Substance Abuse PDF

SUBSTANCE ABUSE  SUBSTANCE ABUSE Substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress affecting occupation, social and other areas of functioning occurring within a 12 months period. It is a recurrent substance use resulting in a...

SUBSTANCE ABUSE  SUBSTANCE ABUSE Substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress affecting occupation, social and other areas of functioning occurring within a 12 months period. It is a recurrent substance use resulting in a failure to fulfill major role obligation at work, home, school causing legal problem (arrest for substance related disorder conduct), and disharmony at home (husband and wife) with or without physical hazards.  WHO defines substance abuse as a persistent or sporadic excessive use of a drug and that use of drug is inconsistent with or unrelated to acceptable medical practice. With the definition any drug can be abused. Drugs are chemicals substances that influence or modify the action of body's chemistry.  TERMS RELATED TO SUBSTANCE ABUSE DRUG DEPENDENCE (Drug Addiction, Drug Habituation) the two are similar and because of the similarity the WHO committee substituted drug addiction with drug dependence. Drug Dependence is the reliance on drugs psychologically, or physically to the extent of experiencing a withdrawal syndrome if left unfulfilled (if the drug is not taken)  Addiction is a compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity having harmful physical, psychological, or social effects and typically causing well-defined symptoms (such as anxiety, irritability, tremors, or nausea) upon withdrawal or abstinence (Webster, 2020).  DRUG TOLERANCE This is a situation whereby an abuser have to increase dosage to get the initial pleasurable effect of the substance OR The need for increasingly larger or more frequent doses of substance in order to obtain the desired effects originally produced by a lower dose  PHYSICAL DEPENDENCE This refers to the continuing, uncontrolled and compulsive use of drugs not only to induce intoxication but also to avoid the tortures of its withdrawal or to avoid desirable side effects that may arise from sudden withdrawal symptoms. Withdrawal symptoms can be accompanied with pain, dyspnoea, sweating, tremor, lacrimation, diarrhea, etc.  Psychological Dependence This occurs when an individual takes a drug regularly and craves for it because of its pleasant effects has been so used to having it and there is tendency to relapse after stopping it.  DSM-IV Criteria for Substance Dependence At least three of the following must present for a diagnosis of substance dependence: 1. Tendency for tolerance to develop and for the dose of the drug to be steadily increased 2. Unpleasant withdrawal effect which follows when the drug is stopped. 3. An over powering desire or need to continue taking the drug and to obtain it by any means or at all cost. 4. Important social, occupational or recreational activities are given up or reduced because of substance use. 5. There is a persistent desire or unsuccessful efforts to cut down or control substance use.  Substance Intoxication: is defined as the development of a reversible effect, specific syndrome caused by the recent ingestion of (or exposure to) to a substance (APA,2000) Withdrawal syndromes: the unpalatable physiological and mental re-adjustment that accompanies the discontinuation of an addictive substance.  CLASSES OF DRUG DEPENDANT Therapeutic Dependant: When people are placed on analgesics on course of the treatment for physical disabilities or other ailment and eventually become dependents on the drug. Occupational Dependant: Professional dependant e.g. doctors, nurses pharmacists, dental and surgeon.  CLASSES OF DRUG DEPENDANT True Dependant: People in this group includes men and women, well educated people and business executives who are induced to take drugs usually by their friends as an attempt to widen the range of awareness and experience.  ETIOLOGY Idiopathic 2. Social Theory Predisposing Factors This postulates peer include: influence can 1. Biological Factors predispose to (Genetics) substance use. Apparent hereditary factor is evident with alcoholism. Children of alcoholics are 3 3. Cultural Factor times more likely to become Individuals who grow alcoholics (Harvard Medical up within a culture School, 2001) Monozygotic twins have where substances are higher rate for concordance acceptable, available of alcoholism than dizygotic and accessible are twins (Andreasen & Black, more likely to become 2006). abuser. 