Substance - Related

Psychotic Disorders
 Substance Induced Disorder
Occurrence of adverse social, behavioral,
psychological, & physiological effects caused by 1 or
more of the following abused substances:
1) Alcohol 7) Cannabis
2) Inhalants 8) Cocaine
3) Amphetamines 9) Sedatives, Hypnotics, or Anxiolytics
4) Nicotine 10) Hallucinogens
5) Caffeine
6) Opioids
 TERMINOLOGIES
• Substance

• Substance dependence

• Substance abuse
• Withdrawal

• Tolerance

• Substance intoxication
Substance
A chemical that alters a person’s mood or behavior when it is
smoked, injected, junked, inhaled, or swallowed in pill form.

Substance Dependence
Maladaptive pattern of use manifested by cognitive, behavioral,
and physiological symptoms during a 12 month period and caused by
continued use of substance.
Substance Abuse

Maladaptive pattern of substance use occurring within a 12

month period that leads to significant impairment or distress
evidence by:

 Failure to meet obligations

 Repeated use of substances in physically
 Hazardous situations
 Legal problems
 Interpersonal problems
Withdrawal:
Physiological and psychological changes that occur when an
individual stops taking a substance.

Tolerance:
Extent to which the individual requires larger and larger
amounts of a substance in order to achieve its desired effects, or the
extent to which the individual feels less of its effects after using the
same amount of the substance.

Substance Intoxication:
The temporary maladaptive experience of behavioral or
psychological changes that are due to the accumulation of a
substance in the body.
 SUBSTANCE ABUSE
• 8.9 percent of the population are current users of illicit drugs.
• Marijuana is the most commonly used illicit drug

• Most drugs of abuse directly or indirectly target the reward center of the
brain by flooding its circuits with dopamine.
DSM-IV-TR DIAGNOSTIC CRITERIA:
EFFECTS OF DRUGS OF ABUSE ON
DOPAMINE PATHWAYS
 ALCOHOL EFFECTS

• Alcohol is a depressant
• A psychoactive substance that causes the depression of central nervous system activity.

• Immediate effects
• Sedating
• Central nervous system depressant
• Potentially fatal in excess

• Potentiation compounds these effects

 ALCOHOL EFFECTS

• Long-term effects
• Permanent brain damage

• Dementia
• Wernicke’s disease
• Korsakoff’s syndrome

• Harmful changes in the liver, gastrointestinal system, bone density, muscles,

and immune system
Wernicke’s disease
Form of aphasia in which the individual is able to produce
language but has lost the ability to comprehend so that these verbal
productions have no meaning.

Korsakoff’s syndrome
Permanent form of dementia associated with long term alcohol
use in which the individual develops retrograde and anterograde
amnesia, leading to an inability to remember recent event or learn new
information.
 THEORIES AND TREATMENT OF ALCOHOL
DEPENDENCE
• Biological
• Genetic factors
Genetics of alcohol-related disorders comes from studies examining associations with
genes involved in alcohol metabolism and neural transmission.

• Medications
• Naltrexone
• Disulfiram
• Acamprosate
Naltrexone
Blocks the effects of the body’s production of alcohol induced opioids
through involving dopamine.

Disulfiram
Used in the treatment of alcoholism that inhibits aldehyde
dehydrogenase (ALDH) and causes severe physical reactions when combined
with alcohol.

Acamprosate
Reduces the risk of relapse by reducing the individual’s urge to drink
and thereby reducing the drive to use alcohol as a way of reducing anxiety and
other negative psychological state.
 THEORIES AND TREATMENT OF ALCOHOL
DEPENDENCE
• Psychological
• Dual-process theory
Proposes there are automatic processes that generate an impulse to drink
alcohol and controlled, effortful processing that regulates these automatic
impulses.

• Alcohol myopia theory

Proposes that as individuals consume greater amounts of alcohol, they are
more likely to make risky choices because the immediate temptation of the
moment overcomes the long term consequences of the behavior.
• Treatment
• Cognitive-behavioral interventions
• Motivational approaches
• Expectancy manipulation
• Relapse prevention
Based on the expectancy model in which individuals are encouraged not to
view lapses from abstinence as signs of certain failure.

