Substance Use and ETOH (Chapter 14) PDF

Hallucinogens [pg. 323]: Diverse group of drugs with unpredictable, idiosyncratic reactions Natural: ○ Mescaline, Psilocybin, Salvia Synthetic compounds: ○ Lysergic acid diethylamide (LSD) ○ Dextromethorphan (DXM) ○ Phencyclidine (PCP) (...

Hallucinogens [pg. 323]: Diverse group of drugs with unpredictable, idiosyncratic reactions Natural: ○ Mescaline, Psilocybin, Salvia Synthetic compounds: ○ Lysergic acid diethylamide (LSD) ○ Dextromethorphan (DXM) ○ Phencyclidine (PCP) (dissociative anesthetic) ○ Ketamine (dissociative anesthetic) ○ MDMA (also has stimulant effects) Intoxication symptoms: ○ Altered perceptions, hallucinations ○ Impaired judgment ○ Intensification of sensations and feelings ○ Depersonalization/derealization ○ Emotions- euphoria, peace, paranoia, and panic ○ Increased BP, HR, and blood glucose ○ N/V, chills, loss of appetite ○ Insomnia ○ Supportive care based on symptoms [calm, low-stimulus environment until it wears off] Toxic Reactions: ○ Panic reaction = “bad trip” ○ Flashbacks ○ Hallucinogen Persisting Perception Disorder: This phenomenon refers to the transient, spontaneous repetition of a previous LSD-induced experience that occurs without taking the substance. Overdose symptoms: ○ Serious psychological harm ○ Death usually occur due to dangerous behaviors & accidents Severe OD of PCP or Ketamine: ○ Respiratory depression, coma, respiratory arrest ○ Convulsion and seizures ○ Supportive care based on symptoms No specific withdrawal syndrome Cannabis [pg. 326]: Marijuana Hashish Synthetic cannabinoids ○ K2, Spice Depressant and Hallucinogenic effects Major psychoactive ingredient ○ THC (delta-9-tetrahydrocannabinol) Intoxication: ○ Impaired motor movement ○ Lowered inhibition, talkativeness ○ Euphoria  ○ Relaxation ○ Mood swings ○ Conjunctival reddening ○ Increased appetite ○ Dry mouth Overdose, toxicity, and withdrawal with very potent forms ○ Overdose is usually non-fatal ○ Cannabis Hyperemesis Syndrome [not in book] Severe abdominal pain and vomiting Can lead to acute kidney failure from dehydration ○ Withdrawal Symptoms: Irritability, restlessness, insomnia Headache, chills, N/V, stomachache Loss of appetite Amotivational Syndrome Gambling Disorder [pg. 352] Persistent and recurrent problematic gambling behavior that intensifies when the individual is under stress. As the need to gamble increases, the individual may use any means required to obtain money to continue the addiction. ○ Usually begins in adolescence, although compulsive behaviors rarely occur before young adulthood. ○ Usually runs a chronic course, with periods of waxing and waning. ○ Interferes with interpersonal relationships, social, academic, or occupational functioning. Treatment Modalities for Gambling Disorder ○ Behavior therapy ○ Cognitive therapy ○ Motivational interviewing ○ Gamblers Anonymous ○ Psychopharmacology SSRIs Clomipramine Lithium Carbamazepine Naltrexone Application of the Nursing Process Nurses must begin relationship development with a substance abuser by examining their own attitudes and personal experiences with substances. Nursing Process: Assessment [pg. 333] Various assessment tools are available for determining the extent of the problem a client has with substances. ○ Drug history and assessment ○ Drug abuse screen test (DAST) [not in book] ○ Screening, Brief Intervention, and Referral to TX (SBIRT) ○ Clinical Institute Withdrawal Assessment of Alcohol Scale ○ Clinical Opiate Withdrawal Scale Assessment ○ Michigan Alcoholism Screening Test (MAST)  CAGE Questionnaire [not in book] ○ Have you ever felt you should Cut down on your drinking? ○ Have people Annoyed you by criticizing your drinking? ○ Have you ever felt bad or Guilty about your drinking? ○ Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)? Assessment ○ Physical, Mental Health, and Psychosocial Assessments Psychosocial assessment: Who do they live with? How do they cope with stressors? ○ Admission history ○ Substance use Current s/s of intoxication, overdose, withdrawal, & complications