumes and other wastes that can cause CNS and liver damage, cancer, permanent brain damage, immune and respiratory problems, and can cause dangerous explosions.

Symptoms of cannabis Abuse

- The most common effect of THC is a dreamy state, characterized by euphoria; the person's perception of space and time may be distorted, although signs and symptoms vary among people. - The person with a cannabis use disorder often shows poor motor coordination, restlessness, emotional lability, impaired judgment, tachycardia, dyspnea, palpitations, hunger, nausea, bloodshot eyes, coughing, and dry mouth. - Signs of intoxication include delirium, delusions, hallucinations, anxiety or panic, and a feeling of choking or suffocation. - Cannabis can induce psychological and physical dependence. - There is no empirical evidence that smoking marijuana directly leads to the use of opiates or other drugs. However, most people who use "harder" drugs smoked marijuana first. - The person who regularly smokes MJ often has the same disorders as those who smoke tobacco. "Researchers have ... found an association between (THC) use and an increased risk of depression ... and earlier onset of schizophrenia, and other psychiatric disorders" in certain cases

Long-Term Follow-up and Treatment

- The period after detoxification is very important. - The client remembers vividly the extreme discomfort experienced and may now be willing to enter treatment. - role of the nurse includes discussing the possibility of a comprehensive drug evaluation. - person may be diagnosed as having mild, moderate, or severe substance use disorder. - The person may also have a polysubstance use disorder (having overused several drugs). - Many of these people are also codependents, living with or caring for another person who overuses alcohol or other drugs.

Symptoms of Opiate Use Disorder

- The user has a strong, uncontrollable desire for the drug and builds up a tolerance, requiring increasing doses. Symptoms of opiate intoxication include • drowsiness or coma • euphoria or dysphoria • confusion • nausea • constipation • slurred speech • decreased memory and attention span • bradypnea (respiratory depression) • depression. - Suicide is a great risk

Opiate Use Disorders

- This group includes: • morphine • Codeine • heroin—"horse" (including "black tar") • oxycodone (Oxycontin) • Hydrocodone • hydromorphone (Dilaudid). • methadone (Dolophine) • butorphanol tartrate (Stadol) • pentazocine (Talwin) • Vicodin • Percocet • Percodan - With the exception of codeine, all these drugs are highly addictive and rapidly induce tolerance and physical and psychological dependence. - These drugs are prescribed to treat pain and are later abused. - They are also sold as street drugs and sometimes are snorted or injected, with a high risk of overdose

Sedatives, Hypnotics, and Anxiolytic Drugs

- This large group of drugs includes barbiturates and antianxiety agents. The illegal street use of these drugs is increasing. - Most of these drugs are prescription drugs, with legitimate medical uses but the concern here is their abuse. - It is important to destroy any prescribed medications no longer being used, to prevent their diversion to the illegal drug market. - Frequently abused sedatives, hypnotics, and anxiolytic drugs include: • Barbiturates: secobarbital Na (Seconal, "reds"), and "yellow jackets" • Benzodiazepines: alprazolam (Xanax), chlordiazepoxide HCl (Librium), diazepam (Valium), and lorazepam (Ativan) • Others: oxycodone (OxyContin, "oxy," many other names), • zolpidem (Ambien), • hydroxyzine (Vistaril), and • gamma hydroxybutyrate (GHB, many nicknames). • Many combination drugs are also abused. Some of these are: • hydrocodone with acetaminophen (Vicodin) • oxycodone with acetaminophen (Percocet) • hydrocodone and ibuprofen (Vicoprofen) • oxycodone with aspirin (Percodan

Physical Factors Theory

- This theory states that excessive consumption of substances is the most obvious cause of these disorders. For example, some investigators believe that a nutritional deficiency or an endocrine factor (similar to diabetes) can lead to excessive alcohol use. (It is known that nutritional deficiencies result from excessive use.) - Another theory is that ingestion of alcohol and certain other drugs causes an allergic response, or an altered reaction of body tissues, to a specific substance (e.g., alcohol) that would not produce the same effect in nonallergic people

Family counseling

- Treating only the client is not sufficient; significant others also need intensive counseling. - Treatment centers offer family programs, conducted simultaneously with the client's treatment. - The person and family must realize that they all need follow-up care, which is vital if the client is to maintain sobriety. - The client and family need encouragement and support to deal with normal familial stressors, plus added challenges of recovery. - The person's recovery is less likely to be successful if significant others are not also in the recovery mode. - Referrals to social service agencies may assist in locating support groups, education/retraining, employment, financial assistance, or housing.

