117 LEC | Week 8 Sir Jethro Noel Chu Daños

SUBSTANCE RELATED DISORDER

Statistical Reports: SUBSTANCE ABUSE
 There’s in 9.4% of population used drugs - use of drug that is inconsistent with medical or
 25.6 million individuals of those 93% (approx. social norms.
22.7 million) in drug use and abuse rate had a o Despite negative consequences, substance
problem with severe enough to require abuse denotes problems in social,
treatment vocational or legal areas of the person’s life
 NICOTINE: 35% used for men while 23% is used - substance or chemical dependence can be used
for women interchangeably.
 MARIJUANA: 3x Men are more likely to use over o Associated with addictions such as
women tolerance, withdrawal land unsuccessful
 COCAINE & METH: 50%/50%; just as likely to attempts to stop using the substance
use - Distinction between abuse and dependence is
 PRESCRIPTION OPIATES: Women are most likely frequently views as unclear and unnecessary
to use because the distinction does not affect clinical
 ALCOHOLISM: 9.4% for Men and 4.7 for Women decisions once withdrawal or detoxification has
been completed
Types of Substance Abuse - This term includes both abuse and dependence, it is
 Substances can be used and abused not mean to refer to occasional or one-time use
 Some can be obtained legally while others are
illegal ONSET AND CLINICAL COURSE
 So much research and substance use has focus on
1. Polysubstance Abuse – Abuse more than one alcohol because it is legal and more widely used,
substance thus more is known about alcohol’s effect
Categories of Drugs include:  In general, the prognosis for alcohol use in is
a. Alcohol unclear because only people seeking treatment for
b. Sedatives, Hypnotics and anxiolytics problems with alcohol are usually studied
c. Stimulants
Alcoholism
d. Cannabis
 Begins to emerge in the mid-20s to the mid-30s
e. Hallucinogens
 These difficulties can be:
f. Inhalants
o Alcohol related breakup of a significant
2. Designer Drugs (Club Drugs)
relationship
 Became a problem in recent years
o arrest for public intoxication (driving while
 Synthetic substances made by altering existing
intoxicated)
medications or formulating new substances yet
o alcohol withdrawal
controlled or regulated
o early alcohol related health problems
 Made illegaly; most are amphetamine-like
stimulants & some also have hallucinogenic o interference with functioning at work or school
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 may contain unknown compounds as a filler or
additive, and the effects are unknown until the
drug is ingested.
 Generic/Specific terms:
a. Bath salts
b. Plant food
ALCOHOLISM
c. Ecstasy
(methylenedioxymethamphetamine)
d. Special K (Ketamine)
e. Smiles (2C-1)

INTOXICATION - use of substances that result in

 For many people, substance use is a chronic
maladaptive behavior.
illness characterized by remissions and relapses
WITHDRAWAL SYNDROME - negative psychological & to former levels of use
physical reactions that occur when use of substance  Dearth of recent scientific literature: “Anecdotal
ceases or dramatically decreases reports state that the abstinence was often in
response to:
DETOXIFICATION - safely withdrawing from a o a crisis or a promise to a loved one
substance.

