1. SUBSTANCE ABUSE
Intake through various means or route of both legal
and illegal substances with the intention of
producing a different state of mind or overall
feeling.
Intake of substances to achieve brain-altering effect

2. SUBSTANCE ABUSE
PREVALENCE .....
DETRIMENTAL EFFECTS:
-Workplace injuries
-Motor vehicle accidents and
fatalities
-Domestic abuse, homicide, and
child abuse and neglect

3. Substance Abuse
14% of adults have an alcohol-related
disorder-
6.2% have a substance-related disorder
(excluding nicotine)
Children of alcoholics are 4 times more
likely than the general population to
develop problems with alcohol

4. TYPES OF SUBSTANCE ABUSE
CLASSES OF SUBSTANCE ABUSE
- Alcohol
- Amphetamines or similarly acting
sympathomimetics
- Caffeine
- Cannabis
- Cocaine
- Hallucinogens
- Inhalants
- Nicotine
- Opioids
- Phencyclidine (PCP) or similarly
acting drugs
-Sedatives, hypnotics, or anxiolytics
-Methamphetamine

5. SUBSTANCE ABUSE DEFINITIONS
Intoxication is use of a substance that
results in maladaptive behavior
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

6. SUBSTANCE ABUSE
Substance abuse is using a drug in a
way that is inconsistent with medical
or social norms
(WHO) A maladaptive pattern of substance
use leading to significant problems or distress
such as
- failure to attend school, work
- substance use in dangerous situations
(driving a car)
- substance-related legal problems
- continued substance use that interferes
with family relationships and friendships

7. DSM-IV Criteria for Substance Abuse
- Maladaptive pattern of substance use,
manifested by >1 of the following occurring
at anytime within a 12 month period
1. Recurrent substance use resulting in failure to
fulfill major obligations at work, school or home
2. Recurrent substance use in situations in which
it is physically hazardous
3. Recurrent substance –related legal problem
4. Continued substance use despite having
persistent social or interpersonal problems caused
by the substance

8. SUBSTANCE DEPENDENCE
Substance dependence includes
problems associated with addiction
such as tolerance, withdrawal, and
unsuccessful attempts to stop using
the substance
(WHO) Continued use of a
substance, despite its negative
consequences or even when
significant problems related to
its use have developed.

9. DSM-IV Criteria for Substance Dependence
Maladaptive pattern of substance use, manifested by
>3 of the following symptoms occurring at anytime
in the same 12 month period:
1. Tolerance
2. Withdrawal
3. Substance taken in larger amounts or longer
periods
4. Persistent desire, unsuccessful efforts to
control substance use
5. Much time spent in activities to obtain
substance
6. Important social, occupational, recreational
activities are given up because of substance use
7. Substance use is continued despite knowledge
of having physical or psychological problem that is
likely due to substance use.

10. Onset and Clinical Course
Typically begins with the first episode of
intoxication between 15 and 17 years of
age
More severe difficulties begin in the mid-20s to
mid-30s
- Alcohol-related breakup of a significant
relationship
- An arrest for public intoxication or
driving while intoxicated
- Evidence of alcohol withdrawal
- Early alcohol-related health problems
- Significant interference with functioning at
work or school

11. ONSET AND CLINICAL COURSE
BLACKOUT....
TOLERANCE....
TOLERANCE
BREAK...
ABSTINENCE OR TEMPORARY
CONTROLLED DRINKING...
... OR SPONTANEOUS
REMISSION......... (20%)

12. HIGHER RATES OF SUCCESSFUL RECOVERY:
PEOPLE WHO ABSTAIN
HIGHLY MOTIVATED TO
QUIT
HISTORY OF LIFE
SUCCESS

13. PROGNOSIS IS POOR WHEN:
EARLIER AGE AT
ONSET
LONG PERIODS OF
SUBSTANCE USE
CO EXIST WITH MAJOR
PSYCH ILLNESS

14. EXTENDED USE COULD CAUSE RISK IN....
MENTAL AND
PHYSICAL
DETERIORATION
INFECTIOUS
DISEASES

15. ETIOLOGY.......
Biologic factors
- Genetic vulnerability
- Neurochemical influences
Psychological factors
- Familial dynamics
- Coping styles
Social and environmental factors
- availability
- cultural factors
-social attitude
- peer behavior

16. 1. ALCOHOL (DEPRESSANT)
STANDARD DRINKS - ALCOHOL

17. The Alcohol Use Disorders Identification Test:
0 1 2 3 4
1. How often do you
have a drink
containing
alcohol?
never Monthly
or less
2-4x a
month
2-3x a
week
4 or
more
times a
week
Please skip to Questions 9 and 10 if reply to Question 1 is
NEVER, or if both answers to Q 2 and 3 are 0.

