Substance Abuse, Psychiatric Nursing, B. Sc (N) PPT

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    Substance Abuse, Psychiatric Nursing, B. Sc (N) PPT
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    • 1. SUBSTANCE ABUSE NITHIYANANDAM. T Asst. Lecturer, KGNC
    • 2. SUBSTANCE ABUSE Disorders due to Psychoactive substance use refer to conditions arising from the abuse of Alcohol, Psychoactive drugs & Other Chemicals such as Volatile Solvents.
    • 3. TERMINOLOGIES Substance refers to any Drugs, Medication, or Toxins that shares the potential of abuse. Addiction is a Physiological & Psychological dependence on Alcohol or other drugs of Abuse that affects the Central Nervous System in such a way that withdrawal symptoms are experienced when the substance is Discontinued.
    • 4. Abuse refers to Maladaptive pattern of Substance use that impairs health in a board sense. Dependence refers to certain Physiological & Psychological phenomena induced by the repeated taking of a Substance. Tolerance is a state in which after repeated administration, a drug produced a decreased effect, or increasing doses are required to produce the same effect. Withdrawal State is a group of signs & symptoms recurring when a drug is reduced in amount or withdrawn, which last for a limited time.
    • 5. ICD – 10 CLASSIFICATION F10 – F19 Mental & Behavior Disorders due to Psychoactive Substance Use. F10 - Mental & Behavior Disorders due to use of Alcohol. F11 - Mental & Behavior Disorders due to use of Opioids. F12 - Mental & Behavior Disorders due to use of Cannabinoids. F13 - Mental & Behavior Disorders due to use of Sedatives & Hypnotics. F14 - Mental & Behavior Disorders due to use of Cocaine. F16 - Mental & Behavior Disorders due to use of Hallucinogens.
    • 6. COMMONLY USED PSYCHOTROPIC SUBSTANCE  Alcohol  Opioids  Cannabis  Cocaine  Amphetamines & other sympathomimetics  Sedatives & Hypnotics ( Eg : Barbiturates )  Inhalants ( Eg : Volatile Solvents )  Nicotine  Other Stimulants ( Eg : Caffeine )
    • 7. ETIOLOGY BIOLOGICAL FACTORS Genetic Vulnerability : Family History Of Substance use Disorders Biochemical Factors : Role of Dopamine & Nor-epinephrine have been implicated in Cocaine, Ethanol, & Opioid Dependence. Abnormalities in Alcohol dehydrogenase or in the Neurotransmitter mechanisms are thought to play a role in Alcohol Dependence.
    • 8. Neurobiological theories : Drug addict may have an inborn deficiency of Endomorphins. Enzymes produced by a given gene might influence hormones & Neurotransmitters, contributing to the development of a personality that is more sensitive to the peer pressure. Withdrawal & Reinforcing effects of drugs. Co-morbid medical Disorder (Eg: To Control Chronic Pain)
    • 9. BEHAVIORAL THEORIES Drug abuse as the result of Conditioning / Cumulative reinforcement from drug use. Drug use causes euphoric experience perceived as rewarding, thereby motivating user to keep taking the drug. Stimuli & Setting associated with drug use may themselves become reinforcing or may trigger drug craving that can lead to relapse.
    • 10. PSYCHOLOGICAL FACTORS  General Rebelliousness  Sense of Inferiority  Poor Impulse Control  Low Self-Esteem  Inability to cope up with the pressures of living & society (Poor Stress Management Skills)  Loneliness, Unmet needs  Desire to escape from reality  Desire to experiment, a sense of Adventure  Pleasure Seeking  Machoism  Sexual Immaturity
    • 11. SOCIAL FACTORS  Religious Reasons, Peer Pressure  Urbanization, Extended Period of Education  Unemployment, Overcrowding  Poor Social Support  Effects of Television & Other Mass Media  Occupation: Substance use is more common in chefs, Barmen, Executives, Salesman, Actors, Entertainers, Army, Personnel, Journalists, Medical personnel, etc.,
    • 12. EASY AVAILABILITY OF DRUGS Taking Drugs Prescribed by the Doctors (Eg: Benzodiazepine Dependence) Taking drugs that can be bought legally without Prescription (Eg: Nicotine, Opioids) Taking Drugs that can be Obtained from illicit Sources (Eg: Street Drugs)
    • 13. PSYCHIATRIC DISORDERS Substance Use Disorders are more Common in Depression, Anxiety Disorders (Social Phobia), Personality Disorders (Especially Anti-Social Personality), & Occasionally in Organic Brain Disorders & Schizophrenia.
    • 14. CONSEQUENCES OF SUBSTANCE ABUSE This Commonly Leads to Physical Dependence, Psychological Dependence, Or Both. It may cause Unhealthy Lifestyles & Behaviors Such as poor diet. Chronic Substance abuse impairs Social & Occupational Functioning, Creating Personal, Professional, Financial, & Legal Problems (Drug Seeking is commonly associated with Illegal Activities, Such as Robbery or Assault).
