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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
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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.
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Definitions
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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.
3
Scope of the Problem
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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 nondrugs; 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.
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Harm Reduction Model
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New approach to ATOD problems; recognizes that:
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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.
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Psychoactive Drugs
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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.
6
Psychoactive Drugs: Depressants
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Drugs that reduce the activity of the CNS
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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.
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Psychoactive Drugs: Depressants
(cont’d)
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Alcohol
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Oldest and most widely used psychoactive drug in the world
About two-thirds of American adults drink alcohol
Binge drinking
Chronic alcohol abuse
Heroin
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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.
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Psychoactive Drugs: Stimulants
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Drugs that increase the activity of the CNS, causing
wakefulness
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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.
9
Psychoactive Drugs: Marijuana
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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.
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Psychoactive Drugs: Hallucinogens
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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
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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.
11
Psychoactive Drugs: Inhalants
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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.
12
Predisposing/Contributing Factors
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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
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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.
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Primary Prevention
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Promotion of healthy lifestyles and resiliency
factors
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Assisting clients to achieve optimal health
Teaching assertiveness and decision-making skills
Teaching stress reduction and relaxation
techniques
Drug education
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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.
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Secondary Prevention
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Assessing for ATOD Problems
Drug testing
High-risk groups
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Adolescents
Older adults
 Injection drug users
 Use of drugs during pregnancy
 Use of illicit drugs
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Codependency and family involvement
Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
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Tertiary Prevention
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Detoxification
Addiction treatment
Smoking cessation programs
Support groups
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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.
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Nurse’s Role
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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.
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