KESHLATA COLLEGE OF NURSING

LESSON PLAN
ON
TOPIC- SUBSTANCE USE DISORDER

SUBMITTED BY:

HIMANSHU PAL
NURSING FACULTY
KESHLATA COLLEGE OF NURSING

SUBMITTED ON: ________________

 IDENTIFICATION DATA

NAME OF TEACHER : Himanshu Pal

SUBJECT : Psychiatric
UNIT : IX UNIT
TOPIC : Substance Use Disorder
GROUP : B.SC IIIrd Year
NO. OF STUDENTS : 40
DURATION : 45 Minutes
VENUE : Class-room
METHOD OF TEACHING : Lecture cum discussion teaching method
A.V Aids : PPT & Black Board, Flash cards, Charts, Pamphlet etc.
PREVIOUS KNOWLEDGE : The students may have some knowledge regarding Substance use
disorder
 GENERAL OBJECTIVE: After the class the students will be able to acquire knowledge in depth about substance use
disorder.

Executive Plan of action - At the end of the class student will be able to acquire the knowledge regarding substance use
disorder

TEACHER POINT OF VIEW:

 To enhance the effectiveness of the teaching-learning process

 To use appropriate teaching strategies
 To make learning strategies

GROUP POINT OF VIEW:

 To gain knowledge regarding the topic

 To clarify the doubts and generate the new ideas
 SPECIFIC OBJECTIVES: At the end of the teaching session the group will be able to determine these specific
Objectives
 Discuss about introduction of substance use disorder
 Define definition of substance use disorder
 Define some terms used in this unit
 Enlist the classification of substance use disorder
 Enlist some commonly used psychotropic substances
 Describe the epidemiology
 State the etiological factors in substance use disorder
 Explain psychiatric disorder and treatment caused by substance use
 Elaborate nursing diagnosis of substance use disorder
 TEACHING
SPECIFIC A.V
S.No TIME CONTENT LEARNING ACTIVITY EVALUATION
OBJECTIVE AIDS
TEACHING LEARNING
1 INTRODUCTION: Guess the
.1 To Introduce the Substance use disorder commonly known as drug abuse/ Lecture Students are topic?
min substance, use drug addiction refers to a maladaptive patterned use of a cum actively
disorder discussion participating
substance in which the user consumes the substance in
method .
amounts or with methods not advised by medical
professional
Since ancient times men used psychoactive substance not
only to enhance pleasure and relieve discomfort

2 DEFINITION:
2 min Define the Substance abuse: abuse is the use of any substance to that Lecture Students are PPT & What is
Substance use extent when it interferes with individual’s normal cum actively black Substance
disorder functioning. It can be distinguished by following criteria discussion participating board abuse ?
method
1. A pattern of pathological use: It is manifested by
intoxication throughout the day, inability to cut down
or stop the use and continuation of substance use
despite of a serious physical disorders
2. Impairment in social or occupational functioning
due to pathological use: Social relations are
3. 2 min disturbed may be because of individual failure to
Define Substance meet his role and responsibilities towards his family. Students are What is
abuse and some Substance dependence: Lecture actively PPT substance
related terms It is more severe form of substance abuse. Dependence is of cum participate dependence
two types and is evident by tolerance and withdrawal. It can discussion and listening tolerance,
method withdrawal,
be distinguish by following criteria
habit and
1. Physical dependence refers to need of a particular
addiction ?
substance to function normally or to carry out daily
activities.
 2. Psychological dependence, when in the absence of
the particular substance the user’s cognitive
functioning is impaired
Tolerance: it is failure of same amount of drug to produce
desired effect and a larger dose is required to produce the
same degree of substance effects
Withdrawal: substance withdrawal is characterized by
appearance of substance specific symptoms (physical and
psychological) when the substance intake is reduced or
stopped
Habit: It is characterized by only desire to take the drug,
there is no need to increase the dose or frequency and is
usually not followed by physical withdrawal
Addiction: It is a state of periodic or chronic intoxication,
harmful for individual and to the society, produced by
repeated consumption of the drug. It involves both
dependence and habit

