SUBSTANCE-RELATED DISORDERS

OVERVIEW

Substance Dependence
➢ A maladaptive pattern of substance use as manifested by three or
more of the following:
1. Tolerance - increase amount of substance is needed to achieve desired effects
2. Withdrawal
3. A need for more of the substance than was intended
4. Inability to stop using even when wanting to do so
5. Great deal of time is spent in acquiring the substance or in recovering from its effects
6. Substance use causes social, occupational, or recreational problems
7. Continued substance use despite knowledge that the substance is causing physical or psychological
problems

Substance Abuse
➢ A maladaptive pattern of substance use leading to clinically significant impairment
or distress as manifested by one or more of the following:
1. Failure to fulfill major role obligations at work, school, or home
2. Recurrent substance use in hazardous situations
3. Recurrent substance-related legal problems
4. Continued substance use despite problems
➢ Has never met the criteria for substance dependence for this class of substance

Substance Intoxication
➢ The development of a substance-specific syndrome due to a recent ingestion of a substance
➢ Clinically significant maladaptive behavioral or psychological changes due to the effect of the substance
on the central nervous system
➢ Not due to a general medical condition and not better accounted for by another mental disorder

Substance Withdrawal
➢ The development of a substance-specific syndrome due to the cessation of or reduction in the intake of a
substance
➢ The substance-specific syndrome causes clinically significant distress or impairment
➢ Not due to a general medical condition and not better accounted for by another mental disorder

Detoxification
➢ process of safely withdrawing (controlled) from a substance
Withdrawal syndrome
➢ the negative psychological and physical effects after substance use
Tapering

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 ➢ fixed-schedule dosing
Blackout
➢ an episode during which the person continues to function but has no conscious awareness of his or her
behavior at the time or any later memory of the behavior.
Tolerance break
➢ small amount of substance intake intoxicates the person

ETIOLOGY TYPES OF SUBSTANCE ABUSE

1. Biologic Factors DSM-IV-TR

➢ Gender Uppers
✓ Men twice likely
✓ Women at risk Cocaine

1) chaotic life during childhood Hallucinogens

2) victimization during childhood Amphetamines 

3) low self-esteem • Tachycardia

➢ Genetic (50%-60%) • Awake
• Hallucination

2. Psychological Factors • Tachypnea

➢ Parental maladaptive behaviour • Dry mouth

➢ Children of alcoholics are 4x likely to develop • Pupils dilate

alcoholism • Hypertension

➢ As a defense mechanism • Seizures

• Weight loss
3. Social and Environmental Factors Downers
➢ Peer influences
➢ Curiosity Alcohol

➢ Laws and regulations Barbiturate

Marijuana
Narcotics

Opiates
Morphine
Codeine
Heroine
• Bradycardia

• Bradypnea

• Moist mouth

• Pupils constrict

• Constipation

• Urinary retention

• Hypotension

• Coma

• Weight gain

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ALCOHOL

➢ CNS depressant that is absorbed rapidly in the bloodstream

➢ Onset : On average, 15 to 17 years old (first episode of intoxication)
➢ Effects:
Initial effects – relaxation and loss of inhibitions
Intoxication – slurred speech, unsteady gait, lack of coordination, impaired concentration or memory
and judgment, aggressive, inappropriate sexual behavior, blackout
Overdose – vomiting, unconsciousness and respiratory depression
Long-Term – Cardiac myopathy, Wernicke’s encephalopathy, Korsakoff’s psychosis, Pancreatitis,
Esophagitis, Hepatitis, Cirrhosis, Leukopenia, Thrombocytopenia, Ascites

Pattern of Use Behavioral Changes Defense Mechanism

• social drinking Denial • Denial
• drinks secretly Dependency • Rationalization
• binge drinking Demanding • Isolation
• block out Destructive • Projection
Domineering

CAGE Questionnaire

Have you ever felt you should Cut down on your drinking?
CAGE

Have people Annoyed you by criticizing your drinking?

Have you ever felt bad or Guilty about your drinking?

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Have you ever had an Eye-opener in the morning to steady your nerves or get
rid of a hangover?

