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Substance
Abuse: Prevention, Recognition, and Treatment
By: Dr.
Stefanie Kelley
April
2003
The
Substance Abuse and Mental Health Services Administration (SAMHSA) has compiled
the results of the 2001 National Survey on Drug Use and Health (NSDUH).
Their findings reflect a comprehensive, as well as an accurate, depiction
of substance abuse in the United States. This study of 70,000 individuals
ages twelve and up from the fifty states plus the District of Columbia,
revealed that more than seven per cent of the general population was dependent
upon or had abused alcohol or illicit drugs in 2001. These statistics would
indicate that more than five million Americans meet the criteria for substance
abuse treatment, but did not, or would not, recognize the existence of a
problem. (http://www.samhsa.gov/oas/2k3/NSDUH/nsduh.htm).
Although consumption of alcoholic beverages is legal for adults over the
age of 21 throughout the United States, the National Institute on Drug Abuse
(NIDA) considers alcohol a drug of abuse. Alcohol is associated with hallucinogens,
cocaine, inhalants, heroin, marijuana, ecstasy, tobacco, steroids and prescription
medications by the NIDA. While there has been a long-term drop in overall
illicit drug usage, abuse among adolescents has increased in the last ten
years (US Department of Health and Human Services (HHS), 2000). Substance
abuse, however, is more than just a social or legal concern. It causes significant
economic problems in the workplace. The federal government estimates that
nearly 250 billion dollars was lost in 1992 due to substance abuse (http://www.drugabuse.gov/Infofax/costs.html).
Equally important is the fact that substance abuse is a major heath concern
in the United States. It is a disease, albeit one that that can be prevented,
identified, and successfully treated, and ultimately cured.
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
(DSM-IV), was employed by the NSDUH to define and measure alcohol abuse
and dependence (http://www.psych.org/clin_res/pg_substance_2.cfm#a).
In addition, NSDUH also defined specific terms relative to alcohol and drug
use. Among these terms are:
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Current
drug use (drug use of any kind in the past thirty days) |
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Binge alcohol
use (having five or more drinks on the same occasion at least once
in the past thirty days) |
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Heavy
alcohol use (having five or more drinks on the same occasion on at
least five different days in the past thirty days) |
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Moderate alcohol
use (having no more than one drink per day for women and no more than
two drinks per day for men) |
Whenever discussing
alcohol consumption, it is important to understand the general equivalencies
for alcoholic beverages. A "drink" consists of approximately twelve
grams of alcohol (Uphold & Graham, 1998) and can include, but is not
necessarily limited to:
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One
shot or highball (one and a half ounces) of hard liquor (eighty proof
spirits, i.e. whiskey, gin, vodka) |
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One glass of
wine (five ounces) |
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One
twelve ounce serving of beer, regular or "lite" |
When extrapolating
this equivalency into drinks, one mixed drink (depending on the recipe)
can oftentimes actually be more than a drink. With bigger and bigger wine
glasses in common use, a glass of wine is regularly more than five ounces.
(A 750 ml bottle of wine) is equivalent to five drinks.)
Frequently, substance abusers refuse to consider themselves dependent on
alcohol and/or drugs. They often believe that they do not fit the profile
of a substance abuser. In many cases, as their tolerance for alcohol increases
over time, they disregard what is considered a drink and feel that they
are not impaired after consuming moderate or large quantities of alcohol.
They may also simply be in denial. These are all components of the disease
of substance abuse. Responding to a person's substance abuse (or denial
of their abuse) is often a challenge to health care professionals. There
are trained addiction specialists who are skilled in identifying and treating
substance abuse. However, it is often a family member, friend, teacher,
colleague or health care provider who is faced with the initial task of
addressing the abusers situation and confronting them with their problem.
The first step in dealing with the situation, after recognizing the existence
of abuse, is to get help for the abuser and for his or her family and loved
ones. Fortunately, information and support is readily available through
many sources including, but certainly not limited to:
For health care
providers, using an alcohol abuse-screening tool can be helpful in identifying
alcohol related problems. For example the CAGE questionnaire is a simple
four-question tool that asks:
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Have you ever
felt you ought to Cut down on your drinking? |
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Have people ever
Annoyed you by criticizing your drinking? |
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Have you ever
felt badly or Guilty about your drinking? |
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Have you ever
had a drink the first thing in the morning (Eye opener)? |
One "yes"
response indicates the potential for hazardous drinking, and two or more
"yes" answers indicates the likelihood for alcohol abuse or dependence.