Classification
4. 1min Enlist the F10-F19 Mental and behaviour disorder due to psychoactive Lecture Students are PPT & What is the
classification of substance use cum actively black ICD-10
substance abuse F10 Mental and behavioural disorders due to use of alcohol discussion participating board classification
F11 Mental and behavioural disorders due to use of opioids method
disorder F12 Mental and behavioural disorders due to use of
cannabinoids
F13 Mental and behavioural disorders due to use of sedatives
or
hypnotics
F14 Mental and behavioural disorders due to use of cocaine
F15 Mental and behavioural disorders due to use of
Hallucinogens
5. 1 min Enlist commonly Commonly used psychotropic substance Lecture Students are PPT What are the
used psychotropic  Alcohol rum, beer, whiskey and brandy cum actively commonly
substances discussion participating used
  Opioids Heroine, Morphine, pethidine, opium Method psychotropic
 Cannabis Bhang, Charas, Ganja substances
 Cocaine Hashish, Marijuana Crash
 Hypnosedatives Barbitutates, Benzodiazepines
 Hallucinogens LSD, Mescaline
 Inhalants Glue, Paint, Varnish
 Psycho stimulants Methylphenidate
 Nicotine Chewing Tobacco, cigarettes
 Caffeine Coffee powder, soft drinks, tea leaf,cocoa
Describe the Epidemiology
6. Epidemiology of  Some of the substance use disorders are common like Lecture Students PPT & Describe the
2min substance abuse nicotine, caffeine and alcohol in India cum are actively black epidemiology
 Alcohol use is seen predominantly seen in discussion participating board of substance
males and in females less than 5% method abuse ?
 Opiates addiction was between 6.3 to 18.9%
 Cannabis 1.3 to 33%
 Tranquilizers 3.5 to 53.8%
 In United States about 90% of all US residents have had
an alcohol-containing drink

