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Questions and Answers
Questions and Answers
A person needs to consume increasing amounts of a substance to achieve the desired effects. Which of the following characteristics of substance use does this describe?
A person needs to consume increasing amounts of a substance to achieve the desired effects. Which of the following characteristics of substance use does this describe?
- Dependence
- Abuse
- Tolerance (correct)
- Withdrawal
Which of the following best describes substance abuse?
Which of the following best describes substance abuse?
- Needing increasing amounts of a substance to get the same effect.
- Using a substance in a way that leads to significant impairment or distress. (correct)
- Using a substance as prescribed by a doctor.
- Experiencing physical symptoms when a substance is stopped.
Which of the following is a key feature of substance dependence, according to the DSM-IV criteria?
Which of the following is a key feature of substance dependence, according to the DSM-IV criteria?
- Continued use of the substance despite problems (correct)
- Experiencing hallucinations when taking the substance
- Feeling pleasure when taking the substance
- Loss of appetite
Which of the following changes is the MOST indicative of substance abuse?
Which of the following changes is the MOST indicative of substance abuse?
What does 'withdrawal' refer to in the context of substance dependency?
What does 'withdrawal' refer to in the context of substance dependency?
Which of the following is an example of a volatile organic solvent that may be abused?
Which of the following is an example of a volatile organic solvent that may be abused?
Which of the following best describes the focus of Narcotics Anonymous (NA)?
Which of the following best describes the focus of Narcotics Anonymous (NA)?
Which statement accurately reflects a core principle of the 12 steps in programs like Alcoholics Anonymous?
Which statement accurately reflects a core principle of the 12 steps in programs like Alcoholics Anonymous?
Which of the following is a recognized sign or symptom of alcoholism?
Which of the following is a recognized sign or symptom of alcoholism?
Which statement accurately describes alcoholism?
Which statement accurately describes alcoholism?
What physical and psychological set of symptoms occurs when a person suddenly stops or reduces their alcohol intake after a period of dependency?
What physical and psychological set of symptoms occurs when a person suddenly stops or reduces their alcohol intake after a period of dependency?
Which of the following is a potential health consequence of chronic alcoholism?
Which of the following is a potential health consequence of chronic alcoholism?
Which cognitive disorder is closely related to Korsakoff's syndrome and often considered its precursor?
Which cognitive disorder is closely related to Korsakoff's syndrome and often considered its precursor?
What vitamin deficiency is most commonly linked to Korsakoff's syndrome?
What vitamin deficiency is most commonly linked to Korsakoff's syndrome?
Which dietary recommendation would be MOST appropriate for a client diagnosed with Wernicke-Korsakoff syndrome?
Which dietary recommendation would be MOST appropriate for a client diagnosed with Wernicke-Korsakoff syndrome?
A client undergoing detoxification for alcohol withdrawal begins to show signs of Delirium Tremens. Which of the following is the peak risk timeframe for this condition after the last drink?
A client undergoing detoxification for alcohol withdrawal begins to show signs of Delirium Tremens. Which of the following is the peak risk timeframe for this condition after the last drink?
A client is prescribed disulfiram as part of relapse prevention from alcohol abuse. Why is it essential that the client understands how to use disulfiram correctly?
A client is prescribed disulfiram as part of relapse prevention from alcohol abuse. Why is it essential that the client understands how to use disulfiram correctly?
Which of the following is a commonly used narcotic?
Which of the following is a commonly used narcotic?
Which of the following indicate early signs of narcotic withdrawal?
Which of the following indicate early signs of narcotic withdrawal?
A client states that they use heroin to escape reality and problems. Which cause of drug dependency is this behavior illustrating?
A client states that they use heroin to escape reality and problems. Which cause of drug dependency is this behavior illustrating?
A patient is hospitalized for a benzodiazepine overdose. Which of the following symptoms would support this diagnosis?
A patient is hospitalized for a benzodiazepine overdose. Which of the following symptoms would support this diagnosis?
What medication is used as an antidote for a benzodiazepine overdose?
What medication is used as an antidote for a benzodiazepine overdose?
A client is admitted to the hospital with respiratory depression due to an overdose of heroin. Which medication would the nurse prepare to administer?
