Our discussion about Psychiatric Disorders may contain

sensitive topics / issues

 NCM 117 SKILLS LAB

ADDICTION
CHAPTER 19_ PAGE 355
DEFINITION OF use of a substance that results in maladaptive
behavior.

refers to the negative psychological and physical

reactions that occur when use of a substance
ceases or dramatically decreases.

is the process of safely withdrawing from a

substance
SUBSTANCE ABUSE
❑ using a drug in a way that is
inconsistent with medical or social
norms and despite negative
consequences.
❑ Substance abuse denotes problems
in social, vocational, or legal areas of
the person’s life
❑Children of alcoholic parents are at higher
risk for developing alcoholism and drug
dependence than are children of
nonalcoholic parents.
❑This increased risk is partly the result of
environmental factors, but evidence points
to the importance of genetic factors as well
(Haverfield & Theiss, 2016).
❑ Neurochemical influences on substance use
patterns have been studied primarily in
animal research.
❑ The ingestion of mood-altering substances
stimulates dopamine pathways in the
limbic system, which produces pleasant
feelings or a “high” that is a reinforcing, or
positive, experience (Cooper, Robison, &
Mazei-Robison, 2017).
❑ Children of alcoholics are four times as likely
to develop alcoholism compared with the
general population.
❑ Some theorists believe that inconsistency in
the parent’s behavior, poor role modeling,
and lack of nurturing pave the way for the
child to adopt a similar style of maladaptive
coping, stormy relationships, and substance
abuse.
❑ Others hypothesize that even children who
abhorred their family lives are likely to
abuse substances as adults because they
lack adaptive coping skills and cannot form
successful relationships (Haverfield & Theiss,
2016).
❑ Some people use alcohol as a coping
mechanism or to relieve stress and tension,
increase feelings of power, and decrease
psychological pain. High doses of alcohol,
however, actually increase muscle tension
and nervousness.
❑ In general, younger experimenters use
substances that carry less social disapproval
such as alcohol and cannabis, while older
people use drugs such as cocaine and
opioids that are costlier and rate higher
disapproval.
❑ Alcohol consumption increases in areas
where availability increases and decreases
in areas where costs of alcohol are higher
because of increased taxation.
❑ Many people view the social use of
cannabis, though still illegal in most states,
as not harmful; many advocate legalizing
the use of marijuana for social purposes.
❑ Urban areas where cocaine and opioids are
readily available also have high crime rates,
high unemployment, and substandard
school systems that contribute to high rates
of cocaine and opioid use, and low rates of
recovery.
❑ Thus, environment and social customs can
influence a person’s use of substances.
 ALCOHOL
❑is a central nervous system depressant
that is absorbed rapidly into the
bloodstream.
❑Initially, the effects are relaxation and
loss of inhibitions.
❑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
when intoxicated.
❑The person who is intoxicated may
experience a blackout.
 ALCOHOL
❑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.
 ALCOHOL
❑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.
❑The administration of central nervous
system stimulants is contraindicated
(Burchum & Rosenthal, 2018).
❑ Symptoms of withdrawal usually begin 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, and nausea or vomiting.
❑ Severe or untreated withdrawal may progress
to transient hallucinations, seizures, or
delirium, called delirium tremens.
❑ Alcohol withdrawal usually peaks on the
second day and is over in about 5 days.
❑ This can vary, however; and withdrawal may take
1 to 2 weeks.
❑ Because alcohol withdrawal can be life-
threatening, detoxification needs to be
accomplished under medical supervision.
❑ If the client’s withdrawal symptoms are
mild and he or she can abstain from
alcohol, he or she can be treated safely at
home.
❑ For more severe withdrawal or for clients
who cannot abstain during detoxification,
a short admission of 3 to 5 days is the
most common setting.
❑ Some psychiatric units also admit clients
for detoxification, but this is less common.
❑ Safe withdrawal is usually accomplished
with the administration of benzodiazepines,
such as lorazepam (Ativan),
chlordiazepoxide (Librium), or diazepam
(Valium), to suppress the withdrawal
symptoms.
❑ Withdrawal can be accomplished by fixed-
schedule dosing known as tapering, or
symptom triggered dosing in which the
presence and severity of withdrawal
symptoms determine the amount of
medication needed and the frequency of
administration.
SEDATIVES, HYPNOTICS,
ANXIOLYTICS
❑ This class of drugs includes all central
nervous system depressants:
