De addiction

PSYCHIATRIC NURSING AND DE-ADDICTION

1. VISIT TO DE-ADDICTION CENTER Ms. Rama Ms. Renu Mr. Pramod M.Sc. Nursing 1 st year

2. Objectives To know about the organizational setup of the centre. To know about the physical set up of the de-addiction centre. To know about the background of the centre. To know about various facilities provided by the De-addiction centre. To know about records and reports maintained. To gain knowledge regarding the treatment measures for patients with drug addiction

3. INTRODUCTION Disorders due to psychoactive substance use refer to conditions arising from the abuse of alcohol, psychoactive drugs and other chemicals such as volatile agents Substance abuse has also been referred to as any use of substances that poses significant hazards to health.

4. CENSUS Every year 2.5 million people die due to alcohol use disorder world wide. In INDIA, there are around 75 crore drug abusers. In Haryana – 63.3% In Ambala – 60% 12-18 years abusers of alcohol – 21.9% Cannabis – 3% Opiates – 0.7% Illicit drug – 3.6%

5. Definition SUBSTANCE: The term substance is used in reference to any drug, medication or toxin that shares the potential for abuse.

6. Definition ADDICTION : Addiction is a psychological and physiological dependence on alcohol or other drugs of abuse that effects the central nervous system in such a way that withdrawal symptoms are experienced when the substance is discontinued

7. Classification F10-F19 Mental and behaviours disorders due to psychoactive substance use F10 Mental behaviours disorders due to use of alcohol F11 Mental and behavioural disorders due to use of opioids F12 Mental and behavioural disorders due to use of cannabinoids

8. Classification contd ….. F13 Mental and behavioural disorders due to use of sedatives or hypnotics F14 Mental and behavioural disorders due to use of cocaine F16 Mental and behavioural disorders due to use of hallucinogen

9. Commonly used psychotropic substance Alcohol Opioids Cannabis Cocaine Amphetamines and other sympathomimetics

10. Commonly used psychotropic substance Hallucinogens for example, phencyclidine Sedatives and hypnotics, for example, barbiturates Inhalants, for example, volatile solvents Nicotine

11. Etiological factors in psychoactive substance use Biological factors: Genetic vulnerability Biochemical factors Neurobiological theories Withdrawal Comorbid medical disorder

12. Etiological factors in psychoactive substance use 2. Behavioural theories Behavioural scientists view drug abuse as the result of conditioning, or cumulative reinforcement from drug abuse . Drug use causes euphoric experience perceived as rewarding, thereby motivating user to keep taking the drug (which then serves as a biological reward).

13. Etiological factors in psychoactive substance use Stimuli and settings associated with drug use may themselves become reinforcing or may trigger drug carving that can lead to relapse (many recovering addicts change their environment cues that t hat could promote drug use).

14. Etiological factors in psychoactive substance use 3. Psychological factors: General rebelliousness Sense of inferiority Poor impulse control Low self esteem Inability to cope with the pressure of living and society (poor stress management skills)

15. Etiological factors in psychoactive substance use Loneliness , unmet needs Desire to escape from reality Desire to experiment, a sense of adventure Pleasure seeking

16. Etiological factors in psychoactive substance use 4. Social factors: Religious reasons Peer pressure Urbanization Extended periods of education Unemployment Overcrowding

17. Etiological factors in psychoactive substance use Poor social support Effects of television and other mass media Occupation: Substance use is more common in chefs, barmen, executives, salesmen, actors, entertainers, army personnel, journalists, medical personnel etc.

18. Etiological factors in psychoactive substance use 5. Easy availability of drugs Taking drugs prescribed by doctors (for example, benzodiazepine dependence) Taking drugs that can be bought legally without prescription (for example, nicotine, opioids) Taking drugs that can be obtained from illicit sources (for example, street drugs)

19. Etiological factors in psychoactive substance use 6. Psychiatric disorders: Substance use disorders are more common in depression anxiety disorders (particularly social phobias ) personality disorders ( antisocial personality) occasionally in organic brain disease  

20. Consequences of substance abuse P hysical dependence, psychological dependence U nhealthy lifestyles and behaviours such as poor diet Impairs social and occupational functioning, creating personal, professional, financial, and legal problems

21. Consequences of substance abuse I n early adolescence may lead to emotional and behavioural problems In pregnant women, substance abuse jeopardizes foetal well-being Psychoactive substances produce negative outcomes including maladaptive behaviour, ‘ bad trips ’, and even long term psychosis Illicit street drugs pose added dangers; materials used to dilute them can cause toxic or allergic reactions

22. Dynamics of substance related disorders 1. Alcohol dependence syndrome: It refers to the use of alcoholic beverages to the point of causing damage to the individual, society or both. Signs and symptoms of alcohol dependence: Minor complaints: Malaise, dyspepsia, mood swings or depression, increased incidence of infection. Poor personal hygiene, untreated injuries (cigarette burns, fractures that cannot be explained)

23. Dynamics of substance related disorders Unusually high tolerance for sedatives and opioids Nutritional deficiency Consumption of alcohol containing products (mouthwash, aftershave lotion, lighter fluid etc.) Denial of problem Tendency to blame others and rationalize problem

24. Dynamics of substance related disorders ICD10 Criteria for Alcohol Dependence A strong desire to take the substance Difficulty in controlling substance taking behaviour. A physiological withdrawal state Development of intolerance Progressive neglect of alternative pleasures of interests. Persisting with substance use despite clear evidence of harmful consequences

25. Dynamics of substance related disorders 2. Opioids use disorders: India , surrounded on both sides by routes of illicit transport, namely Golden Triangle (Burma, Thailand, Laos) is particularly affected. The most important dependence producing derivatives are morphine and heroin .