Inpatient or Outpatient Treatment

- Treatment for substance use disorders may be as an inpatient in a treatment center, or as an outpatient. The client's attitude, family support, insurance coverage, and work and personal situation often determine what type of treatment is recommended or possible. (The client may also be legally committed to a treatment program.) Treatment centers usually base their treatment on one or more of the following programs: - The 12-step program, based on AA • Rational Recovery Therapy - Dialectical Behavioral Therapy - Health Realization Theory In addition, most treatment programs also include: - Personal and group counseling • Client and family education • Family counseling • Improving nutritional and general health

Treatment of Alcohol Abuse disorders

- Treatment of alcohol use disorders is complex. - After the person completes detoxification and general medical conditions are treated, ongoing follow-up begins. - The client and family are referred to an ongoing support program. - In addition to vitamin replacement and other nutritional and electrolyte replacement therapies, specific medications are available to assist clients with severe dependence to maintain sobriety

*** 12-Step Programs

- Twelve-step groups, such as AA and Narcotics Anonymous (NA), teach that an untreated substance use disorder is a progressive, incurable disease. - The disease is considered to be arrested or in remission when the person is not using. The dependent person is never cured. - Twelve-step programs do not sponsor or endorse any particular treatment program; rather, they are based on helping the individual admit his or her powerlessness over the chemical and that his or her life has become unmanageable because of it. - The person then accepts the existence of a "higher power," determines whom he or she has harmed and makes amends, turns his or her life over to their individual higher power, and assists others to do the same

Stages of Alcohol Withdrawal

- Uncomplicated withdrawal is usually completed within 3 to 7 days. - Unlike withdrawal from most other drugs, alcohol withdrawal progresses through three distinct stages, if medical management is ineffective. - The goal of alcohol detoxification is to keep the client as comfortable and safe as possible and prevent progression into the second and third stages of withdrawal, which are life threatening. - Autonomic hyperactivity: Symptoms include elevated vital signs (temperature over 100°F, pulse over 100 BPM, respirations over 20 to 22/min, and BP over about 160/95 mm Hg). - Other symptoms include nervousness, restlessness, and psychomotor agitation. Stages of Withdrawal - This stage includes anxiety, sleep disturbances (including insomnia and vivid nightmares), irritability, diaphoresis, flushed face, anorexia, and nausea (with copious vomiting and later "dry heaves") A significant sign is the presence of tremors ("shakes"). - Subjective, internal tremors occur first. The client can describe these tremors, but they are not observable to others. Hand tremors are the first objective sign observed. (Stage 1 usually occurs within 12 to 18 hours after the person's last drink.) - Neuronal excitation: Symptoms include severe tremors (internal and external), panic, insomnia, and increased agitation. - The person may experience transient hallucinations of frightening events (e.g., drowning while drunk) or frightening auditory hallucinations. - The person may become paranoid, depressed, and is at extremely high risk for suicide. - (Stage 2 usually occurs within 24 to 36 hours after the last drink, without treatment.) - Sensory-perceptual disturbances: Symptoms include vivid visual hallucinations (e.g., "pink elephants," flashing lights), generalized tonic-clonic seizures, and severe agitation and panic, leading to profound confusion and coma. - Death may occur during a seizure or as a result of aspiration or exhaustion. - This stage is a particularly life threatening and a medical emergency. Untreated, the mortality rate is 25% in this stage. (Stage 3 usually occurs within 3 to 4 days after the person's last drink, without successful treatment.) - An indicator of a severe toxic state in stage 3 is the presence of delirium tremens (DTs). - Symptoms include delusions and vivid and terrifying auditory and tactile hallucinations called alcohol hallucinosis (e.g., "bugs crawling on the skin"), which may last a few days to several weeks. The person often retains consciousness during DTs, so the experience is extremely frightening. - This person is critically ill. Vomiting and severe diarrhea is common. - Vital signs are very high; fever may be as high as 100°F to 103°F, or higher. Tachycardia with pulse range of 130 to 150 bpm. Seizures may be present. - a condition called "rum fits" exists when the person has two to eight tonic-clonic seizures close together; this may progress to status epilepticus. - Death may occur in this stage because of exhaustion, circulatory collapse (resulting from blood volume depletion), aspiration, or hyperthermia (very high fever). Stage 1 (12-18 hours) - elevated vitals - anxiety - restlessness - decreased attention - tremors - insomnia - nausea - craving Stage 2 (24-36 hours) - hallucinations (visual, auditory, tactile) - misperception -irritability - vivid dreams - confused - high risk for suicide Stage 3 (3-4 days) - generalized Tonic Clonic seizures (close together seizures) - vivid visual hallucinations - vomiting - diarrhea - very elevated vital signs

