ADDICTION

COURSE OBJECTIVES

This course is to allow the health professional to gain knowledge and understanding of the disease of addiction. To understand its history and intensity in our society and to deal on a compassionate and medical level with all addicts that come into their professional and personal lives.

LEARNING OBJECTIVES

  1. The student will be able to describe the physiological process and progression of addiction and its relationship to nursing.
  2. The student will be able to verbalize and demonstrate nursing care of the addict.
  3. The student will be able to ID the different types of addiction and the nursing role in each type.
  4. The student will have the knowledge of multi treatment modalities and be able to educate the patient.
  5. Student will be able to recognize at least 5 s/s of abuse and potential relapse with the ability to intervene.

DEFINITIONS

As per Mosby’s Medical Dictionary:

Addiction:
Compulsive, uncontrollable dependence on a substance, habit or practice to such a degree that the cessation causes severe emotional, mental, or physiologic reactions. Habituation:
  1. To become use to, an acquired tolerance gained by repeated exposure to a particular stimulus such as drugs or alcohol.
  2. A decline and eventual elimination of conditioned response by repetition of the conditioned stimulus.
  3. Psychological and emotional dependence on a drug, alcohol or tobacco that results from repeated use of the substance.
Addict:
A person who has become physiologically or psychologically dependent on a chemical such as drugs, alcohol or tobacco, to the extent that a normal social, occupational, and other responsible life function is disrupted and distorted.

In one of the twelve step groups they have pamphlets that ask the question, “Am I an addict?” If a substance makes your life unmanageable it might be something you want to look at. Some of the questions a person might ask themselves to assess they have possible addiction problems are; Do you use alone? Do you substitute one drug for another? Have you ever lied to obtain a drug? Please remember when we talk about drugs we are covering a wide variety of things, many people think a drug addict is a person who sticks needles in their arms or lays in the gutter. This is an error in thinking. Many affluent people have the disease of addiction. Looking at people who smoke cigarettes. This is one of the most deadly drugs known to man. When talking about marijuana or pills, this means the vicodin and other medications prescribed by so many doctors, (we will get into prescription drug abuse later on in the lecture). Cocaine in all forms, methamphetamine, heroin, ecstasy, and so on.

More questions a person might ask themselves; Do you regularly use a drug when you wake up or when you want to go to sleep? Do you avoid people when you are using, feelings of shame? Have you ever tried to stop or control your use? Do you ever purchase your drug when you should be buying something else? Do you ever question your own sanity? Does any of the mentioned drugs cause a disruption in your household? Have you ever stressed when you feared your drugs where low or gone? Have you ever-used drugs because of emotional pain or stress? Do you find yourself becoming bored and lost when you try to stay clean? Do you find a lot of your dealings with others are based around drugs? When you stay clean do you see less and fewer of your friends coming around? Have you hurt yourself or people you love because of drugs? Have you lost goals and dreams around your drug use? Have you lost yourself?

Am I an addict? This is only a question each individual can answer for themselves, and denial is most peoples easy way out. Addiction is a disease not a character defect. When a person has cancer they get treatment and family members all come running to be by their side.

The family of the cancer patient may ask their churches to pray for the family member, they may even tell all their friends about their families hardships. You can hear all kinds of tragic stories in the local supermarket. When the family member is suffering from the disease of addiction, things are much different. It is a shameful issue; no one wants to talk about it. It puts a blackness on the family name. This is so sad as addiction is one of the most fatal diseases on this planet today. If you look closely addiction kills far more people then any other disease or accident on this planet. If you look in hospitals we have people with lung disease dying every minute of every day, related to cigarettes. We have people dying of liver disease every minute of every day from alcohol and other substances. It is not a chosen course in one’s life, it is not the words of a small child when asked “What do you want to be when you grow up?” Have you ever heard a child reply with “Drug Addict.”? I think not! Is it genetic? Researchers are still challenging this; they are still researching the facts. There have been studies done on an enzyme found in the brain of an addict that is not found in the general population, this enzyme is called TIQ. It is a free floating chemical that creates pleasure, it takes a person’s pleasure receptor and makes them function differently then any others; they need stimulus immediately and they need more, without restraint. A saying that comes to mind is,” one is too many and a thousand is never enough." I am going to breakdown the etiology of addiction in relationship to each category of drug. These drugs each have their own way of working within the addict's body.

