chapter 16 ppt

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter : 16Substance Abuse


Chapter Highlights

• Factors affecting prevalence rates of substance use—age, gender, race, socioeconomic level, urban or rural settings

• Population-based interventions to decrease substance use

• Evidence-based treatment protocols for substance abuse that should be incorporated by community health nurses in all practice settings

• Self-help groups—a highly effective community-based treatment with proven efficacy in sustaining recovery


Question

Is the following statement True or False?

Addiction is a term, along with habituation, which the WHO recommends be substituted with substance use.


Answer

False

Rationale: Addiction is a term, along with habituation, which the WHO recommends be substituted with substance dependence. However, clients and practitioners commonly use addiction.


Substance Abuse

• A person is diagnosed as having substance abuse when they exhibit the following behaviors associated with substance use:

– Problems at work, home, and school

– Problems with family or friends

– Physical danger

– Trouble with the law


Substance Use (cont.)

• The use of alcohol, illicit drugs, and nonmedical use of prescription medications

• Illicit drugs include cannabis, cocaine, heroin, hallucinogens, inhalants, and methamphetamine.

• Nonmedical use of prescription medications includes pain relievers, tranquilizers, stimulants, and sedatives.


Question


With no use of illicit substances or alcohol in the preceding 9 months, a person is considered “abstinent”.


Answer

False

Rationale: A person is considered “abstinent” with no use of illicit substances or alcohol in the preceding 12 months.


Addiction

• A term, along with habituation, which the WHO recommends be substituted with substance dependence

• Clients and practitioners commonly use addiction


Substance Dependence

• Health and emotional problems associated with substance use

• Unsuccessful efforts to cut down on use

• Symptoms of tolerance or withdrawal

• Reducing other activities to use the substance

• Spending time in activities related to substance use

• Using the substance in greater quantities or for a longer period of time than intended


Abstinence

• No use of illicit substances or alcohol in the preceding 12 months, a person is considered “abstinent”.


Question


The United States leads the world in rates of substance use.


Answer

True

Rationale: The United States leads the world in rates of substance use. Patterns of substance dependence vary by age, gender, race, ethnicity, and geographic location.


Prevention of International Substance Abuse

• Public health models that address drug and alcohol abuse often focus on interventions at following three points:

– The agent (the distributor of the substance)

– The host (the addicted person)

– The environment (local, national, or international)


National Scope of Experience and Evidence

• The United States leads the world in the proportion of its citizens who abuse or depend on illicit substances or alcohol.

• Cannabis is the most frequently used illicit substance in the United States.

• The United States leads the world in rates of substance use. Patterns of substance dependence vary by age, gender, race, ethnicity, and geographic location.


Health Profiles of High-Risk Groups

• Across the lifespan, the age cohorts at high risk for morbidity associated with substance use disorder include the following:

– Pregnant women

– Children under the age of 14

– College students, older adults in the baby-boom generation


Question


Studies of disadvantaged adolescents in impoverished areas or homeless youth have found that youth follow a stepwise progression of substance use.


Answer

False

Rationale: There is debate in the literature about the “gateway effect” theory of substance abuse, which proposes that substance abuse is progressive and begins with tobacco, then moves sequentially to alcohol or cannabis, and ultimately to other illicit substances. Studies of disadvantaged adolescents in impoverished areas or homeless youth have not found that these youth follow such a stepwise progression of substance use.


Environmental Factors

• Poverty

• Lack of access to health services

• Capacity of law enforcement to constrain supply

• Ethnic groups

– Native Americans

– Alaskan Natives

– African Americans


Biopsychosocial Risk Factors

• Genetic history

• Family history

• History of trauma

• Early initiation

• Environmental factors

– Poverty

– Group affiliation


Population-Based Interventions: Adolescents

• Population-based interventions to decrease substance use among adolescents can be conceptualized in the following four categories:

– Regulatory

– Developmental prevention

– Early screening

– Harm reduction


College Students and Binge Drinking

• Evidence-based programs most effective in decreasing alcohol related harms to underage populations include the following:

– Developmental prevention programs

– Early screening and brief intervention

– Government laws and school policies to reduce harmful incidents

– Tertiary treatments for those who meet criteria for substance use disorder or other associated mental disorders


Older Adults: Assessment

• The National Guideline Clearinghouse has 68 evidence-based treatment protocols for substance abuse, including screening and treatment of older adults.

• The protocols recommend screening for alcohol and prescription drug use yearly for all older adults and more frequent screening if there are any major life changes or transitions or if physical symptoms suggestive of substance abuse appear.


Behavioral Counseling of Alcohol Abuse

• Assess using standardized screening instruments

• Advise the older adult to reduce alcohol consumption to moderate levels

• Agree on goals for reducing alcohol use or abstinence

• Assist clients with acquiring the motivations, self-help skills, or supports needed for behavior change

• Arrange follow-up counseling and treatment


Methamphetamine Users

• School nurses have to be part of the solution to the methamphetamine epidemic through education of children, families, and the community about the effects of methamphetamine and advocacy for prevention and treatment programs.


Question


Screening for substance use is the second step in assessing if a person has substance use disorder.


Answer

False

Rationale: Screening for substance use is the first step in assessing if a person has substance use disorder. The efficacy of screening instruments is highly dependent on the candor of client responses.


Pharmacologic Treatments for Alcohol–Dependent Disorders

• Naltrexone

• Acamprosate

• Disulfiram


Pharmacologic Treatments for Opioid Use Disorders

• Methadone or buprenorphine should only be given as maintenance medications if the client has a history of opioid dependence exceeding 1 year.


Evidence-Based Psychosocial Treatments in Substance Use Disorders

• The evidence-based modalities for people with substance use disorders include

– Cognitive behavioral strategies that focus on relapse prevention and social skills training

– Motivational enhancement therapy

– Brief motivational interviewing

– Behavioral therapy that uses community reinforcement and contingency contracting

– Psychodynamic and interpersonal therapies for people with dual diagnoses

chapter 16 ppt

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