ADDICTION

Terms

SUBSTANCE ABUSE SUBSTANCE DEPENDENCE ADDICTION

Polysubstance abuse

•Abuse of more than one substance

Drugs and alcohol can lead to legal

problems. Categories of drugs include:
1. Alcohol Intoxication is use of a substance that
2. Sedatives, hypnotics, and anxiolytics results in maladaptive behavior.
3. Stimulants
4. Cannabis Withdrawal syndrome refers to the
5. Opioids negative psychological and physical
6. Hallucinogens reactions that occur when use of a
7. Inhalants substance ceases or dramatically decreases.

Detoxification is the process of safely

withdrawing from a substance.
RELATED DISORDERS

• Gambling disorder is a non–

substance-related diagnosis.
• Caffeine and tobacco or nicotine
are substances that are addictive
• Addiction to the internet, noting
that some people spend more than
half of their waking hours on the
computer and become upset and
irritable if use is limited or
curtailed.
Biologic Factors
Genetic link
Neurochemical influences on substance use patterns have been
studied primarily in animal research.
The ingestion of mood-altering substances stimulates dopamine
pathways in the limbic system, which produces pleasant feelings or
a “high” that is a reinforcing, or positive, experience
Psychological Factors
family dynamics are thought to play a part. Children of alcoholics are
four times as likely to develop alcoholism compared with the general
population. Some theorists believe that inconsistency in the parent’s
behavior, poor role modeling, and lack of nurturing pave the way for the
child to adopt a similar style of maladaptive coping, stormy relationships,
and substance abuse.
Social and Environmental
Factors Cultural factors, social attitudes, peer behaviors, laws, cost, and availability all
influence initial and continued use of substances.
 TYPES OF SUBSTANCES AND TREATMENT
Overdose, or excessive alcohol
Alcohol Intoxication and Overdose intake
•Alcohol is a central nervous system •vomiting, unconsciousness, and
depressant that is absorbed rapidly in to the respiratory depression.
bloodstream. •can cause aspiration pneumonia
• Initially, the effects are relaxation and loss of or pulmonary obstruction.
inhibitions. •Alcohol-induced hypotension can
•With intoxication lead to cardiovascular shock and
• slurred speech, death.
• unsteady gait
• lack of coordination
• impaired attention, concentration, memory,
and judgment.
•Some people become aggressive or display
inappropriate sexual behavior when intoxicated.
•blackout
•Treatment of an alcohol overdose

•gastric lavage or dialysis to remove the

drug,

•support of respiratory and cardiovascular

functioning in an intensive care unit.

•The administration of central nervous

system stimulants is contraindicated
(Burchum & Rosenthal,2018).

• The physiological effects of repeated

intoxication and long-term use
Withdrawal and Detoxification •Alcohol Withdrawal can be life-
•symptoms of withdrawal usually begin 4 to 12 threatening, detoxification
hours after cessation or marked reduction of needs to be accomplished under
alcohol intake. medical supervision.

•Symptoms: •If the client’s withdrawal

• coarse hand tremors, sweating, elevated symptoms are mild and he or
pulse and blood pressure, insomnia, she can abstain from alcohol,
anxiety, and nausea or vomiting. he or she can be treated safely
at home.
•Severe or untreated withdrawal may
progress to transient hallucinations, seizures,
or delirium, called delirium tremens. •For more severe withdrawal or
for clients who cannot abstain
during detoxification, a short
• Alcohol withdrawal usually peaks on the admission of 3 to 5 days is the
second day and is over in about 5 days.
most common setting
•This can vary, however; and withdrawal may
take 1 to 2 weeks.
Safe withdrawal is usually accomplished with the
administration of benzodiazepines, such as lorazepam
(Ativan), chlordiazepoxide (Librium), or diazepam
(Valium), to suppress the withdrawal symptoms.

Treatment Settings and Programs

•Clients being treated for intoxication and

withdrawal or detoxification are encountered in a
wide variety of medical settings from emergency
departments to outpatient clinics.

•medical units in the hospital setting and then Alcoholics Anonymous (AA)
referred to an appropriate outpatient treatment •The self-help group developed
setting when they are medically stable the 12-step program model for
recovery
•Pharmacologic Treatment

•Pharmacologic treatment in substance abuse has two main

purposes:
• (1) to permit safe withdrawal from alcohol, sedative–hypnotics,
and benzodiazepines and
•(2) to prevent relapse.

