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By: Joseph Alvin C. Paulino, RN. MAN.

Faculty of Nursing Bulacan State University

SUBSTANCE ABUSE

Substance Abuse
Causes maladaptive behaviors secondary to mood-altering substances. Substance abuse is a widespread concern with broad social ramification and personal consequences.
May lead to addiction (dependency).
Substance Abuse by Joseph Alvin Paulino, RN. MAN 9/11/2013

Most commonly abused substances:


1. 2.

3.
4. 5.

6.

Alcohol Opiates Narcotics Hallucinogens Stimulants Inhalants

Alcohol abuse is considered as the leading

abused substance;
About 2/3 of American adults are somewhat

related to alcohol abuse.


Substance Abuse by Joseph Alvin Paulino, RN. MAN 9/11/2013

About 14% of the adult population meet the

criteria for an alcohol-related disorder.


About 6.2% of adults meet the criteria for a

substance-related disorder.
The actual prevalence of substance abuse is

difficult to determine precisely because many people will not seek treatment and data may not be accurate.

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Theoretical Perspective
1. Biological Theory
increase risk among monozygotic twins; relationship of dopamine stimulation in the limbic

system producing pleasant feelings.

2. Psychological Theory

to lift underlying depression or to reduce tension, frustration, and emotional pain; children of alcoholics are four times as likely to develop alcoholism.
Substance Abuse by Joseph Alvin Paulino, RN. MAN 9/11/2013

3. Socio-cultural Theory
Effect of the society or other people on substance

abuse such as adolescent peer pressure, laws, culture, social attitudes and availability.

4. Behavioral-Cognitive Theory
Associated with certain cues or changes in the

personality with the ingestion of the substances.

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DSM-IV Criteria for SubstanceRelated Disorders


a. Substance Dependence

A maladaptive pattern of substance use as manifested by 3 or more of the ff.:


1. 2. 3. 4. 5. 6. 7. Tolerance Withdrawal A need for more of the substance than what is intended Inability to stop using even when wanting to do so Great deal of time is spent in acquiring the substance Causes social, occupational, or recreational problems Continued use of the substance despite knowing the adverse effects.
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b. Substance Abuse
With clinically significant impairment or distress

as manifested by one or more of the ff.:


1. Failure to fulfill obligations at work, school, or home 2. Recurrent use in hazardous situation 3. Substance-related legal problems 4. Continued use despite problems

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c. Substance Intoxication
Development of group of symptoms due to recent

use of a substance;
Significant change in the behavior or personality

due to the effect of the substance to the CNS,


Not related to general medical condition and

other mental health disorders.

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d. Substance Withdrawal
Development of a group of clinical manifestations

due to sudden cessation or reduction in the intake of a substance;


Symptoms may cause clinically significant distress

or impairment,
Not related to general medical condition or

another mental health problem.

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Alcohol Abuse
Alcohol is a CNS depressant that is rapidly absorbed into the bloodstream.
Alcoholism is considered to be present when there is 0.1% or 10ml for every 1000ml of blood. Levels:
0.1-0.2% - slow coordination 0.2-0.3% - with tremors or irritability 0.3% and above unconciousness
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Effects of Alcohol Intake:


1. A ggressive 2. B lackouts 3. C oordination problem 4. D ifficulty in walking (unsteady gait) 5. E xperience slurred speech

6. F polyuria
7. G one are inhibitions 8. H anep makapagpa-relax

9. I mpaired attention, concentration, memory and

judgement
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An overdose or excessive alcohol intake in short period of time can result to (ABCD):
1. A ltered level of conciousness
2. B reathing is depressed and vomiting 3. C oma

4. D ecrease BP and D eath

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Physiologic Effects of Long-term Alcohol Abuse: 1. Cardiomyopathy 2. Hepatitis 3. Esophagitis 4. Cirrhosis of the liver 5. Wernicke-Korsakoffs Syndrome 6. Encepalopathy 7. Pancreatitis 8. Leukopenia 9. Ascites 10. Thrombocytopenia
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Wernicke-Korsakoffs Syndrome Characterized by amnesia, clouding of conciousness, confabulation (falsification of memory), memory loss, and peripheral neuropathy.

