Florida National Substance Abuse Community Health Problem Discussion Substance abuse as a community health problem. Violence and nursing response. Read c
Florida National Substance Abuse Community Health Problem Discussion Substance abuse as a community health problem.
Violence and nursing response.
Read chapters 26 and 27 of the class textbook and review the attached PowerPoint presentations. Once done answer the following questions.
Discuss the historical trends and current conceptions of the cause and treatment of substance abuse.
Identify and discuss the issues related to substance abuse in various populations encountered in the community health nursing practice.
Describe and discuss the concepts of interpersonal and community violence.
Describe and discuss the role of the nurse in primary, secondary and tertiary prevention of violence.
Present your assignment in an APA format word document, Arial 12 font attached to the forum. A minimum of 2 evidence-based references besides the class textbook no older than 5 years must be used. A minimum of 700 words is required. Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.
For your guidance, there is a rubric attached in the assignment. Chapter 26
Substance Abuse
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
More deaths, illnesses, and disabilities are
attributed to substance abuse than to any other
preventable health conditions in the United
States.
Substance Abuse and Mental Health
Services Administration (SAMSHA)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Social Consequences of Substance
Abuse
?
?
?
?
?
Crimes while under the influence of drugs,
alcohol, or both
Need for money to buy substances
Specific theft of drugs
Almost 75% of inmates report prior drug use
All aggregates in society are potentially
affected by substance abuse problems
regardless of age or economic level
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Etiology of Substance Abuse
?
Numerous theories try to explain it
? Combination
of many factors
? Genetics within families
? Individual (impulsivity and ease of disinhibition)
? Environmental factors
? Medical models
? Biopsychosocial models
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4
Historical Overview of Alcohol and Illicit
Drug Use
?
?
Alcohol use has gained
more social acceptance
than other drug use.
Public attitudes and
governmental policies have
also influenced the history of
illicit drug use.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Historical Overview of Alcohol and Illicit
Drug Use (Cont.)
?
Consumption and laws affected by:
? Alcohol-related
deaths after lowered drinking age
? Less tolerant national attitudes toward drinking
? Increased societal and legal pressures and actions
against drinking and driving
? Increased health concerns among Americans
? Knowledge of addictive properties
? Counterculture acceptance of hallucinogens,
cannabis, and heroin
? The War on Drugs
? Renewed interest in prevention/treatment efforts
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Laws Impacting Substance Abuse
?
AntiDrug Abuse Acts of 1986 and 1988
?
?
?
?
Increased funding for treatment and rehabilitation
Created the Office of National Drug Control Policy (drug
czar)
Worked on a public health approach to drug control
National Institute on Drug Abuse (NIDA)
?
Science on drug abuse and addiction
Prevention
Treatment
Decreasing the spread of HIV/AIDS
Other priority areas
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Laws Impacting Substance Abuse
(Cont.)
?
Substance Abuse and Mental Health Services
Administration (SAMHSA)
? Builds
and sustains programs, policies, information
and data, contracts, and grants toward helping the
nation act on the knowledge that promotes
behavioral health treatment through all levels of
prevention
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Prevalence, Incidence, and Trends
?
Alcohol use by persons aged 12 or older:
? Slightly
more than half (52.8%) drink alcohol
? Binge drinking at least once in prior 30 days
(22.6%)
? Heavy drinking6.2%
? Young adults ages 18-25 had highest prevalence
of binge and heavy drinking39.8%
? Drove under the influence of alcohol at least once
in past year11.1%
SAMHSA (2011)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Prevalence, Incidence, and Trends
(Cont.)
?
Illicit drug use by persons aged 12 or older:
? About
8.7% were current drug users, used an illicit
drug during the past month
?
Illicit drugs used
? Marijuana
was the most commonly used drug
? Others included cocaine (including crack), heroin,
hallucinogens, inhalants, or prescription-type
psychotherapeutics (pain relievers, tranquilizers,
stimulants, and sedatives) used nonmedically
SAMHSA (2011)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Prevalence, Incidence, and Trends
(Cont.)
