UNIT TEN

SUBSTANCE ABUSE

10/28/2021 Gizachew A ( Bsc , MPH) 1

 Substance abuse

 Substance abuse = refers to excessive and prolonged use of

some chemical (alcohol, drugs, tobacco) that leads to serious
physical, emotional and social problems.
 The people who make up the substance abusing population are
those who abuse the use of chemicals in three areas alcohol, drug
(both legal and illegal) and tobacco
 People who become affected first develop tolerance so that it
takes increasing amounts of the drug to achieve the desired
effect.
10/28/2021 Gizachew A ( Bsc , MPH) 2
Cont.

o Withdrawal occur when drug dependent individuals

go without the drug (either intentionally or because
they cannot obtain it) and is accompanied by
distressing physical symptoms unless the drug is
taken in increasing smaller doses.
o Substance abuse leading to chemicals dependence
and addiction is a serious public health problem.

10/28/2021 Gizachew A ( Bsc , MPH) 3

 Cont.
 Drug abusers fall into four groups.
a. Individual, primary adolescents and young adults who
try drugs on experimental basis, often because of peer
pressure. Repeated use in many cases leads addiction.
b. Those relatively well adjusted persons who become
addicts as a result of over prescription of medication for
treating insomnia, pain and other medical reasons.

10/28/2021 Gizachew A ( Bsc , MPH) 4

 Cont.

c. People with neurotic tendencies who use drug to excess

to cope with problem.
d. Individual with psychopathic tendencies who become
addicted as repeatedly seek escape or release through illicit
drug use.

10/28/2021 Gizachew A ( Bsc , MPH) 5

Cont.
 Characteristics commonly noted among drugs dependent
person include:
o Under achievement
o Loneliness
o Mistrust
o Fear of closeness
o Identity problem
o Social conflict
o Self destructive tendencies
10/28/2021 Gizachew A ( Bsc , MPH) 6
 Terminology
 Addiction = defined as a compulsive use and impaired
control of over using a substance, pre occupation with
obtaining the drug and continued use despite adverse
consequences.
N.B: The word compulsive indicates that addictive
behavior is beyond the individual self-control
 Chemical substances = is a strong, over whelming
preoccupation with desire to have a drug. It is often
described as craving
 Detoxification = a term used to describe the process of
riding the body of harmful substances.

10/28/2021 Gizachew A ( Bsc , MPH) 7

 Cont.
 Relapse = refers to continuing to use a chemical or
participate in activity after a period of abstinences.
 Poly substance use and abuse = Occurs when a person using
or abuse more than one chemical. Typically combination of
drugs includes alcohol and marijuana, alcohol and cocaine.
 Tolerance = a need for increasing the amount of substance to
achieve the desired effects or significantly diminished effect
with continued use of the same substance.

10/28/2021 Gizachew A ( Bsc , MPH) 8

Cont.

 Triggers = are events and activities that may cause a

person to continue addictive.
 Withdrawal symptom = Physical or psychological
symptoms, such as tremors, lethargy, anxiety, and
depression, that typically are opposite to the effect of the
addictive substances and that occur when an addictive
individual does not use the substance for a certain
period of time.
10/28/2021 Gizachew A ( Bsc , MPH) 9
 Commonly Abused Drugs
 A wide variety of drugs are used by substance abusers currently, some of the
commonly abused drugs include alcohol, marijuana, cocaine, caffeine and
tobacco.
 Mood altering or psychoactive drugs include those that are legal as well as
illegal. They fall into seven categories:
 Cannabis
 Depressant
 Hallucination
 Inhalant
 Narcotics
 Steroid
 Stimulants
10/28/2021 Gizachew A ( Bsc , MPH) 10
Cannabis
 More commonly known, as marijuana is an illegal
substance made from the hemp plant
 When smoked or consumed, makes user feel mildly
euphoric and relaxed with more intense sensory
perception.
 Hashish or hashish oil come from the same plant and
has similar effect as marijuana.
 Adverse reaction and abuse can cause hallucination,
anxiety and paranuia.
 Users may develop tolerance and physical dependence.

