Substance Abuse

Substance abuse
By Mr. Sushil Sudarshan Humane
MSN Rn
Presentation by Sushil Humane MSN, RN 1

Concept
• The disorder due to psychoactive substance use refer to condition
arising from the abuse of alcohol, psychoactive drugs and other
chemicals such as volatile solvents.
• Classified under F1 in ICD 10
• The word substance means any drug, medication, or toxin that shares
the potential for abuse.
2
Presentation by Sushil Humane MSN, RN

Terminologies
• Addiction: it is a physiological and psychological
dependance on alcohol or other drugs of abuse that
affects the central nervous system in such a way that
the withdrawal symptoms are experienced when the
substance is discontinued.
• Abuse: it refers to maladaptive pattern of substance
use that impairs health in a board sense
• Dependance: it refers to certain physiological and
psychological phenomenon induced by the repeated
taking of a substance.
3

Terminologies
• Tolerance: it is a state in which after repeated
administration, a drug produces a deceased
effect, or increasing doses are required to
produce the same effect.
• Withdrawal state: a group of sign and symptoms
recurring when a drug is reduced in amount or
withdrawn, which is last for limited time.
4

Classification
• F10 – F19 Mental & Behavior Disorders due to
Psychoactive Substance Use.
• F10 - Mental & Behavior Disorders due to use of
Alcohol.
Opioids.
Cannabinoids.
Sedatives & Hypnotics.
Cocaine.
Hallucinogens.
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Substances to be used
• Alcohol
• Opioids
• Cannabis
• Cocaine
• Amphetamine and other sympathomimetics
• Hallucinogen: LSD, phencyclidine
• Sedative and hypnotics
• Inhalants
• Nicotine
• Other stimulants: caffeine
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Epidemiology
8

Etiological factors
• Biological factors
• Behavioral factors
• Psychological factors
• Social factors
9

10

Impact of
substance
abuse
• This Commonly Leads to Physical Dependence,
Psychological Dependence, Or Both.
• It may cause Unhealthy Lifestyles & Behaviors Such
as poor diet.
• Chronic Substance abuse impairs Social &
Occupational Functioning, Creating Personal,
Professional, Financial, & Legal Problems (Drug
Seeking is commonly associated with Illegal
Activities, Such as Robbery or Assault).
• Drug Abuse May lead to Life Threatening
Complications.
• Illicit Street Drugs pose added Dangers; Materials
used to dilute them can cause toxic Or allergic
Reactions.
11

ALCOHOL DEPENDENCE SYNDROME
• Alcohol Means Essence, anciently it called as Magnus
Hass which is derived from Arabic Word.
• Alcoholism refers to the uses of alcoholic Beverages to
the Point of Causing Damage to the Individual, Society,
Or Both.
• (Or)
• Chronic Dependence of Alcohol Characterized by
Excessive & Compulsive Drinking that produce
Disturbances in mental Or Cognitive level of
functioning which interferes with social & Economic
Levels.
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PROPERTIES OF
ALCOHOL
• Alcohol is a Clear Coloured Liquid with a
Strong Burning Taste.
• The Rate of Absorption of alcohol into
the Blood stream is more Rapid than its
Elimination.
• Absorption of Alcohol into the
Bloodstream is Slower when food is
Present in the Stomach.
• A Small amount is Excreted through
Urine & a Small Amount is Exhaled.
14

CONCENTRATION
OF ALCOHOL IN
BLOOD
15

EPIDEMIOLOGY
• Incidence of Alcohol Dependence is
2% in India.
• 20 – 30 % of Subjects Aged Above
15years are Current Users Of Alcohol,
& Nearly 10% of them are Regular Or
Excessive Users.
• 15 – 30 % Of Patients are Developing
Alcohol – Related Problems & Seeking
admission in Psychiatric Hospitals.
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CAUSES OF
ALCOHOLISM
• Hard physical Labour, ( Occupations – Bar mates,
Medical Professionals, Journalists & Actors).
• A Sudden loss of Properties or Closed ones.
• Ignorance Suddenly a person Become a Rich /
Poor.
• Disorders Like Depression, Anxiety, Phobia, & Panic
Disorders.
• Biochemical Factors (Alterations in Dopamine &
Epinephrine) Psychological factors (Low self
Esteem, Poor Impulse, Escape From reality,
Pleasure Seeking).
• Sexual Immaturity Social Factors ( Over Crowding,
Peer Pleasure, Urbanizations, Religious Reason,
Unemployment, Poor Social Support, Isolation).
20

