1-

5.Complementary
And Alternative
Therapies
8.DRUGS In
Substance Use
Disorder
LORIE ANN S. BALILI RN, CNN, MAN
 Commonly
Used Herbal
Remedies
Herbs- is any plant that us used
for culinary or medical
purposes.
Phytomedicine- the basis of
therapeutic value of plants
pressure
 @* Commonly used Herbal Remedies
. . _ Used to treat postoperative, pregnancy-related, and chemotherapy related
Ginger (Zingiber officinale) eae i aa a
nausea as well as motion sickness and diarrhea.
Provide relief of pain, swelling, and stiffness of both osteoarthritis and
rheumatoid arthritis. Side effects: gas, bloating, heartburn and nausea

Gingko (Gingko biloba) Use to treat asthma, bronchitis, fatigue and tinnitus, it recent time it is used to
improve memory, prevent Alzheimer disease and other dementia, sexual
dysfunction and multiple sclerosis.
Side effects: headache, nausea, GI upset, dizziness and allergic reactions that
include severe reactions leading to death.
In patients taking blood thinners it has been shown to increase bleeding risk.

Ginseng (Panax ginseng) Boost immune system, increase person’s well being, and increase stamina,
used to treat erectile dysfunction, hepatitis C, and menopausal
symptoms_andto lower glucose and blood pressure. Patient
diabetes should used caution especially if used in conjunction
other herbs or drugs because hypoglycemia may result.
 @* Commonly used Herbal Remedies
Green tea (Camellia sinensis) Improve mental alertness, relieve headaches, protect against heart disease
and cancer, and promote weight loss. Patient with liver disease should
not use the product.

Peppermint (Mentha Used to treat a wide variety of ailments from nausea, indigestions, and irritable
piperita) bowel syndrome to cold symptoms, headaches and muscle and nerve pain.
Side effects: possible allergic reaction and heartburn.

Tumeric (Curcuma longa) Used for heartburn, stomach ulcers, gallstones, inflammation, and cancer.
High doses may cause nausea or diarrhea. Persons with gallbladder disease
should avoid the herb because it may worsen condition.
of
Substance use
Disorder
 SUBSTANCE USE DISORDER
POLYDRUG Used more than one
USE drug
Cognitive development at the time drugs are introduced
plays a major role.
Adolescents are in a period of brain development where they are especially vulnerable to
stress and risk-seeking behavior.
Other factors related to substance use disorder:
1. Family-related risk factors: between 16% and 29% of children who suffer neglect or
abuse-physical, sexual, and emotional have tried or use drugs.
2. Social risk factors: deviant peer relationships (i.e the adolescent associates with the
abuser s and uses drugs to feel accepted), Peer pressure, popularity , and bullying have
all been correlated to drug use. Gang affiliation is associated with higher drug use and
deliquent behavior.
3. Individual risk factors: individual with attention-deficit/ hyperactivity disoder (ADHD)
are three times as likely as the general population to use drugs such as nicotine,
alcohol, and drugs other than cannabis; Depression is associated with alcohol use,
 Substance use disorder
- Occurs “when the recurrent use of alcohol and/or drugs causes
clinically and functionally significant impairment such as
health problems, disability, and failure to meet major
Neurobiology
responsibilities at work, school, or home.”
 Drugs that are misused typically increase the availability of
dopamine and other neurotransmitters in the limbic system of
the brain.
 Reward circuit a structure that regulates our ability to feel
pleasure and other emotions, both positive and negative.
 The drug interfere with the way neurons in the brain normally
send, received, and process information by mimicking the
brain own neurotransmitters; however, drugs do not copy
neurotransmitters exactly, which results in faulty transmission
or excessive stimulation.
 Most of the drugs facilitates transmission of dopamine in the
Some drugs increase the availability of other neurotransmitter, such as
serotonin and gamma-aminobutyric acid (GABA), but the dopamine’s
effect on the reward system appears to be pivotal to substance use
disorder.
Repeated use of drugs remodels the neural circuitry of the brain cells
and reduces the responsiveness of receptors. This decreased the
responsiveness leads to tolerance.
The need for a larger dose of a drug to obtain the original euphoria.
Drug use results in levels of dopamine that do not naturally occur;
tolerance also reduces the sense of pleasure from experiences that
previously resulted in positive feelings such as food, sex, or
relationships. Without drugs, the individual may experience depression,
anxiety, and/or irritability.
Nonpharmacological Therapy for Substance Use Disorders: Individual And Group
Counseling
Therapy Description
Cognitive behavioral therapy CBT teaches people to recognize and stop negative patterns of thinking and
behavior and helps enhance self-control.
For instance, therapy might help a person become aware of the stressors,
situations, and feelings that lead to substance use so that the person can
avoid them or act differently when they occur.

