Substance Use Disorder Symptoms and Treatments

Substance Use Disorders

• Four groupings of symptoms include impaired control, social impairment, risky use, and physical effects.
• DSM categories include alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anti-anxiety medications, stimulants, and tobacco.

Concepts of Substance Use Disorders

• Addiction includes a chronic medical condition rooted in environment, neurotransmission, genetics, and life experiences.
• Addiction affects the reward pathway of the brain.
• Intoxication involves using a substance to excess.
• Intoxication can result in being under the influence, intoxicated, high, drunk, or stoned.
• Tolerance occurs when a person no longer responds to a substance in the way they initially responded.
• Withdrawal includes physiological symptoms when use of a substance is withheld.
• Substance-specific withdrawal can range from mild to life-threatening.

Epidemiology

• Approximately 100,306 individuals in the US died from a drug-involved overdose from 4/2020 to 4/2021.
• Schedule I drugs consists of heroin, LSD, and marijuana.
• Schedule II drugs includes opium, morphine, oxycodone, fentanyl, and methamphetamine.
• Schedule II often includes ADD and ADHD medications.
• Schedule III drugs consists of testosterone, suboxone, tylenol with codeine ketamine.
• Schedule IV drugs includes Xanax and Ativan.
• Schedule V drugs consists of Lomotil, Robitussin with Codeine, Lyrica.

Comorbidity

• Comorbidities include major depressive disorder, bipolar disorder, anxiety disorders, antisocial personality disorder, and conduct disorder.

Risk Factors

• Genetic estimates range from 30% to 40% for hallucinogens and stimulants.
• Genetic estimates range from 70% to 80% for cocaine and opioids.
• Neurotransmitters related to risk factors consists of dopamine, GABA, and opioid.
• Too little opioid activity or too much opioid antagonism may lead to self-medication.
• Environmental factors includes chronic stressors and poverty
• Environmental factors includes lack of parental supervision, poor educational resources, and impaired support system.
• Coping mechanisms may include drugs and acting out behaviors.

Caffeine Use Disorder

• Caffeine is the most widely used psychoactive substance in the world.
• Symptoms of caffeine intoxication include restlessness, nervousness, excitement, agitation, rambling speech, and inexhaustibility.
• Physical symptoms of caffeine intoxication includes flushed face, diuresis, gastrointestinal disturbance, muscle twitching, tachycardia, and cardiac arrhythmias.
• Withdrawal symptoms includes headache, drowsiness, nausea, vomiting, diarrhea, and muscle aches.
• Withdrawal symptoms occur within 12-24 hours after last dose.

Cannabis Use Disorder

• Cannabis is the third most commonly used psychoactive drug in the US
• Intoxication increases sensations and impairs motor skills for 8-12 hours.
• Withdrawal symptoms occur within a week of cessation, including irritability, anger, aggression, anxiety, and restlessness.
• Depressed mood and insomnia may occur.
• Physical symptoms of cannabis use disorder includes abdominal pain, shakiness, sweating, fever, chills, or headache.
• Treatment includes abstinence, family and group therapies, and anti-anxiety medications.

Hallucinogen Use Disorder

• Hallucinogens are Schedule 1 controlled substances with no medical use and high abuse potential.
• Intoxication includes paranoia, impaired judgment, hallucinations, and synesthesia.
• PCP intoxication is a medical emergency.
• PCP intoxication symptoms: hypertension, tachycardia, diminished pain response, muscle rigidity, seizures, coma, hyperacusis, and hyperthermia.
• Withdrawal symptoms may last weeks, months, years, and often involve re-experiencing perceptual symptoms.
• Treatment includes benzodiazepines.

Inhalant Use Disorder

• Involves solvents, adhesives, aerosols, thinners, and fuels.
• "Sudden sniffing death" can occur, involving cardiac arrhythmias with inhalants such as butane and propane.
• Low doses of inhalants can cause euphoria and disinhibition.
• Large doses of inhalants can cause fearfulness, illusions, hallucinations, distorted body image, apathy, impaired judgment, impulsivity, aggression, nausea, anorexia, slowed reflexes, nystagmus, delirium, psychosis, and dementia.
• Haldol may be used for agitation.

Opioid Use Disorder

• Intoxication symptoms includes psychomotor retardation, slurred speech, drowsiness, altered mood, impaired memory and attention, pupillary constriction, and coma.
• Withdrawal symptoms includes mood dysphoria, nausea/vomiting/diarrhea, muscle aches, fever, insomnia, watery eyes, runny nose, yawning, pupillary dilation, and goosebumps.
• Morphine, heroin, and methadone withdrawal begins 6-8 hours after last use and lasts around a week.
• Demerol withdrawal begins 8-12 hours after last use and lasts 5 days.
• Overdose usually results from respiratory depression.
• Narcan and mechanical ventilation is the treatment for overdose.
• Methadone, suboxone, and buprenorphine is the maintenace treatment.