PROCESS OF ALCOHOLISM
• Experimental Stage
• Recreational Stage
• Relaxation Stage
• Compulsion Stage
• Progressive Phase
• Crucial Phase
• Chronic Phase
• Rehabilitative Phase
• Road For Recovery
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CLINICAL FEATURES OF
ALCOHOL DEPENDENCE • Minor Complaints : (Malaise,
Dyspepsia, Mood Swings Or
Depression, Increased
Incidence of Infection) Poor
Personal Hygiene.
• Untreated Injuries (Cigarette
Burns, Fractures, Bruises
that cannot be fully
Explained).
• Unusually High tolerance for
Sedatives & Opioids.
• Nutritional Deficiency (
Vitamins & minerals).
23

CLINICAL FEATURES
OF ALCOHOL DEPENDENCE
• Secretive Behavior (may
Attempt to Hide disorder or
Alcohol supply).
• Consumption Of Alcohol-
Containing products
(Mouthwash, After-Shave
lotion, Hair Spray, Lighter
Fluid, Body Spray, Shampoos).
• Denial of Problem.
• Tendency to Blame others &
Rationalize Problems
(Problems Displacing Anger,
Guilt, Or Inadequacy Onto
Others to Avoid Confronting
Illness).
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DIAGNOSTIC
CRITERIA FOR
ALCOHOL
DEPENDENCE
25

PSYCHIATRIC DISORDERS DUE TO ALCOHOL
DEPENDENCE
• Acute Intoxication
• Withdrawal Syndrome
• Alcohol-Induced Amnestic Disorders
• Alcohol-Induced psychiatric Disorders
26

ACUTE INTOXICATION
• It Develops During Or Shortly After Alcohol
Ingestion. It is Characterized by,
• Clinically Significant Maladaptive Behavior
or Psychological Changes (Eg’s:
Inappropriate Sexual or Aggressive
Behavior).
• Mood Lability
• Impaired Judgment
• Slurred Speech
• Inco-ordination
• Unsteady gait
• Nystagmus
• Impaired Attention & Memory
• Finally Resulting in Stupor or Coma.
27

WITHDRAWAL
SYNDROME
• Person Who Have been
Drinking Heavily Over a
Prolonged period of time,
Any Rapid Decrease in the
amount of Alcohol in the
Body is likely to Produce
Withdrawal Symptoms. These
are:
• Simple Withdrawal
Symptoms
• Delirium Tremens
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SIMPLE WITHDRAWAL
SYNDROME It is Characterized by,
• Mild tremors
• Nausea
• Vomiting
• Weakness
• Irritability
• Insomnia
• Anxiety
29

SIMPLE
WITHDRAWAL SYNDROME
• It Occurs Usually within 2-
4days of Complete or
Significant Abstinence From
Heavy drinking.
• The course is Very Short,
with Recovery Occurring
within 3-7days.
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ALCOHOL-INDUCED
AMNESTIC
DISORDERS
34

WERNICKE’S
SYNDROME
is
Characterized
by,
Prominent
Cerebellar
Ataxia
Palsy of the
6th Cranial
Nerve
Peripheral
Neuropathy
Mental
Confusion
35

KORSAKOFF’S
SYNDROME
Memory disturbance
Disorientation
Confusion
Confabulation
Poor Attention Span & Distractibility
Impairment of Insight
36

ALCOHOL-INDUCED
PSYCHIATRIC DISORDERS • Alcohol Induced Dementia:
• It is a long term
Complication of Alcohol
Abuse, Characterized by
Global decrease in cognitive
Functioning (Decreased
Intellectual Functioning &
Memory).
• This Disorder tends to
Improve With Abstinence,
But Most of The Patients
may have Permanent
disabilities.
37

