Florida National Historical Trends of Substance Abuse Cause & Treatment Paper Substance abuse as a community health problem. Violence and nursing response

Florida National Historical Trends of Substance Abuse Cause & Treatment Paper 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.

The assignment is going to be checked by Turnitin by the professor, to detect Plagiarism. Plagiarism will not be tolerated, it result in an automatic 0. The % has to be lees than 12. This is the most important part in the assignment.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font . A minimum of 3 evidence-based references besides the class textbook no older than 5 years must be used and make sure the references are properly quoted in your assignment. 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. 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)
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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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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.
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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
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Laws Impacting Substance Abuse
?
Anti–Drug 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
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7
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
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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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 drinking—6.2%
? Young adults ages 18-25 had highest prevalence
of binge and heavy drinking—39.8%
? Drove under the influence of alcohol at least once
in past year—11.1%
– SAMHSA (2011)
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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 relievers—specifically
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.
12
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)
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13
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.
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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)
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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
graduate—skepticism about drug’s 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 varies—from 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.
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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
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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.
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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.
30
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
?
?
Mutual help groups
?
?
Used in detoxification, stabilization, maintenance,
as antagonists, and as treatment for coexisting
disorders
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
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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.
34
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
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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
Americans—increased risk for substance abuse.
?
?
?
?
?
?
?
Economically disenfranchised groups
Discrimination and racism
Socioeconomic, political, and historical realities
Myths and stereotypes
Social support—positive effect on treatment/outcome
Environmental cues and conditioned reinforcement
Treatment poses special challenges.
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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
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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 individual’s and family’s
awareness of the problem.
Involve the social network in getting the client
into treatment.
Develop a caring nursing relationship.
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