1-

5.Complementary And
Alternative Therapies
8.DRUGS In Substance
Use Disorder
LORIE ANN S. BALILI RN, CNN, MAN
pressure
of
Substance use
Disorder
 SUBSTANCE USE DISORDER
POLYDRUG Used more than one drug
USE
Cognitive development at the time drugs are introduced plays a major role.

Adolescents are in a period of brain development where they are especially vulnerable to stress and risk-seeking
behavior.
Other factors related to substance use disorder:
1. Family-related risk factors: between 16% and 29% of children who suffer neglect or abuse-physical, sexual,
and emotional have tried or use drugs.
2. Social risk factors: deviant peer relationships (i.e the adolescent associates with the abuser s and uses drugs
to feel accepted), Peer pressure, popularity , and bullying have all been correlated to drug use. Gang
affiliation is associated with higher drug use and deliquent behavior.
3. Individual risk factors: individual with attention-deficit/ hyperactivity disoder (ADHD) are three times as
likely as the general population to use drugs such as nicotine, alcohol, and drugs other than cannabis;
Depression is associated with alcohol use, particularly among young men.
 Substance use disorder
- Occurs “when the recurrent use of alcohol and/or drugs causes clinically and
functionally significant impairment such as health problems, disability, and
failure to meet major responsibilities at work, school, or home.”
Neurobiology
 Drugs that are misused typically increase the availability of dopamine and
other neurotransmitters in the limbic system of the brain.
 Reward circuit a structure that regulates our ability to feel pleasure and other
emotions, both positive and negative.
 The drug interfere with the way neurons in the brain normally send, received,
and process information by mimicking the brain own neurotransmitters;
however, drugs do not copy neurotransmitters exactly, which results in faulty
transmission or excessive stimulation.
 Most of the drugs facilitates transmission of dopamine in the system, leading
to mood elevation or euphoria.
Some drugs increase the availability of other neurotransmitter, such as serotonin and
gamma-aminobutyric acid (GABA), but the dopamine’s effect on the reward system
appears to be pivotal to substance use disorder.

Repeated use of drugs remodels the neural circuitry of the brain cells and reduces the
responsiveness of receptors. This decreased the responsiveness leads to tolerance.

The need for a larger dose of a drug to obtain the original euphoria. Drug use results in
levels of dopamine that do not naturally occur; tolerance also reduces the sense of pleasure
from experiences that previously resulted in positive feelings such as food, sex, or
relationships. Without drugs, the individual may experience depression, anxiety, and/or
irritability.
Nonpharmacological Therapy for Substance Use Disorders: Individual And Group
Counseling
Therapy Description
Cognitive behavioral therapy CBT teaches people to recognize and stop negative patterns of thinking and
behavior and helps enhance self-control.
For instance, therapy might help a person become aware of the stressors,
situations, and feelings that lead to substance use so that the person can
avoid them or act differently when they occur.

Contingency management This approach is based on frequent monitoring of behavior and removal of
rewards for drug use and was designed to provide incentives to reinforce
positive behavior and help the person remain abstinent from drug use.

Motivational enhancement MET helps people with substance use disorders develop internally motivated
therapy changes and commit t specific plans to engage in treatment and seek
recovery. It is often used early in the process to engage people in treatment.

Twelve-step facilitation therapy Seeks to guide and support engagement in 12 steps programs such as
alcoholics anonymous or narcotics anonymous.
 Terminology Related to Substance Use Disorder
Term Definition
Abstinence Refraining from drug use
Craving Strong desire for a drug or for the intoxicating effects of that drug
Intoxication A condition that results in disturbance in the level of consciousness, cognition, perception, judgment, affect or behavior, or
other psychological functions and responses.

Stabilization Acute treatment for substance use disorder involving supervision, observation, support, intensive education and counseling
that involves multidisciplinary treatment interventions

Tolerance Requiring a significantly increased amount of a drug to achieve the desired effect

Withdrawal syndrome A group if symptoms of varying severity that occur upon cessation or reduction of use of a drug that has been taken
repeatedly, usually for a prolonged period and/or in high doses; may be accompanied by signs of physiologic disturbances.

