1.  What are the criteria for a substance use disorder? 2.  If your client asked you “What is the difference between substance abuse and substance dependence? ”  How would you explain (teach)  the difference to them?  referring to ATI? 3.  Many people are described as having a dual diagnosis.  What does that mean? and how would that impact your nursing treatment of that person? How would you go about prioritizing what issue you would treat first? 4.  Many people have a substance abuse disorder yet so many people are not identified or treated for this disorder.  What are some reasons cited in the text regarding failure to detect substance abuse disorders and failure to provide treatment? 5. Review some methods used to screen for substance abuse disorders?  What is CAGE? 6.  What is the legal limit of blood alcohol content with a breathe device?  What is the level that could cause death?  Is that true for everyone?  can the levels change?  why or why not? 7.  Explain briefly what is alcohol withdrawal?  what happens in the body? What is the treatment course for alcohol withdrawal?  is it life-threatening?  What is the most significant concern with alcohol withdrawal? 8.  What medications are used when a person is going thru active withdrawal from alcohol? How long does withdrawal typically last? What are the common symptoms of alcohol withdrawal?

1. The criteria for a substance use disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). According to the DSM-5, substance use disorder is characterized by a problematic pattern of substance use leading to significant impairment or distress. The criteria include (a) impaired control over substance use, (b) social impairment, (c) risky use, and (d) pharmacological criteria.

Impaired control refers to the inability to control or cut down on substance use despite negative consequences. Social impairment involves the disruption or negative impact on social, occupational, or other areas of functioning. Risky use refers to using substances in physically hazardous situations, such as driving under the influence. Pharmacological criteria include tolerance (needing more of the substance to achieve the desired effect) and withdrawal (experiencing physical and psychological symptoms when substance use is discontinued or reduced).

2. Substance abuse and substance dependence, as defined in the DSM-5, have been replaced with the single category of substance use disorder. However, it is still useful to understand the difference between these two terms as they were previously used. Substance abuse referred to a pattern of substance use that led to significant impairment or distress but did not meet the full criteria for substance dependence. In contrast, substance dependence indicated a more severe, chronic pattern of substance use that resulted in tolerance, withdrawal, and compulsive drug-seeking behavior.

To explain the difference to a client, I would emphasize that substance abuse typically refers to problematic substance use that causes significant negative consequences in various areas of their life. On the other hand, substance dependence implies a higher level of severity, where the individual becomes physically and psychologically dependent on the substance, experiencing withdrawal symptoms when they try to stop using it. By using these explanations, clients can understand the progression of substance-related issues and the different levels of severity.

3. Dual diagnosis refers to the coexistence of a substance use disorder and another mental health disorder, such as depression, anxiety, or bipolar disorder. Having a dual diagnosis can significantly impact the nursing treatment of a person because it requires an integrated approach that addresses both conditions simultaneously. It is essential to recognize that these conditions often influence and exacerbate each other, leading to more severe symptoms and complications.

When prioritizing treatment for someone with a dual diagnosis, it is crucial to consider the severity and acuity of each condition. The treatment plan should be individualized, taking into account the person’s unique needs and preferences. Generally, ensuring the person’s safety and stabilization should be prioritized initially, followed by addressing the substance use disorder and the co-occurring mental health disorder. Collaborative care, involving a multidisciplinary team and evidence-based interventions, is often necessary to achieve successful outcomes.

4. The failure to detect substance abuse disorders and provide treatment can be attributed to various factors outlined in the text. One reason is the stigma associated with substance use disorders, which may prevent individuals from seeking help or disclosing their substance use. Additionally, healthcare professionals may lack the necessary training or knowledge to identify and address substance abuse disorders effectively. Limited access to treatment services, financial barriers, and systemic factors also contribute to the underidentification and undertreatment of substance use disorders.

5. Screening for substance abuse disorders involves the use of standardized tools and questionnaires to assess an individual’s use of substances and related problems. One commonly used screening tool is the CAGE questionnaire. CAGE stands for Cut down, Annoyed, Guilty, and Eye-opener. This brief questionnaire consists of four questions that assess an individual’s alcohol use and potential signs of problem drinking.

The CAGE questionnaire helps identify individuals who may have an alcohol use disorder and need further assessment and treatment. Other methods used for screening include the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST). These screening tools help healthcare professionals identify individuals at risk for substance abuse disorders and determine the appropriate level of intervention or referral.

6. The legal limit of blood alcohol content (BAC) with a breath device can vary depending on the jurisdiction. In most places, the legal limit is set at 0.08%, indicating that a person is considered legally impaired if their BAC exceeds this level. However, it is important to note that impairment can occur at lower levels for some individuals, particularly those with less tolerance to alcohol or certain medical conditions.

The level of BAC that could cause death varies among individuals and depends on various factors, such as body weight, tolerance, and overall health. It is impossible to determine a specific BAC level that would be fatal for everyone universally. BAC levels can change based on several factors, including the rate of alcohol consumption, the presence of food in the stomach, and individual variations in metabolism.

7. Alcohol withdrawal refers to the physiological and psychological symptoms that occur when a person stops or reduces their alcohol consumption after a period of heavy or prolonged use. The symptoms can range from mild to severe and can include tremors, anxiety, insomnia, hallucinations, seizures, and delirium tremens (DTs).

During alcohol withdrawal, the body undergoes several changes as it tries to adapt to the absence of alcohol. The treatment course for alcohol withdrawal typically involves supportive care, including close monitoring of vital signs, administration of fluids and medications to manage symptoms, and addressing nutritional deficiencies. In severe cases, medications such as benzodiazepines may be used to prevent seizures and reduce the risk of delirium tremens.

Alcohol withdrawal can be life-threatening, especially in severe cases. The most significant concern with alcohol withdrawal is the potential for seizures, delirium tremens, and other complications that can lead to medical emergencies or death. Therefore, close medical monitoring and appropriate interventions are critical to ensure the safety and well-being of individuals experiencing alcohol withdrawal.

8. When a person is going through active withdrawal from alcohol, medications such as benzodiazepines may be used to manage withdrawal symptoms and prevent complications. Benzodiazepines, such as diazepam or lorazepam, have sedative and antianxiety properties that can help reduce symptoms such as tremors, agitation, and seizures.

The duration of alcohol withdrawal can vary depending on various factors, including the severity and chronicity of alcohol use. Typically, the acute withdrawal phase lasts for about five to seven days, but some individuals may experience prolonged withdrawal symptoms that can persist for weeks or even months.

Common symptoms of alcohol withdrawal include tremors, anxiety, irritability, sweating, nausea, vomiting, insomnia, and an increased heart rate. Severe symptoms, such as hallucinations, seizures, and delirium tremens, may occur in some cases and require immediate medical attention.

In conclusion, understanding the criteria for a substance use disorder, the difference between substance abuse and dependence, and the impact of a dual diagnosis on nursing treatment are essential for providing effective care for individuals with substance-related issues. Recognizing the barriers to identifying and treating substance abuse disorders and being familiar with screening methods is crucial for improving outcomes. Additionally, knowing the legal limit of blood alcohol content, understanding alcohol withdrawal and its treatment, and being aware of the medications used during alcohol withdrawal are vital in managing this condition.