01/23/2025 MCPDP 14  ETIOLOGY 4. Psychological Theory 5. Behavioral Theory This theory holds the notion Certain behavioral that people with the following characteristics of childhood personality traits are more & adolescence can susceptible to substance predispose to substance abuse: use. E.g. i. Deviance i. Excessive dependency needs ii. Misbehavior ii. Needs for success or power iii. Aggression iii. Inability to adequately care for self iv. Religiousness iv. Gender identity problem v. Emotionality v. Inability to cope with vi. Depressed mood overwhelming painful feelings vii. Low self-esteem vi. Dysfunctional family viii.Self-derogation dynamics (Chassin, 2000) 01/23/2025 MCPDP 15  Risk Factors for Substance Abuse Peer pressure Success Desire to experiment Disappointment Siblings exposure High-risk job Employment outside Advertisement home Poor parenting Unemployment syndrome Loss of job Rapid urbanization Parental deprivation Drug availability Failure Drug accessibility  SUBSTANCES COMMONLY ABUSED CNS Depressants OPIOIDS 1. Alcohol (most common) 2. Barbiturate 1. Morphine 3. Diazepam 4. Marijuana 2. Heroine (Cannabis/Indian 3. Codeine hemp/Igbo/Ganja) 4. Pethidine CNS Stimulants 5. Meperidine 1. Amphetamines (Ephedrine) 6. Opium 2. Cocaine 3. Caffeine 7. Pentazocine 4. Colanuts 8. Tramadol 5. Tobacco 01/23/2025 MCPDP 17  SUBSTANCES COMMONLY ABUSED HALLUCINOGENS Analgesics e.g. Lysergic Acid Diethylamide (LSD) Paracetamol, Ibuprofen, Mescaline (peyote) Diclofenac, Psilocybin (mushroom) Indomethacin, etc. Phencyclidine piperidine, PCP (angel dust, peace pill, horse tranquilizer) Antibiotics e.g. Marijuana (Cannabis/Indian Ampiclox, Ampicillin, hemp) Tetracycline, Metronidazole, etc. Hallucinogens lead to disturbances of feeling, thinking and perception i.e. psychotic-like syndrome There may be no physical dependence but psychological dependence is strong 01/23/2025 MCPDP 18  Others include: Pit toilet Cough syrups - gas/fumes Benylin, Tutolin, Spirit Groundnut shell Pawpaw leaves Vitamin C, ‘Gegemu’ Prednisolone, Colorado Piriton Shisha Gelucil Paint And so on……. Nail polish remover Lizard feaces 01/23/2025 MCPDP 19  Withdrawal Syndrome This refers to an unpleasant withdrawal effects which occurs if the use of drug or substance is stopped abruptly. Some drugs may produce symptoms such as shivering, stomach cramps, tremors, convulsion, diarrhea, delirium, etc.  Heroine Withdrawal Symptoms Excitement Altered mental Restlessness altered state Diaphoresis Apprehensive (sweating) Twitching Nausea Tremors Vomiting Anxiety Diarrhoea Loss of weight Insomnia Convulsion Abdominal cramp Headache collapse Alcohol Withdrawal Symptoms Tremor Diaphoresis Tachycardia Depressed mood Anxiety Elevated Bp Palpitation Nausea Hallucination vomiting Headache Irritability Insomnia seizure  Cannabis Withdrawal Intoxicating Effects Symptoms Impaired judgment Restlessness Increased appetite Agitation Suspiciousness Insomnia Sensation of slowed Irritability time Loss of appetite Anxiety Conjunctiva redness Hallucination Euphoria Tachycardia  Cocaine Withdrawal Intoxicating effects Symptoms Delirium Paranoid delusion Euphoria Psychomotor agitation Papillary dilatation Anxiety Perspiration Social withdrawal Tachycardia Suicidal ideation Hallucination Fatigue Hyper vigilance Irritability Fighting Insomnia Impaired judgment Depression Grandiosity  NOTE-Drug Misuse the use of drug for purpose for which it was not intended or using a drug in excessive quantities. OR The illegal or illicit drug taking or alcohol consumption which leads a person to experience social, psychological, physical or legal problems.  MANAGEMENT The management is geared towards dealing with overdoses The incidental medical consequences of drug use such as malnutrition and medical problems caused by unsterile needles An addict may require hospitalization for detoxification as is common among alcoholics  Medical Management Psychotherapy (Individual or group) Aversion therapy (Using disulfiram) Occupational therapy Social Support Group Rehabilitation.  