Substance Abuse

Substance Use/Abuse & Related Disorders

 International Health Problem

 Drug & alcohol abuse costs business and industry and estimated $100 billion

annually.

 One person is killed every 30 minutes in an alcohol-related traffic accident.

 The number of infants suffering due to prenatal exposure to alcohol or drugs is

increasing.

 Chemical abuse = increased violence (domestic abuse, homicide, & child abuse

and neglect)

 Children of alcoholics are four times more likely than the general population to

develop problems with alcohol.

Types of Substance Abuse

 Many substances can be used & abused;

 Some can be obtained legally, whereas others are illegal.

 Polysubstance Abuse – abuse of more than one substance.

The DSM-IV-TR lists 11 diagnostic classes of substance abuse:

1. Alcohol

2. Amphetamines or Similarly Acting Sympathomimetics

3. Caffeine
 4. Cannabis

5. Cocaine

6. Hallucinogens

7. Inhalants

8. Nicotine

9. Opioids

10. Phencyclidine (PCP) or Similarly Acting Drugs

11. Sedatives, Hypnotics, or Anxiolytics

2 Groups of Substance-Related Disorders:

1. Those that include disorders of abuse & dependence

2. Substance-induced disorders such as intoxication, withdrawal, delirium,

dementia, psychosis, mood disorder, anxiety, sexual dysfunction, and sleep

disorder.

 Although caffeine & nicotine abuse can cause significant physiologic health

problems and result in substance-induced disorders such as:

• Sleep disorders

• Anxiety

• Withdrawal

 Treatment of these two substances usually is not viewed as falling into the

mental health arena.

 Intoxication. Use of a substance that results in maladaptive behavior.

Withdrawal Syndrome. Refers to the negative psychologic & physical

reactions that occur when use of a substance ceases or dramatically decreases.

Detoxification. The process of safely withdrawing from a substance.

Substance Abuse. Using a drug in a way that is inconsistent with medical or

social norms and despite negative consequences.

Denotes problems in social, vocational, or legal areas of the person’s life.

Substance Dependence. Also includes problems associated with addiction

(tolerance, withdrawal, and unsuccessful attempts to stop using the substance).

Onset & Clinical Course

 Much research on substance use has focused on alcohol because it is legal an

more widely used.

 The early course of alcoholism typically begins with first episode of

intoxication between 15 & 17 years of age.

 The first evidence of minor alcohol related problems is seen in the late teens.

 A pattern of more severe difficulties for people with alcoholism begins to

emerge in the mid-twenties to mid-thirties;

Blackout. An episode during which the person continues to function but has

no conscious awareness of his or her behavior at the time or any later memory

of the behavior.
 Tolerance. The alcoholic person needs more alcohol to produce the same

effect.

Tolerance Break. The very small amounts of alcohol intoxicate the person.

 The later course of alcoholism, when the person’s functioning definitely is

affected, often characterized by periods of abstinence or temporarily

controlled drinking.

 This period of controlled drinking soon leads to an escalation of alcohol

intake, more problems, and a subsequent crisis.

 Spontaneous Remission. Or natural recovery, some people with alcohol-

related problems can modify or quit drinking on their without a treatment

program.

 Can occur in as many as 20% of alcoholics, although it is highly unlikely that

people in the late stageof alcoholism can recover without treatment.

 The highest rates for successful recovery are for people who abstain from

substances, are highly motivated to quit, and have a past history of life

success.

 Poor outcomes have been associated with an earlier age at onset, longer

periods of substance use, and the coexistence of a major psychiatric illness.

 People addicted to alcohol and drugs have a rate of suicide 20% higher than

that of the general population.

Related Disorders

 Substance-induced disorders such as anxiety, mood disorders, and dementia.

  Cognitive disorders which may be seen in severe alcohol withdrawal.

 The exact causes of drug use, dependence, and addiction are not known.

Biologic Factors

 Children of alcoholic parents are at higher risk for developing alcoholism and

drug dependence.

 This increased risk is partly the result of environmental factors.

 Twins have shown a higher rate of concordance (when one has it, the other

twin gets it) among identical than fraternal twins.

 Adoption studies have shown higher rates of alcoholism in sons of biological

fathers with alcoholism.

 50% of the variation in causes of alcoholism was the result of genetics, with

the remainder caused by environmental influences.

 The ingestion of mood-altering substances stimulates dopamine pathways in

the limbic system, which produces pleasant feelings or a “high” that is a

reinforcing, or positive, experience.

