Substance Abuse
 using a drug in a way that is inconsistent with
medical or social norms and despite negative
consequences
Substance Dependence
 includes problems associated with addiction such
as tolerance, withdrawal, and unsuccessful
attempts to stop using the substance
Withdrawal syndrome refers to the negative
psychological and physical reactions that occur when use
of a substance ceases or dramatically decreases
 Detoxification is the process of safely
withdrawing from a substance
Tolerance person needs more of the substance to
produce the same effect
Tolerance break which means that very small amounts of
the substance will intoxicate the person
Intoxication is use of a substance that results in
maladaptive behaviour
Classes of substances abused:
 Alcohol
 Amphetamines or similarly acting
sympathomimetics
 Caffeine
 Cannabis
 Cocaine
 Hallucinogens
 Inhalants
 Nicotine
 Opioids
 Phencyclidine (PCP) or similarly acting drugs
 Sedatives, hypnotics, or anxiolytics
ALCOHOL
 Central nervous system depressant
 Overdose can result in vomiting, unconsciousness,
and respiratory depression
 Symptoms of withdrawal usually begin 4 to 12
hours after cessation or marked reduction of
alcohol intake
 Usually peaks 24 – 48 hours, is over in about 5
days
 Withdrawal symptoms include:
 Altered LOC, coarse hand tremors, sweating,
elevated pulse, BP, temp., insomnia,
anxiety, and nausea or vomiting, irritability,
profuse sweating, blackouts
 Severe or untreated withdrawal may
progress to transient hallucinations,
nervousness, or delirium—called delirium
tremens (DTs) = 2 - 4 days up to 7 days
after last drink
 Withdrawal symptoms are monitored using an
assessment tool such as the Clinical Institute
Withdrawal Assessment of Alcohol Scale, Revised
(CIWA-AR)
Treatment:
 Most effective treatment = ABSTINENCE
 Vitamin B1 (thiamine) to prevent or to treat
Wernicke’s syndrome and Korsakoff’s syndrome
Korsakoff’s Psyhosis
 Deficiency in Thiamine and Niacin
 Memory Disturbances, confabulation,
amnesia (retro/anterograde), loss of
coordination
 Irreversible
 Wernicke’s Psychosis
 Thiamine deficiency SEDATIVES, HYPNOTICS, AND ANXIOLYTICS
 Confusion, ataxia,opthalmophlegia  Central nervous system depressants
 Reversible Physical Symptoms:
 Slurred speech
 Cyanocobalamin (vitamin B12) and folic acid for  Apnea
nutritional deficiencies  Decreases RR, PR, BP
 Detoxification
 Drugs: benzodiazepines - Lorazepam  Withdrawal symptoms in 6 to 8 hours or up to 1
(Ativan), chlordiazepoxide (Librium), or week
diazepam (Valium) suppress the withdrawal  Withdrawal syndrome is characterized by
symptoms symptoms opposite of the acute effects of the
NX RESPONSIBILITY: drug:
 Free from alcohol prior to giving the drug  Autonomic hyperactivity (increased pulse,
 NO! blood pressure, respirations, and
Mouthwash temperature), hand tremor, insomnia,
OTC cold remedies anxiety, nausea, and psychomotor agitation;
Food sauces made up of wine seizures and hallucinations occur rarely in
Fruit flavored extracts severe benzodiazepine withdrawal
Aftershave lotions  Detoxification from sedatives, hypnotics, and
Vinegar anxiolytics is managed by tapering the amount of
Skin products the drug
 Support Groups – Alcoholic Anonymous
 Relatives – Alanon 1. BENZODIAZEIPNES
 Teenagers - Alateen are a class of psychoactive drugs with varying
hypnotic, sedative, anxiolytic, anticonvulsant, muscle
Nursing Intervention: relaxant and amnesic properties, which are mediated
by slowing down the central nervous system. The
 Maintain client safety
drugs are useful in treating anxiety, insomnia,
 Monitor vital signs and neurologic status, and
agitation, seizures, and muscle spasms, as well as
notify physician if any abnormal value.
alcohol withdrawal. Using of benzodiazepines in long
 Quiet environment with a light on term can cause physical dependence.
 Orient patient to place, person, and time
 Record intake and output Types of Benzodiazepines are Diazepam (Valium) and
 Encourage patient to express fears and anxiety Lorazepam (Ativan)
 Therapy:
 Support groups – AA Psychotherapy Effect of Substance:
Behavior therapy Sleepiness and deep sleep, poor coordination, slurred
 speech, falling, poor thought processes, memory
difficulty, weak comprehension, poor judgment, mood
swings, constricted pupils, nystagmus, and
tachypnea.
Effect of Withdrawal:
STIMULANTS (AMPHETAMINES, COCAINE, OTHERS)
Anxiety, rage, insomnia, panic attacks, depression,
night-mares, nausea, constipation, diarrhea, shaking,
muscle pain, sweating, tachycardia, paresthesia,
seizure, and death if combine with alcohol.
Treatment:
 Detoxification
 Drugs: antagonist fumezenil (Romazicon), slowly
taper the abused benzodiazepine.
2. BARBITURATE
are a group of drugs known as sedative-hypnotics,
which generally describes their sleep-inducing and
anxiety-decreasing effects.
There are many different kind of barbiturate:
1. METHAMPHETAMINES
Amobarbital (Amytal), pentobarbital (Nembutal),
Secobarbital (Seconal), Phenobarbital, and Tuinal
Effect of Subtance:
Sluggish coordination, emotional lability, faulty
judgment, aggressiveness, nystagmus, strabismus,
diplopia, decreased reflexes, ataxic gait, bradycardia,
respiratory depression, stupor, decreased tendon
reflexes.