•For clients whose primary substance is alcohol, vitamin B1

(thiamine) is often prescribed to prevent or to treat Wernicke–
Korsakoff syndrome, which are neurologic conditions that can
result from heavy alcohol use. Cyanocobalamin (vitamin B12)
and folic acid are often prescribed for clients with nutritional
deficiencies.
•Sedatives, Hypnotics, and Anxiolytics
• (Barbiturates, Nonbarbiturate hypnotics,
and Anxiolytics, particularly
benzodiazepines)
• This class of drugs includes all central
nervous system depressants

•Intoxication and Overdose

• Intoxication symptoms
• slurred speech, lack of coordination,
unsteady gait, labile mood, impaired
attention or memory, and even stupor
and coma.

•Treatment
• gastric lavage followed by ingestion of
activated charcoal and a saline cathartic;
• dialysis
Withdrawal and Detoxification

•Medications such as lorazepam, with actions that typically last about 10

hours, produce withdrawal symptoms in 6 to 8 hours; longer acting
medications, such as diazepam, may not produce withdrawal symptoms for 1
week.

•The withdrawal syndrome symptoms :

• autonomic hyperactivity (increased pulse, blood pressure, respirations, and
temperature), hand tremor, insomnia, anxiety, nausea, and psychomotor
agitation.
• Seizures and hallucinations occur only rarely in severe benzodiazepine
withdrawal (Tamburin et al., 2017).

•Detoxification from sedatives, hypnotics, and anxiolytics is often medically

managed by tapering the amount of the drug the client receives over a period of
days or weeks, depending on the drug and the amount the client had been using
Stimulants
•Stimulants are drugs that
stimulate or excite the
central nervous system and
have limited clinical use
and a high potential for
abuse.

• Amphetamines
• Cocaine
Intoxication and Overdose Overdoses of stimulants
•Intoxication from stimulants develops can result in seizures
and coma; deaths are
rapidly;
rare (Iannucci & Weiss,
• Intoxication effects include: the high 2017).
or euphoric feeling, hyperactivity,
hypervigilance, talkativeness, anxiety,
grandiosity, hallucinations, stereotypic Treatment with
or repetitive behavior, anger, fighting, chlorpromazine
and impaired judgment. (Thorazine), an
antipsychotic, controls
• Physiological effects include
hallucinations, lowers
tachycardia, elevated blood pressure, blood pressure, and
dilated pupils, perspiration or chills, relieves nausea
nausea, chest pain, confusion, and (Burchum &
cardiac dysrhythmias Rosenthal, 2018).
Withdrawal and Detoxification

•Withdrawal from stimulants occurs within

a few hours to several days after cessation of
the drug and is not life-threatening.

•Marked dysphoria is the primary symptom

and is accompanied by fatigue, vivid and
unpleasant dreams, insomnia or
hypersomnia, increased appetite, and
psychomotor retardation or agitation.

•Marked withdrawal symptoms are referred

to as “crashing”; the person may experience
depressive symptoms, including suicidal
ideation, for several days. Stimulant
withdrawal is not treated pharmacologically
Cannabis

•Cannabis sativa is the hemp plant that is

widely cultivated for its fiber used to make
rope and cloth and for oil from its seeds.
•It has become widely known for its
psychoactive resin.

•This resin contains more than 60

substances, called cannabinoids, of Marijuana refers to the upper leaves,
which δ-9-tetrahydrocannabinol is flowering tops, and stems of the plant;
thought to be responsible for most of the hashish is the dried resinous exudate from
the leaves of the female plant (Hall &
psychoactive effects.
Degenhardt, 2017).
Cannabis is often smoked in cigarettes
(joints), and it can also be eaten.
Intoxication and Overdose

•Cannabis begins to act less than 1 minute after

inhalation.

•Peak effects usually occur in 20 to 30 minutes

and last at least 2 to 3 hours.

•Users report a high feeling similar to that with

alcohol, lowered inhibitions, relaxation,
euphoria, and increased appetite.
Symptoms of intoxication:

•impaired motor coordination, inappropriate laughter,

impaired judgment and short-term memory, and
distortions of time and perception.
•Anxiety, dysphoria, and social withdrawal may occur
in some users.

Physiological effects:
• in addition to increased appetite, include
conjunctival injection (bloodshot eyes), dry mouth,
hypotension, and tachycardia.
•Excessive use of cannabis may produce delirium or
rarely, cannabis-induced psychotic disorder, both of
which are treated symptomatically.
•Overdoses of cannabis do not occur.
Withdrawal and Detoxification

Although some people have reported

withdrawal symptoms of muscle aches,
sweating, anxiety, and tremors, no
clinically significant withdrawal
syndrome is identified.
Opioids

•Opioids are popular drugs of abuse

because they desensitize the user to
both physiological and psychological
pain and induce a sense of euphoria
and well being.