 Some people have an internal alarm that limits the amount of alcohol

consumed to one or two drinks.

Psychologic Factors

 Inconsistency in the parent’s behavior, poor role modeling, and lack of

nurturing pave the way for the child to adopt a similar style of maladaptive

coping, stormy relationships, and substance abuse.

  Children who abhorred their family lives are likely to abuse substances as

adults because they lack adaptive coping skills and cannot form successful

relationships.

 Some people use alcohol as a coping mechanism or to relieve stress and

tension, increase feelings of power, and decrease psychologic pain. High doses

of alcohol, however, actually increase muscle tension and nervousness

Cultural Factors

 Cultural factors, social attitudes, peer behaviors, laws, cost, and availability all

influence initial and continued use of substances

 Younger experimenters use substances that carry less social disapproval such

as alcohol and cannabis.

 Older people use drugs such as cocaine and opioids that are more costly and

rate higher disapproval.

 Many people view the social use of cannabis, although illegal, as not very

harmful.

 Urban areas where cocaine and opioids are readily available also have high

crime rates, high unemployment, and substandard school systems that

contribute to high rates of cocaine and opioid use and low rates of recovery.

Types of Substances & Treatment

DSM-IV-TR DIAGNOSTIC CRITERIA:

Symptoms of Substance Abuse

 Denial of problems
  Minimizes use of substance

 Rationalization

 Blaming others for problems

 Anxiety

 Irritability

 Impulsivity

 Feelings of guilt and sadness or anger and resentment

 Poor judgment

 Limited insight

 Low self-esteem

 Ineffective coping strategies

 Difficulty expressing genuine feelings

 Impaired role performance

 Strained interpersonal relationships

 Physical problems such as sleep disturbances and inadequate nutrition

Alcohol

Intoxication & Overdose

 CNS depressant
 Effects: relaxation & loss of inhibitions

 Symptoms (Intoxication): slurred speech, unsteady gait, lack of coordination,

and impaired attention, concentration, memory, and judgment

 Some people become aggressive, or display inappropriate sexual behavior

 May experience a blackout

PHYSIOLOGIC EFFECTS OF LONG-TERM ALCOHOL USE

 Cardiac myopathy

 Wernicke’s encephalopathy

 Korsakoff’s psychosis

 Pancreatitis

 Esophagitis

 Hepatitis

 Cirrhosis

 Leukopenia

 Thrombocytopenia

 Ascites

Overdose – excessive alcohol intake in a short period.

 Can result in vomiting, unconsciousness, and respiratory depression

 This combination can cause aspiration pneumonia or pulmonary obstruction.

  Alcohol induced hypotension can lead to cardiovascular shock and death.

Treatment: gastric lavage or dialysis to remove the drug and support of

respiratory and cardiovascular functioning in an intensive care unit

Withdrawal and Detoxification

 Symptoms of withdrawal usually begin 4 to 12 hours after cessation.

 Alcohol withdrawal usually peaks on the second day and is over in about 5

days (1-2 weeks)

o Symptoms (withdrawal):

 Coarse hand tremors

 Sweating

 Elevated pulse and blood pressure

 Insomnia

 Anxiety

 nausea or vomiting

o Delirium tremens (DTs)

 Severe or untreated withdrawal may progress to transient hallucinations,

seizures, or delirium

Detoxification needs to be accomplished under medical supervision.

 Mild withdrawal symptoms - the client can be treated safely at home

  Severe withdrawal symptoms - a short admission of 3 to 5 days is the most

common setting.

Safe withdrawal is usually accomplished with the administration of:

 lorazepam(Ativan)

 chlordiazepoxide (Librium)

 diazepam (Valium)

 Withdrawal can be accomplished by fixed schedule dosing known as tapering.

 Sedatives, Hypnotics, Anxiolytics

Intoxication & Overdose

 Barbiturates

 Nonbarbiturate hypnotics

 Anxiolytics

 Benzodiazepines

 In the usual prescribed doses, these drugs cause drowsiness and reduce

anxiety, which is the intended purpose.

Sedatives, Hypnotics, Anxiolytics

Intoxication Symptoms

 Slurred speech

 Lack of coordination
  Unsteady gait

 Labile mood

 Impaired attention or memory

 Stupor and coma

 Benzodiazepines alone, when taken orally in overdose, are rarely fatal, but the

person is lethargic and confused.

 Treatment: gastric lavage followed by ingestion of activated charcoal and a

saline cathartic; dialysis can be used if symptoms are severe.

