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    Substance Use Disorder

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    Rejitha John
    This document provides an overview of substance use disorder, including definitions of substance abuse and dependence. It discusses the DSM-IV criteria for diagnosing these disorders and lists common substances of abuse. Risk factors are outlined at the individual, family, and societal levels. Various treatment approaches are mentioned, including Alcoholics Anonymous, medications like disulfiram, counseling, and group therapy. Nursing assessments and potential nursing diagnoses for patients with substance use disorders are also summarized.

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    Substance Use Disorder

    Uploaded by

    Rejitha John
    786 views42 pages
    This document provides an overview of substance use disorder, including definitions of substance abuse and dependence. It discusses the DSM-IV criteria for diagnosing these disorders and lists common substances of abuse. Risk factors are outlined at the individual, family, and societal levels. Various treatment approaches are mentioned, including Alcoholics Anonymous, medications like disulfiram, counseling, and group therapy. Nursing assessments and potential nursing diagnoses for patients with substance use disorders are also summarized.

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    This document provides an overview of substance use disorder, including definitions of substance abuse and dependence. It discusses the DSM-IV criteria for diagnosing these disorders and lists common substances of abuse. Risk factors are outlined at the individual, family, and societal levels. Various treatment approaches are mentioned, including Alcoholics Anonymous, medications like disulfiram, counseling, and group therapy. Nursing assessments and potential nursing diagnoses for patients with substance use disorders are also summarized.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    786 views42 pages

    Substance Use Disorder

    Uploaded by

    Rejitha John
    This document provides an overview of substance use disorder, including definitions of substance abuse and dependence. It discusses the DSM-IV criteria for diagnosing these disorders and lists common substances of abuse. Risk factors are outlined at the individual, family, and societal levels. Various treatment approaches are mentioned, including Alcoholics Anonymous, medications like disulfiram, counseling, and group therapy. Nursing assessments and potential nursing diagnoses for patients with substance use disorders are also summarized.

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    © All Rights Reserved
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    of 42

    SUBSTANCE USE DISORDER

    Rejitha John J R
    1st year MSc Nursing

    INTRODUCTION

    Substance use disorders


    Dependence
    Abuse

    Substance induced disorders

    SUBSTANCE USE DISORDER


    Substance Abuse:

    Substance abuse is a maladaptive


    pattern of substance use leading to
    signicant adverse consequences
    manifested by psycho- social, medical, or
    legal problems or use in situations in which
    it is physically hazardous that must recur
    during a 12-month period

    DSM IV TR Criteria for Substance Abuse


    Recurrent substance use resulting in a failure to
    fulfil major role obligations at work, school, or
    home
    Recurrent substance use in situation in which it is
    physically hazardous
    Recurrent substance related legal problems
    Continued substance use despite having persistent
    or recurrent social or interpersonal problems
    caused or exacerbated by the effect of the
    substance

    Substance dependence
    Physical dependence

    Tolerance:
    Psychological dependence:

    DSM IV-TR Criteria for substance dependence

    1.Tolerance
    2.Withdrawal

    3.The substance is often taken in larger amounts


    or over a longer period than was intended.
    4. There is a persistent desire or unsuccessful
    effort to cut down or control substance use

    5. A great deal of time is spent in activities


    necessary to obtain the substance, use the substance,
    or recover from its effects
    6. Important social, occupational, or recreational
    activities are given up or reduced because of
    substance use
    7. The substance use is continued despite
    knowledge of having a persistent or recurrent
    physical or psychological problem that is likely to
    have been caused or exacerbated by the substance

    SUBSTANCE INDUCED DISORDER


    Substance Intoxication
    DSM IV Criteria for Substance Intoxication
    1. The development of a reversible substance-specic syndrome
    due to recent ingestion of (or exposure to) a substance.

    2. Clinically
    signicant
    maladaptive
    behavioural
    or
    psychological changes that are due to the effect of the
    substance on the central nervous system and develop during or
    shortly after use of the substance.
    3. The symptoms are not due to a general medical condition and
    are not better accounted for by another mental disorder.

