Substance Abuse Disorder - Essay Example

Substance Abuse Disorder of the of the In this paper, the discussion covers the various aspects of disorders related to substance abuse/drug abuse, their effects on psychological behavior of the person along with the physical health, including the problems related to drug abuse in today’s world, with the increasing demand in susbtances that are being abused, the health care system approaches and recommendations for a better mental care for the person affected. This study utilizes information from the experienced professionals and their work done on this disorder along with published books. The start of this work largely focuses upon substance abuse, and the substances that are most likely to cause substance abuse disorders. Later on, the discussion turns towards the vulnerable population, the psychosocial and psychological causes and factors that cause the addictive vulnerability in such people. It also focuses on the health care system and the health reforms in United States. In the end the research study also provides adequate recommendations and suggestions for future research and also provides implications for the study. Introduction Substance abuse disorder commonly result due to the constant use of addictive substances/drugs that leads to significant mental disorders and other physical ailments; the drugs responsible for causing this disorder usually don’t have any medicinal significance and are not indicated for medical purposes. (Herrman et al, 2005). This disorder doesn’t only cause severe effects psychologically but they also affect the social life of the person; the use of such drugs may also have legal implications. There is a difference between substance abuse and substance dependence; which is still a matter of controversy. The substance abuse is characterized by misuse of a drug that can possibly have social consequences; whereas the substance dependence is said to be a type of dependence that leads to mental and physiological impairment of a person. These drugs can cause a person to show multiple psychological symptoms and causes them to experience more stress than any normal individual. Research indicates that people already having some kind of mental disorders are more prone to substance abuse. Whereas, about one in four adults with psychological illnesses are victims of drug abuse. Discussion Substance Abuse: The term substance abuse which is also referred to as drug abuse is defined as the utilization of substances that produce intoxications or hallucinations in the minds of the users. Substance abuse (alcohol, drugs or illicit drugs) can also be defined as the process which requires use of a substance or consumption in ever increasing quantity, (Herrman et al, 2005). Depressants (Alcohol, barbiturates, benzodiazepines), stimulants (Amphetamines, cocaine, MDMA [ecstasy]), hallucinogens (LSD) and narcotics (former. codeine, heroin and morphine) are the most common examples of substances of abuse. Anabolic steroids are sometimes improperly taken to improve athletic performance. Problems of substance abuse are complex medical problems. They not only affect the human body but also have diverse impact on human brain and its functions. There are a lot of negative feelings associated with problems of substance abuse and health professionals prefer not to use terms like "addict" or "addiction." Many studies have been conducted that show there are many issues and problems associated with patients suffering from substance abuse (Hockenbury, 2009). Substance abuse can also generate social consequences and affect work, family and interpersonal relationships. Individuals who neglect their families generate social problems for their spouses and children. They can also commit criminal acts merely for the purpose of getting financial gain to fulfill their desire of drug consumption. Driving under the influence of substances can cause death or injury to an individual and others in the society. Substances may alter the perception of reality and cause apathy at work or at school. A pregnant woman with a substance abuse problem can generate a dependency of the fetus to the substance she consumes. A number of studies have revealed that drug and substance abuse play a significant role in the lives of many prisoners. The studies have concluded that out of every four prisoners, three prisoners are either alcohol or drug dependent. It has also been observed that prisoners who are already drug or alcohol addicted, force other prisoners to follow their path (Grunewald, 2004). In the last few years, the department of justice conducted a survey which revealed that more than 70 percent of prisoners worldwide are affected due to drug abuse. Due to alcohol and drug, many prisoners are becoming ill which is further increasing health costs of many nations. Therefore it can be concluded that drug or alcohol abuse has also become a major health concern for many nations all across the globe. Substance Abuse Disorder Substance abuse disorder is defined as a disorder that is the outcome of a severe drug addiction; the substances that are highly addictive are more likely to cause this disorder. Substance abuse causes substance dependence which results in serious mental health problems. This disorder was previously added into the DSM-IV manual as Substance abuse disorder, but in DSM-V it was renamed as Substance use disorder. Substance abuse is an illness, characterized by intense desire (craving) and compulsive consumption (repeatedly), often uncontrollable (including alcohol and some drugs, such as tranquilizers, benzodiazepines), despite the negative consequences of such use. The path to drug abuse starts with over usage of abusive substances. The persons ability to avoid taking the drug is compromised and consumption becomes compulsive. Such conduct is in part a result of permanent changes in the form of communication between neurons (brain cells). Drugs of abuse affect several of these circuits, especially those related to gratification, feelings of pleasure and displeasure, motivation, learning, memory and cognitive control of behavior. Some of the neuronal populations are more affected than others to develop chemical dependence (addiction). Repeated