SUBSTANCE ABUSE

Definition of Terms

• Substance Abuse
- defined as the inability to meet the major role obligations, an increase in the legal problems or risk-taking
behavior, or exposure to hazardous situations because of an addicting substance.
- use of chemicals to improve a maternal state or induce euphoria
• Substance dependent
- When a person has withdrawal symptoms following discontinuation of the substance, and such activities as
abandonment of important activities, spending increased time in activities related to substance use, using
substances for a longer time than planned, and continued use despite the existence of worsening problems due
to the substance use
Types of Abused Substances:
1. Cocaine
- derived from the Erythroxylum coca, a plant grown almost exclusively in South America
- often called in the street as snow and white lady
- often abused drug, found in both: powder (cocaine or coke) and stronger rock forms (crack cocaine)
- is a powerful short-acting Central Nervous System (CNS) stimulant
- is used as topical anesthetic in mucous membranes of the oral, laryngeal and nasal cavities
can be used off-label to stop nosebleeds and make cauterization and packing wound easier
- when sniffed or smoked in a pipe, it is absorbed across the membranous membranes and affects the central
nervous system resulting to sudden vasoconstriction
- it blocks the reuptake of the neurotransmitters: norepinephrine and dopamine at the nerve terminals,
producing a hyperarousal state that results in euphoria
SIGNS AND SYMPTOMS OF TOXICITY
- restlessness
- paranoia
- irritability
- auditory hallucinations
- convulsions
- respiratory or cardiac arrest
SIGNS AND SYMPTOMS OF WITHDRAWAL
- depressed mood
- lethargy
- impaired concentration
- craving for drug
MATERNAL AND FETAL EFFECTS
- hyperarousal state; euphoria
- generalized vasoconstriction
- hypertension
- tachycardia
- STDs
- spontaneous abortion
- abruptio placentae
- preeclampsia
- premature rupture of membranes (PROM)
- preterm labor/fetal death
- precipitous delivery
- fetal hypoxia
- meconium staining
- stillbirth

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 2. Amphetamine
- is a neurostimulant and neurotoxin that has pharmacologic effect similar to cocaine
- group of drugs sometimes used in the treatment of hyperactivity and narcolepsy
- these are called uppers or speed because they give the user a false sense of well-being, alertness, or self-
esteem
- common names include speed, crystal, glass, crank, ice, and ecstasy
- Ice, a stronger form, rock type of methamphetamine that produces intense symptoms
SIGNS AND SYMPTOMS
- aggressive or demanding behavior
- paranoia
- extreme restlessness
- extreme fatigue
- dry mouth
- no appetite
- shakiness
- insomnia
- blackened and infected teeth
MATERNAL AND FETAL EFFECTS
- vasoconstriction
- hypertension
- tachycardia
- spontaneous abortion
- fetal growth restriction
- low birth weight
- preterm labor
- abruptio placentae
- preeclampsia
- retroplacental hemorrhage
- cleft palate
- abnormal sleeping pattern
- agitation
- diaphoresis
- poor feeding
- vomiting

3. Marijuana
- widely known as pot or grass
- derived from the leaves and stems of the Indian hemp plant, Cannabis sativa
- rolled into cigarettes (joints/reefers)
- sinsemilla, a seedless form that is even more potent
- hashish, a much stronger substance from a scraping of the resin from the flowering leaves
- when smoked, they produced tachycardia and a sense of well-being
- women use marijuana to counteract nausea and vomiting or “morning sickness” in early pregnancy
- In United States, many pregnant women legally using marijuana
SIGNS AND SYMPTOMS
- sleepiness
- wandering mind
- enlarged pupils
- lack of coordination
- irritability
- drowsiness
- cravings for high carbohydrate snacks

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 MATERNAL AND FETAL EFFECTS
- often used with other drugs like tobacco and cocaine
- unclear; more study needed, may be related to problems in motor development; increased risk of anomalies or
mortality unproven
- loss of short-term memory
- increased incidence of respiratory infection
- pulmonary disorders: sinusitis, bronchitis, emphysema, lung cancer
- more research is needed about its possible side effects during breastfeeding; reduced milk production and the
risk to the newborn from excretion of the substance in the breast milk

4. Heroin
- is an example of an illegal opiates, a CNS depressant and an appetite suppressant
- is a raw illicit opiate that is also increasing incidence in late adolescents
- it can be administered intradermally (skin popping), inhalation (snorting), or intravenously (shooting)
- it produces an immediate and short-term feeling of euphoria, then followed by sedation
- can lead to acute cerebral vascular accident and death when snored
SIGNS AND SYMPTOMS
- stupor
- drowsiness
- needle marks on the body
- watery eyes
- loss of appetite
- bloodstains on shirt and sleeve
- runny nose
SYMPTOMS OF ABSTINENCE
- nausea
- vomiting
- diarrhea
- abdominal pain
- shivering
- insomnia
- body aches
- muscle jerks
MATERNAL AND FETAL EFFECTS
- gestational hypertension
- phlebitis
- subacute bacterial endocarditis
- hepatitis B
- HIV infection
- malnourished
- anemic
- fetal growth restriction
- preterm labor
- premature rupture of membranes
- fetal distress
- stillbirth
- increased incidence of SIDS
If pregnant women are heroin dependent:
- fetal opiate dependence and severe abstinence symptoms in the infant after birth (neonatal abstinence
syndrome)
- infants tend to be small for gestational age and have an increased incidence of fetal distress and meconium
aspiration syndrome due to intermittent hypoxia

