Substance Abuse

NCM 117 (LEC)
MALADAPTIVE PATTERNS OF BEHAVIOR

HANDOUT
H. SUBSTANCE RELATED DISORDER
I. DEFINITION
SUBSTANCE:
Any form of matter that affects the pleasure centers of the brain producing pleasurable
changes in mental or emotional states leading to potential for abuse.
Addiction
A psychological, behavioral and physical inability to control use or consumption of a
substance (ex. alcohol), or partaking in activity (ex. gambling), resulting to dependency on
it to cope with daily life, no matter how harmful, at times dangerous it could be.
Substance Abuse
Continued, often times, excessive use of substance despite occurrence of related
problems due to its pleasure given to the person.
Substance Dependence
Indicates a severe condition associated with addiction, such as tolerance, withdrawal and
unsuccessful attempt to stop using the substance. The person cannot, think, work or
function without using the substance.
Dual Diagnosis
Is the co-existence of substance abuse and psychiatric disorders within the same person.
Tolerance
The need for increased amount of a substance to produce the same effect
Withdrawal Symptoms
Refers to the negative physical reactions that occur when use of a substance ceases either
gradually or abruptly.
II. DYNAMICS OF SUBSTANCE ABUSE
Prepared by Prof. Amelia Z. Manaois for AU-College of Nursing to be used as Instructional Material only for the Lecture in Maladaptive
Patterns of Behavior. Refrain from reproducing this material without the consent of the preparer and the AU--CN
By nature, humans have the ability to be naturally high without the use of any substances.
Through meditation, relaxation, or doing activities one can enjoy (like exercising, watching
movies, chatting with friends) may already make an individual simply “high”. Either such
feeling causes the release of serotonin (natural “happy” pill) or dopamine (“pleasure” pill)
or the activities people do that stimulates release of dopamine and serotonin causing
“natural high”, or both.
Minimal use of substances to dependency may start through the following:
1. ACUTE to CHRONIC use

Use of substances may progress from acute to chronic use (social drinking, curiosity,
peer pressure or pakikisama”, temporary relief of pain or tension)
2. Relief of tension and discomfort (Activation of the brain’s reward system: HIGH)
Reliance on use of substances as a means of dealing with personal tension and
discomfort
3. Vicious cycle of behavior:
III. TEN MOST COMMON ABUSED SUBSTANCES

Based on the Diagnostic and Statistical Manual of Mental Disorder, 5th edition, (DSM-V)
1. Alcohol (F10.XX)
2. Opioids (F11.XX)
3. Cannabis (F12.XX)
4. Sedatives, Hypnotics, & Anxiolytics (F13.XX)
5. Stimulants (Cocaine F14.XX)
6. Stimulants (Amphetamines F15.XX)
7. Caffeine (F15.9X)
8. Hallucinogens (F16.XX)
9. Tobacco (F17.XX)
10. Inhalants (F18.XX)
11. Other or Unknown Substance Use Disorder (F19.XX)
IV. SUBSTANCE RELATED DISORDERS
A. SUBSTANCE USE DISORDER
Substance use disorder (SUD) is a complex condition in which there is

uncontrolled use of a substance despite harmful consequence. People with SUD
have an intense focus on using a certain substance(s) such as alcohol, tobacco,
or illicit drugs, to the point where the person’s ability to function in day-to-day life
becomes impaired. People keep using the substance even when they know it is
causing or will cause problems. The most severe SUDs are sometimes called
addictions.
People with a substance use disorder may have distorted thinking and behaviors.
Changes in the brain’s structure and function are what cause people to have
intense cravings, changes in personality, abnormal movements, and other
behaviors. Brain imaging studies show changes in the areas of the brain that relate
to judgment, decision making, learning, memory, and behavioral control.
Repeated substance use can cause changes in how the brain functions. These
changes can last long after the immediate effects of the substance wears off, or
after the period of intoxication.
CRITERIA FOR SUBSTANCE USE DISORDER

