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Very few human behaviors have consequences as far reaching as do those of the substance-dependant individual. In addition to affecting his own physical, emotional, and social well-being, the behavior of the substance dependant individual affects the well being of his family and that of the society at large. For example, industry has documented that alcoholism is one of the primary reasons for the loss of time and productivity both on the assembly line and in the executive suite. Therefore alcohol dependence has become a significant factor in the economic health of the nation (Berger, 1983, pp.

1040-1043; Spring & Rothgery, 2004). Criminal activity is an integral aspect of drug dependence. Hard drugs must be procured from an illegal source, thereby contributing to the maintenance of organized crime. In addition, the price they command often causes the individual to resort to criminal activity to obtain sufficient funds to maintain his dependence. Even when the individual does not have to engage in criminal activity to support his dependence, he most certainly must spend money better used for other purposes. As a result it is not unusual for his family to have inadequate food, clothing and shelter.

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As the substance dependence increases, the source of legally gained income inevitably cuts off, usually because of the individual’s inability to maintain his job (Mueller, 1974). Introduction Although alcohol is technically a drug, the term drug dependence refers only to those chemicals taken in forms other than drinking (Morgan et al, 1973). Some drugs are injected into the blood stream; others are ingested in the form of pills, while still others are absorbed through mucous membranes of the nose or mouth. Marijuana is smoked (Barbee, 1971, pp. 195-199).

Alcohol is a central nervous system depressant. Once alcohol is absorbed into the bloodstream it affects all body tissues but its immediate effects are caused by its action on the brain. At a level of 0. 05 percent of alcohol in the blood, inhibitions are diminished and the individual is likely to say and do things that would be unacceptable to him if he were sober (McCoy et al, 1981; Naigle, 1983). Interestingly, there is a societal norm that, to a point, ex¬cuses the behavior of an individual who has been drinking on the grounds that he has been drinking.

This cyclical thinking is based on the belief that the behavior of a person when drunk is not a reflection of him but rather a manifestation of the alcohol (Burkhalter, 2005; Smith, 2003). The reality is that the impulses acted on emanate from the per¬son and the alcohol merely removes the barriers to their imple¬mentation. At a level of 0. 10 percent of alcohol in the blood, motor and speech activity is impaired. It is for this reason that there has been a recent national campaign against driving a motor vehicle when drinking (McCoy et al, 1981; Fultz, 2000). Literature Review

Opiates are central nervous depressants. Morphine, heroin, and codeine are derivatives of opium. Although some opiate-dependent persons use morphine and Demerol most do not have access to these drugs and use heroin, which is readily available on the streets of large cities. Barbiturates are central nervous system depressants and include Phenobarbital, pentobarbital (Nembutal), secobarbital (Se¬conal), and methaqualone (Quaalude). They are legally pre¬scribed treatments for insomnia and epilepsy (Spring & Rothgery, 2004). Their effect is similar to that achieved by drinking alcohol.

In some respects barbiturate dependence is more dangerous than dependence on alcohol because large numbers of pills can be and are taken at the same time by suicidal people although it is unlikely that a sufficient amount of alcohol could be consumed at one time to result in death. In addition, the mental confusion caused by both alcohol and barbiturates often leads to these substances being used together, resulting in accidental death. Early stages of intoxication are manifested by muscular in-coordination with ataxia, dizziness, nystagmus, slurred speech, and sluggish mentality (Burkhalter, 2005).

The person acquires many bruises by falling or stumbling against walls and furniture. In more profound barbiturate intoxication, there are varying degrees of stupor, speech is incoherent, memory is defective and hallucinations may appear. When aroused, the person is very irritable and resistive. He presents the symptoms of a person suffering from delirium. Recovery may be slow and may leave in its wake a mild degree of permanent brain damage. Treatment of persons dependent on barbiturates must begin with gradual withdrawal of the drug. Sudden, complete withdrawal is often fatal.

Individuals who present themselves voluntarily for detoxification are also treated with a high-calorie, high vitamin diet. Persons who are in coma caused by barbiturate over dose must be treated aggressively with dialysis to lower the level of barbiturates in the blood. Amphetamines are central nervous system stimulants. Nu¬merous chemical compounds fall in this category, the most com¬mon of which are racemic amphetamine sulfate (Benzedrine) and methamphetamine (Desoxyn). In the past these drugs have been legitimately used in small doses under medical supervision to treat depression and curb appetite.

Individuals who take these drugs solely to become “high” take from 6 to 200 times the daily dose usually prescribed by a physician. Intravenous amphet¬amines are called “speed” in street language (Mitchell, 2006). The physiological effect of these drugs is to raise the blood pressure, sometimes to dangerous levels. Large doses have been known to cause immediate death, accounting for the saying among drug users that “speed kills. ” Individuals who use amphetamines think these drugs increase their physical energy, sharpen their physical and sexual reactions, and increase their confidence.

