Gregor Alfonsin C.

Pondoyo

 Substance-

drug of abuse, a medication, or a toxin (American Psychiatric Association, 2000) Substance use- the ingesting (eating, drinking, injecting, or inhaling) of any chemical that affects the body. Includes legal, illegal, medicinal substances (Morrison-Valfre, M., 2009).

 Abused

substances- drugs or chemicals that alter a persons perception and emotions by directly affecting the CNS Using a chemical despite negative consequences and against medical and social norms Habituation- (a psychological phenomenon) occurs when a person relies on a substance to provide relief or pleasure

 Substance

(chemical) dependence- (a physiological phenomenon) occurs when the taking of the drug or chemical of abuse is a need in order to stop withdrawal symptoms Intoxication- use of the chemical that results in maladaptive behaviour.

 Withdrawal

syndrome- negative physical and psychological symptoms experienced after abruptly decreasing chemical intake to which the person is addicted.

Addiction

Polysubstance

abuse- abuse of more than one

substance

 Taken

from the Monitoring the Future (MTF) and the National Survey on Drug Use and Health (NSDUH).

 Alcohol

In 2009, an estimated 30.2 million people (12.0 percent) aged 12 or older reported driving under the influence of alcohol at least once in the past year. Although this reflects a downward trend from 14.2 percent in 2002, it remains a cause for concern.

 Tobacco

The NSDUH found that from 2002 to 2009, the rate of past-month cigarette use fell from 13.0 percent to 8.9 percent among 12- to 17-yearolds. Another encouraging trend is the decline in cigarette use by young adults aged 18 to 25 years; rates of use fell from 40.8 percent in 2002 to 35.8 percent in 2009.

 Illicit

drugs

Daily marijuana use increased among 8th, 10th, and 12th graders from 2009 to 2010. Among 12th graders, use was at its highest point since the early 1980s, at 6.1 percent. Marijuana use is now ahead of cigarette smoking on some measures; in 2010, 21.4 percent of high school seniors used marijuana in the past 30 days, while 19.2 percent smoked cigarettes.

Trends in lifetime use of amphetamine and methamphetamine indicate statistically significant declines from peak-year use among all three grades combined. Amphetamine use peaked in 1996 at 15.5 percent and decreased to 8.9 percent in 2010. Methamphetamine (or shabu) use declined from 6.5 percent in 1999 to 2.2 percent in 2010.

According to NSDUH, current cocaine use gradually declined between 2003 and 2009 among people aged 12 or older (from 2.3 million to 1.6 million). MTF survey results show a steady decline in 2010 for current, annual, and lifetime prevalence of cocaine and crack abuse among all three grades combined from peak-year use in 1999.

After several years of decline, current and pastyear use of ecstasy (MDMA) has risen among 8th and 10th graders. From 2009 to 2010, lifetime use of ecstasy among 8th graders increased from 2.2 percent to 3.3 percent, past-year use from 1.3 percent to 2.4 percent, and current use from 0.6 percent to 1.1 percent.

Annual rates of hallucinogen use remained unchanged from 2009 to 2010, although significant increases were reported by 12th graders for annual (2.6 percent) and past-month (0.8 percent) use of LSD.

Past-year use of inhalants also remained steady from 2009 to 2010, with 8 percent of 8th graders reporting past-year use.

 Prescription

Drugs

Prescription and over-the-counter (OTC) medications accounted for most of the top drugs abused by 12th graders in the past year.

and Genetic Theories Learning Theory Social Theory The Addictive Personality
Biologic

 1980s-

discovery that all drugs of abuse stimulates the secretion of dopamine. Researchers found out that these drugs directly affect the neural pathways involved in pleasure and reinforcement of behavior Cocaine

Blocks the mechanism by which dopamine is reabsorbed into the cells that release dopamine. Provoke the release of dopamine

Amphetamines

 Nicotine

Acts on a receptor for the neurotransmitter acetylcholine and may prevent the enzyme monoamine oxidase from breaking up the molecule of dopamine. Act at receptor sites for the brains own morphine-like subsntaces.

Opiates

 Sedative-hypnotics,

alcohol, barbiturates, and benzodiazepines

Act in various parts of the brain on neurons that release gamma-aminobutyric acid (GABA), which directs neurons to cease firing.

These

changes in emotions prompts the person to take another dose of the drug previously ingested.