The AUDIT (Alcohol Use Disorders Identification Test) and the MAST (Michigan
Alcoholism Screening Test) are two other screening instruments used to detect
alcohol abuse. While screening tests do not necessarily diagnose substance
abuse, they are useful to clinicians in identifying patients in need of
a more thorough assessment. The use of intervention can also be used to
assess a substance abuse problem and motivate a person to consider treatment
(Chychula & Sciamanna, 2003). There are five strategies of a brief intervention:
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Introduce the
issue in the context of the patient's health |
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Screen, evaluate
and assess |
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Provide feedback |
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Talk about change
and set goals |
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Summarize and
reach closure |
April is Alcohol Awareness Month, sponsored by the National Council on Alcohol
and Drug Dependence, Inc. April 10, 2003 is National Alcohol Screening Day
(NASD). This annual event offers individuals free, anonymous screenings
for alcohol-related problems at more than four thousand sites across the
country. Screenings are held in a variety of settings, including hospitals,
senior centers, colleges, malls and community centers (www.NationalAlcoholScreeningDay.org).
Treatment methods for substance abuse are most successful when tailored
to the individual's needs. Behavioral therapy can include counseling, psychotherapy,
support groups or family therapy. However, research has shown, to no one's
surprise, that the more treatment received, the better the outcome. Treatment
for three months or more usually results in a more positive outcome. Certain
prescribed medications can suppress withdrawal symptoms, but those who choose
medically assisted withdrawal programs, without further treatment, may experience
similar results as those that seek no treatment. The possible pitfalls of
treating an addict with drugs would seem obvious.
The old adage "An ounce of prevention is worth a pound of cure,"
although trite, is certainly applicable in the case of substance abuse.
Prevention of substance abuse is a crucial component in reducing the incidence
and prevalence of drug and alcohol addiction. NIDA has funded research on
prevention techniques for communities, workplaces, schools, families, and
individuals. As a result, ninety per cent of worksites in the United States
with fifty or more employees have taken the first steps in preventing substance
abuse by adopting policies on alcohol and drug use (HHS, 2000).
Research has indicated that family-focused strategies have a greater impact
on substance abuse prevention than parent-only or child-only techniques.
Effective prevention programs focus on life skills training and on establishing
an anti-drug community attitude. Research strongly recommends that parents
take an pro-active role in their children's lives, talking with them about
drugs, monitoring their activities, getting to know their friends, and understanding
their problems and personal concerns.
While prevention is the most cost-effective and successful way to reduce
the incidence and prevalence of substance abuse, it does not always reach
those most vulnerable. Ultimately, despite all the good intentions of health
care providers, family and friends, substance abuse treatment is the responsibility
of the individual.
Here are several substance abuse related products
that might help:
References:
Chychula, N. M. & Sciamanna, C. (2003). Help substance abusers attain
and sustain abstinence. The Nurse Practitioner, 27 (11), 30-47.
U.S. Department of Health and Human Services (HHS). (2003). The National
Survey on Drug use and Health (NSDUH). Retrieved on March 29, 2003 from
http://www.samhsa.gov/oas/2k3/NSDUH/nsduh.htm.
HHS (2000). Healthy people 2010. (2nd ed.) Washington, DC: U.S. Government
Printing Office.
Martin, Kimberly. (2003, January). Youths' opportunities to experiment influence
later use of illegal drugs. NIDA Notes, 17 (5). Retrieved March 25,
2003 from http://www.drugabuse.gov/NIDA_notes/NNVol17N5/Youths.html).
Uphold, C.R. &Graham, M.V. (1998). Clinical Guidelines in Family
Practice (3rd ed.). Gainesville, Florida: Barmarrae Books.
Stefanie J. Kelley, ND, RN, CS has been in
the nursing field for over 10 years. She has clinical expertise in general
pediatrics and pediatric hematology, oncology, and bone marrow transplantation.
As a family nurse practitioner she has advanced practice expertise in internal
medicine, urban health care, and general pediatrics. As a faculty member
at Texas A&M University and Case Western Reserve University, she has
taught in the undergraduate and graduate didactic and clinical portions
of nursing. Dr. Kelley's interest in web-based instruction and health care
has been a part of her academic, clinical, and research practice.
Dr. Kelley welcomes your comments about her article or suggestions for future
topics. She can be emailed at sjkelley6@yahoo.com.
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