Substance Abuse, Dependence, and Addictions- Substance Use Disorders (SUDs) 药物滥用, 依赖, 成瘾

Incidence and prevalence

As according to Raynor and Pope (2016), “it is estimated that more than 8 million (an estimated 12%) children in America lived with at least one parent who was dependent on or abused alcohol or illicit drugs”, “according to the results from the 2013 National survey on Drug Use and Health, approximately 5.4% of pregnant women were current illicit drug users based on data averaged across 2012 and 2013”. (p. 180).

In the terms of substance abuse or dependence, the substance can be defined as a prescribed drug, an illegal drug, alcohol, or a substance used in an unintended manner to produce mood or mind-altering effect. Substance abuse may be unintentionally from initial used, but the abuse of alcohol and other psychoactive substances has become an endemic problem, and the individuals are facing not only psychological but physiological consequences.

As according to Mayerson and Julian (2017),

• Abuse- inappropriate use of medications or use of illicit substances
• Addiction- a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences
• Dependence syndrome- a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behavior that once had greater value.
• Physical dependence- the body’s reliance on an external source of opioids to prevent withdrawal.
• Substance-use disorder- clinical diagnosis using criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Diagnostic Evaluation

The DSM-V describes a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period:

1. The substance is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
8. Recurrent use of the substance in situations in which it is physically hazardous.
9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by either of the following:
    • The characteristic withdrawal syndrome for that substance (as specified in the DSM-V for each substance).
    • The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Treatment Management

As according Nettina (2010) as follow:

• Inpatient modalities include programs of detoxification and therapy sessions designed to aid in the recognition of a substance-related disorder
  • Detoxification is unique to each substance:
    • Benzodiazepine taper is utilized during detoxification from alcohol
    • The treatment of cocaine withdrawal may include administration of prescribed drugs that can reduce craving, such as amantadine or bromocriptive
    • The treatment of heroin withdrawal generally involves transdermal clonidine along with oral administration as necessary
• Outpatient therapies include support groups, continued therapy sessions, and the use of pharmacologic drugs to aid in the maintenance of sobriety
  • Drugs may use in treatment of alcohol abuse: Disulfiram (Antabuse), Acamprosate (Campral), and Topiramate (Topamax)
  • Drug therapy in treatment of opiate withdrawal:
    • opioid antagonist: naloxone (Narcan) and naltrexone (ReVia)
    • Methadone
    • Levo-alpha-acetylmethadol (LAAM)
    • Buprenorphine (Suboxone)
  • Psychosocial support: 12-steps or other programs, family support, and educational groups.

(p. 1827).

Patient education

Patient and family should always educated regarding about adverse physiologic and psychological effects of substance use, explain the potential for injury from risk taking behaviors, and reinforce the need for aftercare groups, supports, and activities. Patient and family should be assisted and encouraged in adherence to drug therapy regimen. The individual may benefit from placement in a residential treatment program with supportive services, referrals may be necessary. Health care provider may help patient and family to develop a plan of care with ongoing attendance of MD follow up, as well as support groups meetings.

References:

Mayerson, E. A., & Julian, T., (2017). Acute pain management for patients on medication-assisted treatment for opioid-use disorder. Topics in Pain Management. 33(3). P 1-12

Nettina, S. M., (2010) Lippincott manual of nursing practice (9^th ed)

Raynor, P., & Pope, C., (2016). The role of self-care for parents in recovery from substance use disorders: An integrative review of parental self-care. Journal of addictions nursing.27(3). P 180-189