 Etiology
7. 5min State the Biological Factors Lecture Students PPT & Explain the
Etiological factors cum are actively black etiological
 Genetic vulnerability: Family history of substance use
of substance abuse discussion participating board factors of
disorder, for example, twin studies suggest that genetic
method substance
mechanisms might account for alcohol consumption
 Biochemical factors: Abnormalities in alcohol abuse
dehydrogenase or in the neurotransmitter mechanism are
thought to play a role in alcohol dependence
For example: role of dopamine and norepinephrine have
been implicated in cocaine, ethanol and opioids
 dependence
 Neurobiological theories: Drug addicts may have an
inborn deficiency of endomorphins
Behavioral theories
 Behavioral scientists view drug abuse as the result of
conditioning or cumulative reinforcement from drug use
 Drug use causes euphoric experience perceived as
rewarding, thereby motivating user to keep taking the
Stimuli and setting associated with drug use may
themselves become reinforcing
Psychological factors
 General rebelliousness
 Sense of inferiority
 Poor impulse control
 Low self-esteem
 Loneliness, unmet needs
 Pleasure seeking
 Sexual immaturity
 Desire to escape from reality
Social factors
 Religious reasons
 Peer pressure
 Urbanization
 Unemployment
 Poor social support
 Occupation: more common in chefs, barmen,
executives, salesmen, actors, army personnel,
medical personnel, etc…
Easy availability of drug
 Psychiatric disorders
6. 15 Discuss about the Substance use disorders are more common in depression,
min the Psychiatric anxiety disorders, personality disorders (antisocial) and Lecture Students PPT & What are the
disorder. occasionally in organic brain diseases cum are actively black Psychiatric
Goals of treatment discussion participating board disorder ?
method
 Immediate goal: The immediate goal is treatment of
intoxication and then detoxification, treatment of acute
medical condition and crisis intervention
 Short term goals: short term goals aim at treatment of
co-morbid and psychiatric disorder, maintenance of
abstinence, vocational placement and family
reintegration
 Long term goals: long term goals focus on relapse
prevention, occupational rehabilitation, social
reintegration, abstinent lifestyle and improvement of
quality of life
Phases of treatment:
 Pre treatment phase: preparation and acceptance on the
part of client about the problem and need for external
help
 The detoxification phase: usually lasts 2-4 weeks
followed by active treatment phase
 Active treatment phase: usually last 3-12 months or
more and involves the choosing from many
pharmacological and psychosocial modalities of
treatment
 Post treatment/ after care phase: usually lasts for 3-5
years or even longer. In this phase family members and
other social agencies play a more active role to maintain
abstinence and rehabilitation of the client
Alcohol Dependence syndrome
Alcoholism refers to the use of alcoholic beverages to the
point of causing damage to the individual, society or both
Properties of Alcohol
 Alcohol is a clear colored liquid with strong burning
 taste
 The rate of absorption of alcohol into the bloodstream is
more rapid than its elimination
 Absorption of alcohol into the bloodstream is slower
when food is present in the stomach
 A concentration of 80-100 mg of alcohol per 100ml of
blood is considered intoxication
 A concentration of 200-250 mg will be toxic, sleepy and
confused
 If the alcohol level is 300 mg/100 ml of the blood the
person may lose consciousness
 A concentration of 500mg/100 ml is fatal
Signs and symptoms of alcohol dependence
 Minor complaints: Malaise, dyspepsia, mood swings or
depression, increased incidence of infection
 Poor personal hygiene, untreated injuries
 Unusually high tolerance for sedatives and opioids
 Nutritional deficiency (vitamins and minerals)
 Consumption of alcohol containing products
 Denial of problems
 Tendency to blame others
ICD 10 criteria for alcohol dependence
 A strong desire to take substance
 Difficulty in controlling substance taking behavior
 A physical withdrawal state
 Development of tolerance
 Progressive neglect of alternative pleasures or interests
 Persisting with substance use despite clear evidence of
harmful consequences
 Psychiatric disorders due to alcohol dependence
1. Acute intoxication:
 It develops during or shortly after alcohol ingestion.
 It is characterized by clinically significant maladaptive
behavior or psychological changes
 For Example – inappropriate sexual or aggressive
behaviour, mood lability, impaired judgment, slurred
speech, unsteady gait, impaired attention
2. Withdrawal syndrome:
 In persons who have been drinking heavily over a
prolonged period of time, any rapid decrease in the
amount of alcohol in the body is likely to produce
withdrawal symptoms. They are
o Simple withdrawal syndrome
o Delirium tremens
o Simple withdrawal syndrome: It is characterized by
mild tremors, nausea, vomiting, weakness, irritability,
insomnia and anxiety
o Delirium tremens: it occurs usually within 2-4 days of
complete or significant abstinence from heavy alcohol
drinking. The course is short, with recovery occurring 3-
7 days Delirium tremens (DTs) is a rapid onset of
confusion usually caused by withdrawal from alcohol.
When it occurs, it is often three days into the withdrawal
symptoms and lasts for two to three days. Physical
effects may include shaking, shivering, irregular heart
rate, and sweating.
3. Alcohol induced amnestic disorders:
 Chronic alcohol abuse associated with thiamine (Vit B)
deficiency is the most frequent cause of amnestic
disorders. This condition is divided into
o Wernick’s syndrome
o Korsakoff’s syndrome
o Wernick’s syndrome: This is characterized by
 prominent cerebellar ataxia, palsy of the 6 th cranial nerve,
peripheral neuropathy and mental confusion
o Korsakoff’s syndrome: The prominent symptoms are
gross memory disturbance. Other symptoms include
o Disorientation
o Confusion
o Confabulation(the unconscious filling of memory
gaps by imagined)
o Poor attention span and distractibility
o Impaired of insight
4. Alcohol induced psychiatric disorders:
 Alcohol induced dementia: it is a long-term
complication of alcohol abuse, characterized by global
decrease in cognitive functioning
 Alcohol induced mood disorders: Excess drinking may
induce persistent depression or anxiety
 Suicidal behavior: suicidal rates are higher in alcoholics
when compared to non-alcoholics of the same age
 Alcohol-induced anxiety disorder: alcoholics report
panic attacks during acute withdrawal, similarly during
the first 4 to 6 weeks of abstinence
 Alcoholic seizures (rum fits): Generalized tonic clonic
seizures occur usually within 12-48 hours after a heavy
bout of drinking. Sometimes, status epileptics may be
precipitated
 Alcoholic hallucinosis: This is characterized by the
presence of hallucinations (auditory) during abstinence.
Diagnosis
 Blood alcohol level to indicate intoxication (200mg/dl)
 Urine toxicology to reveal use of other drug
 Serum electrolyte analysis
 Liver function test
 Echocardiogram and electrocardiogram
Treatment modalities:
Symptomatic treatment, may involve respiratory support,
fluid replacement, IV glucose to prevent hypoglycaemia,
correction of hypothermia and emergency measures for
trauma, infection or GI bleeding
Treatment for withdrawal symptoms
a. Detoxification: it is the treatment for alcohol withdrawal
symptoms. The drug of choice is benzodiazepines.
The most common used drug is chlordiazepoxide 80-
200mg/day and diazepam 40-80 mg/day in divided doses
b. Others:
 For vitamin B deficiency–vitamin B containing 100 mg
of thiamine administered parenterally, twice daily 3 to 5
days. Followed by oral administration at least 6 months
 Administration of anticonvulsants
 Maintaining fluid and electrolyte balance
 Monitoring of vitals
 Level of consciousness and orientation
Alcohol deterrent therapy
Deterrent agents are those which are given to
desensitize the individual to the effects of alcohol and
maintain abstinence.
The most commonly used drug id disulfiram (tetraethyl
thiuram disulfide)
5.Opioids Use Disorder
 In the last few decades, the use of opioids has increased
markedly world over.
 The most important dependence producing derivatives
are morphine and heroin
 The commonly abused opioids in our country are heroin
 (brown sugar, smack)
 Synthetic preparation like pethidine, fortwin
(pentazocine) and tidigesic (buprenorphine)
 The drugs that are injected through needle are heroin,
buprenorphine and pentazocine. Though most opiate
users had begun chasing (inhaling the smoke or chasing
the dragon (Chasing the dragon is a way of smoking heroin.
It usually involves placing powdered heroin on foil and
heating it from below with a lighter. The heroin turns to a
sticky liquid and wriggles around like a Chinese dragon,
hence the name))
Acute intoxication
 It is characterized by apathy, bradycardia, hypotension,
respiratory depression, subnormal temperature and
pinpoint pupils.
 Delayed reflexes, thready pulses and coma can occur
Withdrawal syndrome
 Narcotic withdrawal rarely produces a life threatening
situation
 Withdrawal symptoms begin within 12 hrs of the last
dose, peak in 24 to 36 hrs and disappear in 5 to 6 days
 Common symptoms include watery eyes, running nose,
yawning, loss of appetite, diarrhea, raised body
temperature
Complication
 Due to illicit drug use: Parkinsonism, peripheral
neuropathy, transverse myelitis
 Due to intravenous use: Skin infection, thrombophlebitis,
pulmonary embolism, endocarditis, septicemia, AIDS,
viral hepatitis
 Involvement in criminal activities
Treatment
  Opioids overdose can be treated with narcotic
antagonists, for example naloxone, naltrexone
 Naltrexone is available as 50 mg tablet. It is well
absorbed from GI tract and after ingestion effective
receptor blockade is obtained for 48-72 hrs
 Three common regimens available for naltrexone
administered first 50mg daily, second is thrice a week
(mon and wed 100mg and 150 mg on fri), third is twice a
week (150mg on mon and 200mg on thrus) however
daily is prefered
 Withdrawal symptoms can be managed by mrthadone,
clonidine, naltrexone, buprenorphine
 In some settings opioids dependence is treated by
aversion therapy in which a small dose of opium is given
followed by an emetic agent.
6.Cannabis Use Disorder
 Cannabis is derived from hemp plant, cannabis sativa.
 The dried leaves and flowering tops are often referred to
as Ganga or marijuana
 The resin of the plant is referred as hashish.
 Bhang is a drink made from cannabis
Acute intoxication
 Mild intoxication: mild impairment of consciousness,
orientation, a sense of floating in the air, euphoria,
alteration in psychomotor activity
 Severe intoxication: perceptual disturbances like
depersonalization, derealization, synesthesias (may see
sounds, taste words or feel a sensation on their skin when they
smell certain scents.) and hallucination
7.
Withdrawal symptoms
 They are mostly found in the first 72-96 hours and
include increased salivation, hyperthermia, insomnia,
 decreased appetite, loss of weight and insomnia
Complications
 Short lasting psychiatric disorders such as
o acute anxiety
o Paranoid psychosis
o Hysterical fugue-like states
3 min Enumerate Nursing o Hypomania
Diagnosis of o Schizophrenia-like state
substance use A motivational syndrome
disorder Memory impairment
Treatment:
 Supportive and symptomatic treatment
7.Cocaine Use Disorder
 Common street name is ‘crack’. It can be administered
orally, intranasal by smoking or parenterally
Acute intoxication
 Characterized by papillary dilatation, tachycardia,
hypertension, sweating and nausea
Withdrawal syndrome
 Agitation, depression, anorexia, fatigue and sleepiness

