Podcast
Questions and Answers
Which characteristic of substances is NOT typically associated with higher addiction potential?
Which characteristic of substances is NOT typically associated with higher addiction potential?
What physiological response occurs when an individual attempts to stop using a substance?
What physiological response occurs when an individual attempts to stop using a substance?
What occurs as a result of repeated substance use over time?
What occurs as a result of repeated substance use over time?
What is a typical outcome of the experience of intoxication after initial use?
What is a typical outcome of the experience of intoxication after initial use?
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Which of the following is NOT a consequence of substance use disorder?
Which of the following is NOT a consequence of substance use disorder?
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In the context of substance use, what does a 'short half-life (T ½)' imply?
In the context of substance use, what does a 'short half-life (T ½)' imply?
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Which factor is most likely to lead to increased substance use after initial experience?
Which factor is most likely to lead to increased substance use after initial experience?
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What symptom is NOT commonly associated with minor alcohol withdrawal?
What symptom is NOT commonly associated with minor alcohol withdrawal?
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Which medication is used in the seizure protocol for alcohol withdrawal?
Which medication is used in the seizure protocol for alcohol withdrawal?
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What should a positive response to any of the universal screening questions indicate?
What should a positive response to any of the universal screening questions indicate?
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What is a potential consequence of untreated alcohol withdrawal?
What is a potential consequence of untreated alcohol withdrawal?
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Which question in the CAGE-AID screening directly addresses feelings of guilt related to substance use?
Which question in the CAGE-AID screening directly addresses feelings of guilt related to substance use?
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Which stage of alcohol withdrawal is characterized by hallucinations?
Which stage of alcohol withdrawal is characterized by hallucinations?
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What is a primary concern when discontinuing benzodiazepines?
What is a primary concern when discontinuing benzodiazepines?
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What is the score interpretation for the CAGE-AID test if a person answers yes to one or more questions?
What is the score interpretation for the CAGE-AID test if a person answers yes to one or more questions?
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Which of the following is not a component of the CAGE-AID screening tool?
Which of the following is not a component of the CAGE-AID screening tool?
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Which medication is NOT indicated for alcohol cravings?
Which medication is NOT indicated for alcohol cravings?
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Which of the following statements about the universal screening questions is correct?
Which of the following statements about the universal screening questions is correct?
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What is the recommended approach for symptom management in alcohol withdrawal?
What is the recommended approach for symptom management in alcohol withdrawal?
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In which situation would a patient be sent to the ER during alcohol withdrawal?
In which situation would a patient be sent to the ER during alcohol withdrawal?
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Which of the following is NOT a possible impact of alcohol on health?
Which of the following is NOT a possible impact of alcohol on health?
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What is a significant characteristic of withdrawal symptoms?
What is a significant characteristic of withdrawal symptoms?
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Which of the following benzodiazepines is considered more potent and long-acting?
Which of the following benzodiazepines is considered more potent and long-acting?
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What constitutes substance use disorder according to the DSM-5?
What constitutes substance use disorder according to the DSM-5?
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What is NOT a factor that influences the physiological and psychological effects of substance use?
What is NOT a factor that influences the physiological and psychological effects of substance use?
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How does the continued use of the same amount of a substance affect its effects?
How does the continued use of the same amount of a substance affect its effects?
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Which of the following statements about the context of substance use is true?
Which of the following statements about the context of substance use is true?
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What characterizes the relationship between improvement in effects and continued substance use?
What characterizes the relationship between improvement in effects and continued substance use?
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When is substance use deemed more acceptable according to the content?
When is substance use deemed more acceptable according to the content?
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What implication does a diminished effect from continued substance use suggest?
What implication does a diminished effect from continued substance use suggest?
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What aspect of substance use is highlighted as potentially harmful?
What aspect of substance use is highlighted as potentially harmful?
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What is one potential indicator of stimulant use concerning behavioral changes?
What is one potential indicator of stimulant use concerning behavioral changes?
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Which of the following is a common physiological symptom of stimulant use?
Which of the following is a common physiological symptom of stimulant use?