?
Nonmedical use of prescription-type
psychotherapeutics
? There
is a significant increase in the lifetime
nonmedical use of pain relieversspecifically
Percocet®, Percodan®, Vicodin®, Lortab®,
Darvocet®, Darvon®, Tylenol® with Codeine,
Propoxyphene, or Codeine Products, Oxycodone,
and Hydrocodone
NIDA (2010)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Prevalence, Incidence, and Trends
(Cont.)
?
Hallucinogen, inhalant, and heroin use
? LSD
(d-lysergic acid diethylamide)
? Peyote cactus
? Psilocybin
? PCP (phencyclidine)
? Inhalants of choice are amyl nitrite, poppers,
followed by glue, shoe polish, or toluene; correction
fluid, degreaser, or cleaning fluid; gasoline or
lighter fluid; and spray paints and other aerosols.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Prevalence, Incidence, and Trends
(Cont.)
?
Gender difference
?
?
?
Geographic trends
?
?
Males more likely to be current illicit drug users
Female illicit drug use (12 and older) increasing
Highest in West > Midwest > Northeast > South
Racial/ethnic groups
?
Highest among American Indians or Alaska
natives > African Americans> whites > Hispanics
> Asians
SAMHSA (2010)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Trends in Substance Abuse
?
?
?
?
May or may not relate to classically or
clinically defined dependence or addiction.
Many are turning to recovery before they have
developed physiological dependence.
Need to differentiate between use and
misuse/abuse.
Use of harmful substances is indirectly and
directly related to all of the leading health
indicators targeted in Healthy People 2020.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Methamphetamine (MA)
?
?
?
?
Most widely produced controlled substance in
the United States.
Illegal street names of the drug (crank, crystal,
meth, ice, or glass).
Can be injected, inhaled, taken orally, or
smoked.
Used predominantly by white young persons,
with an overrepresentation of females.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Methamphetamine (MA) (Cont.)
?
Pleasurable effects are caused by the release
of high levels of dopamine in the brain,
leading to increased energy, a sense of
euphoria, and increased productivity.
? Short-term
effects: increased heart rate, insomnia,
excessive talking, excitation, and aggressive
behavior
? Prolonged use results in tolerance and
physiological dependence
?
Negative consequences range from anxiety,
convulsions, and paranoia, to brain damage.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Methamphetamine (MA) (Cont.)
?
The impact of MA abuse on communities,
families, and social networks is considerable.
? Young
children of users are at risk for abuse and
neglect.
? Prenatal use puts children at risk for developmental
problems, aggression, and attention disorders.
? Exposure to combustible second-hand fumes.
? Associated with increased incidence of violence
(e.g., domestic abuse, homicide, and suicide)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Steroids
?
Anabolic steroids are synthetic variants of male
sex hormone testosterone
?
?
?
Build muscle and said to be androgenic
Most commonly used in athletes and other individuals
willing to risk potential and irreversible health
consequences to build muscle
Potentially fatal risks
?
?
Blood clots, liver damage, premature cardiovascular
changes, increased cholesterol
Increased potential for suicide and aggressive and
risky behaviors
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Inhalants
?
Contain volatile components with
psychoactive properties
? Many
products found in home or workplace (e.g.,
spray paints, markers, glues, and cleaning fluids)
?
?
Produce a rapid high that may resemble
alcohol intoxications; may progress to loss of
sensation and even unconsciousness
Irreversible effects:
? Hearing
loss, limb spasms, CNS or brain damage,
or bone marrow damage; may result in death from
heart failure or suffocation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Adolescent Substance Abuse
?
Highest prevalence of illicit drug use during
lifetime between 18 and 25 years
? Teen
use of cigarettes and smokeless tobacco has
declined
? Nearly half of teens try marijuana before they
graduateskepticism about drugs danger
?
