OTHER SUBSTANCE USE DISORDERS. Shilpa hotakar pptx

Other substance use disorders-Substance use disorders For VI Semester Students Psychiatric Nursing

1. OTHERS SUBSTANCE USE DISORDERS MRS.SHILPA H ASSISTANT PROFESSOR SRI SIDDHARTHA COLLEGE OF NURSING TUMKUR

2. Disorders Due to Use of Cannabis Cannabis is the most commonly abused illegal drug. It is a mild hallucinogen derived from the Cannabis sativa plant. The dried leaves and flowering tops of the plant are known as ganja or marijuana, while the resin is called hashish, and bhang is a drink prepared from cannabis. Cannabis may be smoked or consumed in liquid form. It acts as a central nervous system depressant, stimulant, and hallucinogen. The drug possesses dependence-producing properties, leading to cannabis dependence.

3. Disorders Due to Use of Cannabis Chronic or heavy use of cannabis is associated with several cannabis-induced mental disorders, such as intoxication, psychosis, and amotivational syndrome. Marijuana abuse can result in distorted perceptions, impaired coordination, and difficulty in thinking, problem-solving, learning, and memory. At higher doses, it may increase heart rate and raise blood pressure.

4. SYMPTOMS OF ACUTE INTOXICATION Euphoria or feeling “high” Anxiety or mild paranoia Impaired judgment Difficulty concentrating Short-term memory loss Altered perception of time and space Dry mouth Bloodshot (reddened) eyes Increased heart rate (tachycardia) Impaired coordination and balance Increased appetite (“munchies”) Excessive talking or laughter

5. CANNABIS-WITHDRAWAL SYMPTOMS Cannabis withdrawal symptoms usually start within 24 to 48 hours after the last use of cannabis. Peak intensity: Around 2 to 4 days after stopping use. Duration: Symptoms generally last for 1 to 2 weeks, though mild sleep and mood disturbances may persist longer in some individuals.

6. CANNABIS-WITHDRAWAL SYMPTOMS Irritability Anxiety Restlessness Insomnia or disturbed sleep Decreased appetite Depressed mood Headache Craving for cannabis

7. Treatment for Acute Cannabis Intoxication Aspect Treatment / Nursing Management Supportive care Provide a calm, quiet environment; reassure the patient; reduce anxiety and agitation. Observation Monitor vital signs, level of consciousness, and behavior. Hydration Encourage oral fluids to prevent dehydration. Safety Prevent injury due to impaired coordination or judgment. Psychotic symptoms (if present) Short-term use of antipsychotics (e.g., haloperidol) may be prescribed by a physician. Anxiety or panic Benzodiazepines (e.g., diazepam) may be given for severe anxiety under medical supervision.

8. Treatment for CANNABIS WITHDRAWAL SYMPTOMS Aspect Treatment / Nursing Management Supportive therapy Provide reassurance, emotional support, and a nonjudgmental approach. Symptomatic treatment Mild sedatives or sleep aids for insomnia, analgesics for headache, and antiemetics for nausea as prescribed. Psychological support Cognitive-behavioral therapy (CBT), motivational enhancement therapy, or counseling to manage cravings and prevent relapse. Hydration and nutrition Encourage adequate fluids and a balanced diet to restore body balance. Follow-up and relapse prevention Encourage participation in support groups or substance-use rehabilitation programs.

9. Complications of Cannabis Use Impaired memory, concentration, and coordination Anxiety, paranoia, or psychosis Respiratory problems from smoking Dependence and withdrawal symptoms Poor academic or occupational performance

10. Disorders Due to Use of Opioids A group of physical, psychological, and behavioral problems resulting from the use or misuse of opioid drugs such as morphine, heroin, codeine, or pethidine. Common Disorders: 1.Opioid Intoxication: Occurs after recent use of opioids. Symptoms: Euphoria, drowsiness, pinpoint pupils, slurred speech, impaired attention, and respiratory depression. 2.Opioid Withdrawal: Appears after abrupt reduction or cessation of opioid use. Symptoms: Yawning, lacrimation, muscle aches, abdominal cramps, diarrhea, dilated pupils, sweating, and restlessness.

