Substance Abuse: Opioid Abuse

Opioid is a chemical substance that has a morphine-like action in the body. It is use mostly for pain relief. Opioid works by binding to opioid receptors in the central nervous system and the gastrointestinal tract. The receptors in these two organ systems mediate both the beneficial effects, and the undesirable side effects.

Classes of opioids:

1. natural opiates, alkaloids contained in the resin of the opium poppy including morphine, codeine and thebaine, but not papaverine and noscapine which have a different mechanism of action;
2. semi-synthetic opiates, created from the natural opioids, such as hydromorphone, hydrocodone, oxycodone, oxymorphone, desomorphine, diacetylmorphine (Heroin), nicomorphine, dipropanoylmorphine, benzylmorphine and ethylmorphine;
3. fully synthetic opioids, such as fentanyl, pethidine, methadone, tramadol and propoxyphene;
4. endogenous opioid peptides, produced naturally in the body, such as endorphins, enkephalins, dynorphins, and endomorphins.

Effect of Substance:
Temporary sense of well being, drowsiness, poor coordination, light-headedness, impaired thought processes, memory difficulty, confusion

Effect of Withdrawal:

Anxiety, gastrointestinal distress, nausea, insomnia, muscle pain, fever and chills, runny nose and eyes, sweating, tachypnea, coma, pintpoint pupils

Treatment:

• Detoxification
• Drugs: Opiate antagonis naloxone (Narcan) IV in emergency situation.
• In morphine and heroin addicts can use methadone daily to stabilize patient.
• In other opioid addicts, slowly taper the abused opioid.
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain airway
• Maintain safety
• Do not leave patient unattended because of risk of lapsing into coma quickly
• Monitor and assess for pulmonary edema
• Monitor vital sign and neurologic status and report to physician any abnormal redings
• Provide a quiet environment
• Encourage patient to express fears and anxiety

Substance Abuse: Nicotine Abuse

Nicotine is the drug in tobacco leaves. It a poisonous volatile alkaloid derived from tobacco (Nicotiana spp.) and responsible for many of the effects of tobacco. It first stimulates (small doses), then depresses (large doses) at autonomic ganglia and myoneural junctions.

Nicotine in inhaled tobacco smoke or in smokeless tobacco applied to buccal or nasal mucosa enters the circulation within seconds, causing an increase in heart rate, ventricular stroke volume, and myocardial oxygen consumption, as well as euphoria, heightened alertness, and a sense of relaxation. Nicotine use is powerfully addictive, readily leading to habituation, tolerance, and dependency. Withdrawal from nicotine causes restlessness, irritability, anxiety, difficulty concentrating, and craving for nicotine. Addiction to nicotine is the reason for most tobacco use and is thus directly responsible for the resulting morbidity and mortality.

Nicotine: Tobacco smoking, chewing, and dipping.


Effect of Substance:
Mild euphoria, feeling of relaxation, anorexia, hypertension, tachycardia

Effect of Withdrawal:
Restlessness, irritability, difficulty in concentrating, depression, insomnia, increased appetite, weight gain

Treatment:

• Detoxification
• Drugs: nicotine gum, nicotine nasal sprays, and nicotine patches.
• Behavior therapy
• Psychotherapy
• Support groups

Nursing Intervention:

• Maintain safety
• Monitor vital sign and neurologic status and report to physician if any abnormal readings
• Provide support to patient, family, and significant others
• Encourage patient to express fears and anxiety

Substance Abuse: Methamphetamines

Methamphetamine is a member of the family of phenylethylamines. Methamphetamine acts as a dopaminergic and adrenergic reuptake inhibitor and in high concentrations as a monamine oxidase inhibitor (MAOI). Since it stimulates the mesolimbic reward pathway, causing euphoria and excitement, it is prone to abuse and addiction.

Methamphetamines: amphetamine (Benzedrine), dextroamphetamine (Dexedrine), MDMA (Ecstasy), methylphenidate (Ritalin)

Effect of Substance:
Increased attention, increased activity, decreased fatigue, decreased appetite, euphoria, hyperthermia, tachycardia

Effect of Withdrawal:

Insomnia, restlessness, irritability, panic, paranoia, confusion, homicidal behavior, depression with suicidal ideation, hallucination, vomiting, nausea, chills

Treatment:

• Detoxification
• Drugs: small doses of diazepam IV or haloperidol to combat CNS hyperactivity
• Treat seizure with benzodiazepines
• Activated charcoal for overdose
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain airway
• Maintain safety
• Monitor for suicide attempts
• Calm, cool, and quiet environment
• Monitor vital signs and neurologic status and report to physician if any abnormal readings
• Encourage patient to express fears and anxiety

Substance Abuse: Cocaine Abuse

Cocaine is a crystalline alkaloid obtained from the leaves of Erythroxylon coca (family Erythroxylaceae) and other species of Erythroxylon, or by synthesis from ecgonine or its derivatives.

Cocaine is a potent central nervous system stimulant, vasoconstrictor, and topical anesthetic, widely abused as a euphoriant and associated with the risk of severe adverse physical and mental effects.

