Chapter 12: Substance use and the health of communities

How to calculated (Disability-adjusted life years) DALYs?

DALY= YLL (years of life lost) + YLD (year of life disabled)

YLL= N (number of deaths) x L (standard life expectancy at age of death in years)

YLD= I (number of incident cases) X DW (disability weight) X L (average duration of the case until remission or death)

Substance use

Use of psychoactive substances that alter mood, perception, and level of consciousness.

Stimulants

Overstimulate the CNS, resulting in accelerated heart rate, high blood pressure, and other symptoms related to stimulation of the CNS

Examples of stimulants

Cocaine, amphetamines, methylphenidate, nicotine, methamphetamine, Ritalin, caffeine, and methedrine

Narcotics

relieve pain and can result in a state of euphoria and other mood changes

Examples of narcotics

Vicodin and OxyContin, opium, morphine, heroin, codeine, hydromorphone, meperidine, methadone, Darvon

Dissociative anesthetics

inhibits the body’s ability to perceive pain

Example of Dissociative anesthetics

PCP

Depressants

Depress the CNS, thus slowing down the brain and the body

Examples of depressants

Alcohol, barbiturates, and anti-anxiety tranquilizers (e.g., Valium, Librium, Xanax, Prozac, and Thorazine)

Inhalants

Come from a wide range of chemicals that are inhaled, producing mind-altering effects

Examples of Inhalants

Butyl nitrite, amyl nitrite gas used in some aerosol cans, gasoline and toluene vapors from correction fluid, glue, marking pens

Hallucinogens

Result in altered perception of reality

Examples of hallucinogens

PCP, LSD, mescaline, peyote, psilocybin, ecstasy, PCE, methamphetamine, and cannabis

Cannabis

Results in a feeling of euphoria and can include distorted perceptions and memory impairment, as well as difficulty thinking and solving problems

Examples of Cannabis

marijuana, tetrahydrocannabinol, or THC; hashish; hashish oil; and synthetics such as dronabinol

Components of substance use

helps determine the risk of adverse consequences

• quantity of substance

• frequent use

• pattern of use

• duration of use over lifetime

• quality of substance

quantity of substance

the amount consumed (dose)

Frequency

how often the substance us consumed (daily, weekly, or monthly)

Pattern of use

whether the use is consistent or occurs in an episodic manner (binging)

Duration of use over a lifetime

how long over a lifetime the use has occured.

Quality of substance

manufacturing process of the substance consumers and whether the product might include toxins or other substances.

what are levels of continuum of substance use?

1. No use

2. Beneficial use: under medical supervisions

3. Non-problematic: use without any physical or mental health impacts

4. Problematic use: patterns and types if use that have a higher risk of physical and mental health impacts.

5. Potential harmful: episodic use that can and may be leading to harmful impacts

6. Substance use disorder

Substance Use Disorder

maladaptive pattern of substance use leading to clinically significant impairment or distress

Tolerance

an adaptation of the body to a drug that results in needing more drug to achieve a certain effect

Withdrawal

drug-specific physical or mental symptoms that occur on abrupt stop of drug use.

Physiologic dependence

evidence of tolerance to or withdrawal of a foreign substance.

Physical Dependence

unpleasant physical symptoms that occur when the drug is stopped or taken in smaller doses

What are some upstream approach for substance use disorder?

Reduce harm at the population level through prevention of substance use.

Reduction of harms associated with substance use.

Early treatment of substance use disorders (SUDs).

Decriminalization of substance use. ( rather than sending them to jail, they focus on treating the problems)

Broader policy initiatives.

Harm reduction model

Intervention focus ranges from safer use to abstinence

Intervention goals are to minimize physical, emotional, social and economic harm

Interventions address individual and population levels

Interventions are free of judgement and blame

Nursing guidelines for harm reduction

Be culturally competent and nonjudgmental in providing services.

Be responsible for delivering interventions that reduce the impact of SDOH in the community.

Develop new strategies to address unsafe health practices in addition to traditional strategies.

Develop harm reduction strategies for those clients who are unable or unwilling to modify unsafe behaviors.

Don’t’ treat relapses and returns to unsafe health practices as failure of treatment.

Work in collaboration with other programs to provide comprehensive services.

Offer a range of treatments across a continuum of care for your clients.

Effects of alcohol

The direct effect of alcohol is determined by the blood

Excess alcohol that is not metabolized circulates in the blood and affects the central nervous system and the brain alcohol level.

The body processes alcohol dependent on several factors

Size and weight of the drinker

Sex (affects metabolism)

Carbonation (increases absorption)

Time elapsed during alcohol consumption

Food in the stomach

The drinker’s emotional state

Type of alcohol

What are the vulnerable population exposed to alcohol across the lifespan?

Pregnancy and Fetal Exposure

Children

Adolescents and early adulthood

Older Adults

What are the 5-As

• Ask about nicotine use

• Advise to quit using clear, personalized massages

• Assess willingness to make a quit attempts

• Assists in quit attempt

• Arrange follow up and support

MPOWER

Policy interventions

Monitor tobacco use and prevention policies.

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about the dangers of tobacco

Enforce bans on tobacco advertising, promotion, and sponsorship

Raise taxes on tobacco

Physical Assessment Findings

VITAL SIGNS: Varies depending on the substance being used.

APPEARANCE: Individual can appear disheveled with an unsteady gait.

EYES: Pupils can appear dilated or pinpoint, red, and with poor eye contact.

SKIN: Can be diaphoretic, cool, and/or clammy. Needle track marks or spider angiomas can be visible.

NOSE: Can be runny, congested, red, and/or cauliflower‐shaped.

TREMORS: Fine or coarse tremors can be present.