Substance abuse as a community health problem.

Violence and nursing response.

Read chapters 26 and 27 of the class textbook and review the attached PowerPoint presentations.  Once done answer the following questions.

1. Discuss the historical trends and current conceptions of the cause and treatment of substance abuse.
2. Identify and discuss the issues related to substance abuse in various populations encountered in community health nursing practice.
3. Describe and discuss the concepts of interpersonal and community violence.
4. Describe and discuss the role of the nurse in primary, secondary and tertiary prevention of violence.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 6 discussion questions”  and the SafeAssign exercise in the assignment tab of the blackboard.   If you don’t post your assignment in any of the required forums you will not get the points.  A minimum of 2 evidence-based references besides the class textbook no older than 5 years must be used (excluding the class textbook).  You must post two replies to any of your peers on a different dates sustained with the proper references no older than 5 years as well and make sure the references are properly quoted in your assignment.  A minimum of 800 words is required.  Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.

Please check your assignment after the week is due because I either made comments or ask for clarification in some statements. 

Chapter 27

Violence

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Overview of Violence
Violence is a national public health problem.
WHO (2013) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”
Injuries from violence are referred to as intentional injuries.
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Factors That Contribute to Violence
Poverty, unemployment, economic dependency
Substance abuse
Dysfunctional family and/or social environment and lack of emotional support
Mental Illness
Media influence (e.g., violent video games, television shows, and movies)
Access to firearms
Political and/or religious ideology
Intolerance and ignorance
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History of Violence
Long history of human violence.
In the Bible, Cain killed his brother Abel out of jealousy and anger
Audience pleasure (e.g., gladiators in Rome)
Infanticide—if child was female, a twin, sickly, or deformed
Children, especially firstborn, sacrificed for religious reasons
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History of Violence (Cont.)
Corporal punishment used to control children
“Spare the rod and spoil the child” (Proverbs, 13:24)
“Beating some sense into him”
First legal protection in the United States in 1874
Spousal abuse/marital rape
“Rule of thumb”
“Wives be subject to your husband” (Ephesians, 5:22)
Assault against women not explored until 1960s
Elder abuse
Often undetected because of lack of awareness of HCP
Lack of mandatory reporting
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Interpersonal Violence
Crosses all ethnic, racial, socioeconomic, and educational lines
Interpersonal Violence (IPV) is about control, not anger.
Includes:
Homicide and suicide
Intimate partner violence
Child maltreatment
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Interpersonal Violence: Homicide
Homicide
One of the leading causes of death in the United States.
For black males aged 15 to 34, homicide is the leading cause of death.
Young people, women, and African American and Hispanic males at higher risk than the general population.
African Americans were more likely to commit homicide than whites and were more likely to be victims of homicide than whites (2010 data)
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Interpersonal Violence: Suicide
Suicide is 10th leading cause of death for all Americans in all age groups (2010)
More people die from suicide than homicide.
Men often use firearms.
Women use poisoning.
In Native Americans and Alaska Natives, suicide is the second leading cause of death in persons 15 to 34 years of age.
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Interpersonal Violence: Suicide (Cont.)
Risk factors for suicide
Psychiatric disorders such as major depression, bipolar disorder, and/or schizophrenia
Substance abuse
Posttraumatic stress disorder (PTSD)
Bulimia or anorexia nervosa
Past history of attempted suicide
Genetic disposition to suicide
Age, such as elderly, and white males (highest rate)
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Interpersonal Violence: Partner
Intimate partner violence (IPV)
A pattern of coercive behaviors perpetrated by someone who is or was in an intimate relationship with the victim
May include battering, resulting in physical injury, psychological abuse, and sexual assault to progressive social isolation and intimidation of the victim
Typically repetitive and often escalates in frequency and severity
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Interpersonal Violence: Partner (Cont.)
Risk factors for IPV
Low self-esteem
Poverty
Risky sexual behavior
Eating disorders and/or depression
Substance abuse
Trust and relationship issues
Victims often suffer in silence and accept abuse as a transgenerational pattern of normal behavior
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Interpersonal Violence: Partner (Cont.)
Pregnancy
May increase stress within the family
All pregnant women should be routinely screened for abuse for commons sign of IPV
Delay in seeking prenatal care
Unexplained bruising or damage to breasts or abdomen
Use of harmful substances (cigarettes, alcohol, drugs)
Recurring psychosomatic illnesses
Lack of participation in prenatal education
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Interpersonal Violence: Dating
Abusive, controlling, or aggressive behavior in an intimate relationship that takes the form of emotional, verbal, physical, or sexual abuse
May involve the use of date rape drugs
Studies have linked alcohol with dating violence
Stalking—a pattern of repeated and unwanted attention, contact, harassment, or any type of conduct directed at a person that instills fear
Bullying—a repeated oppression, psychological or physical, of a less powerful person by a more powerful person or group of persons
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Wheel of Power and Control
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Figure 27-1
Developed by the Domestic Abuse Intervention Project. 206 West Fourth Street, Duluth, MN 55806. Used with permission.

