Substance Use and Addictive Disorders - Concept Map
Substance Use and Addictive Disorders
Related concepts
Core Terminology and Definitions
Sub concepts
- Tolerance - physiologic adaptation requiring increased amounts
- Physical Dependence - withdrawal syndrome on cessation
- Addiction/Substance Use Disorder - compulsive use despite harm
- Withdrawal - signs/symptoms after substance reduction
- Intoxication - acute substance-specific syndrome
- Codependency - enabling family relationship patterns
- Dual Diagnosis - substance use + comorbid psychiatric illness
Relationship to central
Foundational understanding required to distinguish addiction types and severity
Alcohol Use Disorder
Sub concepts
- Intoxication - CNS depression, respiratory arrest risk
- Withdrawal Timeline - 6-12h tremors, 12-24h hallucinosis, 24-48h seizures, 48-72h DTs
- Delirium Tremens - severe autonomic hyperactivity, confusion, hallucinations
- CIWA-Ar Assessment - symptom-triggered benzodiazepine dosing
- Wernicke-Korsakoff Syndrome - thiamine deficiency disease
- Wernickes Encephalopathy - acute reversible phase
- Korsakoffs Psychosis - chronic irreversible memory loss
- Disulfiram - aversion therapy with severe alcohol reaction risk
- Benzodiazepine Management - first-line treatment
- Thiamine Administration - always before glucose
Relationship to central
Most heavily tested substance on NLE; includes life-threatening withdrawal emergencies
Opioid Use Disorders
Sub concepts
- Intoxication - pinpoint pupils, respiratory depression, LOC decrease
- Overdose Emergency - naloxone as rapid reversal agent
- Naloxone Management - short-acting, repeat dosing, withdrawal risk
- Withdrawal Syndrome - uncomfortable but not life-threatening
- Withdrawal Signs - dilated pupils, lacrimation, muscle aches, diarrhea
- Methadone Maintenance - medically supervised replacement therapy
- Buprenorphine - alternative maintenance and withdrawal agent
- Clonidine - autonomic symptom relief
Relationship to central
CNS depressant with overdose emergency; specific antidote management
Stimulant Use Disorders
Sub concepts
- Cocaine and Amphetamines - classic stimulants
- Methamphetamine Shabu - highly prevalent in Philippines
- Intoxication Signs - dilated pupils, hypertension, hyperthermia, agitation
- Acute Complications - seizures, dysrhythmias, MI, stroke, psychosis
- Intoxication Management - supportive care, environmental control
- Withdrawal Crash - fatigue, depression, intense craving
- Suicide Risk - critical danger during crash phase
- Psychotic Features - paranoia and hallucinations during use
Relationship to central
CNS excitation producing acute medical emergencies and psychiatric complications
Sedative-Hypnotic Use Disorders
Sub concepts
- Benzodiazepine Dependence - withdrawal parallels alcohol
- Barbiturate Dependence - narrow therapeutic-lethal margin
- Withdrawal Danger - seizures and delirium without taper
- Abrupt Cessation Contraindication - always gradual supervised taper
- Flumazenil Use - benzodiazepine reversal with seizure risk
- Barbiturate Overdose - especially lethal profile
Relationship to central
CNS depressant withdrawal mimics alcohol withdrawal and requires supervised taper
Rehabilitation and Recovery Model
Sub concepts
- Detoxification Phase - safe acute withdrawal management
- Rehabilitation Phase - coping skills and relapse prevention
- Maintenance and Support Phase - ongoing recovery support
- Twelve-Step Programs - AA, NA, Al-Anon self-help model
- Therapeutic Nursing Stance - firm, consistent, non-judgmental
- Boundary Setting - avoid enabling and rescuing behaviors
- Confrontation of Defense Mechanisms - denial, rationalization, manipulation
- Family Involvement and Codependency Work
Relationship to central
Long-term management strategy across three phases of recovery
Nursing Assessments and Interventions
Sub concepts
- CIWA-Ar Scale - withdrawal severity and medication titration
- Vital Sign Monitoring - autonomic instability detection
- Fall and Injury Precautions - especially in altered mental status
- Environmental Modifications - safe, quiet, well-lit space
- Seizure Precautions - during withdrawal emergencies
- Fluid and Electrolyte Management - restore normal balance
- Nutritional Support - thiamine, folate, multivitamins
- Reorientation and Reassurance - addressing hallucinations and confusion
Relationship to central
Clinical tools and priority-based care strategies using nursing process
Pharmacological Management
Sub concepts
- Benzodiazepines - diazepam, lorazepam, chlordiazepoxide first-line
- Benzodiazepine Tapering - symptom-triggered dosing protocol
- Thiamine B1 - mandatory before glucose in alcoholics
- Magnesium Replacement - seizure threshold protection
- Folic Acid and Multivitamins - nutritional restoration
- Naltrexone - opioid antagonist for abstinence support
- Acamprosate - craving reduction agent
- Clonidine - autonomic symptom management in opioid withdrawal
Relationship to central
Evidence-based medication strategies for specific substances and phases
Legal and Regulatory Framework
Sub concepts
- Republic Act 9165 - Comprehensive Dangerous Drugs Act 2002
- Dangerous Drugs Board DDB - policymaking authority
- Philippine Drug Enforcement Agency PDEA - enforcement agency
- Voluntary Submission Program - treatment option for dependents
- Court-Ordered Rehabilitation - judicial referral pathway
- Patient Confidentiality - mandatory record protection
- Mandatory Drug Testing - specified populations screening
- Nurse Role in RA 9165 - screening, treatment, education, prevention