ALCOHOL-
INDUCED PSYCHIATRIC
DISORDERS
• Alcohol-Induced Mood Disorders: Persistent
Depression & Anxiety Suicidal Behavior
• Alcohol-Induced Anxiety Disorders: Panic Attacks
Impaired
• Psychosexual Dysfunction: Erectile Dysfunction &
Delayed Ejaculation
• Pathological Jealousy: Delusion of Infidelity
Alcoholic Seizures:
• Generalized Tonic - Clonic Seizures Occur Within
12-48 Hours After a Heavy Bout of Drinking.
• Status Epilepticus Alcoholic Hallucinosis:
• Presence of Auditory Hallucination during
Abstinence
• Regular Alcohol Intake
38

RELAPSE
• Relapse refers to the process of returning to the
use of alcohol or drugs after a period of
Abstinence. Relapse Dangers:
• The presence of drugs or Alcohol, Drug users,
Places where you used Drugs.
• Negative Feelings, Anger, Sadness, Loneliness,
Guilt, Fear, & Anxiety.
• Positive Feelings which make you celebrate.
• Boredom – A State of Feeling Bored.
• Increase the Intake of drug.
• Physical pain
• Lot of Cash
39

Warning
Signs Of
Relapse
• Stopping medications on one’s own or against the
advise of medical professionals.
• Hanging around old drinking haunts & drug using
Friends.
• Isolating themselves.
• Keeping Alcohol, drugs around the houses for
some reason.
• Obsessive thinking about using drugs / Drinking.
• Fail to follow their treatment plan, Quitting
therapies, Skipping doctor’s appointments.
• Feeling Over – Confident
40

Warning
Signs Of
Relapse
• Difficulties in Maintaining Relationships.
• Setting Unrealistic Goals.
• Changes in Diet, Sleep, Energy levels, & Personal
Hygiene.
• Feeling Overwhelmed.
• Constant Boredom.
• Sudden Changes in Psychiatric Symptoms.
• Unresolved Conflicts.
• Avoidance.
• Major life Changes – loss, Grief, Trauma, Painful
Emotions, Winning the Lotteries.
• Ignoring Relapse warning Signs & Symptoms
41

COMPLICATIONS
OF ALCOHOL
ABUSE
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DIAGNOSTIC
EVALUATION
• History collection.
• Mental Status Examination.
• Physical Examination.
• Neurologic Examination.
• CAGE Questionnaires.
• Michigan Alcohol Screening
Tests (MAST).
• Alcohol Use Disorders
Identification Tests (AUDIT).
• Paddington Alcohol Test (PAT).
• Blood Alcohol Level to
indicate Intoxication
(200mg/dl).
• Serum Electrolytes Analysis Revealing
Electrolyte Abnormalities associated
with Alcohol Use.
• Urine Toxicology to reveal use
of Other Drugs.
• Liver function Studies demonstrating
alcohol related Liver Damage.
• Hematologic Workup Possibly
revealing Anemia,
Thrombocytopenia.
• Echocardiography &
Electrocardiography demonstrating
Cardiac Problems.
• Based on ICD10 Criteria.
44

TREATMENT MODALITIES
• Symptomatic Treatment.
• Fluid Replacement Therapy.
• IV Glucose to Prevent Hypoglycemia.
• Correction of Hypothermia / Acidosis.
• Emergency Measures for Trauma, Infection or GI Bleeding.
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TREATMENT FOR WITHDRAWAL
SYMPTOMS DETOXIFICATION
• The Drugs of Choice are
Benzodiazepines. Egs:
Chlordiazepoxide 80-200 mg/day
Diazepam 40-80 mg/day, in
divided doses.
• Vitamin B – 100mg of Thiamine
Parenterally, Bd 3 to 5 days,
Followed by Oral Administration
for At least 6 months.
• Anticonvulsants
• Maintaining Fluid & electrolyte
Balance
• Strict Monitoring of Vitals, Level
of Consciousness & Orientation.
• Close Observation is Essential
46

ALCOHOL
DETERRENT
THERAPY
• Deterrent agents are given to desensitize the
individual to the effects of alcohol & Abstinence.
• The Most commonly Used Drug is Disulfiram or
Tetraethyl thiuram disulfide or Antabuse.
47

DISULFIRAM
• Disulfiram is used to ensure
Abstinence in the Treatment
of Alcohol Dependence.
• Its Main effect is to Produce a
rapid & Violently Unpleasant
Reaction in a Person who
ingests even a Small amount
of alcohol While Taking
Disulfiram.
48