Impact of Interpersonal Violence
Victims often experience…
Chronic fatigue and tension
Disturbed sleeping and eating patterns
Vague gastrointestinal and genitourinary complaints
Misdiagnosis often occurs because of the obscurity of symptoms and/or failure to adequately assess
Victims stay in abusive relationships because of cultural, religious, and economic factors
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Impact of Interpersonal Violence (Cont.)
Victims who are most likely to leave a battering situation:
Have resources and power
No children
No personal history of abuse (themselves or their mother)
Most dangerous time for victim is when he or she leaves or attempts to leave the relationship
More likely to be killed at this time than any other time in the relationship
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Interpersonal Violence: Child
Child maltreatment
Most child maltreatment occurs within the family.
More often abused by parents than other relatives or caregivers.
More commonly seen in families in poverty, families in disorganization, or with parents who are younger and who are substance abusers.
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Interpersonal Violence: Child (Cont.)
Child maltreatment
Risk factors include but are not limited to
Special needs children
Children less than 4 years of age
Family history of violence
Substance abuse
Poverty
Social isolation
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Interpersonal Violence: Child (Cont.)
Child maltreatment
Four types of child abuse:
Neglect
Physical abuse
Includes beating, burning, biting, and bruising
Abusive head trauma/shaken baby syndrome is leading cause of death in the United States from abuse
Emotional abuse
Sexual abuse
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Interpersonal Violence: Elderly
Elder abuse
Society fails to recognize the cruelty many older adults experience.
Elders are an “invisible” segment of the population.
Reasons for underreporting of elder abuse
Shame on part of victim
Social and physical isolation from resources
Failure of health care provider to routinely assess during points of contact
No uniform reporting system
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Interpersonal Violence: Elderly (Cont.)
Elder abuse
Types of abuse and neglect
Physical abuse
Psychological-emotional abuse
Sexual abuse
Neglect
Financial exploitation
Health care fraud and abuse
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Community Violence
Community violence usually occurs suddenly and without warning and can potentially destroy entire segments of the population
Community violence includes
Workplace violence
Youth violence
Gang-related violence
Hate crimes
Terrorism
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Community Violence: Workplace
Risk factors include:
Increasing number of acute and chronically mentally ill patients
Working alone
Availability of drugs at worksite
Low staffing levels
Poorly lit parking areas and corridors
Long waits for service
Inadequate security
Increasing number of substance abusers
Access to firearms
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Workplace violence includes physical assaults, muggings, and verbal and written threats

Community Violence: Youth
Youth-Related Violence
Concentrated in minority communities and inner cities, causing a disproportionate burden on these communities
Adolescents and youth increasingly use violence to settle disputes.
Even when taught peaceful ways of resolving differences, learn by what they observe at home, on television, and in movies.
Schools have become common sites for violence.
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Risk Factors for Youth Violence
(from Textbook, Table 27-3)
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Individual Risk Factors Community Risk Factors
Involvement with drugs, alcohol, or tobacco Diminished economic opportunities
Antisocial beliefs and attitudes High concentration of poor residents
Low IQ High level of family disruption
History of violent victimization Low levels of community participation
History of early aggressive behavior Socially disorganized neighborhoods

Risk Factors for Youth Violence
(from Textbook, Table 27-3—Cont.)
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Individual Risk Factors Community Risk Factors
Attention deficits, hyperactivity, or learning disorders High level of transiency
Poor behavioral control
Deficits in social, cognitive or information-processing abilities
Exposure to violence and conflict in the family
High emotional distress
History of treatment of emotional problems

Risk Factors for Youth Violence
(from Textbook, Table 27-3—Cont.)
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Family Risk Factors Peer/Social Risk Factors
Poor family functioning Association with delinquent peers
Low emotional attachment to parents of caregivers Involvement in gangs
Low parental education and income Social rejection by peers
Parental substance abuse or criminality Lack of involvement in conventional activities
Poor monitoring and supervision of children Poor academic performance
Harsh, lax, or inconsistent disciplinary practices Low commitment to school and school failure
Authoritarian childrearing practices

