PREVENTION OF SUBSTANCE USE DISORDER
Primary Prevention
• Reduction of over prescribing by doctors (especially with
benzodiazepines and other anxiolytic drugs).
• Identification and treatment of family members who may be
contributing to the drug abuse.
• Introduction of social changes is likely to affect drinking
patterns in the population as awhole. This is made possible by:
• Putting up the price of alcohol and alcoholic beverages
• Controlling or abolishing the advertising of alcoholic drinks
• Controls on sales (by limiting hours or banning sales in
supermarkets)
• Restricting availability (Governmental measures)
• Other approaches are to strengthen the individual's personal
and social skills to increase self-esteem and resistance to peer
pressure.
• Health education to college students and the youth about the
dangers of drug abuse through the curriculum and mass media.
Health education should also include certain specific groups
where a substance like alcohol may be culturally accepted. Such
attitudes should be addressed and corrected.
Secondary Prevention
• Early detection and counseling.
• Brief intervention in primary care (simple advice by a general
practitioner plus an educational leaflet).
• Motivational interviewing which involves providing feedback
to the patient together with a number of options for change.
• A full assessment including an appraisal of current medical,
psychological and social problems. Assessment includes
whether alcoholism is the primary or secondary problem.
• Detoxification with benzodiazepines (diazepam,
chlordiazepoxide).
Tertiary Prevention
Specific measures include:
• Alcohol deterrent therapy (Disulfiram or Antabuse).
• Other therapies include assertiveness training (to prevent
yielding to peer pressure), teaching coping skills (some take
drugs to combat stress), behavior counseling, supportive
psychotherapy and individual psychotherapy.
Some practical issues under relapse prevention include:
• Education about health consequences of alcohol use
• Identifying high-risk situations and developing strategies to
deal with them (craving management)
• Learn refusal skills(assertivenesstraining)
• Dealing with faulty cognitions
• Handling negative mood states
• Time management
• Stress management
• Recreation
•Family counseling to reduce interpersonal conflicts, which may
otherwise trigger relapse.
NURSING MANAGEMENT FOR SUBSTANCE USE
DISORDER
Nursing Assessment
1. Recognition of alcohol abuse:
2. The CAGE questionnaire may be adopted for this purpose:
C: Have you ever felt you ought to CUT down on your
drinking? A: Have people ANNOYED you by criticizing
your drinking?
G: Have you ever felt GUILTY about your drinking?
E: Have you ever had a drink first thing in the morning (an
EYE-OPENER) to get rid of a hangover?
3. Find out at risk factors:Problems in the marriage and
family, at work, with finances, at risk occupations,
withdrawal symptoms after admission, alcohol-related
physical disorders, deliberate self-harm.
4. Certain clinical signs lead to the suspicion that drugs are
being injected: needle tracks and thrombosed veins, wearing
garments with long sleeves, etc. IV use should be suspected in
any patient who presents with subcutaneous abscesses or
hepatitis.
5. Behavioral changes: Absence from school or work,
negligence of appearance, minor criminal offences,isolation
from former friends and adoption of new friends in a drug
culture.
6. Laboratorytests
Blood alcohol concentration.
Liver function test
Most drugs can be detected in urine, the notable
exception being LSD.
Nursing Diagnosis I
Risk for injury related to acute intoxication, withdrawal and
substance specific psychological changes i,e hallucinosis.
(a) Place the client in a room near the nurse's station or where
the staff can observe the client closely.
(b) Monitor the client's sleep pattern; he may need to be
restrained at night if confused or if he wanders .
(c) Decrease environmental stimuli (bright lights, television,
visitors) when the client is restless, irritable or have tremers.
(d) Institute seizure precautions (airway/oxygenation at bedside
and raised side-rails, etc.)
(e) Re orient the client to person, time, place and situation as
needed.
(f) Talk to the client in simple, direct, concrete language.
Nursing Diagnosis II
Altered health maintenance related to inability to identify,
manage or seek out help to maintain health.
(a) Monitor the client's health status. Administer medications as
prescribed. Observe the client for any behavioral changes and
inform physician when necessary.
(b) Maintain fluid and electrolyte balance.