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SUBSTANCE RELATED DISORDER
o was accomplished by engaging in o About 40% caused by environmental
alternative activities relying on influences
relationships with family and friends
o avoiding alcohol users and social cues 2. PSYCHOLOGICAL FACTORS
associated with drinking  Inconsistency of parent’s behavior, poor role
 Poor outcomes associated with an earlier age at modeling and lack of nurturing. Coping
onset so longer period of substance use and mechanism (to relieve stress & tension),
coexistence of a major psychiatric illness increase feeling of power.
o Family dynamics are thought to play a
ALCOHOLISM OUTCOMES part, so children of alcoholic are 4x as
GOOD OUTCOME POOR OUTCOME
likely to develop alcoholism compared
Spontaneous Remission  Mental and Physical
with the general population
(Natural Recovery): can Deterioration.
o Paved the way for the child to adopt a
modify or quit drinking on  Infectious Disease
similar style of maladaptive coping,
their own without (HIV/AIDS, hepatitis
stormy relationships and substance
treatment program. and tuberculosis) –
abuse
Intravenous (IV) drug
use.
3. SOCIAL & ENVIRONMENTAL FACTORS GENETICS
 Increase numbers of
ENVIRONMENT
alcohol dependent
 Alcohol consumption increases in areas where
people commit
availability increases and decreases in areas
SUICIDE.
where costs of alcohol are higher are higher
because of increased taxation.
RELATED DISORDERS
 influence initial and continued use of
 Substances can induce symptoms that are
substances: Cultural factors, social attitudes,
similar to other metal diagnoses (anxiety,
peer behaviors, loss, cost and availability
psychosis or mood disorders).
 Younger experimenters use substances that
 SUBTANCE-INDUCED ANXIETY, SUBSTANCE-
carry less social disapproval (such as alcohol &
INDUCED PSYCHOSIS ETC.
cannabis) while older people use drugs (such as
 The symptoms may subside once the substance
cocaine & opioids) that are cause liar and rate
is eliminated from the body, but this is not
higher disapproval
always the case.
 Alcohol increases and decreases in areas where
 Example: Methamphetamine
costs of alcohol are higher because of increased
o can cause substance induced psychosis
taxation
but psychotic symptoms may persist
due to damage to the brain CULTURAL CONSIDERATIONS
o NSG Care for client with delusions and  Attitudes toward substance use, patterns of use
hallucinations and physiological differences to substances vary
in different cultures.
ETIOLOGY
o Muslims do not drink alcohol
 Exact causes of drug use dependence and
o Wine is an integral part of Jewish
addiction are not known but various factors are
religious rights
thought to contribute to the development of
o Some Native American tribes use
substance related disorders
Peyote (spineless cactus) and
 So much of the research on biological and
hallucinogen in religious ceremonies
genetic factors has been done on alcohol abuse
 It is important to be aware of such beliefs when
but psychosocial and environmental studies
assessing for a substance abuse problem
have examined other drugs as well
 Ethnic groups have genetic traits that either
1. BIOLOGIC FACTORS
predispose them to or protect them from
 Children of alcoholic parents are at high risk for
developing alcoholism for instance flushing
developing alcoholism and drug dependence
FLUSHING
than are children of non-alcoholic parents.
 a reddening of the face and neck as a result of
o Result of environmental factors but
increased blood flow, has been linked to
evidence points to the importance of
variants of genes for enzymes involved in
genetic factors as well
alcohol metabolism.
o About 60% of the variation in causes of
 small amounts of alcohol induce flushing which
alcoholism = genetic
may be accompanied by that headache, nausea

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SUBSTANCE RELATED DISORDER
 highest people among Asian ancestry

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SUBSTANCE RELATED DISORDER
Types of Substances & Treatment
I. ALCOHOL
 Is a central nervous system depressant that is absorbed rapidly into the bloodstream
 Initial effects: relaxation and loss of inhibitions
 Alcohol Withdrawal usually peaks on 2nd day, is over in about 5 days (this can vary)l; some may take 1 -2 weeks

