SUBSTANCE – RELATED DISORDER - The Wall Stage: Eventually, the over-

optimism of the honeymoon stage wears off.

- defined as a pattern of harmful use of any
This is the time when most relapses occur
substance for mood-altering purposes.
due to the reemergence of feelings of anxiety
- another definition for substance abuse is “the and depression.
use of illicit drugs or the abuse of prescription
- -Adjustment Stage: The next stage is a period
or over-the-counter drugs for purposes other
of realization and acceptance that change is a
than those for which they are indicated or in a
lifelong struggle.
manner or in quantities other than directed.
- -Resolution Stage: The final stage of
Substance Dependence
withdrawal occurs after six months of
- - is when a person has developed a tolerance sobriety or abstinence.
for a particular substance (needing increased
Polysubstance Abuse
amounts to experience the effects) and has
withdrawal symptoms when not using the - is defined as abuse of three or more
substance for a period of time. substances over a period of 12 months.
Intoxication - polysubstance abusers usually develop a
"drug of choice," which is the drug they prefer
- is the acute state of physical and cognitive
to abuse, with the other drugs serving as a
impairment caused by drinking alcohol or
fallback when the drug of choice is not
being exposed to a psychoactive drug.
available.
Intoxication typically has both physical and
mental effects, which can include difficulties Polysubstance Dependence
with controlling movement, mood changes,
- - refers to a type of substance dependence
impairment of cognitive skills, impaired
disorder in which an individual uses at least
judgment, impaired impulse control, and
three different classes of substances
changes in interpreting your surroundings or
indiscriminately and does not have a favorite
the behavior of others.
drug that qualifies for dependence on its own.
- intoxication is most commonly used to refer
to the acute effects of alcohol, but it may also
be used to refer to the effects of other drugs. COMMONLY ABUSED SUBSTANCE AND THEIR
EFFECTS
- other terms of intoxication: inebriation,
drunkenness, pissed, rat-arsed, out of it, 1. CNS Depressants
under the influence, stoned, hammered,
smashed. -sometimes referred to as sedatives and
tranquilizers, are substances that can slow brain
Withdrawal activity. This property makes them useful for treating
anxiety and sleep disorders.
- is a term referring to the feelings of
discomfort, distress, and intense craving for a  Alcohol
substance that occur when use of the
substance is stopped. -Alcohol has became a part of the world’s culture.
People drink alcohol to relax, socialize, celebrate,
- these physical symptoms occur because the and also for its taste.
body had become metabolically adapted to
the substance. -Balancing the consumption of alcohol becomes the
problem for some people.
- the withdrawal symptoms can range from
mild discomfort resembling the flu to severe -There are health risks associated with drinking too
withdrawal that can actually be life much and drinking more than is healthy over a longer
threatening. period.