ETIOLOGY

CIGARETTES

There are over 4,000 chemicals found in tobacco and many of them are very addicting. The body gets dependent eventually for the need of nicotine and of the ingredients that the tobacco companies put in their products. Many people started using tobacco before we knew the deadly effects of it, and now find it extremely hard or impossible to quit. Why is this? How can a person know that something they are taking into their body is going to kill them?

We can pretend all we want; that lovely place of denial; but cigarettes harm the smoker and the non-smoker (through second hand smoke.)

Cigarettes cause numerous medical problems, lung disease, vascular disease, and on and on; yet we still have the patient who will take off their oxygen to smoke that cigarette. This has to prove to people the intensity of addiction.

Smoking is physically and psychologically addicting. The nicotine level becomes a normal part of the circulating blood. The fatal little creature jumps on the back of the red blood cells and takes frequent trips through the users body every minute of every day. Each time a smoker takes a drag it constricts all the vessels in the body, constricting blood flow to many places, if that place happens to have some blockage anyway it can cause a complete block leading to stroke and heart attack. As a smoker tries to cut back or quit smoking the physical body panics, it needs that learned and acquired level of nicotine in its circulation to maintain a now normal environment. This is why some people wake up at night to smoke. The body's nicotine level has dropped and its need is so great that it can wake a person in the middle of REM sleep.

We have come up with medical ways to help with the physical addiction. We have patches that feed nicotine into the blood stream at an even level, and the person cuts back as they wean the body slowly off the drug. There is the nicotine gum. The gum feeds the bodies physical need. The drug maintains it's learned balance. There is also a nasal spray that can be used; each time there is an urge to smoke the person inhales a mist from their inhaler. These are all great tools. As an addict a person needs to pay attention to their triggers and their potential for addiction to this new product. These tools can be very helpful in quitting; they rid the person of the physical portion of their addiction. Then they just need to deal with the psychological, and that can be the hardest task a person will ever face in their life. I once read the “most courageous person walking on the planet is the addict who admits their problem and does something about it!”

With nicotine it is as much a psychological addiction as it is physical. Smoking is a learned behavior, many find their cigarettes are their best friends. This may sound crazy to a non-smoker, or to a smoker who has never tried to quit, but to many of you, you know what I mean.

When your sad, happy, afraid, nervous, excited, any and all emotions make you want or need to share time with your best friend your cigarette. You can be alone and find relief or euphoria with your best friend your cigarette. Crazy, but very true.

Nicotine is out of the system in about ten days but the strong additive brain still yells for a cigarette. The mind can make up excuses; it even causes chaos to happen to give the user an excuse to use. “One is too many and a thousand is never enough." A smoker or ex- smoker will want a cigarette if they smoke one or not. It gets better one day at a time; it just does not feel like it for a while.

ALCOHOL

Many people are familiar with alcohol. Alcohol it is still a very acceptable drug in a lot of cultures, many even promote its use. The bible speaks of it, and yes Jesus did turn water into wine, but the bible also says let no man become a drunkard.

There are many ways to define the word alcoholic. Most people in the United States would tell you they do not have an alcohol problem, yet many of these people drink alcohol on a daily basis. Someone close to me once quit drinking after many years of daily abuse, they went to Twelve Step meetings a few times and when they had thirty days sober, they said, “see I have no problem” and started to drink to celebrate.

People drink to socialize, “I will meet you for a drink” is a very common invitation. Society has changed its views a little and we now have coffeehouses and juice bars, which is a huge plus for many. The weekend rolls around and its time to socialize, party, get together. Call it what you want, but in most cases it's based around alcohol. You can buy alcohol in the store, you can even drink it on the streets and in the parks, sporting event even religious events, like christenings have alcohol. Wine in moderation, a beer here and there, is not bad for you. Some researchers even say a glass or two of red wine each night could be good for you. How many people are content with that? How many of you have parents or grandparents that had a cocktail or two before dinner and then wine with dinner then an after dinner brandy. They did not have an alcohol problem, until they tried to drive to the store or stop drinking.

