Substance Abuse in Primary Care

¶ … americannursetoday.com/AuthorGuidelines.aspx Substance Abuse in Primary Care: Treating with Competence and Confidence Dealing effectively with substance abuse in primary care is not just about technique, it is also about attitude. Therefore, in order for you to treat your patients competently and confidently, you need to be aware of how your attitude towards substance abuse affects the quality of care you are able to provide.

For example, the United States National Institute on Drug Abuse (NIDA) Clinical Trials Network examined medical staff attitudes towards substance abuse and determined that medical professionals' personal thoughts and feelings about substance abuse influenced their treatment methods; in particular, their likelihood of adopting new interventions. Primary care nurses are apt to encounter patients with substance abuse problems on a regular basis. Whether the substance being abused is alcohol, prescription drugs or illegal drugs, the patient needs to be encouraged and directed toward seeking professional treatment.

If you are a nurse who believes that substance abuse can be successfully treated through therapy, you are more likely to feel comfortable guiding the patient in that direction than a nurse who thinks that all that these clients need is willpower. You are also more likely to take the time to look for the signs of abuse. Unfortunately, identifying a patient with a substance abuse problem is rarely as easy as simply asking them if they abuse drugs or alcohol.

One helpful way to get more information than the client may be initially willing to give is to ask about things like their general health, accidents, arrests and so on, and then ease the topic of substance abuse into the conversation.

For example, if you find out that the client has had three car accidents in the last two years, you might say something to the affect of "Were alcohol or drugs involved in any of those accidents?" Many clients may still not be forthcoming, but there are other signs you can look for to help you identify a client that is need of substance abuse treatment.

For example, someone who is addicted to prescription pills may try to 'scam' their way into receiving a prescription for a mood altering medication by saying that non-addictive medications don't work, or that they cannot take them because of an allergy. They may also try to get refills before the available date by saying that they accidentally dropped their pills down the sink or lost them somewhere. Additionally, they may demand brand name drugs instead of generic drugs because they have a higher street value.

Nurses need to be aware of these tricks so that they do not inadvertently become enablers. Additional training in substance abuse can help to ensure that nurses are prepared to effectively deal with these types of situations. Researchers such as Jackson, Alford, Dube and Saitz assert that despite the widespread substance abuse problems in our nation, there is a considerable lack of training for primary healthcare providers in this area.

Both psychotherapeutic (such as cognitive and behavioral strategies) and pharmacological (such as Buprenorphine, Methadone, LAAM and Naltrexone) interventions have shown to be successful at treating substance abuse. However, if the medical professionals making contact with these individuals are not properly trained to deal with these issues, nobody benefits. As a primary care nurse, it is also important to know the best treatment centers for referral in the community.

While most communities have Alcoholics Anonymous and other twelve step programs readily available, knowing where to refer a client for in-patient treatment is critical as well. Some in-patient treatment facilities can be very difficult for substance abusers to get into on their own, but a referral from a medical professional can help them get accepted more quickly. Once again, your attitude toward substance abuse will play a significant role in how likely you are to make these types of referrals.

In addition, the NIDA study (mentioned above) reports that having a manual or a written set of guidelines that explains exactly what nurses should do to recognize and inquire about a substance abusing client is likely to increase the number of patients identified and referred for treatment. Primary care nurses deal with a wide variety of clients.