Results from poor nutrition of the alcoholic particularly inadequate amounts of Thiamine (B1) and also niacin, and neurotoxic nature of alcohol.

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Common behavioral problems of Alcoholics:

(5 Ds)
1.

2.
3. 4.

5.

Denial Dependency Demanding Destructive Domineering

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Treatment
Symptoms of withdrawal usually begin 4-12 hours after

cessation or marked reduction of alcohol intake;

Manifestations of alcohol withdrawal (SHE AND HID)


1. 2. 3. 4. 5. 6. 7. 8. 9.

Sweating and seizures Hand tremors Elevated pulse rate and BP Anxiety Nausea and vomiting Delirium (delirium tremens) Hallucinations Insomnia Delusions

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.
Alcohol withdrawal can be life-threatening, so detoxification needs to be accomplish under medical supervision.
Safe withdrawal is usually accomplished by

benzodiazipines (Lorazepam and Diazepam)

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Disulfiram (Antabuse)
Inhibits the breakdown of acetaldehydes by an

enzyme (aldehyde dehydrogenase)


the person who drinks alcohol while taking disulfiram

will become ill.


1. 2. 3. 4. 5. 6. 7. 8. 9. Sweating Flushing of the neck and face Tachycardia and palpitations Hypotension Throbbing headache Nausea and vomiting Dyspnea Tremors Weakness
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Disulfiram may also cause arrythmias, MI, cardiac failure, seizures, coma and dealth. The unpleasant effects to alcohol is intended to help reinforce stop alcohol drinking.
Once disulfiram is started, the patient must

not take alcohol because of the danger of these adverse effects.

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Fetal Alcohol Syndrome (FAS)


Is the result of alcohols inhibiting effects on fetal development during the first trimester of pregnancy;
Pregnant woman who drink alcohol run the risk of seriously harming their unborn child,

Characteristics:
Microcephaly Severe mental retardation
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SEDATIVES, HYPNOTICS, AND ANXIOLYTICS


These are CNS depressants
Intoxication symptoms: (SIC LULI)
1. Slurred speech and stupor 2. Impaired verbal communication 3. Coma

4. Lack of coordination
5. Unsteady gait 6. Labile mood

7. Impaired attention or memory


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Benzodiazipines when taken orally are rarely fatal

(lethargic and confused)


Barbiturates can be lethal when taken in overdose (2-10g

can be fatal)
1. 2. 3. 4.

Coma Respiratory arrest Cardiac failure Dealth

Treatment of intoxication and overdose


1.
2. 3.

Gastric lavage Ingestion of activated charcoal and saline Dialysis for severe symptoms

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Withdrawal symptoms:
Usually occurs 6-8 hours after cessation of some

benzodiazipines
Manifested by: 1. Autonomic hyperactivity (increase in BP TPR) 2. Hand tremors 3. Anxiety 4. Nausea 5. Insomnia 6. Psychomotor agitation

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Detoxification from sedatives, hypnotics, and anxiolytics often manage by tapering the amount of drugs the client recieves over a period of days or weeks
Tapering is important to prevent withdrawal symptoms, coma, and even death Barbiturates can cause fetal abnormalities because these can cross the placental barrier
Infants born to mothers who take barbiturates during the last

trimester of pregnancy can experience withdrawal symptoms postpartum


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STIMULANTS (Amphetamines and Cocaine)


Also known as uppers
These drugs excite the CNS The effects of these drugs, even though they are different, are the virtually same These drugs have limited clinical indications and a high potential for abuse
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Amphetamines are commonly used before to

lose weight
Cocaine have no clinical use and is highly

addictive
Commonly used as a recreational drug because of

intense and immediate feeling of euphoria

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Intoxication from stimulants develops rapidly


1. Super active 2. Talkative

3. Impaired judgement
4. Mabilis pumayat (weight loss) 5. Unhappiness or anger

6. Loss of appetite
7. Anxiety 8. The presence of hallucinations and illusions

9. Euphoria

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10. Physiologic effects: a. Tachycardia b. Elevated BP c. Dilated pupils d. Diaphoresis with chills e. Nausea f. Chest pain g. Confusion h. Cardiac arrythmias Cocaine users may also report bugs crawling beneath the skin (formication) and foul smells

