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Vulnerable populations: Substance Abuse

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Jeffrey Fahmer

on 20 March 2014

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Transcript of Vulnerable populations: Substance Abuse

Thank You!
Actions For a Better Community. (2012). New directions. Retrieved from http://www.abcinfo.org/health-services/alcohol-and-substance-assistance

Centers for Disease Control and Prevention. (2014). Infections among persons who use drugs. Retrieved from http://www.cdc.gov/pwud/infections.html

Elements Behavioral Health. (2013). Common reasons why those who need treatment don’t get it. Retrieved from http://www.elementsbehavioralhealth.com/addiction-treatment/common-reasons-why-those-who-need-treatment-dont-get-it/

Health Action. (2013). Monroe County adult health survey 2012. Retrieved from http://www2.monroecounty.gov/files/health/DataReports/final%20AHS%20results%20-%2011-11.pdf

Healthy People. (2013). Substance Abuse. Retrieved from http://healthypeople.gov/2020/lhi/substanceabuse.aspx?tab=data#adults

National Institute of Health. (2014).
Drug facts: Nation wide trends
. Retrieved from http://www.drugabuse.gov/publications/drugfacts/nationwide-trends

Nies, M. A., & McEwen, M. (2011). Community/public health nursing: Promoting the health of populations. St. Louis, MO: Elsevier.

NYSPI Division of Substance Abuse. (2014). Research. Retrieved from http://substanceabuse.columbia.edu/contact.htm

Robert Wood Johnson Foundation. (2001). Substance abuse: The nation’s number one health problem. Retrieved from http://www.rwjf.org/content/dam/farm/reports/reports/2001/rwjf13550

Substance Abuse and Mental Health Services Administration News (2010). State-by-state data trends in substance abuse, mental illness. Retrieved from http://www.samhsa.gov/samhsaNewsletter/Volume_18_Number_4/StateDataTrends.aspx

United States Department of Health and Human Services. (2011). State estimates of substance abuse from the 2007-2008 national surveys on drug use and health. Retrieved from http://oas.samhsa.gov/2k8state/ageTabs.htm

The Watershed Addiction Treatment Program. (2012). We can help end addiction. Retrieved from https://www.thewatershed.com/lp/substance-abuse-2-a/?mm_campaign=ece6a2a2787948286933d5b2d8067b6e&mm_keyword=%2Bsubstance%20%2Babuse%20%2Bprogram&gclid=CKTmj4Klk70CFYFhMgodgU0Aqg

Kaitlyn Mannix, Jeffrey Fahmer & Megan Gawronski
Vulnerable Populations: Substance Abuse

* Appreciate statistical data with regards to substance abuse

*Factors that affect the health of this population

* Identify common health concerns

* Identify resources available to patients
What is Substance Abuse?
"maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances"
According to the DSM IV:
National Statistics
* In 2012, it was estimated that
23.9 million
Americans over the
age of 12
used an illicit substance or abused a therapeutic drug
* This is equivalent to 9.2 % of the population
National Institute on Drug Abuse (NIH)
National Statistics: Most Commonly Abused Drugs
Annual Increase in Substances Abused
Distribution of Drugs Abused
* Marijuana use has shown a significant increase since 2002.

* Marijuana continues to be the most abused drug.

New York State

* 1.314 million people currently use illicit drugs in the past month.

* In the past year 1.658 million people used marijuana.

* In the past year 403,000 people used cocaine as their drug of choice.

* 576,000 people used pain relievers for non medical use in the past year.

* Illicit drug dependency is equal to 442,000 people.

New York State:

Alcohol Abuse
Drug Use Statistics
* Alcohol use in people under the age of 20 equals 778,000 people.

* Binge drinking under 20 years of age is 497,000 individuals.
* People who have used alcohol in the month totals 8.728 million.

- 3.631 million individuals have participated in binge drinking in the last one month.

* Alcohol abuse/ dependence in the past year equals 1,075,000 people.
Monroe County Statistics
8% of the population in Monroe County (ages 18 - 64) have used marijuana in the past month.

