Drug and Alcohol Abuse and Depression - Research Paper Example

?Running head: DRUG AND ALCOHOL ABUSE AND DEPRESSION Drug and Alcohol Abuse and Depression (school) Drug and Alcohol Abuse and Depression Introduction The nursing and midwifery practice is a rich and dynamic practice which includes various applications of theories and skills. Nursing research plays a crucial role in this practice because it helps enrich and validate its interventions and applications in the practical clinical setting. This paper shall present a review of the nursing/midwifery practice, particularly focusing on a review of the relationship between drug and alcohol use and depression. It shall first present a description of the current practice in the clinical unit, including its related policies, procedures, guidelines, reporting mechanisms, and the literature underpinning its practice. Then a comprehensive overview of a systematic review of a study related to drugs and alcohol and their relation to depression shall be presented. Two appraisal guidelines which can be used to appraise the systematic review shall be critically discussed. Similarities and differences between these guidelines shall be included. Finally, based on evidence discussed in the systematic review, advice and recommendations in my area of practice shall be forwarded. These recommendations shall be explained in relation to relevant literature. This study is being undertaken in order to establish a critical and comprehensive assessment of the current subject matter and nursing/midwifery practice. Body Brief description of unit The current practice in my clinical unit as a nurse is on dealing with alcohol and drug abuse patients who have a history of prepubescent sexual abuse. We routinely carry out PAP smears on these patients and find many of them to be positive for precancerous CIN cells. Many of them are also found to be depressed. Nurses who are working in units with alcohol and drug patients are involved with patients who usually have had a history of using drug and alcohol abuse. Patients in this unit are those who have used tobacco, alcohol, prescribed drugs, illicit drugs, amphetamines and cannabis, and a combination of drugs and alcohol. Nurses are the most numerous members of the health care profession and are often the ones who spend the most time with the patients. As such, they have to be equipped with the skills and the expertise in order to guide their patients towards full recovery. Working with drug and alcohol patients is a role of the advanced nurse practitioner. Advanced nurse practitioners are registered nurses who are educated and authorized to perform duties autonomously and in coordination with other nurses in the advanced clinical setting (Ling, 2007). It includes the process of assessment and management of clients using skills and knowledge which may include the direct referral of patients to other health professionals, prescribing medications, and ordering further diagnostic tests (Ling, 2007). In the clinical setting where I work, we usually receive drug and alcohol patients. Upon meeting them, an overall initial assessment is carried out on these patients, including an assessment of the way they talk, the way they talk, their mannerisms, their physical demeanor, and similar qualities. An interview would then follow with the end goal of gathering as much information as possible about the patient’s history, as well as their living conditions, their eating, alcohol, drug, and possibly other habits impacting on their health. This assessment process would determine the next steps for the nurse and the patient – whether more diagnostic tests need to be undertaken, whether there is a need to refer the patient to a therapist, and whether or not the patient needs to be assessed for depression. Since this unit is involved in carrying out PAP smears, the PAP smear shall be scheduled for the patient after proper consent forms are signed and filled up. As an advanced practice nurse in the clinical unit, the role as counselor also sets in, especially if these patients are also depressed. The nurse can apply her therapeutic skills of listening, sympathizing, and communicating with the patient in order to assist in the management of the patient’s depression (Morrison, 2002). The relationship between the patient’s depression and his drug and alcohol use can be linked during this interaction with the patient. For nurses dealing with drug and alcohol patients, it is important for them to recognize the fact that there are deeper reasons behind their abuse and their depression – one may be causing the other and vice versa (Morrison, 2002). Any remedies and interventions to be recommended for the drug and alcohol patient must therefore be based on interventions which address the cause of the addiction and the abuse. Systematic review A systematic review by Sullivan, et.al., (2005) set out to establish the prevalence of alcohol problems in major depression. The authors carried out their study with the assumption that major depression and alcohol issues are common problems in primary care, and yet not much is known about the incidence of alcohol issues among patients with depression. Moreover not much is known about the impact of alcohol on the outcomes of depression. The authors then specifically noted the following questions: how common alcohol issues are among patients with depression; does alcohol affect the course of the depression, the response to therapy, the risk of suicide, social functioning, and healthcare use; and where the alcohol categories and treatment settings have patients with depression and alcohol issues been assessed (Sullivan, et.al., 2005). Various related studies from MEDLINE, PsychInfo, and the Cochrane Controlled Trial Registry were evaluated in terms of their applicability to the study. Studies were then chosen according to predefined inclusion criteria, most commonly if they considered the prevalence or the impact of alcohol issues in depression (Sullivan, et.al., 