NRNP 6675 Midterm Study Guide 2022/2023 - Walden University

NRNP 6675 Midterm Study Guide 2022/2023 - Walden University. SUBSTANCE-RELATED DISORDERS Substance use disorders are a cluster of disorders in which cognitive, behavioral, and physiological symptoms indicate that a person continues using a substance despite significant substance-related problems Psychiatric symptom clusters may be related to substance use, discontinuation of substance use, or withdrawal from habitual substance use. Substance use disorders lead to changes in brain circuits and physiological functions that lead to a need for detoxification and a possible need for long-term treatment. The word substance can describe a drug of abuse, a medication, or a toxin that produces psychoactivation and alters cognitive, behavioral, and affective perceptions. Dependence: repeated use of a substance with or without physical dependence Abuse: use that is inconsistent with sociality use patterns Misuse: usually applies to a prescribed substance Intoxication: reversible syndrome caused by a specific substance affecting memory, judgment, behavior, or social or occupational functioning Withdrawal: substance-specific symptoms that occur after stopping or reducing use Tolerance: needing more of the substance to get the desired effect Etiology Multiple theories ranging from psychological to neurobiological Probable multifactorial etiological profile Two common types of theories: psychodynamic and biological Psychodynamic theory Behaviors of abuse are seated in oral-stage fixation. A person seeks gratification through oral behaviors. Maladaptive regressive behaviors can become overlearned, fixed, and reinforced through dysfunctional family patterns. Sociocultural factors attempt to explain population-based differences in substance abuse rates. 1 Biological theory Genetic loading People with a strong genetic vulnerability to addiction are thought to have defects in the working of the reward center of the brain, which predisposes them to stronger-than-normal positive rewards that draw them to substance use. Gender differences Ethnic differences A person is predisposed to stronger-than-normal negative rewards, making it more difficult to stop abuse once it has begun. Involves two neurobiological processes: 1. Reinforcement Brain-based changes in structure and function can lead to addictive behavior. The process of positive and negative rewards is physiologically linked to memory function. Changes appear to occur with any drug of abuse. Reinforcement results in “feel good” sensations when a drug of abuse is used and in “feel bad” sensations when the drug exits the body. Positive rewards of reinforcement result in the social rewards commonly associated with drug use, such as disinhibition, euphoric mood, and anxiety reduction. Mediated by dopamine (DA) pathways. Negative rewards are aversive, such as increased anxiety and dysphoria. Mediated by the gamma amino butyric acid (GABA) pathways . Reinforcement occurs in the ventral tegmental area and the nucleus accumbens of the brain, collectively called the reward center. DA release within the reward center is enhanced further by the release of natural morphine-like neurotransmitters called neuropeptides (enkephalins, beta-endorphins). Neuropeptides further enhance the reinforcing pleasure experienced by the person. With repeated drug use, the DA system becomes increasingly sensitized. Eventually, associated drug use stimuli (e.g., pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use. 2. Neuroadaptation 2 3 Brain-based changes in structure and function can lead to tolerance and withdrawal. Drug-specific alterations in the normal level and function of neurotransmitters occur as the body adapts to the chronic presence of the substance of abuse. Neuroadaptive processes become very significant when the person stops substance use. These processes become the basis for withdrawal symptoms, because adaptive responses are unopposed when the substance is no longer present. Neuroadaptive changes may be more enduring in some persons, possibly lasting for years, thus increasing their potential for relapse. This concept helps to explain why, after a long period of sobriety, a person who returns to substance abuse often picks up at the same level of tolerance and physical impact as experienced before sobriety. Incidence and Demographics Persons age 18 to 24 years of age have high prevalence rates for using most substances. The United States has higher rates of substance use than any other developed country. More than 50% of U.S. clients with a psychiatric disorder have a comorbid substance use disorder. Persons with schizophrenia are 4 times more likely to have a substance use comorbidity than the general population. Persons with bipolar affective disorder are 5 times more likely to have a substance use comorbidity than the general population. More than 2 million admissions annually are made to inpatient substance use treatment facilities. Though now legal in some states, marijuana is the most commonly abused illegal substance. Alcohol is the most commonly abused legal substance. Rates are higher in men than in women. 90% of men have used alcohol. 70% of women have used alcohol. 4 Rates are highest in African Americans, Hispanic Americans, and Native Americans; rates are lowest in Asian Americans. 55% of fatal driving accidents in the United States occur with a driver under the influence of alcohol. 50% of crimes in the United Stated are committed under the influence of alcohol. The lifetime risk for alcohol use disorder is 15% in the general U.S. population. Risk Factors Genetic loading Family history of substance abuse or major depressive disorder (MDD) Association with peer structure with heavy substance use Co-occurring psychiatric disorder X Age and gender (younger, males) Existence of chronic pain Untreated chronic pathological-level anxiety Substance-Related and Addictive Disorders 297 Prevention and Screening At-risk family education Stigma reduction Signs and symptoms of illness Treatment potential for control of symptoms Early recognition, intervention, and initiation of treatment to prevent disease development of complications of disorder Implications of alcohol and other drugs of abuse during pregnancy: Fetal alcohol syndrome (FAS) Prevalence: one third of all infants born to females with alcohol use disorder Signs: low birth weight and height, microphthalmia, short palpebral fissure, midface hypoplasia, smooth or short philtrum, thin upper lip Birth defects Acute alcohol intoxication in nontolerant persons such as teenagers: Coma Respiratory depression Death Administered by asking the client four questions Each positive answer scored as 1 point; negative answers receive no score The more positive answers, the greater the likelihood of an alcohol abuse disorder. Clients scoring 2 or greater are at mild to moderate risk for alcohol dependency, and the score is considered clinically significant Clients scoring 3 to 4 are considered at high risk for alcohol dependency Other screening AUDIT: Alcohol Use Disorders Identification Test S-MAST: Short Michigan Alcoholism Screening Test (or Geriatric Version) CRAFFT: Children and adolescents under 21 years of age COWS: The Clinical Opiate Withdrawal Scale CAGE SCREENING TEST IS THE MOST COMMONLY USED SCREENING TOOL FOR ALCOHOL ABUSE C: Have you ever felt the need to cut down on your drinking? A: Have people annoyed you by mentioning your drinking? G: Have you ever felt bad or guilty about your drinking? E: Have you ever had a drink the first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)? Assessment History Assess for the following: Detailed history of present illness, including time frame, progression, and associated symptoms Social history, including present living situation; marital status; occupation; education; and alcohol, tobacco, or illicit drug use Medication use, including prescription, over-the-counter, alternative, supplements, and home remedies Initial and periodic functional history and assessment Validate history with a family member Identify the category of drug abused by the client Knowing category allows for anticipation of physical impact of drug and to predict potential symptoms of withdrawal Clients often abuse drugs from categories with similar pharmacological properties. 5 Categories of abused agents: Alcohol Amphetamines or similar sympathomimetics Caffeine Cannabis Cocaine Hallucinogens Inhalants Nicotine Opioids Phencyclidine (PCP) or similar arylcyclohexylamines Sedatives Hypnotics Anxiolytics Assess for presence of substance abuse Maladaptive pattern of substance use manifested by recur. 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