Cocaine: cocaine hydrochlororide (sniffed) free-base cocaine (smoked), crack cocaine (small rocks that are smoked), cocaine that may be injected intravenously

Effect of Substance:

Euphoria, risk taking behavior, feeling of confidence, anorexia, inappropriate sexual behavior, tachycardia, tachypnea, nervousness, hypertension, dilated pupil, agitation, fever, inability to concentrate.

Effect of Withdrawal:
Psychosis, delusion, hallucinations, paranoia, depression, ideas of persecution, aggressiveness, tremor, hypervigilance, insomnia, fatigue, muscle pain, nausea, vomiting, general malaise, suicidal ideation

Treatment:
Detoxification
Drugs: antidepressant, antipsychotic
Charcoal to treat ingested cocaine
Behavior therapy
Psychotherapy
Halfway houses
Day or night hospitalization
Twelve-step support groups

Nursing Intervention:
Maintain and ensure the airway and ventilation
Maintain safety
Monitor and assess patient for using of alcohol and benzodiazepine
Control seizure
Treat hyperthermia
Monitor cardiovascular status
Quiet environment
Encourage patient to express fears and anxiety

Substance Abuse: Benzodiazeipnes

The benzodiazepines are a class of psychoactive drugs with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are mediated by slowing down the central nervous system. The drugs are useful in treating anxiety, insomnia, agitation, seizures, and muscle spasms, as well as alcohol withdrawal. Using of benzodiazepines in long term can cause physical dependence.

Types of Benzodiazepines are Diazepam (Valium) and Lorazepam (Ativan)

Effect of Substance:
Sleepiness and deep sleep, poor coordination, slurred speech, falling, poor thought processes, memory difficulty, weak comprehension, poor judgment, mood swings, constricted pupils, nystagmus, and tachypnea.

Effect of Withdrawal:

Anxiety, rage, insomnia, panic attacks, depression, night-mares, nausea, constipation, diarrhea, shaking, muscle pain, sweating, tachycardia, paresthesia, seizure, and death if combine with alcohol.

Treatment:

• Detoxification
• Drugs: antagonist fumezenil (Romazicon), slowly taper the abused benzodiazepine.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support group

Nursing Intervention:

• Maintain safety
• Monitor vital sign and neurologic status and notify physician if abnormal readings
• Monitor for alcohol abuse
• Monitor for dysrhythmias
• Encourage patient to express fears and anxiety, Provide a quiet environment
• Implement seizure precaution

Substance Abuse: Barbiturate

Barbiturates are a group of drugs known as sedative-hypnotics, which generally describes their sleep-inducing and anxiety-decreasing effects.

Person uses barbiturates as abused mostly to reduce anxiety, decrease inhibitions, and treat unwanted effects of illicit drugs. Barbiturates can be extremely dangerous because the correct dose is difficult to predict. Barbiturates are also addictive and can cause a life-threatening withdrawal syndrome.

There are many different kind of barbiturate: Amobarbital (Amytal), pentobarbital (Nembutal), Secobarbital (Seconal), Phenobarbital, and Tuinal

Effect of Subtance:
Sluggish coordination, emotional lability, faulty judgment, aggressiveness, nystagmus, strabismus, diplopia, decreased reflexes, ataxic gait, bradycardia, respiratory depression, stupor, decreased tendon reflexes.


Effect of Withdrawal:
Irritability, anxiety, tachycardia, tachypnea, nausea, tremors, muscle pain, confusion, hallucination, seizures, insomnia, vivid dreaming, coma, death.

Treatment:

• Detoxification
• Drugs: slowly taper the abused barbiturate, sodium bicarbonate (promotes excreation of barbiturates, and activated charcoal for overdose.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain airway
• Maintain client safety
• Monitor for alcohol abuse
• Monitor vital signs and neurologic status and notify physician if any abnormal readings
• Orient client to place, person, and time
• Provide a quiet environment with a light switched on
• Control combative behavior
• Encourage patient to express fears and anxiety
• Implement seizures precautions

Substance Abuse: Alcohol Abuse

Alcohol abuse is a psychiatric diagnosis describing the use of alcoholic beverages despite negative consequences. Alcohol abuse is different from alcohol dependence means by the lack of symptoms such as tolerance and withdrawal.

Effect of Substance:
Drunkenness, drowsiness, behavioral changes, poor judgment, coordination difficulty, slurred speech, inappropriate sexual behavior, aggression, memory problems, nystagmus, poor attention span, stupor, coma.

Effect of Withdrawal:
Altered consciousness, agitation, aggressiveness, anxiety, fear, confusion, delusions, disorientation, hallucinations, insomnia, blackouts, profuse sweating, acute psychosis, tachycardia, hypertension, tachypnea, anorexia, nausea, grand mall seizure, abdominal cramps, tremors, and vomiting.

Treatment:

• Detoxification
• Drugs: benzodiazepines, anti-seizure dugs.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain client safety
• Orient patient to place, person, and time
• Monitor vital signs and neurologic status, and notify physician if any abnormal value.
• Quiet environment with a light on
• Record intake and output
• Encourage patient to express fears and anxiety