1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.