Alcohol has a high concentration of sugar, and the body becomes dependent on it quickly. You might see the hands of an alcoholic become very shaky when they miss a few drinks. The liver breaks down alcohol and disposes of it through the kidneys. When the liver becomes scarred its composition becomes that of a useless tool. The alcohol then converts itself into ammonia, a by-product of toxins in the body. Ammonia builds up in the blood and in the brain causing the alcoholic to become confused and very ill. The liver also helps control the clotting of blood with its production of fibergin. When the liver is damaged and has to continue to try to breakdown the alcohol it may fail, leaving the clotting of blood a defeated task.

There are many small veins in the esophagus. In liver failure these small vessels may rupture and the person bleeds out. Once this process of esophageal varicosity begins it is too late for any remedy, the person will die. Another unfortunate side effect of alcoholism is ascites. In this process the perineal cavity or the abdomen fills up with fluids. These fluids are usually broken down and filtered out though the normal process of the body, but in end stage of liver disease it does not function correctly. The person may become very uncomfortable due to the excess fluid and large abdominal girths. This can also cause dyspenia. Many times this fluid can be withdrawn, but seldom is it done because the fluids will reappear quickly.

There are numerous medications to assist with these disorders such as lactalose, which causes liquid stools. These liquid stools pull out the built up ammonia from the blood, but it also pulls a lot of potassium out with it, causing all kinds of secondary problems. This also causes the patient to become very weak.

In most end stage liver disease many body systems are involved. A lot of damage has occurred and one medical problem usually leads to another.

Alcoholism is one of the largest killers known to man. We know that alcoholism is not a moral deficiency, or a character defect, it is a fatal disease. We have known this for a very long time, yet we continue to sell it, and even promote its use. There are those who can drink in moderation and then there are those who go past the line, from use to abuse.

STIMULANTS (Cocaine, Methamphetamine, Ecstasy)

Stimulants work on the neurotransmitters within the brain. We have an electrical system in our brains causing a synapse. These synapses are at the peak of each junction and for an electrical impulse to get from point to the next it must jump the gap. In order to do this it needs the assistance of neurotransmitters. Dopamine is a neurotransmitter responsible for mood and pleasure, and it’s efficiency and ability to fire and pass on to its destination is mandatory for the body to feel; feel happy, a euphoria.

When we ingest in any form an outside stimulants our bodies are deceived. The body thinks it is getting dopamine and gives us an extremely high euphoria. These drugs prevent the round peg from getting into the round whole so the brain is firing strictly on ingested means of feeling. When the addict ingests a stimulant a pleasure much higher then the body could ever produce on its own from dopamine occurs. When the person does not continue to ingest the stimulant the body responds completely opposite and becomes very low. This can activate the body to have very strong urges for the missing stimulant. The stimulant properties of these drugs work on all of the body systems. A stimulant will constrict all of the blood vessels in the body and speed up the heart to deadly speeds.

Stimulants can put holes in the lining of the stomach and in the septum of the nose if snorted. Cocaine is a God given plant intended for medical use, but with the greed and addiction of the world we have changed it into something of fatal danger. Cocaine is cut with a multitude of things that the body can not filter or tolerate well. Many times the cut in the drug will do great damage to the body.

Methamphetamine is 100% chemicals put together by untrained people in their homes, basements, and even storage sheds. It does not take a skilled person to make this drug. All of the ingredients in methamphetamine are poison to the body; paint thinner, Iodine, draino. Are these things you want to ingest.

Ecstasy is just a few chemical bonds away. It is one of the newer so called designer drugs. These are drugs that the homemade chemists come up with to try and stay one step in front of the law.

People not only go into respiratory and cardiac arrest from these drugs but they can also become very delusional and end up in a psychiatric hospital for the rest of their lives. I have seen these drugs take the sweetest most kind God loving mom and turn her in to a mean selfish whore who cares little about anyone but herself. Many people try and say that stimulants are only psychologically addicting, this is not true! They are very much physically addicting as well. Stimulants work on the nervous system and when withdrawing many times muscle twitching and spasm are very apparent, panic attacks, arrthymias, nausea, and seizures can occur.