DISULFIRAM
• DOSAGE: Initial Dose is 500mg/day orally for the 1st 2weeks,
followed by a maintenance dosage of 250mg/day. The
Dosage should not exceed 500mg/day.
• INDICATIONS: Disulfiram use is as an Aversive Conditioning
Treatment for Alcohol Dependence.
• CONTRAINDICATIONS:
1. Pulmonary & Cardiovascular Disease
2. Disulfiram Should be used with caution in patients with
Nephritis, Brain Damage, Hypothyroidism, Diabetes,
Hepatic Disease, Seizures, Poly-drug Dependence or an
Abnormal EEG.
3. High Risk for Alcohol Ingestion.
49

INDICTIONS
• It is an Aldehyde Dehydrogenase inhibitor that
interferes with the metabolism of alcohol & Produces a
marked increase in blood acetaldehyde levels.
• Accumulation of acetaldehyde( more than 10 times
which occurs in the normal metabolism of alcohol)
produces a wide array of Unpleasant reactions Called
DISULFIRAM-ETHANOL REACTION (DER).
• Characterized by Nausea, Throbbing headache,
Hypotension, Sweating, thirst, Chest Pain, tachycardia,
Vertigo, blurred Vision associated with Severe Anxiety.
50

ADVERSE
EFFECTS
• Fatigue, Dermatitis, Impotence, Optic Neuritis,
Mental Changes, Acute Polyneuropathy, Hepatic
Damage, Convulsions, Respiratory Depression,
cardiovascular Collapse, Myocardial Infarction,
Death.
51

NURSING
RESPONSIBILITY
• An informed Consent should be taken before
Starting treatment. Ensure that at least 12hours
have elapsed since the last ingestion of Alcohol
before Administering the Drug.
• Patient should be warned against Ingestion of any
alcohol- containing preparations such as Cough
Syrups, Sauces, Aftershave Lotions, Etc.,
• Caution patient against taking CNS Depressants &
Over-the- Counter(OTC) Medications during
disulfiram therapy.
• Instruct The Patient to avoid driving or other
activities requiring alertness.
52

NURSING
RESPONSIBILITY
• Patients should be warned that the
Disulfiram-alcohol Reaction may
continue for as long as 1or 2 weeks after
the last dose of disulfiram.
• Patients should carry identification cards
describing Disulfiram- alcohol reaction &
listing the name & phone number of the
physician to be called.
• Emphasize the Importance of Follow-Up
visits to the physician to monitor
progress in long-term therapy.
53

PSYCHOLOGICAL
THERAPY:
• Motivational Interviewing
• Group Therapy
• Aversive Conditioning / Therapy
• Cognitive Therapy
• Relapse Prevention Technique:
This technique helps the patient
to identify high-risk relapse
factors & develop strategies to
deal with them.
54

PSYCHOLOGICAL
THERAPY
• Cue Exposure Technique: The
technique aims through
repeated exposure to
desensitize drug abusers to drug
effects, & thus improve their
ability to Remain Abstinent.
• Assertive Training
• Behavior Counselling
• Supportive Psychotherapy
• Individual Psychotherapy
55

AGENCIES
CONCERNED
WITH
ALCOHOL-
RELATED
PROBLEMS
• This is a self Help organization founded in the USA
by 2 Alcoholic men Dr. Bob Smith & Dr. Bill Wilson
On 10th june,1985.
• Alcoholic Anonymous considers Alcoholism as a
Physical, Mental, Spiritual disease, a Progressive
one, which can be Arrested but not Cured.
• Members attend Group meetings usually twice a
week on a long – term basis.
• Each member is assigned a support person from
whom he may seek help when the temptation to
drink occurs.
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Al-Anon
• This is a Group Started by Mrs. Annie, Wife of Dr.
Bob to support the Spouses of Alcoholics.
• Al-Teen Provides Support to their Teenage Children.
Hostels These are intended mainly for those
rendered homeless due to alcohol-related
problems.
• They Provide Rehabilitation & Counselling.
• Usually abstinence is a Condition of Residence.
57

