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Mental Health - Addictions


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- result of a complex interaction of factors with no distinct single cause
- it is not the result of a character flaw, personal choice or weakness
- also called DEPENDENCE

Influencing Factors of Addictions:
- genetics
- brain physiology
- physical/mental illness
- complex trauma
- stress
- street culture
- Hx of abuse
- social determinants of health (ex. homelessness, unemployment, and poverty)

2 Types of Addictions:
1. Psychological: needs substance to function or feel normal (ex. cocaine)
2. Physical: needs more of drug to get same effect.
- When drug is stopped, withdrawal can occur (ex. Oxycotin and Heroin)

*psychological can be just as serious as physical (ex. cocaine)
*Negative life consequences often result

Path to Addiction:
1. Experimenting
2. Repetitive Use
3. Result

Why is addiction a chronic, relapsing condition?
1. Drug use becomes INVOLUNTARY behaviour
2. Drugs of abuse produce CHANGES in BRAIN PHYSIOLOGY that endure long after the use has stopped
3. ENVIRONMENTAL cues and triggers
4. Loss of SUPPORT & COPING mechanisms

Barriers to Service:
- fear of being judged
- long wait times
- being female (especially if kids involved)
- transportation and housing
- literacy issues
- wanting to keep anonymity
- easier to continue using than facing reality and raw emotions

Harm Reduction Model:
- meeting clients where they are in life
- No moral judgment is made to condemn or support their use
- reality check: substance MISUSE WILL CONTINUE in society
***- Focuses on DECREASING the NEGATIVE CONSEQUENCES of drug use
**- Abstinence is not rejected but it is NOT the sole long term goal!
- these individuals are often MARGINALIZED and EXPLOITED (at highest risk for drug related harm)

Key Principles of Harm Reduction:
1. Individuals set their OWN PACE for change
2. ANY MOVE toward reducing harm is seen as POSITIVE
3. Attainable, SHORT-TERM GOALS are stressed more than long-term, complex goals

- needle exchange screening
- counseling
- moderate use guidelines
- methadone maintenance
- designated driver
- HIV and STD
- safer using practices
- nicotine gum or patch
- treatment

Mental Health and Addictions
- very strong link between the 2
- similar risk factors for development of addiction and a mental health disorder (ex. childhood neglect)
- substance use may increase risk of mental illness (ex. consequences from substance use may lead to depression)
- person with mental illness may use substances to cope with symptoms
(ex. tetrahydrocannabinol and psychosis; alcohol and anxiety)
- treatment depends on the diagnosis
- 50-80% of those with addictions also have a mental health issue
- RESILIENCY MODEL: why some people are more prone to mental health & addictions than other (ex. protective factors such as good support and adequate finances vs. risk factors)

Stages of Change Model:
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance (stable behaviour)
6. Relapse
- commonly used in assessing readiness to make changes
- relapse can happen at any point in recovery [a person with addictions is never fully recovered]
- motivational interviewing: good tool used in moving from one stage to the next

Pregnancy in Addictions:
- can evoke strong feelings
- pregnant women should be prioritized and bypass wait lists whenever possible
- Detoxification (withdrawal management) should be medically managed
- fear of CTFS (child youth and family services)
- ***OPIOIDS should NOT be STOPPED in pregnancy!
- not all pregnant clients will stop using

Alcohol Addiction
- CAGE Questionniare:
- 5 drinks at a time for MALES
- 4 drinks at a time for FEMALES
- 31% of Canadians reported drinking once/week or more
- 9.4% reported HEAVY frequent drinking

Alcohol and Nursing Implications:
- Alcohol withdrawal can be life threatening!
Nursing Care:
- monitor V/S
- ask about CURRENT/PAST USE
- history of SEIZURE activity
- Delirium Tremens (DT): medical condition of uncontrolled shaking, typically due to alcohol or drug withdrawal
- implement withdrawal protocols

- extreme high lasts 5-15 MINUTES
- DOPAMINE levels INCREASE in brain --> PLEASURE
- price dropping (more people can afford it as economy improves)
- snorting, injecting, smoking
- powered form vs. crack
- Recovery Centre reports increase over past 3-4 years in NL