10/28/2021 Gizachew A ( Bsc , MPH) 11

Depressants

 Drugs that slow down the CNS relax muscles and

reduce co-ordinations; decrease pulse, respiration, calm
nerves and generally lowers energy level, producing
sleep.
 If taken high enough doses they can cause comma
 Depressants are made up of sedatives – hypnotics and
tranquilizers drugs.

10/28/2021 Gizachew A ( Bsc , MPH) 12

 Cont.
 There are addictive, users develop tolerance for them so that
increasingly larger dose must be taken to achieve the same
effect.
 Example: Benzodiazepines, Diazepam, chlorediazepoxide,
barbiturates.

Hallucinogens
 They are called psychodelic drugs, stimulate the CNS and are
mind altering producing hallucinations that affect perceptions,
feelings, thinking and self awareness.
10/28/2021 Gizachew A ( Bsc , MPH) 13
 Inhalants
Includes gas and solvents inhaled via the nose, which
initially acts as stimulants and they slow body function
& causing depression.
These groups of drug are easily obtainable as
household industrial product, and are used most often
by children and adolescent.
Their effects ten to be rapid in onset and short duration.
Example: cleaning solvent, aerosol spray…
10/28/2021 Gizachew A ( Bsc , MPH) 14
 Narcotics

 Including opiates initially stimulating the higher centers

of the brain but then depressing the CNS
 Used to induce sleep and relieve pain
 The better known narcotic includes heroin, codeine,
morphine, opium.
 They are extremely addictive

10/28/2021 Gizachew A ( Bsc , MPH) 15

 Steroid
Chemically related to male hormone testosterone, increasing muscular strength

and body weight.

They appeal particular to athletes and young adults because of their function in

accelerating physical development and athletic power

They are called anabolic and androgenic, because:

Anabolic means to build up muscle and body tissue

Androgenic means development of male sex characteristics.

Steroids may be taken orally or injected directly to muscle.

Their use and abuse can lead to a variety of problems, including hypertension,

liver and kidney damage and heart disease.

10/28/2021 Gizachew A ( Bsc , MPH) 16
 Stimulants


Chemicals that increase ‘alertness and’ activity by stimulating the CNS

Caffine a mild stimulant found in coffee, tea, chocolate, and soft drinks is

the most widely used psychoactive drug in the world.


The effect of stimulant is to cause nerve fibers to release nor adrenaline

and others stimulating neurotransmitters, which allow the expend more of

its energy sooner. Thus harmful effects can be avoided by allowing the

body time to replenish it.


Abusers repeat the dose to avoid the “down” and become dependent.

The most known stimulant include caffeine, cocaine, nicotine…
10/28/2021 Gizachew A ( Bsc , MPH) 17
Factors that influence the vulnerability of the substance abusing
population

10/28/2021 Gizachew A ( Bsc , MPH) 18

Health – related problems of the substance – abusing population

Physical problems
 Physical damage
 Disease
 Head ache
 Malnutrition
 Memory disorder
 Respiratory arrest
 Cardiac arrest
 Suffocation
 Unconsciousness
 Coma and death

10/28/2021 Gizachew A ( Bsc , MPH) 19

Cont.
 Psychological dependence
 Anxiety
 Depression
 Agitation
 Hyperactivity
 Hallucination
 Neurosis
 Psychosis

 Violence
 Suicide
10/28/2021 Gizachew A ( Bsc , MPH) 20
Cont.

