Chapter 19: Substance-Related & Addictive Disorders

Substance-Related & Addictive Disorders begins by defining addiction not as a moral failing, but as a chronic, relapsing brain disease characterized by compulsive drug-seeking behavior despite harmful consequences, driven by dysregulation in the brain’s reward circuit and neurotransmitters like dopamine. The text navigates the shift in diagnostic terminology within the DSM-5, moving away from stigmatizing language like abuse and dependence toward a spectrum-based diagnosis of substance use disorder (SUD). A significant portion of the content is dedicated to the neurobiological underpinnings of addiction, explaining how psychoactive substances hijack the limbic system to create intense euphoria and how chronic exposure leads to tolerance and withdrawal through neuroadaptation. The chapter details the clinical presentation, medical complications, and specific withdrawal syndromes associated with major drug classes, including central nervous system depressants like alcohol, sedatives, and benzodiazepines, as well as CNS stimulants such as cocaine, methamphetamines, and nicotine. Special attention is given to the opioid epidemic, outlining the lethal triad of overdose symptoms—pinpoint pupils, respiratory depression, and coma—and the life-saving role of antagonists like naloxone. The discussion extends to hallucinogens, cannabis, inhalants, and emerging designer drugs like synthetic cathinones and club drugs. The text also emphasizes the importance of holistic assessment using screening tools like CAGE and CIWA-Ar, while addressing the psychological defense mechanisms of denial, minimization, and rationalization often seen in patients. Furthermore, it covers evidence-based interventions including Medication-Assisted Treatment (MAT) utilizing methadone, buprenorphine, and naltrexone, alongside psychotherapeutic modalities like Cognitive Behavioral Therapy (CBT), Motivational Interviewing, and the Transtheoretical Model of Change. The chapter concludes by exploring the recovery model, the vital role of family support in addressing codependency and enabling behaviors via groups like Al-Anon, and the ethical responsibilities of nurses in recognizing and reporting impaired practice among colleagues to ensure patient safety and professional rehabilitation.