11. Disorders Due to Use of Opioids Opioid Dependence: Characterized by compulsive drug-seeking behavior , tolerance, and withdrawal symptoms. Opioid-Induced Mental Disorders: Includes opioid-induced mood disorder, psychotic disorder, and sleep disturbance.

12. Treatment of Opioid Use Disorder Detoxification: Gradual withdrawal using methadone or buprenorphine to reduce cravings and prevent severe withdrawal. Symptomatic Treatment: Medications like clonidine and analgesics to relieve restlessness, pain, and other withdrawal symptoms. Psychotherapy: Counseling, CBT, and motivational therapy to manage triggers and promote abstinence. Rehabilitation: Family support, follow-up, and relapse prevention programs to ensure long-term recovery.

13. Complications of Opioid Use Respiratory depression and possible death Constipation and gastrointestinal disturbances Tolerance and physical dependence Withdrawal symptoms on stopping the drug Infectious diseases (HIV, hepatitis) from needle sharing Cognitive impairment and poor judgment Social and occupational dysfunction

14. DISORDERS DUE TO USE OF SEDATIVES,HYPNOTICS OR ANXIOLYTICS 1 . Acute Intoxication: Occurs after recent use. Symptoms: Drowsiness, slurred speech, incoordination, impaired judgment, and at high doses, respiratory depression or coma. 2 . Withdrawal: Appears after abrupt reduction or cessation, especially after long-term use. Symptoms: Anxiety, restlessness, insomnia, tremors, sweating, nausea, seizures (in severe cases). 3 . Dependence : Characterized by tolerance, craving, and compulsive use. 4 . Sedative/Hypnotic-Induced Mental Disorders: Includes mood disturbances, cognitive impairment, or psychotic symptoms in chronic users.

15. Treatment Detoxification: Gradual tapering of the drug to prevent withdrawal symptoms. Symptomatic treatment: Medications for anxiety, insomnia, or seizures if needed. Psychotherapy: Counseling and behavioral therapy to manage dependence. Rehabilitation: Family support, follow-up, and relapse prevention programs.

16. Complications Respiratory depression and risk of coma or death (especially in overdose) Tolerance and physical dependence Withdrawal symptoms (anxiety, insomnia, seizures) Cognitive impairment and poor concentration Accidents due to sedation or impaired coordination Social, occupational, and relationship problems

17. DISORDERS DUE TO USE OF COCAINE 1. Cocaine Intoxication Symptoms: Euphoria and increased energy Talkativeness and hyperactivity Dilated pupils Increased heart rate and blood pressure Restlessness, anxiety, or agitation Paranoia (in some cases)

18. DISORDERS DUE TO USE OF COCAINE 2. Cocaine Withdrawal Symptoms: Fatigue and lethargy Depression and irritability Increased appetite Vivid or disturbing dreams Strong craving for cocaine

19. Treatment of Cocaine Use Disorder Detoxification & Supportive Care: Monitor vital signs; ensure safe environment. Symptomatic Treatment: Manage agitation, anxiety, or sleep disturbances; use medications if prescribed (e.g., benzodiazepines for severe agitation). Psychotherapy: Cognitive Behavioral Therapy (CBT), counselling, and motivational enhancement. Rehabilitation & Relapse Prevention: Family support, follow-up, and participation in support groups.