5 basic stages of withdrawal: -Alcohol consumption have effects in our behavior

and our body.
- Withdrawal Stage: This first stage lasts up to
15 days and may be accompanied by fatigue, Effects:
pain, anxiety, and depression. - Short-term effect:
- Honeymoon Stage: During the second stage, a • Alcohol starts to affect the brain within five
period begins that is the opposite of minutes of being consumed.
withdrawal. The honeymoon stage is often
accompanied by feelings of energy, optimism, • The effects of alcohol vary depending on a
and confidence. number of factors including:
  type and quantity of alcohol consumed Effects:
 age, weight and gender Sedative effect - can produce sedation. Drugs –
Diazepam
 body chemistry
Hypnotic effect -Drugs – Temazepam
 food in the stomach
Time to fall asleep ↓
 drinking experience
o Duration of N-REM sleep ↑
 situation in which drinking occurs
o Duration of REM sleep ↓
 mental health status
o Duration of sleep ↑
 other health conditions made worse by
alcohol. Anxiolytic effect— Drugs – Diazepam(standard)
o Calming effect
Oxazepam
Effects on the behavior:
o Euphoria
STAGES BAC LIKELY EFFECTS Chlorazepate
Feeling of well Up to .05g% Talkative, relaxed,
being more confident o Impaired judgment
Some raised .05-.08g% Talkative, Acts and
riskd feels self- o Loss of self
confident,
 Opioids
Judgment and
movement - An opioid is any psychoactive chemical that
impaired, resembles morphine or other opiates in its
Inhibitions pharmacological effects.
reduced
Moderate .08-.15g% Speech slurred, - Opioids work by binding to opioid receptors,
raised state Balance and which are found principally in the central and
coordination peripheral nervous system and the
impaired, Reflexes gastrointestinal tract.
slowed, Visual
attention impaired, - Opioids are among the world's oldest known
Unstable emotions, drugs; the therapeutic use of the opium
Nausea, vomiting poppy predates recorded history.
Very elevated .15-.30g% Unable to walk
risk without Effects of opiods:
help, Apathetic,
Opioid Side Effects
sleepy, Labored
breathing, Unable - One of the reasons why your doctor needs to
to remember manage your pain medications so closely is that they
events, Loss of can potentially cause side effects, such as:
bladder control,
Possible loss of • constipation
consciousness
Death Over .30g% Coma or Death • drowsiness
• nausea and vomiting
 Sedatives/Hypnotics/Anxiolytics - Opioids can be dangerous if you take them with
- Sedatives: is a substance that induces alcohol, or with certain drugs such as:
sedation by reducing irritability or • some antidepressants
excitement.
• antihistamines
- Hypnotics: drugs are a class of psychoactives
whose primary function is to 2. CNS Stimulants
induce sleep and to be used in the treatment
- Drugs that are used to increase mental
of insomnia, and in surgical
alertness and wakefulness
anesthesia.
- Central nervous system (CNS) stimulant
Anxiolytics: They act on the central nervous system
drugs act by increasing activity in the brain,
to alleviate the symptoms of anxiety
which increases wakefulness and mental
and nervousness, mood stabilizing and improving
alertness.
sleep.
-Common drugs: - Side effects and adverse reactions:
restlessness, insomnia, tachycardia,
• Atomoxetine
hypertension, heart palpitations, dry mouth,
• Caffeine anorexia, weight loss, diarrhea or
constipation, and impotence.
• Dexamfetamine
Cocaine- a high-priced way of getting high -- has a
• Methylphenidate mystique.
• Modafinil - Called "the caviar of street drugs,"
Caffeine - Cocaine is a purified extract from the leaves
- Caffeine is classified as a central nervous system of the Erythroxylum coca bush.
stimulant. 2 main forms of cocaine:
- Caffeine can increase alertness; it also can - Powdered cocaine -- commonly known on
increase the amount of time it takes to fall the street as "coke" or "blow" -- dissolves in water.
asleep, cause headaches and nervousness, Users can snort or inject powdered cocaine.
and reduce fine motor coordination.
- Crack cocaine -- commonly known on the
- Caffeine stays in the body for hours – only street as "crack" or "rock" -- is made by a
about half of the caffeine is eliminated in the chemical process that leaves it in its
first 6 hours. “freebase” form, which can be smoked.
- If caffeine can be fatal to those overdose to Effects of cocaine:
the extreme.
• Heart attack, heart arrythmias
Effects: (overdose)
• Seizures
• Heart attack
• Permanent lung damage
• High Blood pressures
• Perforation of the stomach and intestine
• Arrhythmias
• Long-term kidney damage
• Cholesterol levels
• Impaired sexaul activity
• Sleeplessness
3. Hallucinogens
Nicotine
- Hallucinogens are a general group of
- Nicotine is a potent parasympathomimetic pharmacological agents that can be divided into three
alkaloid found in the nightshade family of broad categories: psychedelics, dissociativesand
plants (Solanaceae) and a stimulant drug. deliriants.
- Both a stimulant and a relaxant. - can cause subjective changes in perception,
The effects of nicotine: thought, emotion and consciousness.

• Relaxation - these drugs do not merely amplify familiar

states of mind, but rather induce experiences
• Sharpness that are qualitatively different from those of
ordinary consciousness.
• Calmness
- Hallucinogens are mind-altering drugs that act on
• Alertness
the Central Nervous System (CNS), producing
changes to the users perception and state of mind.

