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Chapter 30 – Addiction and Substance Related Disorders
Healthy People 2020 Goal: to reduce substance abuse to protect the health, safety, and quality of life for all,
especially children.
Addiction- a condition of continued use of substances (or reward-seeking behaviors) despite adverse consequences
Diagnostic Criteria
Substance-induced disorders - when medications used for other health problems or medical/mental health
disorders causes intoxication, withdrawal, or other health-related problems
Substance use disorder - when an individual continues using substances despite cognitive, behavioral, and
physiologic symptoms
Occurs when there is an underlying change in the brain circuitry that may persist after
detoxification, the process of safely and effectively withdrawing a person from a substance,
usually under medical supervision.
These brain changes lead to pathologic behaviors that with repeated relapses and intense drug
cravings when exposed to drug-related cues.
Characteristics:
taking substances in larger amounts or over a longer period than intended
persistent desire to cut down or regulate substance use
a great deal of time spent obtaining, using, or recovering from its effects,
cravings,
recurrent use results in failure of work, school, or home obligations,
continues to use despite persistent or recurrent social or interpersonal problems because of substance use,
may withdraw from family activities
recurrent use in situations that are physically hazardous
continue to use substance despite the knowledge of having physical or psychological problems that are
likely caused by the use of the substance
tolerance develops
withdrawal syndrome occurs when blood or tissue concentration of a substance declines.
Epidemiology (see page 535 for exact statistical numbers)
Most abused substance: alcohol (followed by marijuana)
Marijuana use reflects a change in attitude and perception that marijuana is a safe drug, especially in light of recent
legalization.
Ethnicity and Culture
o The use of illicit and legal substances among Asians is consistently lower than any other ethnic group.
o The highest use of alcohol is among whites and persons reporting two or more races.
o The highest tobacco use is reported among American Indians and Alaska Natives.
Comorbidity
Nurses should be aware that patients who abuse substances often have psychotic, anxiety, or mood disorders. Other
coexisting mental disorders include attention-deficit hyperactivity disorder and personality disorders.
Individuals who abuse substances are at a high risk for death from drug overdoses and are at an increased risk for
death from other causes such as: homicide, suicide, and opportunistic infections (such as HIV) secondary to
drug injection
Etiology
Temperament, self-concept, age, motivation for change, social consequences for problematic behaviors, parental and
family relationships, and peer pressure all contribute to expression of substance abuse – a chronic progressive
disorder.
Family Responses to Substance Use and Abuse
o Fetal alcohol syndrome (FAS) results from drinking alcohol during pregnancy.
o Addictions lead to loss of jobs and family relationships.
o Use of illegal substances can lead to arrest and prison.
Treatment and Recovery
Recovery- involves a partnership between health care providers and the individual and family
o Many individuals will require an intense treatment necessary to safely manage the physical and
psychological withdrawal symptoms that occur when a substance is no longer being used
o Withdrawal process usually involves detoxification
, 2
o A primary concern will be relapse, the recurrence of alcohol- or drug- dependent behavior
Types of Substances and Related Disorders
ALCOHOL
o Mood swings ranging from bouts of gaiety to angry outbursts
o Cognitive impairments can vary from reduced concentration or attention span to impaired judgment and
memory
o Produces sedative effect by depressing the CNS
o Feelings can range from mild sedation and relaxation to confusion and serious impairment of motor
functions and speech to severe intoxication that can result in coma, respiratory failure, and death.
Table 30.1 has a summary of effects of abused substances
o CAGE questionnaire should be used as a screening tool
Consists of four self-report responses to questions about respondent’s beliefs of cutting down on
their drinking, their experience of others criticizing their drinking, the presence of guilt about
drinking, and early morning drinking.
o Intoxication is determined by the level of alcohol in the blood, called a blood alcohol level (BAL).
The body can metabolize 1 oz. of liquor, a 5 oz. glass of wine, or a 12 oz. can of beer per hour
without intoxication.
1-2 drinks; BAL = 0.05% (impaired judgment, giddiness, mood changes)
5-6 drinks; BAL = 0.10% (difficulty driving and coordinating movements)
10-12 drinks; BAL = 0.30% (stupor, disorientation, confusion)
20-24 drinks; BAL = 0.40% (coma)
25 drinks; BAL = 0.50% (respiratory failure, death)
o Alcohol-induced amnestic behaviors are specific neurologic complications, that lead to organic brain
disorders. (individuals with this have a history of many years of heavy alcohol use and generally older than
40 years)
Wernicke encephalopathy is a degenerative brain disorder caused by thiamine deficiency,
characterized by vision impairment, ataxia, hypotension, confusion, and coma.
