Many substances can be used and abused;

SUBSTANCE RELATED some can be obtained legally, while others are

illegal. This discussion includes alcohol and
DISORDER prescription medications as substances that can
be abused. Abuse of more than one substance
GERONILLA, JENNY BAEL is termed polysubstance abuse.
PINERO, HANNAH LEAH Drugs and alcohol can lead to legal problems.
BSN3-FITZPATRICK Categories of drugs include:
1. Alcohol
2. Sedatives, hypnotics, and anxiolytics
3. Stimulants
OBJECTIVES:
4. Cannabis
5. Opioids
After reading this chapter, the students should
6. Hallucinogens
be able to:
7. Inhalants
1. Explain the trends in substance abuse and
Intoxication is use of a substance that results in
discuss the need for related prevention
maladaptive behavior.
programs.
Withdrawal syndrome refers to the negative
2. Discuss the characteristics, risk factors, and
psychological and physical reactions that occur
family dynamics prevalent with substance use
when use of a substance ceases or dramatically
disorders.
decreases.
3. Describe the principles of a 12-step
Detoxification is the process of safely
treatment approach for substance use
withdrawing from a substance.
disorders.
Blackout, which is an episode during which the
4. Apply the nursing process to the care of
person continues to function but has no
clients with substance use issues.
conscious awareness of his or her behavior at
5. Provide education to clients, families, and
the time or any later memory of the Behavior.
community members to increase knowledge
As the person continues to drink, he or she
and understanding of substance use.
often develops a tolerance for alcohol; that is,
6. Discuss the nurse’s role in dealing with the
he or she needs more alcohol to produce the
chemically impaired professional.
same effect. After continued heavy drinking,
7. Evaluate your feelings, attitudes, and
the person experiences a tolerance break,
responses to clients and families with substance
which means that very small amounts of alcohol
use disorders.
intoxicate the person. The later course of
alcoholism, when the person’s functioning is
INTRODUCTION
definitely affected, is often characterized by
periods of abstinence or temporarily controlled
Substance-related disorders refers to the use
drinking some people with alcohol-related
and abuse of alcohol, illicit drugs, or substances
problems can modify or quit drinking on their
such as over-the-counter (OTC) or prescription
own without a treatment program; this is called
drugs. When substance use creates difficulties
spontaneous remission or natural recovery.
for the user or ceases to be entirely volitional, it
becomes the concern of all the helping
RELATED DISORDERS
professions, including nursing
Gambling disorder is a non–substance-related
diagnosis. It is characterized by problem
Substance use disorders and related disorders
gambling, spending money one cannot afford to
are a national health problem.
lose, lying about gambling, getting money from
others, and an inability to refrain from gambling
The Department of Health and Human Services
for any specific time. Attempts to quit or cut
initiated a fivepoint program to address this
down result in restless, anxious, and irritable
crisis in 2019. It includes:
behavior.
• Access: Better prevention, treatment, and
recovery services
A. CENTRAL NERVOUS SYSTEM DEPRESSANT
• Data: Better data on the epidemic
• Pain: Better pain management
B. Alcohol (eg, beer, wine, whiskey) is
• Overdoses: Better targeting of overdose-
considered a central nervous system (CNS)
reversing drugs
depressant that causes false self-confidence,
• Research: Better research on pain and
false sense of belonging, and lowering of
addiction
inhibition
Alcohol is known to shorten an individual’s life
span by 12 to 15 years unless treatment is
TYPES OF SUBSTANCE ABUSE
received. Like other chronic illnesses,
alcoholism has certain observable symptoms.
 hand tremors, nausea and vomiting, insomnia,
Patterns of alcohol use disorders include: transient hallucinations or illusions,
Alcohol dependence psychomotor agitation, and anxiety (APA, 2000;
Alcohol abuse. Sadock & Sadock, 2008).