use of these substances increases the risk of users developing mental and physical illnesses. For example, liver cirrhosis is a physical illness resulting from chronic alcohol use and schizophrenia can be triggered by marijuana use. In addition to the disease, drug abusers are likely to face the social consequence of the habit in the form of isolation from society, family issues, and the risk of getting involved in criminal acts that may have serious legal implications. So they are more exposed to injury, often with severe consequences, and more prone to violent behavior. As the abuse of drugs and alcohol alters human behavior to produce losses in many important aspects of anyones life, treatment is necessary. A person suffering from the problem should be allowed to understand the fact that the simple avoidance of drugs is not enough for the process of addication to reverse. Although abstinence is highly recommended, the process of recovery requires a number of additional measures to bring about a positive change in the condition of the addict. The recovery demands the addict to maintain a lifestyle free from the consumption of psychoactive substances, and develop a productive functioning in the family fields, social and professional, taking into account individual characteristics. Symptoms of substance abuse disorder: The main symptoms of substance abuse disorder are: 1. Depressive mood or irritability, anxiety and distress 2. Discouragement, tiring easily, requiring greater effort to do things 3. Decrease or inability to feel joy and pleasure in activities previously considered pleasant 4. Pessimism, frequent and disproportionate ideas of guilt, low self-esteem, a feeling of senselessness, uselessness, ruination, failure, illness or death. 5. The person may wish to die, plan a way to die or attempt suicide 6. Difficulty in concentrating, slower thinking and forgetfulness 7. Decreased sexual performance (addict may possibly continue sexual activity, but without the usual pleasant connotation) and libido. 8. Loss or increase in appetite and weight 9. Anorexia. 10. Unusual cravings. 11. Insomnia. 12. Pain and other physical symptoms not justified by medical problems such as stomach aches, poor digestion, heartburn, diarrhea, constipation, flatulence, tension in the neck and shoulders, headache or body aches, heavy body sensation or pressure in the chest etc. Mental Illnesses Related to Substance Abuse: Mental condition varies in every situation and is differentiated according to the levels of stress and distress; experiencing a certain level of mental discomfort is a normal part of life however there are instances in life in which one has good emotional health and such a man considers that he has his mind and emotional health under control. If a person is capable of going on with his day to day activities without any impact on daily activities like eating, sleeping and meeting people, such a person is considered to be mentally healthy. However on the other side there are many people who have prolonged mental issues and constant disturbances which makes it hard for them to deal with these occurrences. When a person is not capable of dealing with frequent disturbances in life; someone who tends to lose easily under pressure is considered to be a victim of mental health problems. Mental illnesses can occur at any time and depression and anxiety are frequent occurrences among young individuals. Having a mental illness can directly affect a person’s thoughts, actions, beliefs and memory. Mental health issues are usually long lasting and tend to have a more significant impact on the health of an individual. Some of the major mental health disorders young individuals have to deal with include; 1 Depression 2 Anxiety 3 Eating disorders 4 Bipolar disorders 5 Self-harming tendencies 6 Psychosis. 7 Addiction disorders 8 Personality disorders These mental health issues are also linked with substance misuse. The substances which are involved in causing these issues are alcohol, snuff and illicit drugs that cause several negative consequences, which are related to health, including, but not limited to the diseases such as, cancers, cardiovascular disease and stroke, fatal and nonfatal overdoses, hepatitis, HIV infection, and violence and pregnancy complications. According to the National Comorbidity Survey (NCS), almost fifty percent of individuals who are diagnosed with a substance use disorder also met criteria for a mental illness. Vulnerable Populations: Alcohol or Substance Abusers: Men and women with less formal education and high income may be at greater risk for becoming victims of drug and alcohol abuse due to numerous psychological variables like stress, or frequent visits to bars and the perception of drinking behavior as being acceptable religiously. Numerous studies have been conducted on this subject that have covered the adult population of both genders that abuse alcohol or some other addictive substance (Grant et al, 1995). Psychological variables such as stress that are evident in the US society due to social problems such as unemployment and family issues as well as professional problem such as workload and hectic jobs are primarily contributory towards the behavior of drug abuse among young men and women in United States. These psychological variables make this population vulnerable to health problems as well as substance abuse (Bowden & Fergusson, 2011). A general perception is that alcohol provides relief from stress; this is one of the main contributing factor towards promotion of the habit of alcohol consumption. The effect of this thinking becomes more profound when social variables like an established culture of drinking in public places like bars is favored by social values. Although this is done by those seeking entertainment or escape from the bitter realities of life; the ultimate consequence of this pattern of consumption is drug dependence. Urban populations are more at risk of developing substance use disorders as compared to those living in rural settings. Some experts on the subject have attributed this difference to the less demanding nature of jobs and working conditions that prevail in rural settings. Moreover, the culture of drinking