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BLOOD ALCOHOL LEVEL (BAL)
peaks within 50 minutes

BAL % Physiologic Effect

0.05 Euphoria, decreased inhibitions
0.10-0.15 Labile mood, talkative, impaired judgment
0.15-0.20 Decreased motor skills, lured speech, double vision
0.25 Altered perceptions
0.30 Altered equilibrium
0.35 Apathy, inertia
0.40 Stupor, coma
0.40-0.50 Severe respiratory depression, death

Criteria Alcohol Withdrawal Korsakoff’s Psychosis/ Wernicke’s Psychosis/

Delirium (Delirium
Tremens)
Faulty metabolism of alcohol
Cause
Acute (1-3 days after last
Onset drink) May appear after 14
days from last drink
Essential Feature Delirium
Increased vital signs, (Temp., Amnesia = confabulation
BP, RR, HR) tremors,
vomiting, malaise, loss of
appetite, nervousness,
Manifestations insomnia, tactile
hallucinations, extreme
perspiration (diaphoresis),
nausea, sleep disturbance, and
irritability
Syndrome Syndrome
Thiamine (B1) Thiamine (B1) deficiency
and Niacin deficiency
Chronic Chronic
Memory disturbances Wernicke’s encephalopathy
Inflammatory, degenerative
(to hide/conceal condition of the brain
condition) (lesions in several parts of
the brain), opthalmoplegia
(eye paralysis), ataxia
(motor incoordination)

➢ Withdrawal/Treatment/Detoxification
- occurs 4-6 hrs after cessation of intake
- best treatment: Abstinence

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- Pharmacology:
1. Vit. B1 (Thiamine) - to prevent/treat Wernicke-Korsakoff syndrome
2. Vit. B12 (Cyanocobalamine) and folic acid - for nutritional deficiencies
3. Disulfiram (Antabuse) - deter clients from drinking
- causes a severe physical reaction to alcohol that includes nausea, vomiting and headaches
- if client drinks: flushing, headache, sweating, nausea, vomiting, hypotension, coma, death
Nursing consideration:
a. Clients should avoid alcoholic products, e.g., cough syrup, mouthwash,
perfume, aftershave, vinegar, etc.
b. Patient should be free of alcohol for at least 12 hours to prevent Antabuse reaction
4. Acamprosate (Campral)
5. Naltrexone (Vivitrol) - suppresses cravings by targeting the brain chemicals affected by alcohol
- Support groups:
1. Alcoholic Anonymous - develop the 12-step program for recovery
2. Women for Sobriety - exclusive for women
3. Rainbow recovery - for gays and lesbians
4. Al-Anon - for spouses, partners, and friends
5. AlaTeen - for children of parents with substance abuse

TWELVE STEPS OF ALCOHOLIC ANONYMOUS

1. We admitted that we were powerless over alcohol, that our lives had become
unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our wills and lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our
wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them
all.
9. Made direct amends to such people whenever possible, except when to do so would
injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we
understood Him, praying only for knowledge of His will for us and the power to carry
that out.
12. Having had a spiritual awakening as a result of these steps, we tried to carry this message
to alcoholics and to practice these principles in all our affairs.

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SEDATIVES, HYPNOTICS, AND ANXIOLYTICS

➢ Class of Barbiturates, Non-barbiturate hypnotics, anxiolytics (Benzodiazepines)

➢ CNS depressants
➢ causes psychological dependence
➢ Therapeutic purpose: sedation, anti-anxiety
➢ Intoxication: slurred speech, lacks coordination, labile mood,
stupor, coma
➢ Withdrawal:
- opposite of the acute effects of the drug (Increased vital signs)
- hand tremor, insomnia, anxiety, nausea, and psychomotor agitation
➢ Detoxification: medically managed (tapering) to prevent coma and
death if stopped abruptly
➢ Overdose treatment:

1. Benzodiazepines - rarely fatal (lethargic, confused)

Tx: Flumazenil (Mazicon) - can cause SEIZURES as common adverse side effect
2. Barbiturates - fatal (coma, respiratory arrest, cardiac failure, death)
Tx: In ICU, lavage and dialysis to remove the drug from system and to support respiratory and
cardiovascular system

OPIOIDS (NARCOTICS)

➢ Class of Analgesics - Morphine sulfate, Meperidone (Demerol), Codeine (cough suppressant),

