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Psychoactive Substance Disorders

By:
Bryan Mae H. Degorio, BSN, RN
SUBSTANCE ABUSE
- Misuse of substance with significance
and recurrent adverse consequences
related to the repeated use.
- refers to the continued use despite the
recurrence of the related problem
Substance or chemical dependence
- cluster of cognitive and behavioral and
physiologic symptoms indicating
continued use of the substance
despite of the significance
Characteristics of Substance Abuse
1. tolerance- increased amount of the
substance to obtained desired
effect
2. Withdrawal- behavioral, physiologic and
cognitive symptoms occuring when
blood or tissue concentration of
substance abruptly decline
3. Compulsive drug taking behavior
Intoxication- is use of substance that results
in maladaptive behavior
Detoxification- is the process of safe
withdrawal
Habituation- a psychological dependence on
the use of drug
Addiction- the physical dependence on a
substance
Concepts of Substance Abuse
1. The most common abuse substance is the
alcohol
2. About one in five nurses is a substance
abuser
3. Substance abuse is a family problem
4. Common personality traits are associated
with substance abuser
5. Polysubstance abuse involves concurrent
use of two or more substance
Etiology of Substance Abuse
1. Exact cause of substance abuse remains unclear
2. Biologic theories:
a. genetic factor
b. biochemical
3. Sociocultural Theory
a. hopelessness and defeat of living
condition
b. peer pressure
c. easy availability of the substance
d. social ambivalence about the use of
substance.
4. Family theory
- implicates dysfunctional family
pattern
5. Behavioral Pattern
- substance abuse is a response
to stressful stimuli because
substance provide temporary
relief of anxiety
6. Psychoanalytic theory
- maladaptation in the early stage
of development
Management:
1. Detoxification followed by residual or
outpatient program
2. Self-help 12 step program designed to help
members achieve and maintain sobriety
one day at a time
3. Psychotherapy on reality orientation
focusing on coping without the use of the
drug
4. Family therapy
- improves communication by
encouraging the family members to
define and maintain family
functioning
5. Alcoholic determinant therapy with
disulfiram
6. Methodone treatment as a substitute for
opioid
7. Family support such as self helping
organizations
COMMONLY ABUSE SUBSTANCES
Alcohol
- immediate effect due to action to the
brain manifested by slurring of speech,
incoordination and unsteady gait, impaired
attention and memory
- withdrawal symptoms:
Stage 1- minor withdrawal characterized by
sleeplessness, restlessness, agitation,
diaphoresis, tachycardia, hypertension
and tremorss
Stage 2- major withdrawal
- stage 1 + visual and auditory
hallucination
Stage 3- delerium tremens as anifested by
elevation of temperature,
disorientation + stage 1 and 2
manifestations
- Physiologic Effect of Chronic Alcohol
Smoking
1. Cardiac myopathy
2. wernicke’ encephalopathy
- thiamine deficiency
3. Korsakoff psychosis
- associated with thiamine and
vitamin b 12 deficiency
4. pancreatitis, hepatitis, cirrhosis and ascitis
5. Fetal alcohol syndrome
- occurs to infant born to an
alcoholic mother
- Treatment of Withdrawal
1. Anxiolytic- prevent withdrawal
manifestations
2. Anticonvulsant- can be use for seizure
prevention
3. Diet/Promotion of adequate nutrition
- vitamin supplementation
including multivitamins, vit.
