1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 37 Alcohol, Tobacco and Other Drug Problems

2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Analyze personal attitudes toward alcohol, tobacco, and other drug problems. 2. Differentiate among these terms: substance use, abuse, dependence, and addiction. 3. Discuss the differences among the major psychoactive drug categories of depressants, stimulants, marijuana, hallucinogens, and inhalants.

3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 4. Explain the role of the nurse in primary, secondary, and tertiary prevention of alcohol, tobacco, and other drug problems as it relates to individual patients, their families, and special populations. 5. Evaluate the role of the nurse in primary, secondary, and tertiary prevention of alcohol, tobacco, and other drug problems as it relates to the community and national policies on drug control.

4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview  Alcohol prohibition from 1920 to 1933  Sharp increase in violent crime and corruption  War on drugs and prohibition on marijuana, cocaine, and other drugs  Increase in violent crime and reports of corruption among law officials  Drug war budget grows each year  Most of it goes to law enforcement and punishment.  Only 1/3 goes toward prevention and treatment.

5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Attitudes  “Good” drugs  Over-the-counter (OTC) drugs  Prescription drugs  “Bad” drugs  Illegal drugs  Addicts often viewed as immoral, weak-willed, or irresponsible persons who should try harder to help themselves  Nurses must examine their attitudes toward alcohol, tobacco, and other drug (ATOD) use, abuse, and addiction before working with this health problem.

6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Myths  “An alcoholic is a skid row bum.”  “If you teach people about drugs, they will abuse them.”  “Addiction is a sin or moral failing.”

7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Paradigm Shift  Shift from “War on drugs” to an approach that includes role of treatment  National drug policies need to be more comprehensive rather than focusing on law enforcement strategies.  Harm reduction model  Addiction is a health problem.  Any psychoactive drug can be abused.  Accurate information can help people make responsible decisions about drug use.  People who have ATOD problems can be helped.

8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Definitions  Drug use  Drug abuse  Psychoactive drugs  Drug dependence  Withdrawal  Drug addiction  Alcoholism

9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Psychoactive Drugs  Alcohol  Fetal alcohol syndrome (FAS) or fetal alcohol effects (FAEs)  Tobacco  Mainstream smoke  Sidestream smoke  Marijuana

10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Predisposing/Contributing Factors Set Setting Bio-psychosocial Model of Addiction

11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Set  Refers to the individual using the drug as well as that person’s expectations (including unconscious expectations) about the drug being used  A person’s current health may alter a drug’s effect from one day to the next.  Genetically predisposed to alcoholism or other drug addiction  Underlying mood disorders or other mental illness

12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Setting  The influence of the physical, social, and cultural environment within which the use occurs  Daily stressors  Advertisements  Lower socioeconomic background

13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Bio-psychosocial Model of Addiction  Provides a framework for understanding addiction as being the result of the interaction of multiple factors

14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Primary Prevention  Promotion of healthy lifestyles and resiliency factors  Drug education

15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Secondary Prevention  Assessing for alcohol, tobacco, and other drug problems  Drug testing  High-risk groups  Codependency and family involvement

16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Tertiary Prevention  Detoxification  Addiction treatment  Smoking cessation programs  Support groups  Nurse’s role

17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Outcomes  Nurses can assess the health of the community and its citizens, prioritize the needs, and identify local resources to collaborate with others to develop strategies that will improve the underlying health of the community.  Early identification and intervention for persons with ATOD problems can prevent many of the harmful physical, emotional, and social consequences that may occur if abuse continues and may prevent abuse patterns from developing into addiction.