__________________________________________ Chapter 57Substance-Related and Addictive Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
Slide 39
Other Psychoactive Substances
• Stimulants
• Amphetamines
• Cocaine
• Crack
• Tobacco
• Synthetic drugs
• Depressants
• Sedatives
• Hypnotics
• Anxiolytics
TALKING POINTS:
• Amphetamines usually are used orally or intravenously on a daily basis or on binges.
• They are psychologically addictive; the dose is gradually increased over time to
produce the euphoria (or “high”) that is extremely pleasurable.
Slide 40
Other Psychoactive Substances (cont.)
• Hallucinogens
• LSD (lysergic acid diethylamide, or “acid”)
• PCP (phencyclidine, or “angel dust”)
• MDMA (3,4-methylenedioxymethamphetamine, known as “ecstasy” or “Adam”)
• Marijuana
TALKING POINTS:
• LSD is not physically addicting but can produce physical symptoms of altered perceptions
that are dreamlike, often with an altered sense of time and feelings that one has attained
special insight.
• PCP (phencyclidine) differs from other hallucinogens in that abusers experience a
Slide 41
Other Psychoactive Substances (cont.)
• Narcotics (opioids)
• Heroin
• Morphine
• Oxycodone (OxyContin)
• Hydrocodone
• Pentazocine (Talwin)
• Methadone
• Meperidine (Demerol)
16 Chapter 57Substance-Related and Addictive Disorders ___________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
Slide 42
Other Psychoactive Substances (cont.)
• Inhalants
• Paint, glue, aerosol sprays, typing correction fluid, and gasoline
• Designer drugs
• Synthetic drugs especially designed to sidestep categorization with any of the drugs
identified as illegal in the United States
TALKING POINTS:
• Inhalants are usually placed in a plastic bag or other container that is then placed over the
Slide 43
Disorders Associated with Substance Abuse
• Human immunodeficiency virus disease (HIVD), which leads to acquired
immunodeficiency syndrome (AIDS)
• Those who have or are predisposed to serious psychiatric illness may present with active
mental disorder
Slide 44
Treatment for Substance Abuse
• Treatment similar to alcohol detoxification/rehabilitation
• Narcotics Anonymous (NA) structured much like AA
• Often inpatient treatment programs place recovering addicts with alcoholics for
TALKING POINTS:
• A booming area of research is the identification of alternative treatments and medications
that will help drug abusers detoxify more comfortably from the chemicals that they are
addicted to and reduce the risks of relapse.
• How may the legal system influence an abuser to seek treatment?
Slide 45
Detoxification
• Complex because of the likelihood of polysubstance abuse and the uncertainty of what to
expect when two or more drugs are mixed together
• Inpatient hospitalization recommended for safety
• However, some individuals who have been using drugs that are primarily psychologically
addicting may not demonstrate many physical symptoms, but rather experience intense
psychologic cravings
__________________________________________ Chapter 57Substance-Related and Addictive Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
Slide 46
Medications
• Methadone
• Used in the treatment of heroin addicts
• Clonidine (Catapres)
• A nonopioid antihypertensive drug that partially blocks withdrawal symptoms
TALKING POINTS:
• What are the most typical side effects of methadone?
• Clonidine does not completely remove the unpleasant feelings accompanied by heroin
withdrawal.
Slide 47
Rehabilitation
• Patient participates in Narc-Anon (NA) at least some of the time
• Based on the 12 steps of Al-Anon, except that the word “alcohol” is replaced by
“drugs” in all of the literature, and the case histories used for reading assignments are
Slide 48
other recovering addicts during the difficult transition back into the community
Aftercare and Recovery
• Recovering abusers offered opportunity to participate in a support group provided by a
hospital
• Many of the same people who went through treatment at the same time participate
• Relationships built during this time of crisis are often intense; thus, groups can be helpful
Slide 49
Methadone Maintenance
• For patients who have experienced multiple relapses into heroin abuse after treatment
who may have sustained permanent damage to chemical receptor sites in the brain,
which decreases their ability to resist relapse
• The person goes to a methadone clinic daily or 3 times/week to receive medication for
TALKING POINTS:
• A single dose may be administered in liquid form or in a diskette dissolved in juice, and
the person is carefully observed by clinic staff members to ensure that the medication is
actually taken and not hoarded in any way.
• How does naltrexone (Trexan) work to help prevent the use of heroin?
18 Chapter 57Substance-Related and Addictive Disorders ___________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
5
Slide 50
Care of the Person with a Substance Disorder
• Assessment
• Thorough assessment is the initial step
• Data can help identify and prioritize problems that must be addressed to maximize the
likelihood that the patient will remain sober
• Problems seen in substance abusers of any kind include denial, poor impulse control,
high risk for injury, high risk for relapse, guilt, and low self-esteem
6
Slide 51
Care of the Person with a Substance Disorder (cont.)