INTOXICATION OVERDOSE
o Slurred speech o Vomiting
o Unsteady gait o Unconsciousness
o Lack of coordination o Respiratory depression
o Impaired attention, concentration, memory and This combination can cause:
judgment o Aspiration Pneumonia
o Aggressive o Pulmonary Obstruction
o Display inappropriate sexual behavior o Alcohol-induced hypotension -> cardiovascular shock &
o Blackout death
Treatment:
o Gastric Lavage
o Dialysis (to remove the drug)
o Support of respiratory and cardiovascular functioning
in ICU.
WITHDRAWAL DETOXIFICATION
Symptoms (4-12 hours after cessation/marked reduction MILD SEVERE
of alcohol intake) o Abstain from alcohol o If those who cannot
o Coarse hand tremors o Treated SAFELY at abstain from alcohol
o Sweating home. o 3 – 5 Days Admission
o Elevated pulse and blood pressure o Admission to psychiatric
o Insomnia units is less common
o Anxiety TREATMENT:
o Nausea and vomiting o Benzodiazepines (lorazepam, chlordiazepoxide or
Severe or untreated: diazepam) – to suppress withdrawal syndorme
o Transient hallucinations o Tapering (fixed-schedule dosing)
o Seizures o Symptom-Triggered Dosing
o Delirium(delirium tremens)  the presence and severity of withdrawal symptoms
determine amount of medications needed &
frequency of administration
o Clinical Institute Withdrawal Assessment of Alcohol
Scale- protocol based assessment tool

II. SEDATIVES, HYPNOTICS AND ANXIOLYTICS

 CNS Depressants: barbiturates, nonbarbiturate hypnotics, and anxiolytics (benzodiazepines).
 Mostly abused drugs: benzodizapines and barbiturates
 Intended Purpose: Drowsiness and reduce anxiety.
 Intensity of effects depend on the particular drug , so effects are similar to those of alcohol

INTOXICATION OVERDOSE
o Slurred speech Benzodiazepines:
o Lack of coordination o Lethargic and confused
o Unsteady gait Barbiturates:
o Labile mood o Coma
o Impaired attention or memory o Respiratory arrest
o Stupor o Cardiac failure
o Coma o Death
Treatment:
o Gastric Lavage
o Dialysis (to remove the drug) – if symptoms are severe
o Support of respiratory and cardiovascular functioning
in ICU.
WITHDRAWAL DETOXIFICATION
Symptoms Tapering the amount of the drug the client receives over a
Short acting (lorazepam) – produce withdrawal symptoms period of days or weeks, depending on the drug and the
in 6 to 8 hours amount the client had been using.
Long acting (diazepam) - produce withdrawal symptoms in
1 week Example:
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SUBSTANCE RELATED DISORDER
o Autonomic Hyperactivity: (increased pulse, blood o Dosage of Benzodiazepine: Valium 10mg 4x a day
pressure, respirations and temperatures) (decreased every 3 days and the frequency daily)
o Hand tremor
o Insomnia
o Anxiety
o Nausea
o Psychomotor agitation
Severe Benzodiazepine Withdrawal:
o Seizures and hallucinations

III. STIMULANTS
 Drugs that stimulate or excite the CNS and have limited clinical use.
 High potential for abuse
o Examples:
 Amphetamines (lose weight quickly & stay awake)
 Cocaine (produces intense and immediate feeling of euphoria)
 Methamphetamine (addictive & causes psychotic behavior, produces brain damage related to
frequent usage, primary as a result of liquid agricultural fertilizer )
 Withdrawal occurs within a few hours to several days after cessation of the drug; is not life-threatening
 marked withdrawal symptoms referred to as “crushing”

INTOXICATION OVERDOSE
o High or euphoric feeling o Seizures and coma
o Hyperactivity, Hypervigilance and Talkativeness o Deaths are rare
o Anxiety
o Grandiosity and Hallucinations
o Stereotypic or Repetitive Behavior
Treatment:
o Anger, Fighting and Impaired Judgment
o Chlorpromazine (Thorazine) - an antipsychotic,
Physiological Effects:
controls hallucinations, lowers BP and relieves nausea.
o Tachycardia, elevated BP, dilated pupils, perspiration
or chills, nausea, chest pain, confusion and cardiac
dysrhythmias
WITHDRAWAL DETOXIFICATION
Marked dysphoria (primary symptom) o Stimulant withdrawal is not treated pharmacologically.
Accompanied by:
o Fatigue
o Vivid
o Unpleasant dreams
o Insomnia
o Hypersomnia
o Increased appetite
o Psychomotor retardation
o Agitation
Depressive symptoms:
o Suicidal ideation for several days

