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Core Curriculum of

ADDICTIONS
NURSING
THIRD EDITION

Al Rundio, PhD, DNP, RN, APRN, CARN-AP, NEA-BC, DPNAP


Associate Dean for Post Licensure Nursing Programs: RN to BSN Program
Graduate Nursing & Doctoral Programs & CNE
Clinical Professor of Nursing
College of Nursing & Health Professions
Drexel University
Philadelphia, PA

William J. Lorman, PhD, MSN, PMHNP-BC, CARN-AP


Vice President, Chief Clinical Officer
Livengrin Foundation, Inc.
Bensalem, PA
Assistant Clinical Professor
College of Nursing and Health Professions
Drexel University
Philadelphia, PA
Executive Editor: Shannon W. Magee
Product Development Editor: Maria M. McAvey
Senior Marketing Manager: Mark Wiragh
Editorial Assistant: Zachary Shapiro & Kathryn Leyendecker
Production Project Manager: Bridgett Dougherty
Creative Services Director: Doug Smock
Manufacturing Coordinator: Kathleen Brown
Prepress Vendor: Aptara, Inc.

Copyright © 2015 Wolters Kluwer Health

Copyright © 2006 2nd Edition International Nurses Society on Addictions. Copyright © 1990 1st Edition. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any
form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any
information storage and retrieval system without written permission from the copyright owner, except for brief
quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as
part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To
request permission, please contact Wolters Kluwer Health at Two Commerce Square, 2001 Market Street,
Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and
services).

987654321

Printed in China

978-1-4511-9403-6
Library of Congress Cataloging-in-Publication Data available upon request

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including
any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals examination of
each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions,
medication history, laboratory data and other factors unique to the patient. The publisher does not provide
medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the
publisher, are solely responsible for the use of this work including all medical judgments and for any resulting
diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment
options should be made and healthcare professionals should consult a variety of sources. When prescribing
medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s
package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects
and identify any changes in dosage schedule or contradictions, particularly if the medication to be administered is
new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable
law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a
matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this
work.
LWW.com
Dedication
This book is dedicated to all of those individual nurses who care for patients with
substance use disorders in a variety of practice settings. Your stewardship for the
patients that you serve is more than commendable.

We also dedicate this book to the editors and authors of this edition of the Core
Curriculum of Addictions Nursing. We more than appreciate your hard work on this
project.

Al Rundio
Bill Lorman
Contributors
Carolyn Baird, DNP, RN-BC, CARN-AP, CCDPD, FIAAN
Suzan Blacher, MSN, RN, CARN, TTS
J. Frisicaro, RN, MS, NP
Karen D’Apolito, RN, PhD
Harvey “Skip” Davis, PhD, RN, CARN
Gladys Diji, RN, MSN
Janice Dyehouse, RN, PhD
Janice Cooke Feigenbaum, RN, PhD
Elizabeth Fildes, EdD, RN, CNE, CARN-AP, APHN-BC
Deborah Finnel, RN, PhD, CARN
Robin Foley, MS, APN, PMHNP-BC, CARN-AP
Audrey Forka, MSN, APN, PMHNP-BC
Katherine Fornili, MPH, RN, CARN
Dennis E. Hagarty, RN, MSN, CARN-AP, LCAS
Mary Ann Johnson, RN, PhD, GNP
Julie Levin, RN, MSN
Sean McCarthy, RN, MSN
Dana Murphy-Parker, MS, CRNP, PMHNP-BC, CARN-AP
Angela Fernanda Tumolva Natividad, RN, BSN, MSN
Cheryl Nosek, RN, DNS
Elizabeth Pace, RN, MSM, CEAP
Roseann Reagan, PhD, APRN-BC
Christine Savage, RN, PhD, CARN
Karen L. Schultz, RN, MSN, CARN, LADC
Pooja Shah, MS, CRNP, FNP-BC
Faith Smith-Goff, MSN, RN, CARN-AP, LCAS
Stephen Strobbe, PhD, RN, PMHCNS-BC, CARN-AP
Barbara Traver, RN, MSN
Christine Vourakis, PhD, RN, FIAAN, FAAN
Janet Wray, RN, PhD
Foreword
We felt that it was time to make revisions to the Core Curriculum of Addictions
Nursing. What certainly motivated this decision was the new role delineation
examinations that were completed for the CARN (Certified Addictions Registered
Nurse) and the CARN-AP (Certified Addictions Registered Nurse-Advanced
Practice) examinations that was completed 2 years ago.
Although addictions nursing practice does not change nearly as quickly as some
other specialties, there have certainly been some changes since the last edition of
the Core Curriculum. A few of the most noted changes are the use of
pharmacologic agents for relapse prevention, complimentary therapies and
recovery models across the life span. In order to accommodate such new
information, the chapters have been expanded from 7 Chapters to 10 Chapters.
There are two new chapters on pharmacologic agents. From our review, two of
the chapters, Chapters 5 and 7, required no changes for this edition.
This is the first time that we have partnered with a publisher to publish this
edition. Previously IntNSA’s management company printed and marketed the Core
Curriculum from our society’s web site. Wolters Kluwer Health publishers will be
publishing this edition of the Core Curriculum. We are very excited about this
opportunity as this edition will be marketed internationally. As addictions nursing
crosses all practice settings, this edition should reach a much larger audience.
Our intent is that the Core Curriculum of Addictions Nursing will be utilized in a
variety of ways, for example, as a review book for studying for the CARN and/or
CARN-AP board certification examinations and certainly by faculty teaching in
nursing programs so that much needed addiction content becomes part of nursing
curriculums.
Our plan going forward is to review the Core Curriculum of Addictions Nursing
much more frequently than in the past. As changes are made in the practice of
addictions nursing, content in the Core Curriculum will be updated.
For those reading this Foreword, we hope that you enjoy this edition of the Core
Curriculum of Addictions Nursing. We also thank you and applaud you for the
work that you do in caring for patients with substance use disorders regardless of
your practice setting.