• Interventions
• Ineffective coping
• Ineffective denial
• Risk for injury
Slide 52
Care of the Person with a Substance Disorder (cont.)
• Interventions
• Regular physical assessment
• Administration of appropriate medications
TALKING POINTS:
• What is the biggest issue to be addressed at first that most substance abusers possess?
Slide 53
Care of the Person with a Substance Disorder (cont.)
• Interventions
• Teaching stress management and practicing these new skills with patients can greatly
increase the odds that they will not relapse after discharge
• Patient must be taught to recognize symptoms that often lead to relapse
• Act as a good role model in handling feelings, participating appropriately in meetings,
and communicating to the patient in a way that supports the program
7
Older Adults
• Older adults more likely to abuse over–the-counter and prescription sleeping pills, pain
__________________________________________ Chapter 57Substance-Related and Addictive Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
Slide 55
Older Adults (cont.)
• Consequences of alcohol abuse: malnutrition, cirrhosis of the liver, bone thinning,
gastritis, poor memory, decreased cognitive ability to process new information
• If the person combines alcohol with any other medication that has central nervous system
Slide 56
Older Adults (cont.)
• Treatment of alcoholism in older adults is similar to that of younger individuals except that
the period of withdrawal must be more closely monitored and occur more slowly because
of physical fragility
• Rehabilitation groups and educational programs should be structured to permit processing
information more slowly to allow for cognitive slowing for this age group
TALKING POINTS:
• Cognitive changes may be more pronounced because of the neurologic effects of chronic
use of alcohol or other drugs, or both.
Adolescents
• One in four adolescents is involved in substance abuse
• The younger the age at onset of drug use, the greater is the risk for significant
TALKING POINTS:
• It is estimated that one in four adolescents becomes involved in substance abuse.
• What developmental tasks are adolescents establishing?
Slide 58
Adolescents (cont.)
• Substance abuse is symptom of family issues
• Family history of substance abuse, or the adolescent may fall in with the “wrong crowd” of
other young people
• Entry into treatment is a result of a crisis situation, revealing the severity of drug use and
parental insistence
• Rehabilitation requires that treatment be modified to meet needs of this age group
TALKING POINTS:
• How is the use of drugs linked to the risk of HIV infection?
20 Chapter 57Substance-Related and Addictive Disorders ___________________________________________
LESSON 57.1
Slide 59
Comorbidity/Dual Diagnosis
• Patients diagnosed with a serious psychiatric illness and have a substance abuse
problem
• Usually have psychiatric illnesses of depression, schizophrenia, or bipolar illness
TALKING POINTS:
• What may cause toxic psychosis to occur more frequently?
Comorbidity/Dual Diagnosis (cont.)
• People with chronic psychiatric problems require special teaching and supervision in the
event of substance relapse
TALKING POINTS:
• What could happen to patients taking anxiolytic or antidepressant agents with alcohol?
Peer Assistance Programs
• Offer a supportive alternative to health professionals (physicians, dentists, nurses) who
Peer Assistance Programs (cont.)
• Goals of an intervention for a nurse
• Assist the nurse whose practice is impaired to receive treatment
Slide 63
Peer Assistance Programs (cont.)
• Usually, there is also at least a 2-year period after diagnosis and onset of treatment in
which the nurse is required to attend AA or NA groups regularly, participate in peer
support groups, meet routinely with identified support person, and undergo random urine
drug screens to ensure that he or she has not relapsed
TALKING POINTS:
• The information regarding each nurse involved is kept confidential and, if they
Introduction to Medical-Surgical Nursing, 6th ed.
Slide 64
Question 1
• There are several theories to explain drug addiction and dependence. Which of the
following theories is described by the following passage?
A faulty physiologic process that is not clearly understood contributes to dependence
on a specific substance or substances. It is a dopamine gene on chromosome 11 that
is responsible for transmitting a predisposition for alcoholism from generation to
generation.
A. Can only be treated with medicine.
B. Genetic predisposition to develop under the right conditions.
C. Medicine is the only way to cure it.
D. Potential to be treated effectively only by total abstinence from the substance that
the body cannot handle.
TALKING POINTS:
Slide 65
Question 2
• Personality traits in common among those persons who abuse substances include all of
the following except __________.
A. having a great difficulty delaying the gratification of their needs
B. having a low need to be in control of others
C. seeking attention
D. being self-centered
TALKING POINTS:
22 Chapter 57Substance-Related and Addictive Disorders ___________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the biologic theory of substance-
related disorders and offer an example of
how theorists would view the addictive
disorders of a particular patient.
