Substance use in the context of health assessment

Substance use varies based on

1. social practices and acceptability

2. Affordibility

3. Issues of trauma, violence, chronic pain, etc.

4. Mental health and substance use are linked

Substance use is not a problem to be targeted

• substance use is a symptom that pre-exists a problem or circumstance

How is knowledge of substance use applied in health assessment

• health promotion

• take patient’s and population’s context into account

• trauma and violence informed care

• minimize harm

Relevent terms & documentation

• avoid discrimination and stigma - this makes people reluctant to share and seek help

• avoid labels such as “drug addict or user”

• use factual terms

• non judgemental tone

• accurate as possible; include:

  • Type of substance used

  • amounts

  • route

  • results of health history and physical assessment

Examining Attitudes

• Take a moment to reflect on values and beliefs about substance use and how this may influence your assessment practices.

How do you feel about working with people who use substances?

What judgements may arise when providing care?

what situation do you find it would be most challenging to be respectful?

Putting harm reduction principles into action

• we consider harm redduction principles as a practice of health promotion

• also have to screen for substance use

• again emphasizing importance of developing a rapport and asking the questions in a non-judgemental way

• NEVER ASSUME, ALWAYS STAY CURIOUS

Screening tools and assessments: TWEAK

tolerance - how many drinks does it tke to make you feel the first effect?

worry - have close friends or relatives worried or complained about your drinking in this past year?

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

amnesia - has a friend or family member ever told you about things you said or did that you cant remember

k-cut down - do you sometimes feel the need to cut down on your drinking?

• used to identify women who are at-risk for alcohol use problems

• >2 points - likely a drinking problem

Screeing tools and assessments: CAGE tool

• CUTDOWN - ANNOYED - GUILTY - EYEOPENER

• commonly used in accute care & pre-op settings to screen for possible substance use that may result in withdrawal symptoms

(Please note: This test will only be scored correctly if you answer each one of the questions.

Please check the one response to each item that best describes how you have felt and behaved over your whole life.)

Have you ever felt you should cut down on your drinking? Yes No

Have people annoyed you by criticizing your drinking? Yes No

Have you ever felt bad or guilty about your drinking? Yes No

Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)? Yes No

If client answers 2 or more “yes” responses, consider at risk for alcohol withdrawal.

Assessing for withdrawal

• hospitalization can interrupt patterns of substance use

• assessment and alertness needed to manage withdrawl

• know withdrawal symptoms specific to different substances**

• Do not assume symptoms are due to withdrawal - could be another medical emergency!

Alcohol withdrawal symptoms

• insomnia

• sweating

• tachycardia

• tremors

• N&V

• tremors

• anxiety

• seizures

sedative withdrawal symptoms

• anxiety

• othostatic hypotension

• tremors of hands, tongue, eyelid

nicotine withdrawal symptoms

• vasodilation, headaches, irritability and nervousness

cannabis withdrawal symptoms

• irritability

• nervousness

• sleep difficulty

• decreased appetite

• restlessness

• decreased mood

• physical symptoms - discomfort

Cocaine withdrawal symptoms

• dysphoric mood

• agitation

• insomnia

• hypersomnia

amphetamines withdrawal symptoms

• same as cocaine

• dyphoric mood

• agitation

• insomnia

• hypersomnia

Opiates

Same as Cocaine and amphetamines

• dyphoric mood

• agitation

• insomnia

• hypersomnia

two assessments

1. CIWA-Ar - Clinical institution withdrawal assessment - alochol revised

   1. use objective assessment data to obtain score and follow protocol

2. COWS - Clinical opiate withdrawal scale

   1. assess for and treat opiod withdrawal

5 A’s for integrating knowledge of substance use in health assessment

1. Acquire knowledge - replace assumptions

2. Anticipate harm that may be caused by your practices, reactions, judgements

3. Analyze organizational practices and resources

4. Avoid social judgement about substance use, such as seeing a person as “bad”, deviant or morally weak

5. Approach patients respectfully