Sedative, Hypnotic, and Antianxiety Medication Use Disorder

• Includes benzos, barbiturates, Ambien, Lunesta, and methaqualone.
• Intoxication symptoms includes slurred speech, incoordination, unsteady gait, impaired thinking, nystagmus, coma, aggression, sexual behavior, mood changes, and impaired judgment.
• Withdrawal symptoms includes rebound hyperactivity, insomnia, agitation, anxiety, and grand mal seizures.
• Treatment for withdrawal involves weaning.

Stimulant Use Disorder

• Includes amphetamines and cocaine.
• Intoxication Symptoms inculdes chest pain, arrhythmias, blood pressure changes, heart rate changes, dilated pupils, nausea/vomiting, weight loss, chills, psychomotor changes, weakness, confusion, seizures, and coma.
• Withdrawal begins a few hours to several days, includes tiredness, nightmares, increased appetite, sleep disturbances, psychomotor changes, depression, and suicidal thoughts.
• Treatment for amphetamines inpatient care involving Valium and antidepressants.

Tobacco Use Disorder

• Withdrawal Symptoms includes irritability, anxiety, depression, restlessness, difficulty concentrating, insomnia, and decreased heart rate.
• Treatment includes behavioral therapy, hypnosis, replacement therapy, bupropion, and Chantix.

Gambling Disorder

• More common in males.
• Gamblers Anonymous groups.

Alcohol Use Disorder (DSM 5 Criteria)

• At least two of the following within 12 months: alcohol use in larger amounts over a longer period than intended & persistent desire or unsuccessful efforts to stop use
• A great deal of time is spent in activities to obtain or use alcohol and recover from the effects.
• Craving alcohol can occur.
• Recurrent use results in failure to fulfill roles.
• Continued use despite problems caused.
• Activities are given up due to use.
• Recurrent alcohol use occurs when it is physically hazardous.
• Continued use occurs despite the psychological or physical problems caused.

Alcohol Intoxication

• Generally impaired vital signs and death will occur with 400 MG/DL.

Alcohol Withdrawal

• Tremors occur first, 6-8 hours after use.
• Other symptoms includes agitation, lack of appetite, nausea and vomiting, insomnia, impaired cognition, increased pulse and blood pressure, increased body temperature.
• Psychosis can begin in 8-10 hours, may give Ativan and Librium for treatment.
• Seizure risk 12-24 hours after cessation, may give Valium for treatment.
• Delirium tremens: may give valium, librium, ativan.
• Tachycardia, fever, diaphoresis, fever, anxiety, hypertension, insomnia, delusions, hallucinations may occur.
• All of the above generally occur within 72 hours.

Wernicke-Korsakoff Syndrome

• Wernicke's encephalopathy symptoms is altered gait, confusion, vestibular dysfunction, nystagmus, gaze palsy, and unequal pupils.
• Wernicke's encephalopathy should be treated with thiamine.

Systemic Effects of Alcohol Use

• Systemic effects includes peripheral neuropathy, reduction in muscle mass, cardiomyopathy, esophagitis, gastritis, pancreatitis, hepatitis, cirrhosis, leukopenia, low platelet count, and cancer.

Screening

• Screening, Brief Intervention, and Referral to Treatment (SBIRT).
• Alcohol Use Disorders Identification Test (AUDIT) should be completed
• CAGE questionnaire
• T-ACE questionnaire
• Psychosicial interventions promotes safety and sleep.
• Psychosocial intervention includes support and encouragement for self-care, therapeutic relationship, and goal setting.
• Pharmacological interventions includes Disulfiram (Antabuse).
• Naltrexone (Vivitrol, ReVia) helps with cravings for alcohol and opiates.
• Acamprosate Calcium (Campral)
• Use Benzodiazepines during the withdrawal phase
• Psychotherapy includes cognitive behavioral therapy and motivational interviewing.
• Stages of Change Theory
• Person-Centered Approach to Strengthen Motivation for Change.

Care Continuum

• Alcoholics Anonymous involves a 12 step program
• In Alcoholics Anonymous services are Free with daily meetings, peer support, and the guiding principle of "one day at a time".

Neurocognitive Disorders - Introduction

• Neurocognitive disorders involve a clinically significant deficit in cognition or memory, representing a significant change from a functioning previous level.
• The objective of care for those with neurocognitive disorders is to provide individuals with the dignity and quality of life they deserve.
• Care should offer guidance and support individuals involved families and/or primary caregivers
• In the DSM-5-TR, they include Delirium and Mild and Major Neurocognitive Disorders.