 Barbiturates, in contrast, can be lethal when taken in overdose.

 They can cause coma, respiratory arrest, cardiac failure, and death.

 Treatment: ICU. Lavage or Dialysis.

Withdrawal and Detoxification

 Medications such as lorazepam, whose actions typically last about 10 hours,

produce withdrawal symptoms in 6 to 8 hours;

 Medications such as lorazepam, whose actions typically last about 10 hours,

produce withdrawal symptoms in 6 to 8 hours;

 Withdrawal Syndrome. Characterized by symptoms that are the opposite of

the acute effects of the drug.

 Seizures and hallucinations occur only rarely in severe benzodiazepine

withdrawal.
  Detoxification from sedatives, hypnotics, and anxiolytics is often managed

medically by tapering.

Symptoms:

 Autonomic hyperactivity (increased pulse, blood pressure, respirations, and

temperature)

 Tremor

 Insomnia

 Anxiety

 Nausea

 Psychomotor agitation

Stimulants (Amphetamines & Cocaine)

 CNS stimulants

 Stimulants have limited clinical use and a high potential for abuse.

 Amphetamines (uppers) were used by people who wanted to lose weight or to

stay awake.

 Cocaine is highly addictive and a popular recreational drug because of the

intense and immediate feeling of euphoria it produces.

 Methamphetamine is particularly dangerous.

 Brain damage related to its use is frequent, primarily as a result of the

substances used to make it—that is, liquid agricultural fertilizer.

Intoxication and Overdose

Intoxication Effects:

 High or euphoric feeling

 Hyperactivity

 Hypervigilance,

 Talkativeness

 Anxiety

 Grandiosity

 Grandiosity

 Hallucinations

 Stereotypic or repetitive behavior

 Anger

 Fighting

 Impaired judgment

o Overdoses of stimulants can result in seizures and coma; deaths are rare.

Physiologic Effects:

 Tachycardia

 Elevated blood pressure

 Dilated pupils
  Perspiration

 Chills

 Nausea

 Chest pain

 Confusion

 Cardiac dysrhythmias

Treatment: chlorpromazine (Thorazine)

Withdrawal and Detoxification

 Marked dysphoria is the primary symptom

 Accompanied by fatigue, vivid and unpleasant dreams

 insomnia or hypersomnia

 increased appetite

 psychomotor retardation or agitation.

 Marked withdrawal symptoms are referred to as “crashing”;

 the person may experience depressive symptoms, including suicidal ideation,

for several days.

Cannabis (Marijuana)

 hemp plant that is widely cultivated for its fiber used to make rope and cloth

and for oil from its seeds.

  Known for its psychoactive resin.

 This resin contains more than 60 substances, called cannabinoids.

 -9- tetrahydrocannabinol is thought to be responsible for most of the

psychoactive effects.

Marijuana. Upper leaves, flowering tops, and stems of the plant

Hashish. the dried resinous exudate from the leaves of the female plant.

Cannabis. Most often smoked in cigarettes (joints), but it can be eaten.

 Currently, two cannabinoids, dronabinol (Marinol) and nabilone (Cesamet),

have been approved for treating nausea and vomiting from cancer

chemotherapy.

Intoxication and Overdose

 Cannabis begins to act less than 1 minute after inhalation.

 Peak effects usually occur in 20 to 30 minutes and last at least 2 to 3 hours.

 Users report a high feeling similar to that with alcohol, lowered inhibitions,

relaxation, euphoria, and increased appetite.

Intoxication Symptoms:

 impaired motor coordination

 Inappropriate laughter

 impaired judgment and short-term memory

 distortions of time and perception

  Anxiety

 dysphoria

 social withdrawal

Physiologic Effects:

 increased appetite

 conjunctival injection (bloodshot eyes)

 Dry mouth

 Hypotension

 tachycardia.

 Excessive use of cannabis may produce delirium or, rarely, cannabis-induced

psychotic disorder, both of which are treated symptomatically.

 Overdoses of cannabis do not occur.

Withdrawal and Detoxification

 Although some people have reported withdrawal symptoms of muscle aches,

sweating, anxiety, and tremors, no clinically significant withdrawal syndrome

is identified.

Opioids

 popular drugs of abuse

 they desensitize the user to both physiologic and psychologic pain and induce

a sense of euphoria and well-being.

  Morphine

 Meperidine (Demerol)

 Codeine

 Hydromorphone

 Oxycodone

 Methadone

 Oxymorphone

 Hydrocodone

 Propoxyphene

 as well as illegal substances such as heroin and normethadone.

