SUBSTANCE ABUSE

1. Submitted to : Ms. Seema rani
Associate professor
RCON, JH
Submitted by: Ms. Arushi Negi
M.Sc. Nursing
RCON, JH

2. Introduction
Excessive use of alcohol, psychoactive drugs and chemicals like
volatile substances causes psychological disorder.
In India 20 to 40% of subjects aged above 15 years are current
users of alcohol and nearly 10% of them are regular or excessive
user.
Nearly 15 to 30% of patient are developing alcohol related
problem and seeking admission in psychiatric hospitals.
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3. It is a maladaptive pattern of substance use that
impairs health.
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4. 4
• Alcohol
• Opioids
• Cannabis
• Coccain
• Sedative and hypnotics
• Nicotine
• Hallucinogens

5. 5
Biological
Factors
Genetics
Biochemical
Psychological Factors
Sense of inferiority
Low self-esteem
Inability to cope with pressure
of living society
Loneliness, Unmet need
Sexual immaturity.

6. Social Factor
• Religious reason
• Peer pressure
• Urbanization
• Extended period of education
• Unemployment
• Over crowding
• Occupation: Chef, barmen, army personnel, actor, entertainer, etc.
Easy Availability of Drug
• Drug that can be obtained from elicit sources such as street drugs.
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7. Psychiatric Disorder due to Substance
Abuse
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Alcohol
dependence
syndrome
Opioid
disorder
Canabis use
disorder
Cocaine use
disorder
LSD use
disorder
Barbiturate
use disorder.

8. CONSEQUENCES OF SUBSTANCE
ABUSE
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Commonly Leads to Physical Dependence, Psychological Dependence, Or Both.
It may cause Unhealthy Lifestyles & Behaviors Such as poor diet.
Impairs Social & Occupational Functioning, Creating Personal, Professional, Financial, & Legal
Problems
Adolescence may lead to emotional & behavioral Problems, Including Depression, Family Problems
with Relations, problems with or Failure to Complete School, & Chronic Substance abuse Problems.
In Pregnant women, substance Abuse Jeopardizes (Danger of Loss) fetal Well-being.
IV Drug Abuse May lead to Life Threatening Complications. • Illicit Street Drugs pose added Dangers;
Materials used to dilute them can cause toxic Or allergic Reactions.

9. ALCOHOL DEPENDENCE SYNDROME
Symptom
• GI: Gastritis, peptic ulcer, Ca. stomach, pancreatitis, malabsorption syndrome.
• CVS: HTN, cardiomyopathy
• CNS: Peripheral neuropathy, epilepsy, cerebral degeneration
• Damage to fetus: Fetal alcohol syndrome, LBW, still birth.
• Social: Marital disharmony, unemployment, financial problem, accident, criminality.
Psychiatric Disorders
• Acute intoxication
• Withdrawal syndrome
• Alcohol induced amnestic disorder
• Alcohol induced psychiatric disorder.
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10. OPIOD DISORDER
• The commonly used narcotics in India are heroin, pethidine, fortwin, etc.
• Acute intoxication:Bradycardia, apathy,hypotension, respiratory depression.
• Withdrawal syndrome: Watery eye, running nose, loss of appetite, irritability, tremor, sweating,
cramps etc.
• Complications: Peripheral neuropathy, parkinsonism, criminality, AIDS
• Treatment: Detoxification, Antidote (naloxone).
CANNABIS USE DISORDER
• It is derived from hemp plant (cannabis sativa). The dried leaves and flower is called as
marijuana, Ganja. It is either smoked or taken in liquid form
• Acute intoxication: Impairment of consciousness and orientation, tachycardia, euphoria,
dream-like state
• Withdrawal svndrome: Mostly found within 72-96 hr.Increased salivation, hyperthermia,
insomnia, decreased appetite.
• Complications: Hypomania, paranoid psychosis.
• Treatment: Supportive and symptomatic.
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11. COCAINE USE DISORDER
• The street name is crack'. It can be taken orally, smoking or parenterally.
• Acute intoxication: Pupillary dilatation, tachycardia, hypertension, sweating.
• Withdrawal syndrome: Agitation, depression, anorexia, fatigue and sleepiness.
• Complications: Acute anxiety reaction, seizure, respiratory depression, cardiac arrhythmia,
etc.
• Treatment: Amyl nitrate is an antidote, Diazepam also be used.
LSD USE DISORDER
• It is a powerful hallucinogen. It effects by acting on 5-HT levels in brain.
• Acute intoxication: It is characterized perceptual changes occurring in clear consciousness,
illusion, paranoid ideation, automatic hyperactivity, marked anxiety, etc.
• Withdrawal syndrome: Flashback (brief experiences of the hallucinogenic).
• Complications:Anxiety, depression, visual hallucinosis.
• Treatment: Symptomatic treatment with antianxiety, antidepressant.
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12.  Provision of recreation and entertainment
 Proper channelization of energies of the adolescents into constructive activities
 Health education
 Inculcation of the dangers of drug abuse students, teacher and the family increasing awareness
 Provision of periodic psychiatric guidance
 Strict implementation of drug control measures
 Measures for deaddiction
 Effective prevention and intervention programs consider cultural context, social resistance skills, and developmental
level of the child
 Skills training
 Teaching the problem solving and coping skills
 Development of proper social and problem solving skills
 Treatment of family problems
 Increased opportunities for prosocial activities with peers
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13. 13
Primary
• Reduction over
prescribing by doctor. (
Anxiolytics Especially
Benzodiazepines)
• Identification and
treatment of family
member who may be
contributing to drug
abuse.
• Make social change:
Putting up price of
alcohol, controlling
advertising about
alcohol, controlling sale.
• Increasing individual's
personal and social skill,
i.e. development of self-
esteem and resistance to
Peer Pressure.
• Health education to
college students and
youth about dangers of
substance abuse.
• Overall improvement
socioeconomic
improvement of the
population.