17% of the population in Monroe County residents binge drink.
Common Health Concerns in Substance Abusers
Physical Concerns
* General: heart disease, stroke, hepatitis, TB
* Cardiovascular: MI, atrial fibrillation, hypertension, cardiomyopathy
* Bloodborne: HIV/AIDS, hepatitis B & C
* Pregnancy Complications
Demographics of Substance Abusers
Males: 11.6 %
Females: 6.9 %
Race and Ethnicity

* 11.3 % African Americans

* 9.2 % White

* 8.3 % Latino/Hispanic

* 3.7 % Asian

* Reported using illicit substance in last month
Substance Abuse by Age
Ages 12 - 17: 9.5 %

Ages 18 - 25: 21.3 %

Ages 26 - 49: 7.0 %

Ages 50 - 54: 7.2 %

Ages 55 - 59: 6.6 %

Ages 60 - 64: 3.8 %
Education and Substance Abuse
College Graduates: 6.6 %

Some College Education: 10.2 %

High School Graduate Only: 9.8 %

Did Not Graduate From High School: 11.1 %
Alcohol and Tobacco
Smoking: emphysema, lung cancer

Alcohol: liver cirrhosis,
hepatitis, dementia,
neuropathy, pancreatitis, hypertension
Mental and Emotional
* Coexisting mental illness
* Synergistic Effects
* Self-medication
* Underlying causes

* Family Strain

* Stigma
* Provider
* Co-morbidities
Children of Substance Abusers
* Pregnancy complications
* Low birth weight
* Premature birth
* Miscarriage
* Fetal Alcohol Syndrome
* Teen pregnancy
* Children prone to illness
Access to Care
* Transportation
* Healthcare
* Unemployment
* Finances
* Hospital Policies
Health Risks
* Violence/Domestic Violence/Child Abuse
* Motor Vehicle Accidents
* Homicide/Suicide
* Occupational Hazards
* Drug Overdoses
Factors that Affect the Health of Substance Abusers
* stigma of receiving health care
* co-morbidities related to medical issues
* homelessness
* lack of education
* legality and danger of being caught
* lack of health insurance
* not ready to discontinue use
* personal neglect of a problem
* lack of transportation

New York State Programs
* SURC: Substance Use Research Center

* Buprenorphine Program (Private): heroin, pain pills, and methadone addictions

* Substance Treatment and Research Service (Free): alcohol, cocaine, heroin, and marijuana

Local Programs
* Outpatient
* Conifer counseling services
* Action for a better community: New directions
* Unity chemical dependency program
* East House Corp-CD community residence
* Huther Doyle
* Catholic Family Center
* Veterans Outreach Center Inc.- supportive living program
* Watershed addiction treatment programs

Physical Effects of Withdrawal
* CNS Depressants: Anxiety, Irritability, Seizures, Delusions, Hallucinations, Paranoia

* CNS Stimulants: Depression, Apathy, Lethargy, Sleepiness

* Narcotics/Opioids: Anxiety, Irritability, Agitation, Chills, Sweating, Watery eyes, N/V/D, tremors

* Hallucinogens: Depression

* Cannabis: Restlessness, Insomnia, Anxiety

* Inhalants: Restlessness, Anxiety, Irritability

Substance Abuse Case Study
You're a nurse in the ED at Unity Hospital when a male identified as Joe Mallo arrives at the bay via ambulance for a suspected drug overdose. Joe is unconscious, unresponsive, and has shallow respirations. Neuroloigcal assessments identify that his pupils are fixed and dilated, as well as a hole in the septum of his nose, track marks on his arms, bluish-colored nails and lips, and a discolored tongue.
Vital Signs: BP: 89/42, HR: 41, Temp: 35.6, Resp.: 10, SpO2: 91%
. After contacting is family, his wife Marnie arrives 20 minutes later with four sandwich bags of unidentified substances relating to Joe's possible overdose. The lab samples taken from the patient were insufficient for drug test due to decreased tissue perfusion. The team is collaborating on which substance could be the possible cause of his comatose state.
After a long discussion, Marnie identified that Joe had recently lost his job and returned to his illicit drug and alcohol usage that he was sober from for 9 years. Marnie and Joe have 3 children together and live in low-income housing. Marnie explains extreme frustration with Joe's spending habits causing them to lose their health insurance.
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