Abuse
Content
ABUSE - Continued use despite problems (social, occupational, psychologic) that are caused by substance or continued use in hazardous situations. - Commonly abused substance includes alcohol, amphetamines (affect CNS: uppers ), caffeine, cannabis, cocaine (feeling of euphoria), hallucinogens, inhalants, nicotine, opioids (pain killers for terminal ill and who undergone extensive surgery), PCP, barbiturates, nonbarbiturates sedative hypnotics, and anxiolytics. *methampithamine- brain damage DEPENDENCE 1. Need for larger amounts (tolerance) 2. Unsuccessful attempt to decrease/ discontinue use 3. Inability to function as usual in work and social activities 4. Withdrawal symptoms (psychologic/ physical distress when substance is reduced or discontinued) ADDICTION (Cross Tolerance) -compulsive use of a substance, physiologic & psychologic dependence -demonstrated when a person dependent on one substance requires higher doses of another substance in the same general category. * Addicts needs more anesthesia when undergoing operation SUBSTANCE- INDUCED DISORDER A. Alcohol Abuse Alcohol- CNS depressant (8 ounces-standard) A disease that can be arrested but not cured Long-term use may result in loss of health (gastritis, hepatitis, cirrhosis, pancreatitis, cardiac & neural disorders) & life (suicide, MVA) Individuals present with boisterous & euphoric/ aggressive, or may be depressed & withdrawn DENIAL- defense mechanism Physical Effects: a) CNS: psychosis, dementia, seizure disorders, memory loss, ataxia, confusion (thiamine & niacin deficiency) b) Cardio: arrhythmias, HPN, myopathy c) GI: gastritis, cirrhosis, pancreatitis, hypoglycemia, ulcers, esophageal varices d) Resp: COPD, pneumonia, cancer e) GU: fetal alcohol syndrome (there is no safe amt of alcohol for pregnant Woman), decreased libido f) Skin & skeletal: ulcers, spider angiomas, fractures
Psychosocial Effects: a) Erratic, impulsive, abusive behavior b) Poor judgment, loss of memory c) Family problems d) Depression, low self-esteem e) Suicide f) Job loss Phases of alcohol addiction: I. Prealcoholic- drinks almost everyday to relieve tension, increase in amt. of alcohol ingestion II. Addiction- blackouts (antegrade amnesia), secret drinking, large mounts ingested III. Dependence- physical craving, makes up reason for drinking, aggressive behavior, reduced nutrition IV. Chronic long periods of intoxication, impaired thinking, less alcohol produces sedation tremors Directly-related problems with alcohol abuse/ dependence Withdrawal Delirium Tremens (DTs) Alcohol hallucinosis. Presence of hallucinations only Alcohol-related dementia, caused by poor nutrition o WERNICKE s ENCEPHALOPATHY -Mental confusion/ delirium occurring in combination with paralysis of the eye muscles, nystagmus, and unsteady gait (ataxia) -Caused by deficiency of vit. B1 (thiamine) with persistent vomiting o KORSAKOFF s PSYCHOSIS Irreversible Chronic disorientation & confabulation (forgets then makeup new stories> filling of gap memory) Stages of Alcohol Withdrawal I. At least 8 hrs after last drink; symptoms include mild tremors, tachycardia, increased pressure, diaphoresis, nervousness II. 8-12 hrs after last drink or significant decrease of consumption from the usual; gross tremors, hyperactivity, profound confusion, loss of appetite, insomnia, weakness, disorientation, illusions, auditory & visual hallucinations III. 12-48 hrs after last drink: symptoms include (in addition to 1&2), severe hallucinations, grand mal seizures IV. 3-5 days: delirium tremens, confusion, agitation, severe psychomotor activity, hallucinations, insomnia, tachycardia
