Psychoactive Substance Disorders

By:
Bryan Mae H. Degorio, BSN, RN
SUBSTANCE ABUSE
- Misuse of substance with
significance and recurrent
adverse consequences related to
the repeated use.
- refers to the continued use
despite the recurrence of the related
problem
Substance or chemical dependence
- cluster of cognitive and
behavioral and physiologic
symptoms indicating continued
use of the substance despite of
 Characteristics of Substance
Abuse
2. tolerance- increased amount of the
substance to obtained
desired effect
3. Withdrawal- behavioral, physiologic
and cognitive symptoms
occuring when blood or
tissue concentration of
substance abruptly decline
4. Compulsive drug taking behavior
Intoxication- is use of substance that
results in maladaptive behavior
Detoxification- is the process of safe
withdrawal
Habituation- a psychological
dependence on the use of drug
Addiction- the physical dependence on
a substance
Concepts of Substance Abuse
2. The most common abuse substance
is the alcohol
3. About one in five nurses is a
substance abuser
4. Substance abuse is a family
problem
5. Common personality traits are
associated with substance abuser
6. Polysubstance abuse involves
concurrent use of two or more
Etiology of Substance Abuse
2. Exact cause of substance abuse remains
unclear
3. Biologic theories:
a. genetic factor
b. biochemical
6. Sociocultural Theory
a. hopelessness and defeat of living
condition
b. peer pressure
c. easy availability of the substance
d. social ambivalence about the use of
substance.
4. Family theory
- implicates dysfunctional
family pattern
5. Behavioral Pattern
- substance abuse is a
response to stressful
stimuli because substance
provide temporary relief of
anxiety
6. Psychoanalytic theory
- maladaptation in the early
stage of development
Management:
2. Detoxification followed by residual
or outpatient program
3. Self-help 12 step program designed
to help members achieve and
maintain sobriety one day at a time
4. Psychotherapy on reality orientation
focusing on coping without the use
of the drug
4. Family therapy
- improves communication by
encouraging the family
members to define and
maintain family functioning
5. Alcoholic determinant therapy with
disulfiram
6. Methodone treatment as a
substitute for opioid
7. Family support such as self helping
organizations
COMMONLY ABUSE SUBSTANCES
Alcohol
- immediate effect due to action to
the brain manifested by slurring of
speech, incoordination and unsteady
gait, impaired attention and memory
- withdrawal symptoms:
Stage 1- minor withdrawal
characterized by sleeplessness,
restlessness, agitation, diaphoresis,
tachycardia, hypertension and
tremorss
Stage 2- major withdrawal
- stage 1 + visual and auditory
hallucination
Stage 3- delerium tremens as
anifested by elevation of
temperature,
disorientation + stage 1 and 2
manifestations
- Physiologic Effect of Chronic Alcohol
Smoking
1. Cardiac myopathy
2. wernicke’ encephalopathy
- thiamine deficiency
3. Korsakoff psychosis
- associated with thiamine
and vitamin b 12
deficiency
4. pancreatitis, hepatitis, cirrhosis and
ascitis
5. Fetal alcohol syndrome
- occurs to infant born to an
alcoholic mother
 - Treatment of Withdrawal
2. Anxiolytic- prevent withdrawal
manifestations
3. Anticonvulsant- can be use for
seizure prevention
4. Diet/Promotion of adequate
nutrition
- vitamin
supplementation
including multivitamins, vit.
