Substance Abuse

DEFINITION
Disorders due to Psychoactive substance use refer to

conditions arising from the abuse of Alcohol, Psychoactive
drugs & Other Chemicals such as Volatile Solvents.
TERMINOLOGIES
SUBSTANCE:- Refers to any Drugs, Medication, or Toxins that

shares the potential of abuse.
ADDICTION:- It is a Physiological & Psychological dependence on

Alcohol or other drugs of Abuse that affects the Central Nervous
System in such a way that withdrawal symptoms are experienced
when the substance is Discontinued.
ABUSE:- Refers to Maladaptive pattern of Substance use that
impairs health in a board sense.
DEPENDANCE:- Refers to certain Physiological & Psychological

phenomena induced by the repeated taking of a Substance.
Tolerance is a state in which after repeated administration, a drug
produced a decreased effect, or increasing doses are required to
produce the same effect.
WITHDRAWAL STATE:- It is a group of signs & symptoms recurring

when a drug is reduced in amount or withdrawn, which last for a
limited time.
BLACKOUT:- It is an episode during which the person
continues to function but has no conscious awareness of
his or her behavior at the time nor any later memory of the
behavior.
INTOXICATION:- Intoxication is use of a substance that

results in maladaptive behavior.
DETOXIFICATION:- Detoxification is the process of safely

withdrawing from a substance.
ICD-10 CLASSIFICATION
F10-F19 Mental&Behavior Disorders due to Psychoactive Substance Use.
F10 Mental & Behavior Disorders due to use of Alcohol.
F11 Mental & Behavior Disorders due to use of Opioids.
F12 Mental & Behavior Disorders due to use of Cannabinoids.
F13 Mental & Behavior Disorders due to use of Sedatives & Hypnotics.
F14 Mental & Behavior Disorders due to use of Cocaine.
F16 Mental & Behavior Disorders due to use of Hallucinogens.

COMMONLY USED PSYCHOTROPIC SUBSTANCE
Alcohol
Opioids
Cannabis
Cocaine
• Amphetamines & other sympathomimetics
• Sedatives & Hypnotics ( Eg : Barbiturates )
• Inhalants ( Eg : Volatile Solvents )
• Nicotine
• Other Stimulants ( Eg : Caffeine )
ETIOLOGY
BIOLOGICAL FACTORS
1. Genetic Vulnerability:-
Family History Of Substance use Disorders.
2. Biochemical Factors:-
• Role of Dopamine & Nor-epinephrine have been implicated in
Cocaine, Ethanol, & Opioid Dependence.
• Abnormalities in Alcohol dehydrogenase or in the
Neurotransmitter mechanisms are thought to play a role in
Alcohol Dependence.
NEUROBIOLOGICAL THEORIES:-
• Drug addict may have an inborn deficiency of Endomorphins.
• Enzymes produced by a given gene might influence hormones &

Neurotransmitters, contributing to the development of a
personality that is more sensitive to the peer pressure.
• Withdrawal & Reinforcing effects of drugs.
• Co-morbid medical Disorder (Eg: To ControlChronic Pain).

BEHAVIORAL THEORIES
• Drug abuse as the result of Conditioning / Cumulative

reinforcement from drug use.
• Drug use causes euphoric experience perceived as rewarding,

thereby motivating user to keep taking the drug.
• Stimuli & Setting associated with drug use may themselves

become reinforcing or may trigger drug craving that can lead to
relapse.
PSYCHOLOGICAL FACTORS
General Rebelliousness
Sense of Inferiority
Poor Impulse Control
Low Self-Esteem
Inability to cope up with the pressures of living & society (Poor Stress
Management Skills)
Loneliness, Unmet needs
Desire to escape from reality Desire to experiment, a sense of of Adventure.
Pleasure Seeking
Machoism
• Sexual Immaturity.
SOCIAL FACTORS
• Religious Reasons, Peer Pressure.
• Urbanization, Extended Period of Education.
• Unemployment, Overcrowding.
• Poor Social Support.
• Effects of Television & Other Mass Media.
• Occupation: Substance use is more common in chefs, Barmen, Executives,

Salesman, Actors, Entertainers, Army, Personnel, Journalists, Medical
personnel, etc.,
EASY AVAILABILITY OF DRUGS
• Taking Drugs Prescribed by the Doctors.

(Eg: Benzodiazepine Dependence).
• Taking drugs that can be bought legally

without Prescription.(Eg: Nicotine,Opioids).
• Taking Drugs that can be

Obtained from illicit Source.
(Eg: Street Drugs).
PSYCHIATRIC DISORDERS
• Substance Use Disorders are more Common in Depression,

Anxiety Disorders (Social Phobia),Personality Disorders
(Especially Anti-Social Personality), & Occasionally in Organic
Brain Disorders & Schizophrenia.
CONSEQUENCES OF SUBSTANCE ABUSE
• This Commonly Leads to Physical Dependence, Psychological Dependence,

Or Both.
• It may cause Unhealthy Lifestyles & Behaviors Such as poor diet.
• Chronic Substance abuse impairs Social & Occupational Functioning,

Creating Personal,Professional, Financial, & Legal Problems (Drug Seeking
is commonly associated with Illegal Activities, Such as Robbery or Assault).
• Drug Use Beginning in early Adolescence may lead to emotional
& behavioral Problems, Including Depression, Family Problems
with Relations, problems with or Failure to Complete School, &
Chronic Substance abuse Problems.
• In Pregnant women, substance Abuse Jeopardizes (Danger of

Loss) fetal Well-being.
• Psychoactive substances Produce negative Outcomes In Many