 Health care professionals who abuse opioids often write prescriptions for

themselves or divert prescribed pain medication for clients to themselves.

Intoxication & Overdose

Opioid Intoxication Symptoms:

 Apathy

 Lethargy

 Listlessness

 Impaired judgment

 psychomotor retardation or agitation

  constricted pupils

 Drowsiness

 slurred speech

 Impaired attention and memory

Severe Intoxication or Opioid Overdose Symptoms:

 Coma

 respiratory depression

 pupillary constriction

 Unconsciousness

 death

Treatment: Naloxone (Opioid anatgonist)

 Naloxone is given every few hours until the opioid level drops to nontoxic;

this process may take days

Withdrawal and Detoxification

 Opioid withdrawal develops when drug intake ceases or decreases markedly

Initial Symptoms:

 Anxiety

 Restlessness

 aching back and legs

  cravings for more opioids

Symptoms as withdrawal progresses:

 Nausea

 Vomiting

 dysphoria,

 Lacrimation

 Rhinorrhea

 Sweating

 Diarrhea

 Yawning

 Fever

 Insomnia

 Does not require pharmacologic intervention to support life or bodily

functions.

 Short-acting drugs such as heroin produce withdrawal symptoms in 6 to 24

hours; the symptoms peak in 2 to 3 days and gradually subside in 5 to 7 days.

 Longer-acting substances such as methadone may not produce significant

withdrawal symptoms for 2 to 4 days, and the symptoms may take 2 weeks to

subside.
  Substitution of methadone during detoxification reduces symptoms to no

worse than a mild case of flu.

 Withdrawal symptoms such as anxiety, insomnia, dysphoria, anhedonia, and

drug craving may persist for weeks or months.

Hallucinogens

 substances that distort the user’s perception of reality and produce symptoms

similar to psychosis, including hallucinations (usually visual) and

depersonalization.

Examples of hallucinogens:

 Mescaline

 Psilocybin

 Lysergicacid diethylamide

 “designer drugs” such as Ecstasy

 PCP, developed as an anesthetic, is included in this section because it acts

similarly to hallucinogens.

Intoxication and Overdose

Hallucinogen Intoxication Symptoms:

 Anxiety

 Depression

 paranoid ideation
  ideas of reference

 fear of losing one’s mind

 potentially dangerous behavior such as jumping out a window in the belief

that one can fly

Physiologic Symptoms:

 Sweating

 Tachycardia

 Palpitations

 blurred vision

 Tremors

 lack of coordination.

• PCP intoxication often involves belligerence, aggression, impulsivity, and

unpredictable behavior

 These drugs are not a direct cause of death, although fatalities have occurred

from related accidents, aggression, and suicide.

 Psychotic reactions are managed best by isolation from external stimuli.

 physical restraints may be necessary for the safety of the client and others.

Treatment

 PCP toxicity can include seizures, hypertension, hyperthermia, and respiratory

depression.
  Medications that control seizure and BP

 Cooling Devices (Hyperthermia Blankets)

 Mechanical Ventilation

Withdrawal and Detoxification

 No withdrawal syndrome

 some people have reported a craving for the drug

 Flashbacks. transient recurrences of perceptual disturbances like those

experienced with hallucinogen use.

 may persist for a few months up to 5 years

Inhalants

 diverse group of drugs that include anesthetics, nitrates, and organic solvents

that are inhaled for their effects.

The most common substances in this category are:

 Aliphatic and aromatic hydrocarbons found in gasoline

 Glue

 Paint thinner

 Spray paint

Less frequently used halogenated hydrocarbons include

 Cleaners
  Correction fluid

 Spray can propellants

 And other compounds containing esters, ketones, and glycols

 Inhalants can cause significant brain damage, peripheral nervous system

damage, and liver disease.

Intoxication and Overdosage

Inhalant Intoxication Symptoms:

 Dizziness

 Nystagmus

 Lack of coordination

 Slurred speech

 Unsteady gait

 Tremor

 Muscle weakness

 Blurred vision

 Stupor and coma

Significant behavioral symptoms:

 Belligerence

 Aggression
  Apathy

 impaired judgment

 Inability to function

 Acute Toxicity: anoxia, respiratory depression, vagal stimulation, and

dysrhythmias

 Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration

of the compound or vomitus

Treatment:

 supporting respiratory and cardiac functioning until the substance is removed

from the body.

 no antidotes or specific medications to treat inhalant toxicity.

