Term
Topic 4: Substance related disorders
DSM-IV diagnosis of substance abuse: |
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Definition
A maladaptive pattern of substance use leading to clinically significant impairment or distress occurring within a 12 month period, recurrent or continued substance use resulting in:
- failure to fulfil major role obligations at work, school or home
- Placing self at physical risk, i.e driving while under the influence
- Legal problems
- Social or interpersonal problems i.e fights with partners when intoxicated
*symptoms have never met the criteria for substance dependence for this class of substance* |
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Term
Topic 4: Substance related disorders
DSM-IV diagnosis of substance dependence: |
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Definition
A maladaptive pattern of substance use leading to clinically significant impairment or distress manifested by three or more problems occurring over a 12 month period.
1.Tolerance to the substance
a. Need to increase the amount of drug
b. Diminished effect with continue use of the same amount of drug
2.Withdrawal symptoms
3.Increasing amounts of drug taken over a longer period of time
4.Persistent desire or unsuccessful efforts to cut down or control use
5.Increasing time to obtain drug, use the substance, or recover form its effect
6.Important social, occupational or recreational activities are given up or reduced because of substance use
7.The substance use is continued despite the knowledge of a persistent or recurring physical problems
Specify if:
- with physiological dependence: either item 1 or 2 is present.
- without physiological dependence: neither item 1 or 2 present. |
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Term
Topic 4: Substance related disorders
DSM-IV-TR Substance of Abuse Categories (12): |
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Definition
- alcohol-related disorders
- amphetamine-related disorders
- caffeine-related disorders
- cannabis-related disorders
- cocaine-related disorders
- hallucinogen-related disorders
- inhalant-related disorders
- nicotine-related disorders
- opioid-related disorders
- phencyclidine-related disorders
- sedative-, hypnotic-, or anxiolytic-related disorders
- polysubstance dependence |
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Term
Topic 4: Substance related disorders
Caffeine is... |
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Definition
- CNS stimulant
- works by blocking adenosine receptors in the brain
- alters pathways for release of dopamine
- actions:
- dilates coronary arteries
- cerebral artery constriction
- bronchial relaxation
- increased gastric acid secretion and urine output |
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Term
Topic 4: Substance related disorders
Tobacco is... |
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Definition
- drug found in cigarettes
- many negative LT health effects
- smokers report feelings of (probably due to ther already increased stress levels):
- relaxation
- calmness
- alertness
- New smokers experience:
- nausea
- dizziness
- tachycardia |
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Term
Topic 4: Substance related disorders
Marijuana is... |
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Definition
- psychoactive drug
- travels to brain and initiates feelings of relaxation, euphoria, disinhibition and altered time preception.
- other feelings include anxiety, paranoia, panic, hallucinations, impaired co-ordination, ST memory loss, tachycardia and arrhythmias.
- heavily associated with mental illness |
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Term
Topic 4: Substance related disorders
Alcohol is... |
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Definition
- commonly used, legal drug
- affects neurotransmitters in the brain
- varying effects from improved mood to dizziness, inhibition, blackouts and unconsciousness |
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Term
Topic 4: Substance related disorders
Opiates... |
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Definition
- Include:
- Morphine
- Heroin
- Methadone
- Buprenorphine
- Naltrexone
Are:
- illicit drugs taken orally, IV, smoked or rectally
- taken for the relaxing/euphoric effects
- can also cause resp depression, sedation, constipation and kidney impairment and have other LT consequences |
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Term
Topic 4: Substance related disorders
Amphetamines are... |
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Definition
- Psychostimulants that cause hypoeractivity, dilated pupils, headache, tachycardia, fever, hypotension, constipation, twitching, arrhythmias, stroke, coma, heart attack and death as well as neurotoxic effects.
- Taken for euphoria, alertness and energy.
- can result in ST psychosis because they act on neurotransmitters (dopamine, serotonin and noradrenaline) |
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Term
Topic 4: Substance related disorders
Hallucinogens are |
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Definition
| - drugs that can cause hallucinations. |
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Term
Topic 4: Substance related disorders
Safe level of alcohol consumption for men and women... |
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Definition
THERE IS NO 'SAFE' LEVEL'
HARM MINIMIZATION:
- low risk: < 14 standard drinks per wk
- medium risk: b/w 14-28 standard drinks per wk
- high risk: >28 standard drinks per wk
- 'risky drinking': >6 standard drinks in one sitting for males or >4 standard drinks for females
- Australian legal driving alcohol limit is 0.05g/100ml blood. |
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Term
Topic 4: Substance related disorders
Questions to screen pts for substance use/abuse disorders |
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Definition
When assessing patients for substance use or abuse, it is important to
establish a rapport with the patient, usually through asking questions
typical of a medical history. It is important for the nurse to be nonjudgmental during this process. Patients may find this process less threatening if it is lead in to, typically by asking about exercise,
smoking and alcohol first, then moving on to illicit drugs.
