Coexisting Boose or Stuff and Physical Soundness Problems - Essay Example

Co-existing Alcohol &/or Substance Use and Mental Health Problems Name University Mental illness is a common feature with many alcohol and substance users, especially addicts. Varying research has established that there is a very strong relationship between drug abuse and mental health; such that some researchers believe that chronic drug use may actually cause mental illness. While this is not fully substantiated, it is true that many people suffering from mental illnesses usually self-medicate with various drugs and this phenomenon usually leads to more complex situations; addiction and additional mental health problems emanating from substance use (Casteneda, et al., 1989, p.82). Various studies performed to explain the reasons for these relationships have come to common conclusions as outlined in the next paragraph. Many patients of mental illness who take prescribed medication after diagnosis usually experience terrible side effects and as a result use other substances in order to alleviate the unpleasant effects (Gregory, 2007, p.23). For instance, schizophrenic patients are medicated for hallucinations and one of the side effects is depression. Consequently, they abuse marijuana to alleviate the depression. The next case scenario is when patients with undiagnosed mental health problems self-treat by using various substances such as alcohol and narcotics, which lead to addiction and additional mental illnesses (Anthenelli et al., 1993, p.76). Another case scenario is where, for whatever reasons, seemingly healthy people start using some narcotic drugs associated with mental health problems and develop chronic addictions, consequently experiencing mental illness after years of use. Additionally, people with a high risk factor for mental illness can be easily “pushed” into mental illnesses by substance abuse. Finally, chronic drug use in adolescent and pre-adolescent years alters social and cognitive development resulting in anxiety and depression disorders and possible mental illness in later years (Armstrong et al., 2002, p.1226). A Co-existing substance use and mental health condition refers to situation where a person chronically addicted to a substance also has a mental illness (Mooney et al., 1992, p.14). The entanglement of the two co-occurring conditions makes it difficult to determine what condition causes what symptom. As such, co-existing disorders might include combinations like: alcohol addiction and an anxiety disorder, addiction to marijuana and schizophrenia, heroin addiction and borderline personality, addiction to sleeping pills and depression etc. These conditions should be taken as independent problems that interact with one another such that they seem dependent on one another. Which came first should not be the important question to ask, for it is usually a difficult one to answer (Meyer, 1986, p.32). This essay will critically assess co-existing alcohol and substance use and mental health problems. It will evaluate the evidence on prevention, early intervention, treatment of mental health problems and nursing care requirements as well as critically discuss the challenges faced by nurses in addressing and managing these issues in a community context. The issue of prevention of co-existence of substance use and mental health problems should be addressed independently as well as dependently. The promotion of mental health aims to support, protect and sustain the social and emotional well being of populations from early childhood through adulthood to old age. Prevention mainly addresses the people who are well but at high risk of developing mental illness and those recovering from mental illness (Dumas et al., 2001, p.61). Nurses should know that mental health is affected by various factors in the community. As such, supportive educational, economic, cultural, physical, and cultural environments provide the basic frameworks to be utilized in maintaining and developing mental health, particularly in adolescents and children whose early life experiences determine their mental health (Gregory, 2007, p.23). The identification of the individuals at risk of developing mental disorders early enough is important to the success of prevention efforts. Bodies such as the U.S. Preventive Services Task Force recommend preventive measures such as screening of individuals by clinicians in primary care environments as well as in the communities (Sciaaca, 2007). Prevention has been traditionally referred to as interventions used before or at the onset of diagnosable mental disorders with the main aim of reducing or preventing new cases. Nonetheless, as knowledge on prevention, causes and treatment of such illnesses expand the definition and concept of prevention has evolved. Apart from focusing at the onset of illness, prevention now covers the prevention of relapses, co-morbidity and disability among persons diagnosed with mental illness (Brown et al., 1989, p.570). In the case of substance use related mental illnesses, the primary prevention measure is ensuring that individuals within communities do not use the substances in the first place. The first step should be the promotion of awareness in the communities (Evans et al., 1990, p.55). Health practitioners and government agencies as well as community leaders should work together to formulate effective programs and policies within the communities. Children and teenagers should particularly be made aware of the consequences of drug use and related illnesses. Preventive measures should particularly be taken for children and other individuals exhibiting psychological, social and biological risk factors related to mental illness and likelihood of substance use (Dumas et al., 2001, p.47). For instance, clinicians can establish support groups for adolescents and children exposed to substance use or domestic violence in their homes. There are many challenges faced by health practitioners including: lack of adequate clinical skills to deal with the complex natures of concurrent mental illness and substance abuse, inadequate involvement of victims’ families, existence of cultural issues and barriers in engaging with affected communities, lack of proper follow-ups and insufficient funds for running preventive programs and policies (MaEwan, 2007, p.103). Early intervention has been pointed out as an important phase in dealing with co-existing substance use and mental illness. While it closely related to prevention practices, it refers to the specific interventions and measures taken for people identified to be at high risk as well as those already engaging in substance use and exhibiting mental health problems (Mooney et al., 1992). As such, it involves the early screening