Alcohol Withdrawal Delirium (delirium Tremens) History of alcohol abuse usually more than 5 years May be preceded by seizures Signs include tachycardia, increased temp & BP, agitation, delusions and hallucinations MANAGEMENT: y Vitamin and nutrition therapy y Anxiolytics ( Librium/ valium); high doses of Librium to control withdrawal in acute detoxification y DISULFIRAM (antabuse) adverse effects: thirst, sweating palpitations, vomiting, dyspnea, respiratory and cardiac failure when taken with alcohol *NSG. Responsibilities: Teach the importance of avoiding alcohol Teach to carry an ID bracelet in case of accidental alcohol ingestion Monitor effects of anxiolytics If being taken at the same time ( antabuse increases the effects of anxiolytics and oral coagulants) Monitor for bleeding *NSG. Interventions: Stay with the client Monitor V/s and blood sugar levels Observe for tremor, seizures, increased agitation, anxiety, disorders of perception Administer medication as ordered; observed effects/ side effects of tranquilizers carefully If disorders of perception occur: explain that these are part of the withdrawal process Provide fluids, adequate nutrition, and quite environment When client is stable, provide info about rehab programs (AA); at this stage client may be willing to consider the program B. Psychoactive
Psychosocial Effects: a) Erratic, impulsive, abusive behavior b) Poor judgment, loss of memory c) Family problems d) Depression, low self-esteem e) Suicide f) Job loss Phases of alcohol addiction: I. Prealcoholic- drinks almost everyday to relieve tension, increase in amt. of alcohol ingestion II. Addiction- blackouts (antegrade amnesia), secret drinking, large mounts ingested III. Dependence- physical craving, makes up reason for drinking, aggressive behavior, reduced nutrition IV. Chronic long periods of intoxication, impaired thinking, less alcohol produces sedation tremors Directly-related problems with alcohol abuse/ dependence Withdrawal Delirium Tremens (DTs) Alcohol hallucinosis. Presence of hallucinations only Alcohol-related dementia, caused by poor nutrition o WERNICKE s ENCEPHALOPATHY -Mental confusion/ delirium occurring in combination with paralysis of the eye muscles, nystagmus, and unsteady gait (ataxia) -Caused by deficiency of vit. B1 (thiamine) with persistent vomiting o KORSAKOFF s PSYCHOSIS Irreversible Chronic disorientation & confabulation (forgets then makeup new stories> filling of gap memory) Stages of Alcohol Withdrawal I. At least 8 hrs after last drink; symptoms include mild tremors, tachycardia, increased pressure, diaphoresis, nervousness II. 8-12 hrs after last drink or significant decrease of consumption from the usual; gross tremors, hyperactivity, profound confusion, loss of appetite, insomnia, weakness, disorientation, illusions, auditory & visual hallucinations III. 12-48 hrs after last drink: symptoms include (in addition to 1&2), severe hallucinations, grand mal seizures IV. 3-5 days: delirium tremens, confusion, agitation, severe psychomotor activity, hallucinations, insomnia, tachycardia
Alcohol Withdrawal Delirium (delirium Tremens) History of alcohol abuse usually more than 5 years May be preceded by seizures Signs include tachycardia, increased temp & BP, agitation, delusions and hallucinations MANAGEMENT: y Vitamin and nutrition therapy y Anxiolytics ( Librium/ valium); high doses of Librium to control withdrawal in acute detoxification y DISULFIRAM (antabuse) adverse effects: thirst, sweating palpitations, vomiting, dyspnea, respiratory and cardiac failure when taken with alcohol *NSG. Responsibilities: Teach the importance of avoiding alcohol Teach to carry an ID bracelet in case of accidental alcohol ingestion Monitor effects of anxiolytics If being taken at the same time ( antabuse increases the effects of anxiolytics and oral coagulants) Monitor for bleeding *NSG. Interventions: Stay with the client Monitor V/s and blood sugar levels Observe for tremor, seizures, increased agitation, anxiety, disorders of perception Administer medication as ordered; observed effects/ side effects of tranquilizers carefully If disorders of perception occur: explain that these are part of the withdrawal process Provide fluids, adequate nutrition, and quite environment When client is stable, provide info about rehab programs (AA); at this stage client may be willing to consider the program B. Psychoactive
