Substance Abuse

Disorders

Prepared By: Bella Faith Masong

 Substance Related Disorders
Substances-related disorders are composed of
two groups
1. Substance – use disorders (dependence &
abuse)
2. Substance – induce disorders (intoxication,
withdrawal, delirium, dementia, amnesia,
psychosis, mood disorder, anxiety disorder,
sexual dysfunction & sleep disorders)
Epidemiological Statistics
A high prevalence of substance-related
disorder occur between the ages of 18 & 24.

Substance-related disorder are diagnosed

more commonly in men than in women.
Definition of Terms
1. Substance
 Refers to any Drugs, Medication, or Toxins that shares the potential of
abuse.
2. Addiction
 Is a Physiological & Psychological dependence on Alcohol or other
drugs of Abuse that affects the Central Nervous System in such a way
that withdrawal symptoms are experienced when the substance is
discontinued.
3. Abuse
 To use wrongfully or in a harmful way. Improper treatment or conduct
that may result in injury.
4. Dependence
 A compulsive or chronic requirement. The need is so strong as to
generate distress (either physical or psychological) if left unfulfilled.
5. Tolerance
 is a state in which after repeated administration, a drug produced
a decreased effect, or increasing doses are required to produce
the same effect.
6. Intoxication
 A physical & mental state of exhilaration & emotional frenzy or
lethargy & stupor.
7. Withdrawal
 The physiological & mental readjustment that accompanies the
discontinuation of an addictive substance.
Predisposing Factors of Substance-related Disorders:
Biological factors
- Genetics
- Biochemical
Psychological factors
- Developmental influences
- Personality factors
Sociocultural factors
- Social Learning
- Conditioning
- Cultural and Ethnic Influences
SUBSTANCE USE
DISORDERS
Substance Abuse
Definition:
 The DSM-IV-TR (APA, 2000)
identifies substance abuse as a
maladaptive pattern of
substance use manifested by
recurrent and significant adverse
consequences related to
repeated use of the substance.
Substance Dependence
Physical Dependence:
 Physical dependence on a substance
is evidenced by a cluster of
cognitive, behavioral, and
physiological symptoms indicating
that the individual continuously use
the substance despite significant
substance-related problems (APA,
2000).
Substance Dependence
Psychological Dependence:
 An individual is considered to be
psychologically dependent on a
substance when there is an
overwhelming desire to repeat the use
of a particular drug to produce
pleasure or avoid discomfort.
Criteria for Substance Dependence
SUBSTANCE INDUCED
DISORDERS
Substance intoxication
Definition:
 The development of a reversible

substance-specific syndrome
caused by the recent ingestion of
(or exposure to) a substance
(APA, 2000).
 Criteria for Substance Intoxication
1. The development of a reversible substance-specific syndrome
caused by recent ingestion of (or exposure to)a substance.

2. Clinically significant maladaptive behavior or psychological

changes that are due to the effect of the substance on the CNS
- belligerence - mood liability
- cognitive impairment - impaired judgment
- impaired social & occupational functioning

3. The symptoms are not due to a general medical condition and

are not better accounted for by another mental disorder.
Substance withdrawal
Definition:
 Substance withdrawal is the
development of a substance-specific
maladaptive behavioral change, with
physiological and cognitive
concomitants, that is due to the
cessation of, or reduction in, heavy
and prolonged substance use (APA,
2000).
 Criteria for Substance Withdrawal
1. The development of a substance-specific syndrome caused by
the cessation of (or reduction in) heavy and prolonged substance
use.

2. The substance-specific syndrome causes clinically significant

distress or impairment in social, occupational, or other important
areas of functioning.

3. The symptoms are not caused by a general medical condition

and are not better accounted for by another mental disorder.
Symptoms of Substance Abuse
 Denial of Problems  Feelings of guilt
 Rationalization  Limited insight
 Irritability & Impulsive  Ineffective coping/Impaired
 Minimize use of substance role performance
 Poor Judgement/ Physical
 Blaming others Problems
 Anxiety
 Low self esteem
 Difficulty expressing feelings
 CLASSES OF PSYCHOACTIVE SUBSTANCES
1. Alcohol
2. Amphetamines &related substances
3. Caffeine
4. Cannabis
5. Cocaine
6. Hallucinogens
7. Inhalants
8. Nicotine
9. Opioids
10.Phencyclidine (PCP) &related substances
11.Sedative, hypnoties or anxiolytics
ALCOHOL
 Alcoholism
 Alcohol exerts a depressant effect on the CNS,
resulting in behavioral and mood changes.
 Absorbed quickly in stomach and small
intestines and is metabolized by liver within 12
– 24 hours
 The effects are relaxation and loss of inhibition;
with intoxication, there is slurred speech,
unsteady gait, lack of coordination, and
impaired attention, concentration, memory,
and judgment.
Jellinek (1952) outlined four phases through which the
alcoholic’s pattern of drinking progresses.(Psychopathology)