and subsequent identification of risk features and associated features. The challenge for clinicians, policy makers, families and communities is the early arresting of associated developing patterns that, over time, are difficult to change. It has indeed been proven that early intervention is the main strategy for dealing with the severity and progression of substance use and the decrement or elimination of associated psychosocial effects that represent mental illness (Sciaaca, 1996, p.794). The gist of early intervention is the working within social systems that have great influence on developmental capacities of communities. In the case of individuals involved in substance abuse, early intervention will reduce the likelihood of continued use and development of associated mental health problems. Screening and subsequent early intervention is particularly useful to the following groups within populations: children and adolescents experiencing co-morbid mental health issues; youth with violent pasts and those who had had contact with the justice system; homeless young people who are prone to victimization; youth exposed to use of inhalants, especially in the early phases; early users of narcotics and people at risk of developing mental illness (Armstrong et al., 2002, p.1236). As a first primary step, the involved early intervention health practitioners should screen for substance use, signs of mental illness and likelihood of future use of substances associated with mental health problems (Antherelli et al., 1993, p.88). The next primary step is screening and investigating the stages of use and victims’ readiness for change. The stages of use offer a coherent platform for structuring early intervention procedures. For instance, in the pre-contemplation stage, the victim does not regard the substance as a problem and thus sees no need to change. As such, the intervention focuses on increasing the individual’s awareness on the risks and involved consequences of continued use. In the contemplation stage, the patients are ambivalent and will question the pros and cons of reducing substance abuse. The intervention should seek to address the risks involved and the benefits of reducing or stopping usage, while encouraging the user to follow through with the set programs for good reasons (MaGPIe Research Group, 2003). The preparation stage is when specific steps are identified by the patient and the health practitioners as the basis of positive change. The interventions employed include the specification of goals and identification of necessary resources to support the positive change. Another stage is the action stage and involves the actual execution of specific steps as outlined in the action phase and the intervention is the provision of necessary encouragement and support. The final stage can be taken as relapse and involves a situation where the patient goes back to substance use. Interventions include enhancing the move back to planned actions, demoralization and identification of lessons learnt in the process (Dumas et al., 2001, p.46). Health practitioners and nurses should also be aware of Brief Interventions. These are beneficial but cost-effective ways for intervening with early users and the youth. These encounters usually employ sessions carried out over very brief periods of time. As such, they usually include quick assessments and feedback, goal setting towards improvement, negotiation for change, useful modification techniques, self help therapies and follow ups (Gregory, 2007). In the recent past, there has been a lot of evidence in support of usage of brief interventions and related strategies in dealing with alcohol and other substances abuse. In one study, a brief intervention carried out with heavy drinking campus students was monitored in a period of four years. Subjects with histories of very heavy drinking were assigned for treatment as the high risk control groups. The follow up was completed over four years with 84% of the original sample. The observation showed that those receiving brief interventions experienced greater reductions in unpleasant consequences as compared to the high risk control members. This can be taken to suggest that brief interventions are indeed successful in the reduction of problems emanating from drinking (Armstrong et al., 2003, p.1261). Nurses and other health practitioners face many challenges when implementing interventions to affected communities. The involved individuals are many times unwilling to participate in intervention activities. The health practitioner, despite encouraging these patients, cannot force them to participate unwillingly. The lack of cooperation of involved families is another impediment, so is the high risk and danger of seeking out victims in the streets due to the violent nature of some patients. Another challenge is the lack of proper knowledge as to the expected outcomes of the interventions (Mooney et al., 1992). Treatment of co-existing alcohol or substance use and mental health problems takes many forms. This has resulted from the many attempts to address the special needs of specific patients. These attempts represent philosophical differences amongst health practitioners as to the actual nature of various dual disorders and the best procedures of treatment to be employed. The most common model of treatment of dual disorders has been sequential treatment. In the model, the patients are treated by use of one system that is, mental health or addiction, then the other follows (MacEwan, 2007, p.71). Some health practitioners believe that treatment for substance use or addiction should commence first and the patient should be at abstinence recovery before initiating treatment for the mental condition. On the other hand, others believe in the vice-versa, i.e. treatment of the mental illness first before tackling addiction. Still, others think that the severity of symptoms exhibited by patients should dictate the type and sequence of treatment. As such, sequential treatments refer to non-simultaneous treatment of coexisting conditions. For instance, a patient of dual disorders can get treatment for at a community mental health centre when experiencing depression then later go for alcohol addiction treatment at a substance use treatment centre after incessant alcohol binging. The main challenge faced by nurses in this treatment is finding out which treatment should come first and the outcomes of chosen sequences (Brown et al., 1989, p. 598). Parallel Treatment encompasses simultaneous use of both addiction and mental health problems treatment. For instance, a patient can attend a drug refusal class at an addiction centre; participate in group therapy and medication classes at a centre for mental health before attending a