Week 5 - Substance use disorders Flashcards
(31 cards)
Define Substance Use Disorder
Substance use disorder is the harmful and hazardous use, addiction and dependence on a substance, and is characterised by continued use and impaired control of the substance use, despite significant health consequences
Differentiate between harmful and hazardous substance use
Hazardous - has the potential for physical, psychological and social consequences
* MVA
* violence
Harmful - a pattern of substance use that is dangerous to health
* hepatitis from injecting
* liver disease
* depression
Differentiate between addiction and dependence
Addiction - use which causes changes to brain circuitry that persists after detoxification. These changes lead to chronic compulsive drug seeking and use
relates to a compulsion to use
Dependence - A behavioural, psychological and cognitive controlling urge to use substances after repeated use
relates to the bodys adaptation to long term misuse
*leads to withdrawal syndrome and tolerance
Alcohol
Depressant - decreases CNS activity
Physiological
* impaired coordination
* slurred speech
* N+V
* drowsiness
* blackouts
Psychological
* impaired decision making
* increased confidence
* impaired memory
Cannabis
Depressant - decreases CNS activity
Physiological
* tachycardia
* bloodshot eyes
* diminished psychomotor performance
Psychological
* relaxation
* euphoria
* drowsiness
* enhancement of senses
* pain relief
* increased appetite
Stimulants
Stimulants - stimulate CNS activity
Physiological
* overstimulation
* tachycardia and hypertension
* increased RR
* dry mouth
* jaw clenching and teeth grinding
Psychological
* euphoria
* confidence
* energy
* alertness
* talkative
Opioids
Depressant - decreases CNS activity
Physiological
* drowsiness
* sedation
* decreased RR
* nausea and vomiting
* high risk of overdose due to resp depression
Psychological
* euphoria
* tranquility
* apathy
* memory impairment
The spectrum of substance use
abstinent -> experimental -> recreatonal -> regular -> dependent
Physiology of addiction
- The potency of substances stimulates the dopaminergic and endorphin reward pathways in the brain
- creates euphoria and motivation
- faster and more intense reward than other behaviours -> positive reinforcement of this behaviour -> excessive use
Explain dependence
Suggestive of more severe SUD
However
important to consider dependence without an SUD
* dependence on morphine for pain management
* they will experience withdrawal if abruptly ceased, but do not experience a compulsion
Explain tolerance
repeated chronic use of an illicit substance overstimulates the reward pathway
after a while, the body adjusts to excessive dopamine production and decreased high
person now requires increased dose to achieve same effect
tolerance may extend from a decreased pleasure in substance use to decreased pleasure in other areas eg. sex, eating
Explain withdrawal
refer to withdrawal syndrome
Biological causes of substance use disorders
Genetic vulnerability
Men
* brain development means they are more likely to develop AUD
Women
* more likely to experience harm from alcohol use
* reduced ability to metabolise alcohol
* vulnerability to sexual assault
Adolescence
* substance use in adolesence can compromise pre-frontal cortex development (last part of the brain to develop)
* responsible for executive functioning
Environmental causes of substance use disorders
Adolescence
* parents substance misuse
* increased risk taking behaviour, criminality, relationships
* peer pressure
* family dynamic
* abuse and trauma
Exposure to stress
cultural norms
SES
* employment
* education
* where you live
* your own relationships
* availability of substances
High risk populations
culture, high risk aus populations, religion, SES
Aboriginal and torres strait islander people, people living in rural and remote communities, and LGBTQI+ communities are more likely to consume more substances and experience substance related harm
Alcohol use disorder and consequences
A problematic pattern of alcohol usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Consequences include
* CV disease
* liver disease
* obesity
* Wernickes encephelopathy
* mood disorderws
* suicide and violence
Cannabis use disorder and consequences
A problematic pattern of cannabis usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Consequences include
* Chronic resp symptoms and lung cancer
* cognitive problems
* appetite problems
* systemic problems in CV, immune, reproductive, neuromuscular systems
* exacerbation and emergence of a range of mental health issues eg. depression, anxiety, bipolar, psychosis, suicide
Stimulant use disorder and consequences
A problematic pattern of stimulant usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Complications include
* liver and kidley failure
* cardiopulmonary problems
* respiratory problems (snorting)
* blood borne viruses and infection (injecting)
* tooth decay
* development of other mental health issues eg. anger, anxiety/panic
Opioid use disorder and consequences
A problematic pattern of opioid usage leading to significant impairment or distress
* impaired control over usage
* social impairment due to usage
* craving
* effort to obtain
* recurrent use
* excessive use
* unsuccessful efforts to cut down
encompassing harmful and hazardous use, addiction and dependence with a continued use despite significant health impacts
Complications include
* nausea
* constipation
* amenorrhea
* CV and resp problems related to sedation
* Blood borne viruses, infections, and ‘track marks’ related to IV
Wernickes encephalopathy
excessive and prolonged alcohol misuse -> depletion of vitamin B1 which is essential for CNS function
results in necrotic lesions on the brain stem
Symptoms (only one required for diagnosis)
* confusional state
* ocular disturbance
* ataxia - wide based steps
Nursing management
* reverse condition with IM B1 injection
Delerium tremens
A severe form of alcohol withdrawal in heavy user. Medical emergency
1-5 days post withdrawal
Symptoms
* disorientation
* agitation
* labile blood pressure
* hallucinations
* nightmares
Nursing management
* manage agitation
* administer benzodaizepines to prevent seziures and death
* monitor vital signs
* assess withdrawal symptoms
* reorient person
* manage anxiety
* rehydrate
Overdose and opioids
Opioids cause CNS depression and affect the part of the brain that regulates breathing
Signs of overdose
* cyanosis
* vomiting
* pinprick pupils
* slow respiration
* loss of consciousness
* pale and limp
Nursing management
* Naloxone administration and resus
Overdose risk is increased when mixing with other drugs
Suicide
risk increases with substance use and again when in the presence of a mental health condition
Intentional and unintentional
Assessing for substance use in MSE and risk assessment is essential in deciding on risk of suicide
During pregnancy
- impacts foetal development
- impacts birth
- poor prenatal and postnatal care outcomes
- Mother at risk of PND or PPP