    • 15. Drug Use Beginning in early Adolescence may lead to emotional & behavioral Problems, Including Depression, Family Problems with Relations, problems with or Failure to Complete School, & Chronic Substance abuse Problems. In Pregnant women, substance Abuse Jeopardizes (Danger of Loss) fetal Well-being. Psychoactive substances Produce negative Outcomes In Many Patients, Including Maladaptive Behavior, “Bad Trips” – Drug Induced Psychosis, & even Long Term Psychosis.
    • 16. • IV Drug Abuse May lead to Life Threatening Complications. • Illicit Street Drugs pose added Dangers; Materials used to dilute them can cause toxic Or allergic Reactions.
    • 17. ALCOHOL DEPENDENCE SYNDROME Alcohol Means Essence, anciently it called as Magnus Hass which is derived from Arabic Word. Alcoholism refers to the uses of alcoholic Beverages to the Point of Causing Damage to the Individual, Society, Or Both. (Or) Chronic Dependence of Alcohol Characterized by Excessive & Compulsive Drinking that produce Disturbances in mental Or Cognitive level of functioning which interferes with social & Economic Levels.
    • 18. PROPERTIES OF ALCOHOL Alcohol is a Clear Colored Liquid with a Strong Burning Taste. The Rate of Absorption of alcohol into the Blood stream is more Rapid than its Elimination. Absorption of Alcohol into the Bloodstream is Slower when food is Present in the Stomach. A Small amount is Excreted through Urine & a Small Amount is Exhaled.
    • 19. CONCENTRATION OF ALCOHOL IN BLOOD
    • 20. EPIDEMIOLOGY Incidence of Alcohol Dependence is 2% in India. 20 – 30 % of Subjects Aged Above 15years are Current Users Of Alcohol, & Nearly 10% of them are Regular Or Excessive Users. 15 – 30 % Of Patients are Developing Alcohol – Related Problems & Seeking admission in Psychiatric Hospitals.
    • 21. TYPES OF DRINKERS MODERATE DRINKERS PROBLEM DRINKERS It does not Cause much problems physically & Mentally It Cause Impaired Health, Family & Society
    • 22. CAUSES OF ALCOHOLISM Hard physical Labour, ( Occupations – Bar mates, Medical Professionals, Journalists & Actors). A Sudden loss of Properties or Closed ones. Ignorance Suddenly a person Become a Rich / Poor. Disorders Like Depression, Anxiety, Phobia, & Panic Disorders. Biochemical Factors (Alterations in Dopamine & Epinephrine) Psychological factors (Low self Esteem, Poor Impulse, Escape From reality, Pleasure Seeking). Sexual Immaturity Social Factors ( Over Crowding, Peer Pleasure, Urbanizations, Religious Reason, Unemployment, Poor Social Support, Isolation).
    • 23. PROCESS OF ALCOHOLISM Experimental Stage Recreational Stage Relaxation Stage Compulsion Stage
    • 24. STAGES OF ALCOHOLISM Progressive Phase Crucial Phase Chronic Phase Rehabilitative Phase Road For Recovery
    • 25. CLINICAL FEATURES OF ALCOHOL DEPENDENCE Minor Complaints : (Malaise, Dyspepsia, Mood Swings Or Depression, Increased Incidence of Infection) Poor Personal Hygiene. Untreated Injuries (Cigarette Burns, Fractures, Bruises that cannot be fully Explained). Unusually High tolerance for Sedatives & Opioids. Nutritional Deficiency ( Vitamins & minerals).
    • 26. Secretive Behavior (may Attempt to Hide disorder or Alcohol supply). Consumption Of Alcohol- Containing products (Mouthwash, After-Shave lotion, Hair Spray, Lighter Fluid, Body Spray, Shampoos). Denial of Problem. Tendency to Blame others & Rationalize Problems (Problems Displacing Anger, Guilt, Or Inadequacy Onto Others to Avoid Confronting Illness).
    • 27. ICD-10 CRITERIA FOR ALCOHOL DEPENDENCE A Strong Desire to take the Substance Difficulty in Controlling Substance Taking Behavior A Physiological Withdrawal State. Progressive neglect of Alternative pleasures or Interests. Persisting with Substance Use Despite Clear Evidence of Harmful Consequences
    • 28. PSYCHIATRIC DISORDERS DUE TO ALCOHOL DEPENDENCE Acute Intoxication Withdrawal Syndrome Alcohol-Induced Amnestic Disorders Alcohol-Induced psychiatric Disorders
    • 29. ACUTE INTOXICATION It Develops During Or Shortly After Alcohol Ingestion. It is Characterized by,  Clinically Significant Maladaptive Behavior or Psychological Changes (Eg’s: Inappropriate Sexual or Aggressive Behavior).  Mood Lability  Impaired Judgment  Slurred Speech  Inco-ordination  Unsteady gait  Nystagmus  Impaired Attention & Memory  Finally Resulting in Stupor or Coma.
    • 30. WITHDRAWAL SYNDROME Person Who Have been Drinking Heavily Over a Prolonged period of time, Any Rapid Decrease in the amount of Alcohol in the Body is likely to Produce Withdrawal Symptoms. These are: Simple Withdrawal Symptoms Delirium Tremens
    • 31. SIMPLE WITHDRAWAL SYNDROME: It is Characterized by, Mild tremors Nausea Vomiting Weakness Irritability Insomnia Anxiety
    • 32. DELIRIUM TREMENS It Occurs Usually within 2- 4days of Complete or Significant Abstinence From Heavy drinking. The course is Very Short, with Recovery Occurring within 3-7days.
