Substance Use Disorders

KEY POINTS

SUBSTANCE USE
Substance use disorder occurs on a continuum (mild, moderate, severe) based on
the pattern of use and its functional impact. Knowing the severity allows the health care
team to tailor treatment according to the patients needs.
Almost every drug of abuse harms some tissue or organ in addition to the brain.
Some health problems are caused by the effects of specific drugs or from the behaviors
associated with substance abuse.
The health care setting provides an opportunity for screening and providing
teaching regarding substance use. It is your responsibility to motivate the patient to
change behavior and refer the patient for treatment and rehabilitation.

DRUGS ASSOCIATED WITH SUBSTANCE USE DISORDER

Nicotine
Tobacco is the most commonly abused drug. The effects of nicotine on the brain
are identical to those of other highly addictive stimulant drugs, including cocaine.
Smoking is the most harmful method of nicotine use and can injure nearly every
organ in the body. Tobacco use is the leading cause of preventable illness and death in the
United States.
You are responsible for identifying tobacco users and providing them with
information on ways to stop the use of tobacco. The advice and motivation from health
care professionals can be a powerful force in smoking cessation.
A variety of nicotine replacement products can be used to reduce the amount of
the craving and withdrawal symptoms associated with tobacco cessation.

Alcohol
Alcohol affects almost all cells of the body and has complex effects on neurons in
the central nervous system (CNS). Its effects are related to the concentration of alcohol
and individual susceptibility to the drug.
Persons who abuse alcohol often have a number of health problems that are
frequently the reasons that alcohol-dependent individuals seek health care.
Acute alcohol toxicity occurs when a person has a high blood alcohol level. It
manifests as an emergency primarily because of the narrow range between the
intoxicating, anesthetic, and lethal doses of alcohol.
Abrupt withdrawal may have life-threatening effects. Anticipating withdrawal
syndrome in patients is important because the effects can usually be prevented or
controlled by administration of benzodiazepines.

Stimulants
Frequently abused stimulants include cocaine, amphetamines, and
methamphetamines.
 Stimulant overdose is frequent, and deaths have occurred. At toxic levels, the
patient experiences restlessness, hypervigilance, agitated delirium, impaired judgment,
and paranoia with psychotic symptoms.
Withdrawal from a stimulant usually causes few physical symptoms. Craving for
the drug is intense and can continue for weeks.

Depressants
Commonly used depressants include sedative-hypnotics and opioids. These drugs
cause rapid development of tolerance and dependence.
Unintentional overdose frequently occurs with misuse of depressants, especially
when they are taken with alcohol or other drugs. The first priority of care is always the
CABs. Depressant toxicity can cause death from CNS and respiratory depression.
Opioid overdose can occur when a person deliberately misuses an illegal or
prescription opioid, takes an opioid prescribed for someone else, takes an opioid in
combination with other depressants, or inadvertently receives an incorrect opioid dose. A
patient with opioid toxicity is often treated with an opioid antagonist such as naloxone
(Narcan).
Withdrawal from sedative-hypnotics can be life threatening and often requires
close monitoring in an inpatient setting. Since opioid withdrawal is acutely
uncomfortable but not usually life threatening, treatment is based on symptoms.

Inhalants
Many products found in homes or workplaces contain chemicals with
psychoactive properties when inhaled. Most inhalants are depressants and their effects are
similar to alcohol.
Inhalant toxicity is not usually life threatening. However, sometimes treatment for
dysrhythmias, heart failure, or seizures is required. Withdrawal is rare.

Cannabis
The use of cannabis, or marijuana, continues to increase in the United States.
Patterns of use are similar to alcohol in that there is occasional use, misuse resulting in
temporary problems, and the potential for SUD.
Patients with acute marijuana toxicity can present with acute psychotic episodes,
tachycardia, and hypertension, especially if the patient used a synthetic derivative.
The patient in withdrawal may experience irritability, anxiety, anorexia, chills,
disturbed sleep, fever, and tremors. Supportive care includes measures to ensure patient
comfort.

NURSING MANAGEMENT: SUBSTANCE USE

Early recognition and identification of a patient who uses substances is crucial for
positive treatment outcomes for any health problem.
Use the Screening, Brief Intervention, and Referral to Treatment approach. It
consists of (1) screening or assessing for substance use problems using standardized
 screening tools, (2) brief intervention or education for patients on substance use
consequences, and (3) referring those who screen positive for further treatment.
Acute toxicity and withdrawal may be seen in acute care situations. Each situation
may require physiologic support until detoxification can occur.

GERONTOLOGIC CONSIDERATIONS: SUBSTANCE USE

Substance use is much less likely to be recognized in older adults and may be
mistaken for medical conditions.
Smoking and tobacco use contribute to and exacerbate many chronic illnesses.
Smoking cessation at any age is beneficial, and this includes older adults.