Addictions

I, EATING DISORDERS
A. Description: Characterized by uncertain self-identification and grossly disturbed
eating habits
B. Compulsive overeating
1. Binge-like overeating without purging
2. Food consumption is out of the individual's control and occurs in a stereotyped
fashion
3. Client may be repulsed by eating, and the eating relieves tension but does not
produce pleasure
4. Is aware that eating patterns are abnormal and feels depressed after eating
5. Eats secretly during a binge and consumes high-calorie and easily digestible food
6. Repeatedly tries to diet but without success
7. Lacks interest in exercise programs and feels helpless and hopeless about weight
8. When experiencing guilt, anger, depression, boredom, loneliness, inadequacy, or
ambivalence, responds by eating
C. Anorexia nervosa
1. Description
a. The onset is often associated with a stressful life event
b. The client intensely fears obesity
c. Body image is distorted, and the client has a disturbed self-concept
d. Preoccupied with foods that prevent weight gain and has a phobia against foods
that produce weight gain
e. The eating disorder can be life threatening
f. Death can occur from starvation, suicide, or electrolyte imbalance
2. Assessment
a. Refusal to eat and appetite loss
b. Appetite denial
c. Feelings of lack of control
d. Self-induced vomiting and self-administered enemas
e. Exercises compulsively
f. Overachiever and perfectionist
g. Decreased temperature, pulse, and blood pressure
h. Weightless
i. Gastrointestinal (GI) disturbances
j. Constipation
k. Electrolyte imbalances
l. Scaly, dry skin
 m. Sleep disturbances
n. Hormone deficiencies
o. Amenorrhea for at least three consecutive menstrual periods
p. Teeth and gum deterioration
q. Cyanosis and numbness of extremities
r. Esophageal varices from vomiting
s. Bone degeneration
D. Bulimia nervosa
1. Description
a. The client indulges in eating binges followed by purging behaviors
b. Most clients remain within a normal weight range but feel that their lives are
dominated by the eating-related conflict
2. Assessment
a. Preoccupied with body shape and weight
b. Consumes high-calorie food in secret; guilt about secretive eating
c. Binge-purge syndrome
d. Attempts to lose weight through diets, vomiting, enemas, cathartics, and
amphetamines or diuretics
e. Needs to control yet experiences feelings of powerlessness or loss of control
f. Low self-esteem
g. Poor interpersonal relationships
h. Mood swings
i. Self-mutilating behavior; suicide thoughts and attempts at suicide
j. Electrolyte imbalances
k. Loss of tooth enamel and dental decay
l. Stomach ulcers and rectal bleeding
m. Esophageal varices from vomiting
n. Cardiac disease and hypertension
E. Implementation: Clients with an eating disorder
1. Assess the client's nutritional status
2. Establish a contract with the client concerning the diet plan for the day
3. Assist the client in identifying precipitaters of the eating disorder
4. Encourage the client to state feelings about the eating behavior
5. Be accepting and nonjudgmental, expressing neither approval nor disapproval of the
behavior
6. Encourage behavior modification techniques
7. Provide praise and positive reinforcement for accomplishments
8. Supervise the client during mealtimes and for a specified period after meals
9. Set a time limit for each meal
10. Provide a pleasant, relaxed environment for eating
11. Monitor for signs of physical complications related to the eating disorder
12. Record intake and output (I & O)
13. Weigh the client daily at the same time, using the same scale, after the client voids
14. When weighing the client, ensure that the client is wearing the same clothing as
when the previous weight was taken
15. Monitor and restore fluid and electrolyte balance
16. Monitor elimination patterns
17. Assess and limit the client's activity level
18. Encourage the client to participate in diver-sional activities
19. Assess the client's suicidal potential
20. Administer antidepressant medication as prescribed
21. Encourage psychotherapy as prescribed
22. Refer the client to support groups.
II. SUBSTANCE ABUSE DISORDERS
A. Description: Behavioral changes associated with regular substance abuse that affects
the central nervous system (CMS)
B. Substance dependence (Box 72-1)
1. Pattern of repeated use of a substance, which usually results in tolerance,
withdrawal, and compulsive drug-taking behavior
2. Client takes substances in larger amounts and over longer periods of time than were
intended
3. Client has the desire to cut down but has unsuccessful efforts to decrease or
discontinue use
4. Daily activities revolve around the use of a substance
BOX 72-1