Community Violence: Gangs
Reasons that young people join gangs:
Believe that gangs will protect them
Peer pressure
The need for respect
A sense of belonging
Increasingly responsible for crimes and violence throughout the United States
Crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder.
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Community Violence: Prison
Prison violence
The United States has one of the world’s
highest rates of incarceration
Inmates are both victims and perpetrators of violence.
Includes allegations of physical abuse and reports of rape by corrections officers and inmates
Little sympathy for this population for a variety of reasons, including indifference, disbelief, and denial
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Community Violence: Trafficking
Human trafficking is a global problem and a public health issue.
Involves:
Prostitution
Sexual exploitation
Forced labor
Slavery
Removal of organs
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Community Violence: Hate Crimes
Crimes in which offender is motivated by
An individual’s race*1
Sexual orientation*3
Religious beliefs*2
Ethnic background
National origin
*Rank—most commonly reported
Hate crimes may include
Murder
Rape
Sexual or physical assault
Harassment
Attacks on homes or on places of worship
Vandalism
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Community Violence: Terrorism
“The calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological.”
(Department of Defense)
All terrorist acts include at least three key elements—violence, fear, and intimidation.
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Factors Influencing Violence
Firearms
A gun in the home…
…triples the risk for homicide in the home
…increases the risk for suicide 3 to 5 times
…increases risk for accidental deaths by 4
Firearms are the number one weapon of choice in homicides in the United States.
Direct and indirect costs are staggering.
“Right to bear arms” arguments persist.
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Factors Influencing Violence (Cont.)
Media violence includes exposure to and participation in …
…violent video games
…music and music videos that depict date rape or violence
…virtual violence that allows subscribers to harm or kill victims
Repeated exposure to media violence leads to emotional desensitization to real-life violence
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Factors Influencing Violence (Cont.)
Mental illness is considered by many to be a major factor in violence.
Studies are inconclusive that all violence is committed by mentally unstable persons.
Increasing push for legislation to fund public health strategies that identify and treat mental illness across the country
Funding issues have forced states to eliminate or reduce availability of mental health services
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Violence Is a Public Health Epidemic
The public health system is challenged to go beyond its traditional programs to include prevention and management of violence.
Efforts being made with
Public health strategies
Community approaches
Local, state, and federal governments
Addressed by Healthy People 2020
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Prevention of Violence: Primary Prevention
Goal: to stop violence, abuse, or neglect before it occurs
Education may include life skills training:
Parenting and family wellness
Anger management
Conflict resolution
Nurses should:
Increase awareness of violence
Identify cases
Work with the community
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Prevention of Violence: Primary Prevention (Cont.)
Must begin at community level to change attitudes
Focuses on stopping transgenerational aspect of abuse
Start with young children
Continue across the lifespan
Mentoring and peer programs to promote healthy relationships and decrease conflict
Work with high-risk individuals
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Prevention of Violence: Secondary Prevention
Goal: assess, diagnose, and treat victims and perpetrators of violence.
Consideration of safety of potential victim is critical
Begins with assessment
Once identified, victims must be offered…
Resources to increase their safety
Legal options and how to access them
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Prevention of Violence: Secondary Prevention (Cont.)
Nurses must screen for abuse. Ask questions
Within the last year, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
Since you’ve been pregnant, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
Within the last year, has anyone forced you to have sexual activities?
Intervene when essential
Interdisciplinary approach leads to optimal outcomes.
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Prevention of Violence: Tertiary Prevention
Goal: Aimed at rehabilitation of individuals, families, groups, or communities and includes both victims and perpetrators of violence
May take months or even years
Nurses must work in conjunction with a variety of mental health professionals and social service agencies to provide coordinated care
Self-care and recognition of own limitations and needs
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Chapter 26

