Person w/ Chronic SUD
A concept map of addiction as a chronic illness from a nursing perspective.
1. Cravings
1.1. Full-body experience
1.2. Situational
1.3. Overwhelms cognition
1.4. Prevents seeking help
2. Friends and Family
2.1. Attempting to help
2.1.1. May attempt more in the initial and end periods.
2.1.2. Experience trauma from helping at times.
2.1.3. Complicity may happen and be essential at first.
2.1.4. Attempting to force or coerce them to get help.
2.1.4.1. Frequently feels like it backfires.
2.2. Burnout
2.2.1. Attempting to help multiple times with consistent relapses.
2.2.2. Lack of understanding of the process of addiction.
2.2.2.1. Nursing can provide teaching to help.
2.2.2.2. May need additional social and familial supports.
2.2.3. Desire to help is also motivational.
2.2.3.1. Focus on building that familial/friend help.
2.3. Negative Support
2.3.1. Friends/Family can encourage substance use.
2.3.2. Family may refuse to help at all.
2.3.3. Family may enable behaviors by giving money versus tangible goods.
2.4. Positive Support
2.4.1. Familial/Friendship Accountability for Actions.
2.4.2. Being present at critical times
2.4.3. Reinforcing need for cessation with patience
2.4.4. Creating Meaningful and non-punative consequences for their actions.
2.4.4.1. Not overreacting
2.4.4.2. Consequence matches behavior
2.4.4.3. If they can no longer live with them, then finding them another place to stay. (Shelter, Sober-living)
3. Using (Intox)
3.1. Chronic Use
3.1.1. Full addiction
3.1.2. Typically a slow steady process to chronic use.
3.1.3. Almost always using in inappropriate times or places.
3.1.4. Seeking help becomes difficult
3.1.5. Integrated into daily life.
3.1.6. Exacerbated by trauma or loss.
3.2. Moderate Use
3.2.1. Denial
3.2.2. Experienced use
3.2.3. Others may begin noticing use
3.2.4. More risky behavior (drunk driving, using at work, violence while intoxicated)
3.2.5. Integrating into life as a coping skill. Lifejacket model.
4. Initial Use
4.1. An experience maybe only once.
4.2. No cravings. Typically only social use.
4.3. May involve relationships (sexual, romantic, friendships)
4.4. Young age at first use correllates to likelihood of long-term addiction.
4.5. Only repeated habitual situations tend to cause persistent use.
5. Withdrawal
5.1. Alcohol
5.1.1. Typically worst at day 2-5.
5.1.2. Can lead to DTs
5.1.3. Long-term health effects become apparent.
5.2. Opiates
5.2.1. Nausea/vomiting
5.2.2. Chills and appearing sick
5.2.3. Peaks at 3 days
5.3. Stimulants
5.3.1. Exhaustion
5.3.2. Anhedonia
5.3.3. Panic
5.3.4. Extreme Hunger
5.4. All Negatively Reinforce Sobriety
6. Trauma
6.1. Increased ACEs increase risk
6.2. Abuse/Neglect significant cause
6.2.1. Reshape reward and stress centers of the brain.
6.3. Complicated Grief
6.4. Trauma related to use
6.4.1. Sex work
6.4.2. Violence to/from
6.4.3. Legal problems
6.4.4. Loss of friends/family
6.4.5. Child abuse (towards children)
6.4.6. Accidental Overdose
7. Moments of Change
7.1. Adverse Drug Experiences
7.2. Becoming a Parent
7.3. Hitting Rock Bottom
7.4. (Dis)engagement with social networks
7.5. Addiction Treatment
8. Treatment
8.1. Nursing Care
8.1.1. Mostly Inpatient
8.1.2. Provide caring and reinforcement
8.1.3. Treating the symptoms of withdrawal.
8.1.4. Provide hope and motivation
8.2. Medical Care
8.2.1. Detox
8.2.1.1. Inpatient
8.2.1.1.1. Alcohol
8.2.1.1.2. Opiates
8.2.1.2. Outpatient
8.2.1.2.1. All Substances
8.2.1.3. IOP
8.2.1.3.1. All Substances
8.2.1.4. Residential
8.2.1.4.1. Most substances
8.2.1.5. Sober Living
8.2.1.5.1. Most substances
8.3. Mental Health Care
8.3.1. Motivational Interviewing
8.3.2. Cognitive Behavioral Therapy
8.3.3. Aversion Therapy (Not effective)
8.3.4. Support Groups
8.3.4.1. SMART Recovery
8.3.4.1.1. Only one that is evidence-based and doesn't require complete abstinence.
8.3.4.2. AA/NA
8.3.4.3. Secular Organizations for Sobriety
8.4. Legal System (Forced Treatment)
8.4.1. Drug Court
8.4.1.1. Mandated Drug Testing
8.4.1.2. Diversion Programs
8.4.1.3. Generally involve treatment
8.4.2. Probation
8.4.2.1. Lose driver's license
8.4.2.2. Pay exorbitant fees for treatment
8.4.3. Imprisonment
8.4.3.1. May not actually receive treatment
8.4.4. 3-Strike Policies
8.4.4.1. Increasing consequences for repeated drug crimes