multiple steps group such as Alcoholics Anonymous. The good thing about this treatment model as well as the sequential model is the fact that they utilize the already existing treatment settings such as community mental health centers and sanctioned addiction programs (MaGPIe Research Group, 2003). Since addiction treatment is found with addiction practitioners and mental health dealt with by mental health practitioners, the challenge in parallel treatment is finding a way to synchronize the two camps for the benefit of the patients. Integrated Treatment is another model whose approach involves the combination of mental health components and addiction treatment components into a comprehensive, unified program of treatment for patients exhibiting dual disorders. Therefore, this model involves health practitioners cross-training in both addiction and mental health treatments. Additional training in unified management of the dual occurrences is also recommended (Sciaaca, 1996, p.290). Apart from integration of services and training in management of occurrences, other core components are needed for successful integrated treatment. These include staged interventions where treatment is conceptualized as staged process and the understanding that patients are in different stages for various problems. Assertiveness encourages using assertive community outreach programs to encourage compliance and proper engagement. Multiple psychotherapeutic modalities offer and family, group and individual social interventions that are critical to treatment (Brown et al., 1989). Comprehensiveness seeks to put into perspective the range of problems affecting treatment such as housing, employment, relationships, coping skills and finances. Also important is cultural competence and sensitivity (Mooney et al., 1992, p.95). The three models have different advantages and disadvantages. These differences coupled with severity of symptoms and degree of patient’s impairment affect the choice of treatment to use. For instance, parallel or sequential treatment may be very appropriate for patients exhibiting severe problems with one disorder and mild problems for the other disorder (Antherelli, 1993). The main challenge for health practitioners is how to deal with the conflicting therapeutic directions and messages emanating from each model. Additionally, financial needs and also the existing confidentiality laws often act as barriers to rendering of efficient treatments. A number of issues and nursing care requirements arise when dealing with mental health populations. Treatment engagement is one of such issues and generally refers to the initiation and sustenance of a patient’s participation in a treatment process. It begins with efforts such as the enlisting of individuals into treatment, but is actually a long-term process whose goal is to keep the patients in treatment and help them in managing their ongoing problems (Evans et al., 1990, p.137). Some essentials in this process include; building of personalized relationships with patients; commitment to patients over extended periods and focusing on the needs of individuals as diagnosed in therapy. These in themselves are severe challenges due to the nature of mental health problems and predispositions of substance users. Treatment Continuity is another key requirement for practitioners addressing dual disorders. The continuity of treatment components and treatment programs is essential if actual progress is to be witnessed. Since most patients will participate in treatment episodes at different places, an integrated case management treatment program will be necessary to ensure the continuity of attendance of patients (Mooney et al., 1992). Another issue to look at is the issue of Treatment Comprehensiveness. The overall treatment system should bring together addiction treatment, mental problems treatment and associated collaborative programs, all integrated into a single package. The designing of the programs also ought to take into consideration the levels of disability and severity and also accommodate compliance and motivations of varying degrees (MacEwan, 2007, p.117). The main challenge for nurses is to find balance in integrating all the requirements for comprehensiveness and also meeting the standardized thresholds of nursing engagements. The challenge of financing these activities should not be overlooked nor should one ignore the challenge of putting up necessary departments and engaging with different stakeholders in these fields. References Armstrong, T. D., & Costello, E. J. (2002). Community studies on adolescent substance use abuse or dependence and psychiatric comorbidity. Journal of Consulting and Clinical Psychology, 70, 1224-1279. Anthenelli, R.M. & Schuckit, M.A. (1993). Affective and anxiety disorders and alcohol and drug dependence: diagnosis and treatment. Journal of Addictive Diseases 12(3):73-87. Brown, V.B., Ridgely, M.S., Pepper, B., Levine, I.R., & Ryglewicz, H. (1989). The dual crisis: Mental illness and substance abuse, present and future directions. American Psychologist 44(3):565-599. Casteneda, R., Galanter, M., and Franco, H. (1989). Self-medication among addicts with primary psychiatric disorders. Comprehensive Psychiatry 30(1):80-83. Dumas, J. E., Lynch, A. M., Laughlin, J. E., Smith, E. P., & Prinz, R. J. (2001).Promoting intervention fidelity: Conceptual issues, methods, and preliminary results from the Early Alliance Prevention Trial. American Journal of Preventive Medicine, 20, 38-47. Evans, K., and Sullivan, J.M. (1990). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser. New York: Guilford Press. Gregory, J. (2007). Mad or Bad? The Role of Staff Attributions in Dual Diagnosis. Addiction Treatment Research News, 270, 17-26. MacEwan, I. (2007). Mental Health and Alcohol and Drug Co-existing Disorders: An Integrated Experience for Whaiora?. Matua Raki, National Addiction Treatment Workforce Programme. Retrieved May 13, 2014, from http://www.matuaraki.org.nz. MaGPIe Research Group. (2003). The nature and prevalence of psychological problems in New Zealand primary health care: a report on Mental Health and General Practice Investigation. The New Zealand Medical Journal. Volume 116, No 1171. Meyer, R.E. (1986.) How to understand the relationship between psychopathology and addictive disorders: another example of the chicken and the egg. In: Meyer, R.E., (Ed.), Psychopathology and Addictive Disorders. New York: Guilford Press. Mooney, A.J., Eisenberg, A, & Eisenberg, H. (1992). The Recovery Book. New York: Workman Publishers. Sciaaca, K. (1996). Program Development and Integrated Treatment Across Systems for Dual Diagnosis: Mental Illness, Drug Addiction and Alcoholism, MIDAA. Journal of Mental Health Administration 23, 288-297. Read More