- Republic Act 9173 - Nursing Practice Act Philippine registration and standards
Relationship to central
Philippine-specific laws governing drug treatment and nursing responsibilities
Patient Education and Prevention
Sub concepts
- Withdrawal Danger Education - risks of abrupt cessation
- Disulfiram Teaching - hidden alcohol sources awareness
- Nutrition and Thiamine Importance - long-term health
- Trigger Identification - high-risk relapse situations
- Healthy Coping Mechanisms - stress management alternatives
- Support Group Access - AA, NA, Al-Anon information
- Family Enabling Education - codependency recognition
- Organ Damage Consequences - liver, cardiac, pancreatic, neurological
Relationship to central
Teaching strategies to promote abstinence, prevent relapse, and support family
Complications and Comorbidities
Sub concepts
- Organ Damage - cirrhosis, cardiomyopathy, pancreatitis, neuropathy
- Infection Risks - HIV, hepatitis from injection drug use
- Trauma and Injury - accidents from intoxication
- Overdose Death - lethal dose risks across all substances
- Psychiatric Comorbidity - depression, anxiety, psychosis
- Suicide Risk - especially stimulant withdrawal crash
- Medical Emergencies - seizures, dysrhythmias, stroke, MI
Relationship to central
Medical and psychiatric sequelae requiring integrated management
Concept connections
- TolerancePhysical DependenceTolerance is a physiologic change; Physical dependence is the body's adaptation that causes withdrawal - related but distinct
- Physical DependenceAddictionPhysical dependence can occur without addiction (e.g., appropriately prescribed pain medications); addiction is behavioral/psychological compulsive use despite harm
- Alcohol Withdrawal TimelineDelirium TremensDTs are the severe end of alcohol withdrawal spectrum, peaking at 48-72 hours after last drink
- CIWA-Ar AssessmentBenzodiazepine ManagementCIWA-Ar scores drive symptom-triggered benzodiazepine dosing rather than fixed schedules
- Thiamine B1Wernicke-Korsakoff SyndromeThiamine deficiency causes Wernicke's encephalopathy; early thiamine administration prevents progression to irreversible Korsakoff's
- Wernickes EncephalopathyKorsakoffs PsychosisWernicke's is acute and reversible with early thiamine treatment; without treatment, progresses to chronic irreversible Korsakoff's
- DisulfiramAlcohol AbstinenceDisulfiram blocks alcohol metabolism and requires absolute abstinence; aversion therapy to maintain sobriety
- Opioid OverdoseNaloxoneNaloxone is the specific antidote for opioid overdose; reverses respiratory depression and decreased consciousness
- Stimulant IntoxicationAcute Medical EmergenciesStimulant CNS excitation can precipitate seizures, dysrhythmias, MI, stroke, and acute psychosis
- Stimulant Withdrawal CrashSuicide RiskIntense depression and anhedonia during stimulant crash create critical suicide risk requiring protective measures
- Benzodiazepine WithdrawalAlcohol WithdrawalBoth are CNS depressant withdrawals with similar dangers (seizures, delirium); both require supervised gradual taper with benzodiazepines
- DetoxificationRehabilitationDetoxification addresses acute withdrawal; rehabilitation builds lasting recovery skills and relapse prevention
- RehabilitationTwelve-Step ProgramsAA/NA/Al-Anon self-help programs are cornerstone of long-term maintenance and peer support in rehabilitation
- Therapeutic Nursing StanceBoundary SettingFirm, consistent, non-judgmental approach includes clear limits and avoidance of enabling behaviors
- RA 9165Nursing RolesRA 9165 mandates nursing involvement in screening, treatment, health education, and prevention of dangerous drugs
- RA 9165Patient ConfidentialityRA 9165 mandates confidentiality of treatment and rehabilitation records to protect drug-dependent patients
- RA 9173Nursing Practice StandardsRA 9173 (Philippine Nursing Practice Act) establishes standards for professional nursing care integrated with RA 9165
- Environmental SafetyDelirium Tremens ManagementQuiet, well-lit, safe environment reduces misperceptions and hallucinations during DTs
- Vital Sign MonitoringAutonomic HyperactivityFrequent vital sign assessment detects and monitors the severe autonomic instability of delirium tremens
- Nutritional SupportLong-Term RecoveryThiamine, folate, magnesium, and multivitamins support physiologic healing and prevent neurologic complications
- CodependencyFamily Involvement in TreatmentFamily members may have enabling patterns; treatment must address codependency and teach healthy boundaries
- Dual DiagnosisSubstance Use DisorderCo-occurring psychiatric illness complicates substance use treatment; both conditions require integrated management
- Methamphetamine ShabuPhilippine Healthcare ContextShabu is a major drug of abuse in the Philippines; nurses must address this specific substance in treatment and education
- PDEAMandatory Drug TestingPhilippine Drug Enforcement Agency enforces mandatory testing in specified populations as part of RA 9165
- DDBDangerous Drugs PolicyDangerous Drugs Board sets national policy and strategies for drug prevention and control
Diagrams
Substance Use and Addictive Disorders - Complete Concept Hierarchy
Comprehensive mind map showing all key concepts in Substance Use and Addictive Disorders, organized by major substance categories, nursing interventions, pharmacology, and Philippine legal framework. This map displays the hierarchical relationships between core terminology, specific substance disorders, management strategies, and regulatory requirements essential for NLE preparation.
