Substances Abuse, Research Paper Example

Substance abuse is a maladaptive pattern of using drugs and alcohol for non-medical reasons. Once a person begins to use substances to the point of harm to themselves or others, they are considered to be dependent on the substance. The etiology, prevalence, morbidity and mortality rates vary depending on the individual’s health status and living conditions. The person’s drug of choice will also determine how the body reacts and adapts to the ingestion of chemicals, smoke and alcohol. The abuse of any substance which causes mental, physical or emotional long-term changes can induce symptomatology to resemble various medical and mental illnesses.

Substance abuse, different from other illnesses, begins with a conscious decision to use a drug or take a drink.  Changes that occur in the brain at some point can turn drug use and abuse into a chronic, relapsing illness. (Wasilow-Mueller, S., Erickson, C.K., 2001).  Current acceptance of substance abuse as a medical and mental illness is a relatively new phenomenon; first recognized and acknowledged approximately 20 years ago.  Substance use first activate the brain’s pleasure senses, creating a euphoric sensation. For some individuals who are genetically predisposed can become dependent on the substance quickly and with fewer episodes of use.  Research on the genetics of alcohol dependency or alcoholism suggests that the tendency to become alcoholic is inherited via presumed genetic mutations (Galanter & Kleber, 2008).

Prevalence of substance use and abuse varies depending on local and regional culture and social normals.  Resources and supply/marketing of substances depend on factors such as legal, illegal, prescription and legal ages to purchase. The southern states have a higher incidence of cigarette use, whereas alcohol use is centered more in the northeastern or Midwestern states (SAMHSA, 2010).  Morbidity and mortality rates vary depending on the substance and soci-economic conditions of the individual. A substance such as methamphetamine, with varying methods of administration, is a popular drug among users. This drug has a particularly high rate of death due to the ease of administration.

Nursing Care

Acute nursing care for a patient admitted for substance abuse includes a severity assessment to determine the profile of the patient. Focusing on the chemicals or alcohol the patient has used is important; as well as any medical or psychological issues the patient has been diagnosed with. Asking about legal and family/social aspects is also helpful in determining the treatment needs.  Nursing care also should focus on looking for symptoms that suggest substance use and abuse.  Patients who drink alcohol in excess may have the odor of alcohol on their breath and experience pain when the liver is palpated.  Nasal irritation, suggestive of cocaine insufflation or conjunctival irritation suggestive of marijuana smoke, should be watched for (Mersy, 2003).

Heavy users may need to go through a detoxification phase as a part of treatment. Once this has been determined nursing care will become management of acute symptoms with long-term care planning for continued management. Some facilities are not equipped to deal with a patient needing detoxification.  In this incidence, the nursing care will focus on investigating the various resources available, such as community based facilities and substance abuse treatment centers.

Being able to recognize substance abuse in various age groups can prove to be challenging. Adolescents will be confused by the effects of the substance and may develop a mistrust of adult authority (Mersy, 2003).  Older patients are difficult to assess due to cognitive problems with dementia or effects from early alcoholism in life. This age group is prone to self-medicate also which presents additional problems.  Patients with mental disorders are unreliable on questioning and cognition. Interestingly, another factor observed is the high number of alcohol-dependent and other drug dependent individuals with a preference for foods high in sucrose concentration (Fortuna, 2010). This study demonstrated that children of alcoholic parents not only have the predisposed tendency towards substance abuse, but also eating disorders were recognized in this population.

Future Nursing Care

Substance abusers may or may not feel comfortable talking about their problem. Nursing care for acute and chronic care settings will need to be delivered with total honesty and absent of any judgment or bias. In order to deliver quality nursing care, the patient must feel comfortable and not discriminated against. In a research study conducted through the University of Pennsylvania, it was discovered that nurses assigned to a permanent care setting dealing specifically with substance abuse demonstrated a higher quality of care over nurses in a general hospital setting (Hanrahan & Aiken, 2008). The results are attributed to a nursing population which is an older and more experienced group. These are nurses which have the desire to work with substance abuse patients. Higher populations of male nurses were also seen in this study.

One area of research focused on college substance abuse has demonstrated that prevention is not effective. Educational programs and tools have not derailed the numbers of substance use and abuse for this population. The majority of these studies have found no effect with interventions on alcohol use and/or alcohol related negative consequences (Larimer & Cronce, 2005). The study determined that the most effective way to deal with this issue is the implementation of specific training for awareness. This training would specifically be geared towards police, faculty and the medical/mental health personnel located in areas of colleges and universities (Larimer & Cronce, 2005).

Substance abuse nursing care is not limited to patients admitting to drinking or using drugs.  Patients presenting to the hospital with other complaints who are abusers will have complications from the use/abuse and withdrawal syndrome.  Substance withdrawal complicates patient care, putting them at a higher risk for complications and death (Stewart & Richards, 2000). Nurses must be aware of the signs and symptoms associated with substance problem patients. Patients in denial or are worried over the stigma related with abuse may outright lie about their use/abuse. Making substance use a part of all nursing screening should be a routine part of the nursing assessment (Stewart & Richards, 2000). Surgical procedures are also complicated by substance use. One study found that patients who abstained from alcohol for one month prior to surgery demonstrated a dramatic decrease in perioperative complications (Stewart & Richards, 2000).

Anyone regardless of gender, nationality, location, or financial status can become dependent on various substances. Organizations exist to help combat and education the public. Nursing intervention is important in the care of someone facing the medical and mental complications of substance abuse.  Specific nursing care overall includes controlling symptoms of withdrawal with compassion and commitment. Verbal abuse from the patient should not be taken personally and managed with the understanding that the patient is not fully aware of their actions. Substance abuse is not limited to a certain population of individuals. Understanding the nursing processes for proper care requires ongoing research and consideration of practice changes to assist in the appropriateness of care to substance abuse individuals.

References

Fortuna, J.L. (2010). Sweet preference, sugar addition and the familial history of alcohol dependence; shared neural pathways and genes. Journal of Psychoactive Drugs. June, 2010; 42(2): 147-51. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20648910

Galanter, M., Kleber, H.D. (2008).  Textbook of Substance Abuse Treatment. American Psychiatric Publishing, Inc., Arlington, VA.

Hanrahan, N.P., Aiken, L.H. (2008). Psychiatric nurse reports on the quality of psychiatric care in general hospitals. Quality Management of Health Care. 2008;17(3); 210-217. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582015

Larimer, M.D., Cronce, J.M. (2005). Identification, prevention and treatment: a review of individual focused strategies to reduce problematic alcohol consumption by college students. Addictive Behaviors Research Center, Department of Psychology, University of Washington. September 23, 2005.   Retrieved from http://www.collegedrinkingprevention.gov/SupportingResearch/Journal/larimer.aspx

Mersy, D.J. (2003). Recognition of alcohol and substance abuse  American Family Physician.  2003, April 1; 67(7); 1529-1532. Retrieved from http://www.aafp.org/afp/2003/0401/p1529.html

SAMHSA. (2010).  U.S. Department of Health and Home Services. Retrieved from http://oas.samhsa.gov/2k3state/ch7.htm#7.1

Wasilow-Mueller, S., Erickson, C.K. (2001).  Drug abuse and dependency; etiology of drug dependency.  Journal of American Pharmacists Association. 2001; 41(1).  Retrieved from http://www.medscape.com/viewarticle/406713_4