Korsakoff’s amnestic syndrome involves the heart and the vascular and nervous systems, but the
primary problem is acquiring new information and retrieving memories characterized by
confabulation (telling a plausible but imagined scenario to compensate for memory loss), attention
deficit, disorientation, and vision impairment.
In Wernicke- Korsakoff syndrome, Wernicke’s encephalopathy will be represented in the acute
phase and Korsakoff’s amnestic syndrome will be represented in the chronic phase.
o Detoxification will begin when a patient enters treatment for alcohol addiction and alcohol ingestion is
immediately stopped.
Alcohol withdrawal syndrome, which is symptoms of increased heart rate and blood pressure,
diaphoresis, mild anxiety, restless, and hand tremors will occur.
MILD: HR elevated, temp. elevated, normal or slightly elevated systole BP, slight
diaphoresis, oriented (no confusion or hallucinations), mild anxiety and restlessness,
restless sleep, hand tremors (“shakes”), no convulsions, impaired appetite, nausea
MODERATE: HR 100-120 bpm, elevated systolic BP and temp, usually obvious
diaphoresis, intermittent confusion, transient visual and auditory hallucinates and
illusions (mostly at night), painful anxiety and motor restlessness, insomnia and
nightmares, visual tremulousness, rare convulsions, anorexia, n/v
SEVERE: HR 120-140 bpm, elevated systolic and diastolic BP and temp, marked
diaphoresis, marked disorientation, confusion, disturbing visual and auditory
hallucinations, misidentification of objects, delusions related to the hallucinations,
delirium tremens, disturbances in consciousness, agitation, extreme restlessness, and
panic states, gross, uncontrollable tremors, convulsions common, rejecting all fluid and
food
In patients with alcoholism and in chronic drinkers, the alcohol withdrawal syndrome
usually begins within 12 hours after abrupt discontinuation or attempt to decrease
consumption
Chapter 30 – Addiction and Substance Related Disorders
Healthy People 2020 Goal: to reduce substance abuse to protect the health, safety, and quality of life for all,
especially children.
Addiction- a condition of continued use of substances (or reward-seeking behaviors) despite adverse consequences
Diagnostic Criteria
Substance-induced disorders - when medications used for other health problems or medical/mental health
disorders causes intoxication, withdrawal, or other health-related problems
Substance use disorder - when an individual continues using substances despite cognitive, behavioral, and
physiologic symptoms
Occurs when there is an underlying change in the brain circuitry that may persist after
detoxification, the process of safely and effectively withdrawing a person from a substance,
usually under medical supervision.
These brain changes lead to pathologic behaviors that with repeated relapses and intense drug
cravings when exposed to drug-related cues.
Characteristics:
taking substances in larger amounts or over a longer period than intended
persistent desire to cut down or regulate substance use
a great deal of time spent obtaining, using, or recovering from its effects,
cravings,
recurrent use results in failure of work, school, or home obligations,
continues to use despite persistent or recurrent social or interpersonal problems because of substance use,
may withdraw from family activities
recurrent use in situations that are physically hazardous
continue to use substance despite the knowledge of having physical or psychological problems that are
likely caused by the use of the substance
tolerance develops
withdrawal syndrome occurs when blood or tissue concentration of a substance declines.
Epidemiology (see page 535 for exact statistical numbers)
Most abused substance: alcohol (followed by marijuana)
Marijuana use reflects a change in attitude and perception that marijuana is a safe drug, especially in light of recent
legalization.
Ethnicity and Culture
o The use of illicit and legal substances among Asians is consistently lower than any other ethnic group.
o The highest use of alcohol is among whites and persons reporting two or more races.
o The highest tobacco use is reported among American Indians and Alaska Natives.
Comorbidity
Nurses should be aware that patients who abuse substances often have psychotic, anxiety, or mood disorders. Other
coexisting mental disorders include attention-deficit hyperactivity disorder and personality disorders.
