Chapter 24 Alcohol, Tobacco, and Other Drug Problems in the Community Mary Lynn Mathre Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Introduction Substance abuse is the number-one national health problem, causing more deaths, illnesses, and disabilities than any other health condition The substance abuser not only is at risk for personal health problems but also may be a threat to the health and safety of family members, co-workers, and other members of the community Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Definitions Alcohol, tobacco, and other drugs (ATOD): serves as a reminder that the leading drug problems involve alcohol and tobacco Substance abuse: use of any substance that threatens a person’s health or impairs his or her social or economic functioning Drug dependence: physiological change in central nervous system as a result of chronic drug use Drug addiction: pattern of abuse characterized by an overwhelming preoccupation with obtaining and using a drug; high tendency for relapse if drug is removed Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Scope of the Problem ATOD abuse and addiction can cause multiple health problems for individuals Factors that contribute to substance abuse problems: lack of knowledge about use of drugs; acceptance of certain drugs (alcohol, nicotine, caffeine) as non-drugs; lack of quality control of illegal drugs; drug laws that label certain drug users as criminals Every culture has beliefs and attitudes toward ATOD that are influenced by the way society categorizes drugs as either “good” or “bad” Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Harm Reduction Model New approach to ATOD problems; recognizes that: 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 Model accepts that psychoactive drug use (including alcohol and tobacco) is endemic and focuses on pragmatic interventions, especially education, to reduce adverse consequences of drug use and get treatment for addicts Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychoactive Drugs Psychoactive drugs: drugs that affect mood, perception, and thought Used for enjoyment in social and recreational settings and for personal use to self-medicate physical or emotional discomfort Divided into categories according to their effect on the CNS and the general feelings or experiences the drugs may induce Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychoactive Drugs: Depressants Drugs that reduce the activity of the CNS Lower the body’s overall energy level, reduce sensitivity to outside stimulation; in high doses, induce sleep In general, depressants decrease HR, RR, muscular coordination, and energy while dulling the senses Higher doses can lead to coma and, if vital functions shut down, death Major categories include alcohol, barbiturates, benzodiazepines, and opioids (this chapter discusses alcohol and heroin) Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychoactive Drugs: Depressants (cont’d) Alcohol Oldest and most widely used psychoactive drug in the world About two-thirds of American adults drink alcohol Binge drinking Chronic alcohol abuse Heroin Most common opioid taken for recreational use Tolerance and physical dependence develops quickly Serious complications result from unsanitary administration of the drug and complications due to overdose or the intoxication it can cause Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychoactive Drugs: Stimulants Drugs that increase the activity of the CNS, causing wakefulness Cause the nerve fibers to release noradrenaline and other stimulating neurotransmitters Do not give the person more energy; they make the body expend its own energy sooner and in greater quantities than it normally would Nicotine Cocaine Caffeine Amphetamines Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychoactive Drugs: Marijuana The most widely used illicit drug in the United States Psychological dependence can occur with chronic use; little known about potential physical dependence Because of illegal status, there is no quality control, and a user may consume contaminated marijuana Despite its beneficial effects, especially in treating pain, the only legal access to this medicine has been through the FDA’s Compassionate Investigational New Drug Program, which was closed in 1992. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychoactive Drugs: Hallucinogens Drugs that stimulate the nervous system and produce varied changes in perception and mood Can cause intoxication and lead to altered perception and impaired judgment Responses is related to user’s mood, basic emotional makeup, and expectations, including the ability to cope with perceptual distortions and immediate surroundings Chronic use can lead to psychologic effects and impaired judgment, which can in turn lead to dangerous decisions or accidents Indole hallucinogens; hallucinogens that resemble adrenalin and amphetamines MDMA (Ecstasy) Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychoactive Drugs: Inhalants Substances, often common household chemicals, that are inhaled by drug users; may be inhaled from bottles, aerosol cans, or soaked cloth Often among the first drugs that young children use User can get high several times in short period since inhalants are short-acting and have a rapid onset Depending on dose, user may feel slight stimulation or lowered inhibition or may lose consciousness Link exists between school performance and use of inhalants Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Predisposing/Contributing Factors In addition to the specific drug being used, two major variables influence the particular drug experience: set and setting; all three factors must be considered to understand the various patterns of drug use and abuse Drug (see previous slides) Set: the individual using the drug Setting: the influence of the physical, social, and cultural environment within which the use occurs Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Primary Prevention Promotion of healthy lifestyles and resiliency factors Assisting clients to achieve optimal health Teaching assertiveness and decision-making skills Teaching stress reduction and relaxation techniques Drug education Emphasizing to clients that no drug is completely safe and that any drug can be abused Helping clients make informed decisions about drug use to minimize potential harm Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Secondary Prevention Assessing for ATOD Problems Drug testing High-risk groups Adolescents Older adults Injection drug users Use of drugs during pregnancy Use of illicit drugs Codependency and family involvement Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Tertiary Prevention Detoxification Addiction treatment Smoking cessation programs Support groups Alcoholics Anonymous (AA) Al-Anon and Alateen Narcotics Anonymous (NA) Pills Anonymous (for persons with polydrug addictions) Overeaters Anonymous Gamblers Anonymous Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Nurse’s Role Nurse’s knowledge of community resources and how to mobilize them can significantly influence the quality of care clients receive Brief interventions by a nurse can be as effective as treatment Nurses can play a key role in developing community prevention programs Nurses are in ideal roles to assist with tertiary prevention for addicted person and the family Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.