B12, B, folic acid
CNS Depressant
CLASSIFICATIONS
C.Barbiturates, other sedatives,
hypnotics and anxiolytic
- it is a CNS depressant that have
the same effect like alcohol
- chronic use can lead to
depression and paranoia
 - commonly abuses types:
a. Barbiturates- secobarbital,
pentobarbital
b. Sedative/hypnotics-
methoquolone, chloral
hydrate
c. Anxiolytic- lorazipam, diazepam,
alprazolam,
valium
 - Withdrawal:
- occurs within 24-72
hours after the last
use
- manifested by nausea,
vomiting,
seizure,
depression,
tachycardia and
orthostatic hypotension
- Treatment of Withdrawal
1. tapering of the anxiolytic
2. narcoleptic for psychotic
 3. anticonvulsant to prevent and
treat seizure
B. Narcotics
- a CNS depressant that are
use medically to relieve
moderate and severe pain
- morphin, heroin and cocain-
derivatives of opium
- demerol and methadone-
are synthetic
substitutes
 - manifestations:
- euphoria, well being,
impaired attention,
apparent sedation,
complete relaxation and
PINPOINT or constricted pupil
and scattered pigment of
hypodermic needle
- Withdrawal:
- occurs within few hours
after last dose of short
acting opiates
 - begins 2-3 days
after the last dose of long
acting opioids
- manifested by:
a. Dilated pupil, tearing,
runny nose and
restlessness
b. Heroin- coryza, tears,
yawning, sneezing,
restlessness and
irritability
 - Treatment for Withdrawal:
1. use of Methodone for the first 3-5
days
2. Clonidine hydrochloride to block
the withdrawal
manifestations and maybe
given for 14 days
CNS Stimulant
A. Cocain- a CNS stimulant and causes
dopamine depletion
- can cause euphoria, anxiety,
anger, tachycardia and
 - Common Drugs:
1. Cocaine powder- snorted or
injected
2. Crack crystals- usually smoked
- Withdrawal:
- severe depression, fatigue,
hypersomnia and
psychomotor agitation
- Treatment:
1. anxiolytic to treat psychomotor
agitation
 3. Betacholinegic blockers to treat
hypertension and
tachycardia
4. Dopamine receptor agonist or
dopaminergic
B. Amphetamines
- medically use to treat ADHD
and to loss weight or stay
awake
- Physiologic Effect:
- raise of BP, increase of
energy level, euphoria,
tachycardia, nausea and
 - withdrawal Manifestations:
-severe depression, vivid
dreams, insomnia,
hypersomnia and
psychomotor agitation
- treatment:
1. anti depressant- to counteract
depression
2. neuroleptic- to treat paranoia
and psychosis
3. Anxiolytic- to treat psychomotor
agitation
Cannabinol/ marijuana
- the most common type of
cannabis composed of dried
leaves, stems and flowers of a
plant cannabis sativa that can be
smoked of added to food
- it alters sensory percepion
due t active ingredients
TETRAHYCANNABINOL ( THC )
 - immediate affect:
- euphoria, sensation of
slowed time, impaired
motor coordination,
conjunctivitis, increased
appetite, dry mouth and
tachycardia
- chronic use:
- decrease testosterone
level and chronic lung
disease
- reverse tolerance
 - common drugs:
a. Marijuana
b. Hashish
Nicotine
- is found in tobacco in 1-2 percent
concentration
- manifestations:
- reduce appetite
- Physiologic effect:
a. Respiratory- COPD,
 b. Cardiovascular- ischemic
heart disease, CVA and
peripheral vascular disease
- Withdrawal:
- increase appetite along with
intense craving for
tobacco that may persist
for 6 months or longer
- Treatment:
1. Nicotine Replacement Therapy
- use of nasal patch,
nasal spray or inhaler
 - use of non- nicotine
prescription such as
BUPROPION ( zyban)
2. developing of support system
- relapse is highest during
the first few weeks and
diminishes
considerably
Hallucinogen / LSD or Acids
- refer to the group of
naturally occurring and synthetic
agent that produce essentially the
- manifestations:
1. similar to psychosis and
depersonalization
2. presence of mystical experience
3. intensified perception
- dangerous due to the following:
1. makes the individual believe that
they have supernatural power and
more than one person has been
killed in an attempt to fly
 2. panic reaction occurring for the
first user and is referred to as
BAD TRIP.
3. Flashback as manifested by
hallucination
STEROIDS
- are synthetic derivatives of
testosterone
- can cause androgenic and
anabolic effect
 - Associated problem
1. cholestatis
2. hepatoadenoma
3. hepatocarcinoma
4. gynecomastia
- ttt- manifestation subside upon
withdrawal
Inhalant
- are inexpensive and easy to
obtain substances
 - examples:
- gasoline, kerosene,
isopropyl alcohol, thinner,
acetone, nitrous oxide,
fluorocarbons
- effects:
- euphoria, hallucination and
unsteady gait
- problem:
- COPD and acidosis
- treatment: O2 and resp support