Remission None of the 11 criteria for substance use disorder for at least 3 months (early remission, 3-13 months; sustained remission,
after 12 months)
Controlled environment Environment where access to any drug is restricted (e.g treatment center or halfway house)

Impaired control Diminished ability of an individual to control his or her use of a drug in terms of onset, level or termination

Social impairment Recurrent drug use despite problems at work or school, interpersonal problems, or the cessation of social and recreational
activities.
Risky use Recurrent drug use despite the difficulty it is causing (e.g driving while intoxicated, liver damage)

Recovery A process of change through which an individual improves health and wellness, lives a self-directed life, and strive to reach
full potentials.
Relapse A return to drug use after a period of abstinence often accompanied by reinstatement of substance use disorder.
 Types of substance use Disrorder
ALCOHOL USE
01 DISORDER 05 OTHER SUBSTANCE USE
DISORDER:
02 CANNABIS DISORDER 1. Cough and colds products
2. Anabolic-androgenic steroids

03 OPIOID DISORDER

04 TOBACCO DISORDER
 Types ofUSE
ALCOHOL substance use Disrorder
01 DISORDER
Inhibits the effects if GABA, thereby reducing
neurotransmission in the brain. Short-term
effects of alcohol use include nausea, Increase the chance of dying from automobile
vomiting, headaches, slurred speech impaired accidents, homicide, and suicide.
judgement, memory loss, hangovers, and Spouses and children of person with AUD may
black outs. face family violence, and children may suffer
physical and sexual abuse and neglect and may
Long term problems associated with heavy develop psychologcical problems.
drinking includes stomach ailments, heart
problems, cancer, brain damage, serious
memory loss, immune system compromise and
liver cirrhosis.
 Treatment for AUD
1. Disulfiram- inhibits aldehyde dehydrogenase, the enzyme that involved in metabolizing alcohol.
Used in people who are newly abstinent.
Administered in tablet form dosage ranges from 125 to 500 mg daily.
Should not be taken 12 within 12 hours of alcohol consumption (including mouth wash, cough
medicine or eating desserts that containing alcohol or eating foods cooked in alcohol. Should never be
used in combination with eliglustat and ritonavir.

2. acamprosate-is a GABA analogue thought to work in the brain to restore the balance between
neuronal excitation and inhibition via GABA and glutamate. It should only be used in persons who are
abstinent; may be continued through relapse. Usual dosing is 666 mg orally three times per day.
Dosing adjusted in kidney disease, and serum creatinine level should be obtained at baseline.
Common side effects: includes pain, loss of appetite nausea, diarrhea, dizziness, anxiety, pruritus,
depression, insomnia.
Patient should be assessed for suicidal ideation before beginning treatment.

3. Naltrexone- is a competitive opioid antagonist with a high affinity for mu receptors. Oral form absorbed
through the GI tract undergo up to 40% first pass metabolism. A naloxone challenge test may be done
before initiating treatment and the patient is observed for an hour. If no withdrawal is observed, dosing may
begin the next day at 50 mg per day for 12 weeks or less.
 Types of substance use Disrorder
02 CANNABIS DISORDER
Is the most commonly used recreational drug
in the US.
Cannabis use disorder is more common
among people in their late teens and early
20s.
Users report feeling an alteration in their
senses and an altered sense of time as well as
changes in mood.
Other names: Marijuana, blunt, Bud, Dope,
Ganja, Grass, Green, Herb, joint, Mary jane,
Pot, Reefer, Sinsemilla, Skunk, Smoke, trees
and weeds.
Cannabis contains more than 60 related
psychoactive chemicals known as Cannabinoids;
the most abundant of these is delta-9-
tetrahydrocannabinol (THC)
When smoked, THC rapidly crosses the blood brain
barrier and binds to cannabinoid receptors in many
areas of the brain, overwhelming the
endocannabinoid system and making it difficult for
the user to respond appropriately to incoming
stimuli.
Cannabis increases heart rate and may cause
hallucination, it can cause problem with balance
and coordination and learning ability.
 Treatment for Cannabis
Long term use of cannabis is associated with chronic cough, frequent respiratory infections and
exposure to cancer causing compounds because the smoke has many of the same irritating and lung
damaging properties as tobacco.
The drug has been linked to mental health problems and increased symptoms in persons with
schizophrenia. Babies born to women who use cannabis have behavioral issues and problems with
attention, memory and problem solving.

