Substance & Family Violence

What is the most used & abused psychoactive drug in the United States?

Alcohol

What are the 7 categories of illicit drug use?

• Marijuana*

• cocaine (including crack)

• heroin

• hallucinogens

• inhalants

• methamphetamines

• non-medical use psychotherapeutics (Rx pain relievers, tranquilizers and sedatives)

What are the characteristics that increase risks associated with alcohol use?

• Decrease in body’s metabolic functions (liver, water, and renal) leading to increased bioavailability

• Muscle mass decline leads to increased concentration in the body.

• Effects of polypharmacy may interact with alcohol.

• Increases risk for cognitive decline

• Drinking alcohol increases risk for falls, depression, and gastrointestinal problems

For subjective data, how should screening tools be used?

Identify problem drinking and Require further assessment

AUDIT

will help detect less severe alcohol problems (hazardous and harmful drinking) as well as alcohol abuse and dependence disorders.

What assessment can help diagnose alcoholism?

CAGE assessment

• C - Cutting down

• A - Annoyance by criticism

• G - Guilty feeling

• E - Eye-openers

TWEAK

questions help identify at-risk drinking in women, especially pregnant women

Break down TWEAK

Tolerance, Worry, Eye-opener, Amnesia, Kut down

Tolerance

how many drinks can you hold? Or how many drinks does it take to make you feel high? 

Worry

have close friends or relatives complained about your drinking?

Eye-opener

do you sometimes take a drink in morning when you first get up?

Amnesia

has a friend or family member told you about things you said but could not remember?

Kut down

do you sometimes feel the need to cut down?

SMAST-G

for older adults who report social or regular drinking of any amount of alcohol

The patient says, “I can quit anytime I want.” The nurse should interpret this statement to be a sign that this individual

may be in denial of needing help or having a problem with opiates

Explanation: Most patients will deny needing help for substance abuse and may believe they can stop at any time.

The nurse should examine the way he or she feels about these issues

to provide nonjudgmental care for substance-abusing patients

What are the intimate partner violence?

Physical violence, sexual violence, stalking, psychological aggression; In teens: physical, sexual, psychological, or emotional; Sexting or cyber abuse is 24/7

Physical violence

force resulting in injury or death

Sexual violence

attempted or completed acts without permission

Stalking

repeated unwanted attention through various methods

Psychological aggression

emotional abuse of an aggressive nature

What are forms of older adult abuse?

Physical abuse, sexual abuse, psychological or emotional abuse, Neglect, Financial abuse or exploitation

Physical abuse

intentionally assaulted, injured, threatened, or restrained

Sexual abuse or abusive sexual contact

any sexual contact against one’s will

Psychological or emotional abuse

includes verbal and nonverbal behaviors intended to humiliate, isolate, or affirm control

Neglect

failure of caregiver to meet basic older adult needs

Financial abuse or exploitation

unauthorized use and/or improper use of older adult’s funds/resources

What are the screening requirements?

• All women of childbearing age (14 to 46) should be screened

• Insufficient evidence to support screening of older adult or vulnerable adults

• No current recommendations for children

• Early detection is the key in terms of prevention of long-term complications

• Health care providers are mandatory reporters

• Be aware of potential for Human Trafficking

  • Observe for risk factors, signs of Human Trafficking, and screening tools used in the clinical facility

How to Assess for Intimate Partner Violence:

• Use of open-ended questions to start the conversation

• Interview the individual separately from the perpetrator.

• Listen for cues which may indicate a pattern or responses that don’t match the “physical” injury that is present.

• Be aware of state laws and requirement to report.