Delirium

• Characterized by a disturbance in the level of awareness and a change in cognition.
• Disorientation to time and place, but rarely to self.
• Develops rapidly over a short period
• Acute disorder that is not like the normal Neurocognitive disorer which is progressive.
• Inability to direct, focus, shift, and sustain attention.
• Disorganized thinking
• Safety is the number one concern, you must find the cause and treat it promptly.
• Delirium is reversible unless underlying cause is not fixed/treated.
• Affects short term memory, can have hallucinations/delusions

Delirium - Symptoms

• Difficulty sustaining and shifting attention
• Extreme distractibility
• Disorganized thinking
• Speech that is rambling, irrelevant, pressured, and incoherent
• Impaired reasoning ability and goal-directed behavior
• Disorientation to time and place - not to self
• Impairment of recent memory
• Disturbances in the level of consciousness, with interruption of the sleep-wake cycle - May keep sitters, Close to nurses station, may also use Low beds, Calendar, Clock, more frequent than Q2H, Familiar items may also be present in room.
• Psychomotor activity that fluctuates between agitation and restlessness and a vegetative state.
• Emotional instability and autonomic manifestations may be apparent (tachycardia, sweating)
• Flushed face
• Dilated pupils
• Elevated blood pressure

Predisposing Factors

• May occur from medication use, find out the underlying cause and treat it for the individual
• The disorder can have a slower onset if the underlying etiology is systemic illness or metabolic imbalance
• Duration is brief and subsides upon elimination of the cause.
• Symptoms diminish over a 3 - day period.
• Delirium due may also due to general medical condition, such as Infections, febrile illness, metabolic disorders, head trauma, seizures, migraine headaches, brain abscess, stroke, and electrolyte imbalance.
• Substance-induced delirium includes Intoxication or withdrawal from certain substances (anticholinergics, Antihypertensives, Corticosteroids, anticonvulsants, analgesics, alcohol, amphetamines, cannabis, cocaine, hallucinogens, and/or toxins.

Interventions

• Asses the indivual's for difficulty with orientation, illusions and/or hallucinations.
• Safety is the number one priority for interventions, you must identify the cause and treat it to resolve the issue.
• Frequent reorientation - Simple, and Short directions.
• Avoid sedative medications and sensory adaptations.

Major and Mild Neurocognitive Disorders - Dementia

• Broad term used to describe progressing deterioration of cognitive functioning.
• There is not a change in consciousness.
• Patient experiences difficulty with memory, problem-solving, and complex attention.
• Mild: Does not interfere with ADLs and does not necessarily progess to major
• Major: Interfereres with daiily functioning and independence
• Dementia is a collection of symptoms
• Impairment exists in abstract thinking, judgment, and impulse control.

Neurocognitive Disorder Symptoms

• Conventional rules of social conduct are disregarded (Inappropriate behavior) and there are problems with impulse control.
• Personal apperance and hygiene is neglected.
• Language may and may not be affected.
• Aphasia: in severe cases of neurocognitive disorder, an individual may not be able to speak at at all.
• Personality change is common.
• Language may and may not be affected.
• In severe cases of Neurocognitive disorder, an individual may not speak at all.
• Aprexia: Loss of purposeful movement.
• Agmosia: Loss of sensory ability to recognize objects.
• Personality change is common, ensure Saftey comes first the priority

Reversible Neurocognitive Disorder

• Reversible Neurocognitive disorder(NCD) may be more appropriately termed temporary NCD.
• It can occur as a result of subdural hematomas, brain tumors, depression, side effects of medications, nutritional deficiences, and metabolic disorders.
• As the disease progresses, the patient may expereince Aphasia and Apraxia

Alzheimer's Disease

• Alzheimer's Disease (AD) accounts for 60% to 80% of all cases Neurocognitive disorder and is a common cause of dementia.
• It is importnat to remember the patinet's stage of AD.
• Stage 1. No apparent symptoms and there are no apparent decline in memory despite changes.
• Stage 2. Very mild change, the patient begins to lose things oro need to remeber hte names of people.
• Stage 3 Mild cognitive decline, there is an interference with work performance becoming noticeable to Coworkers, and interruptions in concentation. The patient may experience difficulties recalling names or words noticeable to family.
• STAGE 4. Moderate Cognitive Decline, The individual may forget major events in personal history, such as their child's birthday. Patient may also deny they have a problem.
• STAGE 5. Moderately Severe Cognitive Decline, Individuals loses the ability to perform many activities of daiily living (hygeine)
• Stage 6, Severe Cognitive Decline can occurs when individuas are unable to name thier spouses and may misidentify them. Stage 7: Very severe decline. In the end, stages of Alzheimer's patients cannot recognize family members, the Indivual is often Bedfast and they can Develope Immobile

Neurocognitive Disorder Due to Alzheimer's Disease -Predisposing factor's.