Nasal septum perforation is associated with snorting cocaine and is due to extreme vasoconstriction which impedes blood supply to the nasal septum causing necrosis

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Cocaine or stimulant withdrawal:


Occurs within a few hours to several days after

cessation of the drug and most of the time is not life-threatening


Manifestations:
1. 2. 3. 4. 5. 6. 7. 8. Depressive symptoms Marked dysphoria feeling of unhappiness and anger Agitation Nightmares Increase appetite Psychosis Increase suicidal ideation Sleeping disturbances

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CANNABIS (MARIJUANA)

From Cannabis Sativa, a hemp plant for making ropes and cloth
Contain delta-9 tetrahydocannabinol the active substance

Marijuana upper leaves, flowering tops, and stems of the plant


Hashish is the dried resinous exudate from the leaves of the female plant

Cannabis most of the time is smoked in cigarettes but it can be eaten


Considered as one of the most widely used substance in the US

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Therapeutic use of cannabis:


Lowers IOP Relieves nausea and vomiting associated with cancer

chemotherapy (Dronabinol and Inabilone) Anorexia and weight loss of AIDS

Cannabis intoxications:
Begins to act less than 1 minute after inhalation Peak levels occur in 20-30 minutes and lasts at least 2-

3 hours

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Symptoms of Cannabis Intoxication


1. 2.

3.
4. 5.

6.
7.

Psychotic symptoms (hallucinations) Abnormal motor coordination Short-term memory loss Inappropriate laughter Social withdrawal Impaired judgement Disorientation, delirium and dysphoria

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Physiologic effects of cannabis


a. b. c.

d.
e.

Increased appetite Conjunctival suffusion (bloodshot eyes) Dry mouth Hypotension Tachycardia

Treatment is usually symptomatic and overdose does not occur Withdrawal symptoms are usually not present when sudden cessation is performed
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OPIOIDS
Are popular drugs because these desensitize the person

to both physiologic and psychological pain and induce a sense of euphoria and well-being.
Examples:
1. 2. 3. 4. 5. 6. 7.

Morphine * Opium* Meperidine (Demerol)* Codeine Hydrocodone Methadone Heroin *


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Opioid intoxication happen after the

initial euphoric feeling


1. Pinpoint pupils* 2. Apathy 3. Drowsiness 4. Uncoordinated movement 5. Lethargy and listlessness 6. Attention and memory impairment

7. Slurred speech

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Severe intoxication or drug overdose can lead to:


1. 2. 3. 4. 5.

Coma Respiratory depression Pupillary constriction Unconciousness Death

Naloxone is an opioid antagonist, is the treatment of choice;


It reverses all the signs of opioid toxicity by blocking the neuro-

receptors affected by opioids; Improves patients respiration and consciousness

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Withdrawal develops when (1) drug intake ceases or is (2) markedly decreased, or it can also be (3) precipitated by the administration of naloxone:
Craving for more opioids Restlessness and rhinorrhea Anxiety and aching backs and legs

Nausea and vomiting


Dysphoria and diarrhea Sweating Fever

Insomnia
Lacrimation

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Symptoms of opioid withdrawal cause significant stress but do not require pharmacologic intervention to support life or bodily functions
Short-acting drugs (heroin) produce withdrawal

symptoms in 6-24 hours; symptoms peak in 2-3 days; and gradually subsides in 5-7 days
Methadone is used to replace opioid during detoxification to reduce signs and symptoms of withdrawal
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Hallucinogens
Also referred to as psychotomimetics or pshychedelics
Are substances that distort the users perception of

reality and produce symptoms similar to psychosis


Can heighten awareness of reality or can cause a

terrifying psychosis-like reactions


May report distortions in body image and sense of

depersonalization
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Hallucinogens also cause increased pulse, blood

pressure, and temperature, dilated pupils and hyperreflexia


Two basic groups:

Natural
a. Mescaline peyote from cactus b. Psilocybin psilocin from mushrooms c. Cannabis

Synthetic
a. b. c. d. e. LSD lysergic acid diethylamide STP dimethoxy-4-methylamphetamine Pencyclidine (PCP) most potent DMT dimethyltryptamine MDA - methylenedioxyamphetamine

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Hallucinogen intoxication is marked by a

variety of maladaptive behavioral or psychological changes:


Hallucination Anxiety Paranoid ideation Depression and dangerous behavior Ideas of reference

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Physiologic symptoms of hallucinogens


1. 2. 3. 4. 5.

