Managing a Client With Habitual Marijuana Problem - Essay Example

NURSING MANAGEMENT Management of a client with habitual marijuana and mental health problems Introduction   Marijuana1 is the most widely consumed illicit drug in the world (Maxwell, 2003). According to the statistics on drug abuse published by the Australian Institute of Health and Welfare in 2002 (based on National Drug Strategy Household Survey, 2001), marijuana constituted 33.1% of the illicit drugs ever used. It also constituted 12.9% of the drugs recently used. The mean age of initiation was 18.5 years. According to the same study, at each age, marijuana use was more common among males than females. Males were more likely than females to have ever used marijuana. The prevalence of marijuana use peaked in males and females aged 20–29 years (Maxwell, 2003). In young people aged 14 to 17 years, the drug was used at least once by 28% of persons falling in this group whereas in the elderly people, consumption decreased after the age of 40 years and the rate continued to decrease as age increased thereafter. The consumption of marijuana was much higher in Aboriginal and Torres Strait Islander people (50%) when compared to non-indigenous Australians (33%). Also, there was no difference noted in marijuana intake between those living in urban areas and those in remote and rural areas. The drug abuse was more in those with English speaking background than those with non-English speaking background. Women who were either breast feeding or pregnant or both consumed much less than other women. The consumption of marijuana overseas was most prevalent in New-Zealand (20%) and least in Canada (8.9%). The prevalence in U.K and U.S was same (9%) (Maxwell 2003; Gfroerer 1992) Marijuana is a mixture of dried parts of the plant hemp including leaves, stems, seeds and flowers. It appears green, brown, or grey depending on the composition. It is referred to by many street names such as herb, weed, grass, boom, Mary Jane, gangster, or chronic. It is usually consumed in the form of cigarette (referred to as ‘joint’ or ‘nail’) or pipe. Most often it is consumed with other illicit drugs like cocaine (called ‘blunts’) or tobacco. It is taken in mainly for the mental effects like altered state of consciousness, perceptual changes like hallucinations and heightened sensory experiences. The main active chemical having psycho-activity in marijuana is THC (delta-9-tetrahydrocannabinol) (Astolfi, 1998). Other than euphoria and hallucinations, marijuana has other effects also. The immediate effects are blood shot eyes, dry mouth and throat, sleepiness, paranoia, decreased ability to concentrate, coordinate and react, along with impaired short- term memory, comprehension, speech and learning. There is decreased ability to judge distances and react to signals and sounds on the road causing accidents. Heart rate and blood pressure are increased2, threatening cardiac dangers3 in those with pre-existing heart disease. Some of them even develop panic attacks and hypotension. Those with chronic abuse, have problems with motivation (anti- motivational syndrome). They do not care what happens to themselves in their lives. They lose interest in work and become tired easily. They also have no concern about how they look (Astolfi, 1998). They have strained social relations, develop social inhibitions and become psychologically dependent. They also develop other problems like chronic bronchitis, increased chest colds and abnormal functioning of the lung tissue. These effects are even greater when other drugs like cocaine or tobacco are mixed with marijuana; and most of the times, the users do not know what drugs are given to them (McAllister, 1991). The effects also depend on dosage, route of administration, previous drug experience, the user’s expectation of the effects of the drug, social environment and mood of the user. Case Management: Client with habitual marijuana intake, who exhibits signs of mental health problems. While talking to the client, include the following in history taking: Age and sex of the client, onset and duration of consumption of the drug, reason for consumption, first introduced by whom, mode and dosage of administration of the drug, in whose company does the client take the drug (family members, partners and friends), intake of other drugs, effects of the drug (immediate and long term) and what he likes and dislikes in these effects, changes in life like social relations, performance in school or at work place and finances. Enquire about other health problems (cardiac and respiratory). If the client is female, enquire about change in menstrual cycles and pregnancy. Also enquire about driving and accidents. After an elaborate history taking, do an in-detail physical examination. Assess state of consciousness, dependency, hallucinations and delusions, speech, learning, memory, comprehension, concentration, coordination and reaction. Record vital signs like heart rate, respiratory rate, blood pressure and temperature. Look for signs of other drug abuse like constricted or dilated pupils, signs of ingestion in oral and nasal cavities, injection sites in the skin, muscle tone and nystagmus. After that, the patient’s urine analysis must be done to confirm marijuana consumption (Astolfi, 1998). A record of this has to be made. If the client is female, do tests to confirm pregnancy (Astolfi, 1998). It is important to confirm pregnancy, because marijuana has effects on the fetus (Astolfi, 1998) and this needs to be stressed during counseling. From the above data, you will be able to assess the severity of drug-related problems and safety of the client – (risk of suicide, harm to others due psychoses and depression, and accidents). You will also know about the client’s readiness and determination to quit. Management As of now, there is no drug to treat marijuana dependence. Counseling is the only method