IV. CANNABIS
 Cannabis sativa is the hemp plant that is widely cultivated for its fiber use to make rope, cloth and oil
 Known for its PSYCHOACTIVE RESIN (60 cannabinoids; primary component is Delta-9-tetrahydrocannabinol (Δ9-
THC))
 MARIJUANA: upper leaves, flowering tops, stems of the plant
 HASHISH: dried resinous exudate from the leaves of the female plant
 Is often smoked in cigarettes and it can also be eaten.
 Short term effects of lowering intraocular pressure.
 Other Indication: relieve nausea and vomiting (Associated with cancer chemotherapy), anorexia and weight loss
(AIDS)and control of seizures.
 Some countries/states have legal or illegal status of usage
o some legalized medical marijuana use ,recreational use, both or neither
 research has shown that it has short-term effects lowering intraocular pressure but is not approved for the
treatment of glaucoma

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SUBSTANCE RELATED DISORDER
 Currently, 2 cannabinoids (dronabinol and nabilone) have been approved for treating n/s from cancer
chemotherapy
 Begins to act less than 1 min after inhalation; peak effects usually occur in 20-30 mins and last at least 2-3 hours
 Users report: high feeling similar to euphoria & increased appetite

INTOXICATION OVERDOSE
o Impaired motor coordination o Delirium or rarely, cannabis-induced psychotic
o Inappropriate laughter disorder, both of which are treated symptomatically.
o Impaired judgment and short term memory o Overdoses of cannabis DO NOT OCCUR.
o Distortions of time and perception
o Anxiety, dysphoria and social withdrawal
o Increased appetite
Physiological Effects:
o Conjunctival injection (bloodshot eyes)
o Dry mouth
o Hypotension
o Tachycardia
WITHDRAWAL & DETOXIFICATION
o Some reported withdrawal symptoms of muscle aches, sweating, anxiety and tremors
o No clinically significant withdrawal syndrome is identified

V. OPIOIDS
 Popular drugs of abuse because they desensitize the user to both physiological and psychological pain.
 Induce a sense of euphoria and well-being.
 Include both potent prescription analgesics such as morphine, meperidine, codeine, hydromorphone,
oxycodone, methadone, oxymorphone, hydrocodone and propoxyphene.
 Illegal substances: heroin, fentanyl (synthetic opioid used in clinical setting for anesthesia) and normethadone.

INTOXICATION OVERDOSE
Develops soon after the initial euphoric feeling o Coma
Symptoms: o Respiratory depression
o Apathy o Pupillary constriction
o Lethargy o Unconsciousness
o Listlessness o Death
o Impaired judgment Treatment:
o Psychomotor retardation or agitation o Naloxone (Narcan)
o Constricted pupils  Opioid antagonist; reverses all signs of opioid
o Drowsiness toxicity.
o slurred speech  Given every few hours until opioid level drops to
o Impaired attention and memory non-toxic
 Process make take days
 First responders now carry autoinjector form
WITHDRAWAL DETOXIFICATION
 Develops when drug intake ceases or decreases o Symptoms of opioid withdrawal cause significant
 Can be precipitated by administration of an opioid distress, but do not require pharmacologic
antagonist intervention to support life or bodily functions.
 Short acting drugs such as heroin produce withdrawal o Substitution of methadone during detoxification
symptoms - 6 – 24 hours; peak in 2-3 days, gradually reduces symptoms to no worse than a mild case of flu.
subside in 5-7 days o Anxiety, insomnia, dysphoria, anhedonia and drug
 Longer acting substances such as methadone may not craving may persist for weeks or months
produce symptoms for 2-4 days, but may take 2 weeks
to subside; can be used as a replacement for opioids,
dosage is then decreased over 2 weeks
Symptoms:
o Anxiety
o Restlessness
o Aching back and legs
o Cravings for more opioids
o Nausea and vomiting
o Dysphoria
o Lacrimation
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SUBSTANCE RELATED DISORDER
o Rhinorrhea
o Sweating
o Diarrhea
o Yawning
o Fever
o Insomnia