A client is admitted to the hospital with respiratory depression due to an overdose of heroin. Which medication would the nurse prepare to administer?
A client is diagnosed with a chronic liver disease. Based on drug-disease interactions, which medication prescription should be avoided?
A client is diagnosed with a chronic liver disease. Based on drug-disease interactions, which medication prescription should be avoided?
Which of the following best describes co-dependency in the context of substance abuse?
Which of the following best describes co-dependency in the context of substance abuse?
Questions and Answers
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Flashcards
Flashcards
Substance Abuse
Substance Abuse
Harmful substance use that alters mood, impairs functioning, and increases risks.
Substance Tolerance
Substance Tolerance
Needing more substance for desired effects or diminished effects with regular use.
Substance Withdrawal
Substance Withdrawal
Syndrome of symptoms when substance use is abruptly stopped.
Behavioral Signs of Substance Abuse
Behavioral Signs of Substance Abuse
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DSM-5 Substance Use Disorder
DSM-5 Substance Use Disorder
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Common Health Problems from Substance Abuse
Common Health Problems from Substance Abuse
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Aromatic Hydrocarbons
Aromatic Hydrocarbons
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Dysfunctional Behavior Patterns
Dysfunctional Behavior Patterns
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Alcoholism
Alcoholism
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Signs and Symptoms of Alcoholism
Signs and Symptoms of Alcoholism
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Health Consequences of Alcoholism
Health Consequences of Alcoholism
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Mild Alcohol Withdrawal
Mild Alcohol Withdrawal
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Moderate Alcohol Withdrawal
Moderate Alcohol Withdrawal
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Severe Alcohol Withdrawal
Severe Alcohol Withdrawal
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Alcohol Withdrawal
Alcohol Withdrawal
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Wernicke's Encephalopathy (WE)
Wernicke's Encephalopathy (WE)
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Korsakoff's Syndrome
Korsakoff's Syndrome
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Korsakoff's Syndrome Treatment
Korsakoff's Syndrome Treatment
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Short Term Management of Alcohol Withdrawal
Short Term Management of Alcohol Withdrawal
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Long Term Alcohol Rehab
Long Term Alcohol Rehab
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Drug Abuse
Drug Abuse
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New & Emerging Drugs
New & Emerging Drugs
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Narcotics Purpose
Narcotics Purpose
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Opiate Withdrawal
Opiate Withdrawal
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Cocaine Overdose
Cocaine Overdose
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Flashcards
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Study Notes
Study Notes
Substance Abuse
- Impacts the central nervous system, leading to behavioral changes.
- Harmful substance use alters mood.
- Leads to significant functional impairment.
- Increases the risk of negative consequences.
Commonly Abused Substances
- Alcohol.
- Cannabis.
- Cocaine.
- Opioids.
- Methamphetamine.
- Hallucinogens.
- Inhalants.
Substance Dependency
- Tolerance requires increased substance amounts for desired effects.
- Tolerance results in diminished effects with regular use of the same dose.
- Withdrawal causes specific symptoms upon abrupt cessation of substance use.
Key Features (DSM-IV Criteria)
- Tolerance.
- Withdrawal.
- Taking larger amounts or for longer than intended.
- Persistent desire or unsuccessful efforts to cut down.
- Excessive time spent obtaining the substance.
- Giving up important activities due to substance use.
- Continued use despite problems.
Common Substances Linked to Dependence
- Alcohol.
- Opioids.
- Benzodiazepines.
- Nicotine.
- Stimulants, such as cocaine and methamphetamine.
Behavioral and Emotional Signs of Substance Abuse
- Loss of control over use.
- Irritability or depression when not using.
- Neglecting daily responsibilities.
- Using alone or in secret.
- Continued use despite awareness of harm.
DSM-IV vs. DSM-5
- DSM-IV requires 3+ symptoms for dependence.
- DSM-5 requires 2-3 symptoms for mild, 4-5 for moderate, and 6+ for severe Substance Use Disorder.
- DSM-IV separates abuse and dependence.
- DSM-5 combines abuse and dependence into one diagnosis.
- DSM-IV focuses on tolerance/withdrawal.
- DSM-5 uses broader criteria including craving and risk-taking.
Common Health Problems
- Poor nutritional status, loss of appetite, nausea, vomiting, and diarrhea can be health problems related to substance abuse.
