PHARMACOLOGICAL AND NON-PHARMACOLOGICAL TREATMENT OF SUBSTANCE ABUSE.

PHARMACOLOGICAL MANAGEMENT.
Ilegal drugs or alcohol increases the risk for onset of Mental illness and major medical problems; and the earlier we seek treatment, the better.
Chronic use of Alcohol, Opioids and Nicotine or illegal drugs has direct effects on
1. Cardiovascular damage
2. Liver damage
3. Erosive Gastritis and
4. G I bleeding, acute Pancreatitis
5. Sexual dysfunction
In addition, alcohol independent individuals often consume greater quantities than they plan to consume. Pharmacological interventions are often the key component of treatment for alcohol or drug dependent problems because medication can help ease withdrawal symptons, decrease craving for it and block the reinforcing effects of the substance – Alcohol, Opioids and Nicotine if it is consumed.
Combination of both pharmacological and non pharmacological interventions are often more effective tool than either one alone.

MEDICATIONS FOR ALCOHOL WITHDRAWAL/ABSTINENCE
ABSTINENCE
Dissulfiram (Amtabuse)
Naltresone (Revia)
Acamprosate (Campral)

WITHDRAWAL
Diazepam (Valium)
Lorazepam (Ativan)
Chlordiazepoxide (Librium)

Intended Effects of these medications is to control client’s vital signs within normal limits.
Decrease in the risk of seizures and
Decrease in the intensity of withdrawal symptons.
Decrease in cravings

NURSING INTERVENTIONS /CLIENT EDUCATION
Monitor the clients vital signs and neurological status
Provide for client’s safety by implementing seizure precautions

Dsulfiram (Antabuse)- Daily Oral Medication
Inform clients of the potential dangers of drinking an alcohol
Advise clients to avoid any products that contain alcohol (cough syrups, aftershave lotion etc.)
Client to wear medical alert bracelet.
Advise clients that medication effects acetaldehyde syndrome with alcohol ingestion.

Naltrexone (Revia)
Obtain accurate history to determine if clients are dependent on opioids. Use of naltrexone will initiate withdrawal syndrome.
Advise clients to take the medication with meals to decrease GI distress.
Suggest monthly IM injections for clients with difficulty adhering to regimen.

Acamprosate
It decreases the unpleasant effects from abstinence
Inform clients that diarrhea may result.
Maintain adequate fluid intake and to rest.
Avoid use in pregnancy.

Carbamiazepam (Tegretol)
Clonidine (catapres)

OPIOIDS WITHDRAWAL
1. Methadone ( Dolophine)
2. Clonidine (Catapres)
3. Buprenorphine Combine with Naloxone
4. Suboxone

Methadone is an oral opioid agonist that replaces the opioid to which client are addicted
It will prevent abstinence syndrome from occurring and remove the need for clients to obtain illegal drug
Dependence will be transferred from the illegal opioid to methadone.
Patient Teaching
Inform patient that methadone dose must be slowly tapered to produce detoxification.
Clonidine (Catapres)
Advise clients to avoid activities that require mental alertness until drowsiness subsides.
Encourage clients to chew gum or suck on hard candy and sip small amounts of water or suck on ice chips to treat dry mouth.
BRUPRENORPHINE (SUBUTED) COMBINE WITH NALOXONE (SUBOXONE)
Administer sublingually.