The psychosocial behaviors related to substances dependence are often called addiction.
Withdrawal symptoms and tolerance are signs that the person has physical dependence on the drug. withdrawal symptoms result from a biological need that develops when the body becomes adapted to having the drug in the system.characterisitic symptom occur when the level of the substance in the system decreases. Tolerance means that with continued use, more of the substance is needed to produce the same effect.
Physical dependence can occur independently from the symptoms of substances dependence.
Once use has begun, the risk of becoming dependent is influenced by many biological, psychological and sociocultural factors.
Attitudes toward substance abuse
Nurses should be aware of these social and cultural attitudes and recognize their impact on individual users people close to them.
Changing laws related to consumption, sale,and serving of alcohol and drugs may reflect changing attidues toward their use.Driving while intoxicated (DWI) laws are becoming tougher.
Many nurses have negative attitudes toward alcoholics and other drug abuser, some have had negative experiences with familly members of friends who have had substances related problems. This may influence the nurse’s ability to asses and care for these patients.
Substances abuse is a chronic, relapsing, dissabling health condition with both genetic and societal implications.
Prevalence
Substance abuse is a chronic,relapsing health problem.substances abusers may be in treatment many times, or make repeated attempts to quit, before they are succesful.
Adolesecents is the most common period for the first experience with drugs, although teenagers who use psychoactive substances tend to progress from nicotine to alcohol to marijuanan and then to drugs that are perceived to be more dangerous, drug use patterns seem to be most realated to availability.
According to the national institute on drug abuse, about 81% of people in the united states age 12 and older have used alcohol sometime in their lives(johnson et al.2003)
A part from being illegal,underage drinking poses a high risk for injury and social consequences, such as increased motor vehicles accidents, suicide, sexual assault, and high risk sexual behavior. Underage alcohol use is also more likely to ill young people than is all the illegal drugs combined (alcohol alert,2003)
Overall use of alcohol and illicit drugs appears to increase in to a person’s mid-20’s, level off and then decrease with age. If use begins before age 15 the individuals is 4 times more likely to have abuse problems as an adult compared with individuals who begin usng alcohol after age 21 (DeWit et al,2000)
With more education were more likely to use alcohol, but heavy use was more common among the less educated and unmployed (horgan,2001)
One of the most troubling effects of alcohol is it effects on marriage, whic is reflected in the relationship between heavy drinking and marital violence,illicit drugs and alcohol play a role in domestic violence, affecting both married and unmarried couples. More than ¾ of female victims of nonfatal domestic violence report that their assailant had been drinking of using drugs (horgan,2009)
Most people with alcohol use disorders do not seek treatment (weisner and Matzzger,2002)
Multiple Substance use
Simultaneous or sequential use of more than one substance is very common. People do this to enhase,lessen or otherwhise change the nature of their intoxication or to relieve withdrawal symptoms.
Use of acohol with coccaine of use alcohol with heroin also known as speedballing, is especially common. Heroin users often combine alcohol, marijuanan and benzodiazepines with heroin.
Dual diagnosis
Is the addicted population prevelance of psychiatric illness is no greater than in the general population.
Lifetime prevalence of substance abuse and psychiatric disorders
| Psychiatric disorders | Alcohol abuse | Alcohol dependence | Drug abuse | Drug dependence | note |
| Schizoprenia | 10 | 24 | 15 | 13 | % |
| Antisocial personality | 22 | 52 | 11 | 31 | % |
| Panic disorders | 7 | 22 | 3 | 11 | % |
| Major depression | 5 | 11 |
| 11 | % |
Thus they are referred to as having a dual diagnosis.for example people with schizoprenia are more than 4 times as likely to have a substance use disorder during their lifetimes, and those with bipolar disorder are more than 5 times as likely to have such a diagnosis than are people in the genral population.
Substance –related disorders in nurse
According to the national council of sttae boards of nursing, 53% of all disciplinary actions taken againts registered nurses in 1995 were drug related (down from 94.4%in the 1987 and 68% in 1991) these figures could reflect a decrease in the problem, a decrease in reporting of the problem, earliner and more effective treatment, or an increase in the reporting of non-substance related competency problems.
Alcohol is the drug of choice for nurses, as it in the general population also as in there the nurses choice of substances is influenced by availability and exposure.
Among narcotics, the drug of choice for nurses is meperidine (demerol).Anesthesiologist and nurse anesthetics who abuse substances tend to favor fentanyl, apotent, shortacting narcotic. In general, helath care proffesionals tend to abuse prescription drugs rather than “street” drugs, wheter they acquire them by prescribtion or diversion.
Screening for substance abuse
Simple screening toolas are availbale that are useful in identifying people who may have problems with substance use, becouse screening tools are only suggestive ,finding from them shoud be followed by a full diagnostic assesment.
CAGE
The simplest tool that can be used in any helath setting to screen for alcoholism is the cage questionnare.
1. Have you ever felt you ought to cut down on your dringking?
2. Have people annoyed you by critizing your drinking?
3. Have you ever felt bad or gulty about your drinking?
4. Have you ever had a drink first thing in the morning to steady you nerves or ged rid of a hangover (eye-opener)?
Note : yes answer scoring 2
Breathalyzer : thesimplest biological measure to obatin is blood alcohol content (BAC) by use of a breathalyzer.
Blood and urine screening : blood and urine are the body fluids most often tested for drug content, althought saliva,hair,breath and sweat analysis methods have been developed. Identification and measurement of drug levels in the blood are useful for treating drug overdoses or complications in the emergency room and other medical settings. Otherwise urine drug screening is the method of choice becouse it is nonivansive.
Behaviours of abuse and dependance