HEROIN: Opiates.

Opiates cover a long list of medications, from heroin, codeine, morphine, vicodin, oxycontin, percocet and others. They bring you down; they help the pain go away. Our bodies make a natural painkiller, endorphins. When we hurt our bodies take care of our pain.

Things you never think about cause us a natural pain such as; your hair growing, your intestines sending food throughout the body, these functions would hurt if we did not have the blessing of endorphins...

People use heroin, to ease their pain, usually emotional pain, and some times the pain is justified. This planet is not an easy place to live and most human beings go through a lot of trials and tribulations. So when we do not have a learned way to handle difficult situations we fill the void and kill the pain.

Heroin is one of the most addicting of all drugs. In this same category we find the legal prescriptions, the legal opiates that no one associates with the horrors of heroin. The body’s endorphins are regularly produced within the body. When we have increased pain the body produces more endorphins. When a person ingests opiates in any form the body recognizes it as an endorphin and halts it’s own production. It tells it self, we have way too much of this chemical in our body; in turn it decreases its production of the body’s natural painkiller. The person ingests the opiate and within three days the bodies’ own natural production has almost ceased; this depends on the individual, the frequency and dosage of the opiate.

The body has now been completely fooled and is surviving on the ingested painkiller to do all of the pain killing work within the body.

When there is a decrease of orally ingested opiates the body begins to feel bad. The hair on a person's head begins to hurt. When the opiates are removed completely the body goes into a real pain check. The natural movement of the intestines will have a person doubled over, a pain that is more then real, it is a living hell. To make a person who has a blood level of any opiate come off cold turkey is inhumane and can kill a person. It can take three days to a week for the body to realize it has a job to do and restart its own pain control system, to get its endorphins back up on line and reach a level where the person can feel like a human again. While the body is adjusting the patient should be assisted with a titrating dose of medication to keep them comfortable.

Remember this is not a character defect, it is a disease.

This use to be looked at differently. It was the heroin addict we mostly dealt with. Now we are seeing many people addicted to prescription drugs. They believe they need them for a better quality of life, what quality is this?

The addict's mind is so powerful it can cause pain, it can cause many signs and symptoms that are very justified to receive pain medication. The more pain medications we take for the pain, the more pain we will have, and then the more pain medication we will take, and on and on. It is a viscous cycle, one added to greatly by the doctors in the US. We are so stuck on if it does not feel good we can fix it with a pill. Many times anti-inflammatory medications, that take away the swelling that pushes on the nerve or effected area is much more affective then a narcotic. There are many times when pain medications are justified, but also many times when they become a huge down fall for the injured person. We in the medical field often times over look this issue..

If you have hurt your back and are unable to work, your bills are adding up and your children are running wild; you might just medicate the physical as well as the emotional pain. It helps, unfortunately it pushes many over that fine line of use to abuse.

Then this becomes a shame issue, no not me. It happens to a lot more people then you can count. As a medical person you can help this from happening.

TREATMENT

How does a person quit? If a person could come up with a magic pill or potion they would be a zillionaire. Not many active addicts truly enjoy their lives. Denial may cover the appearance, but the true reality is pain, darkness, shame, despair lurks beneath the surface..

There are medications that are supposed to help. Zyban is an antidepressant that is being used to curb the desire to smoke. There are catapress patches to curb the desire for opiates. These are tools that can assist, but getting clean and staying clean is the hardest task an addict will face in their lifetime. When destruction has fallen all around them repeatedly, and all is gone: no family, no friends, no home, no job. "NADA".

Staying clean is very difficult. A true desire to quit has to be there. A person has to work very hard at their recovery. By recovery I mean clean from all drugs/alcohol and working some sort of program, remember we need to fill that empty space we were filling with drugs/alcohol with something positive. Many people trade one drug for another; pills for alcohol, speed for pot. This is just a change of habits, not recovery.

It gets easier but addiction is never something that goes away. Just as cancer with treatment can go into remission, addiction with treatment can leave your brain alone for longer periods of time and give you back your life.

In the beginning things are one minute or one hour at a time. This all sounds so bizarre to a person who does not suffer from this disease, but it is a true and living hell to the person who suffers from this fatal disease.