    • 33. It is Characterized by,  A Dramatic & Rapidly Changing Picture of Disordered Mental Activity, with Clouding Of Consciousness & Disorientation in Time & Place.  Poor Attention Span.  Vivid Hallucinations which are Usually Visual, Tactile Hallucinations Can also Occur.  Severe Psychomotor Agitation  Shouting & Evident Fear  Grossly Tremulous Hands which Sometimes Pick-Up Imaginary Objects; Truncal ataxia.  Autonomic Disturbances Such as Sweating, Fever, Tachycardia, Raised Blood pressure, Pupillary dilation.  Dehydration with Electrolyte Imbalances.  Reversal of Sleep-Wake Pattern or Insomnia  Blood tests to Reveal Leucocytosis & LFT  Death may Occur due to Cardiovascular Collapse, Infection, Hyperthermia, Or self Inflicted Injury.
    • 34. ALCOHOL-INDUCED AMNESTIC DISORDERS Chronic Alcohol Abuse associated with Thiamine Deficiency (Vitamin B) is the most frequent Cause of Amnestic Disorders. This Condition is Divided into : Wernicke’s Syndrome Korsakoff’s Syndrome
    • 35. WERNICKE’S SYNDROME is Characterized by, Prominent Cerebellar Ataxia Palsy of the 6th Cranial Nerve Peripheral Neuropathy Mental Confusion KORSAKOFF’S SYNDROME The Prominent Symptoms in this Syndrome is Gross Memory disturbance. Other Symptoms Include: Disorientation Confusion Confabulation Poor Attention Span & Distractibility Impairment of Insight
    • 36. ALCOHOL-INDUCED PSYCHIATRIC DISORDERS Alcohol Induced Dementia: It is a long term Complication of Alcohol Abuse, Characterized by Global decrease in cognitive Functioning (Decreased Intellectual Functioning & Memory). This Disorder tends to Improve With Abstinence, But Most of The Patients may have Permanent disabilities.
    • 37. Alcohol-Induced Mood Disorders: Persistent Depression & Anxiety Suicidal Behavior Alcohol-Induced Anxiety Disorders: Panic Attacks Impaired Psychosexual Dysfunction: Erectile Dysfunction & Delayed Ejaculation Pathological Jealousy: Delusion of Infidelity Alcoholic Seizures:  Generalized Tonic - Clonic Seizures Occur Within 12-48 Hours After a Heavy Bout of Drinking.  Status Epilepticus Alcoholic Hallucinosis:  Presence of Auditory Hallucination during Abstinence  Regular Alcohol Intake
    • 38. RELAPSE Relapse refers to the process of returning to the use of alcohol or drugs after a period of Abstinence. Relapse Dangers: The presence of drugs or Alcohol, Drug users, Places where you used Drugs. Negative Feelings, Anger, Sadness, Loneliness, Guilt, Fear, & Anxiety. Positive Feelings which make you celebrate. Boredom – A State of Feeling Bored. Increase the Intake of drug. Physical pain Lot of Cash
    • 39. RELAPSING
    • 40. Warning Signs Of Relapse:  Stopping medications on one’s own or against the advise of medical professionals.  Hanging around old drinking haunts & drug using Friends.  Isolating themselves.  Keeping Alcohol, drugs around the houses for some reason.  Obsessive thinking about using drugs / Drinking.  Fail to follow their treatment plan, Quitting therapies, Skipping doctor’s appointments.  Feeling Over – Confident  Difficulties in Maintaining Relationships.  Setting Unrealistic Goals.  Changes in Diet, Sleep, Energy levels, & Personal Hygiene.  Feeling Overwhelmed.  Constant Boredom.  Sudden Changes in Psychiatric Symptoms.  Unresolved Conflicts.  Avoidance.  Major life Changes – loss, Grief, Trauma, Painful Emotions, Winning the Lotteries.  Ignoring Relapse warning Signs & Symptoms
    • 41. Signs & Symptoms of Relapse: Experiencing Post acute Withdrawal Return to denial Avoidance & defensive Behavior Starting to Build Crisis Feeling Immobilized (Stuck) Become depressed Loss of control Urges & Cravings Chemical Loss of Control
    • 42. COMPLICATIONS OF ALCOHOL ABUSE Alcohol Damages body Tissues by Irritating them Directly Changes that Occur During Alcohol Metabolism by Interacting With other drugs Aggravating Existing disease / Accidents brought on by Intoxcification Tissue Damage can Lead to a Host of Complications
    • 43. Gastro Intestinal Complications Neurologic Complications Chronic Diarrhea Esophagitis Esophageal Cancer Esophageal Varices Gastric Ulcers Gastritis Gastro Intestinal Bleeding Malabsorption Pancreatitis Alcohol Dementia Alcoholic hallucinosis Alcohol Withdrawal Delirium Korsakoff’s Syndrome Peripheral Neuropathy Seizure Disorders Subdural Hematoma Wernicke’s Encephalopathy Cardiopulmonary Complications Psychiatric Complications Arrhythmias Cardiomyopathy Essential Hypertension Chronic Obstructive Pulmonary Disease Pneumonia Increased Risk of Tuberculosis Amotivational Syndrome Depression Impaired Social & Occupational Functioning Multiple Substance Abuse Suicide
    • 44. Hepatic Complications Other Complications Alcoholic Hepatitis Cirrhosis Fatty Liver Beri Beri Fetal Alcohol Syndrome Hypoglycemia Leg & Foot Ulcers Prosatitis
    • 45. DIAGNOSTIC EVALUATION  History collection.  Mental Status Examination.  Physical Examination.  Neurologic Examination.  CAGE Questionnaires.  Michigan Alcohol Screening Tests (MAST).  Alcohol Use Disorders Identification Tests (AUDIT).  Paddington Alcohol Test (PAT).  Blood Alcohol Level to indicate Intoxication (200mg/dl).  Urine Toxicology to reveal use of Other Drugs.  Serum Electrolytes Analysis Revealing Electrolyte Abnormalities associated with Alcohol Use.  Liver function Studies demonstrating alcohol related Liver Damage.  Hematologic Workup Possibly revealing Anemia, Thrombocytopenia.  Echocardiography & Electrocardiography demonstrating Cardiac Problems.  Based on ICD10 Criteria.