18. The Alcohol Use Disorders Identification Test:
0 1 2 3 4
2. How many drinks
containing alcohol do
you have on a typical
day when you are
drinking?
1-2
drinks
3-4
drinks
5-6
drinks
7,8 or 9
drinks
10 or
more
drinks
3. How often do you have
six or more drinks on
one occasion?
never less than
monthly
monthly weekly daily or
almost
daily

19. AUDIT:
0 1 2 3 4
4. How often during the
last year have you
found that you were
not able to stop
drinking once you had
started?
never less than
monthly
monthly weekly daily or
almost
daily
5. How often during the
last year have you
failed to do what was
normally expected
from you because of
drinking?
never less than
monthly
monthly weekly daily or
almost
daily

20. AUDIT:
0 1 2 3 4
6. How often during the
last year have you needed
a first drink in the
morning to get yourself
going after a heavy
drinking session?
never less than
monthly
monthly weekly daily or
almost
daily
7. How often during the
last year have you had a
feeling of guilt or remorse
after drinking?
never less than
monthly
monthly weekly daily or
almost
daily

21. AUDIT:
0 1 2 3 4
8. How often during the
last year have you been
unable to remember what
happened the night
before because you had
been drinking?
never less than
monthly
monthly weekly daily or
almost
daily

22. AUDIT:
0 2 4
9. Have you or
someone else been
injured as a result of
your drinking?
No, never Yes, but not
in the last
year
Yes, during
the last year
10. Has a relative or
friend or a doctor or
another health worker
been concerned about
your drinking or
suggested you cut
down?
No, never Yes, but not
in the last
year
Yes, during
the last year

23. AUDIT:
Risk Level Intervention AUDIT
score
Zone I – Low-risk drinking or
abstinence
Alcohol Education 0-7
Zone II – Alcohol use in
excess of low-risk guidelines
Simple Advice 8-15
Zone III – Harmful and
hazardous drinking
Simple Advice +
brief counseling &
cont’d. monitoring
16-19
Zone IV – Alcohol Dependent Refer to specialist
for Evaluation and
Treatment
20-40

24. ALCOHOL
Central nervous system depressant.
Intoxicated: relaxed, loss of inhibitions, slurred speech,
unsteady gait, impaired attention, aggressive , and
inappropriate behavior.
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
Alcohol withdrawal usually peaks on the second day and
is over in about 5 days

25. Withdrawal symptoms include:
Coarse hand tremors, irritability, heightened
alertness, jerky movements, numbness,
tremors, sweating, elevated pulse and
blood pressure, insomnia, anxiety, and
nausea or vomiting
Severe or untreated withdrawal may
progress to transient hallucinations,
illusion,seizures, or delirium—called
delirium tremens (DTs)
Benzodiazepines used for detoxification tx:
Lorazepam (Ativan), chlordiazepoxide
(Librium), or diazepam (Valium) suppress
the withdrawal symptoms

26. ADDICTION RESEARCH FOUNDATION- CIWA- AR
or CLINICAL INSTITUTE WITHDRAWAL
ASSESSMENT FOR ALCOHOL, REVISED
Less than 8= mild withdrawal
8- 15 = moderate
withdrawal
Greater than 15 = severe
withdrawal

27. TREATMENT AND NSG INT.FOR ALCOHOLISM:
- ANTABUSE (Disulfiram)
1. DETOXIFICATION
- PREVENT SUICIDE
- PREVENT CONVULSION/ SZ
- PROVIDE WELL LIGHTED ENVIRONMENT
- ESTABLISH NUTRITIONAL STATUS
- Vitamin B1 (thiamine) to prevent or to treat
- Wernicke’s syndrome and Korsakoff’s
syndrome
- Cyanocobalamin (vitamin B12) and folic acid for
nutritional deficiencies
2. REHABILITATION