Phase I. The Pre alcoholic phase

Phase II. The early alcoholic phase
Phase III. The crucial phase
Phase IV. The chronic phase
Phase I. The Pre alcoholic phase
 This phase is characterized by the use of alcohol
to relieve the everyday stress and tensions of
life.
 Tolerance develops, and the amount required
to achieve the desired effect increases steadily.
Phase II. The early alcoholic phase
 This phase begins with blackouts—brief periods of
amnesia that occur during or immediately following a
period of drinking.
 Now the alcohol is no longer a source of pleasure or
relief for the individual but rather a drug that is
required by the individual.
 Common behaviors include sneaking drinks or secret
drinking, preoccupation with drinking and maintaining
the supply of alcohol, rapid gulping of drinks, and
further blackouts.
Phase III. The Crucial Phase
 In this phase, the individual has lost control, and
physiological dependence is clearly evident.
 This loss of control has been described as the inability to
choose whether or not to drink.
 Binge drinking, lasting from a few hours to several weeks,
is common.
 These episodes are characterized by sickness, loss of
consciousness, squalor, and degradation.
Phase IV. The Chronic Phase
 This phase is characterized by emotional and physical
disintegration.
 The individual is usually intoxicated.
 Emotional disintegration is evidenced by profound helplessness
and self-pity.
 Impairment in reality testing may result in psychosis.
 Life-threatening physical manifestations may be evident in
virtually every system of the body.
 Abstention from alcohol results in a terrifying syndrome of
symptoms that include hallucinations, tremors, convulsions,
severe agitation, and panic.
 Effect
● Alcohol Dependence: ● Alcohol Intoxication: ● Alcohol Withdrawal:
 Episodes of  Disinhibition of sexual  Coarse tremor of hands, tongue or
anesthesia or amnesia or aggressive impulses. eyelids
 Nausea or vomiting
during intoxication  Mood lability
 Malaise or weakness
(Blackouts).  Impaired judgment  Tachycardia
 Violent behavior when  Impaired social or  Sweating
intoxicated. occupational  Elevated BP
 The need for daily or functioning.  Anxiety
episodic alcohol use  Slurred speech
 Depressed mood or irritability
 Transient hallucinations or illusions
to function  Incoordination  Headache & insomnia
adequately.  Unsteady gait  Delirium tremens
 Inability to stop or  Nystagmus  Severe form of alcohol withdrawal.
reduce intake.  Flushed face  Dramatic increase in pulse,
respiration & BP
Physiologic Effects of Long Term Alcohol use
 Cardiac myopathy  Hepatitis
 Wernicke’s  Cirrhosis
encephalopathy  Leukopenia
 Korsakoff’s  Thrombocytopenia
psychosis  Ascites
 Pancreatitis
 Esophagitis
● Cardiac myopathy ● Wernicke’s ● Korsakoff’s psychosis:
 Accumulation of lipids encephalopathy:  Identified by a syndrome of
in the myocardial  The most serious form confusion, loss of recent
cells, resulting in of thiamine deficiency in memory, and confabulation in
alcoholics
enlargement and a alcoholics.
 Frequently encountered in
weakened condition.  Symptoms include
clients recovering from
 Symptoms include paralysis of the ocular
Wernicke’s encephalopathy.
decreased exercise muscles, diplopia,
 Treatment is with parenteral
tolerance, tachycardia, ataxia, somnolence, and
or oral thiamine
dyspnea, edema, stupor.
replacement.
palpitations, and  If thiamine replacement
nonproductive cough therapy is not
 Treatment is total undertaken quickly,
permanent abstinence death will ensue.
from alcohol.
● Esophagitis ● Gastritis ● Pancreatitis
 Occurs because of the  Inflammation of the  Acute or chronic
toxic effects of alcohol stomach lining  Acute pancreatitis usually occurs
on the esophageal characterized by 1 or 2 days after a binge of
excessive alcohol consumption.
mucosa. epigastric distress,
 Symptoms include constant,
 It also occurs because nausea, vomiting, and
severe epigastric pain; nausea
of frequent vomiting distention.
and vomiting; and abdominal
associated with  Damage to blood distention.
alcohol abuse. vessels may result in  The chronic condition leads to
hemorrhage. pancreatic insufficiency resulting
in steatorrhea, malnutrition,