Many have supported the nationwide legalization of cannabis to treat medical condition; however,
rigorous scientific evidence show that the benefits of cannabis outweigh its health risks is limited and
does not support approval.

Cognitive behavior therapy (CBT) contingency management and Motivational enhancement therapy
(MET) may be effective in the treatment of cannabis use disorder; however, no medication are currently
approved or indicated for this use.
 03OPIOID USE DISORDER
Are controlled substances legally prescribed to treat moderate to severe pain. These drugs
interact with opioid receptors in the brain and nervous system to reduce pain. In addition to
reducing pain, this receptor inteaction floods the brain’s reward system with dopamine,
producing a sense of euphoria and tranquility.

Short term effects of opioid use include drowsiness, mental confusion, nausea, constipation,
and dose-dependent respiratory depression. When taken with alcohol, users may experience
dangerous slowing of heart rate and breathing leading to coma or death.
Prescription opioids are also known by numerous street names including vikes, cody, china
white, fizzies, M, Demmies, Blue heavens, Juice, Smack, Hillbilly, Heroin and Roxy.
The FDA has toughened the safety warnings on opioids including adding a boxed
warning about the potentially lethal risks associated with misuse.
 Treatment for Opioid disorder
1. Naloxone- is the drug of choice in the treatment of respiratory depression
associated with opioid overdose. Is a short-acting opioid antagonist that
competitively attaches to opioid receptors in the CNS, thereby blocking
activation by opioid drugs.
2. Methadone- since 1950s this has been prescribed to treat person’s with OUD.
When taken as prescribed and combined with couseling and behavioral
therapies, administration of this long acting opioid drug is safe and effective.
Methadone works by changing the way a person’s brain respond to pain; it is
an opioid receptor agonist at the mu receptor and an antagonist at the N-
methyl-D- aspartate (NMDA) receptor. Taken daily, it blocks the sense of
euphoria and tranquility caused by opioid use and prevents opioid withdrawal
craving.
 04 Tobacco use disorder
When smoked, nicotine is absorbed from the lungs into the pulmonary venous circulation. It then enters
the arterial circulation and moves quickly to the brain. Once across the blood brain barrier, nicotine
stimulates the release of dopamine, norepinephrine, GABA, glutamate, and endorphins, resulting in
stimulation and pleasure and a reduction in stress and anxiety. These sensations fuel the brain’s reward
circuit.

Treatment for TUD

Quitting is difficult. Persons attempting to quit experience irritability, anger, anxiousness, difficulty thinking,
cravings, and increased in hunger.
Support is very important part of the process and is often combined with pharmacologic measures.
CBT is a goal-directed and problem-focused therapy designed to help the person with TUD identify negative
thought patterns and inaccurate beliefs to learn new ways of coping and develop new ways of thinking.

1. Nicotine replacement drugs-sold as a gum , patch, spray, inhaler, or lozenge-mimic the nicotine effects of
tobacco by binding to nicotine receptors in the CNS
 Treatment for TUD
2. Bupropion-an antidepressant drug , increases level of dopamine and norepinephrine in
the brain, mimicking the effects of nicotine. It is also has some neuronal nicotinic receptor-
blocking activity, reducing reinforcement from the brain’s reward circuit. When used for
smoking cessation, the dosage is 150 mg ER or once daily for 3 days. Treatment should
continue for 7 to 12 weeks; however, ongoing treatment for a year has shown benefit.