• Slow onset and insidious.
• The Course is usually in Progressive
• increasing the Clinicians are ABLE to Identify the Disease with considerable Accuracy Using tools.
• Etiologies May Include Neurotransmitter & Plauqes and Tangles .

Substance Induced ,NeoroCogonititve Disoders factors,.

• This Occurs AS A Result of the abusive substances. ALchol,inhalants,Sedatives and Toxins May Cause.these conditions,.

Neurocognitive Disorders are Also DUE to Other Medical conditions. Hypothyroidism is one the reasons to developing this brain. Application of the Nursing Process/Assessment:

Patient's History.

• Areas of Concern Should Be Addressed .Type, Frequency, and Severity of Mood Swings .Cognitive Changes Such as Problem with Attention Span.
• Physicial Assmt & and a Neuro Assmt Needs to done. Assess Mental Status, Alertness,Muscle Strength, Reflexes. Sensory, Perception.

Other Nursing Interventions for NCD.

• GoalsPreventing Injuries.
• Intervention Adjusting Furniture & Education.
• Disturbed Process
• Keep Safe . Verbal Commincation & Self Care Defiicit Safety,Safety ,Saftey!!!!.

Patient Family Education

• Nature of Illness
• Medication Administration
• Management of the illness
• Ways to Ensure Safety
• Nutritional. High Calorie and Protein PreVent . High Fibre, Increase Fluid Intake
• Support Services .Financial Assistance Legal Assistiance,CareGiver Support Groups. Quality Saftey in Education for Nurses.

Medical Treatments Modals.

• Deliruim is treated by Determine,

• Correct Underlying causes, and Remain with the Patient.

• Low Dose Anit Psychotics To to treat such agression! Neruo Conitive Disorder:

• Primacy Considered GiveN,Primary Consideration IS Given to Resolve all process.

• Agents in Conitive ImpairMent Are all CHOlINSTERASE .

• Pharmaceutical Agents For Anexity Can Be USED In the Proloned Areas.

Medications Specific Notes

• NMDA Antagonist * Nameda .
• Moderte to SeverE.
• NMDA ,Normal Glutimate ,prevnt. Damage!
• Diziness Constipation may occur.

Survivers OF ABUSE

• Ause IS THE maltreatment OF THE, One Person By Another.
• CDc Studies from 2018.1:4 OF WOMEN ,1:10 OF THE .
• CHILD ANd ELDER ABUSE CONTINUE tO be a Sig concern

Predisposing Factors

• -Biological Theories. Neorphusioliogcal. Amygdala & Biocemical Influnece.
• Genetic Influence
• Desorders of brain orgin
• Encepehliss and pyscological Influences.

intimate partner violence .

• Battering IS violence,phyical and sexual .
• Profile and batterting.
• Three phases, Phase Tension .
• Fear of Retaliation By the Partner lack of Financial SuPport &Lack of Support NetWork Religon Reasons &HOPE The the Partner is Changing

Child Abuse

• Pyscial AbuSE Any Non Accidetnal Injury Caused the Caregiver
• Emotional ABUSE Is the PAtern The Childs Impared mental Health
• Indicators ABUSE.
• Behavioral neglect. :
• Frequent Absent
• Begs or steles Food
• Lacks suffentn Clothing.

Sexually Transmitted.

• SEX ABUSE OF CHILDEXPOLiTation
• Inditactros of Sexual ABUSE *
• Difficulty Walking Experinces Suddern Appetite.

the Adult Suvivor INCest .

Is Not to Trus the relationship Low -SELF esteem sexual Assults "RAPE iS AGgreesion"

• Victim Likey Feel helpless and Violating
• The Long Term EFF depends largely of Indvl.
• VlC RESPonees
• Report to Authorities Where There
• Provide Safe ASS.

Treatment Modalitties

• Crisis Inverstion, Safe House ch 21 eating and Feeding Disoders

Risk Factors

• Psyscho factor. Needs the succeed or in sports.
• Coping with feelimgs .emotional abuse/ Neglects
• others Learned,Cultureal Influences
• AnnorexIA .Interence of gaining
• Low Body Wegb.

Bulimia Nervosa

• Sustain the The Food with Voming.
• Them High in racters
• ACcUTE CARE
• CBT
• ANOXIA .

Burmia Nursing!

Intveritons(p.579 to .574) ACUTE CARE. -Ng liQ. .DIETS -Consulit Dietian,. Them 576. THe Aging Adult . Adaption "LOSS Grienf *

" PSYCHATRIC

Always RULE SUbstance: PRetiction

BARRIERS TO .ACCURATE, PAIN MANAGEMENT OF THE MEDICATION OLDER. THE FINACal MEDICAtion

Understand substance use disorders, their symptoms, and treatments. The quiz covers symptom groupings like neglected responsibilities, tolerance, and risky use. It also addresses withdrawal management and effective motivational approaches.