Based on the Diagnostic and Statistical Manual of Mental Disorder, 5th edition, (DSM-V)
Substance use span a wide variety of problems, and cover 11 different criteria:
1. Use of larger amounts or longer than are meant to.
2. Wanting to cut down but cannot manage to.
3. Taking too long to recover from use of the substance.
4. Cravings and urges to use the substance.
5. Neglect of responsibilities at work, home, or school
6. Continues use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities
8. Using substances repetitively even if it threatens life and safety
9. Continues use, even in the presence of physical or psychological problem
that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking
more of the substance.
The Severity of Substance Use Disorders

▪ Mild Substance Use Disorder
Two or three symptoms
▪ Moderate Substance Use Disorder
Four or five symptoms
▪ Severe Substance Use Disorder
Six or more symptoms
B. SUBSTANCE INDUCED DISORDER
Substance-induced disorders are a type of Substance Related Disorder that

involve group of direct effects of a drug to an individual such as:
1. Intoxication - Marked diminished of physical or mental control due to

intake of toxic substances such as alcohol or drugs. Intoxication also is
the intense pleasure, euphoria, calm, increased perception and sense, and
other feelings that are caused by the substance. Intoxication symptoms are
different for each substance
2. Withdrawal - Refers to the negative physical reactions that occur when

use of a substance cease either gradually or abruptly
3. Substance-induced mental disorders - are mental changes produced
by substance use or withdrawal that resemble independent mental
disorders (e.g, depression, psychosis, anxiety, or neurocognitive
disorders).
The toxic effects of substances can mimic mental illness in ways that can
be difficult to distinguish from mental illness. The signs and symptoms of
mental illness in substance induced disorder are the result of substance
abuse— hence referred to as “substance-induced mental disorders.”
CRITERIA FOR SUBSTANCE INDUCED DISORDER
To be considered substance-induced disorder, the substance involved must be

known to be capable of causing the disorder (Substances that are listed by the
DSM-5 as 10 Most Common Abused Substances or many others like
anticholinergics and corticosteroids that may cause temporary psychotic
syndromes). In addition, the mental disorder should
• Appear within 1 month of substance intoxication or withdrawal
• Cause significant distress or impaired functioning
• Not have manifested before use of the substance
• Not occur solely during acute delirium caused by the substance
• Not persist for a substantial period of time*
* Certain neurocognitive disorders caused by alcohol, inhalants, or sedative-
hypnotics and perceptual disorders caused by hallucinogens may be long-
lasting.
Aside from the criteria mentioned, there should be presence of at least 2

symptoms:
• Denial of problems
• Minimizes use of substance
• Rationalization
• Blaming others for problems
• Anxiety
• Irritability
• Impulsivity
• Feelings of guilt and sadness or anger and resentment
• Poor judgment
• Limited insight
• Low self-esteem
• Ineffective coping strategies
• Difficulty expressing genuine feelings
• Impaired role performance
• Strained interpersonal relationship
• Physical problems such as sleep disturbances and inadequate nutrition
Substance-Induced Mental Disorders include:
• Substance-induced psychotic disorder
• Substance-induced mood disorder
• Substance-induced anxiety disorder
• Substance-induced delirium
• Substance-induced persisting dementia
• Substance-induced persisting amnestic disorder
• Substance-induced sexual dysfunction
• Substance-induced sleep disorder
• Hallucinogen persisting perceptual disorder
V. SUBSTANCES ABUSED, INTOXICATION, WITHDRAWAL & DETOXIFICATION
A. Alcohol (F10.XX)
Alcohol is a central nervous system depressant that is absorbed rapidly into the
bloodstream. Initially, the effects are relaxation and loss of inhibitions.
1. INTOXICATION
• With intoxication, there is slurred speech, unsteady gait, lack of
coordination, and impaired attention, concentration, memory, and
judgment. Some people become aggressive or display
inappropriate sexual behavior, some may experience a blackout.
• OVERDOSE
• An overdose, or excessive alcohol intake in a short period,
can result in vomiting, unconsciousness, and respiratory
depression.
• This combination can cause aspiration pneumonia or
pulmonary obstruction.
• Alcohol induced hypotension can lead to cardiovascular
shock and death.
• Treatment of an alcohol overdose is similar to that for any
central nervous system depressant:
• Gastric lavage or dialysis to remove the drug and
support of respiratory and cardiovascular functioning
in an intensive care unit.
• Contraindicated: administration of central nervous
system stimulants is contraindicated
2. WITHDRAWAL SYMPTOMS:
• Begins 4 to 12 hours after cessation or marked reduction of alcohol
intake.
• Symptoms include:
• Coarse hand tremors, sweating, elevated pulse and blood
pressure, insomnia, anxiety, dyspnea and nausea or
vomiting.
• Severe or untreated withdrawal may progress to transient
hallucinations, confusion, seizures, or delirium—called delirium
tremens (DTs).
• Alcohol withdrawal usually peaks on the second day and is over in
about 5 days (American Psychiatric Association [APA], 2000).
• Variation: may take 1 to 2 weeks.
• Alcohol withdrawal can be life-threatening
3. DETOXIFICATION needs to be accomplished under medical supervision:

