i). SUBSTANCE USE AND DE-ADDICTION: (Alcohol, tobacco, and other psychoactive disorders)

PSYCHOACTIVE SUBSTANCE ABUSE

People have been using psychoactive drugs for a very long time not only to increase pleasure and relieve discomfort but also to achieve social, religious purposes.

Psychoactive substance abuse’ is defined as ‘an inappropriate pattern of continued use despite knowledge of social, occupational, psychological or physical problems. Their repeated use is physically harmful.

Drug addiction is a social problem, it is a problem of society, family and individual. Substances such as alcohol, tobacco etc. are abused.

COMMONLY ABUSED DRUGS/ SUBSTANCE

• Narcotic (opium, codeine, morphine)
• Depressants (barbiturates, benzodiazepines, alcohol)
• Stimulants (amphetamines, cocaine)

•Cannabis (marijuana, hashish, hemp)

Hallucinogen (LSD-lysergic acid diethylamide)

• Inhalants (volatile solvents)
• Nicotine

*Other drugs

•Muscle relaxants

•Painkillers

Anti-histamines (for allergies)

ETIOLOGY OR CAUSES OF SUBSTANCE ABUSE

Genetic factors

• Family history of drug problems is the most powerful risk factor for drug dependency.

Interpersonal and Psychosocial Factors.

• Social and family support may not be adequate.

•Family conflict

• Having distance from family.

Parents should not put pressure on children.

•Popularity of medicine in the profession.

•Alcohol and drugs are readily available.

Religious Reasons

Psychiatric and medical disorders

A co-morbid psychiatric disorder may occur in which drug abuse is more common in people with comorbid depression.

A person who is a terminally ill cancer patient may experience substance abuse due to prescribed pain relieving medicine.

Certain drugs produce a strong effect on the client which makes it mandatory for the client to take the drug repeatedly.

Socio-Economic Factors

Drug addiction is more common among people with low socio-economic status. Seen due to poverty, hopelessness, frustration etc.

Biochemical factor.

May be caused by biochemical factors such as alcohol dehydrogenase or neurotransmitter mechanisms.

Psychological factors

•Poor stress management skills.

•In childhood tro

• Low self-esteem

Curiosity

• Poor impulse control

•Alcohol consumption from the beginning.

•Psychological distress

*Ecological factors

Some young people may join groups of drug abusers to establish relationships. Social group is another environmental pressure for drug addiction.

SIGN AND SYMPTOMS OF SUBSTANCE ABUSE

Alcohol:

• Dyspepsia
• Depression
• Infection

Anger

*Opioids

• Apathy
• Hypotension.

•Abnormal temperature.

• Insomnia

*Amphetamine

• Cardiac failure
• Panic
• Illusion
• Insomnia
• Cocaine

•Pupillary dilatation

• Tachycardia

Sweating

•Nozia

• Hypertension
• Loss of appetite
• siezure (tension convulsion)

MANAGEMENT OF SUBSTANCE ABUSE

Hospitalization

Substance abuse requires admitting a person to a hospital, where they are properly treated.

Detoxification

Detoxification is the process by which toxic substances are converted into more soluble and less toxic substances, which are excreted from the body mainly through urine and bile.

Analgesic and vitamin supplements

Analgesic medicine is useful in the treatment of substance abuse. Vitamin B complex, vitamin C and vitamin A supplements are given.

Supportive psychotherapy

Supportive psychotherapy is very useful in the management of substance abuse.

Stress management

Stress is one of the biggest risk factors for developing substance abuse, so stress management is essential.

Methods are used to correct infections, nutritional deficiencies and physical problems.

WITHDRAWAL EFFECT TREATMENT

Medicines help suppress withdrawal symptoms during detoxification. However, medically detoxification is not a “treatment” in itself, it is the first step in the treatment process. Patients who undergo medically assisted withdrawal but do not receive further treatment show the same pattern of drug abuse as those who have never been treated.