Individuals who abuse substances are at a high risk for death from drug overdoses and are at an increased risk for
death from other causes such as: homicide, suicide, and opportunistic infections (such as HIV) secondary to
drug injection
Etiology
Temperament, self-concept, age, motivation for change, social consequences for problematic behaviors, parental and
family relationships, and peer pressure all contribute to expression of substance abuse – a chronic progressive
disorder.
Family Responses to Substance Use and Abuse
o Fetal alcohol syndrome (FAS) results from drinking alcohol during pregnancy.
o Addictions lead to loss of jobs and family relationships.
o Use of illegal substances can lead to arrest and prison.
Treatment and Recovery
Recovery- involves a partnership between health care providers and the individual and family
o Many individuals will require an intense treatment necessary to safely manage the physical and
psychological withdrawal symptoms that occur when a substance is no longer being used
o Withdrawal process usually involves detoxification
, 2
o A primary concern will be relapse, the recurrence of alcohol- or drug- dependent behavior
Types of Substances and Related Disorders
ALCOHOL
o Mood swings ranging from bouts of gaiety to angry outbursts
o Cognitive impairments can vary from reduced concentration or attention span to impaired judgment and
memory
o Produces sedative effect by depressing the CNS
o Feelings can range from mild sedation and relaxation to confusion and serious impairment of motor
functions and speech to severe intoxication that can result in coma, respiratory failure, and death.
Table 30.1 has a summary of effects of abused substances
o CAGE questionnaire should be used as a screening tool
Consists of four self-report responses to questions about respondent’s beliefs of cutting down on
their drinking, their experience of others criticizing their drinking, the presence of guilt about
drinking, and early morning drinking.
o Intoxication is determined by the level of alcohol in the blood, called a blood alcohol level (BAL).
The body can metabolize 1 oz. of liquor, a 5 oz. glass of wine, or a 12 oz. can of beer per hour
without intoxication.
1-2 drinks; BAL = 0.05% (impaired judgment, giddiness, mood changes)
5-6 drinks; BAL = 0.10% (difficulty driving and coordinating movements)
10-12 drinks; BAL = 0.30% (stupor, disorientation, confusion)
20-24 drinks; BAL = 0.40% (coma)
25 drinks; BAL = 0.50% (respiratory failure, death)
o Alcohol-induced amnestic behaviors are specific neurologic complications, that lead to organic brain
disorders. (individuals with this have a history of many years of heavy alcohol use and generally older than
40 years)
Wernicke encephalopathy is a degenerative brain disorder caused by thiamine deficiency,
characterized by vision impairment, ataxia, hypotension, confusion, and coma.
Korsakoff’s amnestic syndrome involves the heart and the vascular and nervous systems, but the
primary problem is acquiring new information and retrieving memories characterized by
confabulation (telling a plausible but imagined scenario to compensate for memory loss), attention
deficit, disorientation, and vision impairment.
In Wernicke- Korsakoff syndrome, Wernicke’s encephalopathy will be represented in the acute
phase and Korsakoff’s amnestic syndrome will be represented in the chronic phase.
o Detoxification will begin when a patient enters treatment for alcohol addiction and alcohol ingestion is
immediately stopped.
Alcohol withdrawal syndrome, which is symptoms of increased heart rate and blood pressure,
diaphoresis, mild anxiety, restless, and hand tremors will occur.
MILD: HR elevated, temp. elevated, normal or slightly elevated systole BP, slight
diaphoresis, oriented (no confusion or hallucinations), mild anxiety and restlessness,
restless sleep, hand tremors (“shakes”), no convulsions, impaired appetite, nausea
MODERATE: HR 100-120 bpm, elevated systolic BP and temp, usually obvious
diaphoresis, intermittent confusion, transient visual and auditory hallucinates and
illusions (mostly at night), painful anxiety and motor restlessness, insomnia and
nightmares, visual tremulousness, rare convulsions, anorexia, n/v
SEVERE: HR 120-140 bpm, elevated systolic and diastolic BP and temp, marked
diaphoresis, marked disorientation, confusion, disturbing visual and auditory
hallucinations, misidentification of objects, delusions related to the hallucinations,
delirium tremens, disturbances in consciousness, agitation, extreme restlessness, and
panic states, gross, uncontrollable tremors, convulsions common, rejecting all fluid and
food
In patients with alcoholism and in chronic drinkers, the alcohol withdrawal syndrome
usually begins within 12 hours after abrupt discontinuation or attempt to decrease
consumption