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Which method of consuming cocaine generally results in the fastest onset of effects?
Which method of consuming cocaine generally results in the fastest onset of effects?
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What is a recommended action if a client exhibits severe agitation during stimulant withdrawal?
What is a recommended action if a client exhibits severe agitation during stimulant withdrawal?
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Which symptom is commonly associated with stimulant withdrawal?
Which symptom is commonly associated with stimulant withdrawal?
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What can occur as a result of long-term stimulant use regarding dental health?
What can occur as a result of long-term stimulant use regarding dental health?
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Which of the following statements about stimulant use is accurate?
Which of the following statements about stimulant use is accurate?
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What is a critical consideration when managing patients withdrawing from stimulants?
What is a critical consideration when managing patients withdrawing from stimulants?
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Which of the following is not a route-related harm associated with stimulant use?
Which of the following is not a route-related harm associated with stimulant use?
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What is the typical duration of effects for crystal meth following use?
What is the typical duration of effects for crystal meth following use?
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Study Notes
Partnering with Persons Who Use Substances
- Using a Harm Reduction Approach is the focus of assessment, treatment planning, and intervention
- This course (PPN 303) is offered at Toronto Metropolitan University's School of Nursing
Checking-in
- This section is part of a course on promoting mental health (PPN 303) at Toronto Metropolitan University.
- The course is taught by Daphne Cockwell.
Parking Lot & Making Space
- The topics of mental health and substance use can be triggering.
- Students should acknowledge their needs.
- If triggered, students should pause and connect to supports.
TMU Student Support Resources
- The Centre for Student Development and Counselling provides academic accommodations, appointments, and frequently asked questions
- It offers resources and policies about student wellbeing.
- Links to additional resources and counselling services are available on the webpage.
Land Acknowledgment
- Toronto is in the Dish With One Spoon Territory, a treaty among Indigenous peoples.
- The treaty involves sharing the land and protecting it.
- Europeans and newcomers are also included in this treaty.
Objectives
- Foundational aspects of screening, assessment, treatment planning, and interventions to support individuals experiencing substance use will be described.
- Nursing management of intoxication, withdrawal, harm reduction, and recovery goals will be introduced.
- Concurrent disorders treatment approaches for people with co-occurring mental health conditions and substance use will be examined.
- Key components of integrating a harm reduction philosophy and a SBIRT approach to practice will be explained.
Question
- What comes to mind when thinking about addiction and substance use?
Spectrum of Use, Foundational Concepts, Harm Reduction
- This section details how drug use, tobacco, alcohol, and cannabis vary across people.
Substance Use Spectrum
- Substance use falls on a spectrum, with various levels from non-use to addiction.
- Substance use (drugs, tobacco, alcohol, etc.) can be used for medical, religious, social, or coping purposes.
- The spectrum shows levels of benefit and harm associated with substance use.
Why We Need to Increase Substance Use Nursing Capacity
- Substance use disorders affect a broad spectrum of people.
- Early assessment and management improve outcomes.
- Stigma delays necessary care.
The Foundations of Substance Use Nursing
- Substance use disorders are complex, interconnected conditions affecting the whole person.
- Nursing care understands the bio-psycho-social aspects of these conditions.
- Nurses can assess, manage, and provide care during intoxication and withdrawal and ongoing recovery.
- Nurses understand various treatment models and options.
- Harm reduction frameworks are used in nursing practice.
What is Harm Reduction?
- Harm reduction is an approach to reduce substance-related harm without requiring abstinence.
- It focuses on reducing negative health, social, and economic consequences for people who use substances.
- It prioritizes public health, human rights, and social justice, along with equity, inclusion, dignity, and respect.
Harm Reduction Theory
- Practical level harm reduction is pragmatic and realistic, with a low threshold for engagement.
- Policy level harm reduction is mid-range and embedded within existing policies.
- Conceptual levels involve a value-neutral view of substance use and active user participation.
- Harm reduction programs include needle exchanges, methadone maintenance, law-enforcement cooperation, and smoking cessation programs.
