Chapter 16 ppt

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter : 16
Substance 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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