Complication
 Acute anxiety reaction, uncontrolled compulsive
behaviour, seizures, respiratory depression
Treatment
Management of intoxication: Amyl nitrite is an antidote;
diazepam or propranolol is also used
Management of withdrawal symptoms: Antidepressants
(imipramine or amitriptyline) and psychotherapy
8. Amphetamine use disorder
 Amphetamine are powerful CNS stimulants with
 pheripheral sympathomimetic effects
 Commonly used amphetamines are pemoline and
methylphenidate
Acute intoxication
 Characterized by tachycardia, hypertension, cardiac
failure, papillary dilation, paranoid hallucinatory
syndrome and amphetamine induced psychosis
Withdrawal syndrome
 Characterized by depression, apathy, fatigue,
hypersomnia or insomnia, agitation and hyperphagia
Complication
 Seizures, delirum, arrhythmias, aggressive behavior,
coma
9. LSD Use Disorder (Lysergic acid diethylamide)
 LSD is a powerful hallucinogen
 It was first synthesized in 1938
 A common pattern of LSD use is ‘trip’ (occasional use
followed by a long period of abstinence)
 It produces its effects by acting on 5-HT ( 5
hydrotryptamine receptors or serotonin receptors.)level
in brain
Intoxication
 Characterized by perceptual changes occurring in clear
consciousness
 For examples depersonalization, derealization, illusion,
synesthesias (colours are heard, sounds are felt),
paranoid ideation and impaired judgment
Withdrawal syndrome
 Flashbacks (brief experiences of the hallucinogenic
state)
Complication
 Anxiety, depression, psychosis or visual hallucinosis
Treatment
 Symptomatic treatment with anti anxiety, antidepressant
or antipsychotic medication
10. Inhalants or volatile solvent use disorders
 The commonly used volatile solvents include petrol,
aerosols, thinners, varnish remover and industrial
solvents.
Intoxication
 Inhalation of a volatile solvent leads to euphoria,
excitement, and slurring speech
Withdrawal symptoms
 Anxiety, depression
Complications
 Irreversible damage to the liver and kidneys, peripheral
neuropathy, perceptual disturbances and brain damage
Treatment
 Reassurance and diazepam for intoxication
 Nursing Diagnosis
1. Disorientation and/or confusion related to alcohol
withdrawal and environmental misinterpretation
2. Potential for injury to self or others related to aggressive
behaviour, suicidal ideation or environmental
misinterpretation
3. Ineffective denial related to weak and underdeveloped
ego evidenced by statement explaining no problem with
substance use
4. Ineffective coping as evidenced by substance taking
behaviour (as a coping mechanism)
5. Imbalanced nutrition less than body requirements related
to substance use rather than eating as evidenced by loss
of weight, malnutrition, weakness.
 SUMMARY:
8. 5 Lecture Students are
.min To summarize the In this class we had to discuss about the Method actively
substance, use introduction of substance use and its disorder, participating.
disorder definition Discuss about introduction of substance
use disorder Define definition of substance use
disorder Define some terms used in this unit Enlist
the classification of substance use disorder Enlist
some commonly used psychotropic substances
Describe the epidemiology State the etiological
factors in substance use disorder Explain psychiatric
disorder and treatment caused by substance use
Elaborate nursing diagnosis of substance use
disorder
9. 5 To recapitulation of RECAPITULATION-
min the substance use  What substance use disorder Lecture cum
disorder discussion
 What is the definition of substance use disorder
 What are classification of substance use disorder
 what are commonly used psychotropic substances
 what is epidemiology of substance use in India or USA
 What are the etiological factors in substance use
disorder
 What is psychiatric disorder and treatment caused by
substance use
 What is nursing diagnosis of substance use disorder