barbiturates, nonbarbiturate
hypnotics, and anxiolytics, particularly
benzodiazepines.
❑ Benzodiazepines and barbiturates are
the most frequently abused drugs in
this category.
SEDATIVES, HYPNOTICS,
ANXIOLYTICS
❑ The intensity of the effect depends on the
particular drug. The effects of the drugs,
symptoms of intoxication, and
withdrawal symptoms are similar to
those of alcohol.
❑ 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.
 BENZODIAZEPINES
❑Benzodiazepines alone, when taken
orally in overdose, are rarely fatal, but the
person is lethargic and confused.
❑Treatment includes gastric lavage
followed by ingestion of activated
charcoal and a saline cathartic; dialysis
can be used if symptoms are severe
(Burchum & Rosenthal, 2018).
❑The client’s confusion and lethargy
improve as the drug is excreted.
 BARBITURATES
❑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.
❑ Medications such as lorazepam, with actions that
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.
❑ The withdrawal syndrome is characterized by
symptoms that are the opposite of the acute effects of
the drug—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 (Tamburin et al., 2017).
❑ Detoxification from sedatives, hypnotics, and
anxiolytics is often medically managed 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.
 TAPERING
❑ For example, when tapering the
or administering decreasing doses of a
dosage of a benzodiazepine, the medication, is essential with barbiturates to
client may be given Valium, 10 prevent coma and death that occur if the drug is
mg four times a day; the dose is stopped abruptly.
decreased every 3 days, and the
number of times a day the dose
is given is also decreased until
the client safely withdraws
from the drug.
.
 STIMULANTS
❑ are drugs that stimulate or excite the
central nervous system and have limited
clinical use (with the exception of
stimulants used to treat attention-
deficit/hyperactivity disorder; and a
high potential for abuse.
❑ Amphetamines (uppers) were popular in
the past; they were used by people who
wanted to lose weight quickly or stay
awake.
❑ Cocaine, an illegal drug with virtually no
clinical use in medicine, is highly
addictive and a popular recreational
drug because of the intense and
immediate feeling of euphoria it
produces.
 STIMULANTS
❑Methamphetamine is particularly
dangerous. It is highly addictive and
causes psychotic behavior.
❑Brain damage related to its use is
frequent, primarily as a result of the
substances used to make it—that is, liquid
agricultural fertilizer.
 STIMULANTS
❑ Cocaine, an illegal drug with virtually no
clinical use in medicine, is highly
addictive and a popular recreational
drug because of the intense and
immediate feeling of euphoria it
produces.
❑ develops rapidly; effects include the
high or euphoric feeling, hyperactivity,
hypervigilance, talkativeness, anxiety,
grandiosity, hallucinations, stereotypic
or repetitive behavior, anger, fighting,
and impaired judgment.
❑ Physiological effects include
tachycardia, elevated blood pressure,
dilated pupils, perspiration or chills,
nausea, chest pain, confusion, and
cardiac dysrhythmias.
❑ Overdoses of stimulants can result in
seizures and coma; deaths are rare
(Iannucci & Weiss, 2017).
❑ Treatment with chlorpromazine
(Thorazine), an antipsychotic, controls
hallucinations, lowers blood pressure,
and relieves nausea (Burchum &
Rosenthal, 2018).
❑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.
❑Stimulant withdrawal is not treated
pharmacologically.
 CANNABIS SATIVA
❑ is the hemp plant that is widely
cultivated for its fiber used to make rope
and cloth and for oil from its seeds.
❑ Marijuana refers to the upper leaves,
flowering tops, and stems of the plant;
hashish is the dried resinous exudate
from the leaves of the female plant (Hall &
Degenhardt, 2017).
❑ Cannabis is often smoked in cigarettes
(joints), and it can also be eaten.
❑ 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.
Users report a high feeling similar to
that with alcohol, lowered inhibitions,
relaxation, euphoria, and increased
appetite.
❑ Symptoms of intoxication include
impaired motor coordination,
inappropriate laughter, impaired
judgment and short-term memory,
and distortions of time and
perception.
❑ Symptoms of intoxication include impaired motor
coordination, inappropriate laughter, impaired
judgment and short-term memory, and distortions of
time and perception.
❑ Anxiety, dysphoria, and social withdrawal may occur
in some users.
❑ Physiological effects, in addition to increased appetite,
include conjunctival injection (bloodshot eyes), dry
mouth, hypotension, and tachycardia.
❑ Excessive use of cannabis may produce delirium or
rarely, cannabis-induced psychotic disorder, both of
which are treated symptomatically.
❑ Although some people have