- CNS dysfunction includes irritability, seizures, tremors, sensitivity to light, auditory & visual disturbances, and insomnia.
- Increased susceptibility to recurrent respiratory infections is a common health problem.
- Liver dysfunction, pancreatitis, hypertension, and cirrhosis may be present.
- Chronic brain damage and mental disorientation may occur.
- Poor hygiene and dermatologic changes are possible.
- HIV positive status.
Volatile Organic Solvents
- Aromatic hydrocarbons include toluene, ethylbenzene, and xylene.
- Aromatic hydrocarbons are found in adhesives, spray paint, thinner, lacquer, leather tanner, disinfectant, cleaner, petroleum, and octane booster.
- Halocarbons include trichloroethylene (TCY), 1,1,1-trichloroethane (TCE), tetrachloroethylene (PERC), and n-Propyl Bromide (nPB).
- Halocarbons are found in degreasing agents, coffee decaffeination products, film cleaner, correction fluid, dry cleaning agents, metal cleaner, and adhesives.
- Aliphatic hydrocarbons include propane, butane, n-Hexane, and Iso-Octane.
- Aliphatic hydrocarbons are found in domestic & industrial fuel, lighter fluid, adhesive, and automotive fuel.
Inhaled Anesthetics
- Halogenated Ethers include Isoflurane, Halothane, Desflurane, and Sevoflurane, which are general anesthetics.
- Nitrous Oxide is an adjunct anesthetic and aerosol propellant.
- Alkyl Nitrites include Amyl Nitrite, Isobutyl Nitrite, and Isopropyl Nitrite.
- Amyl Nitrite is a vasodilator used in heart disease treatment.
- Isobutyl Nitrite is found in air fresheners and electronics cleaner.
- Isopropyl Nitrite is a cyanide poisoning antidote.
Dysfunctional Behavior Patterns
- Manipulation can be a sign.
- Impulsiveness is a dysfunctional sign.
- Dysfunctional Anger can be a sign to look out for.
- Grandiosity can be a sign.
- Denial is a dysfunctional pattern.
- Co-dependency can be a sign.
Treatment Modalities
- Detoxification.
- Drug treatment & Rehabilitation.
- Pharmacologic Therapy.
- Psychotherapy.
Narcotics Anonymous (NA)
- Founded in California in 1953.
- Modeled after Alcoholics Anonymous (AA).
- Focuses on drug addiction for all types of drugs including prescription drugs, heroin, meth, etc.
- Present in over 140 countries.
The 12 Steps
- Admit powerlessness over addiction.
- Believe a higher power can help.
- Turn life over to that higher power.
- Make a moral inventory.
- Admit wrongs to self, others, and higher power.
- Be ready to remove character defects.
- Ask for help removing shortcomings.
- Make a list of people harmed.
- Make amends where possible.
- Continue self-inventory.
- Improve connection with higher power.
- Carry the message to others in recovery.
Alcoholism
- A drinking pattern that interferes with physical, social, familial, vocational, and emotional functioning.
- A chronic pattern of pathological alcohol use characterized by impairment in social or occupational functioning along with tolerance or withdrawal symptoms.
- Effects of alcohol include sedation.
General Information on Alcohol
- Alcohol is a legal substance, and there are millions of social drinkers.
- Alcohol is classified as a CNS Depressant.
- Incidence is increasing in adolescents.
- Alcoholism is considered a disease that can be arrested but not cured.
- It is a socioeconomic as well as a physiologic problem.
- Long-term use may result in loss of health.
Signs and Symptoms of Alcoholism
- Increased tolerance.
- Frequent blackouts.
- Drinking alone or in secret.
- Neglecting personal, social, or work obligations.
- Mood swings, depression, or anxiety.
- Legal or financial issues.
Health Consequences of Alcoholism
- Liver disease (cirrhosis, hepatitis).
- Heart disease.
- Cancer (mouth, liver, esophagus, breast).
- Neurological damage.
- Increased risk of accidents, suicide, and violence.
Assessment of Alcoholism
- Patterns indicative of alcoholism include episodic drinking (binges) and continuous drinking.
- Morning drinking indicative of alcoholism.
- Increase in family fighting about drinking is a sign.