 Genetics

plays a role in the predisposition of individuals to addiction. It could be due to:

A high level of stress hormones A deficit in dopamine function which may be temporarily corrected by the persons drug/s Inherent electrical phenomena in brains of people at risk for alcoholism

researchers view on genetics was supported on a study comparing data between twins living with biological parents against twins born to alcoholic parents but got separated after birth and raised by nonalcoholic foster parents. Those born from alcoholic parents are more susceptible to alcoholism.

theory suggests that the high or extremely pleasurable emotion or sensation experienced when taking drugs acts as a positive reinforcement for that behavior. Social cognitive theory suggests that because of the influences of other persons and the physical environment, the behavior of a person is affected either possitively or negatively. Simply put, people learn from observing others.
Behavioral

 Potential

for addiction is affected by the economic conditions, formal and informal social controls, cultural traditions, companionship of other drug users. For teenagers, peers and their values are particularly strong influences. Experimentation, rebellion, boredomcommon reasons for drug use among teenagers

particular addictive personality has not been identified Substance abusers are considered to be stuck in an oral or infantile stage of development. Common characteristics of substance abusers:

Low self-esteem Feelings of dependency Low tolerance for frustration and anxiety Antisocial behavior fear

 Other

theorists believe that early childhood rejection, overprotection, undue responsibility can cause an individual to develop dependency on alcohol and drugs to cope with:

Increased anxiety Depression Social or sexual inadequacies Increased social pressures A desire to lower ones inhibitions or selfdestructive behavior

 According

to Videbeck (2008), much of the research on substance abuse is focusing on alcohol because it is widely used. However, it is noteworthy to mention that the clinical course of alcoholism is similar with other abused substances such as nicotine in tobacco smoke or cigarette (Getchell, Pippin, Grover, 1991)

 Early

stage

The individual is able to enjoy his chosen substance A desire to repeat the first pleasurable experience leads to a frequent pattern of use The preference to experience the pleasurable sensation or high or life of the drug use over other activities is beginning Intoxication happens in this stage.

 Middle

(crucial) stage

Intoxicating episodes increase as the body compensates Tolerance develops- increasing amounts of the ingested drug is needed to produce the desired effect Physical tolerance- body has adjusted to function with the chemical in the system Psychological tolerance- the individual thinks that he is incapacitated without the substance of abuse.

 Chronic

(late) stage

Tolerance for the drug is very high Loss of control of ones behavior Every energy is focused in obtaining and ingesting the substance being abused.

 Unlike

other psychological or physical illnesses, there is no classic presentation of a substance abuser. Depending on the chemical of abuse, each person has different presenting signs and symptoms. Physical symptoms however are recognizable such as neurological alterations during the withdrawal phase or when the person is in an acutely intoxicated period.

Abuse Criteria Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:
Substance

Recurrent substance use resulting in a failure to fulfil major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household). Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)

Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

 Note:

The symptoms for abuse have never met the criteria for dependence for this class of substance. According to the DSM-IV, a person can be abusing a substance or dependent on a substance but not both at the same time.

 Substance

dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.

The substance is often taken in larger amounts or over a longer period than intended. There is a persistent desire or unsuccessful efforts to cut down or control substance use. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. Important social, occupational, or recreational activities are given up or reduced because of substance use.

The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

 Alcohol

intoxication & overdose

A central nervous system depressant Absorbed rapidly in the bloodstream An overdose in a short period can result in vomiting, unconsciousness, respiratory depression Can cause aspiration pneumonia or pulmonary obstruction Alcohol induced hypotension can lead to cardiovascular shock and death

 Treatment

Gastric lavage or dialysis in an ICU

Withdrawal

& detoxification

S/Sx usually begin 4-12 mos after cessation or marked reduction of alcohol intake Course hand tremors, sweating, elevated pulse and Bp, insomnia, anxiety, n & v. May progress to delirium tremens ()transient hallucinations, seizures, or delirium

 Treatment

Administration of lorazepam (Ativan), chlordiazepoxide (Librium), diazepam (Valium) to suppress withdrawal symptoms Tapering Disulfiram (Antabuse)

 Sedatives,

Hypnotics, and Anxiolytics Intoxication and Overdose

Includes all central nervous system depressants: barbiturates, nonbarbturate hypnotics, and anxiolytics (particularly benzodiazepines) Similar effects (including intoxication) with alcohol Benzodiazepines- gastric lavage followed by ingestion of activated charcoal and a saline cathartic; dialysis

Barbiturates- lethal when taken in overdose Can cause coma, respiratory arrest, cardiac failure and death Tx in ICU with gastric lavage and dialysis