Substance Abuse

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More deaths, illnesses, and disabilities are attributed to substance abuse than to any other preventable health conditions in the United States.
– Substance Abuse and Mental Health
Services Administration (SAMSHA)
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Social Consequences of Substance Abuse
Crimes while under the influence of drugs, alcohol, or both
Need for money to buy substances
Specific theft of drugs
Almost 75% of inmates report prior drug use
All aggregates in society are potentially affected by substance abuse problems regardless of age or economic level
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Etiology of Substance Abuse
Numerous theories try to explain it
Combination of many factors
Genetics within families
Individual (impulsivity and ease of disinhibition)
Environmental factors
Medical models
Biopsychosocial models
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Historical Overview of Alcohol and Illicit Drug Use
Alcohol use has gained more social acceptance than other drug use.
Public attitudes and governmental policies have also influenced the history of illicit drug use.
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Historical Overview of Alcohol and Illicit Drug Use (Cont.)
Consumption and laws affected by:
Alcohol-related deaths after lowered drinking age
Less tolerant national attitudes toward drinking
Increased societal and legal pressures and actions against drinking and driving
Increased health concerns among Americans
Knowledge of addictive properties
Counterculture acceptance of hallucinogens, cannabis, and heroin
The “War on Drugs”
Renewed interest in prevention/treatment efforts
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Laws Impacting Substance Abuse
Anti–Drug Abuse Acts of 1986 and 1988
Increased funding for treatment and rehabilitation
Created the Office of National Drug Control Policy (“drug czar”)
Worked on a public health approach to drug control
National Institute on Drug Abuse (NIDA)
Science on drug abuse and addiction
Prevention
Treatment
Decreasing the spread of HIV/AIDS
Other priority areas
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Laws Impacting Substance Abuse (Cont.)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Builds and sustains programs, policies, information and data, contracts, and grants toward helping the nation act on the knowledge that promotes behavioral health treatment through all levels of prevention
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Prevalence, Incidence, and Trends
Alcohol use by persons aged 12 or older:
Slightly more than half (52.8%) drink alcohol
Binge drinking at least once in prior 30 days— (22.6%)
Heavy drinking—6.2%
Young adults ages 18-25 had highest prevalence of binge and heavy drinking—39.8%
Drove under the influence of alcohol at least once in past year—11.1%
– SAMHSA (2011)
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Prevalence, Incidence, and Trends (Cont.)
Illicit drug use by persons aged 12 or older:
About 8.7% were current drug users, used an illicit drug during the past month
Illicit drugs used
Marijuana was the most commonly used drug
Others included cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics (pain relievers, tranquilizers, stimulants, and sedatives) used nonmedically
– SAMHSA (2011)
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Prevalence, Incidence, and Trends (Cont.)
Nonmedical use of prescription-type psychotherapeutics
There is a significant increase in the lifetime nonmedical use of pain relievers—specifically Percocet®, Percodan®, Vicodin®, Lortab®, Darvocet®, Darvon®, Tylenol® with Codeine, Propoxyphene, or Codeine Products, Oxycodone, and Hydrocodone
– NIDA (2010)
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Prevalence, Incidence, and Trends (Cont.)
Hallucinogen, inhalant, and heroin use
LSD (d-lysergic acid diethylamide)
Peyote cactus
Psilocybin
PCP (phencyclidine)
Inhalants of choice are amyl nitrite, “poppers,” followed by glue, shoe polish, or toluene; correction fluid, degreaser, or cleaning fluid; gasoline or lighter fluid; and spray paints and other aerosols.
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Prevalence, Incidence, and Trends (Cont.)
Gender difference
Males more likely to be current illicit drug users
Female illicit drug use (12 and older) increasing
Geographic trends
Highest in West > Midwest > Northeast > South
Racial/ethnic groups
Highest among American Indians or Alaska natives > African Americans> whites > Hispanics > Asians
– SAMHSA (2010)
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Trends in Substance Abuse
May or may not relate to classically or clinically defined dependence or addiction.
Many are turning to recovery before they have developed physiological dependence.
Need to differentiate between use and misuse/abuse.
Use of harmful substances is indirectly and directly related to all of the leading health indicators targeted in Healthy People 2020.
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Methamphetamine (MA)
Most widely produced controlled substance in the United States.
Illegal street names of the drug (crank, crystal, meth, ice, or glass).
Can be injected, inhaled, taken orally, or smoked.
Used predominantly by white young persons, with an overrepresentation of females.
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Methamphetamine (MA) (Cont.)
Pleasurable effects are caused by the release of high levels of dopamine in the brain, leading to increased energy, a sense of euphoria, and increased productivity.
Short-term effects: increased heart rate, insomnia, excessive talking, excitation, and aggressive behavior
Prolonged use results in tolerance and physiological dependence
Negative consequences range from anxiety, convulsions, and paranoia, to brain damage.
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Methamphetamine (MA) (Cont.)
