Substance Use Disorders Pt.2, Ch 14
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Questions and Answers

What is a significant risk associated with withdrawal from CNS stimulants?

  • Risk for dehydration from excessive sweating
  • Risk for heart attack due to increased energy
  • Risk for suicide related to feelings of lassitude (correct)
  • Risk for injury due to agitation

    • Which outcome indicates a successful management strategy for a client in denial?

  • Client will deny the need for treatment
  • Client will continue using the substance
  • Client will demonstrate acceptance of responsibility for their behavior (correct)
  • Client will blame others for their substance use

    • What coping mechanism is suggested to clients to handle stress without substances?

  • Exercise and visualization (correct)
  • Meditation only
  • Increased substance use
  • Avoidance of stressful situations

    • What is a primary focus of Alcoholics Anonymous (AA)?

    <p>Providing peer support and understanding</p> Signup and view all the answers

    Which relaxation technique is NOT mentioned as a management strategy?

    <p>Intensive cardio workouts</p> Signup and view all the answers

    The effective management of which aspect can help clients understand the consequences of their substance use?

    <p>Stress management techniques</p> Signup and view all the answers

    What is the main philosophy underlying the 12 steps of Alcoholics Anonymous?

    <p>Peer support and understanding are crucial for sobriety</p> Signup and view all the answers

    What is a key goal of client and family education in the context of substance use treatment?

    <p>Promote a thorough understanding of the illness and its effects</p> Signup and view all the answers

    Which of the following are natural hallucinogens?

    <p>Psilocybin</p> Signup and view all the answers

    What is a primary characteristic of cannabis intoxication?

    <p>Impaired motor movement</p> Signup and view all the answers

    Which of the following is a potential outcome of a severe overdose on PCP or Ketamine?

    <p>Respiratory depression</p> Signup and view all the answers

    Which of the following describes Hallucinogen Persisting Perception Disorder?

    <p>A repeated LSD experience without taking the substance</p> Signup and view all the answers

    Cannabis Hyperemesis Syndrome is characterized by which of the following symptoms?

    <p>Severe abdominal pain and vomiting</p> Signup and view all the answers

    What common symptom is associated with intoxication of hallucinogens?

    <p>Altered perceptions</p> Signup and view all the answers

    Which of the following is a result of gambling disorder?

    <p>Recurrent gambling behavior under stress</p> Signup and view all the answers

    Which psychoactive ingredient is primarily responsible for the effects of cannabis?

    <p>THC</p> Signup and view all the answers

    What is a common characteristic of gambling disorder?

    <p>It usually has a chronic course with periods of waxing and waning.</p> Signup and view all the answers

    Which of the following is NOT a treatment modality for gambling disorder?

    <p>Psychotherapy for eating disorders</p> Signup and view all the answers

    Which tool is used for assessing the severity of a substance use problem?

    <p>CAGE Questionnaire</p> Signup and view all the answers

    What aspect of the nursing process should nurses examine when working with a substance abuser?

    <p>Their own attitudes and experiences with substances</p> Signup and view all the answers

    Which medication is NOT commonly used in the treatment of gambling disorder?

    <p>Benzodiazepines</p> Signup and view all the answers

    What does the SBIRT tool stand for in assessment?

    <p>Screening, Brief Intervention, and Referral to Treatment</p> Signup and view all the answers

    Clients with a dual diagnosis typically require what type of program?

    <p>A special program that addresses both the substance and mental disorders</p> Signup and view all the answers

    Which of the following statements about gambling behavior is accurate?

    <p>Gambling disorder can interfere with multiple areas of functioning.</p> Signup and view all the answers

    What is a common behavior exhibited by codependent individuals?

    <p>They sacrifice their own needs for the fulfillment of others.</p> Signup and view all the answers

    Which medication is commonly used for managing alcohol withdrawal symptoms?

    <p>Benzodiazepines</p> Signup and view all the answers

    What might be a sign of a chemically impaired nurse?

    <p>Inappropriate responses and poor concentration.</p> Signup and view all the answers

    Which of the following is NOT part of the treatment requirements for impaired nurses?

    <p>Mandatory physical fitness training.</p> Signup and view all the answers

    Which of the following medications is categorized as a narcotic antagonist?

    <p>Naltrexone</p> Signup and view all the answers

    What symptom might a patient present with if a nurse is chemically impaired?

    <p>Changes in mood and behavior.</p> Signup and view all the answers

    What role does thiamine play in pharmacotherapy for alcoholism?

    <p>It helps with alcohol withdrawal symptoms.</p> Signup and view all the answers

    What is a potential consequence for a chemically impaired nurse reported for substance abuse?