NURSING MANAGEMENT
Nursing Assessment
• Recognition of Alcohol Abuse using CAGE
Questionnaire
• C – Have you ever felt you ought to CUT down
on your drinking ?
• A – Have People ANNOYED you by criticizing
your drinking ?
• G – have you ever felt GUILTY about your
drinking ?
• E – Have you ever had a drink first thing in the
morning (An EYE – OPENER) to steady your
nerves or get rid of a Hangover ?
58

NURSING
MANAGEMENT
• Be suspicious about ‘At Risk’
Factors:
• Problems in the Marriage &
Family , At Work , With
Finances or with the Law
• At risk occupations
• Withdrawal Symptoms after
Admission
• Alcohol – related physical
Disorders
• Repeated Accidents
• Deliberate Self Harm
• If at – risk Factors raise
Suspicion, the next step is to
ask Tactful but
Persistent Questions to
confirm the Diagnosis.
• Certain clinical Signs lead to
the suspicion that drugs are
being injected: Needle Tracks
& Thrombosed Veins, wearing
Garments with long Sleeves,
etc., IV use should be
suspected in any patient who
presents with Subcutaneous
Abscesses or Hepatitis.
59

NURSING
MANAGEMENT
• Behavioral Changes: Absence from School or
work, Negligence of Appearance, Minor
Criminal Offences, Isolation from Former
Friends& Adoption of new Friends in a Drug
Culture.
• Laboratory Tests: Raised Gamma – Glutamyl
Transpeptidase (GGT), Raised Mean Corpuscular
Volume (MCV), Blood Alcohol Concentration,
Most drugs can be detected in urine except
Lysergic Acid Diethylamide (LSD).
• Gastrointestinal: Nausea/Vomiting , Changes in
Weight/Appetite, Signs of Malnutrition, Color &
Consistency of Stool.
60

NURSING MANAGEMENT
• Identify the type of Substance the person has
been using , the amount, frequency, method of
administration & the length of time the
substance has been abused.
• Note of any Suicidal ideation or interest, with
drained Symptoms.
• Assess for level of motivation for treatment.
• Identify reason for Admission.
• A Baseline Physical & Emotional Nursing
assessment is done to determine Admission
status & Provide baseline from which to
determine progress towards an expected
Outcome.
61

NURSING DIAGNOSIS
• Risk for injury related to Hallucinosis, acute Intoxication evidenced by
Confusion, Disorientation, inability to identify potentially Harmful
Situations.
• Altered Health Maintenance related to inability to identify, manage or
seek out help to maintain health, evidenced by various physical
symptoms, Exhaustion, Sleep Disturbances, etc.,
• Ineffective Denial Related to weak, under-developed ego, evidenced
by Lack of Insight, Rationalization of problems, Blaming Others, Failure
to Accept responsibility for his Behavior.
• Ineffective individual coping related to impairment of adaptive
behavior & Problem – Solving abilities, evidenced by use of substances
as Coping Mechanisms.
62

OTHER SUBSTANCE USE
DISORDERS DRUG ADDICTION IN
INDIA
• 40 lakhs Registered Drug addicts in South Asia,
Among this 1.25 lakhs are in India.
• DISTRIBUTION: Alcohol – 42 % Opioids – 20% Heroin –
13% Cannabis – 6.2% Others – 1.8%
• Majority of Drug Addicts Aged Between 16 – 30 Years
• These drug Abusers are mostly Unmarried, Under low
Socio – Economic status
• Among this Drug users 33% were Engaged in Anti –
Social Activities.
63

CANNABIS USE
DISORDER
• Its derived from hemp plant cannabis
sativa.
• The dried leaves and flowering tops are
often referred to as GANJA or MARIJUANA.
• The resin of the plant is referred to as
HASHISH.
• Bhang is a drink made from cannabis.
• Cannabis is either smoked or taken in
liquid form.
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COMPLICATIONS
• Memory Impairment
• Amotivational Syndrome
• Transient Or Short Lasting
Psychiatric Disorders Such as
Acute Anxiety, Paranoid
Psychosis, Hysterical Fugue Like
States, Hypomania,
Schizophrenia.
• TREATMENT Supportive And
Symptomatic Treatment
67