    • 46. TREATMENT MODALITIES Symptomatic Treatment. Fluid Replacement Therapy. IV Glucose to Prevent Hypoglycemia. Correction of Hypothermia / Acidosis. Emergency Measures for Trauma, Infection or GI Bleeding.
    • 47. TREATMENT FOR WITHDRAWAL SYMPTOMS DETOXIFICATION: The Drugs of Choice are Benzodiazepines. Egs: Chlordiazepoxide 80-200 mg/day Diazepam 40-80 mg/day, in divided doses. OTHERS:  Vitamin B – 100mg of Thiamine Parenterally, Bd 3 to 5 days, Followed by Oral Administration for Atleast 6 months.  Anticonvulsants  Maintaining Fluid & electrolyte Balance  Strict Monitoring of Vitals, Level of Consciousness & Orientation.  Close Observation is Essential
    • 48. ALCOHOL DETERRENT THERAPY Deterrent agents are given to desensitize the individual to the effects of alcohol & Abstinence. The Most commonly Used Drug is Disulfiram or Tetraethyl thiuram disulfide or Antabuse.
    • 49. DISULFIRAM Disulfiram is used to ensure Abstinence in the Treatment of Alcohol Dependence. Its Main effect is to Produce a rapid & Violently Unpleasant Reaction in a Person who ingests even a Small amount of alcohol While Taking Disulfiram.
    • 50. DOSAGE: Initial Dose is 500mg/day orally for the 1st 2weeks, followed by a maintenance dosage of 250mg/day. The Dosage should not exceed 500mg/day. INDICATIONS: Disulfiram use is as an Aversive Conditioning Treatment for Alcohol Dependence. CONTRAINDICATIONS: Pulmonary & Cardiovascular Disease Disulfiram Should be used with caution in patients with Nephritis, Brain Damage, Hypothyroidism, Diabetes, Hepatic Disease, Seizures, Poly-drug Dependence or an Abnormal EEG. High Risk for Alcohol Ingestion.
    • 51. ACTION: It is an Aldehyde Dehydrogenase inhibitor that interferes with the metabolism of alcohol & Produces a marked increase in blood acetaldehyde levels. Accumulation of acetaldehyde( more than 10 times which occurs in the normal metabolism of alcohol) produces a wide array of Unpleasant reactions Called DISULFIRAM-ETHANOL REACTION (DER). Characterized by Nausea, Throbbing headache, Hypotension, Sweating, thirst, Chest Pain, tachycardia, Vertigo, blurred Vision associated with Severe Anxiety.
    • 52. ADVERSE EFFECTS: Fatigue, Dermatitis, Impotence, Optic Neuritis, Mental Changes, Acute Polyneuropathy, Hepatic Damage, Convulsions, Respiratory Depression, cardiovascular Collapse, Myocardial Infarction, Death.
    • 53. NURSING RESPONSIBILITY:  An informed Consent should be taken before Starting treatment.  Ensure that at least 12hours have elapsed since the last ingestion of Alcohol before Administering the Drug.  Patient should be warned against Ingestion of any alcohol- containing preparations such as Cough Syrups, Sauces, Aftershave Lotions, Etc.,  Caution patient against taking CNS Depressants & Over-the- Counter(OTC) Medications during disulfiram therapy.  Instruct The Patient to avoid driving or other activities requiring alertness.  Patients should be warned that the Disulfiram-alcohol Reaction may continue for as long as 1or 2 weeks after the last dose of disulfiram.  Patients should carry identification cards describing Disulfiram- alcohol reaction & listing the name & phone number of the physician to be called.  Emphasize the Importance of Follow-Up visits to the physician to monitor progress in long-term therapy.