- Increase in absences from work or school.
- Blackouts can be sign.
- Hiding drinking pattern.
- Legal problems can indicate alcoholism.
- Health problems such as gastritis often coexist.
- Family history of alcoholism or substance abuse is importnat to identify.
- Being Dependent and yet resentful towards authority.
- Impulsive, abusive behavior is often observed.
- Impaired judgment and memory loss.
- Incoordination and slurred speech.
- Mood varies between euphoria and depression.
- Intoxication.
- Previous experience with treatment centers or Alcoholics Anonymous (AA).
Alcohol Withdrawal
- The set of physical and psychological symptoms that occur when a person who is dependent on alcohol suddenly stops or reduces their alcohol intake.
- Symptoms of alcohol withdrawal include onset shortly after drinking stops, as soon as 4-6 hours.
- Anxiety, nausea, insomnia, tremors, hyper-alertness, and restlessness may appear.
- Sudden or gradual increase in all vital signs.
Timeline of Alcohol Withdrawal
- 6-12 hours after last drink: Tremors, anxiety, insomnia, nausea.
- 12-24 hours after last drink: Hallucinations (usually visual).
- 24-48 hours after last drink: Seizures.
- 48-72 hours after last drink: Delirium Tremens (peak risk).
Stages of Alcohol Withdrawal
- Mild Withdrawal (6-12 Hours after last drink).
- Moderate Withdrawal (12-24 Hours after last drink).
- Severe Withdrawal (24-72 Hours after last drink).
Cognitive Disorders of Alcoholism
- Alcohol hallucinations.
- Alcohol-related dementia, caused by poor nutrition.
- Korsakoff's syndrome.
- Wernicke's syndrome.
Korsakoff's Syndrome
- Also known as Korsakoff's psychosis.
- A chronic memory disorder caused by severe deficiency of thiamine (vitamin B1), often linked to prolonged alcohol abuse.
- Symptoms include memory loss, confabulation, and disorientation.
- Cognitive and emotional effects include impaired learning, attention problems, executive dysfunction, apathy, or emotional flatness.
- Physical symptoms include ataxia, muscle weakness, vision problems, and difficulty with speech.
- Treatment involves thiamine supplementation: intravenous (IV) and oral, nutritional support with Vitamin B1 supplementation, and a balanced diet.
Wernicke's Encephalopathy (WE)
- A neurological disorder closely related to Korsakoff's syndrome, often considered its precursor.
- Symptoms of Wernicke's encephalopathy include: Confusion, Ataxia, Ophthalmoplegia, and Nystagmus.
- Wernicke-Korsakoff's Syndrome Thiamine Rich Diet includes lean pork chops, salmon flax seeds, navy beans, green peas, and asparagus muscles.
- Treatment includes thiamine replacement, nutritional support, alcohol abstinence, and cognitive rehabilitation.
Short-term Management: Detoxification Related to Alcohol Withdrawal
- 6-8 hours after drinking: Tremors, Sweating, and Agitation.
- 8-12 hours after drinking: Visual and auditory hallucinations.
- 2-3 days after drinking: Stage 2 and seizures.
- 2-5 days after drinking: Delirium Tremens.
Long Term Management: Rehabilitation related to Alcohol Withdrawal
- Give up Alcohol with Cognitive Behavior Therapy and Marital & Family counseling.
- Live a positive life.
- Support Groups like:
- Alcoholic Anonymous for patient.
- Al-anon for immediate family (Spouse or parent).
- Alateen for Teenager or child of the alcoholic patient.
- Acoa: Adult children of alcoholics.
Nursing Interventions for Alcohol Withdrawal
- Stay with the client.
- Monitor VS and blood sugar levels.
- Observe for tremors, seizures, increased agitation, and anxiety.
- Provide fluids, adequate nutrition, and a quiet environment.
- When the client is stable, provide information about rehabilitation programs.
- Monitor for bleeding if taking oral anticoagulants.
Group Therapy
- Number of Participants 8-10
- Stage: Forming, Norming, and Storming
- Formation: Circular Formation
- Leader: Stable Patient
- Most Important Element: Motivation
Drug Abuse
- A state of dependency where a substance is used repeatedly, involving altered perception and/or mood.