weight loss, and diabetes
mellitus.
● Hepatitis ● Cirrhosis of the Liver ● Leukopenia
 Inflammation of the  End stage of alcoholic  The production, function, and
liver caused by long- liver disease movement of the white blood
term heavy alcohol  Clinical manifestations cells are impaired in chronic
alcoholics.
use. include nausea and
 Places the individual at high risk
 Clinical manifestations vomiting, anorexia,
for contracting infectious
include an enlarged weight loss, abdominal
diseases as well as for
and tender liver, pain, jaundice, edema, complicated recovery.
nausea and vomiting, anemia, and blood
lethargy, anorexia, coagulation
elevated white blood abnormalities.
cell count, fever, and  Treatment: Total
jaundice. Abstinence, correction
 Ascites and weight of malnutrition, and
loss may be evident in supportive care
more severe cases
● Thrombocytopenia ● Sexual Dysfunction
 Platelet production and  For women: changes in the
survival are impaired menstrual cycles and a
 At risk for hemorrhage decreased or loss of ability to
 Abstinence from alcohol become pregnant.
rapidly reverses this  For men: decreased hormone
deficiency levels result in a diminished
libido, decreased sexual
performance, and impaired
fertility
 Alcoholics Anonymous (AA)
- Is a major self-help organization for the treatment of
alcoholism.
- It was founded in 1935 by two alcoholics—a stockbroker,
Bill Wilson, and a physician, Dr. Bob Smith—who
discovered that they could remain sober through mutual
support
- The self-help groups are based on the concept of peer
support—acceptance and understanding from others who
have experienced the same problems in their lives.
 ADD YOUR MAIN POINT
HERE
SLIDESMANIA.COM
 CAGE question for alcoholics:
 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)
Pharmacologic Management:
 Benzodiazepines.
 Alcohol withdrawal is usually managed with a benzodiazepine-
anxiolytic agent, which is used to suppress the symptoms of
abstinence.
 Disulfiram
 Disulfiram (Antabuse) may be prescribed to help deter clients
from drinking.
 Acamprosate.
 Acamprosate (Campral), may be prescribed for clients recovering
from alcohol abuse or dependence to help reduce cravings for
alcohol and decrease the physical and emotional discomfort that
occurs especially in the first few months of recovery.
Pharmacologic Management:
 Methadone
 Methadone, a potent synthetic opiate, is used as a
substitute for heroin in some maintenance programs.
 Levomethadyl
 Levomethadyl is a narcotic analgesic whose only
purpose is the treatment of opiate dependence.
 Naltrexone
 Naltrexone (ReVia) is an opioid antagonist often used
to treat an overdose. It can also be used to treat
alcohol abuse.
 Nursing Management
 Nursing Assessment
 Assessment of a client with substance abuse disorder
include:
● History
● Thought process and content
● Sensorium and intellectual process
● General appearance and motor behavior
● Self-concept
 Nursing Management
 Nursing Diagnosis
 Risk for injury related to substance intoxication or
withdrawal.
 Ineffective denial related to underlying fears and
anxieties.
 Ineffective coping related to inadequate support system
or coping skills.
 Imbalance nutrition: less than body requirements
related to drinking alcohol instead of eating nourishing
food.
 Chronic low self-esteem related to retarded ego
development
 Nursing Management
 Nursing Care Planning and Goals
 Treatment outcomes for clients with substance use may
include the following:

● The client will abstain from alcohol and drug use.

● The client will express feelings openly and directly.
● The client will verbalize acceptance of responsibility for
his or her own behavior.
● The client will practice nonchemical alternatives to deal
with stress or difficult situations.
● The client will establish an effective after-care plan.
Nursing Intervention
1. DETOXIFICATION and withdrawal
2. Maintain attitude of acceptance and NON-
JUDGEMENTAL
3. Teach client, family or both about substance
abuse, dispel myths
4. Encourage to join self-help groups
5. Help client verbalize and express feelings
6. Review lifestyles changes
7. Stress management and coping measures
8. Enhance self-esteem
THANK YOU!