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Course: Fundamentals of Nursing�Topic: Abuse Patterns within Communities

The Nurses International Community

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Module Goals

Learners will be able to:

Define the terms abuse and addiction.
Identity the risk factors for substance abuse and addition within communities.
Detail the nurse's role in identification,prevention and treatment of addiction in the community.
Define the terms of physical and emotional abuse.
Detail the role of the nurse in the identification, prevention and treatment of physical and emotional abuse.

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Definition Drug Abuse

National Cancer Institute, N.d

“The use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which they are meant to be used, or in excessive amounts”

People with a substance use disorder may have distorted thinking and behaviors.
Drug abuse may lead to:

Social, physical, emotional, and
Job-related problems

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Definition of Addiction

National Institute on Drug Abuse (NIDA), 2005

Addiction is defined as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain”.
It is considered both a complex brain disorder and a mental illness.
A medical illness caused by repeated misuse of a substance.

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Type of Addictions

Healthline, 2018

The most well-known and serious addiction is to drugs and alcohol.
The most common drug addictions are:

Nicotine, found in tobacco.
THC, found in marijuana.
Opioid (narcotics), or pain relievers
Cocaine.

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Effects of Substance Abuse and Addiction on Health

Center for Health Policy, 2018

Substance misuse has been associated with:

An increased morbidity and mortality from:

Cardiovascular conditions.
Injuries and motor vehicle crashes.
Sexually transmitted and blood-borne illnesses including HIV/AIDS and hepatitis B and C, resulting from risky sexual behaviors and/or injection drug use.
Pregnancy complications.
Neonatal abstinence syndrome (NAS).
Drug overdoses.

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Effects of Substance Abuse and Addiction on Health

Center for Health Policy, 2018

Social and Legal Consequences of substance abuse include:

Family disruptions
Financial problems
Lost productivity
Failure in school or at work
Domestic violence
Child abuse and
Crime

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Risk Factors for Substance Abuse and Addiction

Center for Health Policy, Indiana University, 2018

Significant community-level risk factors for substance use include but are not limited to:

Poverty
Violence
Low neighborhood attachment and community disorganization
Community norms and laws favorable toward drug use
Availability of alcohol / other drugs

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Risk Factors for Adolescent Substance Abuse

Whitesell et al., 2013

Risk factors for adolescent substance use are divided into three primary categories:

Familial Risk Factors include:

Childhood maltreatment (including physical and sexual abuse, emotional abuse and neglect)
Parental or familial substance abuse
Marital status of parents
Level of parental education
Parent-child relationships
Familial socioeconomic status and child perception that parents approve of their substance use

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Critical Thinking Question

Which of the following is the familial risk factors for Drug abuse? (Select all that apply)

childhood physical abuse
childhood emotional abuse
level of parental education
Age of parents

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Physical, Emotional Abuse and Neglect

Whitesell et al., 2013

Physical Abuse:

Any act that causes a child to experience physical harm that is not accidental.

Emotional Abuse:

According to a legal definition, emotional child abuse encompasses a situation whereby the child’s “intellectual or psychological functioning or development” is hindered.

Neglect:

A legal definition of child neglect includes any situation where a child’s caregiver does not provide adequate living necessities, including protection, clothing, health care, and/or food.

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Risk Factors for Adolescent Substance Abuse

Whitesell et al., 2013

Social Risk Factors include:

Deviant peer relationships
Peer pressure and Popularity
Bullying and
Gang Affiliation

Individual Risk Factors include:

Attention Deficit Hyperactivity Disorder (ADHD)
Depression
Posttraumatic Stress Disorder (PTSD) or mental illness

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Risk Factors for Adolescent Substance Abuse

Attention Deficit Hyperactivity Disorder (ADHD):

Is defined by either sustained inattention, characterized in part by forgetfulness and distractedness, or ongoing hyperactivity-impulsivity
Childhood ADHD leads to increased risk of developing a substance use disorder during adolescence or adulthood.

Depression:

Depressed adolescents may be at higher risk for developing a substance.use disorder at an earlier age after the onset of substance use.

Posttraumatic Stress Disorder (PTSD) or mental illness.

Whitesell et al., 2013

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Symptoms of Substance Use Disorder

American Psychiatrist Association, 2021

Symptoms of substance use disorder are grouped into four categories:

Impaired control: a craving or strong urge to use the substance; failed attempts to cut down or control substance use.
Social problems: failure to complete major tasks at work, school or home; social, work or leisure activities are given up.
Risky use: continued use despite known problems.
Drug effects: tolerance (need for larger amounts to get the same effect).

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Sign of Addictions

Tyler, 2018

Most signs of addiction relate to a person’s impaired ability to maintain self-control.
Includes changes that are:

Social: seeking out situations that encourage a substance or behavior.
Behavioral: increased secrecy.
Health related: insomnia or memory loss.

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Sign of Addictions

Tyler, 2018

Some behavior and emotional changes associated with addiction include:

Unrealistic or poor assessment of the pros and cons associated with using substances or behaviors.
Blaming other factors or people for their problems.
Increased levels of anxiety, depression, and sadness.
Increased sensitivity and more severe reactions to stress.
Trouble identifying feelings.
Trouble telling the difference between feelings and the physical sensations of one’s emotions.

