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Chapter 95 - Substance Use Disorders
Terms in this set (56)
substance abuse disorder
An unhealthy dependence on alcohol or other drugs
person experiences decreased effects from previously sufficient amounts
the discomfort and distress that follow discontinuing the use of an addictive drug
Is daily/episodic use still considered substance use disorder?
physical factors theory
excessive consumption of substances is the most obvious cause of substance abuse disorders. (
nutritional deficiency or endocrine factor can lead to excessive alcohol use
based on direct biologic transmission or is a learned behavior in children who constantly interact with family members with substance use issues.
stress is a contributing factor for substance abuse disorders. low self-esteem is often considered to be the most potent precipitating factor. person needs the drug to feel good about life and self. (
low self-esteem; difficulties in interpersonal relations; general uneasiness and dissatisfaction with life; low tolerance for frustration; tendency toward excessive and self-destructive, risky, behaviors; coexisting mental illness
recognition; intervention; treatment; recovery
someone must recognize the condition. the first person to do so is very often someone other than the person with the disorder.
must occur. if no one step in the process, it usually escalates.
these disorders often respond to structured therapy. person may need a particular milieu to gain control. in rare cases, the person sees the impact of the destructive behavior and stops using.
client needs assistance to stop using
many therapies assist people with substance use disorders to lead a successful and productive life. (
12-step of AA or apply principles of behavior modification
how many clients receiving care for general medical -surgical conditons have underlying substance use disorders? (majority of these clients overuse alcohol. research shows that more than 1/3 of ER admissions and about 1/5 of acute hospital admissions can be traced to complications related to substance use).
driving under intoxication/driving while intoxicated
not currently active
process of removing a drug and its physiologic effects from the body. may take many days, depending on the drug(s) used, amounts, dependence level, liver and kidney function, and client's size and general health.
requires careful and correct management, especially for those who abuse alcohol
comfort and safety
the most important goals in detoxification
when a person stops taking drugs, such as barbiturates or cocaine, what is the danger?
client may progress to a dangerous w/d that includes terrifying hallucinations and/or seizures. aspiration, coma, and death may follow.
what happens if detoxification is managed improperly?
many chemically dependent people are medication-seeking and ask for medications, even if they are not having true symptoms
why are medications only given if truly necessary?
Clinical Institute Withdrawal Assessment
client should be rehydrated slowly, with small and carefully panned fluids and feedings. carbs (dextrose IV supplements) must be given very carefully.
what happens if a client is severely malnourished?
sudden influx of carbohydrates to stimulate insulin production and other events that may seriously upset electrolyte balance. can also cause cardiac failure, hypertension, peripheral edema, neurologic complications (seizures or coma), respiratory failure, and death.
polysubstance use disorder
having overused several drugs
living with or caring for another person who overuses alcohol or other drugs.
control/prevent seizures; provides sedation.
clients are evaluated for severity of w/d sx before given, because of their abuse potential
NA. teach that an untreated substance use disorder is a progressive, incurable disease.
dialectical behavioral therapy
DBT. developed to treat borderline personality disorder. emphasizes the "here and now" and assists individuals to take charge of their own lives. (individual/group therapy)
HR. psychological/spiritual therapy model. based on the theory that each person possesses inborn or innate (inner) health and has the capacity or ability to lead a healthy life. helps person learn to do this. person changes from "inside out".
follows detoxification and/or intensive treatment. most important factor in maintaining sobriety.
stages of wi/d
autonomic hyperactivity; neuronal excitation; sensory-perceptual disturbances
symptoms include elevated vital signs (temp over 100; pulse over 100 bpm, respirations over 20 to 22/min, BP over about 160/95) nervousness, restlessness, psychomotor agitation. includes anxiety, sleep disturbances (insomnia/vivid nightmares), irritability, diaphoresis, flushes face, anorexia, nausea (with copious vomiting and later "dry heaves").
significant sign is presence of tremors ("shakes"). subjective internal tremors occur first. client can describe theses but they are not observable to others. Hand tremors are first objective sign observed
. (occurs within 12-18 hours)
se3vere tremors (internal and external), panic, insomnia, and increased agitation. person may experience transient hallucinations of frightening events (drowning while drunk) or frightening auditory hallucinations. person may become paranoid, depressed, and is at extremely high risk for suicide. (occurs within 24-36 hours)
vivid visual hallucinations, generalized tonic-clonic seizures, and severe agitation and panic, leading to profound confusion and coma. particularly life threatening and a medical emergency.
untreated, mortality rate is 25%
. (occurs within 3 to 4 days).
DT. indicator of a severe toxic state in stage 3 of w/d. includes alcohol hallucinosis.
tactile hallucinations (bugs crawling on skin). may last a few days to several weeks.
blood alcohol level
BAL. important to know for detoxification.
WKS. severe neurologic disorder from chronic alcohol overuse. (dementia, diplopia, ataxia, somnolence, stupor, and horizontal nystagmus).
liver damage from repeat drinking.
alcohol-related liver disease
fetal alcohol syndrome
newborns of alcohol-abusing mothers.
codependent. "one who has let someone else's behavior affect him or her. The codependent is obsessed with control (the user's) behavior."
disulfiram, sometimes used as
or adverse conditioning in the person with a chronic alcohol use disorder, who is unable to maintain sobriety. only used if the client is preoccupied with or craving alcohol and has had multiple failed treatments.
this dangerous drug is ONLY used when everything else had failed!
THC., the active ingredient in marijuana
drug therapy that uses specific agents to occupy opioid receptors, blocking the opioid effects.
gamma butyric acid
an inhibitory neurotransmitter. A lack is linked to seizures, tremors, and insomnia,.
meth user who has not slept for days and is in acute w/d. he or she may appear normal, except for rapid eye movements or quick, jerky body movements.
lysergic acid diethylamide
LSD; synthesized and tested by Albert Hofmann; one of the most potent psychoactive substances known
DOM, MDA/MDMA, GBA
objects appear larger
objects appear smaller than normal
hallucinogen persisting perception disorder
HPPD. flashbacks. major problem associated with hallucinogens. causes severe panic attacks.
PCP. hallucinogen that was originally developed as an animal anesthetic.
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