    • 54. PSYCOLOGICAL THERAPIES
    • 55. PSYCHOLOGICAL THERAPY:  Motivational Interviewing  Group Therapy  Aversive Conditioning / Therapy  Cognitive Therapy  Relapse Prevention Technique: This technique helps the patient to identify high-risk relapse factors & develop strategies to deal with them.  Cue Exposure Technique: The technique aims through repeated exposure to desensitize drug abusers to drug effects, & thus improve their ability to Remain Abstinent.  Assertive Training  Behavior Counseling  Supportive Psychotherapy  Individual Psychotherapy
    • 56. AGENCIES CONCERNED WITH ALCOHOL-RELATED PROBLEMS This is a self Help organization founded in the USA by 2 Alcoholic men Dr. Bob Smith & Dr. Bill Wilson On 10th june,1985. Alcoholic Anonymous considers Alcoholism as a Physical, Mental, Spiritual disease, a Progressive one, which can be Arrested but not Cured. Members attend Group meetings usually twice a week on a long – term basis. Each member is assigned a support person from whom he may seek help when the temptation to drink occurs.
    • 57. In Crisis he can obtain immediate help by telephone. Once Sobriety is achieved he is Expected to help others. The Organization works on the firm belief that Abstinence must be Complete. The only Requirement for membership is a Desire to stop drinking. There is no authority, but only a fellowship of imperfect alcoholics whose strength is formed out of weakness. Their primary purpose is to help each other stay sober and help each other alcoholics to achieve sobriety.
    • 58. Al-Anon This is a Group Started by Mrs. Annie, Wife of Dr. Bob to support the Spouses of Alcoholics. Al-Teen Provides Support to their Teenage Children. Hostels These are intended mainly for those rendered homeless due to alcohol-related problems. They Provide Rehabilitation & Counseling. Usually abstinence is a Condition of Residence.
    • 59. NURSING MANAGEMENT Nursing Assessment: Recognition of Alcohol Abuse using CAGE Questionnaire C – Have you ever felt you ought to CUT down on your drinking ? A – Have People ANNOYED you by criticizing your drinking ? G – have you ever felt GUILTY about your drinking ? E – Have you ever had a drink first thing in the morning (An EYE – OPENER) to steady your nerves or get rid of a Hangover ?
    • 60. Be suspicious about ‘At Risk’ Factors:  Problems in the Marriage & Family , At Work , With Finances or with the Law  At risk occupations  Withdrawal Symptoms after Admission  Alcohol – related physical Disorders  Repeated Accidents  Deliberate Self Harm If at – risk Factors raise Suspicion, the next step is to ask Tactful but Persistent Questions to confirm the Diagnosis. Certain clinical Signs lead to the suspicion that drugs are being injected: Needle Tracks & Thrombosed Veins, wearing Garments with long Sleeves, etc., IV use should be suspected in any patient who presents with Subcutaneous Abscesses or Hepatitis.
    • 61. Behavioral Changes: Absence from School or work, Negligence of Appearance, Minor Criminal Offences, Isolation from Former Friends& Adoption of new Friends in a Drug Culture. Laboratory Tests: Raised Gamma – Glutamyl Transpeptidase (GGT), Raised Mean Corpuscular Volume (MCV), Blood Alcohol Concentration, Most drugs can be detected in urine except Lysergic Acid Diethylamide (LSD). Gastrointestinal: Nausea/Vomiting , Changes in Weight/Appetite, Signs of Malnutrition, Color & Consistency of Stool.
    • 62.  Nervous System: Orientation, Level of Consciousness, Co-ordination, Gait, Long term & Short term Memory, Signs of Depression & Anxiety, Tremors Or Increased Reflexes, Pupils (Constricted/Dilated)  Cardiovascular & Respiratory: Vital Signs, Peripheral Pulses, Dyspnea on Exertion, Abnormal Breath Sounds, Arrhythmias, Fatigue, Peripheral Edema.  Integumentary: Skin lesions, Needle tracks on Scaring on arms, legs, fingers, toes, under the tongue, or between gums & lips.  Emotional Behavior:  Affect, Rate of Speech, Suspiciousness, anger, agitation, Hallucinations, Blackouts, Violent Episodes, Support Systems  Denial & Rationalization are the feelings of fear, Insecurity, Low Self Esteem.
    • 63. Identify the type of Substance the person has been using , the amount, frequency, method of administration & the length of time the substance has been abused. Note of any Suicidal ideation or interest, with drained Symptoms. Assess for level of motivation for treatment. Identify reason for Admission. A Baseline Physical & Emotional Nursing assessment is done to determine Admission status & Provide baseline from which to determine progress towards an expected Outcome.
    • 64. NURSING DIAGNOSIS  Risk for injury related to Hallucinosis, acute Intoxication evidenced by Confusion, Disorientation, inability to identify potentially Harmful Situations.  Altered Health Maintenance related to inability to identify, manage or seek out help to maintain health, evidenced by various physical symptoms, Exhaustion, Sleep Disturbances, etc.,  Ineffective Denial Related to weak, under-developed ego, evidenced by Lack of Insight, Rationalization of problems, Blaming Others, Failure to Accept responsibility for his Behavior.  Ineffective individual coping related to impairment of adaptive behavior & Problem – Solving abilities, evidenced by use of substances as Coping Mechanisms.
