SUBSTANCE ABUSE
MENTAL HEALTH NURSING
RND 30803
MDM KOGI
INTRODUCTION
• Substance abuse is denoted by
a pattern of pathological use, for
at least one month, associated
with impairment in social and
occupational functioning
• The use of a substance that fall
outside of medical necessity or
social acceptance resulting in
adverse effects to the abuser or
other
LEARNING OUTCOME
At the end of the session, students should be able to
• define substance abuse, dependence, tolerance
and withdrawal
• identify the signs and symptoms of withdrawal from
various proactive substance
• describe the signs and symptoms of withdrawal
from various proactive substance
• discuss the management of acute withdrawal
• discuss management of drug
SUBSTANCE ABUSE
Dependence or addiction
• Occurs when a tolerance to the drug occurs and the
person has to take more and more of the drug to ‘stay
normal’ or prevent withdrawal.
• At this point, people no longer have control over their
substance use, when even it is interfering with
functioning and well being
SUBSTANCE ABUSE
Drug Dependency
• Intoxication throughout the day
• Inability to cut down or stop
• Repeated efforts to control use through periods of
temporary abstinence / restriction of use to certain times
of the day
• Continuation of use despite serious physical disorder
caused by substance abuse
• Episodes of a complication of substance intoxication
Predisposing
factor
DIFFERENT TYPES OF SUBSTANCE
CATEGORIES
• DSM-IV-TR pathological use of substances divided into two
categories:
• Substance abuse
• Substance dependence
• DSM-5 has one category:
• Substance use disorder
• Categorize by specific substance:
• Alcohol
• Amphetamine
• Cannabis
• Cocaine
• Gambling (new to DSM-5)
• Hallucinogen
• Inhalant
• Opioid
• Phencyclidine
• Sedative/hypnotic/anxiolytic
• Tobacco
CRITERIA
Problematic pattern of use that impairs functioning.
Two or more symptoms within a 1 year period:
• Failure to meet obligations
• Repeated use in situations where it is physically dangerous
• Repeated relationship problems
• Continued use despite problems caused by the substance
• Tolerance
• Withdrawal
• Substance taken for a longer time or in greater amounts than intended
• Efforts to reduce or control use do not work
• Much time spent trying to obtain the substance
• Social, hobbies, or work activities given up or reduced
• Continued use despite knowing problems caused by substance
• Craving to use the substance is strong
SUBSTANCE ABUSE
Contributing factors
• research shows that social pressure to belong, to be
accepted, and to be part of a social group, especially in
teenagers, prompts them to confirm to their peer group,
and start trying out drugs start.
SUBSTANCE ABUSE
Contributing factors
• Impact of group identity
• Teens in pop, techno,
skate/hip-hop, and
hippie groups are more
likely to use substance,
compared to those in the
quite, sporty, religious,
computer groups
SUBSTANCE ABUSE
Contributing factors
• Other reason
✓ trying drugs out of curiosity
✓ using drugs as means of rebellion
✓ as an expression of dissatisfaction with traditional
norms and values
COMMONLY ABUSED SUBSTANCE
The major substance of abuse are:
• Marijuana (ganja)
• Opiates (heroine, morphine, candu)
• Hallucinogens (LSD, cocaine)
• Amphetamine (pep pills, ecstacy)
• Inhalants or Volatile (glue and gum sniffing)
• ICE
COMMONLY ABUSED SUBSTANCE
Marijuana
• Drug derived from dried and ground leaves and stems of
the female hemp plant (cannabis sativa)
• Hashish
• Stronger than marijuana
• Produced by drying the resin exudate of the tops of
plants
• In DSM-5, called cannabis use disorder
COMMONLY ABUSED SUBSTANCE
• The opiods include both natural opiates that is drugs the
opium poppy (morphine, heroine) and opiate-related
synthetic drugs, such as meperidine and methadone
• The medical use of these drugs is mainly for their powerful
analgesic actions (pain killer)
• They are abused for their euphoric effects
COMMONLY ABUSED SUBSTANCE
• Group of addictive sedatives that in moderate doses relieve
pain and induce sleep
• Opium
• Morphine
• Heroin
• Codeine
• Synthetic sedatives
• Separate category from DSM-5 sedative/hypnotic/anxiolytic use
disorder
• Opiates legally prescribed as pain medications include:
• Hydrocodone combined with other substances yields vicodin,
zydone, and lortab
• Oxycodone the basis for oxycontin, percodan, and tylox
COMMONLY ABUSED SUBSTANCE
• Heroine can be injected,
smoked or inhaled
• It has the ability to alter
mood and reduce anxiety
• Young people who sniff
heroine report that they
forget everything that
troubles them
COMMONLY ABUSED SUBSTANCE
• These drugs also
produce respiratory
depression,
constipation, reduced
