0:00 hi guys we're going to talk about
0:02 chapter 22 and this is going to really
0:04 focus in on substance related and
0:07 addictive disorders so when we think
0:10 about substance use disorders these are
0:13 not disorders of choice they are very
0:15 complex diseases of the brain that are
0:18 usually characterized by Cravings
0:20 seeking and using regardless of any
0:23 consequences
0:25 continued use can actually change the
0:27 brain structure and function substance
0:31 use disorder is the pathological use of
0:34 a substance that leads to to a disorder
0:37 of use so let's just get started here
0:42 when we think about substance use
0:44 disorder these are symptoms that are
0:48 grouped together they usually have
0:50 impaired control social impairment risky
0:53 use and some of the physical effects
0:56 that we're going to get into are
0:57 intoxication tolerance and withdrawal so
1:02 all of these groups are going to have
1:03 all of these symptoms
1:09 substances that can lead to use
1:11 disorders can fall into remember four
1:16 major groupings that impaired control
1:18 social impairment risky use and again
1:22 those physical effects and the ones that
1:25 we're going to look at are listed here
1:26 alcohol caffeine cannabis hallucinogens
1:30 inhalants opioid sedative hypnotics
1:34 stimulants tobacco and we don't want to
1:37 forget that gambling is also a very
1:40 addictive process so it can also lead to
1:45 a disorder
1:48 so some of the concepts Central to
1:50 Adaptive use disorders we can talk about
1:53 addiction and that's defined as a
1:56 primary chronic disease of brain reward
2:00 motivation memory and related circuitry
2:05 they are typically without addiction
2:07 unable to abstain from whatever
2:09 substance they are addicted to and
2:12 they're real those people are unable to
2:14 really recognize any functional problems
2:18 that may be going on
2:21 without treatment addiction is
2:23 Progressive and it can lead to
2:25 disability or death
2:28 intoxication is that excess use of
2:31 substance
2:33 some of the terminology can vary
2:36 depending on the substance that you're
2:39 using so anyone using substances may be
2:43 considered Under the Influence alcohol
2:46 can cause intoxication or cocaine will
2:51 make you high so some of that
2:53 terminology is just a little bit
2:54 different depending on the substance
2:57 that's being used
2:58 when we think about tolerance an
3:01 individual no longer responds to the
3:04 substance in the initial way that they
3:07 responded so they really need more of
3:10 that substance to feel the same response
3:14 withdrawal we have symptoms that occur
3:16 with when one stops using that substance
3:20 so each substance has its own
3:22 characteristic withdrawal symptoms we
3:25 unfortunately know that the more intense
3:28 the symptoms one has the more likely the
3:31 person is going to start using again
3:33 because the withdrawal symptoms are so
3:37 bad they're like nope I'm not doing this
3:40 this is too bad I'm just going to get
3:42 back on my substance again
3:47 so as far as epidemiology the national
3:50 survey on drug use and health survey is
3:54 conducted annually participants are
3:57 typically 12 years and older and they're
4:00 randomly selected for an interview then
4:03 based on this data they can see about
4:05 165 million people use substances within
4:09 that last month the actual number of
4:12 people with substance use disorder is
4:15 about 20.3 million and that includes
4:19 about 15 million with an alcohol use
4:21 disorder and about 8 million with an
4:24 illicit drug disorder
4:29 so this again is our epidemiology you
4:32 can see
4:33 um note the past Year's substance use
4:36 disorder this came from a 2018 study and
4:40 you can just see the differences in the
4:42 numbers there on which substance was
4:45 used more heavily
4:51 you can think about genetic factors
4:53 substance use disorders such as cannabis
4:56 cocaine and opioids typically run in
4:59 families
5:00 as far as neurobiological factors the
5:03 major neurotransmitter involved in
5:06 developing substance use disorders are