14. Secondary
• Early detection and counseling.
• Brief Intervention in Primary Care (Simple Advices from Practitioner &
Educational Leaflet).
• Motivational Interviewing.
• A Full Assessment which Includes, Appraisal of Current Medical,
Psychological & Social Problems.
• Detoxification with Benzodiazepines.
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15. Treatment Modalities for Substance Related
Disorders
Alcoholics Anonymous
Alcoholics Anonymous is a major self-help organization for the treatment of
alcoholism. It is based on peer support—acceptance and understanding from others
who have experienced the same problems in their lives. The only requirement for
membership is a desire on the part of the alcoholic person to stop drinking. Each
new member is assigned a support person from whom he or she may seek
assistance when the temptation to drink occurs.
Pharmacotherapy
Disulfiram (Antabuse) is a drug that can be administered as a deterrent to drinking
to individuals who abuse alcohol.
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16. Counseling
 Counseling on a one-to-one basis is often used to help the client who abuses substances.
 The relationship is goal-directed, and the length of the counseling may vary from weeks to
years.
 The focus is on current reality, development of a working treatment relationship, and
strengthening ego assets.
 The counselor must be warm, kind, and nonjudgmental, yet able to set limits firmly.
Group Therapy
 Group therapy with substance abusers has long been regarded as a powerful agent of
change.
 In groups, individuals are able to share their experiences with others who are going through
similar problems.
 They are able to “see themselves in others,” and confront their defenses about giving up the
substance.
 They may confront similar attitudes and defenses in others.
 Groups also give individuals the capacity for communicating needs and feelings directly.
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17. Psychopharmacology for Substance Intoxication and Substance Withdrawal
Alcohol
Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol
withdrawal. Chlordiazepoxide (Librium), oxazepam (Serax), lorazepam (Ativan), and diazepam
(Valium) are the most commonly used agents.
Opioids
Examples of drugs in the opioid classification include opium, morphine, codeine, heroin,
hydromorphone, oxycodone, and hydrocodone.
Depressants
Substitution therapy for CNS depressant withdrawal (particularly barbiturates) is most commonly with
the long-acting barbiturate phenobarbital (Luminal).
Stimulants
Treatment of stimulant intoxication usually begins with minor tranquilizers such as chlordiazepoxide
and progresses to major tranquilizers such as haloperidol (Haldol).
Hallucinogens and Cannabinols
Substitution therapy is not required with these drugs. When adverse reactions, such as anxiety or panic,
occur, benzodiazepines (e.g., diazepam or chlordiazepoxide) may be prescribed to prevent harm to the
client or others. 17

