Health Care for Alcohol 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. 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. 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.
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. The World Health Organization 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. The explosion of knowledge about substance disorders 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.
Despite the social and health consequences, 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, 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. A review, two decades ago by documented widespread presence of negative attitudes on the part of substance abuse treatment professionals toward the substance abuser. In his later work, 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. 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.
Attitudes of care providers as important “determinants of the quality of care”, 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. In a classic paper, 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. 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. Other research supports the effectiveness of a therapist’s style using empathy with successful client outcomes and, furthermore, that the therapeutic nature of the client-professional relationship can predict improved treatment outcome.
In the past decade, research conducted under the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, both divisions of The National Institute of Health of the Department of Health and Human Services of the United States of America has overwhelmingly established that addiction is a brain disorder/disease, with symptoms that manifest themselves in complex ways and in all aspects of life. There are neurochemical processes occurring in the brain that lead to addiction, and without appropriate intervention, the disorder typically progresses and worsens. New initiatives by the Physician Leadership on National Drug Policy aim to raise the awareness of policy makers, health care personnel, community leaders, and the public that addiction is a treatable illness. There is evidence that the success rates with behavioral and medical treatments which are effective with other chronic disorders such as diabetes, asthma, and hypertension can also be just as effective in alcohol and drug abuse disorders when comparing compliance and relapse rates.
conducted a review of existing alcohol and drug education in schools of nursing and found that little attention was devoted to either the theoretical or the clinical components of substance abuse education. Other literature and research also support the lack of addiction content in schools of nursing.
states that nurses’ attitude towards persons with addiction problems correlate with their amount of knowledge about addictions. Thus, each nurse develops a knowledge base of addiction-related issues that in turn, guides the development of their beliefs and attitudes, and ultimately to the quality of care they provide to these clients. Clearly then, the accuracy of the information nurses receive is critical to the development of beliefs that can facilitate effective, nondiscriminatory care. Studies support that deliberate education of nurses does improve the nurses’ attitudes and furthermore, knowledge about addictions makes the nurse more likely to refer a person to appropriate treatment resource. Following this line of logic, this study was designed to assess if a focused and deliberate attempt is made to provide accurate and detailed information to nursing students on addiction-related health issues, whether this would have a positive influence on their belief system.
Tags: alcohol use, health care, substance abuse