28. 1. DEPRESSANTS- reduce
nervous activity thus decrease
body function
1. Narcotics Opiates, opioids- drugs
that relieve pain
2. Sedatives Hypnotics, sleeping pills
3. Tranquilizers Produce emotional
calmness and relaxation
4. Volatile Substances “solvents”

29. Examples of Narcotics: (for pain)
1.Demerol
2.Morphine SO4
3.Heroine- prohibited
4.Codeine- found in cough syrups
5.Opium- prohibited
6.Methadone

30. Narcotics (for pain)Intoxication and
Withdrawal
INTOXICATION:
1. DROWSINESS
2. SLURRED SPEECH
3. IMPAIRED ATTENTION/
MEMORY
4. ANALGESIA
5. DECREASE SEXUAL
DRIVE
6. HYPOACTIVITY
SWEATING
- NARCAN (NALOXONE)-
ANTIDOTE (OPIOID)
- Stopped here........
WITHDRAWAL(8-12 hours
after last dose) :
1. INSOMNIA
2. YAWNING
3. CRAVING FOR THE
DRUG
4. NAUSEA, VOMITING,
AND DIARRHEA
5. MUSCLE ACHES
6. LACRIMATION,
RHINORRHEA (FEVER)
7. PUPILLARY
DILATATION

31. Examples of the sedatives (to induce sleep):
1.Barbiturates
- Phenobarbital (Luminal)
- Secobarbital (Seconal)
- Amobarbital (Amytal)
2. Non- barbiturates
- Stilnox
- Dalmane
- Dormicum

32. Examples of Tranquilizers (produce
calmness and relaxation) :
1.Minor Tranquilizers- anxiolytic; anti-anxiety drugs
Examples:
- Valium and Anxionil – diazepam
- Ativan- lorazepam
- Xanax- Alprazolam
- Librium- chlordiazepoxide
- Serax- oxazepam
- Tranxene- chlorazepate
- Equanil- meprobamate Hcl
2. Major Tranquilizers- antipsychotics
- Thorazine, Haldol, Nozinan and Mellaril or Melleril

33. SEDATIVES AND ANXIOLYTICS INTOXICATION
AND WITHDRAWAL: 6-8 hrs.- 1 week
1.Slurred speech
2.Unsteady gait
3. Impaired attention
and memory
1.Nausea and
vomiting
2.Malaise/ weakness
3.Anxiety
4.Irritability
5.Hypersensitivity to
light and sound
6.Coarse tremors
7.Marked insomnia
8. inc. VS
9. seizures and
hallucinations

34. Narcotics, Sedatives, Tranquilizers,
and Anxiolytics
Central nervous system depressants
- Benzodiazepines alone, when taken
orally in overdose, are rarely fatal, but
the person will be lethargic and
confused
- Barbiturates, can be lethal when
taken in overdose. They can cause
coma, respiratory arrest, cardiac
failure, and death

35. Examples of Volatile Substance/ INHALANTS
1.Rugby
2.Acetone
3.Thinner
4.Paint
5.Vicks inhaler
6.White flower
7.Nail polish

36. INHALANTS:
Overdose:
Anoxia, respiratory depression, vagal stimulation,
and dysrhythmias
Death may occur from bronchospasm, cardiac
arrest, suffocation, or aspiration of the
compound or vomitus
People who abuse inhalants may suffer from
persistent dementia or inhalant-induced
disorders such as psychosis, anxiety, or mood
disorders even if the inhalant abuse ceases
Withdrawal symptoms: none
Treatment:
Supporting respiratory and cardiac functioning
until the substance is removed from the body

37. 2. STIMULANTS:
1. Shabu Methamphetamine
HCL- poor man’s
cocaine
2. Cocaine Cocaine, coke, C,
snow,
Crack (hard form of
cocaine)
3. Amphetamines Diet pills

38. Stimulants intoxication and withdrawal:
1. Restlessness
2. Nervousness
3. Tirelessness
4. Insomnia
5. Anorexia
6. Weight loss
7. Hallucinations
8. Suspiciousness
9. Dilated pupils (shabu
and cocaine)
10.Muscle fasciculation
11.Nasal perforation,
epistaxis b/c of
ulceration in the nasal
mucosa
1. Dysphoria
2. Fatigue
3. Sleep DO
4. Agitation
5. Craving
6. unpleasant dreams
7. increased appetite
8. psychomotor retardation
or agitation
9. “crashing”--the person
may experience
depressive symptoms,
including suicidal
ideation, for several days