TREATMENT OF SUBSTANCE ABUSE DISORDER

Alcohol

Many medications have been used to treat alcohol dependence: disulfiram, naltrexone, acamprosate. Disulfiram therapy is called antabuse therapy.

Opioids

Naltrexone is the most effective for the treatment of opioid addiction, medications like methadone and buprenorphine are used for treatment. All these medications help the patient to get rid of drug seeking and related criminal behavior and for behavioral treatment. Makes more receptive.

Tobacco (Tobacco):

Various formulations of nicotine replacement therapy are now available, including patches, sprays, gum, and lozenges that are available over the counter. Nicotine will reduce withdrawal symptoms. Additionally, two prescription medications, bupropion and varenicline, work on nicotinic acetylcholine receptors in the brain.

Behavioral treatments

Treatment for drug abuse and addiction can be delivered in a variety of settings using a variety of behavioral approaches.

1. Outpatient Behavioral Treatment:- It includes a variety of programs for patients who visit the regular clinic. Most programs include individual or group drug counseling.

Some programs also offer other forms of behavioral treatments such as-

•Cognitive Behavioral Therapy(CBT):- This therapy will help patients to identify, avoid and cope with situations in which they are likely to abuse drugs.

• Multidimensional Family Therapy and Interviewing:- Developed for drug abusing adolescents, this therapy is designed to improve overall family function.

Interviews that encourage individuals to change their behavior and seek treatment.

Other therapy

Family therapy

Group therapy

Counselling

Aversion therapy (giving other emetic medicines along with the substance and making the person feel negative towards the substance so as not to become addicted.)

(ADS) ALCOHOL DEPENDENCY SYNDROME (ALCOHOLISM)

Alcoholism is a condition in which chronic alcohol intake leads to health problems and negative social consequences. Alcoholism harms the individual, society, or both.

Alcoholism, also known as “alcohol dependence”, is a disease in which a person continues to consume alcohol despite being aware of its problems, does not use alcohol, and continues to drink despite getting into trouble with the law.

CAUSES OF ALCOHOLISM

Psychiatric Disorders:

• Some depression, anxiety and phobia patients will consume alcohol to elevate their mood.

Occupational Factor:

• Medical professionals, barmates, journalists, actors etc. some people associated with the profession consume alcohol.

Genetics Factor:

-Some heavy drinkers have a family history of alcoholism. Which comes from one generation to another.

Biochemical factor:

• Alterations in dopamine and epinephrine lead to alcoholism.

Social Factor:

• Sudden property loss, unemployment, loss, injustice, peer group pressure, large family, broken homes, neglect, boredom, ignore, isolation.

Personality Factor:

• Alcoholism is more common in people with anxious and anti-social personality.

Psychological Factors:

LOW SELDIAGNOSIS Poor impulse, they use alcohol to escape from reality and avoid stress.

High Risk Groups

-If alcohol is readily available, it leads to alcoholism.

• People traveling with chronic physical illness, business executives, traveling sales personnel are likely to develop alcoholism. -Especially boys follow their parents’ drinking patterns.

PSYCHIATRIC DISORDERS DUE TO ALCOHOL DEPENDENCY

Acute intoxication

It develops soon after drinking alcohol in which the person shows aggressive or sexual behavior.

Mood disturbance, impaired judgment, slurred speech are seen.

Withdrawal symptoms

Withdrawal symptoms occur when a person has been drinking alcohol for a long time and suddenly stops drinking.

In which simple symptoms: Tremor, Nozia, Vomiting, Weakness, Anxiety etc. are seen.

Delirium Tremens: Severe symptoms of alcohol withdrawal.

•Alcohol related amnestic disorders

Thiamine (vitamin B1) deficiency causes amnestic disorders.

Wernicke’s syndrome

Korskoff’s syndrome

DIAGNOSTIC EVALUATION OF ALCOHOLISM

History Collection: An alcoholic client is asked several questions.