Withdrawal and Detoxification

 Psychological cravings

 Persistent dementia

 Psychosis

 Anxiety

 Mood disorders

• These disorders are all treated symptomatically

 Pharmacologic Treatment

Two Main Purposes:

1. To permit safe withdrawal from alcohol, sedative-hypnotics, and

benzodiazepines and

2. to prevent relapse

 For clients whose primary substance is alcohol,

 vitamin B1 (thiamine) - prescribed to prevent or to treat Wernicke–Korsakoff

syndrome.

 Cyanocobalamin (vitamin B12) & folic acid - prescribed for clients with

nutritional deficiencies.

 Benzodiazepine-anxiolytic agent - used to suppress the symptoms of

abstinence.

o lorazepam

o chlordiazepoxide

o diazepam

 Disulfiram (Antabuse) - prescribed to help deter clients from drinking.

 If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs

with flushing, a throbbing headache, sweating, nausea, and vomiting

 In severe cases, severe hypotension, confusion, coma, and even death may

result
 The client also must avoid a wide variety of products that contain alcohol such

as cough syrup, lotions, mouthwash, perfume, aftershave, vinegar, and vanilla

and other extracts.

 Ingestion of alcohol may cause unpleasant symptoms for 1 to 2 weeks after the

last dose of disulfiram.

 Acamprosate (Campral) - prescribed for clients recovering from alcohol abuse

or dependence

 to help reduce cravings for alcohol

 decrease the physical and emotional discomfort that occurs especially in the

first few months of recovery.

 The dosage is two tablets (333 mg each) or 666 mg, three times a day.

 Persons with renal impairment cannot take this drug.

 acamprosate was found to be more effective with “relief cravers”

 naltrexone was more effective with “reward cravers”

 Methadone - used as a substitute for heroin in some maintenance programs.

 The client takes one daily dose of methadone

 which meets the physical need for opiates but does not produce cravings for

more.

 Levomethadyl - narcotic analgesic whose only purpose is the treatment of

opiate dependence.

 Naltrexone (ReVia) - opioid antagonist often used to treat overdose.

  It blocks the effects of any opioids that might be ingested

 negating the effects of using more opioids.

 disulfiram (antabuse); modafinil (Provigil), an antinarcoleptic; propranolol

(Inderal), a beta-blocker; and topiramate (Topamax) - these four medications

that are sometimes prescribed for the off-label use of decreasing craving for

cocaine

 Clonidine (Catapres) - It is most effective against nausea, vomiting, and

diarrhea but produces modest relief from muscle aches, anxiety, and

restlessness

 Ondansetron (Zofran) - It has been used in young males at high risk for

alcohol dependence or with earlyonset alcohol dependence. It is being studied

for treatment of methamphetamine addiction.

Dual Diagnosis

 Dual Diagnosis. A client with both substance abuse and another psychiatric

illness.

 It is estimated that 50% of people with a substance abuse disorder also have a

mental health diagnosis.

Traditional methods for treatment of major psychiatric illness or primary substance

abuse often have little success in these clients for the following reasons:

 Clients with a major psychiatric illness may have impaired abilities to process

abstract concepts; this is a major barrier in substance abuse programs.

  Substance use treatment emphasizes avoidance of all psychoactive drugs. This

may not be possible for the client who needs psychotropic drugs to treat his or

her mental illness.

 The concept of “limited recovery” is more acceptable in the treatment of

psychiatric illnesses, but substance abuse has no limited recovery concept.

 The notion of lifelong abstinence, which is central to substance use treatment,

may seem overwhelming and impossible to the client who lives “day to day”

with a chronic mental illness.

 The use of alcohol and other drugs can precipitate psychotic behavior; this

makes it difficult for professionals to identify whether symptoms are the result

of active mental illness or substance abuse.

 Healthy, nurturing, supportive living environments; assistance with

fundamental life changes, such as finding a job and abstinent friends;

connections with other recovering people; and treatment of their comorbid

conditions.

Clients identified

 the need for stable housing

 positive social support

 using prayer or relying on a higher power

 participation in meaningful activity

 eating regularly
  getting sufficient sleep

 looking presentable as important components of relapse prevention

 Quetiapine (Seroquel) - used in one study to control alcohol cravings as well as

moderating their psychiatric symptoms

Application of the Nursing Process

 Substance use typically includes the use of defense mechanisms, especially

denial.

 Alcohol Use Disorders Identification Test (AUDIT) - useful screening device to

detect hazardous drinking patterns that may be precursors to full-blown

substance use disorders

 Detoxification is the initial priority.

