View
218
Download
0
Category
Preview:
Citation preview
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 1/149
SUBSTANCE-RELATED
DISORDERS
Ms. Jocelyn Alcera Nazario,RN MAN
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 2/149
Brain Mechanisms of Pleasure and Addiction.mp4
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 3/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
The limbic system operates by influencing the endocrine system
and the autonomic nervous system. It is highly interconnected
with the nucleus accumbens, the brain's pleasure center, which
plays a role in sexual arousal and the "high" derived fromcertain recreational drugs. These responses are heavily
modulated by dopaminergic projections from the limbic system.
(nucleus accumbens ventral tegmental area)
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 4/149
Substance ± Use Disorders
Substance Abuse The DSM-IV-TR (APA,2000)
identifies substance abuse as maladaptive pattern of
substance use manifested by recurrent and
significant adverse consequences related torepeated use of the substance. Referred to as any
use of substances that poses significant hazards to
health.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 5/149
DSM-IV Criteria for Substance Abuse
A. Maladaptive pattern of substance use, manifested by
one or more of the following occurring at anytime within
a 12 month period
1. Recurrent substance use resulting in failure to fulfillmajor obligations at work, school or home
2. Recurrent substance use in situations in which it is
physically hazardous
3. Recurrent substance ±related legal problems4. Continued substance use despite having persistent
social or interpersonal problems caused by the
substance
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 6/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 7/149
Dependence- The physiological state of neuroadaptation produced by
repeated administration of a
drug, necessitating continued
administration to prevent theappearance of withdrawalsymptoms
Reinforcement: tendency of a pleasure-
producing drug to lead torepeated self administration
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 8/149
Addiction: A behavioral pattern of drug abuse
characterized by overwhelming
involvement with the use of drug
(compulsive use),the securing of its
supply and a high tendency to relapse
after discontinuation.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 9/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 10/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 11/149
Tolerance: developed when after repeated
administration, a given dose of a drug produces adecreased effect, or conversely, larger doses mustbe administered to obtain the effects observed withthe original use
Cross-Tolerance : Is demonstrated when a persondependent on one substance requires higher dosesof another substance in the same general category;
for example an individual who develops tolerance toalcohol-a CNS depressant- will require a higher thannormal doses of another CNS depressant toachieve the desired effect.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 12/149
Substance Dependence
Tolerance and withdrawal are the essential criteriain establishing substance dependence.
1. Physical Dependence- evidenced by a cluster
of cognitive, behavioral and physiologicalsymptoms indicating that the individual
continues use of the substance despite
significant substance-related problem
( APA, 2000)
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 13/149
2. Psychological Dependence ± There is an
overwhelming desire to repeat the use of a
particular drug in order to produce pleasureor avoid pleasure or discomfort.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 14/149
Criteria for Substance Dependence
At least three of the following characteristics must be present for adiagnosis of substance dependence:
1. Tolerance
2. Withdrawal
3. Substance taken in larger amounts or longer periods4. Persistent desire or unsuccessful efforts to cut down substance
use
5. Much time spent in activities to obtain substance
6. Important social, occupational, recreational activities are given
up because of substance use
7. Substance use is continued despite knowledge of having
physical or psychological problem that is likely due to
substance use.6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 15/149
Substance Intoxication
The development of a reversible substance specific
syndrome caused by the recent ingestion of ( exposure to)
a substance ( APA,2000).
This category does not apply to nicotine
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 16/149
DSM-IV-TR Criteria for Substance Intoxication
1.The development of a reversible substance specific
syndrome caused by recent ingestion of a substance.
2. Clinically significant maladaptive behavior or
psychological changes that are due to the effect of thesubstance in the CNS and develop during or shortly after
use of the substance.
a. mood lability c. impaired social/occupational
b. impaired judgement functioning3.The symptoms are not due to a general medical condition
and are not better accounted for by another mental
disorder.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 17/149
Substance withdrawal ± is the developement of a
substance specific maladaptive behavioral change
with physiological and cognitive concomitants, that
that is due to the cessation of, or reductiion in, heavyand prolonged substance use ( APA,2000).
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 18/149
DSM-IV-TR Criteria for Substance Withdrawal
1. The development of substance-specific syndrome
caused by the cessation of ( or reduction in) heavy and
prolonged substance use.
2. The substance-specific syndrome causes clinicallysignificant 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.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 19/149
CLASSES OF PSYCHOACTIVE SUBSTANCES
1. Alcohol2. Amphetamines and related substances
3. Caffeine
4. Cannabis
5. Cocaine
6. Hallucinogens
7. Inhalants
8. Nicotine
9. Opoids
10.Phencyclidine (PCP)
11.Sedatives, Hypnotics or Anxiolytics
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 20/149
Predisposing Factors:
A. Biological ±
1. Genetics:
An apparent hereditary factor is involved in the
development of substance-use disorders. This isespecially evident in alcoholism, but less so with other
substances.
2. Biochemical:
There is the possibility that alcohol may producemorphine like substances in the brain that are
responsible for alcohol addiction.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 21/149
B. Psychological ±1. Developmental Influences:
Focuses on the superego and fixation at the oral stage
of psychosexual development ( Saddock & Saddock,
2003).
2. Personality Factors:Low self-esteem, frequent depression, passivity, the
inability to relax or defer gratification and inability to
communicate effectively.
Associated with antisocial personality and depressive
response styles.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 22/149
C. Sociocultural-
1. Social Learning : The effects of modeling,imitationand identification on behavior can be observed from
early childhood onward.
