Chapter 67: Addictions

Addiction represents a complex condition where individuals develop physiological and psychological dependence on substances as a maladaptive coping mechanism for underlying emotional or physical distress. The chapter details core addiction concepts including tolerance, which reflects the body's diminished response requiring escalating doses, and withdrawal, the constellation of symptoms emerging when substance levels decline in dependent individuals. Alcohol use disorder receives particular attention as a central nervous system depressant with severe long-term complications such as Wernicke's encephalopathy and Korsakoff's syndrome, alongside acute withdrawal emergencies like delirium tremens that demand immediate medical intervention. The chapter categorizes drug dependencies by their mechanism of action: central nervous system depressants including benzodiazepines and barbiturates that risk respiratory depression, stimulants like cocaine and amphetamines that precipitate cardiovascular crises, opioids characterized by respiratory depression and pinpoint pupils that respond to naloxone reversal, and hallucinogens including lysergic acid diethylamide and phencyclidine that produce persistent psychological effects. Essential nursing management focuses on establishing therapeutic relationships, implementing seizure precautions during acute withdrawal, maintaining low-stimulus environments, and setting firm behavioral limits while avoiding judgment. The chapter also addresses codependency patterns where significant others inadvertently reinforce addictive behaviors, dual diagnosis presentations where substance use disorders coexist with psychiatric conditions, and the identification of impaired healthcare professionals who require mandatory reporting to protect patient safety and institutional integrity. Understanding these distinctions enables nurses to provide appropriate crisis intervention, facilitate rehabilitation, and support long-term recovery outcomes across diverse addiction presentations.