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Substance
Abuse: Prevention, Recognition, and Treatment
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:
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:
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:
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:
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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