Amphetamines and Cocaine Effects of hallucinogens: (Long-term)

- Amphetamines – stimulate the release of the • Physical dependence

neurotransmitters norepinephrine and
• Psychological dependence
dopamine from the brain and the sympathetic
nervous system. • Flashbacks
- Effects: euphoria and alertness, they can also • Severe depression
cause sleeplessness, restlessness, tremors
and irritability, cardiacvascular problems can
result to continuous use of amphetamines.
4. Cannabis - Prevention, early recognition and effective
treatment programs for nurses with substance abuse
- The term 'marijuana' (sometimes spelled
and addiction problems are essential to the health
'marihuana') is Mexican in origin and
and well-being of these nurses and to the provision of
typically refers to any part of -- or any one of -
safe, quality nursing care.
- the three distinctive subspecies of the
cannabis plant. - Substance abuse is caused by many
interacting and cumulative factors. Nurses
Effects of cannabis:
who become addicted, often begin abusing
• Keener perception substances by self-

• A remoteness medicating for emotional distress, post traumatic

stress disorder, pain, fatigue, depression or burnout.
• Feeling of hunger
- Self-medicating for physical and emotional
• Definite feeling of a slowed time pain is seldom given a second thought, and an
• Trancing isolated event may turn into more regular
use, then compulsive use, and finally full
• Paranoia addiction ! sometimes without the user being
aware until behavior becomes compulsive
• Forgetfullness
and the full symptoms of addiction are
• Laziness manifested.

• Whitey - The workplace is often the last place for

substance abuse to be discovered.
5. Inhalants
- An investigation by the manager may establish a
- are drugs that produce chemical vapors
pattern of behavioral indicators, changes in job
which, as the name suggests, are inhaled
performance and/or indications of drug theft or
- these drugs care found in common household tampering that indicate there is a substance abuse
products such as cleaning supplies; hairspray problem.
and beauty products and can have extremely
- Denial is one characteristics of substance
powerful and dangerous effects. abuse. Denial is a defense mechanism that
- still have the ability to be harmful on a may be unconsciously employed when reality
person’s mind and body because they are not is too painful to accept.
made of human consumption.
MEDICAL ISSUES
- inhalants are mind altering, meaning they
1. Physical effects
change the brain’s chemistry, and in effect,
change the way a person feels, as well as the SUBSTANCE PHYSICAL EFFECT
way his/her body functions. Alcohol bad breath, hangovers,
skin problems
- inhalants kill brain cells and quickly infiltrate Cocaine increase in BP, heart
the brain and the bloodstream through the rate, breathing rate, and
lungs. body temp.
Hallucinogens increased heart rate
Effects of Inhalants:
and blood pressure,
• Slurred speech sleeplessness and
tremors, lack of
• Unruly appearance muscular coordination,
sparse, mangled, and
• Nausea incoherent speech
• Faulty motor skills decreased awareness of
touch and pain that can
• Delusions result in self
Marijuana Short-term effects:
• Hallucinations Sleepiness, reduced
Nursing Issues ability to tasks,
increased heart rate.
-Substance abuse by a nurse is a serious and complex
issue that leads to impaired practice and endangers CNS Stimulants Euphoria, Increased
the health and safety of the public, other members of heart rate,and increase
the health care team and the nurse. BP, increased physical
activity.
 Most of the Substance have common physical • You continue to use drugs, despite knowing
effects in us and in our body it’s hurting you. It’s causing major problems
in your life—blackouts, infections, mood
swings, depression, paranoia—but you use
2. Psychological
anyway.
- Substances that are being abused have
Physical warning signs:
common psychological effect in the well being
of a person. • Bloodshot eyes, pupils larger or smaller than
usual
- They can experience violent behavior,
Hallucinations, confusion, anxiety, depression, • Changes in appetite or sleep patterns. Sudden
paranoia, loss of control, flashbacks, catatonic weight loss or weight gain
syndrome, distorted visions, hearing and
coordination, impaired judgment, altered • Deterioration of physical appearance,
perceptions, and emotions personal grooming habits

Signs and Symptoms for addictive drugs • Unusual smells on breath, body, or clothing

