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Substance Abuse in the Community:

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Lindsay Davis

on 17 August 2014

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Transcript of Substance Abuse in the Community:

Tertiary Prevention
: Work to
LIMIT FURTHER NEGATIVE EFFECTS
from substance abuse. Help people reduce or stop substance abuse.

Examples:
FRAMES
Aid clients in finding and entering detoxification and addiction treatment.
Use knowledge of client's health history, environment and support systems to link to most appropriate program.
Collaborate with community members to establish treatment programs for existing substance abusers.
Refer addicts to appropriate support groups: Alcoholics Anonymous, Narcotics Anonymous, Pills Anonymous.
Recognize symptoms of detoxification.
Case management and follow-up
Assess need for additional resources for substance abusers.

Care without judgment!
Substance Abuse in the Community:
A Public Health Nursing Perspective
By: Rebeccah Baird, Lindsay Davis, Robyn DeMartini,
Katie Nguyen & Noelle St. Angelo

References
Definitions
Current Trends
Current Policies
Current Policies
Nursing Implications
Societal & Financial Costs
DSM-IV-TR Definitions:
Abuse
: "A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by
one or more
of the following:
Failure to fulfill major role obligations at work, school or home
Recurrent substance use in hazardous situations
Recurrent substance-related legal problems
Continued substance use despite problems"
Dependence
: "A maladaptive pattern of substance use as manifested by
three or more
of the following:
Tolerance • Withdrawal
A need for more of the substance than was intended
Inability to stop using even when wanting to do so
A great deal of time spend in acquiring the substance or in recovering from its effects
Social, occupational, or recreational problems
Continued substance use despite knowledge that the substance is causing physical or psychological problems
Alcohol use: Conversation starters (2014, August).
In HealthFinder.gov
. Retrieved August 8, 2014

Cao, D., Marsh, J. C., Shin, H., & Andrews, C. M. (2011, July). Improving health and social
outcomes with targeted services in comprehensive substance abuse treatment.
The American Journal of Drug and Alcohol Abuse, 37
, 250-258. doi:10.3109/00952990.2011.591016

Drug Facts: Lessons from prevention research. (2011, July).
In National Institute on Drug Abuse.

Retrieved March, 2014, from http://www.drugabuse.gov/publications/drugfacts/lessons-prevention-research

Drug facts: Nationwide trends. (2012).
National Institute on Drug Abuse
. Retrieved from http://
www.drugabuse.gov/publications/drugfacts/nationwide-trends

Garcia, C.M, Schaffer, M.A. & Schoon, P.M. (2014).
Population-based public health
clinical manual: The Henry Street Model for nurses (2nd ed.)
. Indianapolis, IN: Sigma Theta Tau International

Keltner, L.N., Bostrom, C.E., McGuinness T.M., (2011).
Psychiatric Nursing (6th ed.).
Maryland
Heights, MO: Mosby Elsevier.

Knafo, Saki (2012). The Huffington Post: California Bill Would Give Drug Users Treatment Instead of Prison Time.
Retrieved August 9th 2014 from http://www.huffingtonpost.com/2013/09/11/california-drug-treatment_n_3909240.html

Minnesota Department of Health, Office of Public Health Practice (2006).
Wheel of public health
interventions: A collection of “getting behind the wheel” stories 2000-2006
. Retrieved from www.health.state.mn.us/.../cd/phn/docs/0606wheel_stories.pdf

National Institute of Drug Abuse (2012). National Survey on Drug Use and Health. Retrieved August 10th 2014 from
www.drugabuse.gov/publications/drugfacts/nationwide-trends

Preventing drug abuse: The best strategy. (2014, July).
In National Institute on Drug Abuse.
Retrieved
August 9, 2014, from http://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preventing-drug-abuse-best-strategy

Roussos, S. T., & Fawcett, S. B. (2000, May). A review of collaborative partnerships as a strategy
for improving community health.
Annual Review of Public Health
, 21, 369-402. doi:10.1146/annurev.publhealth.21.1.369





Secondary Prevention
: Assess and screen for substance abuse and risk for substance abuse to implement early interventions and referrals to
TREAT IN EARLY STAGES

Use screening and drug testing.

Target programs to high-risk groups such as adolescents and older adults.