• Discuss the sociocultural theory of
substance-related disorders and offer an
example of how theorists would view the
PRACTICE
• Divide the class into four groups and assign
each group a theory about the cause of
substance abuse. Have each group develop
an explanation of the theory and present it to
the class. Have the class give feedback and
discuss any questions or issues that the
theory raises.
2
DISCUSS
• Discuss ways substance-related disorders
PRACTICE
• Ask students to prepare written materials for
__________________________________________ Chapter 57Substance-Related and Addictive Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
3
DISCUSS
• Discuss alcohol and alcoholism, and
describe simple intoxication, physical
addiction, alcohol withdrawal syndrome, and
delirium tremens.
• Discuss common medical complications of
chronic alcoholism, including Wernicke
encephalopathy, Korsakoff psychosis, and
PRACTICE
• Divide the class into groups. Ask each group
to describe and discuss alcohol withdrawal
and the medical complications of alcohol
addictive disorders. Have the groups discuss
4
DISCUSS
• Discuss the prevalence of gambling
addiction.
PRACTICE
• Ask students to describe how an individual
24 Chapter 57Substance-Related and Addictive Disorders ___________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
5
DISCUSS
• Discuss nursing assessment of the
substance abuser, describe elements of the
health history, and explain important
communication skills and behaviors to use
during the assessment.
• Discuss patterns and consequences of
abuse, including typical behavior patterns
and the combination of physical or
psychologic withdrawal symptoms common
in a patient with an addictive disorder.
PRACTICE
• Invite a nurse who cares for substance
abuse patients to speak to the class about
• Have the class use the case scenario in the
Critical Thinking Question below to develop
a nursing care plan for the patient. Ask the
__________________________________________ Chapter 57Substance-Related and Addictive Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
6
DISCUSS
• Discuss the nursing diagnoses most likely to
be made for patients with substance-related
disorders.
• Discuss which interventions will most likely
be used for patients with substance-related
disorders.
PRACTICE
7
DISCUSS
• Discuss prevalence of substance abuse in
the older adult population, and the
subsequent health risks.
PRACTICE
• Ask students to form groups and practice
data collection techniques for an older adult
patient who admits to “several cans of beer
a night” and has sustained a wrist fracture
following a fall at home.
26 Chapter 57Substance-Related and Addictive Disorders ___________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 57.1
Critical Thinking Question
A 15-year-old female is admitted to the hospital after losing consciousness from inhaling an
aerosol spray (“huffing”). As the nurse collects data from her, the patient states that she and
her friends often do this, and she does not consider it a dangerous practice. What are some
issues related to drug abuse in the adolescent population? What information can the nurse
provide this patient about the risks and complications associated with huffing?
Discussion Guidelines: Adolescents are at increased risk for substance abuse because they tend
Instructor Notes/Student Feedback
__________________________________________ Chapter 57Substance-Related and Addictive Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
57
Assessments for
Substance-Related and Addictive Disorders
CHAPTER OBJECTIVES
Lesson 57.1:
2. Discuss prevention and treatment for substance-related and addictive disorders.
4. Describe the development, course, and outcomes of gambling addiction.
6. Describe the nursing diagnoses and interventions associated with substance–related and addictive
disorders.
Assessments by Lesson & Objective
Lesson 57.1
1
Study Guide
• Part IA: 1, 7 (p. 391)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 5, 9
2
Evolve Instructor Resources
• Test Bank: 27, 29, 30
3
Study Guide
• Part IA: 2-5 (p. 391)
• Part IC: 1-6 (p. 392)
Evolve Instructor Resources
• Test Bank: 3, 9-14, 16, 18-20, 23, 25, 30
Evolve Student Resources
• NCLEX Review: 2, 3, 7, 8
• Prioritization: 1
Introduction to Medical-Surgical Nursing, 6th ed.
5
Study Guide
• Part IA: 6 (p. 391)
• Part IB: 1-5 (p. 392)
• Part IIE: 3, 13, 24, 26 (pp. 393-395)
• Part IIIF: 6 (p. 396)
• Part IIIG: 3 (p. 396)
Evolve Instructor Resources
6
Study Guide
• Part IIIF: 3-5 (p. 395)
• Part IIIG: 1, 2, 4 (p. 396)
Evolve Instructor Resources
• Test Bank: 15, 21, 22
Evolve Student Resources
• Prioritization: 3
Study Guide
Evolve Instructor Resources
• Test Bank: 17, 26, 28
Evolve Student Resources
• Prioritization: 2
Instructor’s Notes/Student Feedback