2. Conditioning: Effect of substance itself.
3. Cultural and Ethnic Influences: Factors within an
individual¶s culture help to establish patterns of
substance use by molding attitudes, influencing
patterns of consumption based on cultural acceptanceand determining the availability of the substance.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 23/149
ADDICTION CYCLE
Consists of a 6-stage sequence thatconceptualize longitudinally the interaction of thebiopsychosocial factors
I. Factors operating at the Pre-Initiation: conductdisorder, anti-social behavior, family history of
disharmony and substance abuse, deprivedsocial environment
II. Initiation is stimulated by: availability,experimentation, peer group pressure, self-medication of physical and emotional pain
III. Continuation is promoted by: on-going stressesand recurrent pattern of reinforcement leading toacquisition of the drug habit
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 24/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
IV. Escalation is mediated by: crises related tosubstance use and by inadequate coping that leads
to dependence
V. Cessation is transient and related to: periods of
relief from pain and factors that reinforce the habit
VI. Relapse is precipitated by: a combination of intercurrent stresses and inadequate coping
mechanisms
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 25/149
Video : When a Man loves a Woman
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 26/149
THE DYNAMICS OF SUBSTANCE-RELATED
DISORDERS
Alcohol Abuse and Dependence:1. Profile
Ethyl alcohol
Classified as food because it contains calories
has no nutritional value
Alcohol exerts a depressant effect on the CNSresulting in behavioral and mood changes.
Most States consider legally intoxicated with a blood
level of 0.08 to 0.10
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 27/149
Patterns of Use/Abuse
Jellinek outlined four phases of alcoholic pattern of drinkingprogresses:
Phase I. The Prealcoholic Phase. Characterized by use of
alcohol to relieve the everyday stress and tensions of
life.Phase II. The Early Alcoholic Phase. Begins with
blackouts- brief periods of amnesia that occurs during or
immediately following a period of drinking.
Phase III.The Crucial Phase. The individual has lost
control and physiological dependence is evident.
Phase IV. The Chronic Phase. Characterized by
emotional and physical disintegration.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 28/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Rapidity of Alcohol absorption is influenced by:
a. Absorption is delayed when the drink is sipped
rather than gulp
b. When stomach contains food rather than
empty
c. When drink is wine or beer rather than distilled
beverages
Low doses:a. Produces relaxation
b. Loss of inhibitions
c. Lack of concentration
d. Drowsiness
e. Slurred speechf. Sleep
Chronic Abuse: Results in multisystem physiological
impairment
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 29/149
EFFECTS ON THE BODY
1. Peripheral Neuropathy.peripheral nerve damage,
results in pain,burning, tingling or prickly sensations of
the extremities.
2. Alcoholic Myopathy.In acute condition, muscle pain,swelling and weakness. In Chronic, gradual wasting and
weakness in skeletal muscles.
3. Wernicke¶s Encephalopathy. Most common form of
thiamine deficiency in alcoholics. Symptoms: paralysis
of ocular muscles.diplopia, ataxia,somnolence andstupor.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 30/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 31/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
9. Alcoholic Hepatitis- Caused by long term alcohol use.
Clinical Manifestations:
a. Enlarged and tender liver b. N/V
c. Lethargy
d. Anorexia
e. Elevated WBC
f. Fever
g. Jaundice
h. Ascites
i. Weight loss
j. Hepatic encephalopathy
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 32/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
10. Cirrhosis of the Liver- end stage of alcoholic liver
disease and results from long ±term chronic alcohol
abuse.Clinical Manifestations:
a. N/V
b. Anorexia
c. Weight loss
d. Abdominal paine. Jaundice
f. Edema
g. Anemia
Portal hypertension
Ascites
Esophageal Varices
Hepatic Encephalopathy
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 33/149
11. Sexual Dysfunction. Alcohol interferes with the normal
production and maintenance of female and male hormones.
Alcohol intoxication:
a. mood lability
b. Impaired Judgementc. impaired social or occupational functioning
d. Slurred Speech
e. Incoordination
f. unsteady gait
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 34/149
Alcohol Withdrawal
4 to 12 hours of cessation or reduction in heavy and
prolonged alcohol use.
Symptoms:
1. coarse tremor of hands,tongue or eyelids2. Nausea or vomiting
3. Malaise or weakness
4. Tachycardia
5. Sweating6. Elevated BP
7. Anxiety
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 35/149
8. Depressed mood or irritability9. Transient hallucinations or illusions
10. Headache
11. Insomnia.
Alcohol Withdrawal Delirium- Onset: 2nd or 3rd day following
cessation of or reduction in prolonged ,heavy alcohol use.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 36/149
Sedative,Hypnotic, or Anxiolytic
Abuse and Dependence
1. Profile of the substance:
The sedative ±hypnotic compounds are drugs of diverse
chemical structures that are all capable of inducing
varying degrees of CNS Depression, from tranqulizingrelief of anxiety to anesthesia, coma and even death.
a. Barbiturates
b. Nonbarbiturates hypnotics
c. Antianxiety agents Taken orally
³downers´
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 37/149
Categories Generic Names Street Names
Barbiturates
Nonbarbiturate
Antianxiety
Pentobarbital ( Nembutal)
Secobarbital ( Seconal) Amobarbital ( Amytal)
Secobarbital/Amobarbital
Phenobarbital
Butabarbital
Chloral Hydrate ( Noctec)
Triazolam (Halcion)Flurazepam (Dalmane)
Temazepam (Restoril)
Quazepam (Doral)
Diazepam ( Valium)
Chlordiazepoxidde (librium)
Meprobanate ( Miltown)Oxazepam ( Serax)
Alprazolam ( Xanax)
Lorazepam(Ativan)
Chlorazepate( Tranxene)
Yellow Jackets, yellow birds
GBs, red birds, red devilsBlue birds,blue angels
Tooies,Jelly beans
Peter, Mickey
SleepersSleepers
Sleepers
Sleepers
Vs(color, designates strength)
Green and Whites; roaches
Dolls ; dolliesCandy,downers ( the benzodia-
zepine)
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 38/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 39/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 40/149
CNS Depressants
1. Effects are additive with one another and with the
behavioural state of the user.
