Concept Analysis: Intoxication

Background: It is estimated that about 20 million individuals aged 18 and older have a diagnosis of substance use disorder. This is approximately 8.5% of the adult population. (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Adults with alcohol or drug dependence and abuse were included in the substance use disorder. Intoxication is one of the broad terms connected to substance use disorder. Nurses and advanced practice nurses play a significant role in identification of intoxication and its negative health consequences. The concept of intoxication has yet to be examined as it applies to nursing practice, thus identifying the need for exploration. Concept analysis is a way to clarify a concept, examine the basic elements, and distinguish it from another concept.

Purpose: To explore the concept of intoxication through a concept analysis.

Methods:Walker & Avant’s eight steps of concept analysis were used. The origin, definitions, uses of the concepts, and defining attributes were identified. Model, related, and contrary cases were constructed. Lastly, antecedents, consequences, and empirical referents were identified.

Search strategy: Electronic databases searched included ProQuest, Google Scholar, MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psych INFO, and National Center for Biotechnology Information (NCBI). Keywords used in the search were: intoxication, drugs, alcohol, intox*, and substances.

Results: Intoxication is a concept used by various disciplines, including literature, religion/spirituality, legal, and medicine. Three defining attributes were identified - ingestion beyond limitations, abnormal and reversible mental state, and emotional and cognitive frenzy. These attributes significantly impact the signs, symptoms, and any physiological and psychological complications. The antecedent of intoxication is for the individual to obtain the substance(s) and ingest them in excess, whether accidental or intentional. Excessive consumption of these substances can potentiate the rate and duration of intoxication to occur. Possible consequences, ranging from minor to serious, associated with intoxication. Minor direct physical consequences of intoxication to an individual may include vomiting, dehydration, electrolyte imbalances, or malnutrition. Serious consequences of intoxication include trauma, delirium, convulsion, and coma (WHO, 2018). Liver damage is a major consequence associated with prolonged substance or alcohol use. Psychosocial implications of intoxication to a person are stigma, and isolation. Financial burden from acute binging or chronic substance consumption is posed on the person. The most serious consequence of an intoxicated person is the probability of injuring or killing another person when driving in this state. Model, related and contrary cases were constructed. Empirical referents are categories of the actual phenomena that demonstrate the existence or presence of the concept in its contextual framework (Walker & Avant, 2011). There are physical signs and symptoms of intoxication. These include increase in talkativeness, impairment of tasks requiring skill, loss of coordination, relaxation, altered perception, amnesia, slurred speech, sweating, flushed face, and loss of thoughts (California Department of Alcoholic Beverage Control, 2017). Toxicology is the broadest form of testing for intoxication. Blood and urine screening are the two most common forms of tests to determine levels of alcohol or presence of substance(s). Substances that can be identified from these tests include opiates, alcohol, THC, cocaine, benzodiazapines, and amphetamines (Apollo, 2018). Levels may vary depending on acute intoxication state or previous intoxication of a substance. In addition to toxicology, there are some assessment tool to determine intoxication. Currently, tool such as breathalyzers, and Intoximeters Drink Wheels are available to instantly calculate the amount of BAC (Intoximeter, 2018). The Intoxication Assessment Tool (A6) is an tool designed for the hospitality industry, licensed premises and policer officers to identify an intoxicated person based on their speech, appearance, coordination, and behavior (Health Promotion Agency, 2018). Additional examination and assessment tools for determining alcohol intoxication include the National Highway Traffic Safety Administration's Standardized Field Sobriety Test (SFST) examination, the Hack's Impairment Index (HII) examination, the Cincinnati Intoxication Examination (CIE), the Binary Intoxication Question (BIQ), and St. Elizabeth Alcohol Intoxication Scale (STE) (Benoit, Hart, Soliman, Barczak, Sibila, Lindell and Fermann, 2017).

Conclusion: The concept of intoxication is relevant to nursing practice due to the high number of patients with co-occurring psychiatric disorders that nurses care for. This concept is broad and encompasses a wide range of disorders relevant today. The current opioid addiction epidemic, the legalization of marijuana, and continued alcohol and drug abuse are just few related conditions that intersect with the concept of intoxication. This concept analysis provides a platform to increase awareness about substance use disorders.

Future directions: The analysis of the concept of intoxication has contributed to the evidence base for nursing practice in psychiatric mental health nursing. In clinical practice, nurses should be able to differentiate between intoxication and addiction during triage and through ongoing assessment. The role of nurses affords the opportunity to educate patients, families, and the community about the dangers of intoxication and make appropriate referrals. Nurses as leaders may be more apt to participate in policy change within the community to heighten awareness of risk and dangers of intoxication.

Keywords: intoxication, drugs, alcohol, intox*, and substance