VI. HALLUCINOGENS
 Substances that distort the user’s perception of reality and produce symptoms similar to psychosis, including
hallucinations and depersonalization.
 Causes increased pulse blood pressure and temperature, dilated pupils and hyper reflexia
o Examples: mescaline, psilocybin, lysergic acid diethylamide and designer drugs such as ecstasy.
 Phencyclidine (PCP), developed as an anesthetic, acts similarly to hallucinogen
 Do not directly cause death, though fatalities have occurred from related accidents, aggressions and suicide

INTOXICATION OVERDOSE
Marked by several maladaptive, behavioral or o Overdoses as such do not occur.
psychological changes
o Depression
o Paranoid ideation
o Ideas of reference Treatment:
o Fear of losing one’s mind o Supportive psychotic reactions
o Dangerous behavior (jumping out a window in the o Isolation to external stimuli
belief that one can fly) o Physical restraints - safety of client and others
Physiological symptoms: o Cooling devices (hyperthermia blankets)
o Sweating, Tachycardia, Palpitations, Blurred vision,
o Mechanical ventilation is used to support respirations.
Tremors and Lack of coordination.
PCP Intoxication:
o Belligerence, aggression, impulsivity and unpredictable
behavior.
PCP Toxicity
o Seizures, hypertensions, hyperthermia, respiratory
depression
WITHDRAWAL DETOXIFICATION
o No withdrawal syndrome has been identified o Flashbacks - transient recurrences of perceptual
o Craving for the drug disturbances.
o These episodes occur even after all traces of the
hallucinogen are gone and may persist for a few
months up to 5 years.

VII. INHALANTS
 Diverse group of drugs that includes anesthetics, nitrates and organic solvents that are inhaled for their effects.
 Most common: Aliphatic and aromatic hydrocarbons (gasoline, glue, paint thinner and spray paint)
 Less frequently used halogenated hydrocarbons nuclide: cleaners, correction fluid, spray, can propellants and
other compound containing esters, ketones and glycols
 Most of vapors are inhaled from a rag soaked with the compound, from a paper or plastic bag, or directly from
the container.
 Cause significant brain damage, peripheral nervous system damage and liver disease.

INTOXICATION & OVERDOSE TREATMENT

o Involves dizziness, nystagmus, lack of coordination, o Supporting respiratory and cardiac functioning.
slurred speech, unsteady gait, tremor, muscle o No antidotes or specific medication to treat inhalant
weakness and blurred vision. toxicity.
o Stupor and coma can occur.
o Significant behavioral symptoms are belligerence,
aggression, apathy, impaired judgment and inability to
function.
ACUTE TOXICITY: anorexia, respiratory depression, vagal
stimulation and dysrhythmias
o Death may occur from bronchospasm, cardiac arrest,
suffocation or compound aspiration or vomitus.
WITHDRAWAL & DETOXIFICATION

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SUBSTANCE RELATED DISORDER
o No withdrawal or detoxification procedures for inhalants.
o Psychological cravings
o Persistent dementia or inhalant-induced disorders (psychosis, anxiety or mood disorders) even if the inhalant abuse
ceases
o These disorders are all treated symptomatically.

