Health care of the substance abuse
IN THE United States of America, Substance Abuse and Dependence Disorders are a major cause of both health and social problems. Abuse of alcohol, tobacco, and illicit drugs cause a tremendous burden on the country with a current annual cost of over $414 billion [Schneider Institute for Health Policy 2001]. As the nation’s number one health problem, it contributes to illness and death, and strains the health care system. Of the estimated two million deaths of Americans every year, one in four is attributed to alcohol, tobacco, and/or illicit drug use [Schneider Institute for Health Policy 2001]. Substance disorders are known to be the primary cause of illness, disability, and mortality, which are preventable, if the appropriate assessment and treatment is available [Naegle 2001].
Misuse of alcohol, tobacco, and other drugs is a global public health threat. Nursing professionals worldwide are actively engaged in studying addiction issues and will play a vital part in reducing the enormous morbidity and mortality associated with this pandemic [Murphy-Parker and Boyjoonauth 2002, Murphy-Parker and Martinez 2001 and Sheehan 1992]. The World Health Organization [World Health Organization 2001] estimates that some 400 million people in the world suffer from mental or neurological disorders and psychosocial problems that co-occur with alcohol and other drug abuse. Given the enormous number of addiction-related health issues, all nurses need education to develop, implement, and renew their knowledge base and skills in substance abuse and dependence disorders [International Nurses Society on Addictions 2002]. The explosion of knowledge about substance disorders [Leshner 2001] make it possible for health care professionals to provide evidenced based care to persons with substance abuse problems. Yet, as a profession, nurses are not viewed and will not be viewed as a group that can make a difference in the incidence and prevalence of these disorders until better understanding and knowledge bring consensus that substance disorders are health related issues (Naegle, in review).
The purpose of this research study was to examine two methods of educating nursing students in the USA about substance disorders, specifically alcohol disorders, and to study the relationship of education and beliefs held by nursing students toward persons with alcohol problems.
Background
Despite the social and health consequences [Anthony et al 1997, Brady 1995, Greenfield 1998, Sullivan 1995b and US Department of Health and Human Services 2000], alcohol is one of the most widely used drugs in the United States. Although millions of Americans use and enjoy the experience of the effects of alcohol, there simultaneously exists a stigma and negative attitude towards those whose use causes adverse consequences for themselves and those around them. Although, the American Medical Association declared alcoholism a disease in 1954 [Schneider Institute for Health Policy 2001], the misconception that alcoholism is caused by an individual’s moral failing and lack of willpower continues and contributes to the stigma associated with substance abuse. In addition, there is the belief that treatment for those with alcohol problems is ineffective (Physician Leadership on National Drug Policy, 1998).
Although the general public’s beliefs and attitudes toward people with alcohol problems might be understood, it is alarming to find these same negative attitudes in health care providers [Naegle 1989]. A review, two decades ago by [Imhof et al 1983] documented widespread presence of negative attitudes on the part of substance abuse treatment professionals toward the substance abuser. In his later work, [Imhof 1995] stated that the health care field has not moved forward in terms of professional attitudes when working with alcohol abusers.
Nurses are no exception when it comes to negative attitudes toward people who abuse substances. Nurse researchers have investigated nurse’s and nursing student’s attitudes towards clients’ problematic use of alcohol and found nurses are stereotypic, moralistic, and pessimistic about this population; they perceive this population group to be weak [Smith 1992 and Starkey 1980]. Inadequate knowledge of drug and alcohol health problems has been explored as a primary reason for the nurses’ negative attitude in working with this patient population [Happell and Taylor 1999]. [Rassool 1998] suggests the development of a nonjudgmental and positive attitude towards persons with alcohol problems may be partly related to education.
Attitudes of care providers as important “determinants of the quality of care” [Sullivan 1995b], p. 414) have been studied as a key treatment variable. An attitude that facilitates a therapeutic relationship is a necessary component of success; however, few nursing studies have focused on the therapeutic relationship between nurses and addicted clients [Conti-O’Hare 1996]. In a classic paper, [Rosenzwieg 1936] introduced the concept of common factors. Common factors are not specifically unique interventions or approaches utilized but are factors, such as, expectation for improvement, warmth, attention, understanding, and encouragement which are central and play an active role in patient improvement [Lambert and Bergin 1994]. Evidence of the importance of common factors as criteria for success for persons treated for addiction problems is supported by Project Match (Matching Alcoholism Treatments to Client Heterogeneity) findings. Project Match, the largest and most statistically powerful clinical research project in the USA studied outcomes of persons who were alcohol dependent and found that all patients who participated in the study showed sustained, significant improvement with positive outcomes. These were not specifically related to any of the three different types of behavioral treatment modalities studied, but to the high quality of care delivered [Naegle 1997]. Other research supports the effectiveness of a therapist’s style using empathy with successful client outcomes [Miller and Sovereign 1989] and, furthermore, that the therapeutic nature of the client-professional relationship can predict improved treatment outcome [Bower 1997 and Miller and Rollnick 1991].
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