at bars is less popular in settings that are far away from main cities. Populations that suffer from stess are more inclined towards drinking if the values of the population are contributory towards promotion of drinking behavior. Additionally, another variable that comes into play and contributes towards the vulnerability of working class men and women is differences in social role and status that eventually leads to alcohol abuse in a hope that it will solve the problem of disparity (McKirnan& Peterson, 2006). Another contributing factor that affects the vulnerability of this population is ethnic and racial differences, especially among women. For instance, in a recent study on the subject that studied the influences of ethnic and racial differences on the health problems associated with alcohol abuse or high drinking levels among Hispanic and Black women, it was found that Hispanic and Black women due to their disadvantaged social and economic life as compared to white women are more vulnerable to drug abuse problems than the white women in United States. Further, in a study conducted in 2009 on the population of a small town adjacent to Washington D.C., it was found that people who have attained their high school or college level degrees are found to have less tendency to engage in alcohol abuse than the people in the population who do not have attained their high school or college degrees. Due to these social, economic and other difficulties, such populations develops more mental health problems and disorders than the populations that are not affected by the discussed problems. Statistics on prevention programs shows that people belonging to population that are affected by the discussed variables are inducted more frequently in rehab programs than the populations that are not affected by the discussed variables. The mortality rate of this population is higher than the other populations in the United States. One of the leading causes of mortality is drunk driving (Drake & Wallach, 1989). Drugs that Cause Substance Abusive Disorder: LSD Drug LSD (lysergic acid diethylamide) is one of the key drugs that produce hallucinations in their users. This drug was discovered in 1938 and is considered to be one of the strongest mood-changing compounds. Often referred to as the ‘acid’, the drug is sold in streets in the form of tablet or capsules. It is colorless, odorless, and has a slightly bitter taste, and is normally taken by mouth. The use of drug results in altered sensory function causing defect in the perception of time, emotions, memory and sensory stimuli. Recent uses of the drug include its use as an anxiolytic specially in the terminally ill patients. In patients suffering from chronic pain (e.g pain due to cancer) the use of LSD has been considered very useful. Marijuana Marijuana is the most commonly used illegal drugs in the United States of America. It is a dry, shredded green and brown mix of stems, flowers, seeds, and leaves of the hemp plant ‘Cannabis sativa’. The major dynamic chemical in this drug is delta-9-tetrahydrocannabinol, or THC in short. Due to its extra-ordinary lipid solubility, the half life of the drug in human boday is considerably higher. As a result the effect of the drug persists for a considerably longer period of time than other substances. Cocaine Being a stimulant drug, cocaine causes a strong addiction in its users. Normally supplied in powdered hydrochloride form, its use depend on the choice of the user; it can be dissolved in water for intake or simple sniffing can provide the desired effect. Apart from the powdered form, there is yet another form which is available in streets with the name of crack. After being processed, the crack takes the form of a crystal that produces fumes and a cracking sound when it is heated. The smoke generated as a result of heating carries the drug which is inhaled by the abusers. Pharmacologically speaking, the drug acts as an appetite suppressant, anesthetic and a stimulant. The numbness of the mucosal lining produced by the use of cocaine is characteristic of this drug. Treatment Interventions: Dependence on monotherapy is not considered the appropriate pathway for treatment of this type of disorders. Although the treatment pattern may vary from case to case, an effort is made to involve multiple modalities to achieve the objective of therapy. Recommendations may vary from center to center or from one specialist to another; however, it is generally considered useful for the patient to engage the services of multiple departments or specialists. This integrated approach involves the treatment of substance abuse along with the mental illness that co-exists in the patient. 1. The recovery from this disorder primarily depends on the level of addiction i.e. extent and the nature of mental health problem. Time, courage, commitment, and hope are basic factor to recover from these co-occurring disorders. The treatment duration may span from month to even years. The can and do of substance abuse and mental health problems bring hope to such patients. It should be kept in mind that relapses in such patients are part of the treatment and recovery process. The condition is therefore challenging for the health workers and a higher level of dedication and hard work is necessary to achieve the desired results. 2. Nursing educators should also teach ways to find the right program for dual diagnosis or co-occurring disorders. Proper licensing and accreditation of substance abuse program is necessary. Sharing decision making process and active gorals setting strategies can stimulate change factors. Educating the patients about their medical condition and the associated problems may allow the patients to develop skills that may allow them to take care of themselves after leaving the hospital settings. Doing this also enhances the relationship between the health care providers and the patients. 