Effect of Withdrawal:
Irritability, anxiety, tachycardia, tachypnea, nausea,
tremors, muscle pain, confusion, hallucination,
seizures, insomnia, vivid dreaming, coma, death.
Treatment:
 Detoxification
 Drugs: slowly taper the abused barbiturate,
sodium bicarbonate (promotes excreation of
barbiturates, and activated charcoal for overdose.
 Central nervous system stimulants
 Overdoses can result in seizures and coma
 Withdrawal occurs within hours to several days
 Withdrawal syndrome:
 Dysphoria accompanied by fatigue, vivid
and unpleasant dreams, insomnia or
hypersomnia, increased appetite, and
psychomotor retardation or agitation;
withdrawal symptoms are referred to as
“crashing”--the person may experience
depressive symptoms, including suicidal
ideation, for several days
 Stimulant withdrawal is not treated
pharmacologically
acts as a dopaminergic and adrenergic reuptake
inhibitor and in high concentrations as a monamine
oxidase inhibitor (MAOI). Since it stimulates the
mesolimbic reward pathway, causing euphoria and
excitement, it is prone to abuse and addiction.
 Methamphetamines: amphetamine (Benzedrine),
dextroamphetamine (Dexedrine), MDMA (Ecstasy),
methylphenidate (Ritalin)
 Also known as crank or speed
 Effect of Substance:
Increased attention, increased activity, decreased
 fatigue, decreased appetite, euphoria, that are smoked), cocaine that may be injected
hyperthermia, tachycardia intravenously
 Overdose:  “Crack”
 Sympathetic stimulation: Incerased BP, RR, PR,  Physical Symptoms
vasoconstriction, pupil dilation  Stuffy or runny nose
 Perforated nasal septum
Weight loss
 Increase HR,RR,BP
Hyperactivity
Increase vital signs  Note for paranoia
Loss of apetite  Extreme restlessness
Euphoria
 Withdrawal
 Effect of Withdrawal:  Psychomotor agitation
 Seizure
Insomnia, restlessness, irritability, panic, paranoia,
confusion, homicidal behavior, depression with Treatment:
suicidal ideation, hallucination, vomiting, nausea, Detoxification
chills Drugs: antidepressant, antipsychotic
Charcoal to treat ingested cocaine
Depression
Irritability OPIOIDS
Psychosis  Central nervous system depressants
 A chemical substance that has a morphine-like
Treatment: action in the body. It is use mostly for pain relief.
 Detoxification  Withdrawal:
 Drugs: small doses of diazepam IV or haloperidol  Short-acting drugs: begins in 6 to 24 hours;
to combat CNS hyperactivity peaks in 2 to 3 days and gradually subside
 Treat seizure with benzodiazepines in 5 to 7 days
 Activated charcoal for overdose  Longer-acting drugs: begins in 2 to 4 days,
subsiding in 2 weeks
2. COCAINE  Physical symptoms:
is a potent central nervous system stimulant,
 Pinpoint pupils
vasoconstrictor, and topical anesthetic, widely abused
as a euphoriant and associated with the risk of severe  Drowsiness
adverse physical and mental effects.  Incoordination
 Withdrawal
 Cocaine: cocaine hydrochlororide (sniffed) free-  Nausea and vomiting
base cocaine (smoked), crack cocaine (small rocks
  Abdominal cramping  Isolation from external stimuli; physical
 Restlessness restraints; (for PCP) medications to control
 Coryza seizures and blood pressure; cooling
devices; mechanical ventilation
 On 2nd-3rd day violent, hysterical, noisy
and threatening INHALANTS
 Tremors  Inhaled for their effects
 Irritability  Overdose:
 Cold and hot flushes with PILOERECTION  Anoxia, respiratory depression, vagal
 Sweating stimulation, and dysrhythmias
 Death may occur from bronchospasm,
Treatment: cardiac arrest, suffocation, or aspiration of
 Detoxification the compound or vomitus
 Drugs: Opiate antagonis naloxone (Narcan) IV in  People who abuse inhalants may suffer from
emergency situation. persistent dementia or inhalant-induced
 In morphine and heroin addicts can use disorders such as psychosis, anxiety, or
methadone daily to stabilize patient. mood disorders even if the inhalant abuse
 In other opioid addicts, slowly taper the abused ceases
opioid. Physical Symptoms:
Bad breath
HALLUCINOGENS Ringing of ears
 Distort reality and produce symptoms similar to Expect respiratory depression
psychosis, including hallucinations (usually visual) Appears intoxicated
and depersonalization Teary eyes
Withdrawal symptoms: none
 Toxic reactions to hallucinogens (except PCP) are
primarily psychological; overdoses as such do not
Treatment:
occur.
 Supporting respiratory and cardiac
 PCP toxicity can include seizures, hypertension, functioning until the substance is removed
hyperthermia, and respiratory depression from the body
 MANAGEMENT:
 Benzodiazepines/neuroleptics CANNABIS (MARIJUANA)
 Acidifying urine to accelerate  Used for its psychoactive effects
excretion – cranberry juice  Excessive use of cannabis may produce delirium or
 Hallucinogens can produce flashbacks that may cannabis-induced psychotic disorder; overdoses of
persist for a few months up to 5 years cannabis do not occur
 Treatment is supportive:  Effects:
  Drowsiness
 Red eyes/blood shot eyes
 Impulsive
 Euphoria
 Dryness of mouth
Withdrawal symptoms:
 Tremors
 Anxiety
 Muscle aches
 Insomnia
 Sweating

 Effects are treated symptomatically