NURS 1028 Chapter 26: Addiction and Substance Use

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Questions and Answers

Which intervention is specifically recommended to minimize the risk of client manipulation during treatment?

Encourage family to provide excessive support

Set limits when dealing with demanding manipulative behavior (correct)

Maintain close contact with the client at all times

Remove medication from the client's access completely

What should be monitored to assess the client's progress during withdrawal treatment?

The level of physical activity

The client's financial status

The effectiveness of administered medications (correct)

The client's ability to make friends

Which of the following group therapies is often utilized for addiction recovery?

Psychoanalytic Therapy

Behavioral Activation Therapy

Twelve-Step Programs (correct)

Crisis Intervention Therapy

What is a primary ethical consideration when providing treatment for individuals with addiction?

Promoting the autonomy of the client in making treatment decisions Signup and view all the answers

What measure should be taken to enhance the safety of clients during withdrawal?

Instituting seizure precautions Signup and view all the answers

What is the primary goal of matching treatment settings to an individual's needs in addiction treatment?

To enhance the chances of successful rehabilitation Signup and view all the answers

Which of the following is NOT one of the goals of addiction treatment programs?

Enhancing clients' legal privileges Signup and view all the answers

How does the therapeutic alliance contribute to addiction treatment success?

By establishing a foundation of empathy and trust Signup and view all the answers

Which harm reduction strategy is appropriate for alcohol addiction?

Handing off keys and phones to loved ones when drinking Signup and view all the answers

What is a key characteristic of the harm reduction approach to addiction treatment?

It respects the rights and choices of individuals using drugs. Signup and view all the answers

Which screening and assessment tool is typically used to evaluate substance use in clients?

The Addiction Severity Index Signup and view all the answers

What aspect of the addiction treatment principle emphasizes the need for clients to be emotionally prepared?

Quality of life improvements Signup and view all the answers

What is the primary goal when establishing a therapeutic alliance with clients?

To minimize negative interactions and judgment Signup and view all the answers

Which component is essential in matching treatment to clients for substance use disorders?

The individual's personal preferences Signup and view all the answers

Which of the following screening tools uses key questions to identify substance use disorders?

CAGE Questionnaire Signup and view all the answers

What is the primary function of a brief intervention in addiction treatment?

To reduce substance use in a time-limited manner Signup and view all the answers

What ethical consideration should nurses keep in mind during addiction treatment?

Addressing their own unresolved conflicts and losses Signup and view all the answers

Which of the following is not a type of service that provides outpatient treatment options?

Medically Managed Intensive Inpatient Services Signup and view all the answers

When assessing a patient for substance use disorder, which aspect is least likely to influence the treatment decision?

The demographic profile of the patient's family Signup and view all the answers

Which of the following is a key feature of the CAGE Questionnaire for substance screening?

Focusing on behavioral patterns and feelings about drinking Signup and view all the answers

In addiction treatment, what is the significance of addressing comorbidities during treatment matching?

It helps in understanding potential treatment complications Signup and view all the answers

What role does a nurse play in minimizing negative bias when treating clients with addiction?

Acknowledging their own prejudices and biases Signup and view all the answers

Study Notes

Addiction is a chronic, relapsing, and treatable medical condition, considered a leading preventable cause of death, disability, and disease globally
It is a brain disease, not a moral failing
Addiction involves cycles of relapse and remission
Substance misuse encompasses using any drug (legal or illegal) for unintended purposes or in excess, as seen with alcohol overuse
Individuals with substance use disorders are often alienated and isolated from their families and communities
Substances activate the brain's reward system, leading to a pleasurable effect primarily through increasing extracellular dopamine in the limbic regions
Without treatment, addiction progresses, potentially resulting in disability or premature death
The DSM-5 classifies substance-use disorders (SUDs) and substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders
SUD diagnosis is substance-specific (e.g., alcohol, opioid, tobacco) and based on a pattern of 11 behaviors grouped into impaired control, social impairment, risky use, and pharmacologic categories
The severity of SUDs can range from mild (2-3 symptoms) to severe (6+ symptoms)
Opioid use disorder has specific criteria for diagnosis, encompassing behaviors like taking opioids in excessive amounts, wanting to cut down but not being able to, having cravings & spending a lot of time acquiring the opioid, regardless of the severity that ranges from 2-3 criteria for mild and 6-7 for severe (APA, 2013)
Substance-induced disorders involve a reversible substance-specific syndrome resulting from recent substance ingestion, showcasing maladaptive behaviors associated with the intoxication (e.g., belligerence, mood lability)
There is a significant risk for adverse effects like accidents, general medical complications, disruption in relationships, and legal issues
Substance withdrawal occurs due to the cessation or reduction of prolonged substance use, potentially causing significant distress and impairment in various aspects of functioning
Non-substance-related disorders such as gambling disorder, internet gaming addiction, sex addiction, exercise addiction, and shopping addiction also exist and fall within the broader spectrum

Etiology

Biological factors:
- Physical environmental stressors (e.g., sleep deprivation, toxic work)
- Genetics (prenatal and postnatal stress, potentially altering genetic expression, Addicted Neonate (drugs), Fetal Alcohol Spectrum Disorder)
- Increased dopamine levels, stimulating the reward system and the limbic system
- Gender (males and females)
Psychological factors:
- Mental health disorders
- Unstable home and family life/conflict
- Disrupted care during infancy and childhood experiences (e.g., trauma/abuse)
Social factors:
- Peer influences (age & exposure)
- Geographical access to substances
- Income and ability to pay for substances

Interdisciplinary Treatment

The adaptation in the brain from chronic substance use is long-lasting, requiring interventions tailored to the individual's needs.
Treatment goals include stabilizing the client's condition, improving quality of life and functioning, improving all areas of affected in client's life, preventing relapse to substance use, providing education about addiction, and fostering a therapeutic alliance.
Multimodal treatment, education, harm reduction, and a strong therapeutic alliance are crucial for success
Treatment must balance the individual's type of addiction, client characteristics, and matching intervention, settings, and services for success.