When did you first drink alcohol?

How much alcohol do you drink?

How often do you consume alcohol?

What types of alcoholic beverages do you usually drink?

Physical Examination

• Telangiectasia: – Vascular lesions from dilatation of small blood vessels, especially on the face.
• Palmar Erythema:- Red spots are seen on the palms.
• Peripheral Neuropathy:- Diseases of the nervous system in the hands and feet.

MSE (Mental States Examination)

Neurological examination

CAGE Assessment

The CAGE question, named for the four questions it asks, is an example that can be used to quickly screen patients in a doctor’s office. Two “yes” answers indicate that the patient should undergo further investigation. Four questions are asked in it.

1. Do you ever feel like you need to cut down on drinks?
2. Have people criticized your drinking and annoyed you?
3. Have you ever felt guilty about drinking?
4. Have you ever felt that you need an Eye Opener first thing in the morning to calm your nerves or stave off a hangover?

C=Cut down

A=Annoyed

G = Guity

E = Eye Opener

Michigan Alcohol Screening Test (MAST)

Alcohol Dependence Data Questionnaire (ADDQ)

Alcohol Use Disorders Identification Test (AUDIT)

Paddington Alcohol Test (PAT)

Blood alcohol level indicates intoxication (200mg/dl)

Liver function study (for alcohol related liver disease)

Echocardiograph and Electrocardiograph

SIGN AND SYMPTOMS OF ALCOHOLISM

Early Sign

-Frequent intoxication

-Angry and violent

-Drinking and driving

• Black out drinking (drinking and forgetting)

•Minor Complaint

-Malays (Excessive Fatigue)

-Dyspepsia (Indigestion)

-Mood swings or depression

-Increased incidence of infection

-to blame

-Inadequate personal hygiene

• Ignore problems

-High tolerance of sedatives and opioids

-Consumption of alcohol product

-Nutritional deficiency (Vitamin B1-Thiamine)

•Withdrawal Symptoms

-tremor (most common)

-Wernix-Korschoff syndrome (caused by deficiency of vitamin B1, which can be caused by chronic alcohol abuse.

Phases Of Alcoholism

-Pre-alcoholic symptomatic phase

-Prodromal phase

-Crucial phase

-Chronic phase

TREATMENT MANAGEMENT OF ALCOHOLISM

Hospitalization

Substance abuse requires admitting a person to a hospital, where they are properly treated.

Group therapy

Group therapy is a treatment method in which patients learn and practice recovery strategies, build interpersonal skills, and develop social support networks.

Detoxification

Detoxification is the process by which toxic substances are converted into more soluble and less toxic substances, which are excreted from the body mainly through urine and bile.

Individual psychotherapy

Psychotherapy provides a controlled and non-judgmental environment where patients can talk about their problems and issues.

Talking about these problems is the heart of psychotherapy. Patients may be able to overcome their need for alcohol.

Family and Marital Therapy

Family therapy is a collection of interventions that use family strengths to bring about change. It views the family as a complex system, where any change affecting one part of the system affects all other parts. Alcoholism harms not only the person with the disorder, but often their family members as well. Family therapy can help reduce this damage.

Aversion therapy

In chemical aversion, the patient is administered a medicine that causes nosia or vomiting when the person drinks alcohol. This is repeated until the person begins to associate drinking alcohol with the feeling of illness, and so the patient withdraws from the alcohol. There is no desire to drink. The patient goes away from alcohol.

Alcoholics Anonymous

Alcoholics Anonymous is a self-help group that meets together to maintain sobriety. The group includes people who have recovered from alcohol dependency. They instruct drinkers and encourage them not to consume alcohol. The original form of Alcoholics Anonymous has 12 steps.

Pharmacological treatment

•Disulfiram : Disulfiram is called Antabuse. which prevents the elimination of acetaldehyde. Disulfiram therapy is also called antabuse therapy.