Contingency management This approach is based on frequent monitoring of behavior and removal of
rewards for drug use and was designed to provide incentives to reinforce
positive behavior and help the person remain abstinent from drug use.

Motivational enhancement MET helps people with substance use disorders develop internally motivated
therapy changes and commit t specific plans to engage in treatment and seek
recovery. It is often used early in the process to engage people in treatment.

Twelve-step facilitation therapy Seeks to guide and support engagement in 12 steps programs such as
alcoholics anonymous or narcotics anonymous.
 Terminology Related to Substance Use Disorder
Term Definition
Abstinence Refraining from drug use
Craving Strong desire for a drug or for the intoxicating effects of that drug
Intoxication A condition that results in disturbance in the level of consciousness, cognition, perception, judgment, affect or behavior, or
other psychological functions and responses.

Stabilization Acute treatment for substance use disorder involving supervision, observation, support, intensive education and counseling
that involves multidisciplinary treatment interventions

Tolerance Requiring a significantly increased amount of a drug to achieve the desired effect

Withdrawal syndrome A group if symptoms of varying severity that occur upon cessation or reduction of use of a drug that has been taken
repeatedly, usually for a prolonged period and/or in high doses; may be accompanied by signs of physiologic disturbances.

Remission None of the 11 criteria for substance use disorder for at least 3 months (early remission, 3-13 months; sustained remission,
after 12 months)
Controlled environment Environment where access to any drug is restricted (e.g treatment center or halfway house)

Impaired control Diminished ability of an individual to control his or her use of a drug in terms of onset, level or termination

Social impairment Recurrent drug use despite problems at work or school, interpersonal problems, or the cessation of social and recreational
activities.
Risky use Recurrent drug use despite the difficulty it is causing (e.g driving while intoxicated, liver damage)

Recovery A process of change through which an individual improves health and wellness, lives a self-directed life, and strive to reach
full potentials.
Relapse A return to drug use after a period of abstinence often accompanied by reinstatement of substance use disorder.
 Types of substance use Disrorder
ALCOHOL USE
01 DISORDER 05 OTHER SUBSTANCE USE
DISORDER:
02 CANNABIS DISORDER 1. Cough and colds
products
2. Anabolic-androgenic
03 OPIOID DISORDER steroids

04 TOBACCO DISORDER
 Types of substance
ALCOHOL USE use Disrorder
01 DISORDER
Inhibits the effects if GABA, thereby
reducing neurotransmission in the
brain. Short-term effects of alcohol Increase the chance of dying from
use include nausea, vomiting, automobile accidents, homicide, and
headaches, slurred speech impaired suicide.
judgement, memory loss, hangovers, Spouses and children of person with
and black outs. AUD may face family violence, and
Long term problems associated with children may suffer physical and sexual
heavy drinking includes stomach abuse and neglect and may develop
ailments, heart problems, cancer, psychologcical problems.
brain damage, serious memory loss,
immune system compromise and
liver cirrhosis.
 Treatment for AUD
1. Disulfiram- inhibits aldehyde dehydrogenase, the enzyme that involved in metabolizing alcohol.
Used in people who are newly abstinent.
Administered in tablet form dosage ranges from 125 to 500 mg daily.
Should not be taken 12 within 12 hours of alcohol consumption (including mouth wash, cough
medicine or eating desserts that containing alcohol or eating foods cooked in alcohol. Should never be
used in combination with eliglustat and ritonavir.

2. acamprosate-is a GABA analogue thought to work in the brain to restore the balance between
neuronal excitation and inhibition via GABA and glutamate. It should only be used in persons who are
abstinent; may be continued through relapse. Usual dosing is 666 mg orally three times per day.
Dosing adjusted in kidney disease, and serum creatinine level should be obtained at baseline.
Common side effects: includes pain, loss of appetite nausea, diarrhea, dizziness, anxiety, pruritus,
depression, insomnia.
Patient should be assessed for suicidal ideation before beginning treatment.