20. Complications of Cocaine Use Cardiovascular problems: Arrhythmias, heart attack, hypertension Neurological issues: Seizures, strokes, headaches Psychiatric problems: Paranoia, anxiety, depression, psychosis Respiratory issues (especially with crack cocaine): Cough, lung damage Social and occupational dysfunction: Relationship problems, legal issues, poor work/school performance

21. Disorders Due to Use of Stimulants (Amphetamines & Methamphetamines) 1. Stimulant Intoxication Symptoms: Euphoria and increased energy Hyperactivity and talkativeness Agitation, anxiety, and insomnia Dilated pupils Increased heart rate and blood pressure Paranoia or hallucinations (in severe cases)

22. Disorders Due to Use of Stimulants (Amphetamines & Methamphetamines) 2. Stimulant Withdrawal Symptoms: Fatigue and lethargy Depression and irritability Increased appetite Sleep disturbances (insomnia or hypersomnia) Strong craving for the drug

23. Treatment of Stimulant Use Disorder Detoxification & Supportive Care: Monitor vital signs; ensure patient safety. Symptomatic Treatment: Medications for agitation, anxiety, insomnia, or severe cravings (as prescribed). Psychotherapy: Cognitive Behavioral Therapy (CBT), counselling, and motivational enhancement therapy. Rehabilitation & Relapse Prevention: Family support, follow-up, and participation in support groups.

24. Complications of Stimulant Use Cardiovascular: Hypertension, arrhythmias, heart attack, stroke. Neurological: Seizures, headaches, cognitive impairment. Psychiatric: Anxiety, paranoia, hallucinations, depression, aggression. Social/Occupational: Poor work/school performance, legal issues, relationship problems. Other: Insomnia, weight loss, malnutrition.

25. DISORDERS DUE TO USE OF CAFFEINE 1.Caffeine Intoxication: Occurs after consuming high amounts of caffeine (usually >250 mg). Symptoms: Restlessness, nervousness, excitement, insomnia, flushed face, increased urination, muscle twitching, rapid heartbeat, and stomach upset. Management: Stop caffeine intake, provide fluids, and treat symptoms (like anxiety or palpitations).

26. DISORDERS DUE TO USE OF CAFFEINE 2.Caffeine Withdrawal: Occurs after sudden stopping of regular caffeine use. Symptoms: Headache, tiredness, irritability, depressed mood, difficulty concentrating, and flu-like symptoms. Management: Gradually reduce caffeine intake and give rest and fluids.

27. DISORDERS DUE TO USE OF SYNTHETIC CATHINONES Bath salts are street names for synthetic cathinones , which are stimulant drugs similar to amphetamines. Examples: Mephedrone, Methylone, and Methylenedioxy pyrovalerone (MDPV). 1.Intoxication symptoms: Euphoria, increased energy, agitation, confusion, hallucinations, increased heart rate and blood pressure, sweating, and sometimes violent behavior or seizures. 2.Withdrawal symptoms: Fatigue, depression, sleep problems, and strong craving for the drug. Treatment: Supportive care with sedation, hydration, and management of complications.

28. Disorders due to use of Hallucinogens Example:LSD-Lysergic acid diethylamide 1.Intoxication symptoms: Altered perception of reality, visual and auditory hallucinations, euphoria, anxiety, panic, dilated pupils, increased heart rate, sweating, and poor coordination. 2.Withdrawal: Usually mild or absent, but some may experience fatigue or mood changes. Treatment: Supportive care, reassurance, and management of anxiety or agitation (calm environment and sedation if needed).

29. Disorders due to use of Nicotine Examples of Nicotine sources: Cigarettes, cigars, e-cigarettes, chewing tobacco, nicotine gum. 1.Intoxication symptoms: Increased alertness, relaxation, ↑heart rate and blood pressure, dizziness, nausea, headache. 2.Withdrawal symptoms: Irritability, anxiety, restlessness, difficulty concentrating, increased appetite, craving. Treatment: Nicotine replacement therapy (patch, gum), counseling , behavioral therapy.

30. DISORDERS DUE TO USE OF VOLATILE Examples of Volatile Inhalants: Glue, paint thinner, gasoline, nitrous oxide, and correction fluid. 1.Intoxication symptoms: Dizziness, euphoria, slurred speech, unsteady gait, hallucinations, confusion, nausea, vomiting, headache, and sudden cardiac arrhythmia. 2.Withdrawal symptoms: Usually mild; may include irritability, anxiety, and sleep disturbances. Treatment: Supportive care, remove exposure, monitor breathing and heart function, hydration, and manage complications.

