Substance Abuse Disorder And Nursing Care

Nursing Care for Substance Abuse Disorders

Drug abuse,Social and Economical Impact,Data and Demographics of Drug Abusers,Preventive Research. 

Drug abuse

    Drug abuse or addiction is a chronic, relapsing, and treatable disease subcategory of psychiatric illnesses called substance-abuse disorders (American Psychiatric Association [APA]), 1994). 

    The most common drugs of abuse in the US, other than alcohol, nicotine, and caffeine, are cocaine (crack), amphetamines, cannabis (marijuana), hallucinogens, inhalants, opioids, phencyclidine (PCP), sedatives, hypnotics, and anxiolytics ( anti-anxiety agents). 

    Drug abuse interferes with normal brain functioning, usually creating powerful feelings of pleasure or euphoria; however, there are long-term effects on brain metabolism and activity such that physical addiction and craving for more of the drug occurs (http://www.nida.gov/Infofax/understand.html).

Social and Economical Impact 

    The societal economic impact of drug abuse in the US was estimated at $97.7 billion per year in 1992. These costs included crime, medical care, drug addiction treatment, social welfare programs, and lost work. 

    Money spent on illicit drug purchases was found to be $57.3 billion, of which $38 billion was paid for cocaine, $9.6 billion for heroin, $7 billion for marijuana, and the rest for all other illegal drugs or misuse of legal drugs (White House Office of National Drug-Control Policy [ONDCP), 1996).

Data and Demographics of Drug Abusers 

    Most drug abusers are men. In 1995 there were 874,000 admissions to publicly funded treatment facilities, with men accounting for 70% and women 30% of admissions. The largest percentage of admissions was for cocaine (38.3%), followed by heroin (25.5%) and marijuana (19.1%). 

    Treatment methods include behavioral therapies (counseling, psychotherapy, support groups, or family therapy), treatment medications (methadone maintenance for heroin addiction), short-term and residential in-patient treatment, drug-free outpatient treatment, and therapeutic communities. 

    In general, longer and more comprehensive treatment programs have better results compared to short-term or minimalist treatment programs. Drug abuse among women often presents different health and treatment challenges compared to men. Up to 70% of drug-abusing women report histories of physical and sexual abuse and drug and alcohol abuse in one or both parents. 

    Case finding and treatment are exceptionally difficult because drug-abusing women are often in relationships with drug-abusing partners and they have well-founded fears of losing the relationship and its economic protection if they seek treatment. 

    Treatment for women often means falling into poverty, homelessness, powerlessness, and losing custody of their children. Furthermore, drug abusing women were found to have exceptionally low self-esteem, self-confidence, and sense of powerlessness, making the decision to seek drug treatment a daunting experience.

    Among both men and women there have been recent increases in illicit use of prescription opiates (oxycodone, hydrocodone), while cocaine/crack use has decreased slightly. Use of PCP and club drugs (MDMA/ Ecstasy, GHB/ date rape drugs, and Ketamine/ Special K/Vitamin K) has increased. 

    The GHB trend is of particular concern as the drug is tasteless and often is put into drinks without the victim being aware of ingesting the drug. Women on college campuses are especially at risk for this scenario.

Preventive Research 

    Areas for future research include prevention research on the special issues facing men versus women and specific to each age group from school aged youth through the elderly. The major foci of prevention research-the individual, the peer group, or the community all require additional research and theory development and testing. 

    Genetic research is adding new insights every day and young scientists would do well to become trained in this area so as to be on the cutting edge of drug abuse knowledge development. Better approaches to case finding and referral for treatment are needed. Finally, the realm of drug-abuse treatment is fraught with drop scouts, treatment failures, and relapses. 

    Creative new treatment modalities need to be developed and tested. Rather than one-size-fits-all treatment modalities, perhaps it is time to develop ones that are designed to best match the needs of a specific subpopulation-youth, adolescents, adult women, adult men, or elderly men or women.