Chapter 22: Substance-Related & Addictive Disorders

Chapter 22 offers an extensive examination of Substance-Related and Addictive Disorders (SUDs), defining them not as moral failings but as complex, chronic diseases of the brain marked by intense craving, seeking behavior, and use despite significant adverse outcomes. The text establishes foundational terminology essential for understanding SUDs, including intoxication, tolerance, and withdrawal, while also detailing the neurobiological underpinnings, which involve altered function in the brain's reward circuits mediated by neurotransmitters such as dopamine and opioids. The chapter reviews the DEA’s scheduling system for drugs based on medical utility and potential for misuse and addresses significant risk factors, encompassing both inherited genetic vulnerability and adverse environmental elements like chronic stress and poverty. Various specific substance use disorders are explored according to DSM-5 criteria, covering acute effects, withdrawal syndromes, overdose concerns, and treatments for categories such as caffeine, cannabis, hallucinogens, inhalants, opioids, stimulants, and tobacco, alongside the behavioral or process addiction of gambling. A dedicated clinical focus is placed on Alcohol Use Disorder (AUD), detailing its prevalence, systemic complications (e.g., Wernicke-Korsakoff syndrome, cirrhosis, Fetal Alcohol Syndrome), types of problematic drinking (binge and heavy), and the progression of alcohol withdrawal symptoms, including the life-threatening condition of delirium tremens. Finally, the chapter comprehensively applies the nursing process to SUDs, outlining screening methods like SBIRT and AUDIT, relevant nursing diagnoses such as Impaired Coping or Denial, and a variety of treatment modalities, including pharmacotherapy (like naltrexone and methadone), psychological interventions (such as Cognitive Behavioral Therapy and Motivational Interviewing), and the continuum of care spanning detoxification, rehabilitation, and long-term recovery supported by mutual help groups like Alcoholics Anonymous.