(c) Provide food as soon as the client can tolerate eating (bland
food usually is tolerated best at first).
(d) Ensure that amount of protein in the diet is correct for
individual patient condition.
(e) Provide small frequent feedings of patient's favorite foods.
Supplement with vitamins and minerals.
(f) Assist the client in self-care activities depending on the
severity of the client's withdrawal.
Nursing Diagnosis Ill
Ineffective denial related to weak, underdeveloped ego.
(a) Develop trust, convey an attitude of acceptance. Ensure that
patient understands it is not him but his behavior that is
unacceptable.
(b) Identify recent maladaptive behaviors or situations that have
occurred in the patient's life and discuss how use of
drugs/alcohol may be a contributing factor.
(c) Do not allow patient to rationalize or blame others for
behaviors associated with substance use.
(d) Provide positive reinforcement when the client shows insight
into his behavior.
Nursing Diagnosis IV
Ineffective individual coping related to impairment of adaptive
behavior and problem- solving abilities.
(a) Encourage client to explore options available to deal with
stress, rather than resorting to substance use.
(b) Give positive reinforcement for ability to respond to stress
with adaptive coping strategies.
(c) Teach client and family that alcoholism requires long-term
treatment and followup. Refer to AA and other support groups
as indicated.
(d) If drinking occurs, discuss the events that led to the incident
with the patient in a non-judgmental manner. Discuss ways to
avoid similar circumstances in the future.
(e) Assist the patient to plan weekly, or even daily, schedules of
purposeful activities, such as appointments, talking ,walks, etc.
Psychosocial Rehabilitation
Psychosocial rehabilitation focuses on restoring and enhancing
the emotional, social, and psychological functioning of
individuals with mental illness or intellectual disabilities. Key
components include:
1. Skills Training: Teaching practical skills for daily living,
such as managing medications and personal hygiene.
2. Cognitive Remediation: Improving cognitive functions
such as attention, memory, and problem-solving abilities
through structured interventions.
3. Social Skills Development: Helping individuals develop
and maintain relationships, communicate effectively, and
participate in social activities.
4. Psychoeducation: Providing education about mental health
conditions, symptom management, and coping strategies
for individuals and their families.
5. Peer Support Programs: Engaging individuals in peer
support groups to share experiences, provide mutual
support, and reduce isolation.
NATURE & FEATURES OF PSYCHOSOCIAL
REHABILITATION
Multidisciplinary team approach: PSR involves a
collaborative effort among professionals from diverse
fields, including psychiatry, psychology, social work,
occupational therapy, and nursing.
Individualized treatment planning: Each individual receives
a tailored treatment plan that addresses their unique needs,
goals, and circumstances.
Holistic approach: PSR encompasses various interventions
aimed at promoting physical, emotional, social, and
vocational well-being.
Community-based services: PSR services are typically
provided in community settings, such as outpatient clinics,
day treatment centers, and residential facilities.
Recovery-focused philosophy: PSR is guided by a
recovery-focused philosophy, which emphasizes hope,
empowerment, and the potential for growth and change.
METHODOLOGY OF PSYCHOSOCIAL
REHABILITATION
Assessment: A thorough assessment of the individual’s
strengths, weaknesses, needs, and goals is conducted by a
team of professionals, including psychiatrists,
psychologists, social workers, and occupational therapists.
Treatment Planning: Based on the assessment findings, a
personalized treatment plan is developed, outlining specific
objectives and interventions. The treatment plan may
include medication management, psychotherapy,
occupational therapy, social skills training, and vocational
training.
Intervention:
Medication Management: Pharmacotherapy may be used to
alleviate symptoms of mental illness and enhance
functional capacity. The individual’s response to
medication is closely monitored, and adjustments are made
as needed.
Psychotherapy: Various forms of talk therapy, such as
cognitive-behavioral therapy, dialectical behavior therapy,
and family therapy, are employed to address underlying
psychological issues and improve coping skills.
Mental Health Policy, Nepal
The Government of Nepal adopted a National Mental health
policy in 2052 but mental health programs was in low priority
on the national health agenda. Now, The Ministry of Health has
drafted a new National Mental Health Policy- 2073 to scale
up mental health activities and make mental health as a
priority health agenda.
