Self education - Best detox information

Specialties Addictions

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Hello!

I just got my first LPN job in an drug and alcohol detox center and am feeling unprepared. I feel as if my nursing program just briefly covered the topic of addiction. I am hopingto get some recommendation for web pages or books to read over to further self educate.

Thanks for the help

The Substance Abuse Handbook byRuiz, Strain, Langrod is a book that is often recommended.

A good substance abuse CEU is offered by Western Schools. I believe it is 30 hours; I found it helpful and thorough.

Specializes in Family Nurse Practitioner.

A good basic rule of thumb: The patient with opiate withdrawal will likely be the one in your face screaming they are dying and demanding medication. They are not. It is the quiet alcoholic or benzodiazepine abuser in the corner who is trying to die on you. I personally don't recommend taking a hard line with alcoholics when it comes to prn benzos, they are at serious risk and acute detox is not the time to be stingy with the benzos, imo. If you have the CIWA orders use them as indicated. I have seen a patient go into full blown DTs because the nurse thought he was "drug seeking" when he started swatting imaginary flies and didn't medicate him. You do not want to be behind the 8-ball with regard to DTs.

Specializes in Psych ICU, addictions.
The Substance Abuse Handbook byRuiz, Strain, Langrod is a book that is often recommended.

That was my first recommendation but you beat me to it :)

NetCE offers a bunch of great CEUs on addictions as well.

Specializes in Psych ICU, addictions.

A crash course for you:

Opiate detoxers look like they're got a really bad flu and think that they are dying. The good news is that they aren't dying. Comfort care and meds, lots of fluids and rest. Their withdrawal is like a roller-coaster: they will feel better, then worse, then better, then worse, and so on. Yes, you will see a blood pressure medication (clonidine) used in this withdrawal even if they're not hypertensive; clonidine helps allievate several of the w/d symptoms. If they choose to go with buprenorphine replacement, they can't start Suboxone/Subutex until they have been off opiates for at least 24 hours and preferably without benzos in their system d/t the risk of respiratory depression.

ETOH withdrawal is at its most dangerous the first 72 hours after the BAC hits zero. NOT after the first drink but after the alcohol has cleared out of the system. However, those who have a long-term history of heavy drinking or history of seizure d/o, you will start worrying about them right away. In alcohol detox, be liberal with the Lib(rium), but also understand that a lot of these patients may get a little too attached to the benzos you're using for withdrawal symptoms. If your MD is wise, he/she has set limits on how long they can get PRN benzos and what their max daily limit is. The last addictionologist I worked with would allow PRN Librium 50mg Q1H for the first 72 hours, NTE 400mg/24 hours. If the MD sees they're hitting the daily limit, they'll reassess and adjust if needed.

Because benzos have a longer half-life, benzo withdrawal is at its most dangerous a few days after their last dose. Symptoms start showing around day 3-4 and run a few days. Anxiety, agitation, tachycardia, feeling like they want to jump out of their skin, in severe cases psychosis and AVH, and it can be fatal. If a benzo taper is used, it will only be a long-acting one such as Librium or Valium even if it was their drug of choice--you will not see Xanax being given.

THC withdrawal is lots of anxiety. They will also pop positive for up to 30 days after stopping d/t THC being fat soluble. Comfort care/meds.

Meth withdrawal is a lot of anxiety and psychosis, followed by a major crash where all they do is sleep. Comfort care and meds, with PRN antipsychotics and benzos as needed.

Tramadol withdrawal has to be the most pleasant withdrawal I have ever seen. Seriously. Minimal issues and complaints, though these patients usually got hooked on tramadol because of chronic pain issues, so they're going to be feeling that pain hard. One thing you do have to watch for: tramadol lowers the seizure threshhold, so your MD may have PRN/scheduled benzos or anti-seizure meds set up for them.

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