reported withdrawal
symptoms of muscle aches,
sweating, anxiety, and
tremors, no clinically
significant withdrawal
syndrome is identified.
 OPIOIDS
❑ are popular drugs of abuse because they
desensitize the user to both
physiological and psychological pain
and induce a sense of euphoria and
wellbeing.
❑ Opioid compounds include both potent
prescription analgesics such as
morphine, meperidine (Demerol),
codeine, hydromorphone, oxycodone,
methadone, oxymorphone, hydrocodone,
and propoxyphene as well as illegal
substances such as heroin, illicitly
produced fentanyl, and normethadone.
 FENTANYL
❑ Fentanyl (Duragesic, Actiq) is a synthetic
opioid used in clinical settings for
anesthesia.
❑ It is 50 to 100 times more potent than
morphine.
❑ Illicitly produced fentanyl use has
skyrocketed in the past decade and is
thought to be responsible for the
dramatic increase in deaths from opioid
overdose.
❑ Opioid intoxication develops soon after
the initial euphoric feeling;
❑ symptoms include 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; this process may take days
(Burchum & Rosenthal, 2018).
❑ 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, and
cravings for more opioids.
❑ Symptoms that develop as withdrawal
progresses include nausea, vomiting,
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 opioids, 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 (Burchum &
Rosenthal, 2018).
❑Withdrawal symptoms such as anxiety,
insomnia, dysphoria, anhedonia, and
drug craving may persist for weeks or
months.
 HALLUCINOGEN
❑are substances that distort the user’s
perception of reality and produce
symptoms similar to psychosis, including
hallucinations (usually visual) and
depersonalization.
❑Hallucinogens also cause increased
pulse, blood pressure, and temperature;
dilated pupils; and hyperreflexia.
❑Hallucinogens distort reality
❑Examples: mescaline, psilocybin, lysergic
acid diethylamide, and “designer drugs”
such as ecstasy.
❑is marked by several maladaptive
behavioral or psychological changes:
anxiety, depression, paranoid ideation,
ideas of reference, fear of losing one’s
mind, and potentially dangerous
behaviors such as jumping out a window
in the belief that one can fly.
❑Physiological symptoms include
sweating, tachycardia, palpitations,
blurred vision, tremors, and lack of
coordination.
❑PCP intoxication often involves
belligerence, aggression, impulsivity,
and unpredictable behavior (Bertron,
Seto, & Lindsley, 2018).
❑Toxic reactions to hallucinogens
(except PCP) are primarily
psychological; overdoses as such do
not occur.
❑These drugs are not a direct cause of
death, though fatalities have
occurred from related accidents,
aggression, and suicide.
❑Treatment of toxic reactions is
supportive.
❑Psychotic reactions are managed best by
isolation from external stimuli; physical
restraints may be necessary for the safety
of the client and others.
❑PCP toxicity can include seizures,
hypertension, hyperthermia, and
respiratory depression. Medications are
used to control seizures and blood
pressure.
❑Cooling devices such as hyperthermia
blankets are used, and mechanical
ventilation is used to support respirations
(Burchum & Rosenthal, 2018).
❑ No withdrawal syndrome has been
identified for hallucinogens, though
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.
 INHALANTS
❑a diverse group of drugs that include
anesthetics, nitrates, and organic
solvents that are inhaled for their effects.
❑The most common substances in this
category are aliphatic and aromatic
hydrocarbons found in gasoline, glue,
paint thinner, and spray paint.
❑Less frequently used halogenated
hydrocarbons include cleaners,
correction fluid, spray can propellants,
and other compounds containing esters,
ketones, and glycols.
 INHALANTS
❑Most of the vapors are inhaled from a rag
soaked with the compound, from a paper
or plastic bag, or directly from the
container.
❑Inhalants can cause significant brain
damage, peripheral nervous system
damage, and liver disease.
❑involves 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 (Howard,
Bowen, & Garland, 2017).
❑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, though frequent
users report psychological
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
❑ Current treatment modalities
are based on the concept of
alcoholism (and other
addictions) as a medical illness
that is progressive, chronic,
and characterized by
remissions and relapses.
❑ Alcoholics Anonymous (AA) was founded in the 1930s by alcoholics.
❑ This self-help group developed the 12-step program model for recovery
which is based on the philosophy that total abstinence is essential and that
alcoholics need the help and support of others to maintain sobriety.
❑ Key slogans reflect the ideas in the 12
steps, such as “one day at a time”
(approach sobriety one day at a time),