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 5. Alcohol
- common abused substance or drug
- it passes easily across the placenta
- once taken, it can lead to vitamin B deficiency and accompanying neurologic damage
- it is detrimental to maternal and fetal health as illicit drugs/substances
- if taken during the first trimester of pregnancy, can affect cell membranes and alter the organization of tissue,
causing structural defects
- a CNS depressant causing lethargy, slurred speech, slowed motor reaction, impaired judgement, decreased
social inhibition
ALCOHOLISM
- a chronic, progressive, multisystem disease
- is fatal
- women are more likely to experience health problems earlier than men because they weigh less than men;
consequently, more concentrated and toxic than men
SIGNS AND SYMPTOMS
- nausea
- vomiting
- loss of coordination
- belligerence
- stupor
- coma
- anxiety
- agitation
- elevated vital signs
- hyper active reflexes
- tremors
- diaphoresis
- insomnia
- hallucinations
- seizures
MATERNAL AND FETAL EFFECTS
- spontaneous abortion
- abruptio placentae
- fetal alcohol spectrum disorders
- fetal alcohol syndrome (FAS) ; facial and cranial anomalies, developmental delay, cognitive impairment,
short attention span
- fetal demise
- fetal growth restriction

6. Cigarette
- most common form of substance abuse in pregnant women
- associated with infertility in women
- causes vasoconstriction, transfer across the placenta and reduces placental blood circulation
- cigarette smoking increases maternal metabolic rate; decreases appetite, thus lower weight gain
- increase amount of smoking increases, infant birth weight decreases
SIGNS AND SYMPTOMS
- weight loss
- fatigue
- yellow teeth
- coughing
- sleep and heart problems
- shortness of breath
- depression

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 MATERNAL AND FETAL EFFECTS
- decreased placental perfusion
- abruptio placentae
- anemia
- PROM
- preterm labor
- spontaneous vaginal abortion
- prematurity
- low birth weight
- neurodevelopmental problems
- increased incidence of SIDS
- perinatal mortality
- decreased milk production
NURSING DIAGNOSIS
1. Risk for injury to self and fetus related to chronic substance dependency
2. Risk for injury related to physiologic and psychological effects of recent drug use
3. Ineffective Health Maintenance related to lack of knowledge of the effects of substance abuse on self and
fetus and inability to manage stress without the use of drugs
NURSING INTERVENTIONS
Therapeutic management vary on the type of drug used and the problems presented. Effective interventions
for substance abuse require the combined efforts of nurses, physicians, social workers, and numerous community
and federal agencies. Nurses must realize that progress is slow and frustrating. The major priority is to protect the
fetus and the expectant mother from the harmful effects of drugs. The nurse must explain the effects of drug abuse
and the risks for continuing drug-taking behaviors.
The “5A” approach to smoking cessation is often effective (Barron, Petrilli, Strath et al., 2007):
1. ASK the women at each visit if she smokes, if the amount of smoking has changed, and if she would
like to quit. Pregnancy is a time when women are motivated to make changes that will benefit their
health and that of the fetus.
2. ADVISE the woman about the importance of not smoking.
3. ASSESS the woman’s willingness to try to stop smoking. Discuss the motivational information if the
woman is not willing to quit at this time. Refer the woman to a smoking cessation program if she is
willing to try to stop smoking.
4. ASSIST the woman in making a plan to stop smoking and provide practical counseling on how to
solve the problems she may encounter-for example, avoiding others who smoke and being aware of
activities she associates with smoking may be helpful. Abstinence is essential to success.
5. ARRANGE follow-up visits or phone calls to discuss the woman’s progress and any problems that
may have occurred and to offer encouragement.
It is very much advisable to include the woman’s partner in all discussions regarding maternal and child health
especially during pregnancy. There are various therapeutic management for each substance abuse as each affect
the mother and fetal health, but these abused substances have common effects, management, and mitigation.
EVALUATION
Interventions can be considered to effectively meet the established outcomes if the mother and her family:
1. Discuss and practice self-care measures to promote safety and health of the mother and fetus,
2. Explain methods to help relieve common discomforts of pregnancy, and
3. Identify a plan early in pregnancy to modify habits or behaviors that could adversely affect health.
If interventions are ineffective, the nurse collaborates with the family to define new plans and work out additional
interventions.

Prepared by:
JERHOME T. BATOHINAY
MARIEL ANN BUENAVISTA

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