Screening tools ○ Vital signs ○ Insight & interest for tx of substance use disorder Dual Diagnosis [pg. 333] Clients with a coexisting substance disorder and mental disorder ○ May be assigned to a special program that targets the dual diagnosis. ○ Program combines special therapies that target both problems. Nursing Diagnosis/Outcome Identification For the client withdrawing from CNS depressants ○ Risk for Injury related to CNS agitation For the client withdrawing from CNS stimulants ○ Risk for suicide related to intense feelings of lassitude and depression, “crashing,” suicidal ideation Denial related to weak, underdeveloped ego ○ Outcome: Client will demonstrate acceptance of responsibility for their own behavior and acknowledge association between personal problems and use of substance(s). Ineffective Coping related to inadequate coping skills ○ Outcome: Clients will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances). ○ Coping skills to teach them: exercise, visualization?? [listen to recording], talk to sponsor Client/Family Education Nature & management of the illness Effects of (substance) on the body ○ Alcohol, Other CNS depressants ○ Hallucinogens, Inhalants, Opioids, Cannabinols Ways in which use of substance affects life Stress management of and coping Relaxation techniques ○ Progressive relaxation, tense and relax, deep breathing, autogenics Problem-solving and good nutrition Support services ○ Alcoholics Anonymous (or other support group specific to another substance) ○ One-to-one support person ○ Therapy Alcoholics Anonymous [pg. 346] A major self-help organization for the treatment of alcoholism Based on the concept of:  ○ Peer support ○ Acceptance ○ Understanding from others who have experienced the same problem The 12 steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety. Total abstinence is promoted as the only cure; the person can never safely return to social drinking. Codependency Defined by dysfunctional behaviors ○ that are evident among members of the family of a chemically dependent person ○ Codependent people sacrifice their own needs for the fulfillment of others to achieve a sense of control ○ Derives self-worth from others ○ Feels responsible for the happiness of others ○ Commonly denies that problems exist Keeps feelings in control, and often releases anxiety in the form of ○ stress-related illnesses ○ Or compulsive behaviors The Chemically Impaired Nurse Absenteeism or perfect attendance Issues involving “wasting” of drugs and narcotic counts Poor concentration, memory, & recall, unmet deadlines, inappropriate responses Problems with relationships Changes in mood, behavior, motor coordination, slurred speech Patient complaints of inadequate pain control, discrepancies in documentation State board response ○ May deny, suspend, or revoke a license based on a report of chemical abuse by a nurse ○ Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. Requires specified treatments: Such as completion of a program, counseling, support groups or 12-step program, random negative drug screens During the suspension period ○ Successful completion of an inpatient, outpatient, group, or individual counseling treatment program ○ Evidence of regular attendance at nurse support groups or 12-step program ○ Random negative drug screens ○ Employment or volunteer activities Pharmacotherapy for Alcoholism Alcohol withdrawal ○ Benzodiazepines ○ Anticonvulsants ○ Multivitamin therapy ○ Thiamine Disulfiram (Antabuse) Acamprosate (Campral) Psychopharmacology for Substance Intoxication and Substance Withdrawal Other medications ○ Naltrexone (ReVia; Vivitrol) ○ Nalmefene (Revex)  ○ Selective serotonin reuptake inhibitors (S S R I’s) Opioids ○ Narcotic antagonists Naloxone (Narcan) Naltrexone (ReVia) Nalmefene (Revex) ○ Buprenorphine ○ Methadone ○ Clonidine Depressants ○ Phenobarbital (Luminal) ○ Long-acting benzodiazepines Stimulants ○ Minor tranquilizers ○ Major tranquilizers ○ Anticonvulsants ○ Antidepressants Hallucinogens and cannabinols ○ Benzodiazepines ○ Antipsychotics