    • 65. OTHER SUUBSTANCE USE DISORDERS DRUG ADDICTION IN INDIA  40 lakhs Registered Drug addicts in South Asia, Among this 1.25 lakhs are in India. DISTRIBUTION: Alcohol – 42 % Opioids – 20% Heroin – 13% Cannabis – 6.2% Others – 1.8%  Majority of Drug Addicts Aged Between 16 – 30 Years  These drug Abusers are mostly Unmarried, Under low Socio – Economic status  Among this Drug users 33% were Engaged in Anti – Social Activities.
    • 66. CANNABIS USE DISORDER Its derived from hemp plant cannabis sativa. The dried leaves and flowering tops are often referred to as GANJA or MARIJUANA. The resin of the plant is referred to as HASHISH. Bhang is a drink made from cannabis. Cannabis is either smoked or taken in liquid form.
    • 67. ACUTE INTOXICATION MILD INTOXICATION It is characterized by  Mild impairment of consciousness and orientation.  Tachycardia  A sense of floating in the air  Euphoria  Dream Like States  Tremors  Photophobia  Dry Mouth  Lacrimation  Increased Appetite  Alteration In The Psychomotor Activity
    • 68. SEVERE INTOXICATION It Causes Perceptual Disturbances Like Depersonalization Derealization Illusion Hallucination Somatic Passivity
    • 69. WITHDRAWAL SYMPTOMS Increased Salivation Hyperthermia Insomnia Decreased Appetite Loss Of Weight
    • 70. COMPLICATIONS Memory Impairment Amotivational Syndrome Transient Or Short Lasting Psychiatric Disorders Such as Acute Anxiety, Paranoid Psychosis, Hysterical Fugue Like States, Hypomania, Schizophrenia. TREATMENT Supportive And Symptomatic Treatment
    • 71. NICOTINE ABUSE DISORDER It is Obtained from “NICOTIANA TABACUM”. It is one of the most Highly Addictive & Heavily Used Drug.
    • 72. TOBACCO PRODUCTS
    • 73. HOW NICOTINE AFFECTS THE BRAIN
    • 74. NICOTINE DEPENDENCE SYMPTOMS Impaired Attention, Learning, Reaction Time, Problem Solving Abilities. Lifts One’s Mood Decreases Tension Depressive Feeling Decreased Cerebral Blood Blow Relaxes the Skeletal Muscles.
    • 75. ADVERSE EFFECTS OF NICOTINE Respiratory paralysis Salivation Pallor Weakness Abdominal Pain Diahorrea Increased Blood Pressure Tachycardia Tremor
    • 76. NICOTINE TOXICITY Inability to Concentrate Confusion Sensory Disturbances Decreases the Rapid Eye Movement while Sleep During Pregnancy, Increased Incidence of Low Birth Weight Babies Increased Incidence of Newborns with Persistent Pulmonary Hypertension.
    • 77. TREATMENT PSYCHOPHARMACOLOGICAL THERAPY Nicotine Replacement therapy:  Nicotine Polacrilex Gum (Nicorette)  Nicotine Lozenges (Commit)  Nicotine Patches (Nicotrol, Nicoderm)  Nicotine Nasal Spray (Nicotrol)  Nicotine Inhaler Non – Nicotine Medications:  Bupiropian (Zyban) – Started with 150mg , Bd For 3 Days ; After that Increase the dose to 300mg, Bd.
    • 78. THERAPIES Smoking Cessation Behavior Therapy Aversive Therapy Hypnosis
    • 79. OPIOID USE DISORDERS The most Important Dependence Producing Derivatives are Morphine & Heroin. The commonly Abused Opioids (Narcotics) in our Country are Heroin (Brown Sugar, Smack) And the Synthetic Preparations Like Pethidine, Fortwin & Tidigesic. More Opiate Users had begun with Chasing Heroin (Inhaling the Smoke / Chasing the Dragon), they Gradually Shifted to Needle use. Injecting Drug users have become a high Risk Group for HIV Infection.
    • 80. ACUTE INTOXICATION It is characterized by,  Apathy,  Bradycardia,  Hypotension,  Respiratory Depression,  Subnormal Temperature,  Pinpoint Pupils. In Later Stage,  Delayed reflexes,  Thready Pulse,  Coma.
    • 81. WITHDRAWAL SYNDROME It Rarely Produce a Life – Threatening Situation. Common Symptoms Includes, Withdrawal Symptoms Begin Within 12 Hours of the Last Dose, Peak in 24 -36 hours, Disappear in 5 – 6 Days. Watery Eyes, Running Nose, Yawning, Loss of Appetite, Irritability, Tremors, Anxiety. Sweating, Cramps, Nausea, Diahorrea, Insomnia, Raised Body Temperature, Piloerection
    • 82. COMPLICATIONS Illicit Drug Use: Parkinsonism, Peripheral Neuropathy, Transverse Myelitis. Intravenous Use: Skin Infections, thrombophlebitis, Pulmonary embolism, Endocarditis, Septicemia, AIDS, Viral Hepatitis, tetanus. Involve in criminal Activities.