5:08 the opioid catecholamine and Gaba
5:11 symptoms systems sorry as far as
5:15 environmental factors poverty raises the
5:18 risk of an unfavorable living
5:20 environment lack of Parental supervision
5:23 poor educational resources and really an
5:27 impaired support system
5:29 a cycle of negative environmental events
5:31 often begins with disadvantaged
5:34 neighborhoods increasing Stress and
5:37 Anxiety along with a lack of negative
5:39 social ties which really contributes to
5:42 depression so the environment is really
5:44 a high risk factor depending on kind of
5:49 that patient's unfortunate poverty level
5:53 so here's our clinical picture we're
5:56 just going to go through each of these
5:58 and we're caffeine so caffeine is the
6:03 most widely used
6:05 psychoactive substance in the world
6:08 why do individuals use caffeine as an
6:11 addiction it increases your alertness
6:14 and it decreases your fatigue right I'm
6:17 sure all of you or most of your coffee
6:19 drinkers I'm not a coffee drinker I'm
6:21 more of a Giant Mountain Dew Drinker
6:24 um but if I'm tired right I can hit one
6:28 of those up and it kind of increases my
6:30 alertness and decreases that fatigue so
6:32 I can keep going
6:34 um this really is an official use
6:36 disorder but it can still result in
6:39 intoxication overdose and withdrawal
6:42 so when we think about caffeine
6:43 intoxication this usually occurs with
6:46 greater than 250 milligrams of
6:49 consumption so those of you that have
6:51 those high energy drinks that's two of
6:54 those and then you can have that
6:55 intoxication feeling some of the
6:58 behavioral symptoms that you might
7:00 notice are restlessness nervousness
7:02 excitement maybe that rambling speech
7:06 where you just are talking super fast
7:08 some of the physical symptoms might be a
7:11 flushed face Maybe diuresis GI
7:14 disturbances such as kind of nausea
7:16 belly aches and tachycardic
7:20 high doses can cause Grand mouth
7:23 seizures respiratory failure and even
7:26 death so a lot of people don't think
7:28 about caffeine in that way but
7:31 understand really high doses can be very
7:33 serious
7:35 when you think about caffeine withdrawal
7:38 this is associated with medical problems
7:44 excuse me and there's really no
7:45 intervention that's needed symptoms can
7:48 occur within 12 to 24 hours after
7:51 consumption and the peak is usually
7:53 about 24 to 48 hours symptoms could
7:56 include headache drowsiness maybe some
7:59 irritability so I think if you can think
8:01 about that time if you've had that time
8:04 or opportunity to maybe cut out your
8:06 caffeine in about a day or two I know
8:10 I've experienced it I start getting that
8:12 headache I get a little more irritable
8:14 because I'm I just have that little bit
8:16 of addiction to that caffeine
8:20 when we think about cannabis or
8:22 marijuana this is the most widely used
8:24 drug in the world it is legalized in
8:27 some states synthetically for the use of
8:30 nausea and vomiting that is associated
8:33 with chemo for cancer
8:35 more states are becoming more widely
8:38 open with cannabis so you just have to
8:42 know which of those States is widely
8:44 using it other synthetic cannaboids
8:48 um are K2 or spice can be associated
8:52 with toxic doses
8:54 it is the fourth most commonly used
8:56 psychoactive drug in the U.S after
8:58 caffeine alcohol and nicotine
9:02 cannabis intoxication we can think about
9:05 the heightened Sensations Sensations are
9:08 barely very heightened they see things
9:11 in brighter colors new details of common
9:14 stimuli time seems to go much more
9:17 slower
9:19 and motor skills are impaired for about
9:21 8 to 12 hours
9:24 cannabis withdrawal typically occurs
9:26 within about one week of cessation some
9:29 of the behavioral symptoms that we might
9:31 see are anger irritability maybe some
9:34 anxiety
9:36 some of the physical symptoms may
9:38 include abdominal pain sweating fever
9:41 chills and even headache as far as
9:44 treatment
9:45 abstinence and support is our main
9:48 principle we can think about individual