2. CNS depressants are capable of producing
physiological dependency.3. CNS depressants are capable of producing
psychological dependence.
4. Cross-Tolerance and Cross-dependence may exist
between various CNS depressants.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 41/149
Patterns of Use/Abuse
1. An individual whose physician originally prescribed the
CNS depressant as treatment for antianxiety or
insomnia.
2. Involves young people in their teens or early 20s who in
the company of their peers use substances that were
obtained illegally.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 42/149
Effects on the Body
1. Effects on sleep and dreaminga. Decreased amount of sleep time spent in dreaming
b. During drug withdrawal-dreaming becomes vivid and
excessive
c. Withdrawal from long term use-rebound insomniaand increases dreaming
2. Respiratory depression
a. Inhibiting reticular activating system
3. Cardiovascular Effectsa. Hypotension
b. Decreased cardiac output
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 43/149
4. Renal Function
a. Suppress urine function5. Hepatic Effects
a. Jaundice
6. Body Temperature
a. Decrease body temperature
7. Sexual Functioninga. Increase libido
b. Decrease in the ability to maintain erection
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 44/149
Sedative,Hypnotic, or Anxiolytic Intoxication
The presence of clinically significant maladaptive
behavioral or psychological changes that develop during
or shortly after, use of one of these substances.
a. Inapropriate sexual or aggressive behavior
b. Mood lability h. Impairment in
c. impaired judgement attention or memory
d. slurred speech i. Stupor or coma
e. Incoordinationf. Unsteady gait
g. nystagmus
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 45/149
Sedative, Hypnotic or Anxiolytic Withdrawal
Produces a characteristic syndrome of symptoms that
develops after a marked decrease in or cessation of
intake after several weeks or more of regular use.
1. Short- acting Anxiolytic ( lorazepam or oxazepam)
symptoms within 6 to 8 hrs.
2. Substances with longer half-lives ( Diazepam)
may not develop for more than a week
peak in intensity on 2nd
week decreased markedly on 3rd and 4th
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 46/149
3. Sedatives, Hypnotics or Anxiolytics
Hyperactivity ( sweating or pulse greater than 100)Increased hand tremor
Insomnia
Nausea or Vomiting
Hallucinations
IllusionsPsychomotor agitation
Anxiety
Grand mal seizures
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 47/149
CNS Stimulant Abuse and Dependence
Profile of the Substance
The CNS stimulants are identified by the behavioral
stimulation and psychomotor agitation that they induce.
The two most prevalent and widely used stimulants arecaffeine and nicotine.
Caffeine: tea
coffee
colaschocolate
Nicotine: Tobacco
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 48/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 49/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 50/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 51/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 52/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
The most common method of use includes:
Oral ingestionSmoking
Injection
Taken orally, inhaled or ingested
³uppers or speed´
Amount of CNS stimulation depends on both the area
in the brain or spinal cord that is affected by the drug
and cellular mechanism fundamental to the increasedexcitability
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 53/149
GRPS. CLASSIFIED ACCORDING TO
SIMILARITIES IN MECHANISMS OF ACTION
Psychomotor stimulants ± Induce stimulation by
augmentation or potentiation of the neurotransmitters
norephinephrine,epinephrine or dopamine
General Cellular Stimulants ± ( caffeine and Nicotine)
exerts their actions directly on cellular activity
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 54/149
Patterns of Use/Abuse
1. Began using the substance for the appetite-suppressant
effects.
2. Chronic users tend to rely on CNS stimulants to feelmore powerful, more confident and decisive. They take
³uppers´ in the morning and ³downers´ at night.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 55/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 56/149
Effects on the Body
1. CNS effects:
a. Tremor
b. Restlessness
c. Anorexiad. Insomnia
e. Agitation
f. Increased motor activity
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 57/149
Amphetamines, nonamphetamines stimulants and cocaine:
a.Alertness
b.Decreased in fatigue
c.Elation
d.Euphoria
e.Greater mental agility
f.Muscular power
Chronic Use:
a.Paranoia
b.Hallucinations
c.Aggressive behaviors
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 58/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Fetal exposure to cocaine during the 1st
trimester = neurological damage leading to
learning and behavior problems.