of helping the client (Astolfi, 1998). The first step in counseling is motivation for abstinence. Advise the patient about the benefits in quitting like good health, good education and job, high self esteem and good social and partner relationships. Advise to stop-at-once than gradual withdrawal. Also, ask the client to stay away from peers, friends and others who indulge in drug abuse. If partner or family members are also drug dependent, involve them in de-addiction programme. Encourage to go back to school or work and concentrate on good results. Encourage to use other modes of entertainment like watching movies and drama, playing games and attending family functions. With all these, the patient must also change his lifestyle (Astolfi, 1998). Regular exercise and balanced diet is a must for sound body and mind. The most important problem during abstinence is emergence of withdrawal symptoms. The patient may need assistance during this phase. These symptoms appear within 24 hours of stopping the drug. They are more pronounced in the first 10 days, but can last up to 4 weeks. Common symptoms are sleeplessness, restlessness, anxiety, mild depression, headache, loss of appetite, irritability and mood swings. Usually these symptoms are mild. Some patients may need anti-anxiety drugs or medicines for sleep. Some others, who have acute withdrawal symptoms of a greater degree, may need benzodiazepines. Depending on the body mass and tolerance, diazepam can be given 5 to 10 mg three times a day for about 4 days. It also causes few side effects like fatigue, muscle weakness, ataxia and drowsiness and is usually dose related (Astolfi, 1998). After the initial phases of motivation, abstinence and control of withdrawal symptoms, advice must be given about precautions and safety. The client must be advised to avoid driving and operation of dangerous machinery especially when on diazepam. He also must be refrained from living alone or traveling alone, especially if having mood swings4. The most important aspect of management is prevention of relapse. Education of client must be done in the early stages of abstinence when the risk of reverting back is high due to withdrawal symptoms (Astolfi, 1998). The way to success is mainly motivation and instilling confidence and positive attitude and not talking about failures. Doctors, nurses, attendants, care takers, friends and family members must get involved during this period in a positive manner. The client must be advised to delay the desire to smoke and distract his mind from smoking by getting involved in other activities like listening to music, watching movies or drama, attending family functions, playing games or indulging in any other hobbies like reading novels or gardening. Further, he should be advised to avoid places and people who trigger the desire to smoke. Issues facing nurses Though nursing is a highly valued profession, the kind of service provided by the nurses takes toll on them physically and mentally, there by making them vulnerable to stress. Those working in substance abuse and mental health departments are more vulnerable to stress because the kind of jobs here are challenging, requiring display quality skills (Happell, 1999). Hence issues dealing with nurses in such departments are gaining more and more importance. For a nurse to work in de-addiction, substance abuse management and mental health departments, it is necessary to have some skills. The skills needed are skills of physical assessment - signs of addiction and withdrawal syndromes, Psychological assessment - state of consciousness, affect, mood and motivation levels, self preservation and self awareness - to keep out of danger from violence due to drug abuse, communication skills - talking and listening, assertive and diplomatic dealing, interactive, ability to confront the patient and get valuable information about personal life and events and other skills like open-mindedness, empathy, observation, intuition, leadership, awareness of family dynamics, understanding medications and their side effects, computers, time management, problem solving, ability to work as a team member and ability to develop and nurture long term relationship (Happell, 1999). There are many challenges encountered by the nurses in drug-abuse management faculty (Jones, 2003). Many nurses have inadequate practical experience. Though the nurses are trained academically, they may not have real-life experience, making them more vulnerable to stress. Also, many de-addiction centers do not have adequate staff because working in these units is highly demanding with fewer pay packets. Most of the services rendered are through government or non-profit making organizations and hence may not be funded appropriately. Above all, the most challenging aspect is patient behavior. The kind patients who come to these units have a wide range of mental problems and hence their behavior will be abnormal. Some may turn violent and others may use abusive language. The staff must be trained in recognizing symptoms of psychosis and de-escalation techniques to prevent aggravation of hostility in a client (Room, 2005). The staff must avoid confrontation. The client must be screened from carrying dangerous objects and he must be kept in a quiet room free from dangerous objects, so that he does not harm himself or others.  