31. LAWS RELATED TO SUBSTANCE ABUSE 1.Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985: Regulates production, possession, sale, and use of narcotic drugs and psychotropic substances. Provides punishment for drug trafficking, consumption, and illegal possession. 2.Cigarettes and Other Tobacco Products Act (COTPA), 2003: Prohibits smoking in public places. Restricts sale of tobacco products to minors and near educational institutions. 3.Mental Healthcare Act, 2017: Provides treatment and rehabilitation for persons with substance use disorders.

32. 4.NTCP: National program to reduce tobacco use and promote quitting through awareness and counseling. 5.Prevention of Illicit Trafficking Act, 1988: Law to prevent illegal production, sale, and use of narcotic drugs and psychotropic substances.

33. GENERAL NURSING INTERVENTIONS FOR A PATIENT WITH ACUTE DRUG INTOXICATION Assess vital signs frequently – Monitor pulse, blood pressure, respiration, temperature, and level of consciousness. Maintain airway, breathing, and circulation (ABCs) – Ensure airway is clear; give oxygen if needed. Prevent aspiration – Place the patient in a side-lying (recovery) position if unconscious. Identify the drug taken – Collect history, containers, or samples to help with diagnosis. Provide gastric lavage or activated charcoal – As advised by the physician, to remove unabsorbed drugs.

34. DURING ACUTE EPISODES Administer prescribed antidotes – Example: Naloxone for opioid overdose. Maintain fluid and electrolyte balance – Give IV fluids as ordered to prevent dehydration or shock. Provide safety and comfort measures – Prevent injury or self-harm, keep the environment calm. Observe for withdrawal symptoms or complications – Such as seizures or respiratory distress. Provide psychological support – Reassure and counsel the patient; involve family if appropriate.

35. During an Acute Episodes Ensure airway, breathing, and circulation (ABCs) – Maintain open airway and give oxygen if needed. Monitor vital signs continuously – Check pulse, BP, respiration, temperature, and consciousness. Prevent aspiration and injury – Keep patient in side-lying position and ensure safety. Administer emergency drugs/antidotes – As prescribed (e.g., naloxone for opioid overdose). Maintain IV access and fluid balance – Give fluids as ordered to support circulation. Provide calm and quiet environment – Reduce stimulation to prevent agitation. Document and report all changes – Inform physician immediately of any deterioration.

36. PREVENTION OF SUBSTANCE USE DISORDERS

37. 1. Primary Prevention (Before the onset of substance use) Aim: To prevent initiation or experimentation with substances. Activities: Health education about ill effects of alcohol, tobacco, and drugs. School-based awareness programs for children and adolescents. Life skill education to improve decision-making, coping, and stress management. Parental guidance and family support programs. Mass media campaigns promoting healthy lifestyles. Strict enforcement of laws against drug trafficking and sale to minors. Promotion of recreational and sports activities to channelize youth energy positively

38. Secondary Prevention 2. Secondary Prevention (Early detection and prompt intervention) Aim: To identify and manage substance use problems early to prevent complications. Activities: Screening programs in schools, colleges, and workplaces to identify early users. Brief interventions and counseling for individuals at risk. Referral to de-addiction centers for detoxification and early treatment. Involving family and peers in recognizing warning signs. Training health professionals to detect early signs of substance abuse.

39. 3. Tertiary Prevention (Rehabilitation and relapse prevention) Aim: To reduce disability and promote recovery among dependent individuals. Activities: Comprehensive treatment (medical, psychological, and social rehabilitation). Relapse prevention programs through regular follow-up and counseling. Vocational rehabilitation and job placement assistance. Self-help groups (e.g., Alcoholics Anonymous, Narcotics Anonymous). Community-based rehabilitation programs. Family therapy and social reintegration support.

