SUBSTANCE ABUSE

M. Zubair
Assistant Professor Kmu
 DEFINTIONS

• DRUG ABUSE- The maladaptive and

consistent use of a drug despite social,
occupational, psychological, or physical
problems exacerbated by the drug ; or
recurrent use in situations that are
physically hazardous, such as driving while
intoxicated (APA 1994)
 DEFINTIONS ( CONT..)

• DRUG DEPENDANCE- Impaired control of

drug use despite adverse consequences,
the development of a tolerance to the
drug, and the occurrence of withdrawal
symptoms when drug intake is reduced or
stopped
 PHYSICAL DEPENDENCE

• CONSUMES MORE THAN INTENDED

• UNABLE TO CONTROL USE
• PREOCCUPIED WITH OBTAINING SUBSTANCE
• INTERFERES WITH A.D.L..
• USES DURING HAZARDOUS ACTIVITIES
• USES RATHER THAN PARTICIPATES IN USUAL
ACTIVITIES
 PHYSICAL DEPENDENCE (CONT.)

• USES DESPITE KNOWLEDGE THAT A PROBLEM

EXISTS
• SIGNIFICANT TOLERANCE DEVELOPS
• W/D SYMPTOMS DEVELOP WITH CESSATION
OR REDUCTION
• SUBSTANCE TAKEN TO RELIEVE OR AVOID
W/D SYMPTOMS
 CLASSES OF PSYCHOACTIVE
SUBSTANCES

• ALCOHOL
• NARCOTICS (Opioids, synthetics)
• SEDATIVES- HYPNOTICS
• STIMULANTS- Caffeine, Nicotine
Cocaine, Amphetamine
 CLASSES OF PSYCHOACTIVE
SUBSTANCES

• HALLUCINOGENS
• CANNABIS
• INHALANTS
• RAVE AND TECHNO DRUGS “Designer
drugs”
 ALCOHOL STATISTICS 2001

14 million Americans considered themselves to

be alcoholics (1 out of every 10)
USA- 53% of those surveyed stated they had
one or more relatives with an alcohol problem
Costs - $100 billion/year
30% of all traffic related fatalities
35 % of suicides
3rd leading cause of death in the USA
 ALCOHOL
LEGAL INTOXICATION
• BLOOD ALCOHOL LEVEL 0.08
DEFENSE MECHANISMS
• DENIAL, PROJECTION, RATIONALIZATION
BEHAVIOR
• MANIPULATIVE
 ALCOHOL ( CONT..)

WITHDRAWAL
• EARLY 6-8 HOURS AFTER LAST DRINK
• DT’S IN 72 HOURS
• ANXIETY, ANOREXIA, INSOMNIA, N&V TREMOR,
“SHAKY”, DELIRIUM, ALTERED L.O.C., PULSE &
B.P., DIAPHORESIS
• POSSIBLE SEIZURES
• VISUAL, TACTILE HALLUCINATIONS
 Nursing Diagnosis
Substance Abuse
 Risk for injury…. (withdrawal)
 Risk for violence to self… (withdrawal)
• Ineffective denial related to weak ego…
• Ineffective coping related to inadequate coping skills…
• Low self-esteem related to a weak ego…
• Risk for infection related to altered immunity and poor
nutrition…
• Imbalanced nutrition less than body requirements/
fluid volume deficit related to not eating or drinking….
TREATMENT OF ALCOHOL WITHDRAWAL

• SEDATIVES (Librium, Valium or Phenobarbital)

• THIAMINE
• MAGNESIUM SULFATE
• MULTIVITAMINS
• ANTIEMETICS
--------------------------------------------------------
• ANTABUSE Used only during rehabilitation phase
 NURSING CARE

• FLUID-ELECTROLYTE REPLACEMENT
• MONITOR VITAL SIGNS
• SAFETY-ONE-TO ONE
• PRESENT REALITY, DECREASE ANXIETY
• SEIZURE PRECAUTIONS
• SUPPORTIVE LIMIT-SETTING
• REINFORCE DISEASE CONCEPT
• CONSISTENCY
• REFER TO ALCOHOLICS’ ANONYMOUS &
EDUCATION PROGRAM AFTER DETOX.
 SEDATIVE, HYPNOTIC OR ANXIOLYTIC
INTOXICATION
• LABILITY
• DECREASED CONTROL OF IMPULSES/INHIBITIONS
• IRRITABLE
• SLURRED SPEECH
• INCOORDINATION/UNSTEADY GAIT
• IMPAIRED ATTENTION AND JUDGEMENT
• CAN LEAD TO COMA AND DEATH
SEDATIVE, HYPNOTIC OR ANXIOLYTIC (
CONT..)