This essay will critically assess co-existing alcohol and substance use and mental health problems. It will evaluate the evidence on prevention, early intervention, treatment of mental health problems and nursing care requirements as well as critically discuss the challenges faced by nurses in addressing and managing these issues in a community context. The issue of prevention of co-existence of substance use and mental health problems should be addressed independently as well as dependently. The promotion of mental health aims to support, protect and sustain the social and emotional well being of populations from early childhood through adulthood to old age.

Prevention mainly addresses the people who are well but at high risk of developing mental illness and those recovering from mental illness (Dumas et al., 2001, p.61). Nurses should know that mental health is affected by various factors in the community. As such, supportive educational, economic, cultural, physical, and cultural environments provide the basic frameworks to be utilized in maintaining and developing mental health, particularly in adolescents and children whose early life experiences determine their mental health (Gregory, 2007, p.23). The identification of the individuals at risk of developing mental disorders early enough is important to the success of prevention efforts.

Bodies such as the U.S. Preventive Services Task Force recommend preventive measures such as screening of individuals by clinicians in primary care environments as well as in the communities (Sciaaca, 2007). Prevention has been traditionally referred to as interventions used before or at the onset of diagnosable mental disorders with the main aim of reducing or preventing new cases. Nonetheless, as knowledge on prevention, causes and treatment of such illnesses expand the definition and concept of prevention has evolved.

Apart from focusing at the onset of illness, prevention now covers the prevention of relapses, co-morbidity and disability among persons diagnosed with mental illness (Brown et al., 1989, p.570). In the case of substance use related mental illnesses, the primary prevention measure is ensuring that individuals within communities do not use the substances in the first place. The first step should be the promotion of awareness in the communities (Evans et al., 1990, p.55). Health practitioners and government agencies as well as community leaders should work together to formulate effective programs and policies within the communities.

Children and teenagers should particularly be made aware of the consequences of drug use and related illnesses. Preventive measures should particularly be taken for children and other individuals exhibiting psychological, social and biological risk factors related to mental illness and likelihood of substance use (Dumas et al., 2001, p.47). For instance, clinicians can establish support groups for adolescents and children exposed to substance use or domestic violence in their homes. There are many challenges faced by health practitioners including: lack of adequate clinical skills to deal with the complex natures of concurrent mental illness and substance abuse, inadequate involvement of victims’ families, existence of cultural issues and barriers in engaging with affected communities, lack of proper follow-ups and insufficient funds for running preventive programs and policies (MaEwan, 2007, p.103). Early intervention has been pointed out as an important phase in dealing with co-existing substance use and mental illness.

While it closely related to prevention practices, it refers to the specific interventions and measures taken for people identified to be at high risk as well as those already engaging in substance use and exhibiting mental health problems (Mooney et al., 1992). As such, it involves the early screening and subsequent identification of risk features and associated features. The challenge for clinicians, policy makers, families and communities is the early arresting of associated developing patterns that, over time, are difficult to change.

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