The impact of MA abuse on communities, families, and social networks is considerable.
Young children of users are at risk for abuse and neglect.
Prenatal use puts children at risk for developmental problems, aggression, and attention disorders.
Exposure to combustible second-hand fumes.
Associated with increased incidence of violence (e.g., domestic abuse, homicide, and suicide)
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Steroids
Anabolic steroids are synthetic variants of male sex hormone testosterone
Build muscle and said to be androgenic
Most commonly used in athletes and other individuals willing to risk potential and irreversible health consequences to build muscle
Potentially fatal risks
Blood clots, liver damage, premature cardiovascular changes, increased cholesterol
Increased potential for suicide and aggressive and risky behaviors
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Inhalants
Contain volatile components with psychoactive properties
Many products found in home or workplace (e.g., spray paints, markers, glues, and cleaning fluids)
Produce a rapid high that may resemble alcohol intoxications; may progress to loss of sensation and even unconsciousness
Irreversible effects:
Hearing loss, limb spasms, CNS or brain damage, or bone marrow damage; may result in death from heart failure or suffocation
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Adolescent Substance Abuse
Highest prevalence of illicit drug use during lifetime between 18 and 25 years
Teen use of cigarettes and smokeless tobacco has declined
Nearly half of teens try marijuana before they graduate—skepticism about drug’s danger
As harmful, illicit substances come in and out of vogue, CHN needs a good understanding of drug culture, terminology, and differing signs and symptoms
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Conceptualizations of Substance Abuse
Conceptualizations have changed over the years, often for political and social reasons rather than for scientific reasons.
“Dependence” or “abuse”
What substances can be abused?
APA focuses on alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, and hypnotics or anxiolytics
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Defining Substance Abuse
Substance abuse: a maladaptive pattern of substance use that is manifested by recurrent and significant adverse consequences related to repeated use of a substance.
Failure to fulfill major role obligations
Repeated use in physically hazardous situations
Multiple legal problems
Recurrent social and interpersonal problems
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Defining Substance Abuse (Cont.)
Dependence: a cluster of cognitive, behavioral, and physiological symptoms that indicate continued use of the substance despite significant substance-related problems
Pattern of repeated, self-administered use
Tolerance, withdrawal, and compulsive drug-taking behaviors
A craving or strong desire for the substance
Preoccupation with supply, money to purchase, and getting through time between periods of use
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Sociocultural and Political Aspects of Substance Abuse
Determined largely by economic, cultural, and political conditions of potential users
Cultural conditions create ambiguity in clearly determining when a problem exists.
Competing value systems lead to cultural disintegration and a sense of powerlessness and hopelessness.
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Course of Substance-Related Problems
Path from initiation to dependency is multidimensional.
Person + substance + context/environment
Progression varies—from initiation to continuation, transition to abuse, and finally, addiction and dependency
Critical point is transition from use to abuse
Addiction/dependency marked by changes in both behavior and cognition
Once addiction is established, withdrawal symptoms are strong motivators to continue use
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Legal and Ethical Concerns
U.S. policy based on prohibition and criminal sanctions against use and sale of illicit drugs
Criminal activities (violence and drug trafficking)
Drinking and driving, working while intoxicated
Impact on fetus (FAS)
Modes of intervention
Limit access
Media campaigns
Educational programs
National organizations that promote community education, research, and support
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Prevention Strategies
Primary prevention
Needs assessment to identify high-risk situations and potential problems
Decriminalization and legalization of drugs(?)
Community-based programs
Training of health professionals
Faith-based initiatives
Volunteer consumer groups
Organized sports programs
Employer programs
Often overshadowed by “War on Drugs”
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Prevention Strategies (Cont.)
Secondary prevention
Screening and finding resources
CAGE: an alcoholism screening test
Clinical Institute Withdrawal Assessment (CIWA)
Use evidence-based programs
Efforts should be specific to aggregates, rather than directed at the “general public”
Incorporate culturally sensitive and appropriate interventions and strategies
Work toward improving individuals’ general competencies, communication skills, and self-esteem
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Treatment
For individuals, consider:
Cultural and educational background
Resources of the person
Attitudes of significant others
Degree of invasiveness of the effects of the substance use The existence of alternatives
Relapse prevention
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Treatment (Cont.)
Inpatient and outpatient treatment programs
May or may not include detoxification component
Voluntary vs. compulsory
Pharmacologically based vs. drug free
Treatment approaches and models vary
Assessment process is of primary importance.
Therapeutic relationship based on trust is essential.
Physical examination is a valuable tool.
Nonjudgmental attitude minimizes defensiveness.