• GOAL: The goal of detox procedure is to flush out any
detectable substances in the body. Water flushing, non-
caffeinated teas and saunas may help to wash out the
substance circulating in the body
• Mild withdrawal symptoms: Detox treatment can be safely
done at home.
• Severe withdrawal symptoms: a short admission of 3 to 5
days is the most common setting.
• Pharmacotherapy: to suppress withdrawal symptoms
• Benzodiazepines:
• Lorazepam (Ativan)
• Chlordiazepoxide (Librium)
• Diazepam (Valium)
• Pharmacotherapy: by producing acute sensitivity to ethanol
• Disulfiram (Antabuse)
B. Opioids (F11.XX)
Commonly use to relieve moderate to severe pain:

Codeine
Heroin
Fentanyl
Morphine
Meperidine
Methadone
Opium
HEROIN (OPIOIDS) – the most common abused opioids

• Mode of Intake: smoke, snort, IV injection
• Heroin has a high association with co-morbid physical condition with pain,
anxiety and depression
• Chance of HIV thru shared needles is high
1. INTOXICATION
• Direct effect to CNS:
• Euphoria
•A pleasurable feeling among people with depression or
anxiety
• Lower doses: calmer, less tense, less lonely
• Higher doses: Floating, dream-like state.
• Physical effects:
• Vomiting
• Suppressed breathing and the coughing reflex,
• Increased risk of choking
• Constipation (Diarrhea-withdrawal)
• Reduce sex drive and the ability to have an orgasm
• Apathy, lethargy, listlessness, impaired judgment,
psychomotor retardation or agitation, constricted pupils,
drowsiness, slurred speech, and impaired attention and
memory
• Severe intoxication or opioid overdose can lead to coma,

respiratory depression, pupillary constriction, unconsciousness,
and death.
• Administration of naloxone (Narcan), an opioid antagonist, is the
treatment of choice because it reverses all signs of opioid toxicity.
Naloxone is given every few hours until the opioid level drops to
nontoxic.
2. WITHDRAWAL AND DETOXIFICATION

• Opioid withdrawal develops when drug intake ceases or
decreases markedly, or it can be precipitated by the administration
of an opioid antagonist.
• Initial symptoms: are anxiety, restlessness, aching back and legs,
leading to cravings for more opioids.
• Symptoms that develop as withdrawal progresses include nausea,
vomiting, pupil dilatation, dysphoria, lacrimation, rhinorrhea,
sweating, diarrhea, yawning, fever, and insomnia.
• Symptoms of opioid withdrawal cause significant distress but do
not require pharmacologic intervention to support life or bodily
functions.
• Short-acting drugs such as heroin produce withdrawal symptoms
in 6 to 24 hours; the symptoms peak in 2 to 3 days and gradually
subside in 5 to 7 days.
• Longer-acting substances such as methadone may not produce
significant withdrawal symptoms for 2 to 4 days, and the
symptoms may take 2 weeks to subside. Methadone can be used
as a replacement for the opioid, and the dosage is then decreased
over 2 weeks. Substitution of methadone during detoxification
reduces symptoms to no worse than a mild case of flu (Lehne,
2006).
• Withdrawal symptoms such as anxiety, insomnia, dysphoria,
anhedonia, and drug craving may persist for weeks or months
C. Cannabis (F12.XX)
Although Cannabis is not a CNS depressant, it produces feeling of relaxation and