Examples:
Apply SBIRT; 5 As.
Thorough health assessment - any negative health, relationship, or socioeconomic problems?
Refer patients to self-assessment tools: http://www.drugscreening.org/ &
http://www.alcoholscreening.org/Home.aspx
Help family members of addicts recognize and confront addiction.
Referrals for treatment, counseling, support, legal & financial services
Develop an employee assistance program (EAP).
Screen homeless seeking healthcare and refer to cessation programs.
Work with insurance providers to ensure coverage for cessation programs.
Educate injection users about reducing transmission of disease.

Strategies to Improve Health
Primary Prevention
: Focus on
PREVENTION
of substance abuse.

Promote healthy lifestyles and alternatives to substance use.

Provide drug education.

Focus on adolescent population.

Examples:
Identify individual, family, & community risk factors to target prevention interventions
Collaborate with community leaders, schools, churches to ensure adolescents have alternative recreational activities
Organize & advise SADD & MADD groups & D.A.R.E. programs
Serve as educator/advisor to schools and community groups
Teach clients about proper medication use
Assess for mental health issues in clients
Mobilize "Smoke Free Zone" initiatives
Organize an adolescent use prevention program based on fostering social norms or students helping students
Referrals for children of substance abusers




Collaborative efforts to improve community health
-Social planning, community organizing and
development, policy development, and acting to
increase social change
-Improve population level health outcomes (Roussos
& Fawcett, 2000).

(Schaffer, Garcia & Schoon, 2001; Stanhope & Lancaster, 2012)
(Schaffer, Garcia & Schoon, 2001; Stanhope & Lancaster, 2012)
Nursing Implications
Individual Risk Factors
Being a victim of child abuse
Minimal attachment or nurturing
Family conflict & domestic violence
Lack of parental supervision
Parental substance abuse
Academic failure & bullying
Social isolation
Poor coping skills

Social Risk Factors
Peer pressure --> desire for acceptance
Separation from family and friends
Influence of social media
Coping with new challenges
Stress

(National Institute on Drug Abuse, 2013)
Risk Factors vs. Protective Factors
Objectives
Defining the problem
Trends
Costs
Risk Factors
Policies
Health Strategies
Nursing Implications
(DSM-IV-TR, 2000, as cited in Keltner, Bostrom & McGuinness, 2011)
The Nation spends approximately
$600 billion annually
on crime, healthcare, and loss of work-related productivity due to substance abuse.
("Trends & Statistics", 2012)
Substances Monitored by the National Institute on Drug Abuse Include
: alcohol, cigarettes, smokeless tobacco, cocaine, crack cocaine, hallucinogens, LSD, MDMA, heroin, inhalants, marijuana/hashish, methamphetamine, PCP, tranquilizers, psychotherapeutics, pain relievers, sedatives and stimulants ("Trends & Statistics",2012)
Nationwide trends from the 2012 National Survey on Drug Use and Health (NSDUH):
Illicit drug use has been increasing
- 9.2% of the population reported using an illicit drug or abusing a psychotherapeutic medication in the past month in 2012, up from 8.3% in 2002 (mostly due to marijuana)
Most people use drugs for the first time when they are teenagers
Drug use is highest among people in their late teens and 20s
- 23.9% of 18-20-year-olds reported using an illicit drug in the past month
Men are more likely to be binge or heavy drinkers than women
Rates of alcohol abuse/dependence have declined 1% since 2002
Cigarette smoking has decreased 4% from 2002 to 2012
("Drug Facts: National Trends", 2012)
According to the 2012 NSDUH, approximately
8.9% of Americans need treatment
for a drug or alcohol-related problem, however,
only 1% received treatment.
("Drug Facts: National Trends", 2012)
Substance Use Trends
("Drug Facts: National Trends", 2012)
Nursing Implications
References cont'd
Drug and alcohol addicted individuals usually suffer from a number of other problems
-physical diseases, mental disorders,
dysfunctional familial, and financial situation
Co-occurring problems limit functioning and capacity when responding to treatment efforts
-effectiveness of substance abuse programs focus
on improving heath and social functioning
-health and social services provided along with
substance abuse treatment (Cao et al., 2011).