    <p>State board may suspend their license.</p> Signup and view all the answers

    Which behavior is a hallmark of codependency?

    <p>Sacrificing personal needs for the needs of others</p> Signup and view all the answers

    What may a chemically impaired nurse experience related to their work performance?

    <p>Poor memory, concentration, and inappropriate responses</p> Signup and view all the answers

    Which medication is specifically used for treating alcohol withdrawal symptoms?

    <p>Benzodiazepines</p> Signup and view all the answers

    What is a possible outcome for a nurse reported for chemical abuse?

    <p>Denial, suspension, or revocation of their license</p> Signup and view all the answers

    What is a requirement for impaired nurses under diversionary laws?

    <p>Seek treatment that includes counseling and support groups</p> Signup and view all the answers

    Which medication is used to support abstinence from alcohol?

    <p>Disulfiram</p> Signup and view all the answers

    In the context of substance withdrawal, what role does thiamine serve?

    <p>Preventing alcohol-related complications</p> Signup and view all the answers

    What symptom might indicate the presence of stress-related illnesses in a codependent individual?

    <p>Compulsive behaviors or anxiety</p> Signup and view all the answers

    What risk is associated with a client withdrawing from CNS depressants?

    <p>Risk for injury related to CNS agitation</p> Signup and view all the answers

    What is a primary outcome desired for a client demonstrating denial regarding substance use?

    <p>Client will acknowledge associations between personal problems and use of substances</p> Signup and view all the answers

    Which coping mechanism is encouraged to replace substance use during stressful situations?

    <p>Exercise and visualization techniques</p> Signup and view all the answers

    What significant concept underpins Alcoholics Anonymous (AA)?

    <p>Peer support and shared experiences</p> Signup and view all the answers

    Which statement about the philosophy of AA is accurate?

    <p>Total abstinence is promoted as the only cure</p> Signup and view all the answers

    Which of the following is a goal of client and family education regarding substance use?

    <p>To highlight the negative impacts of substance use on life</p> Signup and view all the answers

    Which of the following relaxation techniques can be taught to clients in substance use treatment?

    <p>Progressive relaxation and deep breathing</p> Signup and view all the answers

    What is a common approach included in client education about managing substance use disorders?

    <p>Prioritizing good nutrition and problem-solving</p> Signup and view all the answers

    What are common intoxication symptoms for hallucinogens?

    <p>Altered perceptions and hallucinations</p> Signup and view all the answers

    Which of the following substances is considered a natural hallucinogen?

    <p>Psilocybin</p> Signup and view all the answers

    What is a significant characteristic of Cannabis Hyperemesis Syndrome?

    <p>Severe abdominal pain and vomiting</p> Signup and view all the answers

    Which of the following is a potential psychological effect of hallucinogen use?

    <p>Increased anxiety and panic</p> Signup and view all the answers

    What distinguishes a 'bad trip' from typical hallucinogen effects?

    <p>Intense fear and panic reactions</p> Signup and view all the answers

    What is the main psychoactive component of cannabis responsible for its effects?

    <p>Tetrahydrocannabinol (THC)</p> Signup and view all the answers

    Which approach should be taken for managing a severe overdose of PCP or Ketamine?

    <p>Supportive care based on symptoms</p> Signup and view all the answers

    Which symptom is associated with withdrawal from cannabis?

    <p>Restlessness and irritability</p> Signup and view all the answers

    What is a common characteristic of the course of gambling disorder?

    <p>It typically runs a chronic course with periods of fluctuation.</p> Signup and view all the answers

    Which of the following therapies is NOT included as a treatment modality for gambling disorder?

    <p>Yoga therapy</p> Signup and view all the answers

    Which assessment tool helps identify alcohol-related issues and includes a series of questions about drinking habits?

    <p>CAGE Questionnaire</p> Signup and view all the answers

    What role do nurses have when initially developing relationships with substance abusers?

    <p>Examine their own attitudes and personal experiences with substances.</p> Signup and view all the answers

    Clients with a dual diagnosis are typically referred to which type of program?

    <p>Programs combining therapies for both substance and mental disorders</p> Signup and view all the answers

    What is likely the focus of the psychosocial assessment of a client with substance use disorders?

    <p>Coping mechanisms for stressors</p> Signup and view all the answers

    Which medication is used in the treatment of gambling disorder?

    <p>Naltrexone</p> Signup and view all the answers

    Compulsive behaviors associated with gambling disorder usually begin at what stage of life?