mild euphoria. The active ingredient in marijuana is tetrahydrocannabinol (THC)
Mode of intake: Smoking

Cannabis begins to act less than 1 minute after inhalation. Peak effects
usually occur in 20 to 30 minutes and last at least 2 to 3 hours.
Often considered to be a “soft” drug. Prescription needed
Cannabis is one of the most unpredictable of all drug intoxication effects
1. INTOXICATION:
• Altered Sensory Perceptions
• HEARING
• Often the most strongly affected.
• Greater appreciation of music and may spend the
entire experience listening to music and doing little
else
• TASTE
• Enhanced sense of taste: binge eating (“the
munchies”)
• Often in odd combinations, such as chocolate with
pickles.
• VISUAL:
• Familiar faces and objects become unfamiliar or
strange, often in a way that amuses the person who
is high
• Colors appear brighter
• Aesthetic appreciation can be enhanced, and the
mood of the individual can be projected onto
everything around them.
• When effects are perceived in a positive way, this
can be enjoyable — the world seems more beautiful
• When effects are perceived in a negative way – it
can cause to see world as grim and harsh.
• Altered Mood and Mental State

• Exaggerated: previously neutral emotion becomes amusing
or ridiculous, or conversely, intimidating and upsetting.
• Imagined confrontation: intense paranoia
• Rebound:
• Long-term anxiety disorders
• Increased intake
• Vicious cycle
• Confused or slowed down, bizarre, incomprehensible
• Rarely does marijuana improve mental functioning.
• Less creativity
2. WITHDRAWAL
Although some people have reported withdrawal symptoms of muscle

aches, sweating, anxiety, and tremors, no clinically significant withdrawal
syndrome is identified
3. DETOXIFICATION
The goal of detox procedure is to flush out any detectable THC in the body.
Water flushing, teas and saunas may help to wash out THC from the kidney
D. Sedatives, Hypnotics, & Anxiolytics (F13.XX)
CNS Depressants or Downers” – their main purpose is to reduce anxiety, induce

sleep, sedate.
Barbiturates
Benzodiazepine
1. INTOXICATION
• In the usual prescribed doses, these drugs cause drowsiness and
reduce anxiety, which is the intended purpose.
• Intoxication symptoms include: slurred speech, lack of coordination,
unsteady gait, labile mood, impaired attention or memory, and even
stupor and coma.
• Treatment includes gastric lavage followed by ingestion of activated
charcoal and a saline cathartic; dialysis can be used if symptoms
are severe.
• The client’s confusion and lethargy improve as the drug is excreted.
• Barbiturates, in contrast, can be lethal when taken in overdose.
They can cause coma, respiratory arrest, cardiac failure, and death.
Treatment in an intensive care unit is required using lavage or
dialysis to remove the drug from the system and to support
respiratory and cardiovascular function.
2. WITHDRAWAL SYMPTOMS
• The onset of withdrawal symptoms depends on the half-life of the
drug. Medications such as lorazepam, whose actions typically last
about 10 hours, produce withdrawal symptoms in 6 to 8 hours;
longer-acting medications such as diazepam may not produce
withdrawal symptoms for 1 week (APA, 2000).
• The withdrawal syndrome is characterized by symptoms that are
the opposite of the acute effects of the drug: that is, autonomic
hyperactivity (increased pulse, blood pressure, respirations, and
temperature), hand tremor, insomnia, anxiety, nausea, and
psychomotor agitation. Seizures and hallucinations occur only
rarely in severe benzodiazepine withdrawal.
3. DETOXIFICATION
• Detoxification from sedatives, hypnotics, and anxiolytics is often
managed medically by tapering the amount of the drug the client
receives over a period of days or weeks, depending on the drug and
the amount the client had been using.
• Abrupt removal of the drugs may result to coma and death.
• Flushing out
E. Stimulants (Cocaine F14.XX) & Stimulants (Amphetamines F15.XX)
CNS Stimulants or "Uppers" – their main purpose is relief from fatigue, added
energy, added alertness.
COCAINE, METHAMPHETAMINE, ECSTASY