B12, B, folic acid
CNS Depressant
CLASSIFICATIONS
A. Barbiturates, other sedatives, hypnotics
and anxiolytic
- it is a CNS depressant that have the
same effect like alcohol
- chronic use can lead to depression and
paranoia
- commonly abuses types:
a. Barbiturates- secobarbital,
pentobarbital
b. Sedative/hypnotics- methoquolone,
chloral hydrate
c. Anxiolytic- lorazipam, diazepam,
alprazolam, valium
- Withdrawal:
- occurs within 24-72 hours
after the last use
- manifested by nausea,
vomiting, seizure,
depression,
tachycardia and
orthostatic hypotension
- Treatment of Withdrawal
1. tapering of the anxiolytic
2. narcoleptic for psychotic manifestations
3. anticonvulsant to prevent and treat
seizure
B. Narcotics
- a CNS depressant that are use
medically to relieve moderate
and severe pain
- morphin, heroin and cocain-
derivatives of opium
- demerol and methadone- are
synthetic substitutes
- manifestations:
- euphoria, well being,
impaired attention, apparent
sedation, complete relaxation and
PINPOINT or constricted pupil
and scattered pigment of
hypodermic needle
- Withdrawal:
- occurs within few hours
after last dose of short acting
opiates
- begins 2-3 days after
the last dose of long acting
opioids
- manifested by:
a. Dilated pupil, tearing, runny
nose and restlessness
b. Heroin- coryza, tears, yawning,
sneezing, restlessness and
irritability
- Treatment for Withdrawal:
1. use of Methodone for the first 3-5 days
2. Clonidine hydrochloride to block the
withdrawal manifestations and
maybe given for 14 days
CNS Stimulant
A. Cocain- a CNS stimulant and causes
dopamine depletion
- can cause euphoria, anxiety,
anger, tachycardia and DILATION
OF PUPIL
- Common Drugs:
1. Cocaine powder- snorted or injected
2. Crack crystals- usually smoked
- Withdrawal:
- severe depression, fatigue,
hypersomnia and psychomotor
agitation
- Treatment:
1. anxiolytic to treat psychomotor agitation
2. antidepressant to counteract depression
3. Betacholinegic blockers to treat
hypertension and tachycardia
4. Dopamine receptor agonist or
dopaminergic
B. Amphetamines
- medically use to treat ADHD and
to loss weight or stay awake
- Physiologic Effect:
- raise of BP, increase of
energy level, euphoria, tachycardia,
nausea and vomiting and dilated
pupil
- withdrawal Manifestations:
-severe depression, vivid dreams,
insomnia, hypersomnia and
psychomotor agitation
- treatment:
1. anti depressant- to counteract
depression
2. neuroleptic- to treat paranoia and
psychosis
3. Anxiolytic- to treat psychomotor
agitation
Cannabinol/ marijuana
- the most common type of
cannabis composed of dried leaves,
stems and flowers of a plant cannabis
sativa that can be smoked of added to
food
- it alters sensory percepion due t
active ingredients
TETRAHYCANNABINOL ( THC )
- immediate affect:
- euphoria, sensation of
slowed time, impaired motor
coordination, conjunctivitis,
increased appetite, dry mouth
and tachycardia
- chronic use:
- decrease testosterone level
and chronic lung disease
- reverse tolerance
- common drugs:
a. Marijuana
b. Hashish
Nicotine
- is found in tobacco in 1-2 percent
concentration
- manifestations:
- reduce appetite
- Physiologic effect:
a. Respiratory- COPD,
b. Cardiovascular- ischemic heart
disease, CVA and peripheral
vascular disease
- Withdrawal:
- increase appetite along with
intense craving for tobacco that
may persist for 6 months or longer
- Treatment:
1. Nicotine Replacement Therapy
- use of nasal patch, nasal
spray or inhaler
- use of non- nicotine
prescription such as
BUPROPION ( zyban)
2. developing of support system
- relapse is highest during
the first few weeks and
diminishes considerably
Hallucinogen / LSD or Acids
- refer to the group of naturally
occurring and synthetic agent that produce
essentially the same altering mind effect
- manifestations:
1. similar to psychosis and
depersonalization
2. presence of mystical experience
3. intensified perception
- dangerous due to the following:
1. makes the individual believe that they
have supernatural power and more
than one person has been killed in an
attempt to fly
2. panic reaction occurring for the first user
and is referred to as BAD TRIP.
3. Flashback as manifested by
hallucination
STEROIDS
- are synthetic derivatives of
testosterone
- can cause androgenic and anabolic
effect
- Associated problem
1. cholestatis
2. hepatoadenoma
3. hepatocarcinoma
4. gynecomastia
- ttt- manifestation subside upon
withdrawal
Inhalant
- are inexpensive and easy to obtain
substances
- examples:
- gasoline, kerosene, isopropyl
alcohol, thinner, acetone, nitrous
oxide, fluorocarbons
- effects:
- euphoria, hallucination and
unsteady gait
- problem:
- COPD and acidosis
- treatment: O2 and resp support

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