    <p>Adolescence</p> Signup and view all the answers

    Study Notes

    Hallucinogens

    • Diverse group of drugs with unpredictable effects
    • Natural: Mescaline, Psilocybin, Salvia
    • Synthetic Compounds: Lysergic acid diethylamide (LSD), Dextromethorphan (DXM), Phencyclidine (PCP), Ketamine, MDMA (also a stimulant)
    • Intoxication Symptoms: Altered perceptions, hallucinations, impaired judgment, intensified sensations and feelings, depersonalization/derealization, emotional changes (euphoria, peace, paranoia, panic), increased blood pressure, heart rate, and blood glucose, nausea, vomiting, chills, loss of appetite, insomnia
    • Toxic Reactions: Panic reaction ("bad trip"), flashbacks, Hallucinogen Persisting Perception Disorder (HPPD) - transient, spontaneous repetition of an LSD-induced experience
    • Overdose Symptoms: Serious psychological harm, death often due to dangerous behaviors or accidents
    • Severe Overdose of PCP or Ketamine: Respiratory depression, coma, respiratory arrest, convulsions, seizures
    • Treatment: Supportive care based on symptoms (calm, low-stimulus environment)
    • No specific withdrawal syndrome

    Cannabis

    • Marijuana, Hashish, Synthetic cannabinoids (K2, Spice)
    • Depressant and Hallucinogenic effects
    • Major psychoactive ingredient: THC (delta-9-tetrahydrocannabinol)
    • Intoxication: Impaired motor movement, lowered inhibition, talkativeness, euphoria, relaxation, mood swings, conjunctival reddening (red eyes), increased appetite, dry mouth
    • Overdose and Toxicity: Usually non-fatal, can lead to Cannabis Hyperemesis Syndrome (severe abdominal pain, vomiting, dehydration, potentially acute kidney failure)
    • Withdrawal Symptoms: Irritability, restlessness, insomnia, headache, chills, nausea, vomiting, stomachache, loss of appetite
    • Amotivational Syndrome

    Gambling Disorder

    • Persistent and recurrent problematic gambling behavior that intensifies under stress
    • Individual utilizes any means to obtain money for gambling
    • Usually begins in adolescence, but compulsive behaviors rarely occur before young adulthood
    • Chronic course with periods of waxing and waning
    • Interferes with interpersonal relationships, social, academic, or occupational functioning

    Treatment Modalities for Gambling Disorder

    • Behavior therapy
    • Cognitive therapy
    • Motivational interviewing
    • Gamblers Anonymous
    • Psychopharmacology: SSRIs, Clomipramine, Lithium, Carbamazepine, Naltrexone

    Nursing Assessment for Substance Use Disorders

    • Various assessment tools available: Drug history and assessment, Drug abuse screen test (DAST), Screening, Brief Intervention, and Referral to TX (SBIRT), Clinical Institute Withdrawal Assessment of Alcohol Scale, Clinical Opiate Withdrawal Scale Assessment, Michigan Alcoholism Screening Test (MAST), CAGE Questionnaire
    • Physical, Mental Health, and Psychosocial Assessments: Who they live with, how they cope with stressors
    • Admission history: Current symptoms of intoxication, overdose, withdrawal, and complications, screening tools
    • Vital signs
    • Insight and interest for treatment of substance use disorder

    Dual Diagnosis

    • Clients with coexisting substance disorder and mental disorder
    • Special programs combine therapies targeting both problems

    Nursing Diagnosis/Outcome Identification

    • Clients withdrawing from CNS depressants: Risk for injury related to CNS agitation
    • Clients withdrawing from CNS stimulants: Risk for suicide related to intense feelings of lassitude and depression, "crashing," suicidal ideation
    • Denial: Outcome - Client will demonstrate acceptance of responsibility for their behavior and acknowledge association between personal problems and substance use
    • Ineffective Coping: Outcome - Clients will demonstrate adaptive coping mechanisms that can be used in stressful situations (instead of taking substances)
    • Coping skills to teach: Exercise, visualization, talk to a sponsor

    Client/Family Education

    • Nature and management of the illness
    • Effects of substances on the body
    • How substance use affects life
    • Stress management and coping
    • Relaxation techniques: Progressive relaxation, tense and relax, deep breathing, autogenics
    • Problem-solving and good nutrition
    • Support services: Alcoholics Anonymous (or other support groups), one-to-one support person, therapy

    Alcoholics Anonymous

    • Major self-help organization for alcoholism treatment
    • Based on peer support, acceptance, and understanding from others who have experienced the same problem
    • 12 steps provide guidelines on how to attain and maintain sobriety
    • Total abstinence is promoted as the only cure

