SUBSTANCE ABUSE UPDATE 2007 Nurses Research Publication Nurses Research Publications, PO Box 480, Hayward, CA 94543 Copyright 8 2007, 4th edition, All Rights Reserved ALL RIGHTS RESERVED. No part of this material may be reprinted, reproduced, transmitted, stored in a retrieval system, or otherwise utilized, in any form or by any means electronic or mechanical, including photocopying or recording, now existing or hereinafter invented, nor may any part of this course be copied and used for any other purpose without the written permission from the publisher and author. For low-cost copies, contact Taylor College, Reprint Division. This course is presented by: Nurses Research Publications P.O. Box 480 Hayward, CA 94543 Phone: 510-888-9070 FAX: 510-537-3434 Email: [email protected] Notice and Disclaimers: Medicine and Nursing are ever-changing sciences. As new information is gained, changes in treatments and drug therapies are required. The author(s), editor, and publisher of this text have used every possible reliable source in order to verify information in this text, to be sure that the information is accurate and the most current and acceptable information available at the time of publication. However, due to human error and/or changes in medical science, neither the editors nor publishers nor any other parties involved in the preparation or publication of this text, warrant that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, and in particular, readers should check the product information sheet for any drugs mentioned in this text that you plan to administer. This course is designed to provide nursing professionals with general information to assist in their practices and professional development. The information provided in this course is based on research and consultation with medical and nursing authorities, and is, to the best of our knowledge, current and accurate. However, this course is offered with the understanding that Taylor College is not engaged in rendering legal, nursing, or other professional advice. This course is not a substitute for seeking professional advice or conducting individual research. In applying the information provided in this course to individual circumstances, all recommendations must be considered in light of the unique circumstances of each situation. This course book is intended solely for individual use, and not for the benefit of providing advice or recommendations to third parties. Taylor College disclaims any responsibility for any adverse consequences resulting from the failure to seek medical, nursing, or other professional advice, or to conduct independent research. Taylor College further disclaims any responsibility for updating or revising any programs or publications presented, published, distributed or sponsored by Taylor College unless otherwise agreed to as part of an individual purchase contract. 2 TABLE OF CONTENTS Page Title Page.............................................................................................................1 Notices.................................................................................................................2 Table of Contents................................................................................................3 Course Outline ....................................................................................................4 Course Objectives ..............................................................................................6 CHAPTER 1 .........................................................................................................9 CHAPTER 2 The Opioids...........................................................................25 CHAPTER 3 CNS Depressants: Alcohol .................................................40 CHAPTER 4 CNS Depressants: Sedatives-Hypnotics ............................64 CHAPTER 5 Marijuana...............................................................................73 CHAPTER 6 CNS Stimulants: Amphetamines, Cocaine .........................85 CHAPTER 7 The Hallucinogens..............................................................102 CHAPTER 8 The Inhalants: Solvents, Glues, Aerosols ........................114 CHAPTER 9 Designer Drugs ...................................................................119 CHAPTER 10 Other Abused Drugs...........................................................124 CHAPTER 11 Over-the-Counter Drugs.....................................................133 CHAPTER 12 Treating Diverse Populations ............................................141 CHAPTER 13 The Impaired Health Care Professional ............................160 REFERENCES ...............................................................................................168 Pretest / Posttest .....................................................See Separate Test Booklet 3 Course Outline Chapter 1 Introduction to Chemical Dependency (substance abuse) Progression of Dependence - Chronicity and Relapse Chapter 2 The Opioids History, Current Impact, and abuse potential Chapter 3 CNS Depressants: Alcohol History, Current Impact, and abuse potential Chapter 4 CNS Depressants: Sedatives-Hypnotics History, Current Impact, and abuse potential Chapter 5 Marijuana History, Current Impact, and abuse potential Chapter 6 CNS Stimulants: Amphetamines, Cocaine History, Current Impact, and abuse potential Chapter 7 The Hallucinogens History, Current Impact, and abuse potential Chapter 8 The Inhalants: Solvents, Glues, Aerosols History, Current Impact, and abuse potential Chapter 9 Designer Drugs History, Current Impact, and abuse potential Chapter 10 Other abused Drugs History, Current Impact, and abuse potential Chapter 11 Over-the-Counter Drugs History, Current Impact, and abuse potential 4 Chapter 12 Treating Diverse Populations Basic Treatment Concepts, Treatment Issues, Counseling Skills, Support Groups, Therapeutic Approaches, Aftercare and continuing care Chapter 13 Impaired Health Care Professionals Potential for substance abuse by health care professionals, extent of the problem, Prevention and treatment concepts, Involvement by state boards of nursing 5 Course Objectives (Behavioral objectives of the course) At the end of this course, each nurse will be able to: 1. Name and discuss the concept of substance abuse as a disease condition 2. Name and discuss the symptoms of each stage of substance abuse 3. Name and discuss the attitudes and behavior characteristics of denial accompanying substance abuse 4. Name and discuss the risk factors associated with developing substance abuse 5. Discuss the historical development of treatment of substance abuse 6. Discuss the characteristics of opioid abuse and the treatment methods used for this commonly abused substance 7. Discuss the characteristics of alcohol abuse and the treatment methods used for this commonly abused substance 8. Discuss the characteristics of sedative-hypnotic abuse and the treatment methods used for this commonly abused substance 9. Discuss the characteristics of marijuana abuse and the treatment methods used for this commonly abused substance 10. Discuss the characteristics of CNS stimulant abuse and the treatment methods used for this commonly abused substance 11. Discuss the characteristics of the abuse of the hallucinogens and the treatment methods used for these commonly abused substances 12. Discuss the characteristics of the abuse of inhalants and the treatment methods used for these commonly abused substances 13. Discuss the characteristics of Adesigner drugs@ abuse and the treatment methods used for this commonly abused substance 14. Discuss the characteristics of the abuse of over-the-counter drugs and the treatment methods used for these commonly abused substances 15. Name and discuss the two major types of treatment programs presented in this text 6 16. Name and discuss 3 of the treatment modalities presented in this text 17. Name and discuss at least 3 treatment considerations in relation to health care professionals who have substance abuse problems 7 This page has been left blank intentionally. 8 CHAPTER 1 Introduction to Chemical Dependency 9 Introduction In this chapter we will use the term "substance abuse" to refer to the abuse of all the addictive drugs, dangerous drugs, or any other substances. The term will be used interchangeably with the term Adrug abuse,@ although it could be argued that these terms are slightly different in meaning. The terms Adrug dependent,@ Adependence,@ and Aaddiction@ will also be used interchangeably, although these terms do also have slightly different meanings which will be discussed in the text. In this text, we will also use the masculine terms Ahim,@ Ahis,@ Amale,@ etc. Keep in mind that in certain places in the text, Ahe@ may be used to refer to all persons of both genders. We may use the masculine term only for simplicity instead of using Ahim and her; his/hers,@ etc. In this and subsequent chapters, we will present the history of substance abuse and how it became viewed as a disease entity. We will also discuss some of the common characteristics of addiction of various substances as well as many characteristics unique to certain chemicals of abuse. This text will also present select statistics of substance abuse as