• Illicit drugs
• Street Name:
o Coke - cocaine (Plant-derived)
o Shabu - Methamphetamine (Man-made)
• Mode of Intake:
o Oral, Snorting, Smoking, IV
• CNS Stimulants: Direct effect on the brain and nervous system
• On Meth Users:
o "Tweaking" - Fidget movement
o Formication: resulting to skin sores as the users repetitively
scratches skin, accompanied by sensation that resembles
that of small insects crawling on or under the skin.
1. INTOXICATION
Intoxication from stimulants develops rapidly and instantly. Effects
includes:
• Euphoria
o Intense pleasure: rewarding feeling
o Initially: HIGH AND EUPHORIC
o Prolonged use:
▪ Blunting of the emotions.
▪ Sadness, and withdrawal from other people.
▪ Frustrations to these effects: Self Medication and
Addictive Behavior
• Self Confidence
o Feeling superior: grandiosity
o Annoying to other people, leading to social problems.
o Performers, actors, artists commonly use this
• Sociability
o More energetic and sociable
o Talkative and gregarious.
o Sometimes lead to angry outbursts, restlessness, hyperactivity,
anxiety and paranoia.
• Perceptual Disturbance
o Hallucinations, Delusion
• Physical Effects
o Weight loss
o Insomnia
o Increase VS: HR, PR, BP, Temperature
o Sweating
o Fatigue, weakness
o Nausea
o Seizures
o Death
• Increase sex drive
• Treatment with chlorpromazine (Thorazine), an antipsychotic, controls

hallucinations, lowers blood pressure, and relieves nausea (Lehne,
2006).
2. WITHDRAWAL
• Withdrawal from stimulants occurs within a few hours to several
days after cessation of the drug and is not life-threatening.
• Marked dysphoria is the primary symptom and is accompanied by
fatigue, vivid and unpleasant dreams, insomnia or hypersomnia,
increased appetite, and psychomotor retardation or agitation.
Marked withdrawal symptoms are referred to as “crashing”; the
person may experience depressive symptoms, including suicidal
ideation, for several days.
3. DETOXIFICATION
• Stimulant withdrawal is not treated pharmacologically .
• Sauna detoxification aims to flush out toxins through perspiration
F. Caffeine (F15.9X)
The world’s most popular and accessible drug. Typically present in drinks
like coffee, cola, tea or energy drinks, or via weight loss aids, chocolate and
over-the-counter medication.
Caffeine is a naturally occurring stimulant used to boost wakefulness and

alertness.
1. INTOXICATION and WITHDRAWAL

• Nervousness
• Restlessness
• Excitement
• Facial flushing
• Digestive complaints
• Increased or irregular heart rate
• Diuresis
• Insomnia
• Muscle twitching
• Nervous energy
• Periods of tirelessness
2. DETOXIFICATION
• Symptoms will usually go away on its own after several hours.
• Treatment:
• Drinking water for flushing and rehydration, walking to
relieve restlessness and not consuming any further
caffeine.
• In severe cases, when someone has overdosed on
caffeine, medical treatment may be necessary. Patients
may be given supplements, intravenous fluids or activated
charcoal, which stops caffeine being absorbed in the gut.
• Individuals who consume caffeine regularly or in high