Patients, Including Maladaptive Behavior, “Bad Trips” — Drug
Induced Psychosis, & even Long Term Psychosis.
• IV Drug Abuse May lead to Life Threatening Complications.
• Illicit Street Drugs pose added Dangers; Materials used to dilute

them can cause toxic Or allergic Reactions.
OPTIONS FOR WHERE TO TREATMENT
OPTIONS FOR WHERE TO TREATMENT
Hospitalization-
-Due to drug OD, risk of severe withdrawal, medical comorbidities,
requires restricted access to drugs, psychiatric illness with suicidal ideation
Residential treatment unit

-No intensive medical/psychiatric monitoring needs
-Require a restricted environment
Partial hospitalization
Outpatient Program –No risk of med/psych morbidity and highly
motivated patient
TREATMENT
Behavioral Interventions.
Motivation to change.
Group Therapy.
Individual Therapy.
Self-Help Recovery Groups (AA).
Therapeutic Communities.
Aversion Therapies.
Family lnvolvement/Therapy.
•Relapse Prevention.
TREATMENT
Pharmacologic Intervention
Treat Co-Occurring Psychiatric Disorders
• 50% will have another psychiatric disorder
Treat Associated Medical Conditions
cardiovascular, cancer, endocrine, hepatic, hematologic, infectious,

neurologic, nutritional, Gl, pulmonary, renal, musculoskeletal
Nursing Management
Nursing care of a client with substance abuse disorder
include the following:
Nursing Assessment
Assessment of a client with substance abuse disorder include:
HISTORY:-Client with a parent or other family members with substance abuse problems may
report a chaotic family life, although this is not always the case.
THOUGHT PROCESS & CONTENT:-During the assessment of thought process and content,
clients are likely to minimize their substance abuse, blame others for their problems, and
rationalize their behavior.
SENSIRIUM & INTELLECTUAL PROCESS :-Clients generally are oriented and alert unless they
are experiencing lingering effects of withdrawal.
GENERAL APPEARANCE & MOTOR BEHAVIOR:- Assessment of general appearance and
behavior usually reveals appearance and speech to be normal.
SELF CONCEPT:- Clients generally have low self-esteem, which they may express directly or
cover with grandiose behavior.
Nursing Diagnosis
Based on the assessment data, the major nursing diagnosis for substance
abuse are:-
• Risk for injury related to substance intoxication or withdrawal.
• Ineffective denial related to underlying fears and anxieties.
• Ineffective coping related to inadequate support system or coping skills.
• Imbalance nutrition: less than body requirements related to drinking

alcohol instead of eating nourishing food.
• Chronic low self-esteem related to retarded ego development.

Nursing Interventions
Nursing interventions for a client with substance

abuse include:
• Providing health teaching for client and family:- Clients and family members need facts
about the substance, its effects, and recovery.
• Addressing family issues:- Without support and help to understand and cope, many
family members may develop substance abuse problems of their own, thus
perpetuating the dysfunctional circle; treatment and support groups are available to
address issues of family members.
• Promoting coping skills:- Nurses can encourage clients to identify problem areas in their
lives and to explore the ways that substance use may have intensified those problems.

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DEFINITION

Disorders due to Psychoactive substance use refer to

SUBSTANCE:- Refers to any Drugs, Medication, or Toxins that

ADDICTION:- It is a Physiological & Psychological dependence on

DEPENDANCE:- Refers to certain Physiological & Psychological

WITHDRAWAL STATE:- It is a group of signs & symptoms recurring

INTOXICATION:- Intoxication is use of a substance that

DETOXIFICATION:- Detoxification is the process of safely

F10 Mental & Behavior Disorders due to use of Alcohol.

F11 Mental & Behavior Disorders due to use of Opioids.

F12 Mental & Behavior Disorders due to use of Cannabinoids.

F14 Mental & Behavior Disorders due to use of Cocaine.

F16 Mental & Behavior Disorders due to use of Hallucinogens.

• Drug addict may have an inborn deficiency of Endomorphins.

• Enzymes produced by a given gene might influence hormones &

• Withdrawal & Reinforcing effects of drugs.

• Co-morbid medical Disorder (Eg: To ControlChronic Pain).

• Drug abuse as the result of Conditioning / Cumulative

• Drug use causes euphoric experience perceived as rewarding,

• Stimuli & Setting associated with drug use may themselves

• Urbanization, Extended Period of Education.

• Poor Social Support.

• Effects of Television & Other Mass Media.

• Occupation: Substance use is more common in chefs, Barmen, Executives,

• Taking Drugs Prescribed by the Doctors.

• Taking drugs that can be bought legally

• Taking Drugs that can be

• Substance Use Disorders are more Common in Depression,

• This Commonly Leads to Physical Dependence, Psychological Dependence,

• It may cause Unhealthy Lifestyles & Behaviors Such as poor diet.

• Chronic Substance abuse impairs Social & Occupational Functioning,

• In Pregnant women, substance Abuse Jeopardizes (Danger of

• Psychoactive substances Produce negative Outcomes In Many

• Illicit Street Drugs pose added Dangers; Materials used to dilute

Residential treatment unit

Treat Co-Occurring Psychiatric Disorders

• 50% will have another psychiatric disorder

Treat Associated Medical Conditions

cardiovascular, cancer, endocrine, hepatic, hematologic, infectious,

• Ineffective denial related to underlying fears and anxieties.

• Ineffective coping related to inadequate support system or coping skills.

• Imbalance nutrition: less than body requirements related to drinking

• Chronic low self-esteem related to retarded ego development.

Nursing interventions for a client with substance

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