Examples of questions:
Do you think alot about drugs?
Have you ever overdosed on any drug?
Do you think you might have a drug problem? |
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Term
Topic 4: Substance related disorders
Assx of a pt with a substance use/abuse disorder: |
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Definition
- MSE (determine presence of co-morbid psychiatric disorders)
- Health History
- presence of risk factors
- type of drug use
- quantity of use
- frequency of use
- route of administration
- screening questions
- Physical assessment (determine presence of physical conditions) |
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Term
Topic 4: Substance related disorders
List moderate use risk factors (4). |
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Definition
- Peer associations (friend reinforce drug use)
- Illegal drug users have weaker bonds to family/school
- low quality parent-child relationships and non-democratic discipline styles
- Personality traits (rebelliousness and unconventionality) |
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Term
Topic 4: Substance related disorders
List heavy, problematic use risk factors (6). |
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Definition
- Emotional distress and psychological difficulties
- people with AOD disorders say stress is a reason for taking drugs
- relationship between childhood abuse, PTSD and alcohol or drug use.
- co-occurance of ADHD and conduct disorder leading to school difficulties, high risk
- genetic factors may predispose some individuals to alcohol or drug disorders
- reliance of alcohol or drug use as a coping mechanism |
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Term
Topic 4: Substance related disorders
Define 'misuse'. |
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Definition
| the use of substances (legal, prescribed or illicit) in a manner not intended. May include high risk use, such as excessive alcohol consumption, which is not illegal. |
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Term
Topic 4: Substance related disorders
Define 'abuse': |
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Definition
| (interchangeable with 'misuse' in Australia) refers to use of a substance in a way which is physically, socially, financially or otherwise detrimental to everyday living. |
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Term
Topic 4: Substance related disorders
Define 'dependence'. |
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Definition
| An ongoing condition, whereby substance use takes over the patients life, causing them to spend a great deal of time working to procure the substance, and may or may not be associated with signs of physiological tolerance and withdrawal. |
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Term
Topic 4: Substance related disorders
Describe the 'moral explanation' theory of addiction. |
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Definition
- Describes people who have problems with alcohol/drug use as selfish, hedonistic, morally weak, depraved and lacking willpower.
- self indulgent with no regards for the effects on themselves or others.
- deserve to be punished for their wrongdoing.
- emphasis on user's guilt, shame, inferiority and ignores other dimensions of the problem. Eg. AA. |
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Term
Topic 4: Substance related disorders
Describe the 'disease model' theory of addiction. |
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Definition
- User's have unique metabolic or genetic abnormalities that predestine them for addiction. Abnormalities are immutable, abstinence the only "cure" for this disease.
- These people deserve our care and sympathy. Can't help their behaviour.
- If they abstain then it will recurr if use recommences. It is a progressive, downhill path.
- Links to dependent personality disorder or problems. |
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Term
Topic 4: Substance related disorders
Describe the 'sociological' theory of addiction. |
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Definition
- underprivileged, downtrodden, emotionally depressed people turn to drink/drugs because they are denied a share in mainstream societies rewards.
- people seek alternative ways of coping with stress and getting rewards.
- often have poor role models and limited opportunities
- Person chooses social role of "drug addict" for example then feel comfortable there, conforming to the stereotype of that role. |
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Term
Topic 4: Substance related disorders
List the deficiencies of the "grand theories of addiction". |
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Definition
- Context of drug use not included
- cause of the drug use is located within the individual
- "us and them" dichotomy created
- they do not explain recreational, socially sanctioned use
- ignores political and economical factors influencing use |
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Term
Topic 4: Substance related disorders
Describe the broader influences that the 'sociocultural theory' explores. |
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Definition
- Factors such as drug availablity, price, marketing, law enforcement affect patterns of use by subgroups
- poverty, homelessness and unemployment
- racial/ethnic marginality |
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Term
Topic 4: Substance related disorders
General Management of a pt during withdrawal from an addictive substance. |
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Definition
Early recognition and prevention imp:
- Assessment incl readiness to change (Alcohol: CAGE, AUDIT)
- Pathology
- Physical Assessment
- Health history
Interventions:
- self-help materials
- education: safe levels of consumption, how to reduce consumption
- harm reduction
- relapse prevention/planning
- motivational interviewing/CBT/complementary therapies
- brief counselling (prob solving/goal setting)
- follow up |
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Term
Topic 4: Substance related disorders
Pharmacological Interventions for withdrawal/relapse. |
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Definition
Alcohol:
- Benzodiazepines
- Thiamine
- Paracetamol
- Multivitamins
- Anti-emetics, psychotics, diarrhoeals
Caffeine:
- switch to decaf coffee
- paracetamol for headaches/muscle soreness
Tobacco:
- Nicotine replacement therapy:
- gum, inhaler, nasal spray, patch
- Medication: Bupropion (Zyban)
- Support: Quitline |
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