Alcohol Withdrawal Timeline and Management Protocol
Step-by-step flowchart of alcohol withdrawal management from cessation through recovery. Shows the critical timeline (6-12h early withdrawal, 12-24h hallucinosis, 24-48h seizures, 48-72h DTs), decision points based on symptom emergence, and corresponding nursing interventions including CIWA-Ar assessment, benzodiazepine dosing, and seizure precautions. Highlights delirium tremens as a medical emergency requiring intensive monitoring.
Opioid Overdose Recognition and Naloxone Management
Decision tree and management protocol for opioid overdose recognition and naloxone administration. Demonstrates the classic triad diagnosis (pinpoint pupils, respiratory depression, decreased LOC), emergency prioritization (airway protection), naloxone dosing and expected effects, management of re-sedation and withdrawal reactions, and transition to maintenance therapy and support.
Stimulant Intoxication and Withdrawal Management
Comprehensive management protocol for stimulant intoxication and withdrawal. Shows acute intoxication presentation with CNS excitation signs, potential medical emergencies (seizures, MI, stroke, psychosis), supportive care management, transition to withdrawal crash phase, and critical suicide risk assessment during the depressive crash. Emphasizes the contrast between excitement during use and severe depression during withdrawal.
Disulfiram Therapy Patient Education and Safety Checklist
Detailed educational flowchart for disulfiram (Antabuse) therapy implementation. Covers informed consent, mechanism of action, severe reaction symptoms, comprehensive identification of hidden alcohol sources in beverages, food, personal care, and medications, assessment of patient motivation and commitment, and ongoing monitoring. Emphasizes the absolute requirement for total alcohol abstinence and the extended reaction period.
Substance Use Disorder Progression and Recovery States
State diagram illustrating the progression from non-use through experimental use, regular use, tolerance development, physical dependence, and addiction, showing the pathway to crisis and detoxification. Also demonstrates the recovery trajectory through detoxification, rehabilitation, and maintenance phases, with common relapse paths and critical points where intervention is needed. Shows how understanding these states helps nurses identify intervention points and risk factors.
Wernicke-Korsakoff Syndrome Recognition and Management
Diagnostic and management protocol for Wernicke-Korsakoff syndrome in chronic alcoholics. Shows the classic reversible triad of Wernicke's encephalopathy (confusion, ophthalmoplegia, ataxia), emphasizes the critical intervention of immediate IV/IM thiamine BEFORE glucose to prevent worsening, explains the consequence of delayed treatment (progression to irreversible Korsakoff's syndrome), and outlines the permanent features of Korsakoff's psychosis including memory loss and confabulation. Highlights the time-sensitive nature of reversibility.
RA 9165 Dangerous Drugs Act - Nursing Roles and Patient Pathways
Overview of Republic Act 9165 (Comprehensive Dangerous Drugs Act of 2002) and the integration of nursing practice within the Philippine legal framework. Shows the two main authorities (DDB and PDEA), treatment pathways (voluntary submission and court-ordered rehabilitation), recognition of drug dependents as persons needing treatment, four core nursing roles (screening, treatment, health education, prevention), mandatory drug testing requirements, and the critically important confidentiality mandate for patient records. Connects RA 9165 with RA 9173 (Philippine Nursing Practice Act) standards.
High-Yield NLE Topics - Substance Use and Addictive Disorders Distribution
Pie chart showing the proportional distribution of high-yield topics in Substance Use and Addictive Disorders for NLE exam preparation. Alcohol withdrawal timeline and delirium tremens occupy the largest proportion (25%), followed by benzodiazepine management and CIWA-Ar assessment (20%), Wernicke-Korsakoff syndrome (15%), and opioid overdose management (15%). These five categories comprise 75% of likely exam questions. Remaining topics include stimulant complications, disulfiram therapy, and RA 9165 legal framework, emphasizing the heavy focus on alcohol-related emergencies and pharmacologic management on the NLE.