After birth :
a. Abnormal sleep patterns
b. Tremorsc. Occasional seizures
d. Irritability
e. Feeding difficulties
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 59/149
2. Cardiovascular/Pulmonary Effects:
a. Amphetamines ± increased systolic and diastolic BP
- increased heart rate and cardiac
arrythmias
b. Cocaine ± rise in myocardial demand for oxygen
- increase in heart rate
- Myocardial Infarction
- Ventricular Fibrillation- Sudden death
- ( inhaled) pulmonary hemorrhage,chronic
broncholitis and pneumonia
- ( Cocaine snorting) Nasal rhinitis
c. Caffeine ± increased heart rate
- palpitations
- extrasystoles
- cardiac arrythmias
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 60/149
d. Nicotine ± stimulates sympathetic Nervous system
- increase heart rate,BP & cardiac
contractility
- Lung cancer
- Emphysema
3. Gastrointestinal and Renal Effects:
- ( Amphetamines) constipation
- difficult in urination- ( Caffeine) diuretic effects
- (nicotine) reducing excretion of urine
4. Sexual Functioning:
- promote coital urge in both men & women
- (women) feel sexier & more orgasm
- ( Men) sexual dysfunction
- Some aphrodisiac effects
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
CNS Stimulants
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 61/149
Categories Generic Names Common StreetNames
Amphetamines
Noramphetamine
Stimulants
Cocaine
Caffeine
Nicotine
Dextroamphetamines ( Dexedrine)
Methamphetamine (Desoxyn)
3,4-Methylenedioxyamphetamine
(MDMA) Amphetamine +dextroamphetamine
(Adderall)
Phendimetrazine ( Prelu-2)
Benzphetamine ( Didex)
Diethylpropion (Tenuate)
Phentermine ( Adipex-P)
Sibutramine ( Meridin)
Methylprenidate ( Ritalin)
Cocaine Hydrochloride
Coffee, Tea, colas, chocolate
Cigarettes,cigars,pipe,snuff,
Dexies, uppers,truck
drivers
Meth, speed,crystal,ice
Adam,Ecstacy,Eve,XTC
Diet pills
Speed, uppers
Coke,blow,crack,flake
Java,mud,brew,cocoa
Weeds,fags,butts,chaw,
CNS Stimulants
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 62/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 63/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 64/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 65/149
CNS Stimulant Intoxication
Produces maladaptive behavioral and psychological
changes that develop during, or shortly after, use of
these drugs.
Amphetamines and Cocaine intoxication produces:
a. Euphoria or affective blunting
b. Changes in sociability
c. Hypervigilance
d. Interpersonal sensitivitye. Anxiety,tension or anger
f. Stereotyped behaviors
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 66/149
Physical Effects include:
a. Tachycardia or bradycardiab. Pupillary dilation
c. Elevated or lowered blood pressure
d. Perspiration or chills
e. N/V
f. Wt. Lossg. Psychomotor agitation or retardation
h. Muscular weakness
i. Respiratory depression
j. Chest pain
k. Cardiac arrhythmias
l. Confusions, seizures
m. Dystonias or coma
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 67/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 68/149
CNS Stimulant Withdrawal
Presence of characteristic withdrawal syndrome that
develops within a few hours to several days after
cessation of, or reduction in, heavy and prolonged use
( APA,2000).
Withdrawal from Amphetamines and Cocaine:
a. Dysphoria e. Increased appetite
b. Fatigue f. Psychomotor retardationc. Vivid unpleasant dreams or agitation
d. Insomnia or hypersomnia
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 69/149
CAFFEINE WITHDRAWAL
An intake of 500 to 600mg/day ( 4 cups of coffee)
Headache
Fatigue
Anxiety
Irritability
Depression
Impaired psychomotor performance
N/V
Craving for caffeine
Muscle pain and Stiffness
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 70/149
NICOTINE WITHDRAWAL
Dysphoric or depressed mood
Insomnia
Irritability
Frustration or Anger
Anxiety
Difficulty concentrating
Restlessness Decreased heart rate
Increased appetite or weight gain
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 71/149
Inhalant Abuse and Dependence
Profile of the substance: Are induced by inhaling the aliphatic and aromatic
Hydrocarbons found in substances such as fuels,
solvents, adhesives,aerosol propellants and paint
thinners.
e.g.
Gasoline cleaning fluid
Varnish remover spray paint
Lighter fluid shoe conditioner
Airplane glue typewriter correction fluidRubber cement
They are particularly dangerous
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 72/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 73/149
Patterns of Use/Abuse
Inhalant substances are readily available,legal andinexpensive.
Use may begin by ages 9 to 12 and peak in adolescentyears; less common after age 35.
Highest use was seen in the ages 12 to 25 year old grp. Methods of use include ;
a. ³huffing´
b. ³bagging´
Sadock & Sadock ( 2003) reports;a.use among adolescent may be most common in those
whose parents or older siblings use illegal substances.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 74/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 75/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
b. Associated with an increased likelihood of conduct
disorder or antisocial personality disorder.
Tolerance has reported with heavy use Children with inhalant disorder may use inhalants several times
a week.
Adults with inhalant dependence may use the substance at
varying times during each day.
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 76/149
Effects on the Body
1. CNS:
a. Central & Peripheral nervous system damage
b. Generalized weakness and peripheral neuropathies
c. Cerebral atrophyd. Cerebellar degeneration
2. Respiratory:
a.Upper or lower airway irritation e. Cyanosis from
b.pulmonary hypertension pneumonitis or c.acute respiratory distress asphyxia
d.dyspnea/rales or rhonchi
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 77/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
3. Gastrointestinal:
a. Abdominal pain , nausea and vomitingb. Rash around nose and mouth
c. Unusual breath odors
4. Renal system:
a. Chronic renal failure
b. Hepatorenal syndromec. Proximal renal tubular acidosis
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 78/149
INHALANT INTOXICATION
The DSM-IV-TR : Clinically significant maladpative
behavioral or psychological changes-
a. Belligerence d. Impaired judgement
b. Assaultiveness e. Impaired social or
c. Apathy occupational functioning
Two or more of the following signs are present:
a. Dizziness e. Unsteady gait
b. Nystagmus f. Lethargyc.Incoordination g. Depressed reflexes
d. Slurred speech h. Psychomotor retardation
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 79/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
i. Tremor
j. Generalized muscle weaknessk. Blurred vision/diplopia
l. Stupor or coma
m. Euphoria
Although withdrawal syndrome has not been
established: symptoms has been documented 24 to
48 hrs. After last dose
a. Sleep disturbances e. N/Vb. Tremor f.fleeting illusions
c. Irritabilityd. diaphoresis
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 80/149
Opioids Abuse and Dependence
A Profile of the Substance:
a. ³Opioids´ refers to a group of compounds that includes
opium,opium derivatives and synthetic substitutes.