Al Rundio
Bill Lorman
Preface
This third edition of the IntNSA Core Curriculum has been updated from the second
edition. There were sections from the second edition that are still current so we
decided to leave those sections alone. There was no need to change current
information that was written so well. We did add some additional information,
for example, two chapters on pharmacology.
We would like to thank our chapter editors and contributors for their dedicated
hard work on this third edition. We also would like to thank those chapter editors
and contributors, who authored the first and second editions, as their work
provided the foundation for the revisions to this third edition. We especially want
to thank the editorial staff of Wolters Kluwer. We know that they will market this
curriculum worldwide so that other countries beyond the United States will have
access to the information in this edition. Addictions is a global disease and we are
thrilled that other nations will have access to this information.
It is our hope and intent that this curriculum will be utilized by those who are
studying for the CARN and CARN-AP certification examinations offered by IntNSA.
This curriculum has also been designed to be utilized by faculty in schools of
nursing in order to better design curriculum on addictions nursing. It is also our
intent that nurses, who care for patients with substance use disorders in any
practice setting, will embrace and learn from the information contained in the
IntNSA Core Curriculum.
We know that addictions affects many individuals in our society and certainly in
societies of other nations. We know that addictions knows no boundaries—it can
certainly affect any culture or society. It affects any social or economic class.
And, perhaps our most important intent, through the updating of the content in
this curriculum, is that any nurse in any practice setting in any country will have
access to this curriculum so that patients affected by substance use disorders will
be the recipient of improved nursing care.

Al Rundio
Bill Lorman
Acknowledgments
We would like to take this opportunity to acknowledge the editors and
contributors to this third edition of the Core Curriculum of Addictions Nursing.
Their hard work and dedication to this project is not only recognized but truly
appreciated.
We would also like to acknowledge the editors and authors, who worked on the
first and second editions of the Core Curriculum of Addictions Nursing. Their work
served as a very strong foundation for the revisions made to this edition. Much of
the content in these editions was maintained as the information is still current and
relevant. There are still two complete chapters, Chapter 5 and 7, from the second
edition of the Core Curriculum of Addictions Nursing that remain in this third
edition.
We also want to thank and commend the staff at Wolters Kluwer Health for
their willingness to take on yet another project with IntNSA and for their
dedicated time and effort on this edition of the Core Curriculum of Addictions
Nursing. We would especially like to thank Maria McAvey and Julie Vitale for
their hard work and dedication to this project.