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Treatment (Cont.)
Programs usually include:
Group and individual therapy and counseling
Motivational interviewing
Family counseling
Education
Socialization into 12-step mutual self-help groups
Integrate psychotherapy with pharmacotherapy
May include other strategies:
Hypnosis, occupational therapy, confrontation, assertiveness training, blood alcohol level discrimination training, behavior modification approaches
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Treatment (Cont.)
Pharmacotherapies
Used in detoxification, stabilization, maintenance, as antagonists, and as treatment for coexisting disorders
Mutual help groups
Operate through face-to-face supportive interaction focusing on a mutual goal; AA was first
Harm reduction
Elimination of the more harmful effects of substance use through behavior and policy modifications
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Social Network Involvement
Therapy that involves the family has proved to be most effective in aiding recovery.
Family and friends
Highly influential or aid and abet
Codependency and enabling
Effects on the family
Functional or dysfunctional families
Psychological and financial burdens
Professional enablers
Treatment of symptoms by medication
Reluctant to bring up this taboo subject
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Vulnerable Aggregates: Preadolescents and Adolescents
Times of experimentation, searching, confusion, rebellion, poor self-image, alienation, and insecurity
Use of legal substances (e.g., tobacco, alcohol) almost always precedes use of illegal drugs.
Poor school performance and drug use among peers are strongest predictors of subsequent drug involvement, followed by lack of strong family bond.
The younger the initiation, the greater the probability of prolonged and accelerated use.
Feeling of powerlessness; selling drugs seen as a viable economic solution to poverty.
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Vulnerable Aggregates: Preadolescents and Adolescents (Cont.)
Primary prevention focuses on:
Advocating for these vulnerable children
Educating teachers on the vital importance of maintaining a validating, nonjudgmental attitude toward these students
Supporting strong families in the community
Improving knowledge through education and media
Early detection of predisposing factors
Providing structured clubs and organizations
Facilitating school success, career skills, family communication skills, and conflict resolution
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Vulnerable Aggregates: Elderly
Elderly experience
Diminished physiological tolerance
Increased use/misuse of medically
prescribed drugs
Cultural and social isolation
Misuse of prescription drugs may be the most common form of drug abuse among the elderly
Use prescription medications approximately three times as frequently as general population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Vulnerable Aggregates: Women
Alcohol use and abuse affects women much differently than men.
Women absorb and metabolize alcohol differently.
Body composition differences and production of less gastric alcohol dehydrogenase
Metabolize alcohol at a different rate
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Vulnerable Aggregates: Women (Cont.)
Increased risk stems from economic, social, and cultural factors.
Marginalization of certain groups
History of child abuse
Physical and medical problems related to reproductive systems
Use during pregnancy has long-term developmental consequences for the newborn
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Vulnerable Aggregates: Ethnocultural Considerations
African Americans, Hispanics, and Native Americans—increased risk for substance abuse.
Economically disenfranchised groups
Discrimination and racism
Socioeconomic, political, and historical realities
Myths and stereotypes
Social support—positive effect on treatment/outcome
Environmental cues and conditioned reinforcement
Treatment poses special challenges.
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Vulnerable Aggregates: Other Aggregates
Substance abuse is most common psychopathological problem in the general population.
Dual-diagnosis individuals
Psychiatric disorder + substance abuse disorder
Risk for multiple vulnerabilities in one individual
Impact of substance abuse on STDs
Substance abuse among health care professionals
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Nursing Interventions in the Community
Understand own experiences and prejudices.
Routinely assess substance use patterns when performing client histories.
Be alert to environmental cues in the home that indicate substance abuse.
Increase the individual’s and family’s awareness of the problem.
Involve the social network in getting the client into treatment.
Develop a caring nursing relationship.
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Other Traditional Nursing Roles and Interventions
Health teaching regarding addictive illness and addictive effects of different substances
Advocating that EBP treatment works in special populations through problem-solving courts (drug courts), specialized adolescent treatment, and other community case management programs.
Providing direct care for abuse- and dependence-related medical problems
Educating clients and families about problems related to substance abuse
Collaborating with other disciplines to ensure continuity of care
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Other Traditional Nursing Roles and Interventions (Cont.)
Coordinating health care services for the client to prevent prescription drug abuse and avoid fragmentation of care
Providing consultation to nonmedical professionals and lay personnel
Facilitating care through appropriate referrals and follow-up
Knowing how to use community resources for working with substance abuse, mental health, and other issues
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