Substance Use Disorders: An Overview

Substance Use Disorders: An Overview

• Substance use disorders represent a significant national health concern.
• Alcohol use disorder affects more than 16.6 million adult Americans and 697,000 adolescents aged 12-17.
• 14% of adults (18+) report binge drinking within the past month.
• Approximately 88,000 deaths are attributable to alcohol-related causes each year.
• Alcohol-related deaths are the third leading preventable cause of death in the USA.
• 30% of driving fatalities are alcohol-related
• Around one in eight children (8.7 million aged 17 or younger) live with a parent who has a substance use disorder.
• Children of alcoholics are four times more likely to develop alcohol problems.
• Opioid crisis in the US results in roughly 130 deaths daily from opioid overdose.
• Polysubstance abuse refers to the abuse of more than one substance.

Types of Substances and Their Effects

• Categories include alcohol, sedatives/hypnotics/anxiolytics, stimulants, cannabis, opioids, hallucinogens, and inhalants.
• Designer drugs (club drugs) are synthetic substances created by altering existing medications; they pose a problem due to their unregulated nature.
• Makers of designer drugs alter the substance slightly so it falls outside the boundaries of the law
• Intoxication refers to substance use resulting in maladaptive behavior.
• Withdrawal syndrome includes adverse psychological and physical reactions that occur upon substance cessation or reduction.
• Detoxification involves safely withdrawing from a substance.
• Substance abuse is the utilization of a drug in a manner inconsistent with medical or social norms, despite any negative repercussions.
• Substance dependence includes tolerance, withdrawal, and unsuccessful attempts to quit.
• Substance abuse and dependence is often used interchangeably with chemical dependence.

Onset and Clinical Course of Substance Use Disorders

• Alcohol intoxication commonly starts during adolescence.
• Early signs of alcoholism can begin between ages 12 and 14 years.
• "Sipping" alcohol may occur as early as 8 years, while major alcoholism challenges develop in the mid-20s to mid-30s.
• Experiences like relationship breakups, arrests, withdrawal symptoms, early health problems, and interference at work/school may occur
• Blackout: An episode when the individual continues to function with no conscious awareness or memory of their behavior.
• Tolerance: The need for increased amounts of alcohol to achieve the same effect
• Tolerance break: Very small amounts of alcohol cause intoxication after continued heavy drinking.
• Periods of abstinence or controlled drinking often characterize the later stages of alcoholism
• Attempts at controlled drinking often lead to escalation, further problems, and crisis
• Substance use is often characterized by relapses back to former levels of usage.
• Relapse rates are between 60% and 90%
• The highest rates of successful recovery are for people who abstain and actively work on relapse prevention
• Spontaneous remission: Some individuals can modify or discontinue drinking without formal treatment
• Poor outcomes are associated with earlier onset, longer usage, and co-occurring psychiatric illness.
• Extended substance use can cause mental and physical deterioration, infectious diseases, and increased suicide risk

Related Disorders and Etiology

• Gambling disorder is a non-substance-related diagnosis which is characterized by betting money one cannot lose, lying about gambling, getting money from others, and cannot refrain from for any specific time
• Caffeine, tobacco, and nicotine are addictive substances included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition
• Internet addiction is being discussed as a possible new type of addiction as many spend half or more of their time on the computer
• Anxiety, psychosis, and mood disorders may be induced by substance use that stops when they are no longer in the body
• Methamphetamine-induced psychosis can cause persisting psychotic symptoms even when it has left the body due to brain damage
• The causes of drug use, dependence, and addiction are complex, but biological, psychological, and social factors are thought to play a part.

Biological Factors Influencing Substance Use

• Children of alcoholic parents have an elevated risk of developing drug dependence.
• Genetic factors account for approximately 60% of alcoholism's causes.
• Substances trigger dopamine pathways in the limbic system.
• Mood-altering substances cause one to experience a “high”

Psychological and Social Factors

• Children of alcoholics are four times more likely to develop alcoholism
• Poor coping skills can cause substance abuse
• Some use alcohol as a coping mechanism
• Social attitudes affect influence initial and continued use of substances
• Availability and cost of substances correlate to usage
• The environment often influences the use of substances

Cultural Considerations in Substance Use

• Attitudes, usage patterns, and physiological responses vary across cultures.
• Muslims avoid alcohol, whereas wine is integrated into Jewish religious rituals.
• Native American tribes utilize hallucinogens like peyote for religious ceremonies.
• Flushing: Certain ethnic groups are predisposed to, or are protected from, developing alcoholism.
• Native Americans and Alaska Natives experience several leading causes of death that are caused by by alcohol abuse
• Alcohol consumption has quadrupled in Japan since 1960
• High rates of alcohol abuse, suicide, cigarette smoking, accidents, violence, and cardiovascular disease have been found in Russian men in the former USSR

Treatment and Nursing Interventions

• Alcohol is a central nervous system depressant and initial use causes relaxation and loss of inhibitions
• Long-term alcohol abuse can lead to cardiac myopathy, Wernicke encephalopathy, Korsakoff psychosis, pancreatitis, esophagitis, hepatitis, cirrhosis, leukopenia, thrombocytopenia, and ascites
• Initial priorities include safety, nutrition, fluids, and sleep

Treatment and Pharmacological Interventions

• Goals include assisting in a safe withdrawal process and preventing relapse
• Benzodiazepines like lorazepam (Ativan), chlordiazepoxide (Librium), and diazepam (Valium) can be used for safe withdrawal for tapering
• Disulfiram (Antabuse) helps prevent relapse by causing severe adverse reactions when drinking alcohol
• Acamprosate (Campral) reduces alcohol cravings
• Other medications are available to help taper off of opiates and reduce cravings for them
• General warning signs of abuse include poor work performance, frequent absenteeism, unusual behavior, slurred speech, and isolation from peers