Overview
This lecture reviews the assessment, care, and treatment of substance-related and addictive disorders, focusing on different substance classes, intoxication and withdrawal symptoms, and evidence-based nursing interventions.
Substance Use and Addictive Disorders: Overview
- Substance use disorders (SUD) are chronic, relapsing conditions with cravings, impaired control, and negative impacts on functioning.
- Co-occurring psychiatric disorders and SUD are often treated simultaneously.
- Addiction is a chronic disease influenced by environment, genetics, neurotransmission, and experiences.
Psychoactive Substance Classes
- Psychoactive substances include alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, and stimulants.
- Non-substance (behavioral/process) addictions include gaming, social media, shopping, and sexual activity.
Substance-Specific Information
Caffeine
- Most widely used stimulant; not an official use disorder but can cause problems.
- Intoxication: ≥250mg may cause cardiac arrhythmias, hypertension, or rarely, seizures.
- Withdrawal: Headache, irritability, drowsiness.
Cannabis
- Third most commonly used psychoactive drug; active ingredient is THC.
- Intoxication: Heightened senses, slowed time/movement, red eyes, increased appetite, tachycardia.
- Withdrawal: Irritability, aggression, anxiety, insomnia, not life-threatening.
- Long-term use: Amotivation, impaired memory, lethargy.
Hallucinogens & Dissociatives
- Includes LSD, psilocybin, ketamine, PCP (dangerous, can cause violence).
- Intoxication: Distorted reality, hallucinations, paranoia, increased vital signs.
- No physical withdrawal; focus care on psychological support and safety.
Inhalants
- Common among youth; includes adhesives, aerosols, gas.
- Risks: Sudden sniffing death (cardiac arrhythmia), anoxia, brain damage.
- Intoxication: Disinhibition, euphoria, impaired judgment, hallucinations.
Opioids
- Includes heroin, oxycodone, fentanyl.
- Intoxication: Drowsiness, slurred speech, pinpoint pupils, slowed GI and respiratory function.
- Overdose: Pinpoint pupils, respiratory depression, coma; treat with naloxone.
- Withdrawal: Aches, nausea, diarrhea, not life-threatening but extremely unpleasant.
CNS Depressants (Benzodiazepines, Barbiturates)
- Intoxication: Slowed function, slurred speech, impaired coordination.
- Withdrawal: Autonomic hyperactivity, tremors, anxiety, seizures; taper to discontinue.
- Overdose: Life-threatening; manage airway, supportive care, flumazenil for benzodiazepines.
Stimulants (Amphetamines, Cocaine)
- Intoxication: Increased energy, euphoria, decreased appetite, dilated pupils.
- Withdrawal: Depression, fatigue, anxiety, cravings; risk for suicide.
- Methamphetamine: Chronic use damages brain, causes dental issues, psychosis.
Tobacco/Nicotine
- Highly addictive; withdrawal causes irritability, anxiety, strong cravings.
- Treatments: Bupropion, varenicline, nicotine replacement (patch, gum).
Club Drugs
- Includes MDMA, bath salts, usually used for euphoric effects in social settings.
- May cause hallucinogenic symptoms; rarely physical withdrawal.
Evidence-Based Interventions & Nursing Care
- Use therapeutic communication; prioritize safety (especially in hallucination or aggressive intoxication).
- Nursing care includes airway support, medication as indicated, and supportive withdrawal management.
- Promote psychotherapy, group therapy, and family involvement.
Key Terms & Definitions
- Addiction — Chronic, relapsing brain disease with compulsive substance use despite harm.
- Tolerance — Needing increased substance amounts for the same effect.
- Withdrawal — Symptoms that occur after stopping or reducing a substance.
- Intoxication — Acute effects of substance on the mind and body.
- Process Addiction — Compulsive engagement in non-substance-related behaviors.
Action Items / Next Steps
- Read Chapter 22 (pp. 406–428) in Halter, Chapter 8 (pp. 56–71) in McCuistion.
- Reference tables 22.1 and 8.3 for drug details.
- Review safety and withdrawal protocols for each substance class.
- Prepare for exam questions on symptoms, treatment, and nursing interventions.