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SUBSTANCE RELATED DISORDER
TREATMENT SETTING AND PROGNOSIS
Health professionals provide extended or outpatient treatment in various OUTPATIENT
CLIENT
settings
1. Clinics Or Centers – offering day & evening programs
DETOXIFICATIOn
2. Halfway Houses (medically supervised)

3. Residential Settings
(treated in)
4. Special Chemical Dependency Units MEDICAL UNITS

Various Settings:
 The type of treatment setting selected is based on the client’s needs as (referred to an)
OUTPATIENT
well as on his or her insurance coverage. TREAMTENT SETTING

 Example. Someone who has limited insurance cov, is working and has a
o the outpatient setting may be chosen first because it is less expensive
o the client can continue to work and the family can provide support
o if the client cannot remain sober during outpatient treatment, then inpatient treatment may be required
o clients with repeated treatment experiences may need the structure of a halfway house with a gradual
transition in to the community
PHARMACOLOGIC TREATMENT
TWO MAIN PURPOSES:
1. To permit safe withdrawal from alcohol, sedative hypnotics and benzodiazepines
2. To prevent relapse

PROBLEM DRUG OF CHOICE DRUG ACTION

Alcohol Vitamin B1 (Thiamine) To prevent Wernicke-Korsakoff Syndrome
Alcohol Withdrawal Benzodiazepine Anxiolytic Agent Suppress the symptoms of abstinence.
(Lorazepam, Chlordiazepoxide and o Can be administered on fixed schedule around the
Diazepam) clock during withdrawal
o PRN according to the symptom parameters
however, just as effective and results in as speedier
withdrawal
Benzodiazepine- Barbiturates For alcohol withdrawal.
resistant
Alcohol Drinking Disulfiram (Antabuse)* To help deter clients from drinking.
Recovering from Acamprosate (Campral) To help reduce cravings
Alcohol Abuse or To decrease the physical and emotional discomforts (1 st
Dependence few month of recovery)
Addiction to Heroin Methadone Potent synthetic opiate.
Taking Sulfur and drinks alcohol, a sever Substitute for heroin in some maintenance program.
adverse reaction occurs w/ flushing and o 1 daily dose – meets phsycial need for opiates but
throbbing headaches, sweating, n/v does not produce cravings
o Severe cases: severe hypotension, o Does not produce the high associated w/ heroine
confusion, coma and even death o Safer than heroine because it is legal, controlled by
o Interventions: avoid products a physician and available in tablet form
containing alcohol (e.g. Cough  Avoids the risk of IV drug use, the high cost
syrup, lotions, mouthwash of heroin which often leads to criminal acts
perfume, aftershave, vanilla and and questionable content of street drugs
other extracts), client must read
product labels carefully because
symptoms occur for 1-2 weeks
after last dose of Disulfiram

Opiate Dependence. Levomethadyl Narcotic Analgesic.

Treating opiate dependence.
Same manner as methadone
Opiate Addiction Buprenorphine/naloxone (Suboxone) Opiate maintenance
Combination drug To decrease opiate cravings.
B - semi synthetic opioids o 1 daily sublingual dose
N – opioid inverse agonist o Medication ingestion is supervised at least initially
because Suboxone has the potential for abuse and
diversion
o Clients can be tapered after treatment and w/
adequate psychosocial support
o Some may remain on maintenance dose for an

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SUBSTANCE RELATED DISORDER
extended time
Opioids Overdose Naltrexone (Re Via) Receptor Antagonist.
To treat overdose.
Negating effect of using more opioids
Reduce the cravings for alcohol in abstinent clients.
o Extended release null tracks once has been
effective in reduction cravings
o is also available as one smartly injective marketed
as vivitrol
It is important to remember that medications will help the client manage or tolerate the symptoms, such as withdrawal
or cravings, but pharmacology is not a specific treatment for substance abuse. Participation in treatment and follow-up
with community aftercare are essential for long-term positive outcomes.

DUAL DIAGNOSIS
 Both substance abuse and another psychiatric disorder.
 Who have schizophrenia, schizoaffective disorder or bipolar present the GREATEST CHALLENGE to health care
professionals.
 50% of people with a substance abuse disorder also have mental health diagnoses.