As harmful, illicit substances come in and out
of vogue, CHN needs a good understanding
of drug culture, terminology, and differing
signs and symptoms
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Conceptualizations of Substance
Abuse
?
?
?
Conceptualizations have changed over the
years, often for political and social reasons
rather than for scientific reasons.
Dependence or abuse
What substances can be abused?
? APA
focuses on alcohol, amphetamines, caffeine,
cannabis, cocaine, hallucinogens, inhalants,
nicotine, opioids, phencyclidine, sedatives, and
hypnotics or anxiolytics
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Defining Substance Abuse
?
Substance abuse: a maladaptive pattern of
substance use that is manifested by recurrent
and significant adverse consequences related
to repeated use of a substance.
? Failure
to fulfill major role obligations
? Repeated use in physically hazardous situations
? Multiple legal problems
? Recurrent social and interpersonal problems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Defining Substance Abuse (Cont.)
?
Dependence: a cluster of cognitive,
behavioral, and physiological symptoms that
indicate continued use of the substance
despite significant substance-related problems
? Pattern
of repeated, self-administered use
? Tolerance, withdrawal, and compulsive drug-taking
behaviors
? A craving or strong desire for the substance
? Preoccupation with supply, money to purchase,
and getting through time between periods of use
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Sociocultural and Political Aspects of
Substance Abuse
?
?
?
Determined largely by economic, cultural, and
political conditions of potential users
Cultural conditions create ambiguity in clearly
determining when a problem exists.
Competing value systems lead to cultural
disintegration and a sense of powerlessness
and hopelessness.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Course of Substance-Related
Problems
?
Path from initiation to dependency is
multidimensional.
?
?
?
?
?
Person + substance + context/environment
Progression variesfrom initiation to continuation,
transition to abuse, and finally, addiction and
dependency
Critical point is transition from use to abuse
Addiction/dependency marked by changes in both
behavior and cognition
Once addiction is established, withdrawal symptoms
are strong motivators to continue use
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Legal and Ethical Concerns
?
U.S. policy based on prohibition and criminal
sanctions against use and sale of illicit drugs
?
?
?
?
Criminal activities (violence and drug trafficking)
Drinking and driving, working while intoxicated
Impact on fetus (FAS)
Modes of intervention
?
?
?
?
Limit access
Media campaigns
Educational programs
National organizations that promote community education,
research, and support
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Prevention Strategies
?
Primary prevention
? Needs
assessment to identify high-risk situations
and potential problems
? Decriminalization and legalization of drugs(?)
? Community-based programs
? Training of health professionals
? Faith-based initiatives
? Volunteer consumer groups
? Organized sports programs
? Employer programs
?
Often overshadowed by War on Drugs
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
27
Prevention Strategies (Cont.)
?
Secondary prevention
? Screening
and finding resources
CAGE: an alcoholism screening test
Clinical Institute Withdrawal Assessment (CIWA)
Use evidence-based programs
? Efforts should be specific to aggregates, rather
than directed at the general public
? Incorporate culturally sensitive and appropriate
interventions and strategies
? Work toward improving individuals general
competencies, communication skills, and selfesteem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
28
Treatment
?
For individuals, consider:
? Cultural
and educational
background
? Resources of the person
? Attitudes of significant others
? Degree of invasiveness of the
effects of the substance use The
existence of alternatives
? Relapse prevention
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
29
Treatment (Cont.)
?
Inpatient and outpatient treatment programs
? May
or may not include detoxification component
? Voluntary vs. compulsory
? Pharmacologically based vs. drug free
? Treatment approaches and models vary
?
?
?
?
Assessment process is of primary importance.
Therapeutic relationship based on trust is
essential.
Physical examination is a valuable tool.
Nonjudgmental attitude minimizes
defensiveness.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Treatment (Cont.)
?
Programs usually include:
? Group
and individual therapy and counseling
? Motivational interviewing
? Family counseling
? Education
? Socialization into 12-step mutual self-help groups
? Integrate psychotherapy with pharmacotherapy
? May include other strategies:
Hypnosis, occupational therapy, confrontation,
assertiveness training, blood alcohol level discrimination
training, behavior modification approaches
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
31
Treatment (Cont.)
