Test 1 - Substance abuse Flashcards
Wrongful or harmful use, improper treatment which may result in injury
abuse
Need is so strong it may result in physical or or psychological distress if no obtained
dependence compulsive/CHRONIC requirement
Physiological and mental redajustment that accompanies discontinuation of an addictive substance. Reduction or discontinuation of the substance = physical & psychological changes in thinking, feeling and behavior.
withdrawal
A physical or mental state of exhilaration and emotional frenzy or lethargy and stupor. Reversible syndrome, symptoms are substance specific, have direct effect on CNS, judgement is disturbed, social/occupational function is disturbed.
intoxication
use of psychoactive drugs that poses significant hazards to health and interferes with social, occupational, psychological or physical functioning such as work home school issues (in a 12 month period)
Substance abuse
-Hallmark is loss of control. -can be physical or psychological. -tolerance is developed -no desire to change -INABILITY TO STOP -a lot of time spent trying to get substance -flashbacks and synergistic effects
substance dependence/addiction psychological dependence… substance perceived as necessary to maintain optimal state of personal well being
_____ ______ is when a person has become tolerant to one family of chemicals, and becomes tolerant to the effects of other similar drugs. (one drugs results in lessened response to another).
cross tolerance
What is cross dependence?
one drug prevents withdrawals symptoms associated with a diff drug (such as using methadone instead of heroine)
NCLEX Q: A LONG TERM alcoholic arrives in the ED. The healthcare provider orders 1 mg Ativan PO. What is the expected outcome? A. Decreased effect d/t cross tolerance B. Decreased effect d/t cross dependence
A. Ativan is similar to alcohol therefore would not be effective for this patient.
T or F: There is a genetic component to substance use disorders
Per out text: Yes. Children of alcoholics are 3-4x more likely to use. Biochemical - the brain produces morphine like substances and relates to the possibility that the brain is responsible for alcohol addiction.
T or F: Freud would blame addiction on the unconscious mind and say we were stuck in the oral phase.
True. He would state that the person has a punitive superego. In psychoanalytical: -oral phase -parental inconsistency -regressed, fixated -LEAST ACCEPTED THEORY Aye.
Can personality be a predictor for addiction?
Although certain personality characteistics have been found to accompany addiction, it is not a predicter. Characteristics include: low self-esteem, frequent depression, passivity, the inability to relax or to defer gratification, and the inability to communicate effectively are common in individuals who abuse substances
Many substances create a pleasurable experience that encourages the user to repeat it. This is called…
conditioning The person drinks once, feels good, wants it again….
What would socio-cultural theory determine as reasons for substance abuse disorder?
SOCIO CULTURAL -social forces (peer pressure, modeling - coworkers drinking socially) -Ethinicity (irish stereotype, french have wine with dinner, etc)
What would family system theory determine as reasons for substance abuse disorder?
-Addiction serves family purpose, to shift focus away from family issues. -Causes within family - rigid roles, closed system and family secrets (abuse, molestation) -Partners may be codependent
T or F: Alcohol is a CNS stimulant.
False. It is a depressant. Effect of ETOH is relative to amount consumed.
T or F: A person may experience minor withdrawal after 2-3 days.
False. Minor withdrawal after 4-12 hours Major withdrawal after 2-3 days
Symptoms of minor withdrawal from alcohol include:
-anxiety -agitation/irritability -NV
Symptoms of major withdrawal from alcohol include:
-HTN -Tachycardia -Confusion -Tremors -hallucinations -seizures -Delerium LIFE THREATENING
What are the four phases of the alcoholic? Describe each.
Phase 1 - Pre-alcoholic: Using to relieve everyday stress (a glass of wine after work a day). Tolerance develops (turns into 2 glasses of wine a day and so on…)
Phase 2 - Early alcoholic: GUILTY FEELINGS, DEFENSIVE, DENIAL and RATIONALIZATION, BRIEF BLACKOUTS.
ETOH is REQUIRED (you can no longer take it or leave it after work, you must or else! Start to sneak drinks, are preoccupied with drinking and make sure you have constant supply. No more sipping, but gulping instead. Mental dependence)
Phase 3 - Crucial phase: LOSS OF CONTROLand PHYSICAL DEPENDENCE, ANGER & AGGRESSION. LOSING EVERYTHING.
