Substance Use Disorder

Substance Use Disorder 150 150 Tony Guo

Substance Use Disorder

 

Substance Use

  • Serious problem for society and health care
  • Substance use disorders (SUD)
    • Involve a variety of substances
    • Legal and illegal
  • Affects many patients you will encounter in the health care system
    • Many implications for health and care
    • Nursing management involves recognition of substance use, screening for abuse, and patient education
    • Our professional responsibility to address these problems

Criteria for Substance Use Disorders (SUD)

  • Impaired Control
    • Taking more or for longer than intended
    • Failing to quit using despite multiple times of trying to do so
    • Spending a great deal of time obtaining, using, or recovering from use
    • Craving the substance
  • Social Impairment
    • Missing school, work, or other responsibilities due to use
    • Continuing use despite problems caused or exacerbated by use
    • Giving up or reducing important activities because of use
  • Risky Use
    • Recurrent use in hazardous situations
    • Continued use despite problems that are caused or worsened by use
  • Pharmacologic Dependence
    • Physical tolerance to effects of the substance
    • Presence of withdrawal symptoms when not using or using less

 

Nicotine

  • Tobacco use disorder (TUD)
    • Most common SUD that you will encounter
    • Smoking is the main form of tobacco use in the United States
  • Effects of Use
    • CNS stimulant
    • Releases adrenaline
    • Effects last 1-2 hours
    • Withdrawal leaves person tired, irritable, anxious, and craving more nicotine
    • Cycle of addiction
  • Complications 
    • Smoked tobacco
      • Most harmful method of nicotine use
      • Injures nearly every organ in the body
      • Accounts for 14 million major medical conditions in the United States
    • Smokeless tobacco
      • Less risk of lung disease
      • Associated with 
  • Periodontal disease
  • Cancers of mouth, cheek, tongue, throat, esophagus
  • Cardiovascular disease
  • Electronic cigarettes
    • Harmful effects are still emerging
    • Overall impact on health is uncertain
    • Not FDA approved
    • Not recommended as a smoking cessation aid

 

  • Types of Cancers
  • Oropharynx
  • Stomach
  • Larynx
  • Pancreas
  • Esophagus
  • Kidney and ureter
  • Trachea, bronchus, and lung
  • Cervix
  • Acute myeloid leukemia
  • Bladder

 

  • Types of Chronic diseases associated
  • Stroke
  • Peripheral vascular disease
  • Blindness, Cataracts
  • Hip fractures
  • Periodontitis
  • Coronary artery disease
  • Aortic aneurysm
  • Pneumonia
  • Reproductive effects in women (including reduced fertility)
  • Chronic obstructive pulmonary disease, asthma, and other respiratory effects

 

  • Tobacco Cessation
    • Our professional responsibility to help persons stop using tobacco
    • Even brief advice and intervention can impact the likelihood of quitting
    • The five A’s for users who desire to quit
      • Ask: Identify all tobacco users at every contact.
      • Advise: Strongly urge all tobacco users to quit.
      • Assess: Determine willingness to make a quit attempt.
      • Assist: Develop a plan with the patient to help the patient quit (e.g., counseling, medication).
      • Arrange: Schedule follow-up contact.
    • The five R’s for users unwilling to quit
      • Relevance: Ask the patient to indicate why quitting is personally relevant (e.g., health).
      • Risks: Ask the patient to identify his or her potential risks/consequences of tobacco use.
      • Rewards: Ask the patient to identify potential benefits of stopping tobacco use.
      • Roadblocks: Ask patient to identify barriers or impediments to quitting.
      • Repetition: Repeat process every clinic visit.
    • Smoking cessation products
      • Nicotine replacement products
  • OTC skin patches, lozenges, gum
  • Prescription inhalers, nasal spray
  • Non-nicotine medications

 

Alcohol

  • 65% of Americans 18 and older consume alcohol
  • Alcoholism (AUD) affects 7.2%
    • Risky drinking
    • Binge drinking
  • Effects of Use
    • Affects almost all cells of the body
      • All areas and functions of the CNS
      • Centers for impulse control, mood, behavior, motor activity coordination, respiratory, and cardiac function
    • Blood Alcohol Concentration (BAC) 
      • BAC refers to the amount of alcohol contained in a person’s blood
      • Tolerant person drinks larger amounts than non-tolerant drinkers without obvious impairment
  • Complications
    • Numerous drug interactions
      • Additive effects of antihypertensives, antihistamines, antianginals
      • GI bleeding with ASA
      • Liver damage with acetaminophen
      • Potentiating effects of CNS depressants and alcohol
    • Alcohol Withdrawal Syndrome
      • Abrupt cessation of alcohol use
      • Onset depends on quantity, frequency, pattern, and duration of use
      • Within a few hours after last drink
      • Peaks after 24-48 hours

 

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