Methadone, Heroin, Fentanyl (supplement to anesthesia)
➢ decreases response to pain
➢ Route: oral, smoking, sniffing, injection
➢ Intoxication: apathy, lethargy, restlessness, impaired judgment, psychomotor
retardation and agitation, constricted pupils, drowsiness, slurred speech, impaired
attention and memory
➢ Pregnancy risk: premature delivery, 5-10 times higher risk of SIDS
➢ Distinct side effect: Yawning and diaphoresis
➢ Withdrawal: anxiety, restlessness, aching back and legs, craving
➢ Treatment:
1.Methadone - used as replacement for opioid
- helps maintain abstinence from opioids
2.Naloxone (Narcan) - an opioid antagonist given IV, short acting, given in repeat doses
- Nursing consideration: Hypotension

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HALLUCINOGENS

➢ “Ecstacy” (designer drugs), PCP (Phencyclidine, Angel Dust, Love Boat -

developed as an anesthetic), LSD (Lysergic acid diethylamide)
➢ cause psychosis with distorted perception
➢ Route: oral, injection, smoking, sniffing
➢ Intoxication: anxiety, depression, paranoid ideation, ideas of reference,
fear of losing ones mind, potentially dangerous behavior
➢ No significant withdrawal syndrome though can cause flashbacks and may
persist from months to 5 years
➢ Treatment: Supportive
Highest priority: safety needs of the client as well as the staff.

INHALANTS

➢ vapors from gas and gas related products, aerosol, glue, correction fluid,
marking pens, spray paints, paint thinner
➢ can cause significant brain damage, peripheral nervous system damage and
liver damage
➢ Intoxication: dizziness, nystagmus, lack of coordination, slurred speech, unsteady
gait, tremor, muscle weakness, blurred vision
➢ Acute toxicity: anoxia, respiratory depression, vagal stimulation, and dysrhythmias
➢ Death: bronchospasm, cardiac arrest, suffocation, or aspiration of the compound
or vomitus
➢ no withdrawal symptoms
➢ Treatment: symptomatic supporting respiratory and cardiac functioning
➢ no antidotes

STIMULANTS

➢ Class of Amphetamines, Methamphetamines, “shabu”, Cocaine

➢ CNS stimulant
➢ leads to alertness and extra energy
➢ psychological dependence and tolerance can occur
➢ Therapeutic purpose: limited clinical use except to treat ADHD, in the past, used to lose weight or to stay
awake
➢ Route: oral, smoking, injection
➢ Cocaine use leads to dopamine deficiency - amino acid therapy to restore depleted neurotransmitters

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 ➢ Intoxication: high or euphoric, hyperactivity or hypervigilance, insomnia, anorexia and weight loss,
tachycardia, hypertension and psychotic symptoms
➢ Chronic cocaine use: Nasal septum perforation
➢ Overdose treatment: not treated pharmacologically
1. antipsychotic Chlorpromazine (Thorazine)
- control hallucination, lowers BP, relieves nausea
2. Cocaine: Vasodilator - Nifedipine (Procardia)
- to treat hypertension
3. Beta-adrenergic blocker Esmolol
- to reduce the heart rate
➢ Withdrawal/Detoxification
- Withdrawal occurs within hours to days
- Primary withdrawal symptom: “crashing” (depression and suicidal ideation for days) marked
dysphoria, fatigue, vivid and unpleasant dreams, insomnia, increased appetite, psychomotor
retardation or agitation

CANNABIS (MARIJUANA)

➢ A hemp plant cultivated for its fiber used to make rope and cloth and oil from its seeds
➢ Marijuana refers to its upper leaves, flowering tops and stems of the plant
➢ Medical use: Cannabinoids (resin), Dronabinol (Marinol), Nabilone (Cesamet)
➢ Lowers intraocular pressure but not for glaucoma, relieve nausea and vomiting
associated with cancer chemotherapy, anorexia and weight loss of AIDS
➢ acts in < 1min; peaks at 20-30 mins.
➢ last at 2-3 hrs
➢ Intoxication : Impaired motor coordination, inappropriate laughter,
impaired judgment and short-term memory, distortions of time and
perception, increased appetite, bloodshot eyes, dry mouth, hypotension,
tachycardia
➢ Excessive use causes delirium, rarely, psychotic disorder
➢ Overdoses does not occur
➢ No clinically significant withdrawal syndrome

KUNG AYAW MO PANG KUNIN KA NIYA…..

ADIK KA BA? MAGBAGO KA NA!!!!!

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