9:51 family and group therapies to help
9:53 Provide support we also need to just be
9:56 aware as health care providers that drug
9:59 scheme screens can detect cannabis for
10:02 up to four weeks after use
10:06 hallucinogens cause a very profound
10:09 disturbance in reality there are two
10:12 categories we can think about classic
10:14 and disassociative drugs the first one
10:18 is that we're going to talk about is our
10:20 classic which are hallucinogen
10:23 Classics which are LSD so other
10:27 terminology might be acid maybe Boomers
10:31 significant psychological and behavioral
10:33 changes occur with this when they're on
10:35 this paranoia Illusions maybe some
10:38 hallucinations even some of the physical
10:41 symptoms that we could think about are
10:43 pupillary dilation
10:45 tachycardia sweating and Tremors and
10:48 treatment is usually trying to just talk
10:51 that patient down reassuring them that
10:54 the symptoms are going to subside
10:57 sometimes in severe cases we may have to
11:00 administer Haldol or Valium and very
11:03 short-term periods
11:06 um dissociative drugs
11:09 um for hallucinogens are our PCP
11:13 um otherwise known as either angel dust
11:16 Sherman's Zoom or some of the other
11:19 lingo that I've heard of
11:22 um it this is a medical emergency if
11:25 you're in a PCP intoxication your
11:28 patient is in a medical emergency that
11:30 they could result in very violent side
11:33 effects they can be very belligerent
11:35 they can be very assaultive or impulsive
11:39 as far as treatment these patients
11:41 typically are unable to be talked down
11:44 so we will have to restrain most of
11:47 these patients that are in a PCP
11:48 intoxication
11:50 as far as hallucinogen withdrawal
11:53 there's no official withdrawal diagnosis
11:56 they will re-experience symptoms
12:00 while intoxicated so that
12:03 re-experiencing of perceptual symptoms
12:06 may actually prevent normal function for
12:09 weeks months are even years
12:15 inhalants are there are toxic gases that
12:18 are inhaled through the nose or mouth
12:20 and then enter into our bloodstream
12:22 common household products include
12:24 solvents for glues and adhesives
12:27 propellants maybe paint spray or paint
12:31 spray aerosol hair sprays shaving cream
12:34 some of our thinners might be paint
12:36 products Correctional fluid and then
12:39 fuels is the last one gasoline and
12:42 propane so these are all different
12:45 um items that people can inhale in order
12:48 to get that high feeling
12:51 it can cause failure in major life roles
12:54 and interpersonal relationships
12:58 cardiac arrhythmias is a is a big thing
13:02 they can have that sudden sniffing death
13:04 right they sniff something they inhale
13:07 something they go into a cardiac
13:09 arrhythmia that could actually cause
13:11 death
13:12 inhalant intoxication really depends on
13:14 the substance but generally they're
13:17 going to have that disinhibitation
13:19 disinhibition and Euphoria they may have
13:23 some fearfulness Illusions Auditorium
13:26 visual hallucinations impaired judgment
13:29 impulsive aggressive and some of the
13:32 physical symptoms that you might see are
13:34 nausea anorexia diplopia super
13:38 unconsciousness and Amnesia especially
13:42 in some very high doses as far as
13:45 treatment there is no treatment it's
13:48 self-limited
13:50 um they will come off of that high in a
13:52 few hours to a few weeks again depending
13:55 on the substance
13:59 everyone has heard about opioids
14:01 especially the opioid misuse
14:05 particularly heroin or prescription
14:08 drugs and this is a chronic relapsing
14:11 Disorder so our patients get an opioid
14:14 because they have a craving for it that
14:17 craving they become tolerant to it so
14:20 they need larger amounts which just
14:22 increases our intolerance and it's this
14:25 vicious circle that our patients can go
14:27 through it can cause very significant
14:30 life roles and interpersonal impairment
14:33 as far as opioid intoxication drowsiness
14:37 Tacoma slurred speech impaired memory