doses might want to reduce their usage to combat
symptoms of caffeine intoxication or to prevent any
associated problems, such as sleeping difficulties, anxiety
and stomach ulcers.
G. Hallucinogens (F16.XX)
• "ACID TRIP"
• Psychedelic drugs
• LSD (Lysergic Acid Diethylamide): typically used for recreational and social
reasons more than medication purposes
• Belief:
o Gain insight to self, life, nature and universe
o Access greater awareness of spirituality.
• LSD can trigger variety of mental health problems
• Often produces "good trip" or "bad trip"
1. INTOXICATION
• Visual Distortions: hallmark of LSD experience.
• Static objects appearing to move
• Walls are breathing
• Buildings are running after you
• Faces appear as outline of geometric or swirling patterns
• Changes in the perceived size or shape of objects or people
• Hallucinations: Visual, Auditory, Tactile, Olfactory, Gustatory
• Serious Side Effects
• Increased heart rate
• Increased BP
• Excessive sweating
• Hyperthermia (dangerously high body temperature that can
lead to muscle and kidney damage)
• Dehydration
• Risks of injury to self and others ( e.g. jumping out a window in the
belief that one can fly)
• No withdrawal syndrome has been identified for hallucinogens,
although some people have reported a craving for the drug.
• Hallucinogens can produce flashbacks, which are transient
recurrences of perceptual disturbances like those experienced with
hallucinogen use. These episodes occur even after all traces of the
hallucinogen are gone and may persist for a few months up to 5
years.
H. Tobacco (F17.XX)
Nicotine addiction is now referred to as tobacco use disorder in the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
The addictive nature of nicotine includes drug-reinforced behavior, obsessive use

and reoccurring use after abstaining from it, as well as physical dependence and
tolerance.
Nicotine is found in cigarettes, pipes, cigars, chewing tobacco and snuff.
Besides causing dependency, nicotine has many negative physical effects and a
variety of withdrawal symptoms.
1. TOBACCO INTOXICATION
• Euphoria
• Feelings of relaxation
• Increased blood pressure
• Increased heart rate
• Congestion
• Heartburn
2. WITHDRAWAL
• Irritability, frustration, or anger
• Anxiety
• Difficulty concentrating
• Increased appetite
• Restlessness
• Depressed mood
• Insomnia
• Headache
• Sweating
• Tremors
• Digestive issues
• Craving
3. DETOXIFICATION
• Drink 2-3L of water to flush out nicotine
• Drink water with Powdered Activated Charcoal
• Exercise regularly
• Sauna and other procedures promoting sweating
I. Inhalants (F18.XX)
Solvents, fuel, rugby, thinner, paint, gasoline, glue
Inhalants can cause significant brain damage, peripheral nervous system damage,
and liver disease.
1. INTOXICATION
• Dizziness, nystagmus, lack of coordination, slurred speech,
unsteady gait, tremor, muscle weakness, and blurred vision.
• Stupor and coma can occur.
• Significant behavioral symptoms are belligerence, aggression,
apathy, impaired judgment, and inability to function.
• Acute toxicity causes anoxia, respiratory depression, vagal
stimulation, and dysrhythmias.
• Death may occur from bronchospasm, cardiac arrest, suffocation,
or aspiration of the compound or vomitus (Crowley & Sakai, 2005).
• Treatment consists of supporting respiratory and cardiac
functioning until the substance is removed from the body. There are
no antidotes or specific medications to treat inhalant toxicity

• There are no withdrawal symptoms or detoxification procedures for
inhalants as such, although frequent users report psychologic
cravings.
• People who abuse inhalants may suffer from persistent dementia
or inhalant-induced disorders such as psychosis, anxiety, or mood
disorders even if the inhalant abuse ceases. These disorders are
all treated symptomatically (Crowley & Sakai, 2005).
J. SUBSTANCE INTOXICATION DELIRIUM