Inhalant Use Disorder

- Volatile substances, CNS depressants, are inhaled ("huffing"), and are found in thousands of household items, such as air freshener, spray paint, and other vaporized products (known as "boppers, whippets, moon gas, poppers"). - The substance can be inhaled from the mouth, sniffed, or snorted. - When inhaled from a balloon or plastic bag, the practice is known as "bagging." - Inhalants are often the first drug used by younger teens and children (formerly called "glue sniffing"). - When inhaled, they quickly produce altered states of consciousness and varied degrees of intoxication and euphoria, as well as hearing and vision difficulties (including nystagmus and diplopia [double vision]). - They can also cause slurred speech, loss of coordination and other nervous system disorders, lessening of inhibitions, irritability, lethargy, muscle weakness, and dizziness. - More serious effects include hallucinations, marked behavioral and personality changes, impaired perception and judgment, memory loss, permanent brain damage, and depression, as well as lung, liver, and kidney damage. - If the person is pregnant, fetal development can be seriously impaired. Many of these effects are irreversible. - Because the inhaled chemicals spread to the brain within minutes, the intoxication lasts a very short time, often resulting in repeated huffing, thus greatly increasing the dangers. - Death can occur quickly ("sudden sniffing death"), even with first use, due to burns, irregular heart rhythms and heart failure, sudden cardiac arrest, asphyxiation, or aspiration of vomitus. - Clues to inhalant use include the odor of chemicals on the breath (the most important clue), as well as spots on the clothing and spots and sores around the mouth.

Withdrawal Symptoms

- Withdrawal symptoms may be similar to the DTs of alcohol withdrawal, but vital signs are often normal or only slightly elevated - Because continued dependence on GHB requires around-the-clock dosing, withdrawal may begin within 2 to 5 hours. - Nursing and medical care are supportive. - high doses of sedatives, including benzodiazepines and/or anesthetics, may be needed and intubation may be required, to support respiration.

Withdrawal from Marijuana

- Withdrawal symptoms related to THC abuse usually do not appear until about 1 week after use (but may begin within 12 hours). - The symptoms often are not recognized as being related to the use of THC. - Symptoms include diarrhea, "wet dog" shakes, headache, excessive salivation and yawning, ptosis (drooping eyelids), restlessness, irritability, insomnia, diaphoresis, runny nose (rhinorrhea), intractable hiccups, anorexia, hot flashes, stomach pains, and other flu-like symptoms. - Withdrawal is not usually life threatening.

withdrawal

- in acute ("cold turkey") withdrawal from sedative, hypnotic, or anxiolytic drugs, seizures are possible. - Withdrawal must be gradual (although this withdrawal is not as life threatening as is that from alcohol). - Overdose and acute withdrawal are medical emergencies, often requiring hospitalization. - A specific antidote for overdose of benzodiazepines is flumazenil (Romazicon)

Dual Disorder

- many people with substance use disorders also have a coexisting mental illness that complicates both conditions. - *** Chemical dependency can lead to various mental disorders. - This dual disorder or dual diagnosis has been called "mental illness combined with chemical dependency" (MI/CD). - Many people with mental disorders are depressed and use chemicals in an attempt to ease depression or to commit suicide. - Many of these people also suffer from "voices" (auditory hallucinations) and use chemicals in an effort to "make the voices go away."

therapeutic community

- pt is isolated from the substance-oriented environment. - Their lifestyle is helped to change, as they learn drug-free coping skills. - Recovering clients organize and administer many such programs. Clients are assigned to work or study groups and given assigned readings to help them learn more about the disorder and assume personal responsibility. - Group therapy is a common component of treatment programs. Sometimes, the groups are gender-specific and focus on particular concerns of either men or women. - The goals of treatment are to assist clients to address physical and emotional problems associated with the disorder and understand the cycle of dependence.