14:41 pupillary constriction impaired judgment
14:44 and social functioning and we but we can
14:47 give naloxone IV to relieve some of
14:50 those toxic effects
14:52 when we think about opioid withdrawal
14:54 this occurs after cessation of heavy use
14:58 symptoms may include mood dysphoria GI
15:02 symptoms muscle aches fever insomnia
15:04 other classic symptoms include
15:07 lacrimation rhinorrhea and then
15:10 pupillary dilation right because we're
15:12 coming off of it
15:14 morphine heroin methadone is usually a
15:18 six to eight hour after the last dose
15:20 with one week of use when we're coming
15:23 off of it
15:25 meperidamine or Demerol is usually 8 to
15:29 12 hours to about five days for that
15:32 withdrawal
15:35 opioid overdose death usually results
15:38 from respiratory arrest due to
15:41 respiratory depressant effect of the
15:42 drug
15:44 so we're going to really need to do a
15:45 lot of respiratory support and then give
15:47 that naloxone
15:49 as far as general treatment
15:51 individual family behavioral therapies
15:54 can be helpful in managing use
15:56 pharmacological treatment is methadone
16:00 bupary norefine and naloxone
16:05 the methadone just decreases those
16:08 painful symptoms of withdrawal
16:14 sedative hypnotic and anti-anxiety
16:17 medications so these can include our
16:21 benzos benzo like drugs carbamates
16:24 barbiturates and barbavituate like drugs
16:27 it could also include our club drugs
16:30 sorry club drugs like um the date rape
16:33 drug
16:34 it can also include prescriptive sleep
16:37 medication and maybe even anti-anxiety
16:40 medications
16:42 the craving is a typical feature with
16:45 significant tolerance and then
16:46 withdrawal can develop once they stop
16:48 taking it
16:50 as far as intoxication we're going to
16:52 see symptoms like slurred speech
16:54 impaired thinking coma can be a very
16:57 dangerous possibility
16:59 when we're thinking overdose treatments
17:01 gastric lavage is what has to happen we
17:04 have to get that substance out of their
17:07 system so we'll use that activated
17:09 charcoal monitor the vital signs and get
17:13 that substance out as soon as we can
17:15 withdrawal really again depends on the
17:17 degree and timing of the specific
17:19 substance a treatment could be gradual
17:23 reduction of whatever the substance is
17:25 to prevent seizures so especially with
17:29 our benzos we want to just gradually
17:31 reduce those benzos
17:35 stimulants ah cocaine Coke crack snow
17:39 blow sniff whatever you want to call it
17:41 and other amphetamines crank ice speed
17:45 uppers
17:47 um are what we're talking about when
17:48 we're thinking about our stimulants this
17:51 is the second most widely used drug
17:54 euphoric feeling and high energy they
17:57 feel much more awake they're super alert
18:00 they're confident and they're very
18:02 energetic
18:04 increased use plus Cravings plus
18:07 tolerance equals of course your
18:09 decreased function in those major life
18:12 roles
18:13 stimulant intoxication they feel
18:16 superhuman they are elated they are
18:19 euphoric and they are very sociable
18:23 Unfortunately they are also a hyper
18:26 Vigilant sensitive anxious and also
18:29 tense
18:30 some of the physical symptoms we may see
18:33 they may complain of chest pain they may
18:35 have higher low blood pressure
18:37 tachycardic or bradycardic respiratory
18:40 depression weakness confusion and maybe
18:43 even coma
18:44 as far as stimulant withdrawal that
18:48 usually begins a few hours to days after
18:50 they've stopped the substance and it can
18:53 include fatigue though it may have very
18:55 Vivid nightmares depression and then
18:58 that's where suicide may come play a
19:01 role in this is that withdrawal
19:03 as far as treatment
19:05 in patients setting is usually necessary
19:09 individual family group therapies can be
19:13 helpful
19:14 antipsychotics are useful in treating
19:16 agitation and hyperactivity and our
19:19 antidepressants may be prescribed once
19:22 they've gone through that withdrawal
19:23 period
19:26 so I just really liked this box in your