NICOTINE ABUSE
DISORDER
• It is Obtained from “NICOTIANA TABACUM”.
• It is one of the most Highly Addictive &
Heavily Used Drug.
68

TOBACCO
PRODUCTS
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NICOTINE DEPENDENCE
SYMPTOMS
• Impaired Attention,
Learning, Reaction Time,
Problem Solving Abilities.
• Lifts One’s Mood
• Decreases Tension
• Depressive Feeling
• Decreased Cerebral Blood
Blow
• Relaxes the Skeletal Muscles.
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NICOTINE
TOXICITY
• Inability to Concentrate
• Confusion
• Sensory Disturbances
• Decreases the Rapid Eye
Movement while Sleep
During Pregnancy,
• Increased Incidence of Low
Birth Weight Babies
• Increased Incidence of
Newborns with Persistent
Pulmonary Hypertension.
73

TREATMENT
PSYCHOPHARMACOLOGICAL THERAPY
• Nicotine Replacement therapy:
• Nicotine Polacrilex Gum (Nicorette)
• Nicotine Lozenges (Commit)
• Nicotine Patches (Nicotrol, Nicoderm)
• Nicotine Nasal Spray (Nicotrol)
• Nicotine Inhaler Non – Nicotine Medications: Bupiropian
(Zyban) – Started with 150mg , Bd For 3 Days ; After that
Increase the dose to 300mg, Bd.
74

THERAPIES
• Smoking Cessation
• Behavior Therapy
• Aversive Therapy
• Hypnosis
75

OPIOID USE DISORDERS
• The most Important Dependence Producing Derivatives are
Morphine & Heroin.
• The commonly Abused Opioids (Narcotics) in our Country
are Heroin (Brown Sugar, Smack)
• And the Synthetic Preparations Like Pethidine, Fortwin &
Tidigesic.
• More Opiate Users had begun with Chasing Heroin (Inhaling
the Smoke / Chasing the Dragon), they Gradually Shifted to
Needle use.
• Injecting Drug users have become a high Risk Group for HIV
Infection.
76

ACUTE
INTOXICATION
It is characterized by,
• Apathy,
• Bradycardia,
• Hypotension,
• Respiratory Depression,
• Subnormal Temperature,
• Pinpoint Pupils.
• In Later Stage,
• Delayed reflexes,
• Thready Pulse,
• Coma.
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TREATMENT
• Opioid Overdose: Treated with Narcotic Antagonists
[Egs: Naloxone, Naltrexone]
• Detoxification: Withdrawal symptoms can be managed
By Methadone, Clonidine, Naltrexone, Buprenorphine,
etc.
• Maintenance Therapy: After the Detoxification Phase,
the patient is maintained on one of the following
Regimens: - Methadone Maintenance - Opioids
Antagonists - Psychological methods
like Individual Psychotherapy, Behavior Therapy, Group
Therapy, Family Therapy.
82

COCAINE USE
DISORDER
• Cocaine is an Alkaloid derived
from the Shrub “ERYTHOXYLON
COCA”
• Common street name is
“CRACK”
• In 1880 it is used as a Local
Anesthesia.
• It can be administered orally,
intra-nasally by smoking or
parenterally.

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TREATMENT MANAGEMENT
OF INTOXICATION
• Amyl Nitrite is an antidote.
• Diazepam / Propanolol (withdrawal syn
drome)
• Anti - Depressants (Imipramine or
Amitriptyline).
• Psychotherapy.
88

AMPHETAMINE USED DISORDER
• Powerful CNS stimulants with peripheral sympathomimetic effect.
• Commonly used are Pemoline and Methyl Phenidate.
89

ACUTE INTOXICATION
• Characterized by,
• Tachycardia
• Hypertension
• Cardiac failure
• Seizure
• Hyperpyrexia
• Pupillary dilation
• Panic
• Insomnia
• Restlessness
• Irritability
• Paranoid hallucinatory syndrome
• Amphetamine induced psychosis
90

WITHDRAWAL SYNDROME
Characterized by
• Depression
• Apathy
• Fatigue
• Hypersomnia / Insomnia
• Agitation
• Hyperphagia