2005). Thirty five of the assessed studies were able to fulfill the inclusion criteria and were then subsequently included in the review. These studies established that the median prevalence of current alcohol problems was at 16% and of lifetime alcohol problems was at 30%. This related to 7% for the current alcohol issues and 16-24% for lifetime alcohol issues in the general population (Sullivan, et.al., 2005). There is much evidence of antidepressants improving depression among patients with alcohol dependence. These studies further reveal that alcohol issues are related with negative outcomes in the course of depression, suicide risk, social functioning, and healthcare use (Sullivan, et.al., 2005). Majority of the studies (97%) assessed alcohol abuse and/or dependence and about 71% were carried out among psychiatric inpatients. This review established support for the efficacy of antidepressants among alcoholic and depressed patients. The review further noted that alcohol issues in depressed patients contribute to the worsening of depression. Alcohol also increases the risk for relapse into depression, as well as a decreased likelihood of recovering from depression. It is also known to increase suicidal risk for depressed patients. The authors concluded that alcohol issues are much more common in depressed individuals than in the general population. Moreover, these alcoholic and depressed clients manifest with negative clinical and health care use outcomes, and that antidepressants can assist alcoholic patients. Furthermore, the studies highlighted mostly patients with alcohol abuse and dependence in psychiatric inpatient units (Sullivan, et.al., 2005). These findings are however limited in the sense that the studies included were mainly carried out among patients with extreme degrees of alcoholic issues and with a limited scope of clinical setting (Sullivan, et.al., 2005). This study does not include patients having less severe alcohol issues and those in the primary care community setting (Sullivan, et.al., 2005). The authors noted that most of the studies chosen used various recruitment strategies, they had small sample sizes with short periods of observation thereby decreasing the applicability of the results to a bigger population. Eleven of the 12 studies achieved high scores in external validity, they did not grade well in other areas. These studies also used different diagnostic criteria and outcome measures, making it difficult to come up with consistent results (Sullivan, et.al., 2005). Appraisal guidelines/tools Two appraisal tools chosen for this study include the: Critical Appraisal Skills Programme (CASP) and the ARIF Critical Appraisal Checklist (International Center for Allied Health Evidence, 2011). These two tools present thorough and comprehensive details in their assessment of systematic reviews. They present review queries which apply appropriately to systematic reviews. The appraisal questions contain sufficient detail to ensure that the systematic reviews are thoroughly appraised and assessed based on quality (International Center for Allied Health Evidence, 2011). For the CASP tool, the questions are short and specific and in order to ensure adequate comprehension by the reader, hints are provided. There is a middle ground to the answer choices which allow for a more specific assessment of the different aspects of the research (Public Health Resource Unit, 2006). This CASP tool divided its appraisal to cover the different aspects of the review – from the authors to the findings, conclusions, and the samples chosen. No queries on the type of references chosen and included in the study are however subjects of the tool (Public Health Resource Unit, 2006). This is a possible improvement on this tool because an evaluation of references is also crucial to the validity and the reliability of the research and the research process. The ARIF checklist contains more details and questions as compared to the CASP tool. These questions are longer and are well-explained (University of Birmingham, n.d). Such length makes this study more specific in its analysis and assessment of the systematic reviews. It also ensures that most aspects of the research are covered and that the appraisal tool is well understood by the reviewer. The definite yes and no answers to the queries make this appraisal tool highly specific, with no middle ground to play with and to consider (University of Birmingham, n.d). In other words, either the area being reviewed is fulfilled or not fulfilled by the systematic review. This can be difficult to apply for systematic reviews because the review covers more than one study. Nevertheless, providing unequivocal answers to the queries in the appraisal tool helps to focus the appraisal process. These two tools can effectively assess the systematic review I chose because they provide accurate and appropriate tools in evaluating the study chosen (Nordenstrom, 2006). Both tools assess the validity and the reliability of the systematic review and review the results based on their accuracy and applicability to the research question raised. Adequate inclusion and exclusion appraisal tools are also included and these tools help establish the appropriateness of the studies chosen (Nordenstrom, 2006). I would apply these appraisal tools in the systematic review by evaluating the search process conducted by the authors and how they judged the inclusion or inclusion of the researches. I would apply the CASP tool by reviewing the researches chosen and assess how the researches assist in answering the question raised. I would also apply the CASP tool by assessing how the study applies in the local context. I would then apply the ARIF tool by determining if the validity and the reliability of the studies were assessed by the authors in the systematic review. I would assess its repeatability and determine whether or not the studies chosen were up-to-date. Through these appraisal tools, I am able to ensure the