Social problem
 Poverty
 Unemployment
 Stigma
 Family disruption
 Family neglect/Abuse
 High cost of drug treatment
 Homicide
10/28/2021 Gizachew A ( Bsc , MPH) 21
 Preventive strategies or measures

 Preventive measure can be effective when the drugs are

prescribed and education is provided to the client about the
effect and the side effects.
 Working with law enforcement agencies and communities
to force drug dealers out of the neigh bar hood by exposing
their activities and by arresting the dealers.
 Working with law enforcement agencies can help curb
some the illegal drug activity.
10/28/2021 Gizachew A ( Bsc , MPH) 22
 Cont.

 Education of the community about the danger of various

stimulants can decrease the sale of these drugs by
preventing youth from engaging in drug use and sale.
 Public education is helpful to warn people of the
potential dangers of the gambling. Education should
start with youth, who are gambling at greater rate than
ever before

10/28/2021 Gizachew A ( Bsc , MPH) 23

Cont.

• Since the experimentation with alcohol commonly

begins in the early ten years; prevention strategies work
best if they are beginning with young children. Also a
multidimensional approach that includes the family,
social groups, school, church, local community, and
local media is also important at all stages of prevention

10/28/2021 Gizachew A ( Bsc , MPH) 24

 Nursing action with the substance abusing
population
 Addressing the need of the substance abusing population is
challenging task.
 Public health interventions include two major emphases;
prevention and treatment, and community health nurse can
play an important role in both.
 Prevention of substance abuse should be major goal in
serving this vulnerable population.
 CHN have opportunities to intervene three level of
prevention.
10/28/2021 Gizachew A ( Bsc , MPH) 25
 Cont.
1. Primary prevention: Efforts aim at preventing abuse from
occurring at all.
 First and perhaps the most important intervention is
educating people about drug, their use and abuse and the
potential danger of this practice.
 Individual taking medication need to be helped to assume
responsibility for learning their actions and side effects and
the potentially danger of multiple drugs interaction, the
nurse can assist in providing and classifying this
10/28/2021 Gizachew A ( Bsc , MPH) 26
Cont.

 Teach people other way to enjoy social activity than

drinking alcohol or taping drugs.
 Teach to develop alternating methods for coping with
stress, such as planned physical activity and recreational
out let.

10/28/2021 Gizachew A ( Bsc , MPH) 27

 Cont.
2. Secondary prevention: majors at halting or reversing drug
use patterns
 To develop effective intervention the CHN needs information
about these people, who are they, where are they located,
what drugs are they using, and what their problems are:
information come from.
o Daily selected hospital reports
o Compiled nationally and is available to those providing
treatment.
10/28/2021 Gizachew A ( Bsc , MPH) 28
 Cont.
o Community professional, such as school nurse
o Interviewing students in the school and clients in drug treatment
program
 Early detection of cases and management before complication occur.
o Graduation withdrawal
o Substitution of less addictive substance
o Symptom treatment
o Pharmacotherapy
 Psychotherapy and counseling

10/28/2021 Gizachew A ( Bsc , MPH) 29

 Cont.

3. Tertiary prevention: aim at treating problems and

preventing them from getting any worse.
 Treatment for drug abuse must be concerned the harm to
the abusers as well as the problems abuse create for the
family and the community.

10/28/2021 Gizachew A ( Bsc , MPH) 30

 Cont.

 CHN must use the nursing process in a framework of

collaboration with other professional to mount a
comprehensive approach that examine the many factors
influencing drug abuse patterns and design services to
meet abusers needs as well as their family and the
community.
 Need assessment is the first step, and then CHN can assist
in the design, implementation and evaluation of a variety
of services targeted for this vulnerable population.
10/28/2021 Gizachew A ( Bsc , MPH) 31
 Control methods
1. Control of production, supply and availability
 Control of distribution and access
 Stopping the supply process at its source
2. Demand reduction
 Increase price
 Control of advertisement
3. Rational prescribing, dispensing and uses of narcotic and
psychotropic drugs.
 Take as prescribed.
10/28/2021 Gizachew A ( Bsc , MPH) 32
Thank you

10/28/2021 Gizachew A ( Bsc , MPH) 33