- Drug Abuse can involve prescription or Street drugs.
Types of Drugs Commonly Abused
- Legal Drugs:
- Alcohol.
- Tobacco.
- Prescription drugs (painkillers, sedatives).
- Illegal Drugs:
- Marijuana.
- Cocaine.
- Heroin.
- Methamphetamine.
- New & Emerging Drugs:
- Synthetic drugs (Spice, Bath Salts).
- Vaping products.
Narcotics
- Purpose: To escape Reality
- Commonly used Narcotics:
- Codeine.
- Heroin.
- Oxycodone.
- Morphine.
- Meperidine.
Early Signs of Narcotic Withdrawal
- Lacrimation.
- Diaphoresis.
- Rhinorrhea.
- Yawning.
- Dryness during withdrawal.
Late Signs of Narcotic Withdrawal
- Vomiting.
- Diarrhea.
Assessment Findings for Drug Abuse/Dependency
- Determine pattern of drug used.
- What drug is used?
- What the drug of choice is?
- How much is used and how often?
- How long has drug/s been used?
- Physical evidence of drug usage:
- Needle track marks.
- Cellulitis at puncture sites.
- Poor nutritional status.
Possible causes of drug dependency
- Desire to escape reality and problems.
- Low self-esteem.
- Peer or cultural pressure.
- Inherent susceptibility to drug dependence.
Drug Withdrawal, Overdose, and Effects by Drug Type
Opiates (Heroin, Morphine, Meperidine, Codeine, Opium, Methadone)
- Withdrawal: Watery eyes, dilated pupils, Anxiety, Diaphoresis, fever, N/V, and diarrhea, Insomnia, Tachycardia
- Overdose: Respiratory depression-respiratory arrest, Circulatory depression-cardiac arrest, Unconscious-coma, Death
- Effect: General physical and mental deterioration, Rapid tolerance, Impaired judgment
Cocaine
- Withdrawal: Depression, Fatigue, Disturbed sleep, Anxiety, Psychomotor agitation
- Overdose: Tachycardia, Pupillary dilatation, Increased BP, Cardiac arrhythmias, Perspiration, chills, N/V
- Effect: Psychomotor dependence, Tolerance within hours or days
Amphetamines
- Withdrawal: Depression, Fatigue, Disturbed Sleep
- Overdose: Restlessness, Tremors, Rapid Respiration, Confusion, Assaultive behavior, Panic
- Effect: Paranoid Delusion
Hallucinogens
- Withdrawal: None
- Overdose: Panic, Psychosis
- Effect: Flashbacks, Impaired judgement
Benzodiazepines (Valium, Serax, Ativan)
- Withdrawal: Tremors, Agitation, Anxiety, Abdominal Cramps, Grandmal Seizures
- Overdose: Drowsiness, Confusion, Hypotension, Coma
- Effect: Withdrawal occurs if abrupt cessation, Temporary psychosis
Cause of Drug Abuse
- Peer Pressure
Mental Health Issues
- Mental health issues(e.g. depression, anxiety)
- Family problems or Trauma
- Curiosity or Thrill Seeking
- Lack of Education or Awareness
Drug-Disease Interactions
- Asthma: Avoid Beta Blockers as they can cause bronchospasm.
- Chronic Liver Disease: Avoid Warfarin which can cause increase sensitivity and bleeding.
- CHF: Avoid Calcium Channel Blockers and NSAIDs as this can cause Sodium Retention, increase risk of cardiac events.
- Epilepsy: Avoid Steroids (Prednisone) as this causes Sodium & Water Retention
- HPN: Avoid TCA's, Antimalarial, Antipsychotics as this Reduced Seizure Thresholds
- Parkinson's Disease: Avoid NSAIDs as this causes Increase BP due to Sodium Retention
- Renal Failure: Avoid COX-2 Inhibitors as this can cause Worsening of the disease
- Respiratory Failure: Avoid NSAIDs as this causes Nephrotoxicity
- Avoid Neuroleptics as this causes Respiratory Depression
Antidotes by Drug Type
- Opioids - Naloxone (Narcan)
- Warfarin - Vitamin K
- Heparin - Protamine Sulfate
- Digoxin - Digifab/Digi bind
- Anticholinergics - Physostigmine
- Benzodiazepine - Flumazenil
- Cholinergic Crisis - Atropine
- Acetaminophen - Acetylcysteine
- Magnesium Sulfate - Calcium Gluconate
- Lead - Succimer or Calcium Disodium Edetate
- Alcohol Withdrawal - Chlordiazepoxide
- Beta Blockers - Glucagon
- Aspirin - Sodium Bicarbonate
- Calcium Channel Blockers - Glucagon, Insulin, Calcium
Nursing Interventions for Drug Abuse
- Assess level of consciousness and vital signs.
