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In this chapter, you’ll learn:
♦
types of substance abuse disorders
♦
street names for commonly abused substances
♦
proposed causes of substance abuse anddependence
♦
how to assess for substance abuse anddependence
♦
nursing interventions for service users experiencingsubstance withdrawal.
A look at substance abuse disorders
Substance abuse affects males and females of all ages, culturesand socioeconomic groups. People have used alcohol and otherpsychoactive substances – those that affect the central nervoussystem (CNS) – for centuries to induce changes in perception,mood, cognition or behaviour. These substances produce a state of consciousness that the user deems pleasant, positive or euphoric.Substance abuse commonly coexists with – and complicates thetreatment of – other mental health disorders. Likewise, many people with emotional disorders or mental illness turn to drugs and alcoholto self-medicate and help them tolerate their feelings.
Suspicious substances
 A substance of abuse may be any chemical substance or preparation usedtherapeutically or recreationally. Commonly abused substances include:•alcohol•amphetamines and amphetamine-like drugs
 Just the facts
11
Substance abusedisorders
Substanceabuse hasbeen around for centuries. Iwonder if King Tutever got a little tipsy.
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402SUBSTANCE ABUSE DISORDERSAbusinga single drugis bad enough.Mixing severaldrugs togetheris especiallydangerous.
•barbiturates•cocaine – a stimulant derived from the cocoa plant•crack – cocaine hydrochloride mixed with baking soda•hallucinogens•inhalants•marijuana•nonbarbiturate sedatives, hypnotics and anxiolytics (primarily benzodiazepines)•opioids – heroin, morphine and meperidine.Many people abuse a combination of substances. Drug mixing isthe most dangerous form of substance abuse.
Consequences of substance abuse
Substance abuse commonly leads to physical dependenceor psychological dependence or both. It’s also associated with illegal activities and may cause unhealthy lifestyles andbehaviours, such as a poor diet. Chronic substance abuseimpairs social and occupational functioning, creating personal,professional and financial problems.
Teenage wasteland
 When drug use begins in early adolescence, it may lead to emotionaland behavioural problems resulting in the failure to completeschool. In pregnant women, substance abuse jeopardises foetal well-being.I.V. drug abuse may lead to life-threatening complications (See
Complications of I.V. drug abuse
, page xx.)
Terrible trips
Few people would voluntarily take a drug they expect to cause anunpleasant experience. However, psychoactive substances oftenproduce negative outcomes – among them, maladaptive behaviour,‘bad trips’ and even long-term psychosis.
Not so street-smart 
Illicit street drugs pose added dangers. Materials used to dilute streetdrugs can cause toxic or allergic reactions. Specific effects of streetdrugs vary with the substance.
Defining the terms
 According to the
Diagnostic and Statistical Manual of Mental Disorders 
,Fourth Edition, Text Revision (
DSM-IV-TR
), substance use disordersencompass both substance abuse and substance dependence.
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403In the
DSM-IV-TR 
, the term ‘substanceuse disorders’encompassesboth substanceabuse andsubstancedependence.
•
Substance abuse
is the repeated use of alcohol or otherpsychoactive drugs that leads to problems but
not 
to compulsive useor addiction. Also, reducing or completely stopping the drug usedoesn’t cause significant withdrawal symptoms.•
Substance dependence
refers to the persistent use of alcohol or otherpsychoactive drugs despite problems caused by such use. Compulsiveand repetitive use may lead to tolerance of the drug’s effects and withdrawal symptoms when the drug use is decreased or stopped.(For other key definitions, see
The language of substance abuse
, page xx.)
Defining the problem
Substance abuse is a major public health problem. It is increasing inprevalence and young and old alike either abuse or are dependent
Complications of I.V. drug abuse
I.V. drug abuse can lead to numerous complications – evenbeyond those caused by the drugs themselves.Using contaminated needles, for example, raises therisk of such infections as human immunodeficiency virus,viral hepatitis (especially hepatitis B and C) and bacterialinfections. Heroin can cause a nephropathy similar to focal segmental glomerulosclerosis. A condition called
talc granulomatosis 
may occur if the drug was adulterated withan inert substance (such as talcum powder).With chronic I.V. drug abuse, potential complicationsinclude:•skin lesions and abscesses• thrombophlebitis•vasculitis•gangrene•cardiac and respiratory arrest•intracranial haemorrhage•subacute bacterial endocarditis•septicaemia•pulmonary emboli•respiratory infections•malnutrition•GI disturbances•musculoskeletal dysfunction•depression•psychosis•increased suicide risk.
A LOOK AT SUBSTANCE ABUSE DISORDERS
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