Many times I have heard people say well if they wanted to quit they would. Often this comes from people who still live in a place of their own denial. The ex-drug user, who now is married, has cocktails after work and vicodin for the aches and pains and a little sleeping pill to help take the edge off at bedtime or the person who once again does not have the disease of addiction and has no real understanding of its power.

We are all sick, some of us are just sicker than others.

There are in-house treatment programs, some good some not so good. Treatment centers are very costly. Some as high as $ 15,000 for a 28 day program. Some insurance will pay, if you have insurance. Most people that are into their addiction lose everything, before they even realize there is a problem. Most of them have already lost their insurance. There are a few programs, such as the Salvation Army that have wonderful programs and let you work for your keep. If a person truly wants recovery, they can find it. Family and friends can certainly help lead the way, When they are ran to give up and realize an addict never gets healed by themselves.. The medical population should recognize addiction as a disease! Doctors and nurses should be aware of places to help the patient with this fatal disease as they do with chemo centers for their cancer patients.

Many of these programs detox the patient when they arrive; occasionally the patient ends up on more drugs in treatment then they were on outside of treatment. Making it very difficult to participate in their recovery.

The most successful approach has proven to be the Twelve Step programs. In something bigger and more important then ourselves.

In addition to twelve step groups there are many other forms of help a person should look into; self help groups, self-esteem, child hood issues, coping skills, living skills. There are out patient programs, which can be intense or not intense, court ordered or not court ordered.

The feeling of despair is overwhelming when people get sick and tired of being sick and tired, and finally admits to themselves they need help. We all think we can do it alone. 'Not'

Can the Cancer patients cure themselves? I do not think so.

God ( Higher Power) is a key factor in recovery, you can call him what ever you choose, but please just call him.

Many people come to recovery with very negative thoughts about any higher power; their higher power has been themselves, their drug, their spouse, their job, what ever it was, it was not enough. The addict now needs to find something bigger than themselves. You can be a dry drunk, but until you get recovery and figure out how to live, how to feel, how to be the special person you were meant to be you will never get better..

Giving up all your power to something you cannot see is very hard to do. Many addicted people have learned not to trust anyone; certainly not something you cannot see..

With time and work the addict can find peace, they can fill that void or hole they have been medicating all of their lives...

Church works, but as with any disease the addict needs more treatment then church alone. These programs did not happen by accident, they are there to help; let the addict know there is no shame only courage and strength in their reaching out for help.

Drug addiction is fatal. It kills people every minute of every day. I lost both of my brothers to this disease, one at 33 years old and the other at 44, they were not down and out bad people, they were both wonderful full of life people who just couldn't find there way out in time.

Jails, Institutions and Death. That is the truth.

Our jails are over crowded; the conditions are getting very unhealthy, due to excessive incarceration. It is estimated that 80 to 90% of all men, women and children in jail, are there in relationship to their addiction. To get it, To do it, or To have it.

The addict will steal, rob, hit, fight, hurt, and break the law; their families and non using friends means nothing. The active addict tends to be meaner to the ones they love the most.

From cigarettes to heroin, addiction is a addiction and it is all fatal if left untreated..

We lose so many wonderful people to addiction. They didn’t know how to quit. They didn’t have a choose any more, they were not doing the drug, the drug was doing them. A few too many pills, bad dope in a syringe or one last bottle beer..

The one who is gone isn’t the one who suffers anymore, it is those that are left behind; their children, their spouse, their parents, and their siblings. This I know to be true, because I miss my brothers and many friends every single day. All the loved ones I've lost were once again not bad people, they were sick people who found no cure. As medical professionals, we can help stop this fatal outcome for so many..

So many people in the medical field, even doctors are reluctant to even bring up a patients disease of addiction. It is as if they’re to embarrassed. Instead we go along with it, doctors just keep ordering more and more drugs for every tiny complaint a patient has. For a better quality of Life..

Perhaps we need to redefine QUALITY!

Never judge another, for there goes you. God Bless You.

Reach out and help an addict in your life today, even if it is through prayer it will work I promise, just never give up on someone you love that is caught up in this disease, without you they may die, or worse They may never learn to LIVE.

BIBLIOGRAPHY