Nursing Implications for COCAINE users:
- risk for CARDIAC complications
- snorting, sharing pipes and injecting drug user (IDU) - all risks for HEP C/HIV
- cut with many things (skin infections, blown veins, endocarditis)
- may combine with "DOWNERS" to come off the high (ex. Oxycotin, ecstasy, ritalin, and other stimulants)
- CRASH PHASE vs. PHYSICAL WITHDRAWAL (Depression, cravings, high risk of relapse)

- all NATURAL & SYNTHETIC narcotics
- act on OPIATE receptors in the brain: signal release of DOPAMINE and release ENDORPHINS
- highly addictive painkillers
- produces a sense of EUPHORIA
1. Oxycontin (MOST COMMON in NL)
- $80 for 80 Oxy - sometimes use up to 10 per day
2. Morphine
3. Dilaudid
4. Percocet
5. Codeine
6. Heroin - not seen in NL
7. Methadone

Opioid Withdrawal "Worst flu times ten"
- diarrhea
- muscle pain
- sweats
- insomnia
- dilated pupils
- yawning
- tearing of eyes
- runny nose
- goosebumps

- withdrawal is NOT life threatening but REALLY uncomfortable
- usually severe withdrawals that people continue to use
- degree of withdrawal depends on how LONG the use, the TYPE of opioids and INDIVIDUAL response
- withdrawal typically takes 5-10 days with the peak at between days 3-5
- Methadone Maintenance Therapy (MMT) may be an option

- Methadone Maintenance Therapy (MMT)
- comes from Harm Reduction philosophy
- originated from WWII Germany
- long acting opioid 24-36 hour half life
How it works:
- blocks HIGH of other opioids
- reduced or eliminates opioid cravings
- if taken as prescribed, prevents withdrawal
- in NL now for 5 years
- strict federal regulations
- can be fatal if ingested by a non tolerant person [looks like orange juice; can kill a child]
- nurse administering to inpatient should ALWAYS make sure it is swallowed
- program should follow Health Canada's Best Practices for MMT
- interdisciplinary team approach
- access to other services (health, individual counselling, and links with community agencies)

- prescribed for anxiety & sleep
1. Ativan
2. Valium
3. Temazepam
- some self medicate for anxiety/sleep (may be safer options such as SSRI's)
- tolerance can develop over time
- easily bought on the street
- often combined with ALCOHOL or others (ex. Oxycontin or Cocaine)
- abrupt cessation after long term use can cause withdrawal (sometimes seizures)
- may require a tapering dose to be safe (Dr. may be reluctant to do this as trust may be lost)

- frequently used/misused
- hard to get in NL (price is up) - easier to get cocaine
- impairs judgment
- mild euphoria
- linked to early psychosis
- debate whether tetrahydrocannabinol (THC) exacerbates psychosis or THC causes it

Withdrawal symptoms of Marijuana (Cannabis):
1. Amotivational syndrome
2. Irritability and mood swings
3. Usually don't require inpatient detox

Other Substances
- common on the street from diverted prescriptions
- similar to cocaine (stimulant)

- not readily seen much here
- highly addictive, long term treatment

- experimented/used by YOUTH more
- PARTY drug, can cause CARDIAC problems as well as TEMPERATURE imbalance (OVERHEATING)

Polysubstance Use:
- reality in many substance abusers
- often combine UPPERS & DOWNERS to balance
- order of treatment withdrawal according to risks:
1. Alcohol/Barbiturates: monitor V/S [barbiturates are hardly ever abused]
2. Benzodiazepines - V/S (risk for seizures)
3. Opiates - withdrawals (overdose risk) - monitor V/S and level of consciousness
4. Cocaine & other stimulants - EKG, nutrition

Risks associated with:
- combining CNS depressants (increases risk of OVERDOSE)
- combining stimulants (increases risk of cardiac arrest)

Treatment Options:
- is the person wanting treatment? If so, depends on their needs and the substance [cannot force treatment]
- withdrawal management (detox) may be needed first
- often referred to Addiction Services
- Inpatient, outpatient, in-city (Recovery Centre), in-province (Humberwood - 3 weeks inpatient), out-of-province (Bellwood, Portage), etc.
- self-help
- prisons sometimes have options, more so federally...bigger picture is in PREVENTING incarcerations

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