3. Naltrexone- is a competitive opioid antagonist with a high affinity for mu receptors. Oral form absorbed
through the GI tract undergo up to 40% first pass metabolism. A naloxone challenge test may be done
before initiating treatment and the patient is observed for an hour. If no withdrawal is observed, dosing may
begin the next day at 50 mg per day for 12 weeks or less.
 Types of substance use Disrorder
02 CANNABIS DISORDER Cannabis contains more than 60 related
Is the most commonly used psychoactive chemicals known as
recreational drug in the US. Cannabinoids; the most abundant of
Cannabis use disorder is more these is delta-9-tetrahydrocannabinol
common among people in their late (THC) smoked, THC rapidly crosses the
When
teens and early 20s. blood brain barrier and binds to
Users report feeling an alteration in cannabinoid receptors in many areas of
their senses and an altered sense of the brain, overwhelming the
time as well as changes in mood. endocannabinoid system and making it
Other names: Marijuana, blunt, Bud, difficult for the user to respond
Dope, Ganja, Grass, Green, Herb, appropriately to incoming stimuli.
joint, Mary jane, Pot, Reefer, Cannabis increases heart rate and may
Sinsemilla, Skunk, Smoke, trees and cause hallucination, it can cause problem
weeds. with balance and coordination and
learning ability.
 Treatment for Cannabis
Long term use of cannabis is associated with chronic cough, frequent respiratory
infections and exposure to cancer causing compounds because the smoke has
many of the same irritating and lung damaging properties as tobacco.
The drug has been linked to mental health problems and increased symptoms in
persons with schizophrenia. Babies born to women who use cannabis have
behavioral issues and problems with attention, memory and problem solving.

Many have supported the nationwide legalization of cannabis to treat medical

condition; however, rigorous scientific evidence show that the benefits of cannabis
outweigh its health risks is limited and does not support approval.

Cognitive behavior therapy (CBT) contingency management and Motivational

enhancement therapy (MET) may be effective in the treatment of cannabis use
disorder; however, no medication are currently approved or indicated for this use.
 OPIOID USE
03 DISORDER
Are controlled substances legally prescribed to treat moderate to severe
pain. These drugs interact with opioid receptors in the brain and nervous
system to reduce pain. In addition to reducing pain, this receptor
inteaction floods the brain’s reward system with dopamine, producing a
sense of euphoria and tranquility.

Short term effects of opioid use include drowsiness, mental confusion,

nausea, constipation, and dose-dependent respiratory depression. When
taken with alcohol, users may experience dangerous slowing of heart
rate and breathing leading to coma or death.
Prescription opioids are also known by numerous street names including
vikes, cody, china white, fizzies, M, Demmies, Blue heavens, Juice,
Smack, Hillbilly, Heroin and Roxy.
The FDA has toughened the safety warnings on opioids including
1. Treatment
Naloxone- is thefor
drugOpioid
of choice in the treatment of
respiratory depression associated with opioid overdose. Is a
disorder
short-acting opioid antagonist that competitively attaches to
opioid receptors in the CNS, thereby blocking activation by
opioid drugs.
2. Methadone- since 1950s this has been prescribed to treat
person’s with OUD. When taken as prescribed and combined
with couseling and behavioral therapies, administration of this
long acting opioid drug is safe and effective. Methadone works
by changing the way a person’s brain respond to pain; it is an
opioid receptor agonist at the mu receptor and an antagonist
at the N-methyl-D- aspartate (NMDA) receptor. Taken daily, it
blocks the sense of euphoria and tranquility caused by opioid
use and prevents opioid withdrawal craving.
 0
4 Tobacco use
disorder
When smoked, nicotine is absorbed from the lungs into the pulmonary venous
circulation. It then enters the arterial circulation and moves quickly to the brain.
Once across the blood brain barrier, nicotine stimulates the release of dopamine,
norepinephrine, GABA, glutamate, and endorphins, resulting in stimulation and
pleasure and a reduction in stress and anxiety. These sensations fuel the brain’s
reward circuit.
Treatment for TUD
Quitting is difficult. Persons attempting to quit experience irritability, anger, anxiousness,
difficulty thinking, cravings, and increased in hunger.
Support is very important part of the process and is often combined with pharmacologic
measures.
CBT is a goal-directed and problem-focused therapy designed to help the person with
TUD identify negative thought patterns and inaccurate beliefs to learn new ways of
coping and develop new ways of thinking.

1. Nicotine replacement drugs-sold as a gum , patch, spray, inhaler, or lozenge-mimic the

nicotine effects of tobacco by binding to nicotine receptors in the CNS
 Treatment for TUD
2. Bupropion-an antidepressant drug , increases level of dopamine and
norepinephrine in the brain, mimicking the effects of nicotine. It is also
has some neuronal nicotinic receptor-blocking activity, reducing
reinforcement from the brain’s reward circuit. When used for smoking
cessation, the dosage is 150 mg ER or once daily for 3 days. Treatment
should continue for 7 to 12 weeks; however, ongoing treatment for a year
has shown benefit.