Acamprosate : Acamprosate is an anti-craving agent. They are used to treat the maintenance phase of alcohol dependence.

• Tamposil (calcium carbamide): Tamposil works in the same way as Antabuse, but it is weak and safe.

Benzodiazepines: Useful for the management of acute alcohol withdrawal, and anticonvulsant agents are also administered.

Naltrexone: Naltrexone is a competitive antagonist for the opioid receptor.

Topiramate:

D-fructose, which is a derivative of the naturally occurring sugar monosaccharide, is effective in helping people quit alcohol or reduce the amount they drink.

Vitamin and Nutrition: Vitamin and nutritional supplements are given to correct nutritional deficiencies. Vitamin B1 (thiamine) is given to prevent Wernicke-Korschoff syndrome.

IV Fluids: IV fluids are given to maintain fluid and electrolyte balance.

NURSING MANAGEMENT OF PATIENT SUBSTANCE ABUSE

COMMON NURSING DIAGNOSIS OF SUBSTANCE ABUSE

Increased anxiety

Altered sleep patterns

Impaired social interaction

Altered Nutrition Less Than Body Requirement

Disturbed self-esteem

Manipulative Behavior

Ineffective Individual Coping

Risk for Harming Self and Others

Impaired social interaction

decrease coping abilities

1.Increased anxiety

Objectives : To help reduce the patient’s anxiety level.

Nursing Interventions

Assessing anxiety levels.

The patient should be accepted with his problems.

Establish a trusting relationship with family and clients.

The patient should be helped to cope with his symptoms.

Do not fight against them thinking that they are drug addicts.

Encourage the patient to express his feelings and emotions.

Family members should be encouraged to support the patient.

Administer anti-anxiety medication as per prescription.

2. Altered sleep patterns

Objectives: To help the patient to improve his sleep pattern.

Nursing Interventions

The client’s sleep pattern should be assessed.

The patient should be encouraged to get 6-8 hours of sleep during the night

Providing a safe and calm environment to the client.

Anchoring relatives to stay close to the patient.

Provide the patient with a warm glass of milk before sleep.

Back massage and support should be provided to the patient.

Ask the client to bathe with warm water before sleep.

Ask the patient to read books of his choice.

Ask him to do some relaxation exercises.

Playing some music for a smooth effect on the client’s mind.

Encourage the client to attend to spiritual prayer.

Administer sedative medications as prescribed.

3. Impaired communication

Objectives: To improve patient’s communication and interaction with people.

Nursing Interventions

Assessing the patient’s level of communication and social interaction.

A friendly approach should be taken with the patient and proper communication should be done with the patient.

Encourage them to participate in group therapy to promote communication.

Spending time with patients and communicating with them in simple and understandable language.

Giving them opportunities for social interaction and providing a friendly environment.

Clients should be encouraged to engage in social interaction.

4. Reduces self-esteem and self-concept

Objectives :- The patient’s self-concept should be improved.

Nursing Interventions

Brief explanation for the activity and help the patient to identify his positive points.

Enhancing their sense of self by paying attention, empowering the patient to engage in activities he can do confidently.

Anchor the client to positive physical habits.

Teach the patient esteem-building exercises.

Do not put the patient in a difficult decision-making condition and relatives should also support the patient.

Opportunities to express feelings and emotions should be provided in the therapeutic relationship.

Administering medications as prescribed and checking for potential side effects of medications.

REHABILITATION OF SUBSTANCE ABUSE PATIENTS

When a person usually needs continued social support to function and live a normal life.

Available as inpatient units, comprehensive outpatients, day care centers and drug de-addiction centers.

Help them to quit the drug they are addicted to.

Occupational and Social Rehabilitation, Teaching Reflection Techniques, Religious Therapy

Make them aware that they can be helpful and respected too.

Encourage them to participate in self-help groups.

Help them lead a productive and respectful life.