Binge drinking. Anger, aggression, loss of consciousness. Person is willing to lose everything in an effort to maintain addiction. Commonly by this point one has lost a job, marriage and friends.
Phase 4 - Chronic phase: HELPLESSNESS & SELF PITY. ABSTAINING LEADS TO MAJOR WITHDRAWAL. emotional & physical disintegration (evidenced by profound helplessness and self-pity), intoxicated more often than sober.
We can use CAGE to assess patients. What is CAGE?
C- Cut down: have you ever felt the need to cut down on your drinking? A- Annoyed: Have people annoyed you by criticizing your drinking? G- Guilty: Have you ever felt guilty about drinking? E- Eye opener: Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? Two “yes” responses indicate that the possibility of alcoholism should be investigated further. (Although some clinicians think yes to E is enough!)
What are the behaviors of a codependent?
The concept of codependency came out of a need to define the dysfunctional behaviors that are evident among members of a fam with a chemically addicted person. “Co dependence has been called a dysfunctional relationship with oneself.” -CoD person is able to achieve sense of control through fulfilling needs of others -Tries to control events around them -Rescues/blames addict -Focus thoughts/behaviors on other people -People pleasers -Competent on outside, helpless inside. -Denies that a problem exists PAGE 403
What are the four stages of treatment for codependency?
Stage 1 - Survival: Let go of denial
CoD person must let go of the denial that problems exist or that their abilities are unlimited (there is a prob and their abilities are limited).
Stage 2 - Reidentification: sees self, be accountable
Reidentification happens when the CoD is able to catch a glimpse of their true self and break the denial. Accept that one’s behavior is dysfunctional. Accepts ones limitations to deal. Re-identify with reality.
Stage 3 - Core Issues: see truth, become autonomous
CoD must accept that relationships can’t be held together by will. Each person in relationship must be autonomour and independent. Must detach from trying to control beyond their own power (can’t change the addict, can fix all the problems)
Stage 4 - Reintegration: gains integrity, personal power/spirutual consciousness, self discipline.
Stage of self acceptance and willingness to change. Reclaim personal power and relinquish power over others (worry about you and not the addict).
_____ represents the most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. Without replacement of thiamine, death WILL occur.
Wernicke’s Physical
__________ is identified by confusion, recent loss of memory, and confabulation (memory disturbance - product of fabricated, distorted or misinterpreted memories about oneself WITHOUT intention to deceive)
Korsakoffs Mental
What are foods that contain thiamine?
As a rule of thumb, legumes and vegetables are the richest whole food sources of vitamin B1. Nuts and seeds can also be concentrated in vitamin B1. broccoli, onions, green beans, summer squash, carrots, kale, and tomatoes, green peas, beet greens, Brussels sprouts, spinach, cabbage, eggplant, romaine lettuce, and crimini mushrooms, asparagus. Very good sources of vitamin B1 in the seeds group include sunflower seeds and flax seeds. Good sources in the legume group include navy, black, pinto, lima, and kidney beans, as well as lentils and dried peas.
Meats listed were ham and salami
What are the steps used to medically treat alcoholism? detox?
Alcoholism….. 1. Monitor VS (remember withdraw includes HTN, Tachy) 2. Fluid status/I&Os (over/under hydrated.. although drinking a large quantity of alcohol/fluid it can cause severe dehydration…for you science nerds…Firstly, alcohol decreases the body’s production of anti-diuretic hormone, which is used by the body to reabsorb water. With less anti-diuretic hormone available, your body loses more fluid than normal through increased urination.) 3. Magnesium Sulfate give to prvent seizures (phenytoin - Dilantin given if prior sz hx) 4. Thiamine must be given along with other vitamins 5. Banana bag - vitamins/minerals (contains thiamine,folic acid, magnesium sulfate, etc) 6. Benzos to prevent Sz and DT** …preferred chlordiazepoxide (librium) and diazepam (Valium)…Buspar for LT use Detox (All of the above PLUS the following) 7. Provide sitter if necessary 8. Point out reality - explain that hallucinations are expected. The more you educate the lower the pt’s anxiety will be. 9. Adjust lighting to prevent shadows (which could end up causing illusions/hallucinations) 10. Do NOT restrain (can cause aspiration, agitation and additional anxiety) **Delerium Tremens - a psychotic condition typical of withdrawal in chronic alcoholics, involving tremors, hallucinations, anxiety, and disorientation.