•Opioid compounds: morphine,

meperidine (Demerol), codeine,
hydromorphone, oxycodone, methadone,
oxymorphone, hydrocodone, and
propoxyphene as well as illegal
substances such as heroin, illicitly
produced fentanyl, and normethadone.
Intoxication and Overdose

•Opioid intoxication develops soon after

the initial euphoric feeling;
•Symptoms: apathy, lethargy,
listlessness, impaired judgment,
psychomotor retardation or agitation,
constricted pupils, drowsiness, slurred
speech, and impaired attention and
memory.

•Severe intoxication or opioid overdose

can lead to coma, respiratory depression,
pupillary constriction, unconsciousness,
and death.
• Administration of naloxone (Narcan),
an opioid antagonist, is the treatment of
choice because it reverses all signs of
opioid toxicity.
Withdrawal and Detoxification Pharmacologic Treatment
Opioid withdrawal develops when drug intake
ceases or decreases markedly, or it can be •Methadone, a potent synthetic opiate,
precipitated by the administration of an opioid is used as a substitute for heroin in
antagonist. Initial symptoms are anxiety, some maintenance programs.
restlessness, aching back and legs, and cravings
for more opioids. •The client takes 1 daily dose of
methadone
Symptoms that develop as withdrawal progresses
include nausea, vomiting, dysphoria, lacrimation, •Levomethadyl is a narcotic analgesic
rhinorrhea, sweating, diarrhea, yawning, fever, with the only purpose of treating opiate
and insomnia. dependence.

Symptoms of opioid withdrawal cause •Buprenorphine/naloxone (Suboxone)

significant distress, but do not require is a combination drug used for opiate
pharmacologic intervention to support life or maintenance and to decrease opiate
bodily functions. cravings.
Hallucinogens

•Hallucinogens are substances

that distort the user’s perception
of reality and produce symptoms
similar to psychosis, including
hallucinations (usually visual) and
depersonalization.

•Hallucinogens also cause

increased pulse, blood pressure,
and temperature; dilated pupils;
and hyperreflexia
Treatment of toxic reactions Withdrawal and Detoxification
•No withdrawal syndrome has been
identified for hallucinogens.
Psychotic reactions are managed best by
isolation from external stimuli; physical
restraints may be necessary for the safety of •Hallucinogens can produce
the client and others. flashbacks, which are transient
recurrences of perceptual
disturbances like those
PCP toxicity can include seizures, experienced with hallucinogen use.
hypertension, hyperthermia, and
respiratory depression. These episodes occur even after all
traces of the hallucinogen are gone
Medications are used to control seizures and may persist for a few months
up to 5 years.
and blood pressure. Cooling devices such
as hyperthermia blankets are used, and
mechanical ventilation is used to support
respirations (Burchum & Rosenthal, 2018).
Inhalants

•Inhalants are a diverse group of drugs that include

anesthetics, nitrates, and organic solvents that
are inhaled for their effects.

•The most common substances in this category are

aliphatic and aromatic hydrocarbons found in
gasoline, glue, paint thinner, and spray paint.

•Inhalants can cause significant brain damage,

peripheral nervous system damage, and liver
disease
Intoxication and Overdose
Treatment
Inhalant intoxication involves dizziness, nystagmus, •supporting respiratory and cardiac
lack of coordination, slurred speech, unsteady gait, functioning until the substance is
tremor, muscle weakness, and blurred vision. removed from the body.
•no antidotes or specific medications to
Stupor and coma can occur. Significant behavioral treat inhalant toxicity.
symptoms are belligerence, aggression, apathy,
impaired judgment, and inability to function. Acute
toxicity causes anoxia, respiratory depression, vagal Withdrawal and Detoxification
stimulation, and dysrhythmias. •no withdrawal symptoms or
detoxification procedures for inhalants
Death may occur from bronchospasm, cardiac arrest, •People who abuse inhalants may
suffocation, or aspiration of the compound or vomitus suffer from persistent dementia or
(Howard, Bowen, & Garland, 2017). inhalant-induced disorders, such as
psychosis, anxiety, or mood disorders
even if the inhalant abuse ceases.
Data Analysis
Review Question:

• Select the appropriate interventions for caring for the client in alcohol
withdrawal.
A. Monitor vital signs
B. Provide stimulation in the environment
C. Maintain NPO status
D. Provide reality orientation as appropriate
E. Address hallucinations therapeutically
Review Question

• Johnette is reviewing her lessons in Pharmacology. She is aware that the

general classification of drugs belonging to the opioid category is analgesic
and:
A. depressant.
B. hallucinogenic.
C. stimulant.
D. tranquilizing.
Review Question

An adolescent client reports occasionally “sniffing airplane

glue.” When discussing the results of long-term use of
inhalants, which effects would the nurse include?
A.Tremors and CNS arousal
B.Enhanced normal heart rhythms
C.Enhanced attention on focus and memory
D.Brain damage and cognitive abnormalities
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