b. Exerts both sedative and analgesic effectc. Major medical uses- relief of pain, treatment of
diarrhea and relief of coughing.
d. Have addictive qualities
e. Methods of administration include oral or smoking and by subcutaneous,intramuscular and
intravenous injection
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 81/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Sensitize an individual both psychological and
physiological pain induces a sense of euphoria
Lethargy and indifference to environment
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 82/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 83/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Categories Generic Names Common Street Names
Synthetic opiate-
Like drugs
Meperidine ( Demerol)
Methadone ( Dolophine)
Propoxyphene ( Darvon)Pentazocine (Talwin)
Fentanyl (Actiq;Duragesic)
Doctors
Dollies,done
Pinks and graysTs
Apache,China girl,China town,
Dance fever, goodfella,jackpot
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 84/149
Patterns of Use /Abuse
Individuals who had obtained the drug by prescription
Individuals increases the amount and frequency of use
Individuals who uses for recreational purposes and
obtain them from illegal sources
May be used alone to induce euphoric effects or in
combination with stimulants
Babies born to heroin ± dependent women are also
heroin ± dependent and need to go through withdrawal.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 85/149
Effects on the Body
1. CNS
a. Euphoria f.pupillary constriction
b. Mood changes g. Nausea and vomiting
c. Mental clouding h. Respiratory depressiond. Drowsiness
e. Pain reduction
2.Gastrointestinal
a. Constipationb. Fecal impaction
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 86/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
3. Cardiovascular-
a. Induce hypotension
4. Sexual Functioninga. Decreased sexual function
b.diminished libido
c. Retarded ejaculation
d.impotencee.orgasm failure
Watery eyes
Runny nose
Constricted pupils
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 87/149
Opioid Intoxication
Constitutes clinically significant maladaptive behavioral
or psychological changes that develop during or shortly
after opioid use.
Symptoms:
a. Euphoria d. Psychomotor agitation
b. Apathy or retardation
c. Dysphoria e. Impaired judgement
Physical symptoms:
a. Pupillary constriction c.slurred speech
b. Drowsiness d.impairement in attention
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 88/149
Opioid Withdrawal
Produces a syndrome of symptoms that develops after
cessation of, or reduction in, heavy and prolonged use of
an opiate.
Symptoms:
a. Dysphoric mood g. sweating
b. Nausea/vomiting h. Abdominal cramping
c.Muscles aches i. sweating
d. Lacrimation or rhinorrhea j.diarrhea
e. Pupillary dilation k.yawning
f. Piloerection l.fever & insomnia
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 89/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Heroin ( short- acting drugs), withdrawal symptoms occur
Within 6 to 12 hrs. after the last dose,peak within 1 to 3 days
and gradually subsides over a period of 5 to 7 days.
Methadone ( long- acting drugs), withdrawal symptoms
begins within 1 to 3 days after the last dose and are
complete in 10 to 14 days.
Meperidine ( ultra-short acting drugs), withdrawal begins
quickly, reaches a peak in 8 to 12 hrs. and is complete in 4
to 5 days.
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 90/149
HALLUCINOGENS ABUSE AND DEPENDENCE
Profile of the Substance
Hallucinogens are capable of distorting an individual¶sperception of reality.
Ability to alter sensory perception and induce visual
hallucinations. Referred to as ³ mind expanding´.
Perceptual distortions- spiritual, sense of depersonalization ( observing oneself having theexperience) or as being at peace with self and universe.
³bad trips´
Report feelings of panic and fear of dying or goinginsane.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 91/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
A common danger is that of ³ flashbacks´ can occur after
months after the drug was taken.
Recurrent use induces psychological dependence which
Varies according to the drug, dose and individual user.
Hallucinogenic substances have structural similarities. Someproduced synthetically and others are natural products of
Plants and fungi.
Taken orally, inhaled
HALLUCINOGENS
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 92/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
HALLUCINOGENSCATEGORIES GENERIC NAMES STREET NAMES
Naturally occuring
Hallucinogens
Synthetic compounds
Mescaline( peyote cactus)
Psilocybin and psilocin (psilo-
cybe mushroon)
Ololiuqui ( morning glory
seeds)
Lysergic acid diethylamide(LSD)-from fungal sub. Found
on rye
Dimethyltryptamine (DMT)
and Diethyltryptamine (DET)
2,5- Dimethoxy-4-
methylamphetamine(STP,DOM)
Phencyclidine (PCP)
3,4-Methylene-
dioxyamphetamine (MDMA)
Methoxy-amphetamine
Cactus,mesc,mescal,half
Moon,big chief,badseed,peyote
Magic mushroom,Gods
flesh,shrooms
Heavenly blue,pearly gates
Acid,cube,big D, californiasunshine,microdots,blue
dots,sugar,orange wedges
Businessmans trip
STP
(serenity,tranquility,peace)
Angel dust,hog,peace pill
XTC, ecstacy,Adam,Eve
Love drug
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 93/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
MAGIC MUSHROOM
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 94/149
PATTERNS OF USE/ABUSE
Use is episodic
cognitive and perceptual abilities are
markedly affected by these substances, the user setsaside normal daily activities for indulging inconsequences.