Opioid Crisis/A View from the Frontlines
- This section discusses the opioid crisis from a frontline perspective, likely from a video presentation
- This section features commentary from Michael Kumako.
Question: Reasons for Substance Use
- This is a question to spark contemplation about possible reasons for substance use, likely a prompt for a discussion or presentation.
Potential Factors That Increase Risk of Severity of Use
- Concurrent mental health concerns
- Self-medication practices
- Emotional distress
- Decreased coping abilities
- Childhood abuse
- Personal or family history of substance use
But the Brain & Body is Involved as Well!
- Some substances that tend to be "more addictive" have a quicker onset and shorter half-life, requiring frequent use to maintain the effect.
- Examples of faster onset substances include injection, smoking, crushing, snorting.
- Treatment for these substances usually has a slower onset and longer half-life.
Neurobiology
- Drugs of abuse and excessive behaviors trigger similar dopamine release in the reward circuit of the brain, a crucial step towards addiction.
Process of Developing a Substance Use Disorder
- The initial use of substances leads to positive effects, but repeated use causes these effects to decrease, which leads to increased use.
- Shorter intervals between doses are also a marker for increasing use and developing a disorder.
- Long-term use often leads to negative aspects of use such as physical illness, problems with work or personal relationships or legal consequences.
Physiological/Psychological States
- Intoxication is the direct physical and psychological effects of a substance taken.
- Tolerance is a need for an increase in substance use to achieve the same effect or desired effect.
- Withdrawal is the reduction or stopping of a substance and includes symptoms.
Substance Use & Disorder
- Substance use involves ingestion/administration of psychoactive substances impacting health and behaviours.
- Substance use disorder is a cluster of psychological and behavioral symptoms despite significant problems and harms related to use.
DSM5 Substance Use & SUD Categorization
- DSM-5 categorized substance use and disorders into 10 types of substances.
- Severity levels for substance use disorders are mild, moderate, or severe.
Substance Use Disorder DSM V
- A problematic pattern of substance use leading to significant impairment or distress.
- It's characterized by repeated use in quantities or over longer periods than intended, persistent efforts to control use, craving, major role disruption, and use despite consequences.
- Additional factors like physical harm, social issues, and tolerance/withdrawal are important indicators.
Spectrum of Severity
- Mild = 2-3 symptoms
- Moderate = 4-5 symptoms
- Severe = 6+ symptoms
Contributing Factors
- Substance use disorders stem from a combination of internal and external factors.
Classes of Psychoactive Substances
- Depressants (alcohol, benzodiazepines, opioids)
- Stimulants (cocaine, methamphetamine)
- Hallucinogens (MDMA, marijuana, mushrooms)
- Anabolic steroids
Opioids
- Opioids are substances that engage opioid receptors and can include natural and synthetic substances
- Common types of opioids include opium, heroin and prescription pain medications like morphine, fentanyl, carfentanil, codeine, and others.
- They also have differing effects, durations, and levels of harm.
- Kratom is another important substance, and it has both stimulant and opiate effects influencing how it is categorized with respect to harm.
Opioid Effects (Intoxication)
- Symptoms of opioid intoxication include sedation, drowsiness, slowed breathing, decreased level of consciousness, calmness and pleasure, slurred/slowed speech, and heavy limbs
Overdose Prevention
- Carry Naloxone
- Use with Others
- Test Dose First
Opioid Withdrawal Effects
- Flu-like symptoms like muscle aches, pain, cold sweats, chills, stomach cramps, diarrhea, vomiting, nausea, tearing in the eyes, runny nose, agitation, anxiety, yawning, and increased heart rate and blood pressure are part of opioid withdrawal.
Opioid Withdrawal Syndrome
- Severity and length of withdrawal symptoms depend on the opioid substance and route of administration.
- IV/Intravenous routes are more quickly absorbed into the body.
Subjective Opiate Withdrawal Scale (SOWS)
- A subjective scale used to measure and document opioid withdrawal symptoms.
- This includes items like feelings of anxiety, restlessness, yawning and other physical and psychological symptoms.