CAGE Screening Test

C: Have you ever felt the need to cut down on your drinking or drug use?
A: Have you ever been annoyed at criticism of your drinking or drug use?
G: Have you ever felt guilty about something you have done when you have been
drinking or taking drugs?
E. Have you ever had an eye opener, drinking or taking drugs first thing in the morning to
get going or to avoid withdrawal symptoms?

C. Substance tolerance: The need for increased amounts of the substance to achieve the
desired effect
D. Substance abuse
1. Client recurrently uses substances
2. Client experiences recurrent, significant harmful consequences related to the use of
substances
3. Client has legal problems related to substance abuse
E. Substance withdrawal
1. Physiological and/or substance-specific cognitive symptoms
2. Occurs when blood levels decrease in an individual with prolonged heavy use of a
substance
F. Precipitating factors of substance abuse
1. Rebellion and peer group pressure in adolescence
2. Pleasure-seeking experience, as the substance decreases physical and emotional pain
3. Group influence and peer pressure
4. Depression
5. Loss and grieving
G. Dysfunctional behaviors of substance abuse
1. Insensitive to self and others
2. Manipulative
3. Impulsiveness
4. Anger, including physical and verbal abuse
5. Avoidance of relationships, with physical and emotional distancing
 6. Sense of self-importance and requiring special treatment
7. Denial, blaming everything but the substance
8. Codependent and expects others to accept behavior
9. Low self-esteem
10. Depression.

III. ALCOHOL ABUSE

A. Description
1. Alcohol is a central nervous system (CNS) depressant affecting all body tissues
2. Physical dependence is a biological need for alcohol to avoid physical withdrawal
symptoms
3. Psychological dependence is a craving for the subjective effect of alcohol
B. Risk factors
1. Biological predisposition
2. Depressed and highly anxious characteristics
3. Low self-esteem
4. Poor self-control
5. History of rebelliousness, poor school performance, delinquency
6. Poor parental relationships
C. Assessment
1. Slurred speech
2. Uncoordinated movements
3. Unsteady gait
4. Restlessness
5. Belligerence
6. Confusion
7. Sneaking drinks, drinking in the morning, and experiencing blackouts
8. Binge drinking
9. Arguments about drinking
10. Missing work
11. Increased tolerance to alcohol
12. Intoxication, with blood alcohol levels of 0.08% to 0.1% (80 to 100 mg alcohol/dL
blood) or higher
D. Psychological symptoms
1. Depression
2. Hostility
3. Suspiciousness
4. Rationalization
5. Irritability
6. Isolation
7. Decrease in inhibitions
8. Decrease in self-esteem
9. Denial that a problem exists
E. Complications associated with chronic alcohol use
1. Vitamin deficiencies
a. Vitamin B deficiency causing peripheral neuropathies
b. Thiamine deficiency causing Korsakoffs syndrome
2. Alcohol-induced persistent amnesiac disorder causing severe memory problems
3. Wernicke's encephalopathy, causing confusion, ataxia, and abnormal eye
movements
4. Hepatitis; cirrhosis of the liver
5. Esophagitis and gastritis
6. Pancreatitis
7. Anemias
8. Immune system dysfunctions
9. Brain damage
10. Peripheral neuropathy
11. Cardiac disorders

