SEDATIVE-, HYPNOTIC-, OR ANXIOLYTIC-INDUCED DISORDERS
292,89 Sedative, hypnotic, or anxiolytic intoxication
292.0 Sedative, hypnotic, or anxiolytic withdrawal
292.81 Intoxication delirium
292. 84 Induced mood disorder
292.89 Opioid intoxication
292.81 Intoxication delirium
292.0 Opioid withdrawal
(For further listings, consult DSM-IV.)
CNS depressants are drugs that slow down the central nervous system. They are usually divided into four types: barbiturates, antianxiety agents, sedative-hypnotics, and narcotics (opioids such as morphine, heroin).
CNS depressants prescribed for symptoms of anxiety, depression, and sleep disturbances are among the most widely used and abused drugs. These drugs are very likely to be abused when the underlying conditions remain untreated. Sometimes these drugs are used in conjunction with stimulants, with the user developing a pattern of taking a stimulant to be “up,” then needing the depressant drug to “come down.”
Several principles apply to all CNS depressants: (1) The effects are interactive and cumulative with one another and with the behavioral state of the user; (2) there is no specific antagonist that will block the action of these drugs; (3) low doses produce an initial excitatory response; (4) they are capable of producing physiological and psychological dependency; and (5) cross-tolerance and cross-dependence may exist between various CNS depressants. Although the margin of safety of these drugs is great, they have a characteristic syndrome of withdrawal that can be very severe.
This plan of care addresses acute intoxication/withdrawal and is to be used in conjunction with CP: Substance Dependence/Abuse Rehabilitation.
Individuals who abuse substances fail to complete tasks of separation-individuation, resulting in underdeveloped egos. The person has a highly dependent nature, with characteristics of poor impulse control, low frustration tolerance, and low self-esteem. The superego is weak, resulting in absence of guilt feelings. Underlying psychiatric status must be assessed, as these individuals may use stimulants for varying self-medication reasons.
Psychostructural factors (e.g., personality) are seen as significant. The defect is believed to precede the addiction, with the ego structure breaking down and the substance being used as a maladaptive coping mechanism. Characteristics that have been identified include impulsivity, negative self-concept, weak ego, low social conformity, neuroticism, and introversion.
A genetic link is thought to be involved in the development of substance use disorders. Although statistics are currently inconclusive, hereditary factors are generally accepted to be a factor in the abuse of substances.
There is an apparent predisposition to substance abuse disorders in the dysfunctional family system. Factors such as the absence of a parent or a parent who is an overpowering tyrant or weak and ineffectual, and the use of substances as the primary method of relieving stress, appear to contribute to this dysfunction. These role models have a negative influence, and the child learns to handle stress in like manner. However, parents may be average, normal individuals with children who succumb to overwhelming peer pressure and become involved with drugs. Cultural factors such as acceptance of the use of alcohol and other drugs may also influence the individual’s choice.
CLIENT ASSESSMENT DATA BASE
Data depend on stage of withdrawal and concurrent use of alcohol/other drugs.
Interference with sleep pattern, insomnia (withdrawal)
Lethargy, drowsiness, somnolence
Pulse usually slowed; tachycardia (suggests withdrawal syndrome); irregular pulse (atrial fibrillation, ventricular dysrhythmias)
Substance use for stress management
Feelings of helplessness, hopelessness, powerlessness
Underdeveloped ego; highly dependent nature, with characteristics of poor impulse control, low frustration tolerance, and low self-esteem
Weak superego, with absence of guilt feelings
Psychostructural factors (e.g., personality) are seen as significant with substance use/abuse (maladaptive coping mechanisms)
Diarrhea, occasionally constipation
Mental Status: Confusion, concentration, and memory problems; impaired judgment with some affective change; alterations in consciousness may exist, from extreme agitation to coma; slurred speech
Behavior: Mood swings, lack of motivation, aggression, combativeness (related to general “disinhibiting” effect of the drug, loss of impulse control), dysphoric mood (withdrawal)
Temporary psychosis with acute onset of auditory hallucinations and paranoid delusions (unexplained neuropsychiatric presentation may be indicative of drug use)
Psychomotor activity may be increased
Hypersensitivity (e.g., anxiety, tremors, hypotension, irritability, restlessness, and seizure activity)
Pupils small/pinpoint constriction (opiates), dilated (barbiturates); reaction to light slowed; horizontal gaze, nystagmus, lack of convergence
Gait unsteady/staggering, loss of coordination, positive Romberg’s sign
Headache, abdominal pain/severe cramping
Deep muscle/bone pain (methadone abusers)
Continuous rhinorrhea, excessive lacrimation, sneezing
Respiratory depression (overdose)
Increased respiratory rate (withdrawal syndrome)
Hot/cold flashes; diaphoresis
Thermoregulation instability with hyperpyrexia, hypothermia possible
Skin: Piloerection (“gooseflesh”); puncture wounds on arms, hands, legs, under tongue, indicating injection drug use
Dysfunctional family of origin system
Dysfunctional patterns of interaction with family/others
Preexisting physical/psychological conditions
Family history of substance use/abuse
History of chronic condition/disease process
Concurrent use of other drugs, including alcohol
Drug Screen: Identifies drug(s) being used.
STD Screening: To determine presence of HIV, hepatitis B, etc.
Other Screening Studies: Depend on general condition, individual risk factors, and care setting.
Addiction Severity Index (ASI): Produces a problem-severity profile, which indicates areas of treatment needs.
1. Achieve physiological stability.
2. Protect client from injury.
3. Provide appropriate referral and follow-up.
4. Promote family involvement in the withdrawal/rehabilitation process.
1. Homeostasis achieved.
2. Complications prevented/resolved.
3. Abstinence from drug(s) initiated/maintained on a day-to-day basis.
4. Attends rehabilitation program, group therapy (e.g., Narcotics Anonymous).
5. Plan in place to meet needs after discharge.