Clinical Opioid Withdrawal Scale (COWS)
- A clinical scale to assess opioid withdrawal symptoms based on observed cues for withdrawal.
- It uses specific criteria for evaluating physical and psychological symptoms
Opioid Withdrawal Symptom Management Approach
- Non-medical methods like rest, fluids, and warm showers can ease opioid withdrawal symptoms.
- Over-the-counter medications can be useful in managing symptoms like nausea and pain.
- Prescription medications, tailored to the severity of the withdrawal, may be required in more severe cases.
Buprenorphine + Naloxone (Suboxone)
- It's a partial opioid agonist that manages withdrawal symptoms for 24 hours
- It's commonly combined with naloxone to discourage injection
- Suboxone has a lower risk of overdose compared to methadone.
- Potential side effects include nausea, constipation, and sedation.
Methadone
- A full opioid agonist used in maintenance therapy, prescribed by specialists.
- Common side effects include sedation and drowsiness.
Opioid Withdrawal Considerations
- Withdrawal, particularly when tolerance is lost, is associated with significant risks of overdose.
Opioids: Health Impacts
- Opioids pose risks of overdose, escalating tolerance, and withdrawal.
- They also cause gastrointestinal problems like constipation.
- Pregnant individuals should avoid abruptly stopping opioid use.
- Intravenous routes increase the risk of infections.
Medications Options for Opioid Use Disorder
- Various pharmaceutical and therapeutic tools are available to improve opioid use disorder.
- The section lists medication options for opioid use disorders, including opioid agonists (OAT), injectable OAT, and safe opioid supply (SOS).
Label Me Person Lived Experience - Stephanie Bertrand
- Stephanie Bertrand shares her lived experience with substance use disorders/addiction.
Depressants
- Depressants slow down the central nervous system and mental processes.
- They induce a feeling of decreased alertness, slowing heart rate during intoxication and a fast heart rate during withdrawal.
- Common depressants include alcohol, benzodiazepines, and sedatives/tranquilizers.
Alcohol
- Common alcohol consumption limits are presented for women and men, indicating medically prescribed safe limits for weekly and daily drinking intake.
Problematic Drinking Versus Alcohol Dependence
- This section categorizes problematic drinking and alcohol dependence based on frequency and negative impacts on life roles and social contexts.
Screening for Alcohol Problems
- A comprehensive patient history should involve questions about alcohol consumption habits, frequency, and amounts.
Alcohol Withdrawal
- Symptoms of alcohol withdrawal include morning relief drinking, tremor, sweating, anxiety, seizures (especially in those with a previous seizure history), and delirium tremens, a severe form of withdrawal.
The Three Stages of Alcohol Withdrawal
- This section describes the progression of alcohol withdrawal symptoms, categorizing them into mild, intermediate, and major stages.
- The stages vary from autonomic symptoms (sweating, nausea, tremor) to potentially life-threatening consequences (e.g., delirium tremens).
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
- A standardized assessment tool for evaluating alcohol withdrawal symptoms
Medications to Help with Cravings/Relapse
- Specific medications like naltrexone (Revia), acamprosate (Campral), and disulfiram (Antabuse) are utilized to manage cravings and help people avoid relapses.
Alcohol: Health Impacts
- Alcohol use negatively impacts various aspects of health, including the liver, digestive system, and cardiovascular system.
- Alcohol use causes accidents, injuries, and mental health issues.
Alcohol Withdrawal: When to Send to ER
- Signs like escalating tremors, shaking, confusion, sweating, and hallucinations indicate the need for emergency care.
Benzodiazepines
- Benzodiazepines are central nervous system depressants commonly used for anxiety, insomnia, and seizure disorders.
Indications for Benzodiazepines
- Common use for anxiety disorders, mood disorders, sleep problems, and alcohol withdrawal or seizure disorders
Monitoring the Discontinuation of Benzodiazepines
- Gradual tapering under medical supervision should be implemented to avoid serious withdrawal issues.
- Abrupt discontinuation can lead to seizures.