    Substance Withdrawal
    DSM IV Criteria for Substance Withdrawal

    1. The development of a substance-specic syndrome due


    to the cessation of (or reduction in) substance use that
    has been heavy and prolonged.
    2. The substance-specic syndrome causes clinically
    signicant distress or impairment in social,
    occupational, or other important areas of functioning.

    3. The symptoms are not due to a general medical


    condition and are not better accounted for by another
    mental disorder.

    AETIOLOGY
    Biological factors
    Psychological factors
    Social factors
    Easy availability of drugs

    Biological factors
    Genetic vulnerability
    Biochemical factors

    Psychological factors

    General rebellious
    Sense of inferiority
    Poor impulse control
    Low self esteem
    Inability to cope with the pressures of living and society
    Loneliness, unmet needs
    Desire to escape from reality
    Desire to experiment, a sense of adventure
    Pleasure seeking
    Machoism
    Sexual immaturity

    Social factors
    Religious reasons
    Peer pressure
    Urbanisation
    Extended periods of education
    Unemployment
    Overcrowding
    Poor social support
    Effects of television and other mass media
    Occupation

    RISKFACTORS

    Related to the individual:


    o

    Possible genetic predisposition.

    Personality

    Poor coping skills

    Educational problems

    Early age of first use

    Strong personal motivations to use

    Traumatic experiences Low socioeconomic status

    Poor peer
    influences.

    or

    community

    support,adverse

    peer

    Related to the family:


    o

    Patterns of negative communication, low family


    cohesion
    Parental monitoring, discipline
    management techniques

    Poor family relationships

    Parental role modelling.

    or

    family

    Related to the community and society:


    o

    Traumatic environment

    Legislation and law enforcement policies

    Availability of drugs

    Acceptability of substance use

    THEORETICAL MODELS OF SUBSTANCE


    ABUSE
    Psychological Model
    Social Model
    Bio-psycho-social model

    CLASSES OF PSYCHOACTIVE SUBSTANCES

    1)

    Alcohol

    2)

    Amphetamines and related substances

    3)

    Caffeine

    4)

    Cannabis

    5)

    Cocaine

    6)

    Hallucinogens

    7)

    Inhalants (Volatile Solvents)

    8)

    Nicotine

    9)

    Opioids

    10)

    Phencyclidine and related substances

    11)

    Sedatives, hypnotics or anxiolytics

    ALCOHOLISM
    Alcoholism refers to the use of
    alcoholic beverages to the point of causing
    damage to the individual, society or both.

    EPIDEMIOLOGY
    incidence of alcohol dependence is 2 percent in
    india.
    20-40% of subjects aged above 15 years are
    current users of alcohol and nearly 10% of them
    are regular or excessive users.
    Nearly 15-30% of patients are developing alcohol
    related problems and seeking admission in
    psychiatry hospitals.

    PHASES OF ALCOHOLISM
    Phase I. The Prealcoholic Phase
    Phase II. The Early Alcoholic Phase
    Phase III. The Crucial Phase
    Phase IV. The Chronic Phase

    Alcohol abuse
    Comprises a maladaptive pattern of
    alcohol use leading to clinically significant
    impairment or distress that involves recurrent,
    significant, social or occupational problems
    caused by alcohol. (American Psychiatric
    Association [APA], 1994)

    Alcohol dependence

    Encompasses a cluster of cognitive,


    behavioural, and physiological symptoms
    indicating that the individual continues use of
    alcohol despite significant alcohol-related
    problems (APA, 1994)

    Signs and symptoms of alcohol


    dependence
    Minor complaints: malaise, dyspepsia, mood swings or depression,
    increased incidence of infections.

    Poor personal hygiene, untreated injuries.


    Unusually high tolerance for sedatives and opioids
    Nutritional deficiencies ( vitamins and minerals)
    Secretive behaviour (may attempt to hide disorder or alcohol
    supply)
    Consumption of alcohol containing products (mouth wash, after
    shave lotion, hair spray, lighter fluid)
    Denial of problems
    Tendency to blame others and rationalize problems

    ICD 10 criteria for alcohol dependence


    1. A strong desire to take the substance
    2. Difficulty in controlling substance taking behaviour.
    3. A physiological withdrawal state.