Assessment

History

 Clients with a parent or other family members with substance abuse problems

may report a chaotic family life

 other people such as an employer threatening loss of a job or a spouse or

partner threatening loss of a relationship

General Appearance

 Usually reveals appearance and speech to be normal.

 appear anxious, tired, and disheveled if client have just completed a difficult

course of detoxification.
  clients may appear physically ill, depend if client has any health problems

result from substance abuse

 Most clients are somewhat apprehensive about treatment, resent being in

treatment, or feel pressured by others to be there.

Mood & Affect

 Some clients are sad and tearful, expressing guilt and remorse for their

behavior and circumstances.

 Others may be angry and sarcastic or quiet and sullen, unwilling to talk to the

nurse.

 Irritability is common because clients are newly free of substances.

Thought Processes & Content

 Clients are likely to minimize their substance use, blame others for their

problems, and rationalize their behavior.

 They may believe they cannot survive without the substance or may express

no desire to do so.

 They may believe that they could quit “on their own” if they wanted to, and

they continue to deny or minimize the extent of the problem.

Sensorium & Intellectual Processes

 Clients generally are oriented and alert unless they are experiencing lingering

effects of withdrawal.
  Intellectual abilities are intact unless clients have experienced neurologic

deficits from long-term alcohol use or inhalant use.

Judgment & Insight

 Clients are likely to have exercised poor judgment, especially while under the

influence of the substance. Judgment may still be affected: clients may behave

impulsively such as leaving treatment to obtain the substance of choice.

 Insight usually is limited regarding substance use. Clients may have difficulty

acknowledging their behavior while using or may not see loss of jobs or

relationships as connected to the substance use.

Self Concept

 Clients generally have low self-esteem, which they may express directly or

cover with grandiose behavior.

 They often have difficulty identifying and expressing true feelings; in the past,

they have preferred to escape feelings and to avoid any personal pain or

difficulty with the help of the substance.

Roles & Relationships

 Absenteeism and poor work performance are common

 Relationships in the family often are strained.

 Clients may be angry with family members who were instrumental in bringing

them to treatment or who threatened loss of a significant relationship.

Physiologic Considerations
 Many clients have a history of poor nutrition (using rather than eating) and

sleep disturbances that persist beyond detoxification.

 They may have liver damage from drinking alcohol, hepatitis or HIV infection

from intravenous drug use, or lung or neurologic damage from using inhalants.

Data Analysis

 Imbalanced Nutrition: Less Than Body Requirements

 Risk for Infection

 Risk for Injury

 Diarrhea

 Excess Fluid Volume

 Activity Intolerance

 Self-Care Deficits

 Ineffective Denial

 Ineffective Role Performance

 Dysfunctional Family Processes: Alcoholism

 Ineffective Coping

Outcome Identification

 The client will abstain from alcohol and drug use.

 The client will express feelings openly and directly.

  The client will verbalize acceptance of responsibility for his or her own

behavior.

 The client will practice nonchemical alternatives to deal with stress or difficult

situations.

 The client will establish an effective after-care plan.

Intervention

 Health teaching for the client and family.

 Dispel myths surrounding substance abuse:

“It’s a matter of will power.”

“I can’t be an alcoholic if I only drink beer or if I only drink on weekends.”

“I can learn to use drugs socially.”

“I’m okay now; I could handle using once in a while.”

 Decrease codependent behaviors among family members

Codependence is a maladaptive coping pattern on the part of family members or

others that results from a prolonged relationship with the person who uses substances.

One type of codependent behavior is called enabling, which is a behavior that seems

helpful on the surface but actually perpetuates the substance use.

 Make appropriate referrals for family members

 Promote coping skills

 Role-play potentially difficult situations

  Focus on the here-and-now with clients

 Set realistic goals such as staying sober today

Client/Family Education

 Substance abuse is an illness.

 Dispel myths about substance abuse.

 Abstinence from substances is not a matter of willpower.

 Any alcohol, whether beer, wine, or liquor, can be an abused substance.

 Prescribed medication can be an abused substance.

 Feedback from family about relapse signs, e.g., a return to previous

maladaptive coping mechanisms, is vital.

 Continued participation in an after-care program is important.

Evaluation

 The effectiveness of substance abuse treatment is based heavily on the client’s

abstinence from substances. In addition, successful treatment should result in

more stable role performance, improved interpersonal relationships, and

increased satisfaction with quality of life.