WITHDRAWAL
• POTENTIAL FOR SEIZURES

• MUST BE W/D GRADUALLY

 AMPHETAMINES
INTOXICATION
• INCREASED PULSE AND B.P.
• DILATED PUPILS
• N /V
• TWITCHING, ASSAULTIVE
• GRANDIOSE/EUPHORIC
• PSYCHOSIS
• CONVULSIONS, COMA AND DEATH
 AMPHETAMINES ( CONT..)
WITHDRAWAL
• DEPRESSION
• AGITATION
• SLEEPINESS
• DISORIENTATION
• APATHY
 NURSING CARE FOR
AMPHETAMINE O/D AND W/D
OVERDOSE
MANAGEMENT FOR:
• INCREASED TEMP
• CONVULSIONS
• RESPIRATORY DISTRESS
• CV SHOCK
WITHDRAWAL
• ANTIDEPRESSIVE THERAPY
 COCAINE / CRACK
INTOXICATION
• INCREASED PULSE AND B.P.
• DILATED PUPILS
• INSOMNIA
• ANOREXIA
OVERDOSE
• SEIZURES
• CARDIAC ARREST
• CONVULSIONS & DEATH
 COCAINE / CRACK ( CONT..)
WITHDRAWAL
• FATIGUE
• DEPRESSION
• APATHY
• ANXIETY
 NURSING CARE FOR
COCAINE / CRACK O/D AND W/D

SAME AS FOR
AMPHETAMINES
 OPIODS / NARCOTICS
INTOXICATION
• DECREASED B.P. AND RESPIRATIONS
• CONSTRICTED PUPILS
• DROWSINESS
• SLURRED SPEECH
• PSYCHOMOTOR RETARDATION
• EUPHORIA/DYSPHORIA
• IMPAIRED MEMORY/JUDGEMENT
 OPIODS / NARCOTICS ( CONT..)
OVERDOSE
• PUPILS CONSTRICTED, BUT CAN BE DILATED
• RESPIRATORY DEPRESSION/ARREST
• COMA
• SHOCK
• CONVULSIONS AND DEATH
 OPIODS / NARCOTICS ( CONT..)
WITHDRAWAL
• YAWNING
• ANOREXIA
• INSOMNIA
• RUNNY NOSE
• CRAMPS
• CHILLS
• NAUSEA
• PILORECTION OF SKIN
 NURSING CARE FOR O/D AND W/D
NARCOTICS
OVERDOSE
• NARCAN
WITHDRAWAL
• SUPPORTIVE MEASURES, IF NOT LIFE
THREATENING (COLD TURKEY)
• (METHADONE MAY BE USED IN SEVERAL
SITUATIONS)
 HALLUCINOGENS- LSD / PCP

INTOXICATION/OD
• INTENSIFIED PRECEPTIONS
• PCP, LSD- DILATED PUPILS AND TACHYCARDIA, TPR.
AND BP
• ANXIETY/DEPRESSION
• ILLUSIONS AND HALLUCINATIONS
• DEPERSONALIZATION
• PANIC REACTION GRANDIOSITY, PARANOIA
PCP : ASSAULTIVENESS; JERKING; SEIZURES
LSD: “TRIPS” AND “FLASHBACKS”
 HALLUCINOGENS- LSD / PCP
NURSING CARE

• BENZODIAZAPINES (eg, diazepam, lorazepam)

• ANTIPSYCHOTICS (eg, haloperidal)
• ROOMS WITH LOW STIMULATION
• LSD- STAY WITH THE PATIENT “TALK DOWN”
• PCP- SPEAK SLOWLY, CLEAR. DO NOT ATEMPT TO
“TALK DOWN”
• MEDICAL INTERVENTION FOR- HYPERTENSION,
HYPERTHERMIA, RESPIRATORY DISTRESS
 CANNABIS
(CNS DEPRESSANT AND HALLUCINOGEN)

• ALTERED SENSORY PERCEPTIONS

• EUPHORIA, IMPAIRED COORDINATION
• SOCIAL WITHDRAWAL
• “RED EYES” EYE IRRITATION
• INCREASED APPETITE
 INHALANTS
• Paints, glue, cigarette lighter fluid, and propellant
gases used in aerosols. (e.g. hair spray)
• Nitrates, Anesthetics (nitrous oxide)
• Sniffing result in intoxication: disinhibition,
staggering, lightheadness agitation, euphoria.
• Damage to the nervous system and polyneuropathy
and myelopathy in chronic users
• Treatment: Support affected systems, B12 and folate.
 Rave and Techno Drugs, Club Drugs, Date
Rape drugs

• Rave (dance parties) usingdrugs such as Ecstacy (meth-

amphetamine) (MDMA, Adam, yaba, XTC) and other
amphetamines-like recreational drugs producing effects
resembling stimulants and hallucinogens.
• Effects include increased energy, euphoria, self-
confidence, feelings of closeness to people.
• Use results in depression, anxiety and sleep disorders.
• Rohypnol “roofies” used for sexual assault. Fast acting
benzodiaxepine resulting in relaxation and amnesia.
 PSYCHOPHARMACOLOGY ADDICTION

ADDITIONAL MEDICATIONS USED

 TREXAN, REVIA
 ANTABUSE
 ZYBAN
 METHADONE
 CATAPRESS
 SUBUTEX
 NICOTINE PATCH
Unit 10 C-Crisis Intervention
[Link]
Lecturer INS, VCN
 Crisis