IV. ALCOHOL WITHDRAWAL

A. Description
1. Occurs when an addicted person stops ingesting alcohol
2. Can occur 6 to 8 hours after drinking has ended or decreased, and symptoms can last
5 days or longer
3. Alcohol withdrawal is highly individual, and some clients experience mild
withdrawal symptoms requiring minimal medical supervision; others
experience severe systems that can be life threatening
B. Stages of withdrawal
1. Stage 1
a. May begin 6 to 8 hours after last ingestion or a significant decrease in usual
consumption of alcohol
b. Anxiety
c. Anorexia
d. Insomnia
e. Tremors
f. Hyperalertness
g. Internal shaking
h. Nausea and vomiting
i. Headache
j. Increased pulse and blood pressure
k. Depression
2. Stage 2
a. May begin 8 to 12 hours after the last ingestion or a significant decrease in usual
consumption of alcohol
b. Profound confusion
c. Gross tremors
 d. Nervousness
e. Disorientation
f. Illusions
g. Auditory and visual hallucinations
h. Nightmares
3. Stages
a. May begin 12 to 48 hours after the last ingestion or a significant decrease in usual
consumption of alcohol
b. Severe hallucinations
c. Seizures
4. Stage 4
a. May begin 3 to 5 days after the last ingestion or a significant decrease in usual
alcohol consumption
b. Confusion, disorientation, clouding of consciousness, and delirium
c. Hypertension, diaphoresis, tachycardia
d. Visual and tactile hallucinations
e. Fluctuating levels of consciousness
f. Fever (103° to 104° F)
g. Tremors
h. Uncontrolled tachycardia
i. Severe psychomotor activity
j. Agitation k. Hallucinations
l. Sleeplessness
m. A medical emergency
C. Implementation
1. Initiate seizure precautions
2. Administer chlordiazepoxide (Librium) as prescribed for withdrawal and
anticonvulsive effects
3. Administer diazepam (Valium) or pentobarbital (phenobarbital) as prescribed to
produce sedation and control withdrawal
4. Administer phenytoin (Dilantin) to prevent seizures
5. Administer vitamin Bj (thiamine) as prescribed for malnutrition
6. Administer magnesium sulfate as prescribed to increase the effectiveness of vitamin
B1 and help reduce postwithdrawal seizures
7. Hydrate the client
8. Monitor vital signs frequently
9. Monitor l&O
10. Orient client frequently
11. Maintain minimal stimuli
12. Approach client in an accepting and nonjudg-mental manner
13. Assist client to use assertive techniques rather than manipulation to meet needs
14. Set limits on manipulative behavior
15. Direct client to focus on the substance abuse problem
16. Limit the client's blame-placing or rationalizing to explain the substance abuse
problem
17. Encourage the client to participate in group therapy and support groups
 18. Encourage the client to attend weekly Alcoholics Anonymous (AA) meetings
D. Disulfiram (Antabuse) therapy
1. Description
a. An alcohol deterrent used for alcoholic dependence
b. The medication sensitizes the client to alcohol, so a disulfiram-alcohol reaction
occurs if alcohol is ingested
c. The client must abstain from alcohol for at least 12 hours before the initial dose is
administered
d. The client must avoid drinking for 14 days after disulfiram therapy has been
discontinued; otherwise the client is at risk for disulfiram-alcohol
reaction
2. Negative physiological responses
a. Throbbing headache
b. Flushing
c. Nausea
d. Copious vomiting
e. Diaphoresis
f. Dizziness
g. Blurred vision and confusion
h. Hypotension
i. Dyspnea
j. Palpitations and tachycardia
k. Chest pain
BOX 72-2

Hallucinogens
Lysergfc acid dietriylamide (LSD)
Mescaline
Peyote
Phencyclidine (PCP)
Psilocybin (derived from mushrooms)

3. Client education
a. Educate as to the effects of the medication
b. Instruct the client that the effects of the medication may occur for several days
after discontinuance
c. Ensure that the client agrees to abstain from alcohol and any alcohol-containing
substances
d. Instruct the client to avoid the use of substances that contain alcohol, such as
cough medicines, rubbing compounds, vinegar, mouthwashes,
and aftershave lotions
V. HALLUCINOGENS :
A. Cause psychosis, with distorted perception, heightened sense of awareness,
grandiosity, hallucinations, mystical experiences, and distortions of time
and space
B. May harm self when under the influence
C. No withdrawal syndrome when discontinued, but flashbacks may occur for several
months after use stops
D. Bad trips may result in panic and unpredictable psychotic behaviors

