According to the World Health Organization (WHO) substance abuse can be defined as the harmful or hazardous use of psychoactive substances. This definition of substance abuse not only includes the use of illegal drugs but also the dangerous use of drugs that are legal for example alcohol, tobacco, the detrimental use of prescribed medicines by exceeding the recommended prescribed dose and the illegal use of legal drugs such as drinking and driving or smoking cigarettes in a no-smoking area. Psychoactive substances can cause dependence syndrome which includes cognitive, behavioral and psychological phenomena that occurs after repeated substance use. Individuals are considered to have a substance use disorder when use of the substance interferes with their ability to fulfill role obligations, such as at work, school, or home (Townsend, M, 2015, p. 366). Approximately 3.3 million people die from alcohol abuse each year around the world. (WHO). According to the National Drug-Related Deaths Index (NDRDI), there were 6,479 alcohol-related deaths between 2008 and 2013 and from 2006-2014 there were 2,132 deaths in Ireland as a result of drug overdose (Ireland drug report 2018). Recent research shows that over 1 million Europeans receive treatment for problems related to the use of illicit drugs each year. (EMCDDA, 2010). Nurses play a vital role in relation to specialist interventions for the treatment of substance abuse, some of which include physical and mental health triage, assessment and care, risk assessment, referral to health and social care agencies, pharmacological management, psychosocial supports, biopsychosocial supports, motivational interviewing, mobilize and co-ordinate resources in managing alcohol and drug-related clinical crises.
Gail W. Stuart (2013, p. 463) suggests it is of paramount importance that before intervening with a substance-abusing patient, the nurse must develop self-awareness of feelings and attitudes about the problem. In order to achieve the best result for the patient the nurse must ensure that he/she has a knowledge and understanding of drug misuse problems, knowledge and understanding of mental health problems, a knowledge of and ability to operate within professional and ethical guidelines and also a knowledge of motivational interviewing and the application of the model in practice.
Patients with substance abuse problems receive optimal benefits from a comprehensive treatment program that incorporates psychosocial, behavioral, social and spiritual treatments.
Psychosocial interventions the nurse can implement include structured counseling, motivational enhancement, case management, care-coordination, psychotherapy and relapse prevention.
‘Varied individualized pharmacological treatment modalities may be needed by clients/patients during their health maintenance, withdrawal and recovery process.’ (ANA & NNSA, 1988, p. 14, cited in Shives, 2008, p. 452).
Counselling can be defined as an interaction in which one person offers another person time, attention and respect, with the intention of helping that person explore, discover and clarify ways of living more successfully and towards greater well being. (Palmer et al . 1996: 22). There are various forms of counselling for example cognitive behavioral therapy (CBT), family therapy, group therapy, motivational interviewing, twelve-step facilitation, and contingency management which can be provided by a licensed addictions counselor, a mental health therapist, a nurse, a psychologist, a physician, or social worker.
Cognitive behavioral therapy
Incorporating cognitive behavioral therapy (effective psychotherapeutic approach) into nursing practice is the ideal vehicle for the nurse to use to guide counseling and education interactions with the client/ patient. CBT gives nurses another method to use in addition to existing nursing practice. Cognitive behavioral therapy is huge for patients suffering from substance abuse disorder. According to Bailliere’s Nurse’s dictionary 26th ed (P. 90), Cognitive behavioral therapy is a method of treating psychological disorders based on the approach that the patient’s problem arises from a faulty way of looking at the world and oneself. Goulding and shank (2005, cited in Shives, 2008, p. 456) suggests that the cognitive therapy approach is used to help modify the clients thinking, expectations, and behaviors and to increase basic coping skills.
Although cognitive behavioral therapy is one of the more popular forms of therapy for clients/ patients with substance abuse disorders, group therapy can also be very beneficial as in groups, individuals are able to share their experiences with others who are going through similar problems. (Townsend, M, 2014, p. 408). Nursing intervention also includes providing assistance in the location of and referral to support groups that deal with substance abuse, use and addiction. The nurse may refer the client/ patient who has an alcohol addiction to Alcoholics Anonymous (AA), some nurses may serve as leaders of these types of groups in the community.
- COST AND FINANCING OF DRUG TREATMENT SERVICES IN EUROPE: AN EXPLORATORY STUDY. (2011). [ebook] Publications Office of the European Union, p.9. Available at: https://www.drugsandalcohol.ie/16291/1/EMCDDA_financing_TDSI11001ENC.pdf [Accessed 6 Feb. 2019].
- Corrigan, D. (2019). Chapter 2 – Drugs and Drug Related Problems. [online] Drugsandalcohol.ie. Available at: http://www.drugsandalcohol.ie/5845/1/2401-Facts_About_Drugs.pdf [Accessed 7 Feb. 2019].
- Freshwater, Dawn. Counselling Skills for Nurses, Midwives and Health Visitors, McGraw-Hill Education, 2003. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/aitie/detail.action?docID=287805.
- Ireland Drug Report 2018. (2018). [online] Dublin, p.1. Available at: http://www.emcdda.europa.eu/system/files/publications/8874/ireland-cdr-2018-with-numbers.pdf [Accessed 6 Feb. 2019].
- Overview of alcohol consumption, alcohol related harm and alcohol policy in Ireland. (2016). [PDF] Dublin: the Health Research Board, p.3. Available at: https://www.hrb.ie/fileadmin/publications_files/Drugnet_Ireland_59.pdf [Accessed 6 Feb. 2019].
- Shives, L. (2008). Basic concepts of psychiatric-mental health nursing. 7th ed. Philadelphia: Lippincott Williams & Wilkins, p.456.
- Stuart, G. (2013). Principles and Practice of Psychiatric Nursing. 10th ed. South Carolina: Elsevier Health Sciences.
- Townsend, Mary. Psychiatric Mental Health Nursing : Concepts of Care in Evidence-Based Practice, F. A. Davis Company, 2014. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/aitie/detail.action?docID=1776176.
- World Health Organization. (n.d.). Substance abuse. [online] Available at: https://www.who.int/topics/substance_abuse/en/ [Accessed 6 Feb. 2019].
- Weller, B. (2014). BAILLIERE’S NURSES’ DICTIONARY. 26th ed. ELSEVIER HEALTH SCIENCES, p.90.