    Codependency

    • Dysfunctional behaviors among members of the family of a chemically dependent person
    • Sacrificing own needs for fulfillment of others to achieve a sense of control
    • Deriving self-worth from others
    • Feeling responsible for the happiness of others
    • Commonly denying that problems exist
    • Keeping feelings in control, releasing anxiety in the form of stress-related illnesses or compulsive behaviors

    The Chemically Impaired Nurse

    • Absenteeism or perfect attendance
    • Issues involving wasting of drugs and narcotic counts
    • Poor concentration, memory, and recall, unmet deadlines, inappropriate responses
    • Problems with relationships
    • Changes in mood, behavior, motor coordination, slurred speech
    • Patient complaints of inadequate pain control, discrepancies in documentation
    • State Board Response: May deny, suspend, or revoke a license based on reports of chemical abuse. Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment (completion of programs, counseling, support groups or 12-step program, random negative drug screens)
    • During the suspension period: Successful completion of treatment programs (inpatient, outpatient, group, or individual), evidence of regular attendance in support groups or 12-step programs, random negative drug screens, employment or volunteer activities

    Pharmacotherapy for Alcoholism

    • Alcohol Withdrawal: Benzodiazepines, anticonvulsants, multivitamin therapy, thiamine
    • Disulfiram (Antabuse): Aversion therapy to deter alcohol consumption
    • Acamprosate (Campral): Helps reduce cravings and relapse

    Psychopharmacology for Substance Intoxication and Withdrawal

    • Other medications: Naltrexone (ReVia; Vivitrol), Nalmefene (Revex), Selective serotonin reuptake inhibitors (SSRIs)
    • Opioids:
      • Narcotic antagonists: Naloxone (Narcan), Naltrexone (ReVia), Nalmefene (Revex)
      • Buprenorphine
      • Methadone
      • Clonidine
    • Depressants: Phenobarbital (Luminal), long-acting benzodiazepines
    • Stimulants: Minor tranquilizers, major tranquilizers, anticonvulsants, antidepressants
    • Hallucinogens and cannabinols: Benzodiazepines, antipsychotics

    Hallucinogens

    • Diverse group of drugs with unpredictable effects
    • Natural hallucinogens: mescaline, psilocybin, salvia
    • Synthetic hallucinogens: LSD, dextromethorphan (DXM), phencyclidine (PCP), ketamine, MDMA
    • Hallucinogens can cause: altered perceptions, hallucinations, impaired judgment, intensified sensations, depersonalization, derealization, mood swings, increased blood pressure, heart rate, and blood glucose, nausea, vomiting, chills, loss of appetite, insomnia
    • Hallucinogen intoxication symptoms can be managed with supportive care in a calm, low-stimulus environment
    • Hallucinogen toxic reactions include panic reactions ("bad trips"), flashbacks, and Hallucinogen Persisting Perception Disorder where previous LSD-induced experiences are spontaneously repeated without taking the substance
    • Hallucinogen overdose can lead to serious psychological harm and death, usually due to dangerous behaviors and accidents
    • Severe PCP or ketamine overdose symptoms include respiratory depression, coma, respiratory arrest, convulsions, and seizures
    • There is no specific withdrawal syndrome for hallucinogens

    Cannabis

    • Marijuana, hashish, and synthetic cannabinoids (K2, Spice) are examples of cannabis
    • Cannabis has depressant and hallucinogenic effects
    • The major psychoactive ingredient in cannabis is THC (delta-9-tetrahydrocannabinol)
    • Cannabis intoxication: impaired motor movement, lowered inhibition, euphoria, relaxation, mood swings, conjunctival reddening, increased appetite, dry mouth
    • Overdose and withdrawal symptoms can occur with potent forms of cannabis
    • Cannabis overdose is usually non-fatal
    • Cannabis Hyperemesis Syndrome is a severe condition that can lead to acute kidney failure and includes symptoms like severe abdominal pain and vomiting
    • Cannabis withdrawal symptoms: irritability, restlessness, insomnia, headache, chills, nausea, vomiting, stomachache, loss of appetite
    • Amotivational Syndrome is a potential outcome of long-term cannabis use

    Gambling Disorder

    • Gambling Disorder is characterized by persistent and recurrent problematic gambling behaviors that intensify when the individual is under stress
    • The individual may use any means necessary to obtain money for gambling
    • The disorder usually begins in adolescence, but compulsive behaviors rarely occur before young adulthood
    • Gambling Disorder usually runs a chronic course with periods of waxing and waning
    • Gambling Disorder can interfere with interpersonal relationships, social, academic, or occupational functioning