“easy does it” (don’t get frenzied about
daily life and problems), and “let go and
let God” (turn your life over to a higher
power).
❑ People who are early in recovery are
encouraged to have a sponsor to help
them progress through the 12 steps of
AA.
❑ Once sober, a member can be a sponsor
for another person.
❑The 12-step concept of recovery has been
used for other drugs as well.
❑Such groups include Narcotics
Anonymous; Al-Anon, a support group for
spouses, partners, and friends of
alcoholics; and AlaTeen, a group for
children of parents with substance
problems.
❑This same model has been used in self-
help groups for people with gambling
problems and eating disorders.
Pharmacologic treatment in
substance abuse has two main
purposes:
(1) to permit safe withdrawal from
alcohol, sedative–hypnotics, and
benzodiazepines
(2) to prevent relapse
❑ For clients whose primary
substance is alcohol, vitamin B1
(thiamine) is often prescribed to
prevent or to treat Wernicke–
Korsakoff syndrome, which are
neurologic conditions that can result
from heavy alcohol use.
❑ Cyanocobalamin (vitamin B12) and
folic acid are often prescribed for
clients with nutritional deficiencies.
 Alcohol withdrawal
❑is usually managed with a benzodiazepine
anxiolytic agent, which is used to suppress the
symptoms of abstinence.
❑The most commonly used benzodiazepines are
lorazepam, chlordiazepoxide, and diazepam.
❑These medications can be administered on a
fixed schedule around the clock during
withdrawal.
❑Giving these medications on an as-needed basis
according to symptom parameters, however, is
just as effective and results in a speedier
withdrawal.
❑Barbiturates can be used for benzodiazepine-
resistant cases of alcohol withdrawal (Martin &
Katz, 2016).
 Disulfiram (Antabuse)
❑ may be prescribed to help deter clients from
drinking.
❑ If a client taking disulfiram drinks alcohol, a
severe adverse reaction occurs with flushing, a
throbbing headache, sweating, nausea, and
vomiting.
❑ In severe cases, severe hypotension, confusion,
coma, and even death may result .
 Disulfiram (Antabuse)
❑ The client must also avoid a wide variety of
products that contain alcohol, such as cough
syrup, lotions, mouthwash, perfume, aftershave,
vinegar, and vanilla and other extracts.
❑ The client must read product labels carefully
because any product containing alcohol can
produce symptoms.
❑ Ingestion of alcohol may cause unpleasant
symptoms for 1 to 2 weeks after the last dose of
disulfiram.
 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.
❑ These include sweating, anxiety, and sleep
disturbances.
❑ The dosage is two tablets, 333 mg each, three
times a day.
❑ Individuals with renal impairment cannot take
this drug.
 Acamprosate (Campral)
❑ Side effects are reported as mild and include
diarrhea, nausea, flatulence, and pruritis.
❑ Acamprosate is often thought to be more
effective with “relief cravers,” while naltrexone
is more effective with “reward cravers” (Roos,
Mann, & Witkiewitz, 2017).
❑ Relief cravers seek mediation of negative effects of
withdrawal, while reward cravers seek positive
effects of drinking.
 Methadone
❑a potent synthetic opiate, is used as a substitute
for heroin in some maintenance programs.
❑The client takes 1 daily dose of methadone, which
meets the physical need for opiates but does not
produce cravings for more.
❑Methadone does not produce the high
associated with heroin.
❑The client has essentially substituted his or her
addiction to heroin for an addiction to
methadone; however, methadone is safer
because it is legal, controlled by a physician, and
available in tablet form.
 Methadone
❑The client avoids the risks of IV drug use, the
high cost of heroin (which often leads to
criminal acts), and the use, the high cost of
heroin (which often leads to criminal acts), and
the questionable content of street drugs.
For example, a wife who continually calls in to her husband’s job to report that
he is sick when he is really drunk or hungover prevents the husband from
having to face the true implications and repercussions of his behavior. What
appears to be a helpful action really just assists the husband in avoiding the
consequences of his behavior and to continue abusing the substance.
❑ Codependence is a maladaptive coping pattern on the part of family
members or others resulting from a prolonged relationship with the person
who uses substances.
❑ Characteristics of codependence are poor
relationship skills, excessive anxiety and worry, compulsive behaviors,
and resistance to change.
❑ Family members learn these dysfunctional
behavior patterns as they try to adjust to the behavior of the substance
user.
❑ One type of codependent behavior is called enabling, which is a
behavior that seems helpful on the surface but actually perpetuates the
substance use.