39. 3. HALLUCINOGENS
1.Marijuana- cannabis sativa ; maryjane. Pot,
grass, jules
2.LSD – LySergic Diethylamide (acid)
Excessive use of cannabis may produce delirium or
cannabis-induced psychotic disorder; overdoses of
cannabis do not occur
Withdrawal symptoms:
Insomnia, muscle aches, sweating, anxiety, and
tremors. Effects are treated symptomatically
Hallucinogens can produce flashbacks that may
persist for a few months up to 5 years.

40. Assessment
History: chaotic family life, family history,
crisis that precipitated treatment
General appearance and motor behavior:
depends on physical health; likely to be
fatigued, anxious
Mood and affect: may be tearful
(expressing guilt and remorse), angry,
sullen, quiet, unwilling to talk
Application of the Nursing Process: Substance
Abuse (cont’d)

41. Thought processes and content: minimize
substance use, blame others for problems,
rationalize their behavior, say they can quit
on their own
Sensorium and intellectual processes: alert
and oriented; intellectual abilities intact
(unless neurologic deficits from long-term
alcohol or inhalants)
Judgment and insight: poor judgment while
intoxicated and due to cravings for
substance; insight limited
Application of the Nursing Process: Substance
Abuse (cont’d)

42. Self-concept: low self-esteem, feels
inadequate at coping with life
Roles and relationships: strained
relationships and problems with
role fulfillment due to substance
use
Physiologic considerations: may have
trouble eating and sleeping; HIV
risk if IV drug user
Application of the Nursing Process: Substance
Abuse (cont’d)

43. Treatment is based on the concept that
alcoholism and drug addiction are medical
illnesses: chronic, progressive, characterized
by remissions and relapses
Treatment models include:
The Hazelden Clinic model
12-step program of Alcoholics Anonymous
(AA)
Individual and group counseling
Substance Abuse Treatment

44. TWELVE STEPS OF ALCOHOLICS 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.

45. TWELVE STEPS OF ALCOHOLICS ANONYMOUS
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.

46. Pharmacologic Treatment
2 main purposes:
To permit safe withdrawal from alcohol,
sedative/hypnotics, and benzodiazepines
Prevent relapse

47. Pharmacologic Treatment (cont’d)
Safe withdrawal from alcohol involves:
Benzodiazepines to suppress withdrawal symptoms-
Lorazepam, chlordiazepoxide, and diazepam
Antipsychotics- Chlorpromazine (to reduce anxiety-
tremor state and prevent more serious withdrawal
symptom
Vitamin B1 (thiamine) to prevent or to treat Wernicke’s
syndrome and Korsakoff’s syndrome (food rich in
thiamine, lean pork, organ meat, nuts)
Cyanocobalamin (vitamin B12) and folic acid for
nutritional deficiencies

48. Pharmacologic Treatment (cont’d)
Relapse prevention involves:
Disulfiram (Antabuse)
Acamprosate (Campral)
Methadone
Naltrexone (ReVia)
Clonidine (Catapres)
Ondansetron (Zofran)
Propanolol (Inderal)
Topiramate (Topamax)

49. Data analysis
Nursing diagnoses common to physical health
needs include:
oImbalanced nutrition: less than body
requirements
oRisk for infection
oRisk for injury
oDiarrhea
oActivity intolerance
oSelf-care deficits
Application of the Nursing Process:
Substance Abuse (cont’d)

50. Data analysis (cont’d)
Nursing diagnoses common to
psychosocial health needs include:
oIneffective denial
oIneffective role performance
oInterrupted family processes:
alcoholism
oIneffective coping
Application of the Nursing Process: Substance
Abuse (cont’d)

51. Outcomes
The client will:
oAbstain from alcohol/drugs
oExpress feelings openly and directly
oAccept responsibility for own behavior
oPractice nonchemical alternatives to deal
with stress or difficult situations
oEstablish an effective aftercare plan
Application of the Nursing Process: Substance
Abuse (cont’d)

52. Intervention
Providing health teaching for client and
family
Addressing family issues:
oCodependence
oChanges in roles
Promoting coping skills
Application of the Nursing Process: Substance
Abuse (cont’d)