19:29 book talks about the stimuli
19:31 intoxication and short-term what's going
19:33 on and then as they're withdrawing off
19:37 of it you can see some of those symptoms
19:39 as well so I think you can see as they
19:42 withdrawal if they're becoming more
19:45 anxious more irritable right they may
19:47 just be like this isn't worth it and
19:48 they just get back on that substance so
19:51 that's where those withdrawal symptoms
19:52 can be very indicative of why they
19:55 continue to keep going back to it
20:00 tobacco these are cigarettes cigars can
20:03 be smokeless can be snuffed or chewed
20:07 um Cravings that persistence recurrence
20:10 and tolerance are all symptoms
20:13 dependence can happen very quickly with
20:16 these substances cigarettes are the most
20:19 widely used intended effects are usually
20:22 for relaxation decreased anxiety some of
20:26 the long-term effects can be on the
20:28 cardiovascular and respiratory systems
20:32 smokeless can affect that oral mucus
20:35 mucosa though
20:37 as far as tobacco withdrawals again they
20:40 can be irritable depressed difficulty
20:43 concentrating maybe even Restless this
20:46 can happen days after cessation
20:49 the heart rate though once they do have
20:52 that cessation can decrease 5 to 12
20:55 beats per minute within that first year
21:00 of quitting a lot of times our patients
21:04 May gain four to seven pounds so again
21:07 that might be the reason why they get
21:09 back on it as far as treatment we can do
21:12 behavioral therapy recognizing those
21:15 Cravings we can also think about
21:17 nicotine replacement therapy the Patches
21:20 gum things like that
21:23 all right so let's move into a little
21:26 bit of alcohol
21:29 um this is usually a sedative creating
21:31 an initial feeling of euphoria
21:35 usually related to decreased inhibitions
21:39 um severity is really based on the
21:41 number of DSM-5 symptoms so if we have
21:44 mild
21:45 alcoholism it's going to be two to three
21:49 symptoms on that DSM-5 moderates four to
21:52 five and then severe is five or more
21:57 so when we think about alcohol use
21:59 disorder there are two different types
22:02 of problematic drinking binge drinking
22:06 refers to drinking too much alcohol too
22:09 quickly heavy drinking is characterized
22:12 by drinking too much too often
22:15 eight or more drinks in a week
22:16 constitute heavy drinking for women men
22:19 who drink more than 14 drinks in a week
22:22 are considered heavy drinkers
22:26 so what is
22:29 um a standard drink
22:32 standard drinks are defined per National
22:35 Institute of Health as any drink that
22:38 contains about
22:39 0.6 fluid ounces or 14 grams of pure
22:44 alcohol so you can see that each of
22:47 these drinks pictured are different
22:48 sizes but each contains approximately
22:52 the same amount of alcohol and that's
22:55 what's considered a standard drink
23:01 when is drinking in moderation too much
23:06 so if we're drinking in moderation but
23:10 now we're borderline too much maybe
23:13 we're taking a medication that interacts
23:15 with our alcohol
23:17 maybe we're managing a medical condition
23:19 that can be made worse by drinking
23:23 if you're under the age of 21 even in
23:26 moderation that's too much for most for
23:30 all states if you're recovering from
23:33 alcohol use disorder even one drink is
23:36 too much
23:37 and then obviously if you're pregnant or
23:40 could be pregnant then drinking in
23:42 moderation is too much
23:46 so alcohol intoxication these are
23:50 symptoms that are based on the blood
23:51 alcohol level 80 to 100
23:55 MGS per DL are the 0.08 to 0.10 is our
24:01 blouse blood alcohol
24:04 limit or above plummet so for thinking
24:08 about
24:09 um two drinks
24:11 um that's that 20 Megs per Dill
24:15 0.02 is our two drinks we may see some
24:18 slow Motor Performance maybe a little
24:21 altered mood maybe that Euphoria is in
24:23 play but we will have some decreased
24:26 thinking
24:27 three drinks you can see there is 0.05
24:31 we have impaired judgment again more
24:34 Euphoria maybe some lower alertness at
