705-414 Care of the Individual/Population with Adult and Chronic Mental Health Conditions
R. Murray
Brief overview:
Roberta Murray is a 22-year-old female with history of substance use disorder including heroin.
She is currently in an outpatient rehab program after completing a 28-day inpatient detox.
Roberta did not show up for her outpatient appointment this morning. She currently has an
agreement with her program that they can contact her parents if she does not show. Her parents
are at work, so they gave permission for a nurse from the treatment program to enter the home.
Review:
 Read: Drugs, Brain, and Behavior: The Science of Addiction from the NIH:
https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/addictionhealth
 Review journal from 12-step program and be prepared to discuss
 Review CINA tool: https://ncpoep.org/wpcontent/uploads/2015/02/Appendix_7_Clinical_Institute_Narcotic_Assessment_CINA_Sc
ale_for_Withdrawal_Symptoms.pdf
 Review CIWA tool: www.ci2i.research.va.gov/paws/pdfs/ciwa-ar.pdf
Answer the following questions and be prepared to discuss
1. How does the brain’s reward system influence addictive behavior?
 When addictive behavior occurs the brain releases dopamine which activates the brain’s
reward system. The increased dopamine gives a feeling of enhanced pleasure.
Ultimately, the person with the addiction will continue to chase that feeling of euphoria or
enhanced pleasure.
2. How are these three areas of the brain influenced by addictive
chemicals?
 Basal ganglia are responsible for the progression of addiction
because it controls the reward system of the brain which gives
the user the feeling of pleasure.
 Prefrontal Cortex controls the user’s compulsive behaviors to
seek out what they are addicted to
 Extended amygdala is where the user’s feelings of stress come
from once, they are no longer high. The person then begins to
seek the substances again to feel better or euphoric once again.
3. Name at least 2 behavioral therapies to treat drug addiction.
 CBT
 Group Therapy (AA)
4. What are NDRIs?
 NDRIs are norepinephrine & dopamine reuptake inhibitors. The drug is classified as an
antidepressant and can treat disorders such as depression, narcolepsy or ADHD.
5. What type of drug is heroin?
 Heroin is a schedule 1 drug with no know medical use. It is a highly addictive opioid.
Medications to prepare for:
Buprenorphine/Naloxone oral tablets
Indication: Opioid dependence
Reaction: headache, insomnia, pain, withdrawal sx
Adverse effects: respiratory depression, respiratory arrest, central sleep apnea
Nursing Considerations: LFTs at baseline, regular dental exam, s/s of resp depression
Lorazepam tablets and IM
Indication: anxiety, insomnia
Reaction: sedation, dizziness ataxia, fatigue, hypotension
Adverse effects: resp depression, apnea, resp failure, dependency, abuse
Nursing Considerations: monitor resp fx