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378 Unit 3 Mental Disorders

DSM-IV-TR Diagnostic Criteria for Substance Intoxication and Withdrawal

DIAGNOSTIC CRITERIA FOR
SUBSTANCE INTOXICATION
A. The development of a reversible
substance-specific syndrome due to
recent ingestion of (or exposure to) a
substance. Note: Different substances
may produce similar or identical
syndromes.
B. Clinically significant maladaptive
behavioral or psychological changes
that are due to the effect of the
substance on the central nervous
system (e.g., belligerence, mood
lability, cognitive impairment, impaired
judgment, impaired social or occupa-
tional functioning) and develop during
or shortly after use of the substance.
C. The symptoms are not due to a
general medical condition and are
not better accounted for by another
mental disorder.
DIAGNOSTIC CRITERIA FOR
SUBSTANCE WITHDRAWAL
A. The development of a substance-
specific syndrome due to the cessation
of or reduction in substance use that
has been heavy and prolonged.
B. The substance-specific syndrome
causes clinically significant distress or
impairment in social, occupational, or
other important areas of functioning.
C. The symptoms are not due to a
general medical condition and are not
better accounted for by another
mental disorder.
SOURCE: Reprinted with permission from the
American Psychiatric Association. (2000). Diagnostic
and statistical manual of mental disorders (4th ed.,
Text Revision) (pp. 201202). Washington, DC: Author.

drugs are safer than illegal drugs. The rapidly escalating abuse
of amphetamines, especially Ecstasy, is a significant problem
at dance clubs and dance parties known as raves. Young
people take these love drugs for increased energy and sex-
ual desire (Compton et al., 2005; OMalley, 2005).
In the 1800s, alcohol, opiates, cocaine, and marijuana
were part of many medications used to treat a variety of ill-
nesses. The addictive potential of these chemicals were not
known at the time. Those at highest risk for addiction were
physicians, physicians wives, housewives, and nurses. It was
believed that for every male addict there were three female ad-
dicts. By the early 1900s, the process of addiction became
clear but it was believed to be moral failing rather than a dis-
ease that could be treated. Addiction was criminalized with
passage of the Harrison Narcotic Act of 1914, Prohibition,
the Marijuana Tax Act of 1937, the Narcotic Control Act of
1956, the Controlled Substance Act of 1970, and the cre-
ation of the Drug Enforcement Agency in 1973.
In the early 20th century, nurses were identified as being
at high risk for addiction due to high work loads and high
stress levels. There were, however, no treatment options at
the time. In the 1960s, nurses and physicians were identi-
fied as being at higher risk for narcotic addiction. Little was
done about the problem of addiction and most instances were
ignored. When nurses were identified as addicted or abusing
alcohol or drugs, they were either fired or reported to state
boards of nursing and disciplined by censure, suspension, or
having their professional license revoked. In the 1970s re-
search on impaired nursing practice began to appear and in
1982 the American Nurses Association (ANA) passed a res-
olution entitled Action on Alcohol and Drug Misuse and
Psychological Dysfunctions Among Nurses. The hope was
to shift the focus from punishment to rehabilitation. In 2002,
the ANA adopted an updated resolution entitled The Pro-
fessions Response to the Problems of Addictions and Psy-
chiatric Disorders in Nursing, calling attention again to im-
paired nursing practice, stressing the need for peer assistance
programs (Heise, 2003).
When nurses have an addiction, shame and guilt are mag-
nified. After all, nurses are healers and nurturers. They are not
expected to have their own problems, certainly not an addic-
tion that could lead them to take drugs from clients or be less
than 100% in control when they are at work. Early studies
suggested that nurses are at higher risk for addiction than the
general population. More recent studies contradict these find-
ings and state that it is most likely that nurses are not at higher
risk for substance abuse (Snow & Hughes, 2003).
Nurses now have access to peer assistance and statewide
programs to seek treatment and save their licenses. Nurses
with substance abuse problems are required to stop practic-
ing and enter a 12-step treatment program for monitoring.
Those who abuse alcohol are not allowed to perform client
care or handle controlled substances for 6 months. For those
who abuse substances other than alcohol, the ban is for 1 year
(Fletcher, 2004; West, 2002). See Box 15.2 for signs of sub-
stance abuse among nurses.
Signs of Substance Abuse Among
BOX 15.2
Nurses
Frequent or unexplained disappearances from the unit
Increasing difficulty meeting schedules or deadlines
Sloppy or illogical charting
Excessive number of mistakes
Smell of alcohol on breath
Labile emotions
Diminished alertness
Isolation from coworkers
Frequent reports of medication spills or other waste
Discrepancies in end-of-shift medication counts
Increase in client complaints of unrelieved pain

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