24:37 this point four drinks is going to put
24:39 us at that lower limit of our blood
24:41 alcohol content
24:43 0.08 altered speech impaired judgment
24:47 poor self-control
24:49 five drinks puts us at 0.10 slurred
24:53 speech poor coordination slowed thinking
24:56 and then if we are having more than five
24:59 drinks we just have that potential of
25:01 the 0.40 impaired Vital Signs and and
25:05 even possible death
25:09 according to the National Institute on
25:11 alcohol abuse and alcoholism men consume
25:15 more than four drinks on any day or more
25:17 for the 14 drinks per week for women if
25:21 it's three drinks per day or more than
25:23 seven drinks per week then we're
25:25 concerned about that heavy drinking
25:28 alcohol withdrawal Tremors shakes lack
25:32 of appetite nausea vomiting increased
25:34 blood pressure you could see those about
25:37 eight to ten hours after cessation
25:40 and then as far as withdrawal seizures
25:42 this can occur 12 to 24 hours after
25:45 cessation these can be tonic clonic
25:48 Valium may be given when we think about
25:51 withdrawal withdrawal delirium this is a
25:54 medical emergency this could happen
25:56 within the first 72 hours delusions
25:59 hallucinations could result in very
26:02 unpredictable Behavior so we need to
26:05 protect themselves from what they
26:06 believe are genuine dangers how can we
26:09 treat those deliriums diazepam Valium
26:12 for agitation Tremor hallucination
26:15 that'll help keep those patients or
26:17 sorry chlorodized
26:19 Chlor diazepoxide will help keep our
26:23 patient out of danger so alcohol
26:25 withdrawal can be very serious depending
26:29 on how heavy of a drinker they are so
26:33 just being aware of that
26:36 the other thing I just want to talk
26:38 about is where Nikki korsakov syndrome
26:41 this is cognitive disturbances that can
26:44 happen
26:45 people with heavy use of alcohol can
26:49 suffer from short-term memory
26:51 disturbances one reducing memory problem
26:54 is Wernicke's alcohol
26:57 encephalopathy which is an acute and
27:00 reversible condition usually
27:02 characterized by altered gait vestibular
27:05 dysfunction confusion and ocular
27:08 motility abnormalities
27:10 when we think about
27:12 Korsakoff syndrome this is a chronic
27:16 condition with a recovery rate of only
27:18 about 20 percent
27:20 so the patho really behind those these
27:23 two problems is a thiamine deficiency
27:25 because of poor nutrition associated
27:28 with alcohol use or malabsorption of
27:31 nutrients
27:33 treatment for Wernicke or sorry Wernicke
27:37 will respond rapidly to large doses of
27:40 IV thiamine two to three times a day for
27:43 one to two weeks corsicoff is also
27:46 treated with thiamine for about three to
27:48 twelve months so just being aware of
27:51 that cognitive disturbance syndrome that
27:53 you can get with over alcohol use
27:58 fetal alcohol syndrome is
28:01 um unfortunately the leading cause of
28:03 intellectual disabilities those this is
28:06 alcohol during pregnancy that just
28:08 inhibits that uterine growth and
28:11 postnatal development we can see
28:13 microcephaly craniofacial malformations
28:15 limb defects and even heart defects and
28:19 so I just grabbed this picture from your
28:21 book you can see some of the different
28:23 facial malformations that can be seen
28:26 that you can recognize pretty quickly
28:29 for a baby that may have fetal alcohol
28:32 syndrome
28:34 as far as systemic effects peripheral
28:38 neuropathy they may complain of pins and
28:41 needles in that lower extremity because
28:43 of numbness
28:45 alcohol myopathy is decreasing muscle
28:48 mass or they may have a lot of muscle
28:51 weakness
28:52 alcoholic
28:54 cardiomyopathy is again that decrease in
28:56 muscle tone around the heart they can
28:58 have fatigue shortness of breath maybe
29:01 some edematous legs and feet
29:04 esophagitis is comes from vomiting
29:08 gastritis is that nausea and vomiting
29:11 and then pancreatitis is severe
29:14 abdominal pain nausea vomiting that
29:16 usually will subside with cessation
