Substance Use Disorders: Introduction (Nursing)

00:00 Substance use disorders are chronic brain-based disorders. A person who has substance use disorder which sometimes is called an addiction is unable to refuse the cravings for that substance. It is not a willpower, it is a disability. They are unable to refuse their cravings. This diagnosis of substance use disorder, it reflects that there are measurable clinical and functional changes that affect that individual. It affects their health, it affects their behavior, and it affects their activities of daily living. Meaning it impacts work, it impacts social life, it impacts family life, school, academics, and even employment. Substance use disorders are characterized by the substance that the person is using. For example, we have alcohol use disorder, tobacco use disorder, cannabis use disorder, hallucinogen use disorder, stimulant use disorder, and opioid use disorder. One of the things that all of these disorders have in common is there is a genetic composition to it. And genetics are responsible for 40-60% of the vulnerability that a person has to developing a substance use disorder. An example is that a child of an alcoholic is 4 times more likely to have alcohol use disorder than one who is not a child of an alcohol. Psychological factors also come into play as a risk factor for substance use disorder. For example, developmental factors.

02:10 As a child is growing and developing in their home, those factors may increase a risk for substance use. They also have personality factors. Oftentimes you'll hear a mom say "My child was born with this personality. They were easygoing right at birth, right the first week they slept through the night." Or "They were fussy, or they would cry and yell." That is the personality, the factor of that child and growing up how that personality developed into coping mechanisms and allow that child to be able to connect with others growing into adulthood and whether those personalities persisted into adulthood. We also have socio-cultural factors that when we're thinking about substance use disorder like role modeling, if you are living in a household where use of drugs is the norm where it has been normalized subjectively and environmentally, that person is more likely to use these substances. When we are conditioned to believe that it is okay to do something, that again socio-cultural, that increases the risk factor for a substance use disorder. All substance use disorders have similar criteria. The difference is depending upon what the substance is. But the criteria themselves are very similar. For example, we will ask if the patient is using that substance more than it was intended. We will ask if the patient has unsuccessfully attempted to cut back on using that substance. Does the patient spend a lot of time using that substance or recovering from use? Meaning if it's alcohol, are they spending a lot of time drinking or recovering from hangovers? We also ask if that person is going to continue to use the substance despite the negative outcomes or consequences they are experiencing. Does that person prioritize the use of the substance over other activities? And is that person now starting to take increased risks and using behaviors during use of this substance even though it is detrimental to them? There's the question "Is the person going to continue to use that substance even if they can't remember what happened when they were using that substance?" Also, does the person require more and more of the substance in order to get the desired effect. This is called tolerance, that the same amount of substance doesn't give them the effect that they want and therefore they have to start increasing how much they use in order to get that desired effect. When they stop using that substance, are they now starting to experience withdrawal symptoms, is their body now dependent on that substance and now that it can't have it are they showing signs of physical emotional withdrawal? So, sometimes people say "Well, you know, I don't have a substance use disorder. I just like to get high." What is getting high? Getting high is intoxication. It is considered a syndrome but it is reversible. So a person has intoxication by a drug, but that is reversible so they have 1 drink they feel a little bit giddy, they are intoxicated but over the period of an hour or 2 hours and dinner, that intoxication abates. We say that intoxication occurs after the ingestion of the substance or smoking whatever way, whatever route the person takes for their substance and it provides them with a sense of acceleration, sometimes agitation. It could actually be lethargy with some of the depressants and even as with opioids inertia. It's still intoxication when it is that short reversible syndrome. It's important to recall that substances, these substances have an impact on our central nervous system. So, that means our physiological functions are disturbed by the taking of the substance. Our physical reactions are impacted. We don't respond as quickly. And reasoning is also impacted so it's changed. It's impaired. That's intoxication. What about use? What do we mean when we say substance use? Substance use is when a person uses a substance for either medicinal or recreational purposes. There are people who take Percocet, who take other opioids. They have cancer, it affects them so that they can continue with their activities of daily living. They need to use that medication in order to be able to function. The recreational purposes, like I said you go out, you have a glass of wine with dinner. That is substance use. Tolerance, as I just mentioned, tolerance is when the same amount of that substance no longer provides you with that same acceleration or that same effect that you happen to like. Therefore, you need more in order to achieve the same sense of brain reward. Dependence is when now you're using the substance not just because it feels good to use it, but when you don't have it it feels really bad. You are dependent upon that substance in order to have a sense of normality.

09:33 And now that gives rise to seeking behaviors where you start looking for that substance to make sure that there is no drop in the level because if there's a drop in the level you don't feel well. What we call addiction is when we have this illness that we crave a substance, we spend time seeking for that substance. That substance takes priority over just about everything else and we don't care about the consequence because our primary goal when we have an addiction is to be able to secure and take the substance needed.

10:21 So when we think about substance use disorder, or if you want to use the word addiction, it has to be recalled that this is your brain that is now impaired and your brain, this disease of the brain, does not allow the person to make other choices that a person without a substance use disorder can make.