    Treatment Modalities for Gambling Disorder

    • Treatment options include behavior therapy, cognitive therapy, motivational interviewing, Gamblers Anonymous, and psychopharmacology
    • Psychopharmacology medications used to treat gambling disorder may include SSRIs, clomipramine, lithium, carbamazepine, and naltrexone

    Substance Abuse Nursing Process

    • Nurses must be aware of their own personal experiences with substances to establish effective relationships with substance abusers
    • The nursing process for substance abuse involves assessment, nursing diagnosis/outcome identification, client/family education, and pharmacotherapy
    • Assessment tools for substance abuse include drug abuse screen tests (DAST), Screening, Brief Intervention, and Referral to TX (SBIRT), Clinical Institute Withdrawal Assessment of Alcohol Scale, Clinical Opiate Withdrawal Scale Assessment, Michigan Alcoholism Screening Test (MAST), and CAGE Questionnaire
    • Assessment should include: physical, mental health, and psychosocial assessments (including how the individual copes with stressors), admission history, current signs and symptoms of intoxication, overdose, withdrawal, and complications, substance use screening tools, vital signs, and insight and interest for substance use disorder treatment
    • Dual Diagnosis refers to the co-occurrence of a substance disorder and mental disorder
    • Clients with dual diagnosis may be assigned to a special program
    • Clients withdrawing from CNS depressants may be at risk for injury due to CNS agitation
    • Clients withdrawing from CNS stimulants may be at risk for suicide due to intense feelings of lassitude and depression, "crashing," and suicidal ideation
    • Denial is a common issue for substance abusers, as they may have a weak, underdeveloped ego
    • Ineffective coping is a common nursing diagnosis for substance abusers due to inadequate coping skills
    • Clients need to be taught coping skills like exercise, visualization techniques, and talking to a sponsor

    Client/Family Education

    • Client/family education should include: nature and management of substance abuse, effects of substance on the body, how substance use affects life, stress management and coping skills, relaxation techniques, problem-solving, good nutrition, and support services
    • Support services may include: Alcoholics Anonymous, one-to-one support person, and therapy

    Alcoholics Anonymous

    • A major self-help organization for the treatment of alcoholism
    • Based on the concept of peer support, acceptance, and understanding from others who have experienced the same problem
    • The 12 steps of AA provide guidelines on how to attain and maintain sobriety
    • Total abstinence is promoted as the only cure for alcoholism
    • Social drinking is not considered safe for alcoholics

    Codependency

    • Codependency is defined by dysfunctional behaviors evident among members of the family of a chemically dependent person
    • Codependent people sacrifice their own needs to fulfill the needs of others for a sense of control
    • Codependents derive self-worth from others and feel responsible for the happiness of others
    • Codependents often deny that problems exist
    • Codependency can express itself through stress-related illness or compulsive behaviors

    The Chemically Impaired Nurse

    • Signs of a chemically impaired nurse may include: absenteeism or perfect attendance, issues with wasting of drugs and narcotic counts, poor concentration, memory, and recall, unmet deadlines, inappropriate responses, problems with relationships, changes in mood, behavior, motor coordination, slurred speech, patient complaints of inadequate pain control, and discrepancies in documentation
    • State boards may deny, suspend, or revoke a nurse's license based on a report of chemical abuse
    • Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment
    • Required treatments for chemically impaired nurses include: completion of a program, counseling, support groups, 12-step program, and random negative drug screens
    • During the suspension period, the nurse may be required to: successfully complete an inpatient, outpatient, group, or individual counseling treatment program, demonstrate regular attendance at nurse support groups or 12-step program, undergo random negative drug screens, and participate in employment or volunteer activities

    Pharmacotherapy for Alcoholism

    • Medications used to treat alcohol withdrawal include benzodiazepines, anticonvulsants, multivitamin therapy, and thiamine
    • Disulfiram (Antabuse) is a medication used to deter alcohol consumption by causing unpleasant side effects
    • Acamprosate (Campral) is medication that helps reduce cravings for alcohol

    Psychopharmacology for Substance Intoxication and Substance Withdrawal

    • Common medications used to treat substance intoxication and withdrawal include:
      • Opioids: Naloxone (Narcan), Naltrexone (ReVia), Nalmefene (Revex), Buprenorphine, methadone, clonidine
      • Depressants: Phenobarbital (Luminal), Long-acting benzodiazepines
      • Stimulants: Minor tranquilizers, Major tranquilizers, Anticonvulsants, Antidepressants
      • Hallucinogens and cannabinols: Benzodiazepines, Antipsychotics
      • Other: Naltrexone (ReVia), Nalmefene (Revex), Selective serotonin reuptake inhibitors (SSRIs)

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