29:19 alcoholic hepatitis is that inflamed
29:22 liver a lot of times genetics can play a
29:25 role for with that
29:27 as far as cirrhosis of the liver this is
29:29 Progressive eventually to
29:31 non-functioning liver you can see
29:33 jaundice ascites legodemum
29:37 leukopenias that decrease wbcs due to
29:40 cirrhosis so we have to really indicate
29:43 to our patients that cessation is their
29:46 best alternative
29:49 thrombocytopenia or low platelet counts
29:51 due to against cirrhosis bruising
29:53 particular rash prolonged bleeding can
29:55 be a problem
29:57 and then we have noticed that cancer
29:59 especially of the head and the neck
30:01 breast liver and colorectal can come as
30:05 a systemic effect with alcohol use
30:07 disorder
30:09 so let's apply the nursing process
30:12 so when we think about the nursing
30:13 process and we talk about assessment
30:15 there are several screening tools that
30:17 we can think about the first one is
30:19 expert screening brief intervention and
30:22 referral to treatment this really
30:23 identifies at-risk substance abuse
30:26 patients for those early interventions
30:28 the other your book also listed audit
30:31 which is an alcohol use disorder
30:33 identification test
30:35 cage there's four questions that can
30:38 identify alcohol abuse and those four
30:41 questions are listed in your book kjd
30:44 and then T Ace or other screening tools
30:49 so when we think about assessment and
30:51 we've done our screening tools we're
30:54 going to assess for we're going to
30:56 assess the family
30:58 is part of our assessment process we
31:00 want to evaluate the individual
31:01 holistically background pattern of abuse
31:04 are there any mental health symptoms and
31:07 then we're going to look at that family
31:08 assessment and codependence so
31:11 codependence is that the family exhibits
31:13 overly responsible behaviors the
31:16 individual self-worth of caring for
31:18 others to the exclusion of their own
31:21 needs so if you're purchasing alcohol
31:26 your your canceling plans because you
31:30 think your spouse is going to get
31:31 intoxicated and they may need you that's
31:34 being codependent so please understand
31:37 what codependence means
31:40 um especially with alcohol use disorder
31:44 self-assessment alcohol use is
31:47 self-inflicted and the nurses should
31:50 really be careful assessing personal
31:51 thoughts opinions and feelings right why
31:54 don't you just stop right this is
31:56 self-inflicted it's an addiction they a
31:59 lot of times they can't just stop so
32:01 making sure as nurses that we're really
32:03 assessing our own self thoughts opinions
32:07 and feelings
32:09 um once we've done our assessment we're
32:10 going to identify some of those outcomes
32:12 and then start planning and a lot of
32:15 that's going to be immediate detox and
32:17 stabilization abstinence if they're
32:20 actively drinking what's their
32:21 motivation for treatment and then making
32:24 sure that all of those are essential to
32:26 that patient-centered
32:29 as far as implementation we want to
32:32 promote safety and sleep that's the
32:34 first line intervention safe environment
32:37 observing for those withdrawal symptoms
32:39 reorienting them back to time place in
32:42 person and then allowing them to just
32:44 get a really good restful sleep
32:46 reintroducing good nutrition and
32:49 hydration severely compromised nutrition
32:51 due to choosing the substance versus
32:54 sustenance we want to help support body
32:57 systems and that neurological function
33:00 so they may be very malnourished because
33:03 they've chosen their substance over food
33:06 so reintroducing that good nutrition we
33:09 want to support their self-care and
33:11 hygiene this is going to increase their
33:13 self-esteem because they've probably
33:16 neglected themselves for a long period
33:18 of time
33:19 and then we want to make sure we're
33:20 obviously exploring any harmful thoughts
33:22 and spiritual distress making sure our
33:25 patients are safe
33:29 some of the health teaching and health
33:31 promotion that we can consider