Such persons need constant supervision so that they dont harm themselves or others, and in case of any injuries must be given prompt medical service. For the same reason, the staff must have cooperation with police and emergency ambulance services. The staff must also take adequate precautions to prevent infectious disease transmission like wearing gloves, masks, etc (Rom, 2005). Another issue faced by the nurses is lack of resources (Annette, 2004). This is usually a problem in remote and rural areas. Unfortunately, people living in these areas have more incidence rates added to their poverty levels. Social workers and other public health personnel must be involved in tackling the issue (Annette, 2004). Due to the high stressful conditions which drains the nurses physically and mentally, the nurses themselves may go in for alcohol, anti-anxiety medications, etc. Some may develop depression. As such the staff themselves may require counseling and help (Happell, 1999) . What are the financial issues concerning marijuana habituation? Marijuana habituation is not a problem of health issue alone. It also affects the economy of the person, his family, his society and his nation. At family level, the person has to spend lots of money in procuring the drug. If he a working person he may lose his job or have a pay cut due to poor performance and absenteeism. If he is a student he may fail academically. Also, many drug addicts take loans, even if he has to pay back at high interest rates. Dependency can make some addicts sell valuables and property to mobilize money to purchase the drug. Money also has to be spent on injuries, accidents and ill-health due to dependency. Society has to pay the price for nurturing substance abuse individuals. What money can be utilized for public utilization like laying roads, water supply, schools, etc., will be used for management of drug addicts. Also, some of them may get involved in robbery to buy drugs. The brunt of substance abuse is borne by the nation. The government has to spend money on treatment of the addicts: in-patient services, out-patient clinics, de-addiction centers; training centers: for nurse, mid-wives and doctors – to deal with drug addicts; symposiums, seminars and conferences - to enhance the importance of this alarming problem and discuss issues to tackle it and on research and development- to develop measures for early recognition and successful treatment (Health Care Cost and Utilization Project). Also, money has to be spent on dealing with criminals. Drug addiction leads to increase crime. Money has to be spent on police, prisons and courts (Single, 2000). Total social and health costs of dealing with the consequences of illegal use of drugs in the US have been estimated to be a further $66.9 billion a year (Dixon, P). Data from the Agency for Healthcare Research and Qualitys National Inpatient Survey, 2001, indicated that there were an estimated 5,392 discharges from hospitals where marijuana dependence or abuse was the primary diagnosis. Actually, the number of marijuana primary diagnoses is significantly lower than those for alcohol, heroin, and cocaine, but the mean length of stay for marijuana episodes is three times longer than for alcohol and heroin discharges and more than two times longer than for cocaine diagnoses. The mean charge per marijuana discharge is nearly twice as large as those for any of the other substances. Table 1: 2001 National Statistics on Marijuana, Alcohol, Heroin and Cocaine Discharges from the Agency for Healthcare Research and Qualitys (AHRQ) National Inpatient Survey Substance Total Number Of Discharges Mean Length of Stay In Days Mean Charges In Dollars Marijuana 5392 16.4 12447 Alcohol 168472 5.4 6706 Heroin 55642 4.5 5734 Cocaine 21134 6.2 6667 Conclusion The importance of nurses’ role in the management of psychoactive substance use has been recognized world wide. They form a core component of many health care systems (Annette, 2004). But their services have been often under-utilized. The main concerns are of anxieties concerning role adequacy, legitimacy, lack of support and failure to implement interventions in a variety of settings (Annette, 2004). Since nurses have the ability and opportunity to interact with clients and their families, they should be involved more in counseling aspects. Their training must include development of innovative strategies and involvement of support groups. According to a study by Annette and others, the focus must be on developing skills for critical thinking, preventive and therapeutic interventions, clinical judgment, effective organizational capacity and team work (Annette, 2004). Other issues which need to be addressed are ethical and legal issues surrounding health care for substance abuse. Bibliography Annette, M., Nkowane, R.N., & Saxena, S. 2004. Opportunities for an improved role for nurses in psychoactive substance use: Review of the literature. International Journal of Nursing Practice,10 (3), pp 102–110. Astolfi, H., Keonard, L. & Morris, D. June 1998. Cannabis dependence and treatment. GP Drug and Alcohol Supplement 10 Dixon, P. The True Cost of Drug Addiction. Available from: http://www.globalchange.com/drugs/TAD [Cited on 5/29/2007]. Gfroerer, J., & Brodsky, M., September 1992. The incidence of illicit drug use in the United States, 1962-1989. Br J Addict, 87(9), pp 1345-51. Happell, B, & Taylor, C. 1999. We may be different, but we are still nurses – an exploratory study of drug and alcohol in nurses in Australia. Issues in Mental Health Nursing, 20(1), pp 19-32. Health Care Cost and Utilization Project. Agency for Healthcare Research and Quality. Available from: http://www.ahcpr.gov/data/hcup. [cited 30/5/2007]. Jones, R.N., & Cheek, J. March 2003. The Scope of Nursing in Australia: A Snapshot of the Challenges and Skills Needed. Journal of Nursing Management, 11(2), pp 121- 129. Maxwell, J.C., September 2003. Comparison of drug use in Australia and the United States as seen in the 2001 National Household Surveys. Drug Alcohol Rev., 22(3), pp 347-57 McAllister, I., & Makkai, T., 1991. Whatever happened to marijuana? Patterns of marijuana use in Australia, 1985-1988. Int J Addict. 26(5), pp 491-504 Room, R., Babor, T., & Rehm, J. 2005. Alcohol and public health. Lancet. 365, pp 519-530. Single, E., Christie,P., & Ali, R., 2000. The impact of cannabis decriminalisation in Australia and the United States. Journal of Public Health Policy, 21(2), pp 157-186. Read More