NURSING CARE Nursing care should be aimed at promotion of self care, promotion of good nutrition, and prevention of relapse Rest –admission to drug ward Psychological care– create a relationship of mutual trust and understanding. The approach should be sympathetic but firm. Nutrition– good nourishing diet, an addict does not eat well because of constant use of drug or smoking of Indian hemp. Vitamin esp. Vit Bcomplex, protein, minerals, fruits Copious fluid intake  Physical care (grooming, dressing, oral care, care of the hair) Counseling this can be done by allowing former drug addict to relate his experience Addict Anonymous– former addicts who are now helping others to be free from addict through group meeting, discussion and counseling  SOCIAL/ECONOMIC,PSYCHOLOGICAL PROBLEM OF DRUG ABUSE/DEPENDENCE Marital problem—broken homes, neglect of wife, husband, and children Illegal dealing leading to conflict with law enforcement agencies Negligence of duty—lateness to school absenteeism Financial bankruptcy Loss of job Reduce mental and intellectual functioning Personality and emotional disorder Neglect of personal hygiene PHYSICAL PROBLEM (WITH COMPLICATIONS) Neglect of personal hygiene Resistance to most antibiotics Vitamin deficiency Loss of weight Dermatitis Multiple abscess Syringe and needle transmission disease AIDS, Hepatitis, etc.  Liver disturbance Septicaemia as in heroine addiction Endocarditis Dermatitis delirium tremens Dehydration Reduction level of consciousness Psychiatric illness Suicide Loss of job Loss of friends divorce  EFFECTS OF DRUG ABUSE Individual Family Society Dropping out of Family neglect Social isolation school Frequent quarrels Nuisance Loss of job to the Marital disharmony society Unemployment Separation Reduced productivity Accident Financial problem Divorce Increased crime rate Antisocial behavior Social High incidence of Personal hygiene embarrassment psychiatric disorders neglect Stigmatization Problem of withdrawal symptoms Altered CNS functioning 01/23/2025 MCPDP 33  MANAGEMENT The management is geared towards dealing with overdoses The incidental medical consequences of drug use such as malnutrition and medical problems caused by unsterile needles An addict may require hospitalization for detoxification as is common among alcoholics GENERAL PRINCIPLES OF CARE Maintain health, nutrition, safety and hygiene Examine your own feelings about substance abuse Establish a non-judgmental relationship Focus on the positive and reduce the negatives Provide education for clients and families 01/23/2025 MCPDP 34  NURSING MANAGEMENT Nursing care should be aimed at promotion of self care, promotion of good nutrition, and prevention of relapse. Assessment 1. Age 2. Gender 3. Developmental stage (cognitive ability & physical maturity) 4. Medication history (prescription & over-the-counter) 5. Family status (living arrangement, family dynamics, hx or current evidence of substance abuse & financial status) 01/23/2025 MCPDP 35  6. Social status (peer group, related pressures & level of activities) 7. Psychological statue ( evidence of depressive disorder, feelings of isolation, hx of attempted suicide and level of self- esteem) 8. Knowledge of risk associated with drug s, alcohol or other psychoactive substances. Sleep & Rest –admission to drug ward Psychological care– create a relationship of mutual trust and understanding. The approach should be sympathetic but firm Nutrition– good nourishing diet, an addict does not eat well because of constant use of drug or smoking of Indian hemp. 01/23/2025 MCPDP 36  Vitamin esp. vit B complex, protein, minerals, fruits, etc. Copious fluid intake Physical care (grooming, dressing oral care, care of the hair) Guidance & Counseling: this can be done by allowing former drug addict to relate his experience. Psychotherapy (individual or group). Aversion therapy (Antabuse commonly used) 01/23/2025 MCPDP 37  Occupational therapy Social therapy Rehabilitation Addict Anonymous– former addicts who are now helping others to be free from addict through group meeting, discussion and counseling  Prevention Strategies Prevention strategies targeted toward substances use is in three folds: 1. Primary prevention - aims to prevent people from using drugs. Public enlightenment in schools, churches, mosques, market, etc. Drug education in school curriculum. Integrating care into 1,2 and 3 HC’s. 2. Secondary prevention – aims to reduce existing risk behavior & symptoms via early intervention and treatment. 3. Tertiary prevention – aims to reduce the already established disabilities following drug use.  THANK YOU FOR LISTENING. January 23, 2025 40