Management

- recognition, intervention, treatment, and recovery - Recognition: Someone must recognize the condition. The first person to do so is very often someone other than the person with the disorder. - Intervention: Active intervention must occur. If no one intervenes in the process, it usually escalates. - Treatment: These disorders often respond to structured therapy. The person may need a particular milieu to gain control. - Recovery: Many therapies assist people with substance use disorders to lead a successful and productive life. Many such programs use the 12-step approach of Alcoholics Anonymous (AA) or apply principles of behavior modification.

Dealing c an intoxicated pt

- remain c pt at all times - speak calm, and softly - Provide calm, and quiet environment - tell the client frequently where they are, what day it is, and who you are. - monitor LOC and orientation - check neurological Eye signs - monitor vital signs, spo2, and pain levels - rationale: arrhythmia are common. Artificial respiratory support or ventilation may be necessary. Pt may have depressed reflexes, or secretions that block their airway. Emetics and aspiration may occur. Respiration's May be dangerously depressed In cases of an overdose. Elevated or fluctuating vitals are often an indicator of withdrawal.

Emotional and psychological theories

- stress and low self esteem are factors - person needs drug to feel good about life and self - personality traits: difficulties in interpersonal relationships, General uneasiness and dissatisfaction with life, Low tolerance for frustration, Tendency toward excessive and self- destructive

Detoxification

- the process of removing a drug and its physiologic effects from the body. - normally 72 hours or more to detox - Total detoxification may take many days, depending on the drug(s) used, amounts, dependence level, liver and kidney function, and the client's size and general health. - The most important goals in detoxification management are comfort and safety. Use sedation and emotional support to allow the client to rest and recover and prevent injury or exhaustion. - Treatment depends in part on the specific substance(s) used. Remember that detoxification must occur before long-term treatment can begin.

Withdrawal Symptoms

- to begin detoxification, the client's body is denied access to the drug of choice. When this drug is removed, most people with substance use disorders experience withdrawal (W/D) symptoms of varying severity. - Some clients withdraw with minimal discomfort; others experience very difficult and/or dangerous withdrawals. Intensity depends on several factors, including the drug used, amount, and general health and nutritional status. Liver function and the client's history of previous withdrawal episodes are especially important. - Predicting the progression of any individual's withdrawal episode at any given time, however, is impossible. - Those experiencing withdrawal are in psychological and medical jeopardy. - Detoxification from alcohol and certain other drugs is a serious medical problem; the process can be fatal. (Alcohol withdrawal is one of the most dangerous.)

Recovery for codependent

- to break the cycle of dependence, codependents must realize that monitoring another person's behavior and being honest about their own feelings are impossible to reconcile. - Preventing crises and shielding the person with an alcohol use disorder will not solve the problem. - Many persons with alcohol use disorder, as well as other substance abusers, become motivated to seek help only when their well-being or "status quo" is threatened. - Usually when the children begin to suffer, the codependent will take action. - To begin recovery, codependents must stop covering up and protecting the substance abuser; come to understand that these individuals have a bad disease, but are not bad people; realize that some abusers will not stop; they then must decide to "let go" in whatever way is comfortable. - Often, when codependents get help for themselves and stop enabling, individuals with a substance use disorder no longer continue the cycle of abuse, because no one is available to blame for their problems but themselves. Enabling allows a life-threatening condition to continue and progress.

Medication Management of Alcohol Abstinence

Clients must be detoxified before beginning any of these medications. Antabuse • disulfiram (Antabuse), is sometimes used as aversion therapy or adverse conditioning in the person with a chronic alcohol use disorder, who is unable to maintain sobriety. It is used only if the client is preoccupied with or craving alcohol and has had multiple failed treatments Campral • Acamprosate calcium (Campral) is a drug developed in 2004, used to reduce craving for alcohol after withdrawal. Naltrexone • Naltrexone (ReVia, Vivitrol) is a blocking agent, originally used to treat opioid abuse, but now also used as an adjunct treatment for alcohol abuse, after detoxification. Kudzu • Kudzu (an herbal supplement) has proved effective in reducing the craving for alcohol in some cases.