    4. Development of tolerance.
    5. Progressive neglect of alternative pleasure or interest.

    Persisting with substance use despite clear evidence of


    harmful substance

    EFFECTS ON THE BODY

    Peripheral Neuropathy
    Alcoholic Myopathy
    Wernicke's encephalopathy
    Korsakoff's psychosis
    Alcoholic Cardiomyopathy
    Esophagitis
    Gastritis
    Pancreatitis

    Alcoholic Hepatitis
    Cirrhosis of the Liver
    Leukopenia
    Thrombocytopenia
    Sexual Dysfunction
    Use During Pregnancy
    Foetal Alcohol Syndrome

    TREATMENT
    Alcoholics Anonymous
    -self-help organization
    -founded in 1935 by two alcoholics
    a stockbroker, Bill Wilson, and a
    physician, Dr. Bob Smith

    The Twelve Steps


    We admitted we were powerless over alcohol
    that our lives have become unmanageable.
    2. Came to believe that a Power greater than
    ourselves could restore us to sanity.
    3. Made a decision to turn our will and our lives
    over to the care of God as we understood Him.
    4. Made a searching and fearless moral inventory
    of ourselves.
    5. Admitted to God, to ourselves, and to another
    human being the exact nature of our wrongs.

    6. Were entirely ready to have God remove all these


    defects of character.
    7. Humbly asked Him to remove our shortcomings.
    8. Made a list of all persons we had harmed and became
    willing to make amends to them all.
    9. Made direct amends to such people wherever possible
    except when to do so would injure them or others.
    10. Continued to take personal inventory and when we
    were wrong promptly admitted it.
    11. Sought through prayer and meditation to improve our
    conscious contact with God as we understood Him, praying
    only for knowledge of His will for us and the power to carry
    that out.
    12. Having had a spiritual awakening as the result of these
    steps, we tried to carry this message to alcoholics and to
    practice these principles in all our affairs.

    (Antabuse)
    Disulfiram works by inhibiting the enzyme
    aldehyde dehydrogenase, thereby blocking
    the oxidation of alcohol at the stage when
    acetaldehyde is converted to acetate
    disulflram-alcohol reaction can occur within 5
    to 10 minutes of ingestion of alcohol

    Disulfiram should not be administered until it


    has been ascertained that the client has
    abstained from alcohol for at least 12 hours
    The client receiving disulfiram therapy should
    be aware of the great number of alcoholcontaining substances
    The client must be assessed carefully before
    beginning disulfiram therapy

    Other drugs

    Opioid Antagonists
    Serotonergic Medications
    Acamprosate
    Multivitamin therapy

    Counselling
    Group Therapy

    NURSING MANAGEMENT
    Nursing assessment

    The CAGE Questionnaire


    1. Have you ever felt you should Cut down on your drinking?
    2. Have people Annoyed you by criticizing your drinking?
    3. Have you ever felt bad or Guilty about your drinking?
    4. Have you ever had a drink first thing in the morning to steady
    your nerves or get rid of a hangover (Eye- opener)?

    Scoring: Two or three "yes" answers strongly suggests a problem


    with alcohol

    Nursing diagnosis
    Risk for injury related to assaultive behaviour and abusive
    behaviour
    Impaired thought process related to extreme suspicion.
    Ineffective denial related to weak, underdeveloped ego
    evidenced by statements indicating no problem with
    substance use.
    Ineffective coping related to inadequate coping skills and
    weak ego evidenced by use of substances as a coping
    mechanism; manipulative behaviour
    Imbalanced nutrition: less than body requirements related
    to use of substances instead of eating evidenced by loss of
    weight, pale conjunctiva and mucous membranes, poor
    skin turgor, electrolyte imbalance, anaemia.

    CONCLUSION

    Thank u

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