A wide variety of psychoactive substances can cause substance intoxication
delirium, including:
• Alcohol intoxication delirium
• Cannabis intoxication delirium
• Phencyclidine intoxication delirium
• Hallucinogen intoxication delirium
• Inhalant intoxication delirium
• Opioid intoxication delirium
• Sedative-hypnotic intoxication delirium
• Anxiolytic intoxication delirium
• Amphetamine intoxication delirium
• Cocaine intoxication delirium
WITHDRAWAL SYNDROME
HIITSAA
• Hallucinations (visual & tactile)
• Increase VS
• Insomnia
• Tremors/ Delirium tremens
• Sweat / seizure / stomach pain (nausea, vomiting, diarrhea)
• Anxiety, Depression
• Agitation and irritability
VI. SCREENING FOR SUBSTANCE ABUSE

A. CAGE - AID Questionnaire
a. Cut-down - Have you felt you needed to cut down on your drinking?
b. Annoyance - Are people annoyed by your drinking?
c. Guilt - Have you felt guilty about your drinking?
d. Eye-opener - Have you ever had a drink in the morning (eye-opener)?
e. Adapted to Include Drugs
Score of 2 or more is significant, although a score of 1 requires further assessment.
B. B-DAST (Brief Drug Abuse Screening Test)

C. Breath analyzer
D. Blood and Urine screening
E. Blood - test for the drug itself
F. Urine - test for the drug by-products (metabolites) - lingers in system 3 days to 30 days
G. Hair Test
H. Oral Fluid Test
I. Sweat Test
VII. NURSING PROCESS
A. ASSESSMENT:
Assessment Guidelines:
1. Clinical examination of background, pattern of substance use, and any mental health
symptoms.
2. Family History: Trauma, Substance use or mental health problems and any disabilities
3. Strengths and level of willingness to change.
4. Drug Test / Screening
B. NURSING DIAGNOSIS
1. Risk for suicide

2. Risk for injury
3. Disturbed sleeping pattern
4. Nutrition: Less than body requirements
5. Self Neglect
6. Disturbed Sensory Perception
7. Acute Confusion
8. Ineffective Coping Mechanism
9. Dysfunctional Family processes
10. Risk for impaired liver function
C. PLAN / IMPLEMENTATION OF CARE
1. Establish a trusting Nurse – Patient Relationship

2. Self-awareness / insight into the disorder
3. Safety / protection / confidentiality and privacy of patient
4. Modify environment / External control
5. Convey an attitude of acceptance to the patient (Therapeutic NPR and commo)
6. Attitude Therapy
7. Psychotherapies:
• Refer to Self-help group (AA)
• Individual Counseling
• Family Therapy – Confrontation Strategies
8. Continuous monitoring of VS and withdrawal syndromes
9. Pharmacotherapy
o Disulferam (Antabuse) – maintenance, relapse prevention, aversion therapy
o Benzodiazepines – for withdrawal
▪ Diazepam (Valium)
▪ Lorazepam (Ativan)
o Anticonvulsant – Tegretol
o Clonidine (Catapres)
10. Care Continuum
o Detoxification Procedures
o Residential Treatment – In patient (non-hospital setting Rehabilitation)
o Hospitalization Program
o Identifying Coping Resources
▪ Motivation to change
▪ Social support
▪ Health status
▪ Social skills
D. EVALUATION OF CARE
Evaluating patient care depends on the identified treatment plan and outcome measures
that may include immediate detox and stabilization for individuals experiencing withdrawal,
motivation for treatment and engagement in early abstinence, and pursuit of a recovery
lifestyle after discharge. Take into account the safety of the patient and his/ her ability to
recognize the problem and readiness or motivation for change.
Sample Desired Outcome for Substance Related Disorders
Signs and Symptoms Nursing Diagnosis Outcomes
Impulsiveness, loss of relationships and Risk for suicide Expresses feelings, verbalizes
occupation due to focus on substances or suicidal ideas, refrains from
gambling, legal problems, social isolation suicide attempts, plans for the
future
Impairment from substances, overdose, Risk for injury Remains free from injury
withdrawal from substances, hallucinations,
elevated temperature, pulse, respirations,
agitation
Reports not feeling well rested, decreased Disturbed sleeping Minimal awakening, feels
ability to function, reports awakening pattern restored after sleep
multiple times
Substance use or gambling, decreased use Ineffective coping Modifies lifestyle as needed to
of social support, destructive behavior maintain sobriety, maintains
toward self and others, difficulty organizing abstinence from substances,
information, inadequate problem-solving, engages in satisfying
poor concentration, reports inability to cope relationships
Blaming, broken promises, chaos, denial of Dysfunctional family Family members attain cohesion
problems, enabling maintenance of process and emotional bonding
substance use pattern, immaturity, inability
to accept help or express feelings,
loneliness, lying, manipulation,
rationalization, refuses to get help social
isolation, worthlessness, deterioration of
family relationships
References:
• Margaret Jordan Halter, Varcaroli’s Foundations of Psychiatric-Mental Health Nursing,
8th edition, 2018
• Shiela L. Videbeck, Psychiatric Mental Health Nursing 5th edition 2011.