• Combined behavioral intervention

 THEORIES AND TREATMENT OF ALCOHOL
DEPENDENCE

• Sociocultural
• Family, community, & cultural stressors
• Children of alcoholics at greater risk
SUBSTANCES OTHER THAN ALCOHOL
 STIMULANTS
• This category of drugs includes substances that have an activating effect
on the nervous system.

• Amphetamine
Affects the central nervous and the autonomic nervous system.
• Methamphetamine
Related to amphetamine but provokes more intense central nervous system effects.
• Cocaine
Highly addictive central nervous system stimulants that an individual
snorts, injects, or smokes.
LONG-TERM EFFECTS OF METHAMPHETAMINE
ON THE BRAIN
COCAINE IN THE BRAIN
 AMPHETAMINE OR COCAINE
INTOXICATION
Behavioral & Psychological Changes:
• Euphoria or affective blunting
• Changes in sociability
• Hypervigilance
• Interpersonal sensitivity
• Anxiety, tension, or anger
• Stereotyped motor behaviors
• Impaired judgment
• Impaired social/occupational functioning
 AMPHETAMINE OR COCAINE
INTOXICATION
Clinical Signs & Symptoms:
• Tachycardia or bradycardia
• Pupil dilation
• Elevated or lowered blood pressure
• Perspiration or chills
• Nausea or vomiting
• Weight loss
• Psychomotor agitation or retardation
• Muscular weakness, respiratory depression, chest pain, cardiac arrhythmias
• Confusion, seizures, dyskinesias, dystonias, or coma
 AMPHETAMINE OR COCAINE
WITHDRAWAL
• Dysphoric mood
• Fatigue
• Vivid, unpleasant dreams
• Insomnia or hypersomnia
• Increased appetite
• Psychomotor retardation or agitation
 CANNABIS
• Marijuana
Psychoactive substance derived from the hemp plant whose primary active
ingredient is delta-9-tertrahydrocannabinol (THC).

Heavy and continued use of marijuana:

Lead to higher risk of heart attack
Lead to impaired respiratory functioning

• Hashish
Containing a more potent form of THC, comes
from the resins of the plants flowers.
 CANNABIS INTOXICATION
Behavioral & Psychological Changes:
• Impaired motor coordination
• Euphoria
• Anxiety
• Sensation of slowed time
• Impaired judgment
• Social withdrawal
Clinical Signs & Symptoms:
• Conjunctival injection
• Increased appetite
• Tachycardia
• Dry mouth
SUMMARY OF EFFECTS OF CANNABIS
ON EXECUTIVE FUNCTIONS
 HALLUCINOGENS
• Hallucinogens are drugs that cause people to experience profound distortions in their
perception of reality.
• LSD – Lysergic Acid Diethylamide
Users ingest in tablets, capsules, and liquid form. Produces tolerance.
• Peyote
Primary ingredient is mescaline
• Psilocybin
Found in certain mushroom.
• PCP – Phencyclidine AKA Angel dust
Originally develops as an intravenous anesthetic. Symptoms that mimic schizophrenia,
disturbance, memory loss, difficulties with speech and thinking, weight loss and depression.
• MDMA - methylenedioxymethamphetamine
Known on the street as ecstasy, is a synthetic substance chemically similar to methamphetamine
and mescaline. Users experience feelings of increased energy, euphoria, emotional warmth,
distorted perceptions and sense of time, and unusual tactile experiences.

• Included in hallucinogen-related disorders are use and intoxication, but not withdrawal.
 HALLUCINOGENS
Methylenedioxymethamphetamine PCP

LSD Peyote Psilocybin

 HALLUCINOGEN INTOXICATION
Behavioral & Psychological Changes:
• Marked anxiety or depression
• Ideas of reference
• Fear of losing one’s mind
• Paranoid ideation
• Impaired judgment
• Impaired social/occupational functioning
Clinical Signs & Symptoms:
• Pupillary dilation
• Tachycardia
• Sweating
• Palpitations
• Blurring of vision
• Tremors
• Lack of coordination
 OPIOIDS
• An opioid is a substance that relieves pain.
• Within opioid-related disorders are opioid use, intoxication, and withdrawal.