?
Pharmacotherapies
? Used
in detoxification, stabilization, maintenance,
as antagonists, and as treatment for coexisting
disorders
?
Mutual help groups
? Operate
through face-to-face supportive interaction
focusing on a mutual goal; AA was first
?
Harm reduction
? Elimination
of the more harmful effects of
substance use through behavior and policy
modifications
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
32
Social Network Involvement
Therapy that involves the family has proved to
be most effective in aiding recovery.
? Family and friends
? Highly
influential or aid and abet
? Codependency and enabling
?
Effects on the family
? Functional
or dysfunctional families
? Psychological and financial burdens
?
Professional enablers
? Treatment
of symptoms by medication
? Reluctant to bring up this taboo subject
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
33
Vulnerable Aggregates:
Preadolescents and Adolescents
?
?
?
?
?
Times of experimentation, searching, confusion,
rebellion, poor self-image, alienation, and insecurity
Use of legal substances (e.g., tobacco, alcohol)
almost always precedes use of illegal drugs.
Poor school performance and drug use among peers
are strongest predictors of subsequent drug
involvement, followed by lack of strong family bond.
The younger the initiation, the greater the probability
of prolonged and accelerated use.
Feeling of powerlessness; selling drugs seen as a
viable economic solution to poverty.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Vulnerable Aggregates: Preadolescents
and Adolescents (Cont.)
?
Primary prevention focuses on:
? Advocating
for these vulnerable children
? Educating teachers on the vital importance of
maintaining a validating, nonjudgmental attitude
toward these students
? Supporting strong families in the community
? Improving knowledge through education and media
? Early detection of predisposing factors
? Providing structured clubs and organizations
? Facilitating school success, career skills, family
communication skills, and conflict resolution
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
35
Vulnerable Aggregates: Elderly
?
Elderly experience
? Diminished
physiological tolerance
? Increased use/misuse of medically
prescribed drugs
? Cultural and social isolation
?
Misuse of prescription drugs may be the most
common form of drug abuse among the
elderly
? Use
prescription medications approximately three
times as frequently as general population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
36
Vulnerable Aggregates: Women
?
?
Alcohol use and abuse affects women much
differently than men.
Women absorb and metabolize alcohol
differently.
? Body
composition differences and production of
less gastric alcohol dehydrogenase
? Metabolize alcohol at a different rate
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
37
Vulnerable Aggregates: Women
(Cont.)
?
Increased risk stems from economic, social,
and cultural factors.
? Marginalization
of certain groups
? History of child abuse
? Physical and medical problems related to
reproductive systems
? Use during pregnancy has long-term
developmental consequences for the newborn
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
38
Vulnerable Aggregates: Ethnocultural
Considerations
?
African Americans, Hispanics, and Native
Americansincreased risk for substance abuse.
?
?
?
?
?
?
?
Economically disenfranchised groups
Discrimination and racism
Socioeconomic, political, and historical realities
Myths and stereotypes
Social supportpositive effect on treatment/outcome
Environmental cues and conditioned reinforcement
Treatment poses special challenges.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
39
Vulnerable Aggregates: Other
Aggregates
?
Substance abuse is most common
psychopathological problem in the general
population.
? Dual-diagnosis
individuals
Psychiatric disorder + substance abuse disorder
? Risk for multiple vulnerabilities in one individual
? Impact of substance abuse on STDs
? Substance abuse among health care professionals
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
40
Nursing Interventions in the
Community
?
?
?
?
?
?
Understand own experiences and prejudices.
Routinely assess substance use patterns
when performing client histories.
Be alert to environmental cues in the home
that indicate substance abuse.
Increase the individuals and familys
awareness of the problem.
Involve the social network in getting the client
into treatment.
Develop a caring nursing relationship.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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