    • 83. TREATMENT Opioid Overdose: Treated with Narcotic Antagonists [Egs: Naloxone, Naltrexone] Detoxification: Withdrawal symptoms can be managed By Methadone, Clonidine, Naltrexone, Buprenorphine, etc. Maintenance Therapy: After the Detoxification Phase, the patient is maintained on one of the following Regimens: - Methadone Maintenance - Opioids Antagonists - Psychological methods like Individual Psychotherapy, Behavior Therapy, Group Therapy, Family Therapy.
    • 84. COCAINE USE DISORDER Cocaine is an Alkaloid derived from the Shrub “ERYTHOXYLON COCA” Common street name is “CRACK” In 1880 it is used as a Local Anesthesia. It can be administered orally, intra-nasally by smoking or parenterally.
    • 85. ACUTE INTOXICATION Characterized by pupillary dilatation, tachycardia, hypertension, sweating and nausea & hypo manic picture. WITHDRAWAL SYNDROME Agitation Depression Anorexia Fatigue Sleepiness
    • 86. COMPLICATIONS Acute Anxiety reaction. Uncontrolled compulsive behavior. Seizures Respiratory depression Cardiac Arrhythmias
    • 87. TREATMENT MANAGEMENT OF INTOXICATION: Amyl Nitrite is an antidote. Diazepam / Propanolol (withdrawal syndrome) Anti - Depressants (Imipramine or Amitriptyline). Psychotherapy.
    • 88. AMPHETAMINE USED DISORDER Powerful CNS stimulants with peripheral sympathomimetic effect. Commonly used are Pemoline and Methyl Phenidate.
    • 89. ACUTE INTOXICATION Characterized by,  Tachycardia Hypertension Cardiac failure Seizure Hyperpyrexia Pupillary dilation Panic Insomnia Restlessness Irritability Paranoid hallucinatory syndrome Amphetamine induced psychosis
    • 90. WITHDRAWAL SYNDROME Characterized by Depression Apathy Fatigue Hypersomnia / Insomnia Agitation Hyperphagia
    • 91. COMPLICATIONS Seizure Delirium Arrhythmias Aggressive behavior Coma
    • 92. LSD USE DISORDER ( LYSERGIC ACID DIETHYLAMIDE )  A powerful Hallucinogen  First synthesized in 1938.  Produces its effect by acting on 5-Hydroxy Tryptamine (serotonin) levels in brain.  A common pattern of LSD used in TRIP (followed by long period of abstinence)
    • 93. INTOXICATION Characterized by Perceptual changes occurring in clear consciousness Depersonalization Derealization Illusions Synesthesias ( colors are heard, sounds are felt) Automatic hyperactivity Marked anxiety Judgment impaired. Paranoid ideation
    • 94. WITHDRAWAL SYMPTOMS  Flashbacks (a brief experiences of the hallucinogenic state ) COMPLICATIONS  Anxiety  Depression  Psychosis / visual Hallucinosis TREATMENT Symptomatic Treatment with  Anti-Anxiety,  Anti-Depressants or  Anti-Psychotic medications.
    • 95. BARBITURATE USE DISORDER The Commonly Abused Barbiturates are seco - barbital, pento - barbital, amo - barbital. INTOXICATION Acute intoxication characterized Lability of mood Disinhibited behavior Slurring of speech Inco-ordination Attention and memory impairment
    • 96. COMPLICATIONS Intravenous use can lead to skin abscess Cellulitis Infection Embolism Hypersensitivity reaction
    • 97. WITHDRAWAL SYNDROME Restlessness Tremors Seizure in severe cases resembling delirium tremens TREATMENT If the patient is conscious, induction of vomiting and use of Activated Charcoal can reduce the absorption. Treatment is symptomatic.
    • 98. INHALANTS / VOLATILE USE DISORDER The Commonly used Volatile Solvents include Petrol Aerosols Thinners Varnish remover Industrial solvents
    • 99. INTOXICATION Inhalation of a volatile solvent leads to Euphoria Excitement Belligerence Slurring of speech Apathy Impaired Judgment Neurological signs
    • 100. WITHDRAWAL SYMPTOMS Anxiety Depression COMPLICATIONS Irreversible damage to the liver and kidneys Peripheral neuropathy Perceptual disturbances Brain damage TREATMENT Reassurance Diazepam for intoxication.
    • 101. NURSING INTERVENTIONS Acute Intoxication  Care for a Substance Abuse patient starts with an Assessment - To determine which substance he is abusing, Assess the Signs and symptoms vary with the substance and dosage.  During the Acute phase of drug Intoxication and Detoxification - Maintaining the patient’s vital functions, ensuring his safety, and easing discomfort.  During Rehabilitation, caregiver help the patient acknowledge his substance abuse problem and find alternative ways to cope with stress & help the patient to achieve recovery and stay drug-free.
    • 102. Acute Episodes  Continuously monitor the Patient's Vital Signs and Urine Output.  Watch for Complications of Overdose & Withdrawal.  Maintain a safe and quiet environment.  Take appropriate measures to prevent suicide attempts and assaults.  Remove harmful objects from the room, and use restrains only if you suspect the patient might harm himself or others.  Approach the patient in a non - threatening way; limit sustained eye contact, which he may perceive as threatening.  Institute seizure precautions.  Administer IV fluids to Increase Circulatory Volume.  Give medications as Ordered.  Monitor & Record the Patients effectiveness.