Sweating tachycardia Palpitations Blurred vision Tremors Lack of coordination

Pencyclydine (PCP) intoxication often involves:


1. 2. 3.

4.

Belligerence or violent behavior Aggression Unpredictable behavior Impulsivity

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Toxic reactions to hallucinogens (except

PCP) are primarily psychological and overdose usually will not occur
Treatment of toxic reactions is supportive Psychotic reactions are best managed by:
1. Isolation fro external stimuli 2. Using physical restraints if necessary for the clients

safety

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PCP toxicity include:


Seizures 2. Hypertension 3. Hyperthermia 4. Respiratory depression
1.

No withdrawal syndrome has been identified

for hallucinogens although some reported a craving for the drug.

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Inhalants
Are diverse groups of drugs that are

inhaled for their effects


1. Anesthetic 2. Nitrates 3. Organic solvents
1. 2. 3. 4. Gasoline Glue Paint thinner Spray paint

Inhalants can cause significant brain

damage, PNS damage and liver diseases


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Inhalants may cause acute toxicity:


1. Respiratory depression 2. Anoxia 3. Vagal stimulation 4. Arrythmias 5. Death (due to bronchospasm, cardiac arrest,

suffocation or aspiration)

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Treatment consist of supporting

respiratory and cardiac functions until the substance is removed from the body
There are no withdrawal or detoxification

procedures for inhalants


People who abuse inhalants may suffer

from persistent dementia, psychosis, anxiety or mood disorders


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PHARMACOLOGIC TREATMENT
1.

Diazepam (Valium) used to prevent alcohol withdrawal


Monitor VS and neurologic status May cause dizziness or drowsiness

2. Chlordiazepoxide (Librium) used for alcohol withdrawal


Monitor NVS

3. Disulfiram (Antabuse) maintain alcohol-free state


Tell the patient to read labels to avoid products with alcohol
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4. Methadone used to maintain abstinence from heroin and other opioids

Watch our for nausea and vomiting

5. Levomethadyl also maintains abstinence from opiates; opioid antagonist 6. Naltrexone blocks the effects of opiates and reduce alcohol craving

Teach client to avoid narcotics Take drug with food and milk

7. Clonidine is an alpha-2-adrenergic agonist used for hypertension

Used to suppress the effects of opiate withdrawal


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8. Bromocriptine is a dopamine agonist


Prescribes for patient with cocaine dependence to

decrease craving and maintain abstinence

9. Thiamine (B1) prevent or treat WernickeKorsakoffs syndrome of alcoholism 10. Folic Acid to correct folic acid deficiency 11. Cyanocobalamine (B12) also to correct Vitamin B12 deficiency
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EFFECTS OF SUBSTANCE ABUSE


1. Decrease number of social friends 2. Reduction of leisure activities 3. Erosion of spiritual values and moral 4. 5.

6.
7.

standards Abnormal physical functions Mounting family tensions and mental deterioration Sexual promiscuity Occupational problems
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NURSING INTERVENTIONS
1. Teach the client and the family the nature and

2.
3.

4.
5. 6. 7.

adverse reactions of substance abuse Teach the importance of avoiding substance during treatment Stay with the client Monitor for signs of substance withdrawal symptoms Provide adequate nutrition, quiet and substancefree environment Provide information about rehabilitation program Facilitate detoxification
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8. Provide support and stability to optimal level of functioning


9. Establish mutually agreed goals

10. Monitor the clients fluid and electrolyte status


11. Administer medications as prescribed 12. Teach the client about various support groups

Alcoholics Anonymous for alcohol abusers Al-Anon for families and children of alcoholics Center for Substance Abuse treatment

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