40. Rehabilitation and Social Considerations in Substance Abuse Rehabilitation It helps the substance abuser to return to a normal, drug-free, and productive life. Goals: Prevent relapse, restore physical and mental health, and promote social functioning. Measures: Medical treatment for withdrawal and complications. Psychological counseling and behavior therapy. Vocational training and job placement. Family involvement in recovery. Follow-up and participation in self-help groups (e.g., Alcoholics Anonymous).

41. Social Considerations Encourage family and community support for recovering individuals. Reduce stigma and discrimination toward substance users. Provide employment opportunities and social acceptance. Strengthen laws and community programs for prevention and rehabilitation. Promote awareness campaigns on the ill effects of substance abuse.

42. Follow-up and Home Care in Substance Abuse 1. Follow-up Care Helps to prevent relapse and maintain recovery. Regular visits to the de-addiction center or counselor. Monitoring for early signs of relapse or withdrawal symptoms. Reinforcement counseling to strengthen motivation for sobriety. Encouragement to participate in self-help groups (e.g., Alcoholics Anonymous, Narcotics Anonymous). Medication supervision if prescribed (e.g., anti-craving drugs).

43. Follow-up and Home Care in Substance Abuse 2. Home Care Provide a supportive, drug-free environment at home. Family members should show understanding and avoid blame or criticism. Encourage healthy lifestyle – balanced diet, exercise, adequate rest. Engage the patient in positive activities and hobbies. Ensure regular follow-up visits and communication with healthcare providers. Educate the family about warning signs of relapse and how to handle them calmly.

44. PATIENT AND FAMILY TEACHING 1. Patient Teaching Explain the harmful effects of alcohol and drug use on physical and mental health. Encourage the patient to avoid triggers and high-risk situations. Teach coping skills for stress, anxiety, and peer pressure. Emphasize the importance of regular follow-up and adherence to treatment. Motivate to join self-help groups like Alcoholics Anonymous for ongoing support. Educate about healthy lifestyle habits — proper diet, exercise, and rest.

45. PATIENT AND FAMILY TEACHING 2. Family Teaching Educate the family about the nature of substance use disorder as a treatable illness, not a moral weakness. Encourage emotional support and understanding instead of criticism. Teach ways to handle relapse calmly and seek professional help. Involve the family in counseling and rehabilitation programs. Promote a drug-free home environment and positive communication.

46. AGENCIES CONCERNED WITH DISORDERS DUE TO ALCOHOL USE Alcoholics Anonymous (AA) Meaning: Alcoholics Anonymous (AA) is a group of people who help each other to stop drinking alcohol and stay sober. It is a voluntary, non-profit organization — anyone who wants to stop drinking can join. It was started in 1935 in the United States by Bill Wilson and Dr. Bob Smith. AA groups are found all over the world, including in India.

47. Alcoholics Anonymous (AA) Aims and Objectives: To help members stop drinking alcohol and live a healthy, happy life. To provide moral and emotional support through group meetings. To help people understand their problem and take responsibility for recovery. To prevent relapse (avoid going back to drinking).

48. Main Features 12-Step Program: Members follow 12 simple steps that include accepting their problem, seeking help, improving behavior, and helping others. Group Meetings: Regular meetings are held where members share their experiences and encourage one another. Anonymity: Members’ names are kept private and confidential. Peer Support: Members who have recovered help new members with guidance and motivation. Free Membership: There are no fees or charges to join AA.

49. Importance Helps people recover from alcohol dependence and stay alcohol-free. Builds self-confidence, self-control, and positive attitude. Promotes social and family adjustment. Reduces loneliness and gives a sense of belonging.

50. OTHERS Al-Anon A support group for family members and relatives of alcoholics. Helps them cope with the effects of a loved one’s drinking and provides emotional support. Al Ateen A support group for teenagers who have alcoholic family members. Helps young people understand the problem, share feelings, and build coping skills.