SUBSTANCE ABUSE Adanvce Concept of Nursing

Mental Health Nursing

1. Advance concept Mental Health Nursing Post RN BscN Semester 4 th Faculty: Sir Noeem Dawood Presenter's Farman A hmed, N aseer Khan, N oorjehan, K hushal , S hazia Sardar , A sif Raza Dated 19-10-2020 1 SUBSTANCE ABUSE

2. OBJECTIVES 2 At the end of the session learner will able to: Define substance abuse Explain terminologies Discus Static of substance abuser in Pakistan Discus about Users and Abusers. Discus illicit substance What to Look for substance abusers? Why might an adolescent use or abuse illicit drugs ? What can YOU do ? Critical Data Elements to be Impacted by Prevention/Intervention

3. 3 SUBSTANCE ABUSE: Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome (WHO)

4. 4 Substance: refers to any Drugs, Medication, or Toxins that shares the potential of abuse. Addiction: is a Physiological & Psychological dependence on Alcohol or other drugs of Abuse that affects the Central Nervous System in such a way that withdrawal symptoms are experienced when the substance is Discontinued.

5. 5 Abuse : refers to Maladaptive pattern of Substance use that impairs health in a board sense. Dependence refers to certain Physiological & Psychological phenomena induced by the repeated taking of a Substance. Tolerance It is a state in which after repeated administration, a drug produced a decreased effect, or increasing doses are required to produce the same effect. Withdrawal State is a group of signs & symptoms recurring when a drug is reduced in amount or withdrawn, which last for a limited time.

6. 6 In Pakistan, the total number of drug addicts as per a UN report is 7.6 million, where 78% are male while the rest 22% are female. The number of these addicts is increasing at the rate of 40,000 per year in Pakistan .

7. Users and Abusers 7 Older Middle School Students High School Students Substance use and abuse are not racially, ethnically, or gender specific: Everyone and anyone is susceptible Adolescents because of immaturity of impulse control and judgment are especially prone to experimentation with drug & alcohol use Novelty seeking, poor parental supervision and peer involvement further reinforce use Adolescent autonomy and freedom offer opportunities for use Teens with ADHD, Conduct Disorder, Trauma history and school failure are especially at risk

8. 8 Situations with limited opportunity, easy access to drugs, routine family and community use amplify use

9. Some demographics of drug abusers 9 Type of illicit drug Age ranges Pain killers, sedatives and tranquilizers 15-64 years Cannabis ( charas and bhang ) 20-29 years Opium 40-44 years Heroin 30-34 years

10. What are illicit substance 10 Inhalants Prescription Drugs Ritalin Rohypnol Vicodin OxyContin Marijuana MDMA (Ecstasy) Methamphetamine GHB and Ketamine Cocaine , not Crack Cigarettes/Nicotine Alcohol Heroin Crack cocaine PCP Amphetamines Tranquilizers Sedatives Methaqualone

11. Specific risks of drug use: 11 Binge Drinking Inexperience coupled with impulsivity Secondary problem – unwanted sexual behavior, rape Disinhibition Driving while intoxicated

12. 12 Erratic and unreliable behavior Lying Irritability, argumentativeness, relationship problems Economic Deprivation Parental Difficulty Family Conflict

13. Mental Health Co morbidities 13 Depression Anxiety Post trauma difficulties Sequellae of childhood maltreatment ADHD Bipolar Disorder Adolescent schizophrenia Eating disorders, especially bulimia

14. What to Look for substance abusers? 14 Absenteeism Change in Behavior Change in Academic Performance Problems controlling mood and behavior Neglected Physical Appearance Weight loss Peer concern Some Physical Signs: bruises and other marks on arms or other vein-laden areas (neck, behind knees), bloodshot eyes, sniffling nose, dilated pupils, etc.

15. Approach to Treatment 15 Motivation is malleable Relationships critical Treatment individualized Planning and flexibility operate together

16. 16 Look for impairments in 2 or more domains Look for development detouring effects Multiple approaches Multiple targets Multiple interventions

17. Treatment involves… 17 Development Preventing problem behavior Therapy Individual Family Treatment parameters time, space, frequency, etc

18. 18 Motivational interviewing can be very useful in helping youth appreciate consequences of drug use and deciding if drug use furthers their personal goals

19. Assessment 19 Substance Use History Drugs used Frequency of use Places used Type of use: impulsive, planned, measured Goals of use of each drug Progression of use

20. Domains of adolescent function 20 Identify development/support autonomy linked with responsibility Peers Bonding to prosaically institutions Racial/cultural issues Health/sexuality Drug use

21. Develop drug free expectation 21 rules monitoring consequences reparations parental collaboration

22. Decide how to deal with crises 22 suicide intoxication arrest school responses peer difficulties

23. Promoting positive family interaction 23 conflict resolution supportive engagement hope for sober outcomes addressing family conflicts openly constructive not punitive reinforcing drug free activities enhancing communication

24. 24 Encouraging engagement with mutual support organizations and drug treatment programs Engage family in treatment of co morbid problems in child Co morbid problems in parent

25. Prevention efforts 25 Enhancement of academic opportunities Provide treatment for co morbid problems Engage families in shared activities Provide after school opportunities – activities, sports , jobs Target especially at risk teens Build drug-free recreation experiences

26. Resources 26 Schools Jobs Prosocial Support Activities Medical Other

27. Nursing Goals 27 Build a therapeutic alliance with the patient Create a collaborative agenda Establish a developmental – ecological framework of treatment Improve functioning in several developmental domains Transform a drug – using lifestyle into a developmentally normal lifestyle Facilitate developmentally adaptive competence in multiple settings

28. 28 Build a therapeutic alliance with a parent Create a collaborative agenda Establish a developmental – ecological framework Facilitate parental commitment Prevent parental abdication Facilitate an improved relationship or improved communication between the parent and adolescent Increase knowledge about and effectiveness of parenting practices (e.g. limit setting, monitoring, appropriate autonomy granting)

29. References 29 National Institute on Drug Abuse: http://www.nida.nih.gov/index.html Lambie , G. W., & Sias , S. M. (2005). Children of Alcoholics: Implications for Professional School Counseling. Professional School Counseling, 8 , 266 – 274.

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