Tolerance develop quickly and to high degree. LSD used repeatedly for a period of 3 to 4 days may
develop tolerance to the drug.
Recovery from tolerance occurs rapidly in 4 to 7 days.
PCP is taken episodically in binges that lasts for severaldays.
Chronic users take them daily
Psychological dependence in PCP is characterized by
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Craving for the drug
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 95/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
g g
a.Tolerance develops quickly for frequent users.
Psilocybin is an ingredient of Psilocybe mushroom
indigenous in the US and Mexico. Ingestion produces an
effect similar to that of LSD but of short duration.
Mescaline is used legally for religious purposes by
members of the Native American Church of the US.a. Tolerance can develop quickly for frequent users
Derivatives of Amphetamines such as 2,5-dimethoxy-4
methylamphetamine are among the most potenthalllucinogens.
a. Lower doses- produces ³high´ assoc. With CNS
stimulants.
b. Higher doses- hallucinogenic effects occurs.
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 96/149
EFFECTS ON THE BODY
Physiological Effects-a. Nausea and Vomiting f. Trembling
b.Chills g. Loss of appetite
c.Pupil dilation h. Insomnia
d. Increased pulse,BP & Temp. i. sweatinge. Mild dizziness j. A slow respiration
k. Elevation of blood
Conjunctival injection sugar
( bloodshot eyes)
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 97/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Psychological Effects-
a. Heightened response j. Serenity,
to color,texture & sounds peace
b. Heightened body awareness k. Depersona-
c. Distortion of vision lization
d. Sense of slowing time l.derealization
e. All feelings magnified: m.increaseslove,lust,hate,joy,anger,pain libido
terror,despair n. laughing
f. Fear of losing control giggling
g.paranoia, panic blank stares
h.euphoria,blissi. Projection of self into dreamlike
images
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 98/149
Hallucinogen Intoxication
Symptoms develop during, or shortly after hallucinogen
use ( within minutes or a few hours)
Maladaptive behavioral or psychological changes
include;
1. marked anxiety or depression
2. ideas of reference
3. fear of losing one¶s mind
4. paranoid ideation
5. impaired judgement
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 99/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Perceptual changes occurs in a state of wakefulness and
alertness;
1. intensification of perceptions
2. depersonalization
3. derealization
4. illusions
5. hallucinations6. synesthesia
Physical symptoms ;
1. pupillary dilation 5. blurring of vision
2. tachycardia 6. tremors
3. sweating 7. incoordination
4. palpitations
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 100/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 101/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
6. muscle rigidity
7. seizures or coma
8. hyperacusis
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 102/149
CANNABIS ABUSE AND DEPENDENCE
Profile of the substance
1.Cannabis is only second to alcohol
2. Major psychoactive ingredient is delta-9-
tetrahydrocannabinal (T
HC)3. Occurs naturally in the plant Cannabis sativa
4. Marijuana, the most prevalent type of cannabis preparationis composed of dried leaves,stems and flowers of the plant
5. Hashish is a more potent concentrate of the resin derived
from the flowering tops of the plant tops of the plant.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 103/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 104/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
CATEGORY COMMON
PREPARATIONS
STREET NAMES
Cannabis Marijuana Joint,weed,pot,grass,
Mary jane,texas tea,
locoweed,MJ,hay,
stickHashish Hash,
bhang,ganja,charas
CANNABINOIDS
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 105/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 106/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 107/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 108/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
f /
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 109/149
Patterns of Use/Abuse
In 2003, The Saddock & Saddock states , Marijuana is
the most widely used illicit drug among high school
students. It has been termed as a ³ gateway drug´.
Cannabis is incorrectly regarded as a substance of low
abuse potential.
Tolerance can occur in chronic users
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
EFFECTS ON THE BODY
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 110/149
EFFECTS ON THE BODY
1. Cardiovascular effects:
a. Tachycardia
b. Orthostatic hypotension
2. Respiratory effects:
Marijuana
a. Obstructive Airway disorders
b. Laryngitis
c. Bronchitis
d. Coughe. hoarseness
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 111/149
C bi ( h l t )
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 112/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Cannabis ( heavy long-term use)
a. Associated with syndrome called
amotivational syndrome.b. Lethargy
c. Apathy
d. Social and personal deterioration
e. Lack of motivation
5. Sexual functioning: ( Marijuana)a. Enhances sexual experience (men &
women) thus increasing sexual satisfaction
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 113/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
higher doses:
a. Impairment in judgment of time and distance
b. Recent memory and learning ability Physiological symptoms:
a. Tremors
b. Muscle rigidity
c. Conjunctival rednessToxic effects ± panic reactions
Very heavy usage ± precipitate an acute psychosis
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 114/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 115/149
Precipitating event
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 116/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Predisposing factors
Cognitive appraisal
primary
Perceived threat
secondary
Ineffective coping
Quality of
response
Adaptive Maladaptive
Substance
abuse
Substance
dependence
DYNAMICS OF SUBSTANCE USE DISORDERS
APPLICATION OF THE NURSING PROCESS
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 117/149
APPLICATION OF THE NURSING PROCESS
ASSESSMENT
a. Pre-introductory phase:
1.nurse must examine his or her feelings about
working with a client who abuses substances.
