Psychiatric Mental Health Nursing by Videbeck

17 SUBSTANCEABUSE 415

when tapering the dosage of a benzodiazepine, the
client may be given Valium 10 mg four times a day;
the dose is decreased every 3 days, and the number of
times a day the dose is given also is decreased until
the client is safely withdrawn from the drug.

Stimulants (Amphetamines,
Cocaine, Others)

Stimulantsare drugs that stimulate or excite the
central nervous system. Although the DSM-IV-TR
categorizes amphetamines, cocaine, and central ner-
vous system stimulants separately, the effects, intox-
ication, and withdrawal symptoms of these drugs are
virtually identical. They are grouped together here
for this reason.
Stimulants have limited clinical use (with the ex-
ception of stimulants used to treat attention deficit
hyperactivity disorder; see Chapter 20) and a high po-
tential for abuse. Amphetamines (“uppers”) were pop-
ular in the past; they were used by people who wanted
to lose weight or to stay awake. Cocaine, an illegal
drug with virtually no clinical use in medicine, is
highly addictive and a popular recreational drug be-
cause of the intense and immediate feeling of eupho-
ria it produces.
Methamphetamine is particularly dangerous. It
is highly addictive and causes psychotic behavior.
Brain damage related to its use is frequent, primarily
as a result of the substances used to make it.

INTOXICATION AND OVERDOSE

Intoxication from stimulants develops rapidly; effects
include the high or euphoric feeling, hyperactivity,
hypervigilance, talkativeness, anxiety, grandiosity,
hallucinations, stereotypic or repetitive behavior,
anger, fighting, and impaired judgment. Physiologic
effects include tachycardia, elevated blood pressure,
dilated pupils, perspiration or chills, nausea, chest
pain, confusion, and cardiac dysrhythmias. Overdoses
of stimulants can result in seizures and coma; deaths

are rare (Jaffe, 2000a). Treatment with chlorpro-

mazine (Thorazine), an antipsychotic, controls hallu-

cinations, lowers blood pressure, and relieves nausea

(Lehne, 2001).

WITHDRAWAL AND DETOXIFICATION

Withdrawal from stimulants occurs within a few

hours to several days after cessation of the drug and

is not life threatening. Marked dysphoria is the pri-

mary symptom and is accompanied by fatigue, vivid

and unpleasant dreams, insomnia or hypersomnia,

increased appetite, and psychomotor retardation or

agitation. Marked withdrawal symptoms are referred

to as “crashing;” the person may experience depres-

sive symptoms including suicidal ideation for several

days. Stimulant withdrawal is not treated pharmaco-

logically.

Cannabis (Marijuana)

Cannabis sativais the hemp plant that is widely cul-

tivated for its fiber used to make rope and cloth and for

oil from its seeds. It has become widely known for its

psychoactive resin (Macfadden & Woody, 2000). This

resin contains more than 60 substances called canna-

binoids of which delta-9-tetrahydrocannabinol (THC)

is thought to be responsible for most of the psycho-

active effects. Marijuana refers to the upper leaves,

flowering tops, and stems of the plant; hashish is the

dried resinous exudate from the leaves of the female

plant. Cannabis is most often smoked in cigarettes

(“joints”), but it can be eaten.

Cannabis is the most widely used illicit sub-

stance in the United States. Research has shown that

cannabis has short-term effects of lowering intra-

ocular pressure, but it is not approved for the treat-

ment of glaucoma. It also has been studied for its

effectiveness in relieving the nausea and vomiting as-

sociated with cancer chemotherapy and the anorexia

and weight loss of AIDS. Currently two cannabinoids,

dronabinol (Marinol) and nabilone (Cesamet), have

Box 17-2

➤ ADDICTIONRESEARCHFOUNDATIONCLINICALINSTITUTE

WITHDRAWALASSESSMENT FORALCOHOL, REVISED(CIWA-AR)—cont’d

ORIENTATION AND CLOUDING OF SENSORIUM—Ask,

“What day is this? Where are you? Who am I?”

0 oriented and can do serial additions

1 cannot do serial additions or is uncertain about date

2 disoriented for date by no more than 2 calendar days

3 disoriented for date by more than 2 calendar days

4 disoriented for place and/or person

Maximum Possible Score 67

A score of less than 10 usually indicates no need

for additional withdrawal medication.