• Crisis is a Chinese word means “danger” or

“opportunity”
• An internal disturbance caused by a stressful
event or perceived threat to self in which an
individual’s usual coping skills don’t work, rapid
increase in anxiety.
 Types of Crisis

Maturational or developmental; adolescents,

marriage, parenthood
Situational Crisis; loss of job, loss of loved one,
divorce
Adventitious Crisis: Mass disasters; fire, flood, etc.
Unexpected traumatic event, e.g. crime, rape
 Purpose of Crisis Intervention

The purpose of crisis intervention is to

prevent illness; both physical and emotional.
 Three Levels of Prevention

Primary Prevention: Prevents illness from

occurring

Secondary Prevention: Early Dx and treatment

Tertiary Prevention: Rehabilitate to get patient to

highest level of wellness possible
 Balancing Factors

Some events become crisis and some don’t,

depending on Balancing Factors
 Perception of the Event
 Situational Supports
 Adequate coping mechanisms
 CRISIS INTERVENTION
BALANCING FACTORS

 Perception of event  Perception of event

realistic distorted
 Situational support  Situational support
adequate inadequate
 Coping mechanisms  Coping mechanisms
adequate inadequate

No crisis
Crisis
 Assessment of Balancing Factors

• Perception of Event
– Cognitive skills
– Maintains self image and sense of purpose
– Redefines the event
• Situational Supports
– How well does patient utilize other people for support?
 Assessment of Balancing Factors

Coping Skills
 Ability to express strong emotions
 Preferred modes: does client prefer or have
skill with actions, like exercise, writing, crying,
talking?
 Ability to tolerate uncertainty
 Problem solving ability; making plans
 CRITICAL THINKING

• In the following scenario, compare the

balancing factors that influence each clients’
response to the crisis situation.
 Balancing Factors: Crisis Scenario

• There was a fire at an apartment building

which severely damaged it.
• Residents were brought to the emergency
department for evaluation for possible smoke
inhalation. Fortunately, there were no
injuries.
• Two residents in their twenties spoke with the
nurse in the ED . . . . . . . . . . .
 Same Event: Two Individuals

Client “A” Client “Z”

• Perception: “I lost my home but • Perception: “I lost everything
I still have my health and my that means anything to me.”
work.” • Supports: “My Dad always told
me to move out. He says no
• Supports: “My church is already wonder there was a fire .“
taking up a collection.” • Coping: “Now what do I do? I
• Coping: “The first thing I’m can’t think straight about this.
going to do when I leave here is It is too much.”
blog about this incredible
experience.”
 Principles: Crisis Intervention

Crisis counselors do NOT explore early life

events
Focus is on the “Here and Now”
Past traumas may create a current crisis
Crisis therapists assume that clients will be
able to cope if given information and support.
 Crisis Intervention Principles, cont’d

Length of crisis treatment is usually no more

than 6 weeks
Clients often very receptive to help.
Excellent time for teaching, referrals
 Primary and Secondary Prevention:
Community Resources

Disaster planning for vulnerable populations

Walk-in centers, Emergency services
24 hr. Hotlines
Disaster teams, go-to mobile services
 Crisis Case

• Seven year old Sarah is in the hospital for

asthma and respiratory infection. The nurse
learns that one week prior to her
hospitalization, her parents informed her they
are getting a divorce and her father moved
out of the home.
 Crisis Intervention for Family

Perception of event
Situational Supports
Coping strategies
 Crisis Intervention
• Definition:
– Is a form of brief focused and time limited therapy
which deals with the person’s present problem
and its immediate resolution ovly.
Crisis intervention consist of three phases:
– Crisis counseling
– Crisis care
– Crisis intervention in case of attempted suicide
 Crisis counseling
• Listen actively and with concern
• Encourage open expression with concern
• Help the patient gradually accept reality.
• Link the patient to social work
• Engage in decision, counseling, and problem
solving with the patient
• Reinforce newly learned coping device
• Follow up the care after resolution of crisis
 Crisis care
• Provide situational support
• Remove stress
• the nurses and the client work together to solve
the problem
• Help the client focus on the problem and specific
goal leading to its resolution
• Help the client to develop healthier coping skills
• helpful strategies may include open expression of
feeling, progressive relaxation and physical exercise
Crisis intervention in case of attempted suicide

• Move the patient to physically safe

environment
• Assess non-judgemental caring attitude that
does not create self pity in the patient ask the
patient why he choose to attempt suicide at
this particular movement
• Organize a plan with the patient, discuss all
important problems with him
• Remain honest and helpful
 Cnt..
• Evaluate the needs of medication
• Look through the patient belonging with him and remove
harmful objects
• The patient is to be remained in the room unless he/she is
accompanied by the staff or family members; never close
the doors
• Allow the patient to have regular food but check the glass
or any utensils are missing when collecting the tray.
• Continue these precautionary measures until the patient
builds receptivity is free of threat.
Thank you