Thus a period of frantic ac¬tivity results from the ingestion of large amounts of amphet¬amines. This is followed by a great letdown in which the fatigue and depression are so tremendous that the addict is apt to seek release by taking the drug again. Chronic use of amphetamines can lead to a schizophrenic like psychosis with paranoid features (Spring & Rothgery, 2004). This reaction is a result of the drug and is not related to the pre¬morbid personality. In addition, prolonged use at high dosages can lead to massive, irreversible brain damage that may result in death.

The use of amphetamines today is not as great as it was in the 1970s (Fultz, 2000), probably because of the drug’s deserved reputation as highly dangerous. Cocaine, a central nervous system stimulant, is commonly believed not to cause physical dependence. However, in 1983 the National Institute on Drug Abuse declared cocaine to be a “powerfully addictive” substance linked to cardiac arrests, sei¬zures, and respiratory ailments. This agency has received re¬ports of cocaine-related illnesses that have doubled in number since 1980 (Kurose et al, 1981). Cocaine-related deaths have tripled since that time.

Whether or not cocaine causes physical dependence it almost always causes psychological dependence. It acts in much the same way as do amphetamines but has a shorter duration of ac¬tion. It is taken by “snorting” or intravenous injection and pro¬duces an unusually potent euphoria that serves as a major rein-forcement of its use. Lysergic acid diethylamide (LSD or acid) and polychloridated biphenyl (PCP or angel dust) are powerful hallucinogens. LSD was first used in research studies in an attempt to discover the cause of schizophrenia. PCP is legally used as an animal anes¬thetic (Fultz, 2000).

Ingestion of reasonably small doses of either substance produces temporary hallucinations and other schizophrenic-like symptoms. The user experiences waves of color and vibrations seem to pass through the head. Individuals believe that they have had an almost mystical experience in which the nature of emo¬tional conflicts becomes clear. Although there is little evidence that the use of these drugs causes physical dependence, they are dangerous for several reasons. First, these substances cause some individuals to believe that they have supernatural powers, and more than one person has been killed in an attempt to fly.

Second, for reasons that are not clear a “bad trip” sometimes occurs. This adverse reaction is manifested by very frightening perceptions instead of the desired peaceful experience. The bad trip that occurs from the use of PCP sometimes brings to the surface long-repressed mental conflicts and psychotic reactions. “Flash backs” in which the user experiences hallucinations days or weeks after using a hallucinogen can occur either with LSD or PCP (Smith, 2003). Until recently marijuana was an easily obtained and rela¬tively inexpensive drug.

It is a crude preparation from the whole Cannabis sativa plant, which grows wild in Mexico and is easily cultivated in the United States (Burkhalter, 2005). It is usually absorbed into the body through the smoking of cigarettes called reefers. Hashish is prepared by scraping resin from the tops of the hemp plant. The active ingredient in both marijuana and hashish is tetrahydrocannabinol, with hashish being much more potent. Inhalation of marijuana causes a state of exhilaration or eu¬phoria. Under its influence the user feels light in body, as if he were floating through space, and his general behavior is not un-like a mild mania.

Marijuana is not an aphrodisiac but it can lower inhibitions and intensify sexual pleasure. It seems to make many users temporarily passive, in contrast to alcohol, which fre-quently releases aggression. Marijuana affects the individual’s sense of time but not his motor and perceptual skills. Users be¬come psychologically dependent on it but may not become phys-ically addicted as with morphine. Currently a great deal of attention is being given to marijuana by the government because its use has risen dramatically.

Official arguments have been carried on in the press concerning the relative dangers of marijuana and the appropriate penalties that should be or should not be levied against people who use it (Smith, 2003). Unfortunately, there is a limited amount of research on which to base a scientific, unbiased judgment concerning the immediate dangers of smoking marijuana or the eventual outcome of long term use of this drug. Many of the research findings have been contradictory. Certainly the present laws controlling its use are inequitable, as well as widely unenforceable.

Alcohol dependence may take many forms and has many causes. One individual may be a chronic alcoholic, which means that he drinks excessively and is incapacitated most of the time. Another person may be referred to as a periodic or cyclic alco¬holic, which means that he drinks excessively during certain pe¬riods of his life but during other periods may not drink at all (Weist et al, 1982). A third type of alcoholism is exhibited by an individual who drinks large quantities of alcohol daily over a period of years (Ditzler, 2006; Cohn, 2002). At first he may not seem to be seriously affected by this overindulgence.

Slowly and insidiously, physical, mental, and emotional deterioration occurs. Eventually this person may be described as suffer¬ing from alcoholic deterioration (Fortin, 1980; Elliot & Williams, 2002). No matter what type of alcohol ism is being considered, the problem is thought to have as one of its bases some emotional conflict, frustration, or feeling of inad¬equacy. Treatment of Substance Dependence In the past the United States government maintained one treatment center for drug dependent individuals at Lexington, Kentucky (Burkhalter, 2005). It was called the National Institute of Mental Health Clinical Research Center.

In such a specialized hospital every¬thing possible was done to help drug-dependent individuals break their habit and become useful, productive citizens. Many individuals were treated at Lexington several times. Unfortu¬nately, the personality of some drug addicts is so faulty that many were not able to function without the emotional support the drug provides. When the program at this facility proved in¬effective the hospital was closed (Burkhalter, 2005). Many communities have organized facilities for treating indi¬viduals who suffer from drug dependence.