18. TERITARY PREVENTION
• Alcohol Deterrent Therapy
• Other Therapies include Assertive Training, Teaching Coping Skills, Behavior Counseling, Supportive & Individual
Psychotherapy.
• Agencies concerned with Alcohol – Related Problems (Alcoholic Anonymous, Al – Anon, Al – Teen, etc).
• Motivation Enhancement including Education about Health consequences of Alcohol use. Identifying High Risk
Situations & Developing Strategies to Deal with them (Eg: Craving Management).
• Drink Refusal Skills ( Assertiveness Training )
• Dealing with Faulty Cognitions.
• Handling Negative mood States.
• Time Management.
• Anger Control.
• Financial Management.
• Developing the Work Habit.
• Stress management.
• Sleep hygiene.
• Recreation & Spirituality.
• Family Counseling – To Reduce Interpersonal Conflicts, Which may Otherwise Trigger RELAPSE.
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19. REHABILITATION
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The Aim
of Rehabilitation of
an Individual De -
addicted from the
Effects of
Alcohol/Drugs.
To Enable him to
Leave the Drug
Sub – Culture.
To Develop New Social
Contacts, In this
Patients
First Engage in Work &
Social Activities in
Sheltered Surroundings
& then take Greater
Responsibilities for
Themselves in
Conditions Increasingly
like those of Everyday
Life.
Continuing
Social Support
is Usually
Required when
the Person
makes the
Transition to
Normal Work &
Living .

20. ROLE OF COMMUNITY HEALTH
NURSE
Community mental health nursing is the application of specialized knowledge
to populations and communities to promote and maintain mental health and to
rehabilitate population at risk that continue to have residual effects of mental
illness.
Community mental health nursing is differing from hospital set-up.
The community settings requires that the psychiatric nurse possess knowledge
about a broad array of community resources and be flexible in approaching
problems related to individual psychiatric symptoms, family and support
symptoms and basic living needs such as housing and financial support.
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21. Attributes
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• Awareness of
strength and
weakness of
self
•
Nonjudgmental
attitude
• Problem
solving skill
• Knowledge of
community
resources
•
Understanding
the social
values, culture
and political
issues
• Coordinator
with different
available
services.

22. Carr et al (1984) have identified the following roles for nurses working in community mental health services:
 Consultative role: This means giving advice to other professionals in the community about the type and
level of nursing care required for a group.
 Clinician role: Providing direct nursing care to the patients in the community.
 Therapeutic role: Employing psychotherapeutic and behavioral methods for management of patients.
 Assessor: The nurse may assess the care given to the client/group and may also asess the outcome of
ongoing care process.
 Educator: Creating awareness in the community about mental health and mental illness with special focus
on vulnerable groups.
 Trainer: Training of paraprofessionals, community leaders, school teachers,and other care giving
professionals in the community.
 Manager/administrator: Management of resources planning and coordination.
 Domiciliary care: Services are provided to the client by visiting their homes. Services like administration
of medication, assessment of level of the functioning, monitoring side effect of medication, counseling of
patient and their family member, etc.
 Liaison role: Community mental health nurse be liasoning reduces the gap between patient and hospital,
client and employers, etc.
 Preventive role: The preventive role are primary, secondary and tertiary.
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23. Other areas of community health
psychiatric nursing are:
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• Social skill
training
• Anxiety
management
and
relaxation
•
Bereavement
counselling
• Group
meeting
• Community
outreach
work services
• Child care
services
• Adult and
elderly care
services

24. Summary
Through this assignment i learned about substance abuse, factors affecting it,
its prevention, psychiatric disorder , its treatment and role of nurse.
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25. Conclusion
Excessive use of alcohol, psychoactive drugs and chemicals like volatile
substances causes psychological disorder. In India 20 to 40% of subjects aged
above 15 years are current users of alcohol and nearly 10% of them are
regular or excessive user. Nearly 15 to 30% of patient are developing alcohol
related problem and seeking admission in psychiatric hospitals.
25

26. BIBLIOGRAPHY
Dash B. A comprehensive textbook of community health nurrsing.The
health sciences publishers.2017
Townsend M. C. Essentials of psychiatric mental health nursing. Sixth
edition. F.A Davis company publishers. 2014.
PRESENTATION TITLE 26

27. Thank you