2.attitudes are examined
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 118/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
What are my drinking patterns?
If I drink, why do I drink? When,where and how much?
If I don¶t drink, why do I abstain? Am I comfortable with my drinking patterns?
If I decided not to drink anymore, would that be a problem
for me?
What did I learn from my parents about drinking?
Have my attitudes changed as an adult?
What are my feelings about people who are intoxicated?
Does it seem more acceptable for some individuals than
for others?
Do I ever use terms like ³sot´,´drunk´ or ³boozer´ todescribe some individuals who overindulge, yet overlook it
in others?
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 119/149
ASSESSMENT TOOLS
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 120/149
ASSESSMENT TOOLS
Drug history and Assessment
Michigan Alcoholism Screening Test ( MAST)
The CAGE Questionnaire
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
DRUG HISTORY AND ASSESSMENT
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 121/149
DRUG HISTORY AND ASSESSMENT
1. When you were growing up,did anyone in your family drink alcohol
or take other kinds of drugs?
2. If so, how did the substance use affect the family situations?
3. When did you have your first drink/drugs?
4. How long have you been drinking/taking drugs on a regular basis?5. What is your pattern of substance use?
a. When did you use substances?
b. What do you use?
c. How much do you use?
d. Where are you and with whom when you use substances?6. When did you have your last drink/drug? What was it and how much
did you consume?
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 122/149
CAGE QUESTIONNAIRE
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 123/149
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 hangover ( Eye-opener)
Scoring: 2 or 3 ³yes´ answers strongly suggests a problem
with alcohol.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
MICHIGAN ALCOHOLISM SCREENING TEST ( MAST)
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 124/149
MICHIGAN ALCOHOLISM SCREENING TEST ( MAST)
Yes No
1. Do you enjoy a drink now and then?
2. Do you feel you are a normal drinker?
(drink less than or as much as most people)
3. Have you ever awakened the morning after some
drinking the night before and found that you couldnot remember a part of the evening?
4. Does your wife,husband,parent or other near relative
ever worry or complain about your drinking?
5. Can you stop drinking without a struggle after one or
two drinks?
6. Do you ever feel guilty about your drinking?
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 125/149
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 126/149
DUAL DIAGNOSIS
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 127/149
DUAL DIAGNOSIS
If with co-existing substance disorder and mental illness,
a special program that targets both problems will be
assigned to the client.
Counselling for a mentally ill who abuses substance
takes a different approach( supportive). Peer support groups
Psychodynamic Therapy
Cognitive and Behavioral Therapy
12-step recovery programs ( Alcoholics Anonymous or Narcotics Anonymous)
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
THE TWELVE STEPS OF ALCOHOLICS
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 128/149
THE TWELVE STEPS OF ALCOHOLICS
1. We admitted we are powerless over alcohol-that our lives havebecome unmanageable.
2. Came to believe that a power greater than ourselves could restoreus 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 a fearless moral inventory of ourselves.
5. Admitted to God, ourselves and to another human being the exactnature of our wrongs.
6. Were entirely ready to have GOD remove all these defects of character.
7. Humbly ask him to remove our shortcomings.
8. Made a list of all persons we have harmed and became willing tomake amends to them all.
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 129/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
9. Make 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 werewrong 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.
DIAGNOSIS/OUTCOME IDENTIFICATION
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 130/149
DIAGNOSIS/OUTCOME IDENTIFICATION
Ineffective denial related to weak underdeveloped egoevidenced by ³ I don¶t have a problem with ( substance).I can quit anytime I want to´.
Ineffective coping related to inadequate coping skills andweak ego evidenced by the use of substances as copingmechanism.
Imbalanced nutrition:Less than body requirements/deficient fluid volume related to drinking or taking drugsinstead of eating, evidenced of loss of weight,pale
conjunctiva and mucous membranes,poor skin turgor,electrolyte imbalance,anemias and other s/s of malnutrition/dehydration
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 131/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Risk for infection related to Malnutrition and altered
immune condition
Low self-esteem related to weak ego,lack of positive
feedback evidenced by criticism of self and others and
use of substances as a coping mechanism ( self-
destructive behavior)
Deficient knowledge ( effects of substance abuse on thebody) related to denial of problems with substances
evidenced by abuse of substances
Substance Withdrawal:
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 132/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Risk for injury related to CNS agitation ( withdrawal from
CNS depressants)
Risk for suicide related to depressed mood ( withdrawal
from CNS stimulant)
PLANNING/IMPLEMENTATION
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 133/149
PLANNING/IMPLEMENTATION
A. Detoxification:1. provide a safe and supportive environment for the
detoxification process
2. Controlled withdrawal from an abusive substance in amedically prescribed program using gradually tapered
sedation,controlled environment and nutritional supplements.3. Takes several days to 1 week.
B. Intermediate Care
1. Provide explanations of physical symptoms
2. Promote understanding and identify the causes of
substance dependency3. Provide education and assistance in course of
treatment to client and family
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
C. Rehabilitation
1 Encourage continued participation in long term
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 134/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
1. Encourage continued participation in long-term
treatment
2. Promote participation in outpatient supportsystem (e.g. AA)
3. Assist client to identify alternative sources of
satisfaction
4. Provide support for health promotion and
maintenance
D. Client/Family Education
1. nature of the illness- effects on the body and
ways in which the use of substances affects life
2. management of illness- activities to substitute for substance in times of stress, relaxation techniques,
problem solving skills, essentials of good nutrition.