• Hydrocodone
clinicians prescribed hydrocodone products for a variety of painful conditions including
dental and injury related pain.
• Oxycodone
• Morphine
Physicians use morphine before and after surgical procedures to alleviate severe pain
• Codeine
Clinicians prescribe codeine for mild pain
• Heroin
Synthesized from morphines
 OPIOID INTOXICATION
Behavioral & Psychological Changes:
• Initial euphoria followed by apathy
• Dysphoria
• Psychomotor agitation or retardation
• Impaired judgment
• Impaired social/occupational functioning
Clinical Signs & Symptoms:
• Pupillary constriction
• Drowsiness or coma
• Slurred speech
• Impaired attention or memory
 OPIOID WITHDRAWAL

• Dysphoric mood
• Nausea or vomiting
• Muscle aches
• Lacrimation or rhinorrhea
• Pupillary dilation, piloerection, or sweating
• Diarrhea
• Yawning
• Fever
• Insomnia
 SEDATIVES, HYPNOTICS, &
ANXIOLYTICS
• Sedatives have calming effects on the central nervous
system

• Hypnotics induces sleep

• Anxiolytics are anti-anxiety medications

Benzodiazepines
Barbiturates
 SEDATIVE, HYPNOTIC, OR ANXIOLYTIC
INTOXICATION
Behavioral & Psychological Changes:
• Inappropriate sexual/aggressive behavior
• Mood lability
• Impaired judgment
• Impaired social/occupational functioning
Clinical Signs & Symptoms:
• Slurred speech
• Lack of coordination
• Unsteady gait
• Nystagmus
• Impaired attention and memory
• Stupor or coma
 SEDATIVE, HYPNOTIC, OR ANXIOLYTIC
WITHDRAWAL
• Autonomic hyperactivity, e.g. sweating, pulse
greater than 100
• Increased hand tremor
• Insomnia
• Nausea or vomiting
• Transient visual, tactile, or auditory
hallucinations or illusions
• Psychomotor agitation
• Anxiety
• Grand mal seizures
 CAFFEINE
• Found in coffee, tea, chocolate, energy drinks, diet pills, and
headache remedies.

• Increases:
• An individual’s perceived level of energy alertness
• Blood pressure and may lead to increases in the body’s production of
cortisol
 CAFFEINE INTOXICATION
Clinical Signs & Symptoms:
• Restlessness
• Nervousness
• Excitement
• Insomnia
• Flushed face
• Diuresis
• Gastrointestinal disturbance
• Muscle twitching
• Rambling flow of thought and speech
• Tachycardia or cardiac arrhythmia
• Periods or inexhaustibility
• Psychomotor agitation
 TOBACCO

• Nicotine: Psychoactive substance found in cigarettes

• Stimulates the release of adrenaline (norepinephrine)

• Increases blood pressure, heart rate, and respiration
 NICOTINE WITHDRAWAL

• Dysphoric or depressed mood

• Insomnia
• Irritability, frustration, anger
• Anxiety
• Difficulty concentrating
• Restlessness
• Decreased heart rate
• Increased appetite or weight gain
 INHALANTS

Diverse group of substances that cause psychoactive

effects by producing chemical vapors.

• Volatile solvents
• Aerosols
• Gases
• Nitrites
 INHALANT INTOXICATION
Clinical Signs & Symptoms:
Dizziness Blurred vision or diplopia
Nystagmus Stupor or coma
Incoordination Euphoria
Slurred speech Tremor
Unsteady gait Lethargy
Depressed reflexes Generalized muscle weakness
Psychomotor retardation

Behavioral & Psychological Changes:

