Substance Use

Chapter 17: Substance Use

Chapter Highlights

Factors affecting prevalence rates of substance use: age, gender, race, socioeconomic level, urban or rural settings

Population‐based interventions to decrease substance use

Evidence‐based treatment protocols for substance abuse that should be incorporated by community health nurses in all practice settings

Self‐help groups: a highly effective community‐based treatment with proven efficacy in sustaining recovery

Question #1

Is the following statement true or false?

Addiction is a term, along with habituation, which the WHO recommends be substituted with substance use.

Answer to Question #1

False

Rationale: Addiction is a term, along with habituation, which the WHO recommends be substituted with substance dependence. However, clients and practitioners commonly use addiction.

International Aspects of Substance Abuse

Scope of substance abuse

Public health policies to minimize harms from substance use

National scope of substance use

Alcohol

Cannabis

Tobacco

Illicit drugs

Substance Abuse

A person is diagnosed as having substance abuse when they exhibit the following behaviors associated with substance use:

Problems at work, home, and school

Problems with family or friends

Physical danger

Trouble with the law

Substance Use

The use of alcohol, illicit drugs, and nonmedical use of prescription medications

Illicit drugs include cannabis, cocaine, heroin, hallucinogens, inhalants, and methamphetamine.

Nonmedical use of prescription medications includes pain relievers, tranquilizers, stimulants, and sedatives.

Question #2

Is the following statement true or false?

With no use of illicit substances or alcohol in the preceding 9 months, a person is considered “abstinent.”

Answer to Question #2

False

Rationale: A person is considered “abstinent” with no use of illicit substances or alcohol in the preceding 12 months.

Addiction

A term, along with habituation, which the WHO recommends be substituted with substance dependence.

Clients and practitioners commonly use addiction.

Substance Dependence

Health and emotional problems associated with substance use

Unsuccessful efforts to cut down on use

Symptoms of tolerance or withdrawal

Reducing other activities to use the substance

Spending time in activities related to substance use

Using the substance in greater quantities or for a longer period of time than intended

Abstinence

If there is no use of illicit substances or alcohol in the preceding 12 months, a person is considered “abstinent.”

Question #3

Is the following statement true or false?

The United States leads the world in rates of substance use.

Answer to Question #3

True

Rationale: The United States leads the world in rates of substance use. Patterns of substance dependence vary by age, gender, race, ethnicity, and geographic location.

Health Profiles and Interventions for High‐Risk Populations

Pregnant women

Substance use at an early age

College students and binge drinking

Older adults

Persons who inject drugs

Methamphetamine users

Public Health Models for Populations at Risk

Screening

Maladaptive behaviors

Social contexts

Question #4

Is the following statement true or false?

Studies of disadvantaged adolescents in impoverished areas or homeless youth have found that youth follow a stepwise progression of substance use.

Answer to Question #4

False

Rationale: There is debate in the literature about the “gateway effect” theory of substance abuse, which proposes that substance abuse is progressive and begins with tobacco, then moves sequentially to alcohol or cannabis, and ultimately to other illicit substances. Studies of disadvantaged adolescents in impoverished areas or homeless youth have not found that these youth follow such a stepwise progression of substance use.

Environmental Factors

Poverty

Lack of access to health services

Capacity of law enforcement to constrain supply

Contribute to a disproportionate burden of harm among

Native Americans

Alaskan Natives

African Americans

Treatment Interventions #1

Medication‐assisted treatments

Naltrexone

Acamprosate

Disulfiram

Methadone

Buprenorphine

Naloxone

Treatment Interventions #2

Evidence‐based psychosocial treatments

Motivational interviewing

Social skills training

Cognitive‐behavioral strategies

12‐step programs

Question #5

Is the following statement true or false?

Screening for substance use is the second step in assessing if a person has substance use disorder.

Answer to Question #5

False

Rationale: Screening for substance use is the first step in assessing if a person has substance use disorder. The efficacy of screening instruments is highly dependent on the candor of client responses.

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