Alcohol dependence is characterized by D. Opioid-Related Disorders

tolerance to alcohol or by the development of
withdrawal phenomena upon cessation of or An opioid is a drug or naturally occurring
reduction in intake (Shahrokh & Hales, 2003). substance that resembles opium or one or more
Alcohol dependence and alcohol abuse share of its alkaloid derivatives.
features with other substance-dependence and Opiates are powerful drugs derived from the
sub-stance abuse disorders such as those poppy plant that have been used for centuries
associated with sedatives, hypnotics, and to relieve pain. The opioid classification includes
anxiolytics. natural opioids such as morphine,
semisynthetics such as heroin, and synthetics
Two CNS disorders are associated with with morphine-like action such as codeine or
alcoholism: methadone.
Korsa-koff’s psychosis, is a form of amnesia
characterized by a loss of short-term memory Opioids, also referred to as “white stuff,” “hard
and the inability to learn new skills. stuff,” and “junk,” are considered to be the
Wernicke’s encephalopathy, an inflammatory most addictive drugs. Acute overdose or
hemorrhagic, degenerative condition of the intoxication is identified by symptoms of:
brain caused by thiamine deficiency. drowsi-ness
slurred speech
Ten classes of substances, other than alcohol, decreased, slow respirations
are associated with both abuse and constricted pupils and a rapid, weak pulse.
dependence: amphetamines caffeine, cannabis, The client also may exhibit mood swings,
cocaine, hallucinogens, inhalants, nicotine, psychomotor agitation or retardation, impaired
opioids, and the group of sedatives, hypnotics, judgment, or impaired social or occupational
and anxiolytics. functioning (APA, 2000; Sadock & Sadock,
2008).
C. Sedative-, Hypnotic-, or Anxiolytic-Related
Disorders Opioid withdrawal symptoms begin 12 to 16
hours after the last dose and are characterized
Substances included in the category of by watery eyes, rhinitis, yawning, sneezing, and
sedatives, hypnotics, and anxiolytics include diaphoresis
benzodiazepines, carbamates, barbi-turates,
barbiturate-like hypnotics, all prescription
sleeping medications, and all anxiolytic B. CENTRAL NERVOUS SYSTEM STIMULANTS
medications except the non-benzodiazepine 1. CAFFEINE
antianxiety agents (eg, buspirone)
Taken orally or intravenously, these drugs are Caffeine is a central nervous system stimulant
used to relax the CNS or slow down body of the methylxanthine class. It is mainly used
processes. They temporarily ease tension and recreationally as a cognitive enhancer,
induce sleep. Medically, they may be used in increasing alertness and attentional
the treatment of hypertension, peptic ulcers, or performance. (
seizures; as a relaxant before and during
surgery; and as a sedative for use in mental and Caffeine is available in a variety of sources such
physical illness. as coffee, soda, tea, OTC analgesics and cold
remedies, stimulants, and weight loss aids.
Street names for these drugs include:
“libs,” 80%-90% adult’s reports regular caffeine use.
“blues,” 200-280 mg, which translates into the
“rainbows” equivalent of one to two caffeine pills.
“yellow-jackets”
“downers” CAFFEINE INTOXICATION:

- Restlessness
Barbiturates are the leading cause of accidental
- Nervousness
poisoning, as well as a primary method of
- Excitement
committing suicide. Barbiturate dependency is
one of the most difficult disorders to cure. - Insomnia
Clinical symptoms of sedative, hypnotic, or - Flushed face
anxiolytic withdrawal may include diaphoresis, - Diuresis
increased pulse rate (>100 beats per minute), - Gastrointestinal disturbance
 - Muscle twitching hallucinogens are dangerous because
- Rambling thoughts or speech intoxication can lead to panic, paranoia,
- Tachycardia flashbacks, or death
- Hypertension
D.CANNABIS
- Period of inexhaustibility
- Psychomotor agitation Marijuana is a common plant with the biologic
name of Cannabis sativa. With the ability to act
2. NICOTINE
as a stimulant or depressant, it is often
Nicotine is the active ingredient in tobacco, is considered to be a mild hallucinogen with some
available in the form of cigarettes, chewing sedative properties
tobacco, dipping tobacco. It is a stimulant that
When used illegally, marijuana is often
elevates one’s blood pressure and increases
combined with other addictive substances such
one’s heartbeat. TAR found in the smoke,
as alcohol or nicotine. Most users in the 18- to
contains many carcinogens.
25-year-old age range are male. Many people
- LONG TERM EFFECTS- who try marijuana go onto use it extensively,
 Emphysema and many of these people use it in combination
 Chronic with other substances such as opioids and
bronchitis hallucinogens
 CHD
Slang names for marijuana include:
Approximately 28% of adult women and 30% of
“pot”
adult men smokes cigar for stimulation, to relax
or feel better, or due to habit. “herb”
TOBACCO WITHDRAWAL “grass”
 Craving for tobacco smoke “weed”
 Irritability
“smoke”
 Difficulty in concentrating
 Restlessness “Mary Jane”
 Anxiety
 Headache Marijuana acts quickly, in approximately 15
 Drowsiness minutes, after it enters the bloodstream, and its
 GI disturbances. effects last approximately 2 to 4 hours. It affects
a person’s mood, thinking, behavior, and
3. AMPHITAMINE AND COCAINE judgment in different ways, and in large doses,
it can cause hallucinations.
Amphetamine (designer drugs)is a strong
central nervous system stimulant that is used in
the treatment of attention deficit hyperactivity
disorder, narcolepsy, and obesity. It is also E. INHALANTS
commonly used as a recreational drug. Inhalants are a diverse group of drugs that
Cocaine is a tropane alkaloid and central include anesthetics, nitrates and organic
nervous system stimulant. As an extract, it is solvents that are inhaled for their effects.
mainly used recreationally, and often illegally The most common substances are alphatic and
for its euphoric and rewarding effects aromatic hydrocarbons found on gasoline, glue,
C. HALLUCINOGENS paint thinner, and spray paint.

They are referred to as “mindbenders” or Less frequently used halogenated hydrocarbons

psychedelic drugs, affecting the mind and includes cleaners, correction fluid, spray can
causing changes in perception and propellants. And substance containing esters,
consciousness. ketones, and glycols.