accuracy, the validity and the reliability of the systematic review. Recommendations Based on the results of the systematic review, I recommend that the interventions applied to drug and alcohol patients who are also depressed include interventions which address all three health issues (Butts and Rich, 2010). The systematic review reveals that there is a link between alcohol abuse and depression, with most alcoholic patients also showing signs of abuse. It is also safe to extrapolate that one causes the other and vice versa. It is a destructive cycle of alcoholism and depression and the more that one is depressed, the more that he would turn to drinking, and the more a person drinks, the more he gets depressed (Potter-Efron, 2002). As an advanced practice nurse, it is important to address not just the symptom manifested – be it alcoholism, drug abuse, or depression, but the causes of the different health issues. A history of sexual abuse or possibly physical abuse can cause the depressed conditions of the patients, eventually causing them to cope with their depression by drinking and/or by abusing drugs (Mash, 2003). As an advanced nursing practice, I can recommend that changes in my unit be implemented to include nursing counseling trainings for depressed clients who are alcoholic and/or drug abusers. Since the nurses spend time with patients, more than any other health professional, it is important to equip these nurses with the appropriate skills to deal with their patient’s needs. Our practice is already focused on drug and alcohol dependent patients, the nature of our training must therefore be geared towards these areas of nursing care, with particular emphasis on nursing counseling (Butts and Rich, 2010). As a unit particularly dealing with drug and alcohol abuse patients, there is a need for us to be equipped with adequate detection and communications skills, most especially in terms of relating with difficult, defensive, or uncooperative clients (Manos and Braun, 2005). These drug and alcohol abuse patients may be in denial about their condition and communicating with them would be difficult. It is therefore important for advanced practice nurses in our unit to be trained in communicating with these patients while still maintaining a therapeutic relationship with their client. I also recommend that more studies be undertaken on nursing counseling and the role it plays in alleviating the depression being experienced by alcoholic and drug abuse patients. These studies must focus on how these patients feel about nurse counselors and whether or not they feel more comfortable with these counselors or if they prefer to seek counseling from psychiatrists. The role of nurse counselors as advanced nursing practitioners have not been explored thoroughly as the role of counselor often revolves around listening and empathizing with the patients. Additional studies on the more active roles of nurses in counseling drug and alcohol abuse patients can help establish whether or not nurses in counseling roles are effective additions to the advanced nursing care practice. These studies would eventually serve as basis for improvements in the practice on whether or not the status quo needs to be preserved or more time needs to be set aside for the nurse performing her role as a counselor. Conclusion The discussion above exemplifies the work related with the advanced nursing practice, more specifically, working with drug and alcohol abuse clients who are also depressed. The study reveals that the advanced nursing practice is a more specialized practice with the nurses in this field equipped with more specific skills and more experience applicable to various areas of the nursing practice. The systematic review chosen presents a link between depression and alcoholism, with alcoholic patients often diagnosed with depression, and vice versa. The CASP and the ARIF checklist were selected as appraisal tools for the systematic review. They provide thorough and comprehensive guidelines for the assessment of the review, helping ensure that the study is valid and reliable. Finally, recommendations for the advanced nursing practice unit include additions to the practice, additions which cover the expansion of the nurse’s role to include and to enhance nurse counselor roles. These additions are geared towards ensuring the improved functioning of the nursing practice, especially in relation to drug/alcohol abuse and depressed clients. Works Cited Butts, J. & Rich, K. (2010). Philosophies and Theories for Advanced Nursing Practice. Massachusetts: Jones & Bartlett. International Center for Allied Health Evidence (2011). Critical Appraisal Tools. Retrieved 18 June 2011 from http://www.unisa.edu.au/cahe/Resources/CAT/default.asp#SR Ling, S. (2007). Nurse practitioners in drug and alcohol: where are they? Australian Journal of Advanced Nursing, volume 26(4), pp. 64-69. Manos, P. & Braun, J. (2005). Care of the difficult patient: a nurse's guide. New York: Routledge. Mash, E. (2003). Child Psychopathology. New York: Guilford Press Morrison, J. (2002). Straight Talk about Your Mental Health. New York: Guilford Press. Nordenstrom, J. (2006). Evidence-based medicine in Sherlock Holmes' footsteps. Massachusetts: Wiley-Blackwell Potter-Efron, R. (2002). Shame, guilt, and alcoholism: treatment in clinical practice. New York: Haworth Press Public Health Resource Unit (2006). Critical Appraisal Skills Programme (CASP) making sense of evidence. Retrieved 18 June 2011 from http://www.sph.nhs.uk/sph-files/casp-appraisal-tools/S.Reviews%20Appraisal%20Tool.pdf Sullivan, L., Fiellin, D., O’Connor, P. (2005). The Prevalence and Impact of Alcohol Problems in Major Depression: A Systematic Review. Yale University School of Medicine. Retrieved 18 June 2011 from http://www.tresearch.org/add_health/prism_docs/DepressionReview.pdf University of Birmingham. (n.d). ARIF Critical Appraisal Checklist. Retrieved 18 June 2011 from http://www.arif.bham.ac.uk/critical-appraisal-checklist.shtml Read More