***Specific Disorders Caused by Alcohol Abuse

Dietary Deficiencies • Alcohol disrupts nutrient absorption in the proximal small intestine, causing dietary deficiencies. Most common are deficiencies in vitamin B1 (thiamine) and vitamin B9 (folic acid, folate). Routine administration of these, in addition to iron and a multivitamin, is usually part of the treatment protocol. Sequelae of Thiamine Deficiency • Thiamine (vitamin B1, thio-vitamin, "sulfur- containing" vitamin) is vital in the breakdown of sugars. Untreated thiamine deficiency causes a severe neurologic disorder, Wernicke-Korsakoff syndrome (WKS). Many untreated persons with chronic alcohol overuse exhibit symptoms of WKS, including dementia, diplopia (double vision), ataxia, somnolence (extreme sleepiness), stupor, and *** horizontal nystagmus (rapid eyeball movement from side to side). Ocular symptoms are treatable, but ataxia and dementia are often irreversible. The mortality rate in the acute phase of WKS is as high as 15%. Cirrhosis of the Liver and Hepatitis • Chronic liver cirrhosis (hepatic cirrhosis), leading to liver failure, is commonly associated with chronic alcohol use disorder (Laennec cirrhosis). The person may also have acute alcoholic hepatitis, with fever and dehydration. These disorders are sometimes referred to as alcohol-related liver disease (ARLD) Other Disorders • Other disorders directly related to alcohol abuse are esophageal varices (uncontrolled bleeding of the esophagus) and bleeding; cancer of the mouth and esophagus; gastritis, gastric ulcers, and other GI disturbances; kidney disorders; and heart disorders, including coronary artery disease. Sexual impotence is common. Newborns of alcohol- abusing mothers often have fetal alcohol syndrome (FAS)

Reversal for opioid drugs

Drug: Narcan

T/F: Older adults are not at risk for substance abuse?

False - Research shows that over 33% of emergency department admissions and 20% of acute hospital admissions of older adults can be traced to complications related to substance abuse - Chemical dependency and alcoholism among older people are increasing public heath problems. Many serious overuse prescription medications, OTC durgs, or alcohol as a result of loneliness, depression, or confusion. Seniors often live alone, and the problem is not recognized until it has become very serious.

Progressive nature

The progressive nature of these disorders corresponds to their psychological causes.

Important to remember

When was your last drink? Drug use? Have you ever had problems with withdrawal? Seizures? DTs? - The last two questions are very important, in terms of predicting withdrawal. (For example, the person who has been drinking in the past few days must be closely observed for life-threatening withdrawal symptoms for at least 96 hours.) - These questions are very significant for clients who are being prepared for surgery or to deliver babies. They can suddenly go into unexpected withdrawal. - Remember: how often and how much a person drinks or uses drugs are not always the best criteria for determining whether someone has a substance use disorder.

Substance use disorder is now considered ...

a long- term, chronic illness.

A client with alcoholism states to the nurse, "I can't be an alcoholic. I can quit whenever I want." What defense mechanism does the nurse recognize the client is displaying? a. Rationalization b. Denial c. Projection d. Recognition

a. Rationalization

The nurse is caring for a group of clients in a behavioral health unit. Which client would be documented as having a dual disorder? a. A client with diabetes and hypertension b. A client with depression and substance use disorder c. A client with schizophrenia and visual impairment d. A client with borderline personality disorder and chronic kidney disease.

b. A client with depression and substance use disorder

The nurse is caring for a client admitted for alcohol detoxification. When assisting with the development of a care plan, what priority goals should be addressed? a. Nutrition and hydration b. Maintenance of acid-base balance c. Comfort and safety d. Maintenance of skin integrity

c. Comfort and safety

When attempting to obtain information regarding a client's alcohol use, what statement will be most effective? a. "Do you overuse alcohol?" b. "Where do you drink?" c. "How much do you drink?" d. "Tell me about your alcohol use."

d. "Tell me about your alcohol use."