Strategies to Improve Health
Understanding Drug Addiction:
-drugs change the brain
Prevention Programs:
-intended for everyone in the population,
those at risk, or those already involved with
drugs
-research-based programs designed to
prevent drug addiction in youth
designed to increase protective factors and reduce risk factors for drug abuse
used in schools, community, or in the home





Schaffer, M. A., Garcia, C. M., & Schoon, P. M. (2011).
Population-based publichealthclinical
manual: The Henry Street model for nurses (1st ed.)
. Indianapolis, IN: Sigma Theta Tau International.

Stanhope, M., & Lancaster, J. (2012).
Public health nursing: population-centered health care
in the community
(8th ed., pp. 804-827). Maryland Heights, MO: Mosby Elsevier.

Substance abuse (2014, August).
In HealthyPeople.gov
. Retrieved
August 8, 2014, from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=40

Substance abuse (2012).
National Institute on Drug Abuse
. Retrieved from http://
www.drugabuse.gov/ on July 27, 2014.

Substance abuse (2014).
U.S. Department of Health & Human Services
. Retrieved from on
July 27, 2014 from http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

Substance abuse national snapshot (2014, August).
In HealthyPeople.gov
. Retrieved
August 8, 2014, from http://www.healthypeople.gov/2020/topicsobjectives2020/nationalsnapshot.aspx?topicId=40

Talk to your kids about tobacco, alcohol, and drugs (2014, July).
In HealthFinder.gov
.
Retrieved August 9, 2014

Trends & statistics (2012).
National Institute on Drug Abuse
. Retrieved from http:
www.drugabuse.gov/related-topics/trends-statistics

Ventura County Health Care Agency (2012). Behavioral Health Department: Alcohol and
Drug Programs. Retrieved August 10th 204 from http://www.vchca.org/behavioral-health/alcohol-and-drug-programs

Whitehouse (2014). Office of National Drug Control Policy: Policy and Research. Retrieved
August 9, 2014, from http://www.whitehouse.gov/ondcp/policy-and-research
("Drug Facts: Lessons from Prevention Research", 2014)
Healthy People 2020
Goal:
"Reduce substance abuse to protect the health, safety, and quality of life for all, especially children."

Provide multiple research-based articles for improving health and preventing substance abuse complications
-Limiting alcoholic beverage sale times
-Ignition interlocks to prevent alcohol related motor vehicle accidents (HealthyPeople.gov, 2014)

Talk to children and adolescents about tobacco, drugs, alcohol ("Talk to your kids", 2014)

Tips on conversation starters
for alcohol and drug abuse
("Alcohol Use", 2014).



Alcohol or illicit drug use, adolescents, 2008 and 2011
Healthy People 2020
(Substance Abuse National Snapshot, 2014)
Nursing Implications
Substance abuse includes all 17 interventions of the
Public Health Interventions Wheel
(Minnesota Department of Health, Office of Public Health Practice, 2006)
(Schaffer, Garcia & Schoon, 2001; Stanhope & Lancaster, 2012)
Substance use has a devastating effect on individuals, families and communities (Whitehouse.gov, 2014).
Office of National Drug Control Policy (ONDCP)
Eradicate illicit drug use
Reduce drug related health consequences in the US.
Obama Administration
2014 National Drug Control Strategy
Effects of Policies
Ventura County Policies
A New Start For Moms Progam
Adult Services
Youth Services (vchca.org, 2012).
("Preventing drug abuse: The best strategy", 2014)
Conclusion
Substance abuse is a significant problem affecting children, families, and society.

It is extremely costly to society.

Prevention programs are shown to be effective to reduce drug abuse, especially in adolescents.

Reduce substance abuse to protect the health/safety of Americans

There continues to be a large "treatment gap" in our country.

PHNs work to help this vulnerable population on an individual/family, community and systems level.

PHNs role encompasses primary, secondary and tertiary prevention of substance abuse.
California Policies
Emergency Dept Visits
Prisoners - California Bill SB 649 (Knafo,2013).
Healthy People 2020 Goal
Reduce substance abuse to protect the health, safety, and quality of life for all, especially children.
(HealthyPeople.gov, 2014).
National Institute of Drug Abuse (2012)
National Survey on Drug Use and Health
Illicit drug use in America has been increasing
There continues to be a large "treatment gap" in our country.
(Health & Human Services, 2014)

(Health & Human Services, 2014)
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