Ch. 26 Substance Abuse (pg.

515)
Key Terms:

Abstinence: not using substances of abuse at any time.

Addiction: chronic relapsing disease characterized by compulsive drug seeking and use, despite serious
adverse consequences, and by long-lasting changes in the brain.

Alcoholic Anonymous (AA): a self-help organization for people fighting alcoholism.

case management (CM): service to assist clients with serious mental illness and or substance abuse
problems in areas of, but not limited to, housing, finances, social, family, medical, medication
management, transportation, co-occurring substance use (abuse or dependence), and mental disorders.

Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA): tool measuring 10 items that are
associated with alcohol withdrawal: (1) nausea/vomiting, (2) anxiety, (3) paroxysmal sweats, (4) tactile
disturbances, (5) visual disturbances, (6) tremors, (7) agitation, (8) orientation, (9) auditory disturbances,
and (10) headache.

co-occurring disorders: substance use conditions and a mental health condition at the same time.

delirium tremors (DT's): a state of confusion accompanied by trembling and vivid hallucinations.
Restlessness, agitation, trembling, sleeplessness, rapid heartbeat, and possible convulsions. Often
occurring in people with alcohol use disorders after withdrawal or abstinence from alcohol.

detoxification: a clearing of toxins from the body, the medical and biopsychosocial procedure that
assists a person who is dependent on one or more substances to withdraw from dependence on all
substance of abuse.

dual diagnosis/dual disorders: conditions involving persons with one or more psychiatric diagnoses in
addition to a substance abuse problem.

harm reduction: individual and collective approaches to addressing substance use problems that are not
primarily aimed at complete abstinence from all substances. Harm reduction uses incremental change to
eliminate the harmful effects of substance use through behavior and policy modifications.

intensive outpatient treatment (IOT): at least 9 hours of treatment per week.

intervention: any act performed to prevent harming of a patient or to improve the mental, emotional, or
physical function of a patient.

mutual help groups: associations that are voluntarily formed, are not professionally dominated, and
operate through face-to-face supportive interaction focusing on a mutual goal.

National Institute on Drug Abuse (NIDA): Federal agency supporting research to prevent and treat drug
abuse and addiction and mitigate the impact of their consequences, which include the spread of
HIV/AIDS and other infectious diseases.

professional enablers: health care professionals that contribute to the initiation and continuation of
substance abuse and dependency (e.g., prescribing psychoactive medications).
social consequences: the effects that substance abuse have on an individual's role in society. These can
include a life involving crime, the need for money to buy substances, and specific theft of drugs.

specialty courts: problem-solving courts that help break the cycle of drug and/or alcohol addiction that
can influence adult criminal activity, juvenile delinquent behavior, or parental abuse and/or neglect of
children.

Substance Abuse and Mental Health Services Administration (SAMHSA): Federal agency with a mission
to reduce the impact of substance abuse and mental illness on America's communities, with strategic
initiatives working in programs, policies, information and data, contracts, and grants.

substance abuse treatment: An organized array of services and interventions with a primary focus on
treating substance abuse disorders.

substance: the use of psychoactive substances or alcohol for a purpose not consistent with legal or
medical guidelines.

War on Drugs: a U.S. government campaign first used by President Richard Nixon in 1971 as a
prohibition of illegal drug trade to end the import, manufacture, sale, and use of illegal drugs.

Essential Questions –
How does the Substance Abuse & Mental Health Services Administration impact behavioral health?
(p. 517)

 Builds and sustains programs, policies, information and data, contracts, and grants with the
intent of helping the nation act on the knowledge that promotes behavioral health treatment
through all levels of prevention.
 Promotes programs that work with military families as well as justice systems.

What social determinants of health impact substance abuse? (p. 531)

 Public tolerance and political and economic trends

 Each subculture may define abuse differently.
 Family & Friends:
 Used as social lubricants
 Codependency / enabling – promoting/covering up behaviors associated with substance
abuse.
 Effects on the Family:
 Substance abuse has been called a family disease (doesn’t only affect the abuser)
 Function vs Dysfunctional family system (532)
 Professional Enablers:
 Physician prescribing pain medications.
  Reluctancy of HCP to bring up this “taboo” topic, letting S&S of abuse go unaddressed.

How does the nurse identify addiction, substance abuse, and dependence?