Belligerence Impaired judgment
Assaultive Impaired social/occupational functioning
Apathy
 SUBSTANCE-INDUCED
PSYCHIATRIC SYNDROMES
• Delirium • Mood Disorder
• Persisting Dementia • Anxiety Disorder
• Persisting Amnestic
• Sexual Dysfunction
Disorder
• Psychotic Disorder • Sleep Disorder
with Delusions
• Psychotic Disorder
with Hallucinations
 SUBSTANCE-INDUCED
PSYCHIATRIC SYNDROMES
• There is evidence that psychiatric symptoms developed
during or within a month of significant substance
intoxication or withdrawal.
• Every class of abused substances, except nicotine, has the
capacity to produce psychiatric symptoms during
intoxication or withdrawal.
• Specific diagnosis should specify the name of the abused
substance, the psychiatric syndrome, & whether the onset
occurred during withdrawal or intoxication, e.g. Alcohol-
Induced Anxiety Disorder with onset during withdrawal.
TREATMENT
1. Treatment retention and substance use reduction is the initial goal
The ideal outcome for most individuals with substance use disorders is total cessation of substance
use. Nonetheless, many individuals are either unable or unmotivated to reach this goal, particularly in
the early phases of treatment and/or after a relapse to substance use. Such individuals can still be
helped to minimize the direct and indirect negative effects of ongoing substance use.

Reductions in the amount or frequency of substance use, substitution of a less risky substance, and
reduction of high-risk behaviors associated with substance use may be achievable goals when
abstinence is initially unobtainable. Engaging an individual to participate and remain in treatment that
may eventually lead to further reductions in substance use and its associated morbidity is a critical
early goal of treatment planning and is often enhanced by motivational interviewing techniques.
 MOTIVATIONAL INTERVIEWING

Motivation can be understood not as something that someone

has, but as something that someone does, involving recognizing a
problem, finding a way to change, and then starting and sticking with
that change strategy.
2. Reduction in the frequency and severity of substance use episodes

Reduction in the frequency and severity of substance use episodes is a primary goal of long term
treatment. The individual is educated about common types of substance use triggers, such as
environmental cues, stress, and exposure to a priming substance. The individual is then helped to develop
skills to prevent substance use; these skills include identifying and avoiding high-risk situations as well as
developing alternative responses to situations in which substance use may occur. Individuals are at a
greater risk of using substances when any of the following are present:

1) craving or urges to use a substance due to acute or protracted withdrawal states and/or classically
conditioned responses to cues associated with substance use
2) easy access to substances
3) social facilitation of substance use (e.g., holiday parties, association with other substance users)
4) negative affective states
5) negative life events, or any significant, even positively viewed, life event if the event carries with it a
significant increase in responsibility (e.g., marriage, the birth of a child, beginning school or a new job,
work promotion)
6) physical discomfort
7) unstructured time or boredom; or nonadherence to prescribed treatment.
 Many clinicians do not recognize that individuals with substance use
disorders have a chronic condition and may have future episodes of substance use.
Therefore, the clinician may become discouraged when an individual doing well in
treatment over an extended period of time resumes substance use. A useful clinical
strategy is to explicitly anticipate the reality of future substance use and plan a
strategy for recovery in the event of substance use relapse; such a strategy helps
both the patient and the clinician optimally manage and contain the negative
consequences resulting from a return to substance use.
MEDICATION
 DRUGS USED FOR
SUBSTANCE ABUSE TREATMENT
Drug Use Dosage Nursing Considerations
Lorazepam Alcohol withdrawal 2-4 mg every 2—4 hour Monitor vital signs and global
(Ativan) may cause dizziness or
drowsiness
Chlordiazepoxide Alcohol withdrawal 50—100 mg, repeat in Monitor vital signs and global
(Librium) 2-4 hours if necessary; assessments for effectiveness;
not to exceed 300 mg/day may cause dizziness or
drowsiness
Disulfiram (Antabuse) Maintains abstinence from 500 mg/day for 1—2 Teach client to read labels to
alcohol weeks then 250 mg/day avoid products with alcohol
Methadone (Dolophine) Maintains abstinence Up to 120 mg/day for May cause nausea and
from heroin maintenance vomiting
Levomethadyl (Orlaarn) Maintains abstinence 60—90 mg three times Do not take drug on consecutive
from opiates for maintenance days; take-home doses
are not permitted
 Drug Use Dosage Nursing Considerations
Naltrexone Blocks the effects of 350 mg/week„ divided into Client may not respond to
(ReVia, Trexan) opiates; reduces three doses for opiate - narcotics used to treat
alcohol cravings blocking effect; 50 mg/day for cough, diarrhea, or pain;
up to 12 weeks alcohol cravings take with food or milk; may
cause headache restlessness,
or irritability