As in all situations that involve the emotions, it is necessary to discover why this kind of unusual emotional support is needed and then attempt to supply the support in more positive ways while at the same time helping the individual to give up the drug. Some authorities believe that a more realistic approach to the problem of drug dependence would be to supply each drug-de¬pendent individual with a minimum weekly supply of the drug on which he is dependent (Kurose et al, 1981). This practice, it is argued, would make the illegal traffic in drugs unprofitable.

It is thought that this practice of supplying a small amount of the drug to the addict each week would aid in cutting down the crimes that addicts now commit to obtain drugs. It would make it possible for the addict to purchase adequate food and maintain his physical health at an optimum level instead of denying himself food to purchase the drug, as he frequently has done in the past. As is true with the treatment of alcohol-dependent persons, the most effective long-term treatment for drug-dependent indi¬viduals is conducted by a self help group called Synanon.

This organization sponsors residential centers in many large cities. These centers are usually under the direction of a trained profes¬sional worker, who may have one to two other professionally trained people to assist him. Most of the therapy as well as the work required to maintain the center is done by the drug-depen¬dent individuals who are there to be helped or by those who have been helped and who stay on to make a contribution to the work. In these situations, drug dependent individuals who sincerely want to stop the drug habit live with other people struggling with similar problems.

The house is usually organized along the lines of communal living, with each person accepting a share of the work necessary to keep the house liveable and to prepare the meals. Several group sessions are carried on each week, during which members of the group are supportive to each other but are very straightforward in demanding that the group members face their rationalizations, evasions, personal problems, and social de¬ceptions. If a member returns to drugs, he is expected to leave the group.

This realistic but supportive approach has apparently helped many drug-dependent individuals to give up drugs and return to school or to a job. Conclusion To conclude, substance abuse refers to the use of any chemical substance for other than therapeutic purposes. The only potentially effective long-term treatment of any drug addict requires that he accept the fact he is addicted and has to abstain from the drug. This is difficult to achieve since these individuals characteristically use the defense of denial.

And the fact is that unless and until the individual resorts to abstinence, there will be chronic relapsing of the dependence. References Barbee, Evelyn L. 1971. Marijuana a social problem, Perspect. Psychiatr. Care, 9: 195-199. Berger, Fred. 1983. Alcoholism Rehabilitation: a supportive approach, Hosp. community Psychiatry, 34 (11): 1040-1043. Burkhalter, Pamela K. 2005. Nursing care of the alcoholic and the drug abuser, New York, McGraw Hill & Co. Cohn, Lucille. 2002. The hidden diagnosis. Am. J. Nurs. 82: 1862-1864. Ditzler, Joyce. 2006. Rehabilitation for Alcoholics, Am. J.

Nurs. 76: 1172-1175. Elliot, Barbara & Williams, Etna. 2002. An employee assistance program. Am. J. Nurs. 82: 586-587. Fortin, Mary L. 1980. A community nursing experience in alcoholism, Am. J . Nurs. 80:113-114. Fultz, John M. 2000. When a narcotic addict is hospitalized. Am. J. Nurs. 80: 478-482. Gibson, Deborah E. 1980. Reminiscence, self-esteem and self-other satisfac¬tion in adult male alcoholics, J. Psychosoc. Nurs. Ment. Health Serv, 18:7-11. Jefferson, Linda, and Ensor, Barbara. 1982. Help for the helper: confronting a chemically impaired colleague, Am. J. Nurs. 82:574-577.

Kurose K, Anderson T, Bull W, Gibson H, Grubb P, Krefetz N, Naqvi A & Smith M. 1981. A standard care plan for alcoholism. Am. J. Nurs. 81: 1001-1006. Loweree, F. , Freng, S. , and Baines, B. 1984. Admitting an intoxicated patient, Am. J. Nurs. 84:616-618. McCoy, S. , Rice, M. & McFadden, K. 1981. PCP Intoxication: psychiatric issues of nursing care, J. Psychosoc. Nurs. Ment. Health Serv, 19: 17-¬23. Mitchell, C. E. 2006. Assessment of Alcohol Abuse, Nurs. Outlook, 24: 511-515. Morgan, Arthur James, & Morneo, Judith Wilson. 1973. Attitudes toward addiction, Am. J. Nurs. 73: 497-501.

Mueller, John F. 1974. Treatment of the alcoholic: cursing or nursing? Am. J. Nurs. 74: 245-247. Naigle, Madeline. 1983. The Nurse and the alcoholic: redefining a historically ambivalent relationship, J. Psychosoc. Nurs. Ment. Health Serv. 21: 17-25. Smith, James. 2003. Diagnosing Alcoholism, Hosp. Community Psychiatry, 34 (11): 1017-1021. Spring, Gottfried & Rothgery, Jean. 2004. The link between alcoholism and affective disorders, Hosp. Community Psychiatry, 35 (8): 820-823. Weist, J. K. , Lindeman, M. , and Newton, M. 1982. Hospital dialogues, Am. J. Nurs. 82:1874-1877.

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