    • 103. Withdrawal State  Administer Medications as ordered, to Decrease Withdrawal Symptoms, Monitor & Record their Effectiveness.  Maintain a Quiet & Safe Environment, because Excessive Noise may Agitate the Patient.
    • 104. WHEN THE ACUTE EPISODE HAS RESOLVED  Carefully Monitor & Promote Adequate Nutrition.  Administer drugs carefully to prevent Hoarding.  Check the patient’s mouth to ensure that he has swallowed Oral Medication.  Closely Monitor Visitors who might Supply him with Drugs.  Refer the Patient for Rehabilitation as appropriate; Give him a list of available Resources.  Encourage Family Members to seek Help Regardless of whether the Abuser Seeks it.  Suggest Private Therapy or Community Mental Health Clinics.
    • 105.  Use the Particular Episode to Develop Personal Self Awareness and an Understanding and Positive Attitude towards the Patient.  Control Reactions to the Undesirable behaviors, Commonly During Psychological Dependence, Manipulation, Anger, Frustration, and Alienation.  Set limits when Dealing with Demanding Manipulative Behavior.
    • 106. PREVENTION PRIMARY PREVENTION  Reduction of Prescribing by Doctors ( Anxiolytics Especially Benzodiazepines)  Identification & Treatment of Family Members who may be Contributing to the Drug Abuse.  Introduction of social changes by - Putting Up the Price of Alcohol & Its Beverages. - Controlling / Abolishing the Advertising of Alcoholic drinks. - Controls On sales by Limiting Hours Or Banning sales in Super-Markets. - Restricting Availability & Lessening Social Deprivation ( Governmental Measures).
    • 107. Strengthen the Individual’s Personal & Social Skills to Increase Self Esteem & Resistance to Peer Pressure. Health Education to College Students & the Youth about the Dangers of Drug Abuse. Over all Improvement in the Socio – Economic Condition of the Population.
    • 108. SECONDARY PREVENTION Early Detection & Counseling. Brief Intervention in Primary Care (Simple Advices from Practitioner & Educational Leaflet). Motivational Interviewing. A Full Assessment which Includes, Appraisal of Current Medical, Psychological & Social Problems. Detoxification with Benzodiazepines.
    • 109. TERITARY PREVENTION Alcohol Deterrent Therapy Other Therapies include Assertive Training, Teaching Coping Skills, Behavior Counseling, Supportive & Individual Psychotherapy. Agencies concerned with Alcohol – Related Problems (Alcoholic Anonymous, Al – Anon, Al – Teen, etc). Motivation Enhancement including Education about Health consequences of Alcohol use. Identifying High Risk Situations & Developing Strategies to Deal with them (Eg: Craving Management). Drink Refusal Skills ( Assertiveness Training ) Dealing with Faulty Cognitions.
    • 110. Handling Negative mood States. Time Management. Anger Control. Financial Management. Developing the Work Habit. Stress management. Sleep hygiene. Recreation & Spirituality. Family Counseling – To Reduce Interpersonal Conflicts, Which may Otherwise Trigger RELAPSE.
    • 111. REHABILITATION The Aim of Rehabilitation of an Individual De -addicted from the Effects of Alcohol/Drugs.  To Enable him to Leave the Drug Sub – Culture.  To Develop New Social Contacts, In this Patients First Engage in Work & Social Activities in Sheltered Surroundings & then take Greater Responsibilities for Themselves in Conditions Increasingly like those of Everyday Life.  Continuing Social Support is Usually Required when the Person makes the Transition to Normal Work & Living .
    • 112. PSYCHOEDUCATION (FOR PATIENTS & FAMILY)  Teach about the Physical, Psychological & Social Complication of Drug & Alcohol Use.  Inform the Concern that Psychoactive Substance may alter a person’s Mood, Perceptions, Consciousness or Behavior.  Explain to the Family that the Patient may Use Lies, Denial or Manipulation to continue Drug of Alcohol Use and to avoid Treatment.  Teach the Patient/Family that Drug Overdose or Withdrawal can result in a Medical Emergency & even Death, Give the Family Emergency resources for Help.  Caution the Patient that Sharing Dirty or Used Needle can Result in a Life-Threatening Disease such as AIDS, Hepatitis – B.
    • 113.  Teach the Family to Establish Trust with the Patient and to Use Firm limit Setting, when necessary to help the Patient Confront Drug Abuse Issues.  Provide the Patient with a Full Range of Treatment during Hospitalization such as Medication, Individual Therapy, Group therapy, 12 step program(AA) & Behavior Modification to Strengthen the Recovery Process.  Teach how to Recognize Psychosocial Stressors that may Exacerbate Substance Abuse Problem & how to Avoid or Prevent them.  Emphasize the Importance of Changing Lifestyle, Friendships & Habits that Promote Drug Use to Remain Sober.  Teach about the Availability of Local Self – Help Programs (AA, Al – Anon, Al - Teen) to Strengthen the Patient’s Recovery & Support the Family’s Assistance.
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