COMPLICATIONS
• Seizure
• Delirium
• Arrhythmias
• Aggressive behavior
• Coma

LSD USE DISORDER (
LYSERGIC
ACID DIETHYLAMIDE )
• A powerful Hallucinogen
• First synthesized in 1938.
• Produces its effect by acting on 5-
Hydroxy Tryptamine (serotonin) levels
in brain.
• A common pattern of LSD used
in TRIP (followed by long period of
abstinence)

94

INTOXICATION
• Characterized by Perceptual changes
occurring in clear consciousness
• Depersonalization
• Derealization
• Illusions
• Synesthesias ( colours are heard,
sounds are felt)
• Automatic hyperactivity
• Marked anxiety
• Judgment impaired.
• Paranoid ideation
95

WITHDRAWAL SYMPTOMS
• Flashbacks (a brief experiences of the hallucinogenic state )
COMPLICATIONS
• Anxiety
• Depression
• Psychosis / visual Hallucinosis
TREATMENT Symptomatic Treatment with
• Anti-Anxiety,
• Anti-Depressants or
• Anti-Psychotic medications.

BARBITURATE
USE
DISORDER
• The Commonly Abused Barbiturates are seco -
barbital, pento - barbital, amo - barbital.
INTOXICATION
• Acute intoxication characterized
• Lability of mood
• Disinhibited behavior
• Slurring of speech
• Inco-ordination
• Attention and memory impairment

COMPLICATIONS
• Intravenous use can lead to skin abscess
• Cellulitis
• Infection
• Embolism
• Hypersensitivity reaction

WITHDRAWAL SYNDROME
• Restlessness
• Tremors
• Seizure in severe cases resembling delirium tremens
TREATMENT
• If the patient is conscious, induction of vomiting and use of Activated
Charcoal can reduce the absorption.
• Treatment is symptomatic.
99

INHALANTS /
VOLATILE USE
DISORDER
• The Commonly
used Volatile Solvents include
• Petrol
• Aerosols
• Thinners
• Varnish remover
• Industrial solvents

INTOXICATION
• Inhalation of a volatile
solvent leads to Euphoria
• Excitement
• Belligerence
• Slurring of speech
• Apathy
• Impaired Judgment
• Neurological signs

WITHDRAWAL SYMPTOMS
• Anxiety
• Depression
COMPLICATIONS
• Irreversible damage
to the liver and kidneys
• Peripheral neuropathy
• Perceptual disturbances
• Brain damage
TREATMENT
• Reassurance
• Diazepam for intoxication.

NURSING
INTERVENTIONS
• Acute Intoxication
• Care for a Substance Abuse patient starts
with an Assessment - To determine which
substance he is abusing, Assess the Signs and
symptoms vary with the substance and dosage.
• During the Acute phase of drug Intoxication and
Detoxification - Maintaining the patient’s vital
functions, ensuring his safety,
and easing discomfort.
• During Rehabilitation, caregiver help the patien
t acknowledge his substance abuse problem
and find alternative ways to cope
with stress & help the patient to achieve
recovery and stay drug-free.

Acute Episodes
• Continuously monitor the Patient's Vital Signs and Urine Output.
• Watch for Complications of Overdose & Withdrawal.
• Maintain a safe and quiet environment.
• Take appropriate measures to prevent suicide attempts and assaults.
• Remove harmful objects from the room, and use restrains only if you
suspect the patient might harm himself or others.
• Approach the patient in a non - threatening way; limit sustained eye
contact, which he may perceive as threatening.
• Institute seizure precautions.
• Administer IV fluids to Increase Circulatory Volume.
• Give medications as Ordered.
• Monitor & Record the Patients effectiveness.

Withdrawal State
• Administer Medications as ordered, to
Decrease Withdrawal Symptoms,
Monitor & Record their Effectiveness.
• Maintain a Quiet & Safe Environment,
because Excessive Noise may Agitate
the Patient.

WHEN THE ACUTE EPISODE HAS RESOLVED
• Carefully Monitor & Promote Adequate Nutrition.
• Administer drugs carefully to prevent Hoarding.
• Check the patient’s mouth to ensure that he has swallowed
Oral Medication.
• Closely Monitor Visitors who might Supply him with Drugs.
• Refer the Patient for Rehabilitation as appropriate; Give him
a list of available Resources.
• Encourage Family Members to seek Help Regardless of
whether the Abuser Seeks it.
• Suggest Private Therapy or Community Mental Health
Clinics.