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Effects of Substance Abuse and Addiction on Health

Center for Health Policy, 2018

Social and Legal Consequences of substance abuse include:

Family disruptions
Financial problems
Lost productivity
Failure in school or at work
Domestic violence
Child abuse and
Crime

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Critical Thinking Question

You are a nurse working in a community. What are the changes in the behaviors might you observe in the client who is suspected of drug addiction?

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Treatment of Substance Use Disorder (SUD)

The First step is recognition of the problem.
A combination of medication and individual or group therapy is most effective.
Medications are used to control drug cravings, relieve symptoms of withdrawal, and to prevent relapses.
Psychotherapy can help individuals with SUD:

Better understand their behavior and motivations.
Develop higher self-esteem.
Cope with stress, and address other psychiatric problems.

American Psychiatric Association, 2021

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Treatment of Substance Use Disorder (SUD)

Strategies outside of formal treatment which may include:

Hospitalization for medical withdrawal management.
Therapeutic communities (highly controlled, drug-free environments) or sober houses.
Out client medication management and psychotherapy.
Intensive out client programs.
Residential treatment (“rehab”).
Many people find mutual-aid groups helpful (Alcoholics Anonymous).
Self-help groups that include family members.

American Psychiatric Association, 2021

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Nurses Role in Person with Drug Addictions

Mkome, 2018
Tylor, 2018

Assessment:

Identifying the initial sign and symptoms of Addiction:
Some early stage clues include:

Family history of addiction
Being particularly drawn to an activity or substance
Seeking out situations where the substance or activity is present
Episodes of binging or loss of control with little to no feelings of remorse after

Assessment data:

Positive psychotic symptoms, Disorientation, Low concentrate, Fear

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Nurses Role in Person with Drug Addictions

Tylor, 2018

Look for Changes in Personality:

A lack of interest in hobbies or activities that used to be important
Neglecting relationships
Missing important obligations like work
Risk taking tendencies, especially to get drugs or continue certain behaviors
Ignoring the negative consequences of their actions
Distinct change in sleeping patterns that result in chronic fatigue

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Nurses Role in Person with Drug Addictions

Tylor, 2018

Look for Changes in Health:

Bloodshot or glazed eyes
Constant illness
Unexplained injuries
Abrupt change in weight
Bad skin, hair, teeth, and nails (drugs like methamphetamines or cocaine)
Physical withdrawal symptoms like sweating, trembling
Memory loss or problems with recall
Change in speech like slurred words

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Nurses Intervention with Drug Addictions

Imkome, 2018

Observe patterns of food and fluid intake; monitor and record intake, output, and daily weight.
Monitor pattern of elimination.
Calming activities before bedtime facilitate rest and sleep.
Present reality by spending time with the client to facilitate reality orientation because your physical presence is the reality.
Reorient the client to person, place, and time.
Integral part of the multidisciplinary treatment team in caring of symptomatic care, limits setting, structured support.
Psychoeducation and
Referrals for continuing care in the community

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Preventing Drug Misuse in Children and Teenagers

Communicate: Talk to children about the risks of drug use and misuse.

Listen: Be a good listener when children talk about peer pressure, and be supportive of their efforts to resist it.

Set a good example: Don't misuse alcohol or addictive drugs. Children of parents who misuse drugs are at greater risk of drug addiction.

Strengthen the bond: Work on relationship with children. A strong, stable bond between parents and a child will reduce the child's risk of using or misusing drugs.

Mayo Clinic, 2017

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Nurses Role for Children with Maltreatment

National Association of School Nurses, 2018

Involved in prevention, early identification, reporting, and treatment related to child maltreatment:

Know local laws, regulations, policies, and procedures for reporting child maltreatment
Know the signs and potential indicators of child maltreatment including sexual exploitation
Provide clear nursing documentation that includes questions asked and answers given and use a body diagram when appropriate for suspected child maltreatment and sexual exploitation

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Nurses Role for Children with Maltreatment

National Association of School Nurses, 2018

Provide students with personal body safety education.
Educate and support staff regarding the signs and symptoms of child maltreatment.
Identify students with frequent somatic complaints which may be indicators of maltreatment.
Provide support to victims of child maltreatment.
Facilitate the linkage of victims and families to community resources, including a medical home.
Collaborate with community organizations to raise awareness and reduce the incidence of child abuse and neglect.

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Critical Thinking Question

When you are educating parents what advice would you provide to prevent their children from drug abuse?

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References

Imkome, E., 2018. Nursing Care of Persons with Drug Addictions. https://www.intechopen.com/chapters/59036

Mayoclinic, (2017). Drug Addiction ( Substance Use Disorders). https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112

National Cancer Institute, (N,d).Drug Abuse. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-abuse

National Association of School Nurses, (2018). Prevention and Treatment of Child Treatment: The Role of the School Nurse. https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-child-maltreatment

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References

NIDA. (2020), June 25. The Science of Drug Use and Addiction: The Basics.

https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics

Tylor, M., (2018). What is Addiction. Healthline. https://www.healthline.com/health/addiction

Whitesell, M., Bachand, A., Peel, J., & Brown, M. (2013). Familial, social, and individual factors contributing to risk for adolescent substance use. Journal of addiction, 2013, 579310. https://doi.org/10.1155/2013/579310

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