NLE Psychiatric Disorders — Substance Use and Addictive DisordersConcept Map

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

Concept

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

To

Physical Dependence

From

Tolerance

Strength

strong

Relationship

Tolerance is a physiologic change; Physical dependence is the body's adaptation that causes withdrawal - related but distinct

To

Addiction

From

Physical Dependence

Strength

strong

Relationship

Physical dependence can occur without addiction (e.g., appropriately prescribed pain medications); addiction is behavioral/psychological compulsive use despite harm

To

Delirium Tremens

From

Alcohol Withdrawal Timeline

Strength

strong

Relationship

DTs are the severe end of alcohol withdrawal spectrum, peaking at 48-72 hours after last drink

To

Benzodiazepine Management

From

CIWA-Ar Assessment

Strength

strong

Relationship

CIWA-Ar scores drive symptom-triggered benzodiazepine dosing rather than fixed schedules

To

Wernicke-Korsakoff Syndrome

From

Thiamine B1

Strength

strong

Relationship

Thiamine deficiency causes Wernicke's encephalopathy; early thiamine administration prevents progression to irreversible Korsakoff's

To

Korsakoffs Psychosis

From

Wernickes Encephalopathy

Strength

strong

Relationship

Wernicke's is acute and reversible with early thiamine treatment; without treatment, progresses to chronic irreversible Korsakoff's

To

Alcohol Abstinence

From

Disulfiram

Strength

strong

Relationship

Disulfiram blocks alcohol metabolism and requires absolute abstinence; aversion therapy to maintain sobriety

To

Naloxone

From

Opioid Overdose

Strength

strong

Relationship

Naloxone is the specific antidote for opioid overdose; reverses respiratory depression and decreased consciousness

To

Acute Medical Emergencies

From

Stimulant Intoxication

Strength

strong

Relationship

Stimulant CNS excitation can precipitate seizures, dysrhythmias, MI, stroke, and acute psychosis

To

Suicide Risk

From

Stimulant Withdrawal Crash

Strength

strong

Relationship

Intense depression and anhedonia during stimulant crash create critical suicide risk requiring protective measures

To

Alcohol Withdrawal

From

Benzodiazepine Withdrawal

Strength

strong

Relationship

Both are CNS depressant withdrawals with similar dangers (seizures, delirium); both require supervised gradual taper with benzodiazepines

To

Rehabilitation

From

Detoxification

Strength

strong

Relationship

Detoxification addresses acute withdrawal; rehabilitation builds lasting recovery skills and relapse prevention

To

Twelve-Step Programs

From

Rehabilitation

Strength

strong

Relationship

AA/NA/Al-Anon self-help programs are cornerstone of long-term maintenance and peer support in rehabilitation

To

Boundary Setting

From

Therapeutic Nursing Stance

Strength

strong

Relationship

Firm, consistent, non-judgmental approach includes clear limits and avoidance of enabling behaviors

To

Nursing Roles

From

RA 9165

Strength

strong

Relationship

RA 9165 mandates nursing involvement in screening, treatment, health education, and prevention of dangerous drugs

To

Patient Confidentiality

From

RA 9165

Strength

strong

Relationship

RA 9165 mandates confidentiality of treatment and rehabilitation records to protect drug-dependent patients

To

Nursing Practice Standards

From

RA 9173

Strength

strong

Relationship

RA 9173 (Philippine Nursing Practice Act) establishes standards for professional nursing care integrated with RA 9165

To

Delirium Tremens Management

From

Environmental Safety

Strength

moderate

Relationship

Quiet, well-lit, safe environment reduces misperceptions and hallucinations during DTs

To

Autonomic Hyperactivity

From

Vital Sign Monitoring

Strength

strong

Relationship

Frequent vital sign assessment detects and monitors the severe autonomic instability of delirium tremens

To

Long-Term Recovery

From

Nutritional Support

Strength

moderate

Relationship

Thiamine, folate, magnesium, and multivitamins support physiologic healing and prevent neurologic complications

To

Family Involvement in Treatment

From

Codependency

Strength

moderate

Relationship

Family members may have enabling patterns; treatment must address codependency and teach healthy boundaries

To

Substance Use Disorder

From

Dual Diagnosis

Strength

moderate

Relationship

Co-occurring psychiatric illness complicates substance use treatment; both conditions require integrated management

To

Philippine Healthcare Context

From

Methamphetamine Shabu

Strength

strong

Relationship

Shabu is a major drug of abuse in the Philippines; nurses must address this specific substance in treatment and education

To

Mandatory Drug Testing

From

PDEA

Strength

moderate

Relationship

Philippine Drug Enforcement Agency enforces mandatory testing in specified populations as part of RA 9165

To

Dangerous Drugs Policy

From

DDB

Strength

moderate

Relationship

Dangerous Drugs Board sets national policy and strategies for drug prevention and control