Substance Related Disorders & Dual Diagnosis. Phyllis M. Connolly, PhD, RN, CS NURS 127A. Questions to Consider Today 4/20/01. What behaviors indicate that a nurse may be abusing substances? What is the ego/self theory related to substance abuse? When is denial a problem?
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Phyllis M. Connolly, PhD, RN, CS
Drug counts incorrect
Excessive wastage, often not countersigned
Medicine signed out to pt. not in pain
Two strengths of drugs signed out to same pt. Same time
Packaging appears to be tampered
Patient complaints of ineffective pain control
Volunteers to give controlled drugs
Euphoric recall for involvement in unpleasant situations
iIlogical or sloppy charting
Absenteeism, esp. days off
Requesting leave time just before assigned shift
missed deadlinesSigns of Impaired Nursing Practice
Sudden changes in mood
Periods of irritability
Wears long sleeves (hot weather)
Chronic pain condition
Hx pain treatment with controlled substances
Signs of Use
Alcohol on breath
Constant use of perfumes, mouthwash, breath mints
flushed face, reddened eyes, unsteady gait, slurred speech, hyperactivity
Increasing family problems interfere with workSigns Impaired Nurse Cont.
Sedative, hypnotic,or antianxiety agentsClasses of Substances with Potential for Abuse and Dependence
Caffeine not considered to cause either dependence or abuse
** Nicotine is currently classified as causing dependence but not abuse
A. Maladaptive pattern3 or more:
need for more
inability to stop using
time spent acquiring or recovering from effects
problems, social, occupational, or recreational
Continues use despite knowledge
A. Maladaptive pattern leads to significant impairment or distress as manifested by one or more of:
Failure to fulfill major role obligations at work, school, or home
Recurrent use in hazardous situations
Recurrent substance related legal problems
Continued use despite problemsDSM-IV Criteria Substance Related Disorders
Development of a substance- specific syndrome due to a recent ingestion of a substance
Clinically significant maladaptive behavioral or psychological changes due to the effect of the substance on the CNS
Not due to general medical condition and not better accounted for by another mental disorder
Development of a substance-specific maladaptive behavioral or psychological changes due to the effect of the substance on the CNS
The substance-specific syndrome causes clinically significant distress or impairment
Not due to a general medical condition and not better accounted for by another mental disorderDSM-IV Criteria Substance Related Disorders Cont.
Lack of control over drug use and its increasing importance. At least 3 symptoms in 12 month period.
Is it denial?
Is it a problem?
How is it a problem?
What cognitions are in conflict?
What are alternative means of reducing dissonance?
Forchuk & Westwell, 1987
1. Have you ever felt you ought to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (Eyeopener)
Keltner, p. 530
Within a few hours, peaks within 24 hrs.
Ego functioning which does not handle painful affects or maximize protective activity
decreased respiratory rate
Clonidine (Catapress)Opioid Abuse: Signs & Symptoms
Townsend, 1996, p. 374
Keltner, p. 538
Prochaska & DiClemente, 1992
Detox & residential treatment
Behavioral model & disease model
Alcohol-Librium, Valium, Ativan
Treatment of comorbid medical & psychiatric disorders
Life-style issuesTreatment of Substance-Related Disorders
Substance Abuse Dependence 12%
Both Disorders 13.7%
Only Mental Disorder 21.4%
Dahme, 1998, p. 288
Jefferson, 1998, p. 517