33:33 prevention against genetic vulnerability
33:36 remember genetics accounts for about 40
33:39 to 60 percent of someone's risk
33:41 prevention may be the best answer right
33:44 so if you know you have a risk of
33:47 um opioid use prevention needs to be the
33:51 best answer teach the patient to
33:53 recognize indications of relapse or
33:55 factors that could contribute to relapse
33:58 encouraging communication techniques
34:00 going to public classes those 12-step
34:04 programs especially for our alcoholics
34:06 can be very helpful
34:10 and then after we've done our full
34:11 nursing process we definitely have to
34:14 evaluate those interventions that we've
34:16 implemented assess the effectiveness of
34:18 that treatment plan making sure we're
34:21 using objective data to check whether
34:22 those nursing actions worked
34:27 some of the treatment modalities
34:30 pharmacotherapy focus on treatment for
34:32 alcohol use the first one there is
34:37 dysulfurum or antabuse so again that's
34:41 for use for maintenance relapse
34:42 prevention aversion therapy for alcohol
34:45 use disorder
34:47 um naloxone again
34:50 um or sorry that's not naloxone
34:51 Naltrexone
34:55 is withdrawal relapse prevention
34:57 decreased pleasurable feelings and
34:59 Cravings if we give that and then the
35:01 last one is our benzos and that can just
35:03 help with our withdrawal
35:06 as far as motivational interviewing this
35:09 is an approach based on the trans
35:11 theoretical or stages of change therapy
35:15 or Theory it has gained popularity and
35:18 use as a brief long-term and
35:20 supplementary intervention particularly
35:22 in treatment of substance use disorders
35:25 it uses a person-centered approach to
35:28 just really strengthen the motivation
35:30 for change
35:35 as far as care can't Continuum
35:37 continuity of care occurs through a
35:40 Continuum so when we think about
35:42 detoxification or detox this is when an
35:45 individual quits using the substance
35:47 they're going to think about
35:49 Rehabilitation medically monitoring and
35:52 with an inpatient program
35:54 short-term rehab
35:56 um has learned lost skills long-term
36:00 rehab learns new skills as far as
36:03 halfway houses these are residential
36:05 treatments extended sobriety getting a
36:09 case management assistant integrating
36:11 new life skills back into their rep
36:14 repertoire
36:15 other housing we can have Community
36:17 reintegration that's not really part of
36:20 their treatment plan
36:22 partial hospitalization are those
36:24 intense treatments without 24-hour care
36:27 five days a week for six to eight hours
36:30 intensive outpatients treatment our
36:33 structured scheduled treatment groups
36:35 Outpatient Treatment is the least
36:38 intensive form of treatment and it's
36:40 really based off of that individual's
36:42 means and then alcoholics on
36:46 um we can think about
36:48 Alcoholics Anonymous that's that 12-step
36:50 program individuals learn how to be
36:53 sober through support systems most areas
36:55 have around-the-clock meetings
36:58 Al Anon are for friends and families
37:01 that are worried about someone with a
37:03 drinking problem
37:04 alatine or peer support groups for
37:07 teenagers who are struggling with the
37:09 effects of someone else's problem
37:10 drinking naranon are our family and
37:14 friends who are concerned about
37:15 addiction with drug problems not related
37:19 really to alcohol and then Gamblers
37:21 Anonymous is also another group that's
37:23 out there
37:26 relapse prevention is the last care
37:28 Continuum right we want to make sure
37:30 that we are preventing them from
37:32 relapsing advances in technology have
37:34 expanded options for maintaining
37:36 long-term sobriety applications for
37:39 smartphones for example offer a way to
37:42 monitor behavioral patterns for relapse
37:44 cues
37:47 and that concludes chapter
37:49 22. if you have any questions you can
37:52 shoot me an email or we will chat about
37:54 it in class thanks guys
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