Benzodiazepine Withdrawal Considerations
- Long-acting benzodiazepines, such as Xanax, have a higher risk of severe withdrawal compared to shorter-acting ones.
- Symptoms of benzo withdrawal can be masked; therefore, a thorough assessment is required beforehand.
- Clinicians support clients with slow tapering methods and provide primary health care physician/nurse practitioner support to effectively manage tapering periods.
Stimulants
- Stimulants increase central nervous system activity, and produce effects such as wakefulness, euphoria, reduced appetite, aggression, elevated body temperature, agitation, paranoid thoughts, delusions, and hallucinations.
Stimulants - Indicators of Stimulant Use
- This section outlines behavioural and psychological symptoms associated with stimulant use.
Cocaine/Crystal Meth
- Common methods of using these stimulants include smoking, snorting, injecting, and oral ingestion.
Stimulants: Health Impacts
- Stimulant use carries risks for cardiac events, mood deregulation (or mood dysregulation), accidental overdose, and contaminated supply issues.
- Certain routes of stimulant use- such as injecting or snorting - may contribute to nasal/septal perforations.
Perforated Septum
- A physical injury causing a hole in the nose, often from snorting substances
Perforated Palate
- Damage to the roof of the mouth, a physical injury usually from the use of certain substances.
Stimulant Withdrawal
- Symptoms of stimulant withdrawal include: "crash" feelings, fatigue, agitation, mood swings, strong cravings, feelings of anxiety, insomnia, paranoia, and possible suicidal thoughts, and itching.
Stimulant Withdrawal Symptom Management Approach
- Supportive measures during stimulant withdrawal are critical.
- The need for medical attention is highlighted for clients experiencing extreme anxiety, paranoia, or thoughts of self-harm.
Tobacco
- Tobacco use is the leading preventable cause of death in Canada.
- 18% of Canadians are current smokers
Hallucinogens
- Substances that change sensory and thought processes.
- Common hallucinogens include marijuana, PCP, and mushrooms.
Hallucinogens Key Points
- Effects vary among people and include risks for psychosis.
- Withdrawal symptoms are often protracted but not considered medical risks usually.
Steroids
- Performance enhancers that promote body building.
SBIRT
- Screening, Brief Intervention, and Referral to Treatment, a method for identifying and addressing potential substance use issues.
Purpose of Screening
- A formal process used to determine potential substance use or mental health concerns that may warrant more comprehensive assessments, including assessment of suicide ideations and behaviours.
- It's a quick way to gauge substance use in various settings.
Universal Screening Questions for Substance Use Disorders
- Commonly used questions to identify potential substance use issues.
Screening – CAGE-AID
- A validated screening tool for alcohol and substance use issues (consisting of questions to assess for possible substance use and concerns).
Brief Intervention
- Brief intervention utilizes motivational interviewing, goal exploration, and open dialogue with clients to work towards goals and identify possible solutions.
Referral to Treatment
- Referral to treatment should include co-ordinated access (central intake), withdrawal management services, and supervised consumption sites.
Stages of Change Model
- Used in counselling to identify a client's stage of change for better client interaction during counselling.
- Understanding a client's stage of change allows clinicians to tailor their approach and address the client's specific needs more adequately.
Assessing the Stages of Change
- Clinicians should ask clients open-ended questions to ascertain their stage of acceptance and preparation for change.
- Use questions to discover reasons for taking substances, list pros and cons of substance use, and support the client.
Supporting the Person in Action, Maintenance, and Relapse
- Action involves supporting a client in initiating changes and establishing or enacting new habits, and includes planning strategies for slips or relapses.
- Supporting maintenance entails continuing support to reinforce positive behaviours and address obstacles that may arise during the ongoing change period.
- Relapse prevention includes developing safety plans for triggers, coping mechanisms, and seeking support.
Additional Resources Needed to Improve Substance Use Disorders
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Test your knowledge on the characteristics and effects of substance use disorders. This quiz covers addiction potential, physiological responses to withdrawal, and the consequences of repeated substance use. Perfect for those studying psychology or substance abuse topics.