 Not always easy to identify: No predictable course of addictive illness and no “addictive
personality type”.
 Must incorporate sociocultural and political dimensions.
 Possess knowledge to counter media stereotypes.
 Nurses may be the first to identify or suspect an alcohol or drug problem.
 Nurses should routinely assess substance use patterns when performing client histories.
 The Triad: Person, Substance, Environment
 Person: Demographic info, medical history, comorbidities, known perceptions
and meanings the individual displays.
 Substance: Quantity used, physiopharmacological effects, pattern of use,
availability, and toxicity.
 Environment: Family, social, employment, legal, cultural, economic.
 Alert to environmental cues in the home that indicate substance abuse, such as empty liquor
and pill bottles.
 Trust that develops in a caring nursing-client relationship can support disclosure of substance
abuse and decrease denial in the client or family members.
 What are Healthy People 2020 objectives related to substance abuse? (520 chart)

What are primary, secondary, and tertiary nursing interventions related to substance abuse? (p. 526)

Primary –

 Health teaching to individuals and groups on the risk factors, early symptoms, and adverse
health and social consequences of substance abuse; the addictive disease process; and available
treatment services.
 Need to gear educational approaches to the more vulnerable aggregates.
  Community-based programs, training of health professionals, faith-based initiatives, volunteer
consumer groups, organized sports programs, and employer programs.

Secondary –

 Screening and earlier treatment approaches aimed at minimizing health and social
consequences of substance abuse.
 Involvement of physicians, nurses, and other health care professionals in various community
health care settings in this process.
 Screening tools such as the CAGE test (A positive response to any of the CAGE questions does
not constitute a diagnosis of alcohol or drug dependence, but it should raise suspicion and
mandate for further investigation.

Tertiary –

 More direct approaches, such as case management, IOT, family therapy, and NA meetings with
sponsorship. Goals are to halt the physiologically damaging effects of hepatitis C and alcoholism
in Kate’s abstinence and sobriety.
 Frequent use of medications to treat symptoms of substance abuse-related disorders or as part
of aversion therapy.
 Services provided by medical practitioners, treatment services, and mutual help organizations
generally advocate abstinence from the substance and improving the individual’s health status.

What is the most commonly used illicit drug? (518)

 Marijuana

How does the Harm Reduction theory impact substance abuse treatment? (p. 531)

 Incremental change is sought, as opposed to complete abstinence.

 E.g. substitution of methadone for heroin. More of a harm reduction with meth than heroin.
 E.g. Alcohol – decreasing the number of drinks, decreasing the number of days in which drinking
occurs, or avoiding drinking when driving.
 Community level – Decreasing access to alcohol / raising the legal age. Legalization of some illicit
drugs and needle exchange programs.

What aggregates would the nurse identity as vulnerable (regarding substance abuse)? How would the
nurse intervene? (p. 533)

 Nonmedical prescription drug use: Males more often than females (except in ages 12-17 y/o)
 People in the West are the highest percentage of drug use.
 18-25 y/o = highest prevalence of illicit drug use.
 Preadolescents & Adolescents –
 Teenage years may be a time of experimentation, searching, confusing, rebellion, poor
self-image, alienation, and insecurity.
 Poor school performance, social settings where drug use is common, drug use among
peers = strongest predictors of drug involvement; followed by strength of family bonds.
 Feeling of powerlessness and selling drugs as a viable economic solution to poverty.
  Elderly –
 Diminished physiological tolerance, increased use of medically prescribed drugs, and
cultural and social isolation.
 Misuse of prescription drugs may be the most common form of drug abuse among the
elderly.
 Women –
 Alcohol use and abuse affect women much differently from how they affect men.
 Women who were abused as children
 Minorities
 Reproductive issues
 Ethnocultural Considerations
 Poverty, unemployment, decreased job opportunities, macro-level and micro-level
aggression, and ongoing racism  turn to substance abuse to “numb the social pain”
 Be aware of myths about minority aggregates and any triggers that may cause them
stress.

Added Nursing Interventions -

 Increase an individual’s awareness of their problem.

 Referrals to community education programs on substance abuse and dependence and mutual
help groups such as Al-Anon and Narcotics Anonymous are helpful interventions for families and
significant others.
 Involve the social network in getting the client into treatment.
 Must have knowledge of available community resources,
 Help substance abusers facilitate contact with helping agencies such as local treatment
programs or mutual help groups.
 Health teaching regarding addictive illness and addictive effects of different substances
 Advocating that EBP Tx works in special populations through problem-solving courts (drug
courts), specialized adolescent Tx, and other community case management programs.
 Providing direct care for abuse-related and dependence-related co-occurring medical problems.
 Educating clients and families about problems related to substance abuse.
 Collaborating with other disciplines to ensure continuity of care.
 Coordinating health care services for the client to prevent prescription drug abuse and avoid
fragmentation of care.
 Providing consultation to nonmedical professionals and lay personnel.
 Facilitating care through appropriate referrals and follow-up.
 Knowing how to refer to community resources working with substance abuse, mental health,
and other issues.