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NCM 117 (LEC)

MALADAPTIVE PATTERNS OF BEHAVIOR

H. SUBSTANCE RELATED DISORDER

II. DYNAMICS OF SUBSTANCE ABUSE

Minimal use of substances to dependency may start through the following:

1. ACUTE to CHRONIC use

3. Vicious cycle of behavior:

III. TEN MOST COMMON ABUSED SUBSTANCES

IV. SUBSTANCE RELATED DISORDERS

A. SUBSTANCE USE DISORDER

Substance use disorder (SUD) is a complex condition in which there is

CRITERIA FOR SUBSTANCE USE DISORDER

The Severity of Substance Use Disorders

B. SUBSTANCE INDUCED DISORDER

Substance-induced disorders are a type of Substance Related Disorder that

1. Intoxication - Marked diminished of physical or mental control due to

2. Withdrawal - Refers to the negative physical reactions that occur when

CRITERIA FOR SUBSTANCE INDUCED DISORDER

To be considered substance-induced disorder, the substance involved must be

Aside from the criteria mentioned, there should be presence of at least 2

V. SUBSTANCES ABUSED, INTOXICATION, WITHDRAWAL & DETOXIFICATION

3. DETOXIFICATION needs to be accomplished under medical supervision:

Commonly use to relieve moderate to severe pain:

HEROIN (OPIOIDS) – the most common abused opioids

• Chance of HIV thru shared needles is high

• Severe intoxication or opioid overdose can lead to coma,

2. WITHDRAWAL AND DETOXIFICATION

Although Cannabis is not a CNS depressant, it produces feeling of relaxation and

Mode of intake: Smoking

Often considered to be a “soft” drug. Prescription needed

Cannabis is one of the most unpredictable of all drug intoxication effects

• Altered Mood and Mental State

Although some people have reported withdrawal symptoms of muscle

D. Sedatives, Hypnotics, & Anxiolytics (F13.XX)

CNS Depressants or Downers” – their main purpose is to reduce anxiety, induce

E. Stimulants (Cocaine F14.XX) & Stimulants (Amphetamines F15.XX)

COCAINE, METHAMPHETAMINE, ECSTASY

• Treatment with chlorpromazine (Thorazine), an antipsychotic, controls

Caffeine is a naturally occurring stimulant used to boost wakefulness and

1. INTOXICATION and WITHDRAWAL

• Individuals who consume caffeine regularly or in high

The addictive nature of nicotine includes drug-reinforced behavior, obsessive use

Nicotine is found in cigarettes, pipes, cigars, chewing tobacco and snuff.

Solvents, fuel, rugby, thinner, paint, gasoline, glue

2. WITHDRAWAL AND DETOXIFICATION

J. SUBSTANCE INTOXICATION DELIRIUM

VI. SCREENING FOR SUBSTANCE ABUSE

Score of 2 or more is significant, although a score of 1 requires further assessment.

B. B-DAST (Brief Drug Abuse Screening Test)

VII. NURSING PROCESS

1. Risk for suicide

C. PLAN / IMPLEMENTATION OF CARE

1. Establish a trusting Nurse – Patient Relationship

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