REASONS OF LIMITED SUCCESS OF TRADITIONAL METHODS FOR TREATMENT OF MAJOR PSYCHIATRIC ILLNESS OR
PRIMARY SUBSTANCE ABUSE:
1. Impaired ability to process abstract concepts. (major barrier in substance abuse programs)
2. Substance use treatment emphasizes avoidance of all psychoactive drugs. (may not be possible for client who needs
psychotropic drugs to treat his or her mental illness)
3. The concept of ‘limited recovery”. (more acceptable in the treatment of psychiatric illnesses)
4. The notion of lifelong abstinence. (may seem overwhelming and impossible to client who lives day-to-day w/a
chronic mental illness)
5. Use of alcohol and other drugs can precipitate psychotic behavior. (it makes difficulty to professionals to identify
whether symptoms are the result of active mental illness or substance abuse)
Studies of successful treatment and relapse prevention strategies for this population found that integrated treatment
programs that address many unmet needs are more likely to succeed

COMMUNITY-BASED CARE
 Follow-up or aftercare for clients in the community is based on the client’s references or the programs available.
 Some clients remain active in self-help groups.
 Attend aftercare program sessions sponsored by the agency where they complete the treatment.
 Others seek individual or family counseling.
 The nurse may also encounter recovering clients in clinics or physicians’ offices.

SUBSTANCE ABUSE IN HEALTH PROFESSIONALS

HEALTH CARE PROFESSIONALS VS OTHER PROFESSIONALS
 higher rates of dependence on controlled substances such as opioids, stimulants and sedatives than other
professionals
 One reason is the ease of obtaining controlled substances, health care professionals also have a higher rates of
alcoholism than the general population
 The issue of reporting colleagues with suspected of substance abuse is an important and extremely sensitive one so
it is difficult for colleague to report their peers

More specific behaviors and signs that might indicate substance abuse include:
 Incorrect drug counts
 Excessive controlled substances listed as wasted or contaminated
 Reports by clients of ineffective pain relief from medications
 Damaged or torn packaging on controlled substances
 Increased reports of “pharmacy error”
 Consistent offers to obtain controlled substances from pharmacy
 Unexplained absences from the unit
 Trips to the bathroom after contact with controlled substances
 Consistent early arrivals at or late departures from work for no apparent reason

Nurses can become involved in substance abuse, so they deserve the opportunity for treatment and recovery Reporting
suspected substance abuse could be the crucial first step forward toward a nurse getting the help he/she needs

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SUBSTANCE RELATED DISORDER
SELF-AWARENESS ISSUES
 The nurse must examines his or her beliefs and attitudes about substance abuse
 A history of substance use in the nurse’s family can influence strongly his or her interaction with clients
o The nurse may be overly harsh and critical, telling the client he/she should realize how you’re hurting
your family
o Conversely the nurse may unknowingly act out old family roles and engaging in enabling behavior (e.g.
sympathizing with the client’s reason for using substances)
 Examining one’s own substance use or the use by close friends and family may be difficult and unpleasant, but it is
necessary if the nurse is to have therapeutic relationship with clients
 The nurse might also have different attitudes about various substances of abuse
 Example: a nurse may have empathy for client who is addicted to prescription medications but is disgusted to clients
who are using illegal substances. It is important to remember that the treatment process and underlying issues of
substance abuse, remission and relapsed are quite similar regardless of substance

POINTS TO CONSIDER
When working with clients and families with substance abuse
 Is a chronic, recurring disease for many people, just like diabetes or heart disease. Even though clients look like
they should be able to control their substance abuse easily, they cannot without assistance and understanding.
 Examine substance abuse problems in your own family and friends, even though it may be painful. Recognizing
your own background, beliefs, and attitudes is the first step forward managing those feelings effectively so that
they do not interfere with the care of clients and families.
 Approach each treatment experience with an open and objective attitude. The client may be successful in
maintaining abstinence after his or her second or third (or more) treatment experience.

PSYCHIATRIC-MENTAL HEALTH NURSING 8 TH EDITION BY SHEILA L. VIDEBECK (PAGES 355 -377) SLM