VI. CANNABIS
A. Can include marijuana, "pot," hashish
B. Causes altered state of awareness, relaxation, and mild euphoria
C. Decreases inhibitions
D. Decreased motivation from prolonged use
E. Can cause possible psychosis
F. Physiological effects include slowed reflexes
G. Causes drying of mucous membranes and reddening of eyes

VII. OPIOIDS (Box 72-3)

A. Description
1. Cause mental and physical deterioration
2. High risk for infection with human immunodeficiency virus (HIV) or hepatitis virus
if taken intravenously
3. Cause decreased response to pain, respiratory depression, constriction of pupils,
euphoria, apathy, impaired judgment
B. Withdrawal
1. Methadone blocks the action of opioids and may be used to assist with withdrawal
2. Signs of withdrawal include anxiety; yawning; diaphoresis; cramping; rhinorrhea;
achiness and muscle twitching; anorexia; insomnia; increased
temperature, respiration, and blood pressure; nausea, vomiting, and diarrhea; and
restlessness
3. Overdose of opioids can lead to coma, respiratory depression, and death

Opioids

Codeine
(Heroin ("China white," synthetic heroin)
Meperidine hydrochloride (Demerol)
Methadorie
Morphine sulfate
BOX 72-5
Central Nervous System Depressants

Barbiturates
Benzpdiazapines
Methaqualone (quaaludes, "sopers")
BOX 72-6
VIII. CENTRAL NERVOUS SYSTEM DEPRESSANTS
A. Description
1. Act as a depressant, sedative, and hypnotic
2. Cause physical and psychological dependence
3. Cause euphoria
4. Can cause depression and hostility
5. Impaired judgment and lack of coordination can occur
6. Slurring of speech and decreased inhibitions can occur
7. Tolerance can develop
B. Withdrawal: Causes increased temperature, tachycardia, postural hypotension,
insomnia, tremors, agitation, apprehension, weakness, seizures, and
psychosis

IX. CENTRAL NERVOUS SYSTEM STIMULANTS

A. Description
1. Stimulants lead to alertness and extra energy
2. Effects include euphoria, hyperactivity, insomnia, anorexia and weight loss,
tachycardia and hypertension, psychotic behavior
3. Psychological dependence and tolerance can occur
4. Sudden death has been associated with cocaine abuse

Central Nervous System Stimulants

Amphetamines
Benzedrine inhalers
Caffeine
Cocaine, "crack"
Diet pills
Methylenedioxylmethamphetamine (Ecstasy)
Therapies for Substance Abuse Clients

Community treatment programs

Family counseling
Psychotherapy
Self-help groups
Transitional living programs

B. Withdrawal
1. Crash
2. Depression
3. Lack of energy

X. IMPLEMENTATION: WITHDRAWAL
1. Initiate seizure precautions
2. Hydrate the client
3. Monitor vital signs every hour
4. Monitor I & O
5. Orient client frequently
6. Maintain minimal stimuli
7. Approach client in an accepting and nonjudg-mental manner
8. Direct client's focus to the substance abuse problem
9. Identify with client situations that precipitate angry feelings
10. Limit client's blame-placing or rationalizing to explain the substance abuse problem
11. Assist client to use assertive techniques rather than manipulation to meet needs
12. Set limits on manipulative behavior and verbal and physical abuse
13. Hold client firmly to reasonable limits, consistently reinforcing rules, with reasonable
consequences for breaking rules
14. Hold client accountable for all behaviors
15. Assist client to explore strengths and weaknesses
16. Encourage time-out if client is losing control
17. Encourage client to participate in unit activities
18. Encourage client to participate in group therapy and support groups
19. See Box 72-6 for a list of therapies
20. Box 72-7 delineates nursing care for clients

Withdrawal: Nursing Care

Obtain information regarding the drug type and amount consumed

Assess vital signs
Remove unnecessary objects from the environment
Provide one-to-one supervision if necessary
Provide a quiet, calm environment with minimal stimuli
Maintain client orientation Ensure client's safety by implementing seizure precautions
Use restraints, if necessary and prescribed, to prevent client from harming self and others
Provide for physical needs
Provide food and fluids as tolerated
Administer medications as prescribed to decrease withdrawal symptoms
Collect blood and urine samples for drug screening

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