3. Identification and development of recovery goals aid in achiving the therapeutic goals of the treatment. The health care providers should set realistic goals based on their previous experiences. Unrealistic goals are less likely to be achieved and are therefore a cause of distress for the patient in the long run. Substance abuse patients who are already depressed in psychological terms may suffer a severe blow if they learn that their treatment has not been successful. This may have detrimental effects on the health of such patients. Medicinal and Other Therapies: The treatment of substance abuse disorder may consist of medication, behavioral therapy, or a combination of both. Behavioral therapy involves counseling, psychotherapy, and cognitive therapy. Also there is twelve steps recovery developed by Alcoholics Anonymous that is now utilized by more than two fifty self-help groups. Cognitive behavioral therapy can instruct the addicts on how they can manage flashbacks and triggers. Serial therapies can be used for addiction treatment in order to help the users understand the use of drug and drug triggers, and to know about the tools required to deal with the psychological after effects of heavy drug usage. This treatment can lead addicts towards new life skills for helping them to cope with the everyday stresses of life and persistent or negative flashbacks as well. (Futterman et al,2006). Thus, the therapies including motivational enhancement therapy, contingency management, and individual or group based behavioral therapy, have shown promising results for treating addicts of the disorder (McKirnan et al, 2006). Role of collecting data in promoting healthy living Health care workers are encouraged and persuaded to keep a record of their practice data. This persuasion is for the purpose of investigating imperceptible healthcare problem arising in the nation. There are a number of people who undergo routine medical checkups as a preventive measure. The practice makes screening easy at early stages. (Conron, 2011). Individuals who possess healthy lifestyles; immunization in childhood, nutritious dietary habits, evasion of drugs and alcohol abuse, and physical fitness, are active contributors to society’s good health aura. The practice of keeping the record of patients and their diseases will assist in understanding the extent of spread of substance use disorder that prevails in the society at a given time. Data from individual health care providers can be used to get an idea of the spead of a condition in the society. Future programs for the improvement of health conditions of patients suffering from the problem of substance abuse may be based on the findings of the data that is routinely collected by physicians working in the society. Recommendations: Practice based clinical decision making procedures: 1. Creating a local leadership is significance to ensure and maximize individuals to gain support from multiple services and coordinate responses from a range of agencies. Public health bodies should work in close collaboration with nursing professionals, design budgets and administrative alliances to improve the support of substance users. 2. Nursing professionals collaborate with each other to provide a shared vision of recovery for multidimensional approaches and integrated systems to service delivery. Recovery is a growing principle for mental health service. It enables and focuses individuals to take control of their life either with or without the symptoms of mental illness. Workforce development plays an important role in ensuring necessary nursing training and support to work confidently and effectively with clients i.e. patients with dual diagnosis of substance misuse and mental health problems i.e. depression. There are various skills development programs that provide and improve awareness and training to work on mental health issues and in drug and alcohol substance abuse services. There are different considerations for substance abuse disorder’s therapy in everyday clinical practice. One of the key aspects is the promotion of awareness of disorders that result from substance use. Nursing professional and clinical practitioners need to be vigilant in order to monitor the problems of substance abuse and anxiety or mood disorders. Certain personality disorders are directly related to chronic use of substance. Health practitioners incorporate specialized therapy approaches for complex disorders that offer various advantages in treatment. Conclusion Based on the discussion above, it can be concluded that substance use disorders are complicated in nature and there are number of different drugs that ultimately result in these disorders. Although the factors that lead to substance use disorders are multifaceted, the ultimate outcome of these factors is always similar i.e disability to function effectively in the society. The psychological manifestations of the disease are many; for this reason the diagnosis of disease is a challenge for the health care professionals. Moreover, the psychological symptoms are also largely dependent upon the type of substance that is used by the patient. It is therefore mandatory for every practitioner to get a detailed history of the patient who is willing to undergo therapeutic intervention. Following the diagnosis of the disorder, a detailed plan should be developed keeping in view the social and psychological conditions of the patient. The plan should be developed to cater to the needs of individual patients. The goals of the therapeutic interventions should be clearly defined before the onset of treatment. The participation of friends and family should be ensured as success in such endeavors is largely dependent upon the level of participation of the friends and family. As far as the therapeutic approach is concerned, an integrated approach is essential to achieve therapeutic objectives. This may involve psychological intervention in addition to drug use. Cognitive behavioral therapy also plays a significantly positive role in this regard. Success is also dependent upon the relationship that exists between the patient and the health care providers; for this reason, every effort should be made to develop a healthy relationship with the patient. The positive thing about such disorders is that they are treatable; however the challenging aspect of such disorders is that patient tend to relapse frequently. So, the treatment plan should be developed accordingly. References Boden, J. M., & Fergusson, D. M. 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