3. Vernicline- is a partial alpha-4-beta-2 receptor agonist that stimulates

dopamine activty in the brain but not to the extent of nicotine, thereby
reducing craving and withdrawal. Dosing begins 1 week before an
identified quit date at 0.5 mg daily for 3 days.
 Other substance
Cough and cold
use disorder
products
1. Dextromethorpan- ana antitussive that can be purchase without a
prescription. Using DXM is known on the street as “robotripping” or
“skittling”. When taken in higher-than recommended amounts, users
may experience euphoria, dissociative effects, or hallucination.
2. Promethazine-codeine cough syrup- can result in relaxation and euphoria
when taken in higher that recommended amounts; when combined with
Anabolic-androgenic
soda it is referred to as syrup, sizzurp, purple drank, Barre, or lean.
steroids
Is synthetic agent used to treat conditions caused by low levels of
testosterone in the body, such as delayed puberty, hypogonadism,
and cachexia related to chronic disease drugs.
This have used to enhance athletic and sexual performances and
physical appearance in all age groups.
Short term effects of AAS use include headache
acne, fluid retention in the hands and feet, oily skin,
yellowing of the skin and whites of the eyes,
aggression, extreme mood swings, anger, paranoid
jealousy, extreme irritability, delusions, impaired
judgement, and infection at the injection site.

Withdrawal from AAS use may lead to mood swings,

fatigue, restlessness, loss of appetite and decrease
sex drive.

Nurses must be alert when caring for persons

withdrawing from AAS use because withdrawal may
cause depression lasting up to a year, which can
result in suicide attempts.
 Special Needs Of Patients With Substance
Surgical Use Disorder
patients Pain management

Respiratory changes in persons When patients experience pain, the

with TUD make introduction of goal is to treat the pain.
endotracheal and suction tubes Addressing substance use disorder is
more difficult and increase the risk not a priority when a patient is in
for postoperative respiratory pain.
problems.
Nurses should be laert for signs and When patient acknowledge
symptoms of drug interactions with substance use disorder, it is
pain medication or anesthesia and importantn to determine which drug
for signs of withdrawal is used and the amount taken each
day.
 The Nurse With Substance Use
Contributing
factor Disorder
Characteristics Management
Identified as job stress, the Signs and symptoms Nurses may enter
emotional demands of of substance use nondisciplinary
nursing, long hours and shift disorder programs designed for
rotations, and easy access discrepancies in evaluation and
to drugs. controlled- drug treatment, allowing
Nurses internalize their handling and records nurses to maintain their
may indicate drug Itlicences.
is important for nurses to
feelings tom stay in control
during the crisis and have diversion, the identify pateints who
deliberate redirecting misuse drugs and to
little to no time to
of a drug from a intervene. Knowledge of
decompress.
Nurses take care of patient or facility to the most commly used
others before the employee for drugs and their treatment
themselves personal use. is critical to sustained
remision and promotion of
Avoid drugs
value health
 Thank
you for
listening
Icon pack
Alternative resources
E-Books: Resources
● Burchun and Rosenthal (2019). Lehne’s ● Online Journals:
pharmacology for nursing care. 10th Edition. St.
● https://www.reliasmedia.com/articles/44548-joint-
Louis, Missouri: Elsevier.
commission-ids-five-high-alert-meds
● Edmund, M.W (2016). Introduction to Clinical
● https://www.registerednursing.org/nclex/dosage-c
Pharmacology 8th ed. St. Louis, Missouri: Elsevier. alculations/
● Ford, S.M. (2018). Roach’s Introductory: Clinical
pharmacology. 11th Edition. Philadelphia, ● https://parents-life.com/teratogens-in-pregnancy/
Pennsylvania: Wolters Kluwer.
● https://www.ismp.org/sites/default/files/attachme
● Hayes, Kee, and McCuistion (2015). Pharmacology: nts/2018-08/highAlert2018-Acute-Final.pdf
a patient-centered nursing process approach. 8 th
Edition. St, Louis, Missouri: Saunders, Elsevier.
● Hodgson and Kisior (2019). Saunders nursing drug
handbook 2019. 27th Edition. St. Louis, Missouri:
Elsevier.
● Lapham, R. (2016). Drug calculations for nurses: A
Step-by-step approach. 4 th Edition. Boca Raton,
Florida: CRC Press