3 CONCLUSION:
10. min To conclude the
topic. By the end students know about the substance use
 disorder and what the bad impact of substance in
our body and they also know the commonly used
psychotropic substance. Substance abuse problems
are very common they have a great impact on the
individuals families and community. Etiology is
multi- factorial substance abuse problems should be
considered in the differential diagnosis of any
psychiatric disorder.

ASSIGNMENT/ APPLICATION:
Assignment Topic- An Assignment on
11. To enhance the
Further reading. classification of ICD F10 to F19, Substance use
disorder.
Date of Submission.-

REFERENCES:
 Townsend M .C. Psychiatric Mental Health
Nursing.(Latest edn) Jaypee brothers; New Delhi
 R. sreevani, a textbook of mental health nursing
psychiatric nursing 2nd volume 3rd edition jaypee
publications page No- 255.
 Bimila kapoor 1994 a text book of psychaitric
nursing volume 2nd edition 11th kumar
 publications.
 Ram kumar gupta mental and heath nursing vica
and company medical publication 10 th edition
page no.223
 Mary werghese essential of psychiatric and
mental health nursing 3rd edition page no.334

NET REFRENCES
 WHO.ICD 10 Classification of Mental &
Behavioural Disorder.
 https://www.webmd.com/mental-health/
addiction/substance-abuse#1