Withdrawal

and Detoxification

Symptoms depends on the half-life of the drug Symtptoms are opposite to the acute effects of the drug: autonomic hyperactivity (inc. pulse, Bp, respiration, & temp.!), hand tremors, insomnia, anxiety, nausea& psychomotor agitation

Detoxification from sedatives, hypnotics, & anxiolytics is often managed medically by tapering

Stimulants

(Amphetamines, Cocaine)

Stimulate & excite the CNS; high potential for abuse Amphetamines (uppers)- popular in the past & used by people who wants to lose weight and stay awake Cocaine- illegal & has no significant clinical use Methampethamine- highly addictive & causes psychotics behavior; can cause brain damage

 Intoxication

& Overdose

Develops rapidly High or euphoric feeling, hyperactivity, hypervigilance, talkativeness, anxiety, grandiosity, hallucinations, stereotypic or repetitive behavior, anger, fighting, impaired judgment. Physiologic effects: inc. Bp, tachycardia, dilated pupils, perspiration or chills, nausea, chest pain, confusion & cardiac dysrthmias Overdose= seizures & coma; deaths are rare

 Withdrawal

& Detoxification

Occurs within a few hours to few days Not life threatening Marked dysphoria, fatigue, vivid & unpleasant dreams, insomnia & hypersomnia, inc. appetite, psychomotor retardation or agitation Crashing Not treated pharmacologically

 Cannabis

(Marijuana)

Cannabis sativa, a hemp plant that is widely cultivated Most often smoked in cigarettes (joints) but can be eaten Can lower intraocular pressure Relieves nausea & vomiting associated with cancer chemotheraphy & the anorexia & wt loss of AIDS [dronabinol (Marinol) & nabilone (Cesamet)]

 Intoxication

Acts less than 1 minute after inhalation; peak20-30 min; lasts 2-3 hrs. High feeling similar to alcohol, lowered inhibitions, relaxation, euphoria, inc. appetite Intoxication- impaired motor coordination, inappropriate laughter, impaired judgment & short-term memory, distortions of time & perception Physiologic effects- inc. appetite, conjunctival injection (bloodshot eyes), dry mouth, hypotension, & tachycardia

 Opioids

legal: morphine, meperidine (Demerol), codeine, hydromorphone, oxycodone, methadone, oxymorphone, hydrocodone, propoxypene Illegal: heroin & normethadone

Intoxication

& Overdose

I. develops after initial euphoric feeling w/c includes: apathy, lethargy, listlessness, impaired judgment, psychomotor retardation/agitation, constricted pupils, drowsiness, slurred speech, impaired attention & memory.

Severe intoxication can lead to coma, respiratory depression, pupillary constriction, uncosciousness & death. Naloxone (Narcan), opioid antagonist

Withdrawal

& Detoxification

Develops after abrupt cessation Initial symptoms: anxiety, restlessness, aching back & legs, cravings for more opioids May progress to include n & v, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, insomnia. Methadone can be used as a replacement then tapered over 2 weeks

 Hallucinogens

Substances that distort a users perception of reality Hallucinations (usually visual), depersonalization, inc. pulse, Bp, Temp.; dilated pupils, hyperreflexia Mescaline, psilocybin, lysergic acid diethylamide, designer drugs like Ecstasy, PCP

 Anxiety Impaired

verbal communication Ineffective community coping Ineffective coping Ineffective denial Dysfunctional family processes: alcoholism Hopelessness Risk for injury Risk for loneliness Noncompliance (to nursing & medical management)

 Powerlessness Ineffective

sexuality pattern Social isolation Spiritual distress Risk for trauma Risk for other-directed violence Risk for self-directed violence

 The

earlier the onset of abuse the poorer is the prognosis & the longer is the time since first use the poorer also is the prognosis.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183) Ariola, M. M. (2009). General psychology with drug education. Philippines: Katha Publishing Co., Inc. Shives, L.R., & Isaacs, A. (2002). Basic concepts of Psychiatric-Mental health nursing (5th ed.). New York: Lippincott Williams & Wilkins Getchell, Leroy H., Pippin, Grover D., Varnes, Jill W. (1991). Health.USA, Houghton Mifflin Company (pp. 347-348)

 Morrison-Valfre,

M. (2009). Foundations of mental health care (4th ed.). Missouri: Mosby Elsevier Videbeck, S. L. (2008). Psychiatric-Mental health nursing (4th ed.). Philadelphia: Lippincott Williams & Wilkins DeYoung, S. (2003). Teaching strategies for nurse educators. New Jersey: Pearson Education (pp. 69-71)