26. Dynamics of substance related disorders Acute Intoxication: It is characterized by apathy , bradycardia , hypotension , respiratory depression , subnormal temperature and pinpoint pupils . Later delayed reflexes, thread pulse and coma can occur.

27. Dynamics of substance related disorders 3. Cannabis use disorder: Cannabis is derived from hemp plant, Cannabis sativa . The dried leaves and flowering tops are often referred to as ganja or marijuana . The resin of the plant is referred to as hashish. Bhang is a drink made from cannabis. Cannabis is either smoked or taken in liquid form.

28. Dynamics of substance related disorders 4. Cocaine use disorder: Common street name is ‘ crack ’. It can be administered orally, intranasally by smoking, or parentally. Acute intoxication: Characterized by pupillary dilatation, tachycardia, hypertension, sweating, and nausea.

29. Dynamics of substance related disorders 5. Amphetamine use disorder: Amphetamines are powerful CNS stimulants with peripheral sympathomimetic effects. EX. P emoline and methylphenidate . 6. LSD Use disorder (Lysergic acid diethylamide): LSD is a powerful hallucinogen, and was first synthesized in 1938.

30. Dynamics of substance related disorders Barbiturate use disorder: The commonly abused barbiturates are secobarbital , phenobarbital. Inhalants or volatile solvent use disorder: The commonly used volatile solvents include petrol, aerosols, thinners, varnish remover and industrial solvents.

31. De-Addiction Drug rehabilitation is a term for the processes of medical or psychotherapeutic treatment , for dependency on psychoactive substances  such as alcohol, prescription drugs, and street drugs such as cocaine. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.

32. Prevention of substance use disorder 1.Primary prevention: Reduction of over prescribing by doctors Identification and treatment of family members who may be contributing to the drug abuse. Introduction of social changes is likely to affect drinking patterns in the population as a whole. This is made possible by: Putting up the price of alcohol and alcoholic beverages.

33. Prevention of substance use disorder Controlling or abolishing the advertising of alcoholic drinks. Controls on sales Restricting availability Strengthen the individual’s personal and social skills to increase self-esteem and resistance to peer pressure. Health education to college students and the youth

34. Prevention of substance use disorder Secondary prevention: Early detection and counselling Brief intervention in primary care Motivational interviewing A full assessment including an appraisal of current medical, psychological and social problems. Detoxification with benzodiazepines (diazepam).

35. Prevention of substance use disorder 3. Tertiary prevention: Alcohol deterrent therapy ( Disulfiram ) Other therapies include assertiveness training, teaching copying skills, behaviour counselling, supportive psychotherapy Agencies concerned with alcohol- related problems

36. Prevention of substance use disorder Some practical issues under relapse prevention include : Motivation enhancement Identifying high-risks situations and developing strategies to deal with them Drink refusal skills (assertiveness training) Dealing with faulty cognitions Handling negative mood states Time statement Anger control’

37. Prevention of substance use disorder Financial management Developing the work habit Stress management Recreation and spirituality Family counselling, to reduce interpersonal conflicts, which may otherwise trigger relapse.

38. Treatment Treatment includes medication for depression or other disorders, counselling by experts and sharing of experience with other addicts . Some rehab centres include meditation and spiritual wisdom in the treatment process.

39. Types of treatment Various types of programs offer help in drug rehabilitation Some rehab centres offer age- and gender-specific programs. The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication and behavioural therapy, followed by relapse prevention.

40. Treatment Behavioural Therapy Cognitive- behavioural therapy Cognitive therapy of substance abuse 2. Pharmacotherapies 3. Counselling 4. Rehabilitation

41. Follow up and home care Some patients with drug problems complete treatment the first time and remain sober, while others have to repeat treatment several times . Some patients do not succeed in staying sober. Nurses remain hopeful and appropriately supportive but realistic when treating patients.

42. Patient and family teaching Teach the patient/family about the physical, psychological and social complications of drug and alcohol abuse use . Inform the patient/family that psychoactive substances may alter a person’s mood, perceptions, consciousness or behaviour . Explain to the family that the patient may use lies, denial or manipulation

43. Patient and family teaching Teach the patient/family that drug overdose or withdrawal can result in a medical emergency or death, give the family emergency resources for help . Caution the patient that sharing dirty or used needles can result in a life threating diseases such as AIDS, hepatitis B . Teach the family to establish trust with the patient to use firm limit setting, when necessary to help the patient confront drug abuse issues .

44. Patient and family teaching Provide the patient with a full range of treatment during hospitalization such as medication, individual therapy, and behaviour modification to strengthen the recovery process. Teach the family/patient how to recognize psychosocial stressors that may exacerbate substance abuse problem and how to avoid or prevent them . Emphasize to the patient the importance of changing lifestyle, friendships, and habits that promote drug use to remain sober.

45. De-addiction centre, A mbala city

46. History The De-addiction centre in ambala city hospital was established as a psychiatry ward in 2004. Later, in January 2014 it was converted in to De-addiction centre.

47. Staffing pattern Dr. K.S Rana M.B.B.S, D.P.M, HCMS, Psychiatrist 2. Dr. Sandeep Sohni M.O, Psychiatrist 3. Dr. Babita Gupta Counseller

48. Staffing pattern 3. Sr. Veena Sharma Staff nurse 4. Mr. Sumit Pal Ward servant Staff nurses: 4 Ward servant:4 Guard: 2