WHEN THE ACUTE
EPISODE HAS
RESOLVED
• Use the Particular Episode to Develop
Personal Self Awareness and an
Understanding and Positive Attitude
towards the Patient.
• Control Reactions to the
Undesirable behaviors, Commonly
During Psychological Dependence,
Manipulation, Anger, Frustration, and
Alienation.
• Set limits when Dealing with Demanding
Manipulative Behavior.

PREVENTION
PRIMARY PREVENTION
• Reduction of Prescribing by Doctors
( Anxiolytics Especially Benzodiazepines)
• Identification & Treatment of Family
Members who may be Contributing to the Drug
Abuse.
• Introduction of social changes by - Putting Up the
Price of Alcohol & Its Beverages. - Controlling /
Abolishing the Advertising of Alcoholic drinks. -
Controls On sales by Limiting Hours Or
Banning sales in Super-Markets. -
Restricting Availability & Lessening Social
Deprivation ( Governmental Measures).

PRIMARY
PREVENTION
• Strengthen the Individual’s Personal &
Social Skills to Increase Self Esteem
& Resistance to Peer Pressure.
• Health Education to College Students &
the Youth about the Dangers of
Drug Abuse.
• Over all Improvement in the Socio –
Economic Condition of the Population.

SECONDARY
PREVENTION
• Early Detection & Counseling.
• Brief Intervention in Primary Care
(Simple Advices from Practitioner &
Educational Leaflet).
• Motivational Interviewing.
• A Full Assessment which Includes,
Appraisal of Current Medical,
Psychological & Social Problems.
• Detoxification with Benzodiazepines.

TERITARY
PREVENTION
• Alcohol Deterrent Therapy
• Other Therapies include Assertive Training, Teaching
Coping Skills, Behavior Counseling, Supportive &
Individual Psychotherapy.
• Agencies concerned with Alcohol – Related Problems
(Alcoholic Anonymous, Al – Anon, Al – Teen, etc).
• Motivation Enhancement including Education about
Health consequences of Alcohol use.
• Identifying High Risk Situations & Developing
Strategies to Deal with them (Eg: Craving
Management).
• Drink Refusal Skills ( Assertiveness Training ) Dealing
with Faulty Cognitions.

TERITARY
PREVENTION
• Handling Negative mood States.
• Time Management.
• Anger Control.
• Financial Management.
• Developing the Work Habit.
• Stress management.
• Sleep hygiene.
• Recreation & Spirituality.
• Family Counseling – To Reduce Interpersonal
Conflicts, Which may Otherwise
Trigger RELAPSE.

REHABILITATION
• The Aim of Rehabilitation of an Individual De -addicted from the Effects
of Alcohol/Drugs.
• To Enable him to Leave the Drug Sub – Culture.
• To Develop New Social Contacts, In this Patients First Engage in Work & Social
Activities in Sheltered Surroundings & then take Greater Responsibilities for
Themselves in Conditions Increasingly like those of Everyday Life.
• Continuing Social Support is Usually Required when the Person makes the
Transition to Normal Work & Living .

PSYCHOEDUCATION (FOR
PATIENTS & FAMILY)
• Teach about the Physical, Psychological & Social Complication
of Drug & Alcohol Use.
• Inform the Concern that Psychoactive Substance may alter a
person’s Mood, Perceptions, Consciousness or Behavior.
• Explain to the Family that the Patient may Use Lies, Denial or
Manipulation to continue Drug of Alcohol Use and
to avoid Treatment.
• Teach the Patient/Family that Drug Overdose or Withdrawal
can result in a Medical Emergency & even Death, Give the
Family Emergency resources for Help.
• Caution the Patient that Sharing Dirty or Used Needle can
Result in a Life-Threatening Disease such as AIDS, Hepatitis – B.

PSYCHOEDUCATION
(FOR PATIENTS & FAMILY)
• Teach the Family to Establish Trust with the
Patient and to Use Firm limit Setting,
when necessary to help the Patient Confront
Drug Abuse Issues.
• Provide the Patient with a Full Range of
Treatment during Hospitalization such as
Medication, Individual Therapy, Group

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Substance Abuse

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