Substance Abuse5 rtf front page

							SUBSTANCE-RELATED DISORDERS
Carol Amole
Alcoholism
Alcoholism is a chronic disease that is often progressive and fatal.
Symptoms include impaired control over drinking and preoccupation with alcohol
despite adverse consequences
How Alcohol Affects the Body
Integumentary system
Spider angiomas on the face and chest
Facial edema, flushed cheeks, jaundiced sclera
Gastrointestinal system
Alcohol has a toxic effect on the intestinal mucosa
Assess for liver enlargement utilizing percussion




Assess lab data for hepatic cirrhosis and hepatic encephalopathy ( increased ammonia
level)
Please review what medication are indicated for hepatic encephalopathy.
Alcohol usually increases gastric motility.
Ulcers, esophageal varicies, and hemorrhoids are associated with the disease of
alcoholism.
Musculoskeletal System
Alcoholics have an increased incidence of fractures and injury due to decreased
calcium absorption

Neurological system
Alcohol has a dramatic effect on the brain and the damage may be permanent.
Prolonged drinking may cause memory and judgment impairment.
Long term alcohol abuse can cause many neurological conditions.

Genitourinary system
Alcohol causes an inflammatory response in the kidneys and bladder.
Alcoholics frequently suffer from dehydration and frequent urinary tract infections
Psychopathology of Alcoholism
Behavior Characteristics
Lack of control of drinking is the central behavioral characteristic
Under the influence of alcohol, the alcoholic can become loud and hostile or withdrawn
and tearful.
Alcoholics have frequent work absences and decreased productivity
The alcoholic changes jobs frequently and is many times passed over for promotions
Affective characteristics
Many alcoholics experience guilt and shame.
Shameful people feel powerless and feel like a failure.
Depression frequently accompanies alcoholism because alcoholics behave in ways not
matching their value system. Family and friends are hurt by the alcoholics behavior.
Cognitive Characteristics
Alcohol is central focus of the alcoholics thinking.
The defense mechanisms of denial, projection and rationalization are over utilized by
the alcoholic.
Sociocultural characteristics
Alcoholism is a family problem and affects the entire family unit
Roles and Characteristics of Alcoholic Families
Co-dependence
The process of participating in behaviors that maintain the addiction or allow it to
continue without holding the alcoholic accountable for his or her actions.
Codependence Response Patterns
Alienate
The alienated codependent ignores the problem and their pain
Bullies
Bullies manage by lashing out and constantly criticizing.
Managers
Managers take care of everything and shield the alcoholic from distress.
Martyrs
Martyrs passively endure the pain hoping things will change
Children of Alcoholic Families
Don’t talk
Don’t feel
Maintain the secret
Hero Child
Usually the oldest child
Becomes the competent caretaker that keeps the family functioning
Scapegoat
The scapegoat child acts out to take the focus off the alcoholic parent by getting into
trouble.
Lost Child
The lost child tries to avoid conflict and pain by withdrawing physically.
Mascot
The mascot is usually the youngest child. They try to ease family tension with comedy
to mask the sadness.
Conclusion
Each family role provides the family member with a sense of control.
Family members try to solve problems alone and blame themselves.
Alcohol Withdrawal
Withdrawal begins 7-24 hours after last ingestion
Early Symptoms
Irritability
Anxiety
Insomnia
Mild Tremors
Mild Tachycardia
Delirium Tremors (DT’S)
DT’S usually occur 2 to 7 days after the last drink but may occur 14 days later.
Symptoms can last for up to 5 days
There is a 15% mortality rate, usually due to cardio-vascular failure.
Symptoms include:
       Profound Disorientation
       Agitation and Aggressiveness
       Diaphoresis
       Elevation of Vial Signs
       Visual Hallucinations
       Incontinence
       Seizures
       Dehydration
       Nausea, vomiting, and diarrhea


Wernicke-Korsakoff Syndrome
Serious Thiamine Deficiency in Alcoholics
Symptoms include amnesia, clouding of consciousness, confabulation, memory loss,
and peripheral neuropathy.
Alcohol Hallucinosis
Symptoms appear after ingestion of alcohol
Symptoms are similar to Paranoid Schizophrenia
Persecutory delusions
Auditory hallucinations
Violent behavior
Panic


Idiosyncratic Intoxication
The client has an abrupt behavior change after ingesting a small amount of alcohol.
The clients behavior becomes very aggressive.

Nursing Care for the Client Experiencing Alcohol Withdrawal
Monitor vital signs frequently
Priority of Nursing Care is Fluid Replacement
Fluid are most successful if given orally—FORCE FLUIDS!

Librium, Ativan, or Phenobarbital are given to prevent or treat seizures and agitation.

Patient should not be left unattended, if at all possible restraints should be avoided.

Lights should remain on to monitor the patient safety but all other stimuli should be

reduced.
Evaluate gastric content and stools for occult blood

Auscultate breath sounds (patient at risk for pneumonia)

After nausea and vomiting decrease, a diet high in bland carbohydrates can be started.

Alcoholics Annonymous
12 step non-professional help for alcoholics
Most successful treatment for the disease of alcoholism
The first step is to admit you are powerless over alcohol.
Courses Of Withdrawal from Addictive Drugs

Sedatives
Benzodiazepines
Barbiturates
•Withdrawal of these substances should not be done abruptly .
•Abrupt withdrawal may cause tonic and clonic
• seizures.

Opioids
This addiction dominates the client’s life
The withdrawal from these drugs is very difficult for the client.
Many who abuse these drugs overdose accidentally.
What drug is utilized for an overdose of a narcotic?
Stimulants-Amphetamines
This can be an extremely irritable, paranoid, and aggressive patient.(while under the
influence)
Hyperpyrexia can lead to sezures.
Cocaine and crack cocaine are included in this category.
Hallucinogens
In addition to marijuana, LSD, and mescaline, newer “club” drugs have properties of
amphetamines and hallucinogens. (Ectasy)
Personality Disorders
Criteria for personality disorders includes experiences and behaviors that are different
from that which is usually expected from an individual.
Your text book has the DSM-IV-R Criteria for a Personality Disorder.
The 2 personality disorders we will discuss in this class are Borderline and Antisocial
Personality Disorders.
Personality Disorders
Personality disorders include at least two disturbances in the following areas:
Cognition
Affect
Interpersonal functioning
Impulse control
Personality disorders can be viewed as a hole in the personality.
These disorders are usually lifelong.
Personality disorders can be viewed as a “hole” in the personality.

Borderline Personality Disorder

Borderlines have a world view of a being a victim.
Borderlines use the defense of “splitting”- the inability to view self and others as both
good and bad.
Borderline Personality Disorder
Borderlines can exhibit all the major areas of psychopathology as seen in the previous
slide.
They can manifest profound emotional and behavioral fluctuations and are usually in a
crisis situation.
Antisocial Personality Disorder

Main feature of the antisocial is the disregard for the rights of others.
Antisocials see the problem as being within others and not themselves.
Antisocials are charming, intellectual; they are smooth talkers who rationalize their
behavior.

Antisocial Personality Disorder

Main feature of the antisocial is the disregard for the rights of others.
Antisocials see the problem as being within others and not themselves.
Antisocials are charming, intellectual; they are smooth talkers who rationalize their
behavior.

Nursing Interventions for Patients with Personality Disorders
SET FIRM LIMITS
Be consistent when patients try to manipulate and bend the rules.
Confront the patient with his or her behavior and make the patient aware of the
consequences of their actions.