appetite and low libido
• The effects of as usual
dose of morphine lasts
three to four hours
COMMONLY ABUSED SUBSTANCE
• Psychological
dependence exist when a
drug is so central to
person’s thoughts,
emotions, and activities
that he needs to continue
its use because he has a
craving or compulsion
COMMONLY ABUSED SUBSTANCE
• Physical dependence is characterized by tolerance that
is with continued use, the individual must take more
and more of the drug to achieve the same effect
• Tolerance develops rapidly leading to increasing
dosage
WITHDRAWAL SYMPTOMS
• Withdrawal symptoms will occur if use of the drug is
reduced or stopped abruptly
• Withdrawal from opiates, may occur as early as few
hours after the last dose
• Major withdrawal symptoms peak between 48 to 72
hours after the last dose and usually subside within a
week
WITHDRAWAL SYMPTOMS
• Intensive craving for the drug
• Restlessness and insomnia
• Pain in the muscle and joints
• Running nose and eyes
• Sweating
• Abdominal cramps
• Somnolence
WITHDRAWAL SYMPTOMS
• Vomiting and
diarrhea
• Dilated pupils
• Raised pulse rate
and goose
pimples – feeling
cold
SUBSTANCE ABUSE
Medical management of alcohol withdrawal
• Managed by using a benzodiazepine such as diazepam,
lorazepam or chlodiazepoxide
• Thiamine and folate are given to improve nutritional
deficiency
• Anticonvulsants prescribed for patient who are at risk for
seizures
• Antihypertensive drugs prescribed for patients with
sustained hypertension
AVERSION THERAPY
• The treatment involves
the use of the drug called
disulfiram (antabuse) to
induce nausea when
alcohol is consumed
• The reasoning here is
that by inducing
substance will lose its
original appeal
SUBSTANCE ABUSE
Alcohol Anonymous (AA)
• A popular non medical form of treatment where
there is total abstinence, a belief in God and
reliance on prayer
• Social support is in the form of group meetings and
the facility to call someone when in need
SUBSTANCE ABUSE
12 Steps in AA
SUBSTANCE ABUSE
Treatment
• Couples therapy
• Found to be more effective than individual treatment approaches
• Cognitive and behavioral treatments
• Contingency-management therapy
• Patient and family reinforce behaviors inconsistent with drinking
• E.G., Avoiding places associated with drinking
• Teach problem drinker how to deal with uncomfortable situations
• E.G., Refusing the offer of a drink
• Relapse prevention
• Strategies to prevent relapse
• Motivational interventions
• Designed to curb heavy drinking in college
SUBSTANCE ABUSE AND LAW
In Malaysia any person confirmed as a substance
abuser including those who volunteer will be sent for
treatment and rehabilitation under the law for two (2)
years to a drug rehabilitation center
PUSPEN (CCRC)
• The drug rehabilitation institute known from the
beginning as Pusat Serenti was changed to Pusat
Pemulihan Penagih Narkotik (PUSPEN) in 2009 and to
Cure & Care Rehabilitation Centre (CCRC) with effect
from 1st June 2012
• Admission of clients is through Perintah Mahkamah
Seksyen 6(1) (a) Akta Penagih Dadah (Rawatan dan
Pemulihan) 1983
TRANSFORMATION OF PROGRAMME
• Programme which was regimented, though & rugged
was changed to more humanistic with the concept of
fun, effective and easy to implement
TRANSFORMATION OF PROGRAMME
• The treatment time frame has been reduced (6-11
months) according to the patients reputation
• Patient that does not pass the evaluation criteria for
the curtailment of the period, their release is under
section 12 (1) of addicts (treatment and rehabilitation)
• Recovery program meet the needs of the patient,
based on the assessment levels of severity of
dependence of the patient on addiction
TRANSFORMATION OF PROGRAMME
• Effective and easy to implement
PREVENTIVE MEASURES
• The government had set up, under the National Social
Council a committee to look into the need to assist
any voluntary agency or movement to assist in the
drug problem
• The police as the main enforcement agency, continue
to focus on the fight against drug supply and demand
in the country
PREVENTIVE MEASURES
• The government had set up, under the National Social
Council a committee to look into the need to assist
any voluntary agency or movement to assist in the
drug problem
• The police as the main enforcement agency, continue
to focus on the fight against drug supply and demand
in the country
PREVENTIVE MEASURES
• Then police had stepped up enforcement through the
setting up of the Special Tactical Intelligence Narcotics
Group (Sting) to combat drug kingpins and large scale
drug trafficking syndicates
PREVENTIVE MEASURES
• The administration
expenses amounted
to RM 295 million in
2014 under the
National Anti-Drug
Agency
