Question

2. A nurse is participating in a community education session. The purpose of the group is to decrease negative feelings towards citizens with substance abuse issues. What domain of learning would the nurse use to address this topic? Why is that domain appropriate?

Answer 1

Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of substance abuse, provided as a service of the Substance Abuse and Mental Health Service Administration's Center for Substance Abuse Treatment (CSAT). CSAT's Office of Evaluation, Scientific Analysis, and Synthesis draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to a growing number of facilities and individuals across the country. The audience for the TIPs is expanding beyond public and private substance abuse treatment facilities as alcohol and other drug disorders are increasingly recognized as a major problem. The TIPs Editorial Advisory Board, a distinguished group of substance abuse experts and professionals in such related fields as primary care, mental health, and social services, works with the State Alcohol and Other Drug Abuse Directors to generate topics for the TIPs based on the field's current needs for information and guidance. After selecting a topic, CSAT invites staff from pertinent Federal agencies and national organizations to a Resource Panel that recommends specific areas of focus as well as resources that should be considered in developing the content of the TIP. Then recommendations are communicated to a Consensus Panel composed of non-Federal experts on the topic who have been nominated by their peers. This Panel participates in a series of discussions; the information and recommendations on which they reach consensus form the foundation of the TIP. The members of each Consensus Panel represent substance abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Panel Chair (or Co-Chairs) ensures that the guidelines mirror the results of the group's collaboration. A large and diverse group of experts closely reviews the draft document. Once the changes recommended by these field reviewers have been incorporated, the TIP is prepared for publication, in print and online. The TIPs can be accessed via the Internet on the National Library of Medicine's home page at the URL: http://text.nlm.nih.gov. The move to electronic media also means that the TIPs can be updated more easily so they continue to provide the field with stateof-the-art information. Although each TIP strives to include an evidence base for the practices it recommends, CSAT recognizes that the field of substance abuse treatment is evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. For this reason, recommendations proffered in the TIP are attributed to either Panelists' clinical experience or the literature. If there is research to support a particular approach, citations are provided. This TIP, Substance Abuse Among Older Adults, presents treatment providers with much-needed information about a population that is underdiagnosed and underserved. Substance abuse, particularly of alcohol and prescription drugs, often goes undetected among adults over 60 in part due to societal reasons - older adults tend to be ashamed about drinking or drug problems and see them as a moral failing. Providers, for their part, may confuse symptoms of substance use disorders with age-related changes. Because so much of older adults' substance abuse is never even identified, this TIP is aimed at not only substance abuse treatment providers but also primary care clinicians, social workers, senior center staff, and anyone else who has regular contact with older adults. The TIP discusses the relationship between aging and substance abuse and offers guidance on identifying, screening, and assessing not only substance abuse but also disorders such as dementia and delirium that can mask or mimic an alcohol or prescription drug problem.

Plans on preventing substance abuse

Family based prevention programmes

"Prevention programs can strengthen protective factors among young children by teaching parents better family communication skills, appropriate discipline styles, firm and consistent rule enforcement, and other family management approaches. Research confirms the benefits of parents providing consistent rules and discipline, talking to children about drugs, monitoring their activities, getting to know their friends, understanding their problems and concerns, and being involved in their learning. The importance of the parent-child relationship continues through adolescence and beyond" (National Institute of Drug Abuse, 2003).

Smit, Verdurmen, Monshouwer, and Smil conducted research analysis to measure the effectiveness of family interventions about teen and adolescence drug and alcohol use. According to their data alcohol and drug use is very common in Western societies. For example, 18% of the young adults between the ages of 12-14 year old in US have indulged in binge drinking. According to quantities in 2006, 73% of 16-year-old US students were reported having used alcohol; In Northern Europe this is 90%. Since early use of alcohol and other substances may cause serious health, immediate solutions to these problem are required

School-based prevention programmes

US Navy Master-at-Arms 1st Class Michael Turner of Mobile Security Squadron Two (MSS-2) collects information at the Substance Abuse Prevention Summit

Drama based education to motivate participation in substance abuse prevention. (media from BioMed Central)

There are a number of community-based prevention programs and classes that aim to educate children and families about the harms of substance abuse. Schools began introducing substance abuse oriented classes for their students in grades as low as preschool. The inclusion of prevention studies into classroom curriculums at a young age have been shown to help to break early behaviors that could be signs drug abuse in the future. Around 40% of children have tried alcohol by the time that they are ten.

There are organizations that educates, advocates, and collaborates to reduce drug and alcohol problems in the state. Some programs may begin by allowing students to be interactive and learn skills such as how to refuse drugs. This is proven to be a more effective method than strictly educational or non-interactive ones. When direct influences (e.g., peers) and indirect influences (e.g., media influence) are addressed, the program is better able to cover broad social influences that most programs do not consider. Programs that encourage a social commitment to abstaining from drugs show lower rates of drug use. Getting the community outside of the school to participate and also using peer leaders to facilitate the interactions tend to be an effective facet of these programs. Lastly, teaching youth and adolescents skills that increase resistance skills in social situations may increase protective factors in that population.

Community prevention programmes

Prevention programs work at the community level with civic, religious, law enforcement, and other government organizations to enhance anti-drug norms and pro-social behaviors. Many programs help with prevention efforts across settings to help send messages through school, work, religious institutions, and the media. Research has shown that programs that reach youth through multiple settings can remarkably influence community norms. Community-based programs also typically include development of policies or enforcement of regulations, mass media efforts, and community-wide awareness programs. Increasing health education in the community also plays a role in helping to decrease the consequences of substance abuse.

On a community level, established safe injection sites that provide a hygienic space supervised by licensed healthcare professionals allow for safe monitoring of participants and provide health education and care to prevent overdose and abuse. Another way to help prevent overdose and abuse, especially regarding opioids, is the increased access and knowledge of naloxone. Naloxone is the standard opioid overdose reversal agent.[18] Studies show Overdose Education and Naloxone Distribution (OEND) programs decrease the rate of rate of deaths from opioid overdose.[19] Naloxone comes in different routes of administration such as, an injection that's administered intravenously, intramuscular, or subcutaneously and a nasal spray. Naloxone injection and the nasal spray are both commonly used in adults and children who are going through drug overdose because it is successful in reversing the overdose effects As a safety precaution, patients taking opioids are recommended to always carry naloxone with them and should replace the naloxone regularly, via reference to the expiration date.