Examples of hallucinogens include lysergic acid Inhalants can cause significant brain damage,
diethylamide (LSD), mescaline, peripheral nervous system damage, and liver
dimethyltryptamine (DMT), 2,5-dimethoxy-4- disease.
methylamphetamine (STP), and psilocybin. They INTOXICATION & OVERDOSE
may be taken orally or injected
INHALANT INTOXICATION

- Dizziness
 - Nystagmus  To permit safe withdrawal from alcohol,
- Lack of coordination sedative-hypnotics and
- Slurred speech benzodiazepines.
- Unsteady gait  To prevent relapse
- Tremor
Dual Diagnosis
- Muscle weakness
- Blurred vision The client with both substance abuse and
- Stupor another psychiatric illness is said to have a dual
- Coma diagnosis. Dual diagnosis clients who have
schizophrenia, schizoaffective disorder, or
BEHAVIORAL SYMPTOMS
bipolar disorder present the greatest challenge
- Belligerence to health care professionals. It is estimated that
- Aggression 50% of people with a substance abuse disorder
- Apathy also have mental health diagnoses. Traditional
- Impaired judgment methods for treatment of major psychiatric
- Inability to function. illness or primary substance abuse often have
limited success in these clients for the following
ACUTE TOXICITY
reasons:
- Anoxia
• Clients with a major psychiatric illness may
- Respiratory depression
have impaired abilities to process abstract
- Vagal stimulation
concepts; this is a major barrier in substance
- Dysrhythmias
abuse programs.
DEATH may occur due to:
• Substance use treatment emphasizes
- Bronchospasm avoidance of all psychoactive drugs. This may
- Cardiac arrest not be possible for the client who needs
- Suffocation psychotropic drugs to treat his or her mental
- Aspiration illness.

MNGT: • The concept of “limited recovery” is more

acceptable in the treatment of psychiatric
- Supporting respiration and cardiac illnesses, but substance abuse has no limited
functioning recovery concept.
- No antidotes or specific medications.
• The notion of lifelong abstinence, which is
WITHRAWAL & DETOXIFICATION central to substance use treatment, may seem
No withdrawal symptoms or detoxification overwhelming and impossible to the client who
procedure. Though frequent users report lives “day to day” with a chronic mental illness.
psychological cravings. People who abuse • The use of alcohol and other drugs can
inhalants may suffer from persistent dementia precipitate psychotic behavior; this makes it
or psychosis, anxiety, mood disorders. difficult for professionals to identify whether
symptoms are the result of active mental illness
or substance abuse.
SCREENING TOOLS FOR ALCOHOL USE OR
ABUSE Clients with a dual diagnosis (substance use and
mental illness) present challenges that
 MAST (Michigan alcohol screening test) traditional settings cannot meet. Studies of
 CAGE ( CUT, ANNOYED, GUILTY, EYE) successful treatment and relapse prevention
 AUDIT (contains 10 questions about strategies for this population found that
quantity and frequency of drinking. integrated treatment programs that address
 12 question quiz to identify teenager at many unmet needs are more likely to succeed
risk for alcohol abuse. (Kikkert, Goudriaan, de Waal, Peen, & Dekker,
DIAGNOSTIC TEST 2018). Several key elements that need to be
addressed include healthy, nurturing,
 Breath analyzer reading supportive living environments; assistance with
 Liver function test fundamental life changes, such as finding a job
 MCV (MEAN CORPOSCULAR VOLUME) and abstinent friends; connections with other
 Urine screen for alcohol recovering people; and treatment of comorbid
conditions.
PHARMACOLOGIC TREATMENT
KEY POINTS

► Substance use and substance-related

disorders can involve alcohol.

► Substance use and dependence include

major impairment in the user’s social and
occupational functioning and behavioral and
psychological changes.

► Alcohol is the substance abused most often

in the United States; cannabis is second.

► Intoxication is the use of a substance that

results in maladaptive behavior.

► Withdrawal syndrome is defined as negative

psychological and physical reactions when use
of a substance ceases or dramatically decreases.

► Detoxification is the process of safely

withdrawing from a substance. Detoxification
from alcohol and barbiturates can be life-
threatening and requires medical supervision.

► The most significant risk factors for

alcoholism are having an alcoholic parent,
genetic vulnerability, and growing up in an
alcoholic home.

► Routine screening with tools such as the SSI-

AOD in a wide variety of settings (clinics,
physicians’ offices, through emergency services)
can be used to detect substance use problems.

► After detoxification, treatment of substance

use continues in various outpatient and
inpatient settings. Approaches are often based
on the 12- step philosophy of abstinence,
altered lifestyles, and peer support.

► Substance abuse is a family illness, meaning

that it affects all members in some way. Family
members and close friends need education and
support in coping with their feelings toward the
abuser. Many support groups are available to
family members and close friends.

► Clients who are dually diagnosed with

substance use problems and major psychiatric
illness do poorly in traditional treatment
settings and need specialized attention.

► Nursing interventions for clients being

treated for substance abuse include teaching
clients and families about substance abuse,
dealing with family issues, and helping clients
learn more effective coping skills.

► Health care professionals have increased

rates of substance use problems, particularly
involving opioids, stimulants, and sedatives.
Reporting suspected substance abuse in
colleagues is an ethical (and sometimes legal)
responsibility of all health care professionals.