Al Rundio
Bill Lorman
Contents
Contributors
Foreword
Preface
Acknowledgments
CHAPTER 1
Introduction to the Specialty of Addictions Nursing
EDITORS: Dana Murphy-Parker, MS, CRNP, PMHNP-BC, CARN-AP
CONTRIBUTORS: Robin Foley, MS, APN, PMHNP-BC, CARN-AP Audrey Forka,
MSN, APN, PMHNP-BC Roseann Regan, PhD, APRN-BC Pooja
Shah, MS, CRNP, FNP-BC Harvey “Skip” Davis, PhD, RN, CARN
Katherine Fornili, MPH, RN, CARN Christine Vourakis, DNSc, RN
CHAPTER 2
Theoretical Perspectives
EDITOR: Stephen Strobbe, PhD, RN, PMHCNS-BC, CARN-AP
CHAPTER 3
Neurobiology of Addiction
EDITOR: William J. Lorman, PhD, MSN, PMHNP-BC, CARN-AP
CHAPTER 4
Health Promotion and Risk Reduction
EDITOR: Christine Vourakis, PhD, RN, FIAAN, FAAN
CONTRIBUTORS: Carolyn Baird, DNP, RN-BC, CARN-AP, CCDPD, FIAAN Janice
Cooke Feigenbaum, RN, PhD
CHAPTER 5
Diagnosing and Treatment of Addictions
EDITORS: Janice Cooke Feigenbaum, RN, PhD Al Rundio, PhD, DNP, RN,
APRN, NEA-BC, CARN-AP, DPNAP
CONTRIBUTORS: Harvey “Skip” Davis, PhD, RN, CARN Gladys Diji, RN, MSN
Janice Dyehouse, RN, PhD Angela Fernanda, Tumolva Natividad
RN, BSN, MSN Janice Cooke Feigenbaum, RN, PhD J. Frisicaro,
RN, MS, NP Julie Levin, RN, MSN Cheryl Nosek, RN, DNS
Christine Savage, RN, PhD, CARN Karen L. Schultz, RN, MSN,
CARN, LADC Barbara Traver, RN, MSN
CHAPTER 6
Evolving Process of Recovery, Change, and Growth
EDITOR: Dennis E. Hagarty, MSN, RN, CARN-AP, LCAS
CONTRIBUTORS: Janice Cooke Feigenbaum, RN, PhD C. Faith Smith-Goff, MSN,
RN, CARN-AP, LCAS Suzan Blacher, MSN, RN, CARN, TTS
CHAPTER 7
Special Populations
EDITORS: Janice Cooke Feigenbaum, RN, PhD Christine Savage, RN, PhD,
CARN William J. Lorman, PhD, MSN, PMHNP-BC, CARN-AP Al
Rundio, PhD, DNP, RN, APRN, NEA-BC, CARN-AP, DPNAP
CONTRIBUTORS: Karen D’Apolito, RN, PhD Janice Cooke Feigenbaum, RN, PhD
Deborah Finnel, RN, PhD, CARN Katherine Fornili, MPH, RN,
CARN Mary Ann Johnson, RN, PhD, GNP Sean McCarthy, RN,
MSN Elizabeth Pace, RN, MSM, CEAP Christine Savage, RN, PhD,
CARN Janet Wray, RN, PhD
CHAPTER 8
Nicotine Dependency
EDITORS: Elizabeth Fildes, EdD, RN, CNE, CARN-AP, APHN-BC Suzan
Blacher, MSN, RN, CARN, TTS
CHAPTER 9
General Psychopharmacology
EDITOR: William J. Lorman, PhD, MSN, PMHNP-BC, CARN-AP
CHAPTER 10
Pharmacotherapy for Substance Use Disorders
EDITOR: Al Rundio, PhD, DNP, RN, APRN, NEA-BC, CARN-AP, DPNAP
Index
CHAPTER 1

Introduction to the Specialty of Addictions


Nursing
EDITOR: Dana Murphy-Parker, MS, CRNP, PMHNP-BC, CARN-AP
CONTRIBUTORS: Robin Foley, MS, APN, PMHNP-BC, CARN-AP
Audrey Forka, MSN, APN, PMHNP-BC
Roseann Regan, PhD, APRN-BC
Pooja Shah, MS, CRNP, FNP-BC
Harvey “Skip” Davis, PhD, RN, CARN
Katherine Fornili, MPH, RN, CARN
Christine Vourakis, DNSc, RN

Goal Statement
The purpose of this chapter is to provide conceptual frameworks that introduce a
broad variety of theories and concepts relevant to addiction nursing practice, with
a focus on evidence-based practices.

OBJECTIVES

1. Provide an overview of conceptual frameworks of addictive behavior and


evidence-based practice including information on treatment and prevention,
in particular, Cognitive Behavioral Theory.
2. Provide information on the taxonomy of addiction and trends in
classification and organization of addictive phenomena.
Unit 1: History of Substance Use and Organized
Regulatory Efforts in the United States
Goal Statement
This unit will provide a broad overview of substance use disorders from historical,
social, and policy perspectives.

OBJECTIVES

1. Present the history of the prevention and treatment of substance use


disorders in the United States.
2. Provide an overview of policies related to the control and use of substances
in the United States.

I. Historical Overview of Substance Use in the United


States
A. From 1619 to 1785

1. Virginia grew as center of tobacco industry


a. People got drunk because they wanted to
b. Sales of Virginian tobacco equaled sales of Spanish tobacco in London by
1619
2. Marijuana grown as ingredient in rope making
3. 1642: Maryland passed law making public drunkenness crime, with fine of
100 lb of tobacco as punishment
4. Dominant beliefs about alcohol
a. Virginia established as tobacco colony
b. Alcohol was not addicting

B. From 1785 to 1865

1. 1785: Benjamin Rush observed similarity between alcoholism and hereditary


diseases
2. 1794: Alexander Hamilton curbed Whiskey Rebellion in Pennsylvania, caused
by high taxes on whiskey
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prevails, and at the conclusion of each year an Index is
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forms a complete
ASIATIC ANNUAL REGISTER AND LIBRARY OF REFERENCE.

London: W. H. ALLEN & Co., 13, WATERLOO PLACE, S.W.

(PUBLISHERS TO THE INDIA OFFICE),

To whom Communications for the Editor, and Advertisements,


are requested to be addressed.

Crown 8vo., 3s. 6d. each.

EMINENT WOMEN SERIES


Edited by JOHN H. INGRAM.

Already issued:—

GEORGE ELIOT.
By Mathilde Blind.

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London: W. H. Allen & Co., 13 Waterloo Place. S.W.


TRANSCRIBER’S NOTES
1. Typos fixed; non-standard spelling and dialect
retained.
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