3. Vernicline- is a partial alpha-4-beta-2 receptor agonist that stimulates dopamine activty in

the brain but not to the extent of nicotine, thereby reducing craving and withdrawal. Dosing
begins 1 week before an identified quit date at 0.5 mg daily for 3 days.
 Other substance use disorder
Cough and cold products
1. Dextromethorpan- ana antitussive that can be purchase without a prescription. Using DXM
is known on the street as “robotripping” or “skittling”. When taken in higher-than
recommended amounts, users may experience euphoria, dissociative effects, or
hallucination.
2. Promethazine-codeine cough syrup- can result in relaxation and euphoria when taken in
higher that recommended amounts; when combined with soda it is referred to as syrup,
sizzurp, purple drank, Barre, or lean.
Anabolic-androgenic steroids
Is synthetic agent used to treat conditions caused by low levels of testosterone in the body,
such as delayed puberty, hypogonadism, and cachexia related to chronic disease drugs.
This have used to enhance athletic and sexual performances and physical appearance in all
age groups.
Short term effects of AAS use include headache acne, fluid
retention in the hands and feet, oily skin, yellowing of the skin
and whites of the eyes, aggression, extreme mood swings, anger,
paranoid jealousy, extreme irritability, delusions, impaired
judgement, and infection at the injection site.

Withdrawal from AAS use may lead to mood swings, fatigue,

restlessness, loss of appetite and decrease sex drive.

Nurses must be alert when caring for persons withdrawing from

AAS use because withdrawal may cause depression lasting up to
a year, which can result in suicide attempts.
 Special Needs Of Patients With Substance Use
Disorder
Surgical patients Pain management

Respiratory changes in persons with TUD When patients experience pain, the goal is to
make introduction of endotracheal and treat the pain.
suction tubes more difficult and increase the Addressing substance use disorder is not a
risk for postoperative respiratory problems. priority when a patient is in pain.

When patient acknowledge substance use

Nurses should be laert for signs and disorder, it is importantn to determine which
symptoms of drug interactions with pain drug is used and the amount taken each day.
medication or anesthesia and for signs of
withdrawal
 The Nurse With Substance Use Disorder
Contributing factor
Identified as job stress, the
emotional demands of nursing,
long hours and shift rotations, and
easy access to drugs.
Nurses internalize their feelings
tom stay in control during the
crisis and have little to no time to
decompress.
Nurses take care of others
before themselves
Characteristics Management
Signs and symptoms of Nurses may enter
substance use disorder nondisciplinary programs
designed for evaluation and
discrepancies in controlled- treatment, allowing nurses to
drug handling and records maintain their licences.
may indicate drug
diversion, the deliberate It is important for nurses to
redirecting of a drug from a identify pateints who misuse
patient or facility to the drugs and to intervene.
employee for personal use. Knowledge of the most commly
used drugs and their treatment is
critical to sustained remision and
promotion of healthy lifestyle
Avoid drugs
value health
Thank you
for
listening
Icon pack
Alternative resources
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● Edmund, M.W (2016). Introduction to Clinical
● https://www.registerednursing.org/nclex/dosage-c
Pharmacology 8th ed. St. Louis, Missouri: Elsevier. alculations/
● Ford, S.M. (2018). Roach’s Introductory: Clinical
pharmacology. 11th Edition. Philadelphia, ● https://parents-life.com/teratogens-in-pregnancy/
Pennsylvania: Wolters Kluwer.
● https://www.ismp.org/sites/default/files/attachme
● Hayes, Kee, and McCuistion (2015). Pharmacology: nts/2018-08/highAlert2018-Acute-Final.pdf
a patient-centered nursing process approach. 8 th
Edition. St, Louis, Missouri: Saunders, Elsevier.
● Hodgson and Kisior (2019). Saunders nursing drug
handbook 2019. 27th Edition. St. Louis, Missouri:
Elsevier.
● Lapham, R. (2016). Drug calculations for nurses: A
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Florida: CRC Press