3 i fi i l/l l i
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 135/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
3. support services- financial/legal assistance,
alcoholic anonymous, one-to-one support person
EVALUATION
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 136/149
Reassessment is done by using information gathered
from the reassessment questions.
1. Has detoxification occured without complications?
2. Is the client still in denial?
3. Does the client accept responsibility for his or her own
behavior? Has he or she acknowledged a personal
problem with substances?
4. Has a correlation been made between personal
problems and the use of substances?5. Does the client still makes excuses or blame others for
use of substances?
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
6. Has the client remained substance-free during
hospitalization?
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 137/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
hospitalization?
7. Does the client cooperate with treatment?
8. Does the client refrain from manipulativebehavior and violation of limits
9. Is the client able to verbalize alternative
adaptive coping strategies to substitute for
substance use? Has the use of these strategies
been demonstrated? Does positive reinforcementencourage repetition of these adaptive behaviors?
10. Has nutritional status been restored?Does the
client consume diet adequate for his or her size
and level of activity? Is the client able to discussthe importance of adequate nutrition?
11. Has the client remained free of infection during
hospitalization?
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 138/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
12. Is the client able to verbalize the effects of
substance abuse on the body?
13. Does the client verbalize that he or she wants to
recover and lead a life free of substances?
TREATMENT MODALITIES FOR SUBSTANCE-
RELATED DISORDERS
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 139/149
RELATED DISORDERS
Alcoholics Anonymous
is a major self help organization for the treatment of
alcoholism. Founded by 2 alcoholics, Bill wilson and Dr.
Bob Smith.
The self help groups are based on the concept of peer support ±acceptance and understanding from others
who have experienced the same problems in their lives.
Membership requirement: desire to stop drinking
Sole purpose: help members stay sober
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
PHARMACOTHERAPY
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 140/149
Disulfiram ( Antabuse):
a. Drug administered to individuals who abuse alcohol as
a deterrent to drinking.
b.Works by inhibiting the enzyme aldehyde
dehydrogenase, thereby blocking the oxidation of
alcohol at the stage when acetaldehyde is converted
to acetate.
c. Assessment done before beginning therapyd. Medical screening done
e. Written informed consent
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
f Contraindicated for high risk clients for alcohol
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 141/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
f. Contraindicated for high risk clients for alcohol
ingestion, psychotic, clients with severe
cardiac,renal or hepatic diseaseg. Disulfiram therapy is not a cure for alcoholism
but for the maintenance of sobriety
h. Provides measure of control for the individual
who desires to avoid impulse drinking.
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 142/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Symptoms of disulfiram-alcohol reaction can occur
within 5 to 10 minutes of ingestion of alcohol.
Blood alcohol levels of approximately 50mg/dl:
flushed skin
throbbing in the head and neck respiratory difficulty - Tachycardia
Dizziness - Hypotension
n/v - weakness
Sweating - blurred vision
Hyperventilation
Blood level of approximately 125 to 150 mg/dl severe
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 143/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Blood level of approximately 125 to 150 mg/dl,severe
reactions can occur:
respiratory depression
cardiovascular collapse
arrthymias
myocardial infarction
acute congestive heart failure
unconsciousness
convulsions
death
Administration of disulfiram should be at least 12 hrs
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 144/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
Administration of disulfiram should be at least 12 hrs
from no alcohol intake
Sensitivity to alcohol lasts for a 2 week period after discontinuation of disulfiram
Alcohol containing substances:
1. liquid cough and cold preparations
2. vanilla extract3. aftershave lotions
4. colognes
5. mouthwash
6. nail polish remover
7. isopropyl alcohol
OTHER MEDICATIONS FOR TREATMENT OF
ALCOHOLISM
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 145/149
ALCOHOLISM
1. Naltrexone :
a. Treatment of alcohol dependence
b. Works on same receptors in the brain that produce thefeelings of pleasure when heroin or other opiates bind tothem
c. An opiate antagonist
2. Benzodiazepines:
a. Effectively reduce signs and symptoms of withdrawal andprevent seizures
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
MANAGEMENT OF OPIATE WITHDRAWAL
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 146/149
1. Methadone :
Initial administration to stabilize symptoms of heroin
withdrawal.
10-40 mg 1st 24 hrs.
Stabilized- dose is slowly tapered ( 5mg/day)
2. Clonidine:
Available in oral, sublingual or transdermal patch
preparations
0.1 to .03 mg in 3 divided doses on the 1st day
BP shld be initially checked every 45 minutes
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
MANAGEMENT OF NICOTINE WITHDRAWAL
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 147/149
1. Nicotine gum and Nicotine patch:
Serves to replace the nicotine the nicotine in cigarettes
Optimum length of treatment before tapering is 4 to 6 weeks
Dosing: 2-4 mg/hr for the gum ( 2- and 4- mg sticks)
Patches ± 15mg/16 hr patch ( while awake)
2. Buproprion
Non-nicotine replacement therapy for nicotine replacement
150mg in AM for 3 days,then 150mg BID
Tx begins 1-2 wks before initial quit date/lasts 8 to 12wkswith 6 months maintenance
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 148/149
6/25/2009 MS. JOCELYN-ALCERA NAZARIO, RN MAN
8/8/2019 Substance Lec 2010
http://slidepdf.com/reader/full/substance-lec-2010 149/149
Drug abuse pictures before and after.mp4
Recommended