- Monitor intake & output and electrolytes.
- Implement suicide precautions if assessment indicates risk of self-harm.
- Provide adequate nutrition, hydration, and rest.
- Focus on substance abuse problem.
- Confront placing blame on external problems.
- Reinforce reality with simple, concrete terms
- Encourage verbal expression of anger and depression.
- Assist with identification of stressors and areas of conflict.
- Positively reinforce insight into behavior patterns.
- Help identify an appropriate support system.
- Provide support to significant others.
- Provide adequate nutrition, hydration, and rest.
- Administer medications according to the detoxification protocol of the medical unit.
- Teach danger of AIDS and blood-related diseases.
- Provide adequate nutrition, hydration, and rest.
Serious Effects of Drug Addiction
- Impact on Children: 1 in 5 children grow up with a parent who abuses drugs or alcohol, and abused children have a higher chance of addiction later in life
- Loss of Trust: Addicts aren't likely to follow through on their word even if they mean to initially, which causes strain in their relationships
- Increased Stress: Those who live with an addict tend to take on stress due to their partner neglecting them and their responsibilities
- Financial Problems: Whether it's financing drugs & alcohol, or losing a job due to substance abuse, addiction causes massive financial strain
- Physical & Emotional Abuse: Those who abuse substances are likely to act out against their loved ones, abusing them in the process
- Fear & Confusion: Drug abuse typically makes a person's actions unpredictable, so to avoid conflict, loved ones may walk on eggshells out of fear.
Co-Dependency
- It is a set of maladaptive behaviors exhibited by the loved ones of those with substance use disorders.
- Codependent behaviors allow an individual to maintain control by fulfilling the needs of the person with a substance use disorder.
- Behaviors include concealing the severity of the substance use, receiving physical or psychological abuse from the client, withholding the client to experience the consequences of their actions, and making excuses for the client's habit.
- Codependent individuals focus all their attention on others at the expense of their own sense of self.
- Codependent spouses, friends, and family members can keep the client from focusing on treatment; this behavior is counterproductive to both themselves and the client.
- Codependency can look different in each family dynamic, but it is almost always coupled with enabling the client and failure to recognize that the client has a problem.
Questions to ask yourself and key facts to remember
- Opioid use disorder often indicated by dilated pupils and sweating.
- Group therapy for substance use disorder promotes socialization and Provides emotional support.
- Methadone reduces cravings and withdrawal symptoms.
- Narcotics Anonymous (NA) provides peer support for those in recovery.
- Korsakoff syndrome is characterized by severe memory impairment.
- Wernicke's encephalopathy is typically caused by thiamine deficiency.
- Administering Intravenous thiamine is a priority intervention for Wernicke's encephalopathy.
- Common sign of Wernicke's encephalopathy: Nystagmus and ophthalmoplegia.
- Cocaine overdose often indicated by active hallucination, agitation, with irritating nasal septum.
- Cocaine overdoes shows clients frequently use cocaine but can control it at anytime, the client is in denial.
- Spouse exhibiting codependence tries to keep their children quiet so their spouse can sleep off their weekday drinking.
- The LEAST effective education and preventive measure for substance abuse are displaying leaflets and brochures.
- Alcohol withdrawal common in early stages: increased heart rate and tremors.
- Major effect of long term alcohol consumptions includes damage to the GI tract and liver.
- Diazepam is commonly prescribed for delirium tremens (DTs).
- Early stage of alcohol withdrawal could be Perceptual disorder.
- Opiate withdrawal effects can be minimized by use of methadone.
- Do not try to find out WHY they started abusing drugs, try to find out about the drugs they used and the length of time.
- Naloxone (Narcan) reverses sign of meperdine and codeine for personal consumption.
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