Common signs and symptoms of drug abuse: • Tremors, slurred speech, or impaired
coordination
• You’re neglecting your responsibilities at
school, work, or home (e.g. flunking classes, Behavioral Signs:
skipping work, neglecting your children) • Drop in attendance and performance at work
because of your drug use. or school
• You’re using drugs under dangerous • Unexplained need for money or financial
conditions or taking risks while high, such as problems. May borrow or steal to get it.
driving while on drugs, using dirty needles, or
having unprotected sex. • Engaging in secretive or suspicious behaviors

• Your drug use is getting you into legal • Sudden change in friends, favorite hangouts,
trouble, such as arrests for disorderly and hobbies
conduct, driving under the influence, or • Frequently getting into trouble (fights,
stealing to support a drug habit. accidents, illegal activities)
• Your drug use is causing problems in your Psychological warning signs:
relationships, such as fights with your partner
or family members, an unhappy boss, or the • Unexplained change in personality or attitude
loss of old friends.
• Sudden mood swings, irritability, or angry
Common signs and symptoms of drug addiction: outbursts

• You’ve built up a drug tolerance. You need to • Periods of unusual hyperactivity, agitation, or
use more of the drug to experience the same giddiness
effects you used to attain with smaller
• Lack of motivation; appears lethargic or
amounts.
“spaced out”
• You take drugs to avoid or relieve withdrawal
• Appears fearful, anxious, or paranoid, with no
symptoms. If you go too long without drugs,
reason
you experience symptoms such as nausea,
restlessness, insomnia, depression, sweating, Warning Signs of Commonly Abused Drugs
shaking, and anxiety.
• Marijuana: Glassy, red eyes; loud talking,
• You’ve lost control over your drug use. You inappropriate laughter followed by
often do drugs or use more than you planned, sleepiness; loss of interest, motivation;
even though you told yourself you wouldn’t. weight gain or loss.
You may want to stop using, but you feel
powerless. • Depressants (including Xanax, Valium, GHB):
Contracted pupils; drunk-like; difficulty
• Your life revolves around drug use. You spend concentrating; clumsiness; poor judgment;
a lot of time using and thinking about drugs, slurred speech; sleepiness.
figuring out how to get them, and recovering
from the drug’s effects. • Stimulants (including amphetamines, cocaine,
crystal meth): Dilated pupils; hyperactivity;
• You’ve abandoned activities you used to euphoria; irritability; anxiety; excessive
enjoy, such as hobbies, sports, and socializing, talking followed by depression or excessive
because of your drug use. sleeping at odd times; may go long periods of
 time without eating or sleeping; weight loss;
dry mouth and nose.
• Inhalants (glues, aerosols, vapors): Watery
eyes; impaired vision, memory and thought;
secretions from the nose or rashes around the
nose and mouth; headaches and nausea;
appearance of intoxication; drowsiness; poor
muscle control; changes in appetite; anxiety;
irritability; lots of cans/aerosols in the trash.
• Hallucinogens (LSD, PCP): Dilated pupils;
bizarre and irrational behavior including
paranoia, aggression, hallucinations; mood
swings; detachment from people; absorption
with self or other objects, slurred speech;
confusion.
• Heroin: Contracted pupils; no response of
pupils to light; needle marks; sleeping at
unusual times; sweating; vomiting; coughing,
sniffling; twitching; loss of appetite.
Symptoms and Stages of Alcoholism and its
psychopathology
- Alcoholism is a broad term for problems with
alcohol, and is generally used to mean compulsive
and uncontrolled consumption of alcoholic
beverages, usually to the detriment of the drinker's
health, personal relationships, and social standing.
- Signs and Symptoms:
• Early signs
- include frequent intoxication, an established
pattern of heavy drinking and drinking in
dangerous situations, such as when driving. Other
early signs of alcoholism include black-out drinking
or a drastic change in demeanor while drinking,
such as consistently becoming angry or
violent.
- Stages of Alcoholism:
• Early or adaptive stage
• Middle stage
• Late Stage
• Treating Alcoholism
• Relapse to drinking
Nursing Care
As nurses we need to establish care for patients that
are experiencing substance abuse.
Activities:
• Group Therapies
• Self-help group
• Daily ward activities
• Preventive measures