Clonidine (Catapres) Suppresses opiate 0.1 mg every 6 hours PRN Take blood pressure before
withdrawal symptoms each dose; withhold if client
is hypotensive

Acamprosate (Campral) Suppresses alcohol 666 mg three times day Monitor for diarrhea,
cravings vomiting, flatulence, and
pruritis
 Drug Use Dosage Nursing Considerations
Thiamine(vitamin B)) Prevents or treats 100 mg/day Teach client about proper
Wernicke-Korsakoff nutrition
syndrome in alcoholism

Folic acid (folate) Treats nutritional 1—2 mg/day Teach client about proper
deficiencies nutrition; urine may be dark
yellow

Cyanocobalamin Treats nutritional 25--250 mcg/day Teach client about proper

(vitamin B12) deficiencies nutrition
NURSING DIAGNOSIS
Denial
May be related to
 Personal vulnerability; difficulty handling new situations
 Previous ineffective/inadequate coping skills with substitution of drug(s)
 Learned response patterns; cultural factors, personal/family value systems

Ineffective Individual Coping

May be related to
 Personal vulnerability
 Negative role modeling; inadequate support systems
 Previous ineffective/inadequate coping skills with substitution of drug(s)

Powerlessness
May be related to
 Substance addiction with/without periods of abstinence
 Episodic compulsive indulgence; attempts at recovery
 Lifestyle of helplessness
Anxiety/Fear
May be related to
 Cessation of alcohol intake/physiological withdrawal
 Situational crisis (hospitalization)
 Threat to self-concept, perceived threat of death

Sensory-Perceptual Alterations
May be related to
 Chemical alteration:
Exogenous (e.g., alcohol consumption/sudden cessation)
Endogenous (e.g., electrolyte imbalance, elevated ammonia and BUN)
 Sleep deprivation
 Psychological stress (anxiety/fear)

Risk for Injury

Risk for Decreased Cardiac Output
Risk for Ineffective Breathing Pattern
NURSING MANAGEMENT
INTERVENTION RATIONALE
INTERVENTION RATIONALE
CELEBRITIES
V
Jiro Manio
In June 2015, former child star Jiro Manio was found
wandering at the Ninoy Aquino International Airport (NAIA)
terminal 3 for three days. The award-winning actor, who was
spotted dressed in dirty clothes, was acting strangely apparently
because of the effect of withdrawal from maintenance
medication, which was supposed to control the negative effects
of his past drug usage. It could be recalled that Manio
underwent rehab treatment in 2011. Aiai deals Alas, Manio’s
onscreen mom in the “Tanging Ina” movie franchise, convinced
him to undergo rehab treatment that same year. Although he
was released from the rehab facility last January, Manio was
brought back the next month, not because of drug usage, but
because he was chronically ill.
Baron Geisler
• Was arrested numerous times for extreme behavior.

• Previously arrested for acts of lasciviousness, most

notably sexually harassing the daughter of actors
William Martinez and Yayo Aguila.

• He was recently arrested for unjust vexation at a

restaurant in Quezon City. Though it is not clear
whether he was on drugs, Geisler admitted that he was
drunk.

Source: http://www.manilatimes.net/baron-geisler-
jailed-unjust-vexation/357129/
Mark Anthony Fernandez

• Arrested in Angeles City, Pampanga

on October 5, 2016, after police found a
kilo of marijuana in his Ford Mustang.

• Son of the late actor Rudy “Daboy”

Fernandez and actress Alma Moreno.

Source: http://www.manilatimes.net/acto
r-faces-life-in-prison-for-marijuana-
possession/289569/
http://www.mhhe.com/whitbourne7eupdate
http://www.manilatimes.net/ph-actors-actresses-arrested-drug-alcohol-abuse/359016/
https://www.google.com/search?biw