Harm Reduction

Practical strategies and ideas to reduce negative consequences of substance use and move towards abstinence
Examples include safe needle/syringe exchange programs, naloxone (Narcan) programs, and ways to help substance users stay safe (e.g., providing transportation, safeguarding belongings)

Therapeutic Alliance

The therapeutic alliance establishes empathy, mutual respect, and trust, providing hope for recovery, beginning from the initial meeting and supporting a positive therapeutic environment
The alliance aims to minimize confrontations, judgment, negative interactions, and inappropriate/non-congruent techniques.
Acknowledging potential bias, stereotyping, and past experiences of the therapist and client is essential for a successful therapeutic alliance.

Nursing Assessment

Obtaining history from client and support persons, to assess level of motivation & identify reasons for admission, readiness for change, and any denial or guilt
Identifying the type of substance, amount, frequency, and duration of use, to assess any suicidal ideation
Assessing client's physical and emotional status, to gauge their baseline, and progress towards success
Assessing continuously their needs for continual modification of the treatment plan
Establishing a trusting nurse-client relationship via assessment

Objective Data

Physical signs indicative of intoxication and withdrawal include jaundice, tremors, peripheral neuropathy, hypertension, tachycardia, nausea/vomiting, upper abdominal pain, needle tracks, cellulitis, rapid weight loss and changes in pupil size, confusion, and smell of drugs on person/clothing

Lab Diagnostics

Blood alcohol concentration (BAC) measures the amount of alcohol in the blood
Liver function tests (GGT and AST) assess liver health and detect damage or disease linked to alcohol use
Mean Corpuscular Volume (MCV), Uric Acid, and Triglycerides can also be significant markers in individuals experiencing persistent alcohol use
Urea plays a key role in nitrogen homeostasis;
Urine drug screens detect the presence of various substances like marijuana (THC), cocaine, opiates (OPI), amphetamines (AMP), phencyclidine (Angel Dust), and MDMA (Ecstasy)

Management of Intoxication and Withdrawal

Intoxication is a result of being under the influence, acute effects from substance abuse, and varied symptoms between clients and substances
Detoxification involves systematically withdrawing the client from substances under care of a health provider and inpatient/outpatient settings, upholding client dignity during process
Providing adequate initial amounts and then decreasing the substance over time, to treat withdrawal symptoms (e.g, with pain management)

Withdrawal Symptoms

Symptoms from withdrawal from alcohol (AWS) and opioids, as well as CNS depressants, can vary per substances. AWS stage severity, including seizures, hypertension, tachycardia, diaphoresis, tremor, insomnia, agitation, and delirium tremens (DT)

Nursing Interventions

During acute intoxication, monitoring vital signs, urine output, and preventing complications of overdose or withdrawal, maintaining a safe environment, removing harmful items and providing appropriate supports, and administering medications as needed, is of utmost importance
During withdrawal phase the client will need medications to decrease symptoms, and the need for a quiet and safe environment, to prevent further agitation
During post-withdrawal the clients needs for nutrition, adequate medications, checking their mouths, avoiding drug/alcohol from visitors, and monitoring the client are critical
Ongoing encouragement for family involvement (and education) and facilitating a healthy recovery plan (and setting realistic goals) are crucial post-withdrawal

Nursing Interventions for the Family

Educating family members about addiction as a chronic disorder, triggers, bad influences, removing substances from the homes, and setting boundaries
Supporting healthy habits, open communication, patience, honesty, building trust and relationship, are all part of the family support plan
Follow-up support through post-rehabilitation meetings and support groups are key to maintaining sobriety and ensuring continuity of care

Discharge Criteria

Maintains abstinence, admits to dependence, demonstrates increased self-esteem, has better coping mechanisms, and can verbalize realistic goals.
Attends support and recovery groups, and manages negative emotional states.

Interventions

Motivational interviewing, cognitive-behavioral therapy, twelve-step programs, group therapy, and family therapy
Pharmacologic options such as methadone, Narcan, and relapse prevention or toxicology testing are essential to maintaining client's therapy and plan.

References

Kunyk, D., Peternelj-Taylor, C., & Austin, W. (2022). Psychiatric and mental health nursing for Canadian practice (5th ed.). Wolters Kluwer.

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Description

Explore the complexities of addiction and substance-related disorders in this NURS 1028 Chapter 26 quiz. Understand the medical aspects of addiction, its impact on individuals and families, and the classifications outlined by the DSM-5. Test your knowledge on addiction treatment and the neurological implications of substance misuse.