Risk has been used to describe the potential of substance abuse in increasing susceptibility to bloodborne diseases
Health Complications among Drug and Substance Abusers
Over the years, substance abuse treatment approaches been focusing on eliminating or reducing the use of psychoactive materials, a trend that has ignored the adverse health issues. Disregarding the impacts of substance abuse and focusing on underlying issues has resulted in an ever-growing burden of drug-related deaths and blood-borne diseases. Epidemiologists have established a significant association between use of psychoactive materials and new patterns of viral infections such as Hepatitis B and C, and HIV/AIDS (Guarino, Marsch, Deren, Straussner, & Teper, 2015). The growing concern of drug abuse has also influenced the incidence of diseases such as wound botulism and tetanus. The adverse health impacts have informed a number of solutions. Some of the popular evidenced-based approaches include matrix model, family behavior therapy, motivational enhancement therapy, cognitive-behavioral therapy, contingency management interventions, and 12-step facilitation therapy. While the efficacy of the approaches has been confirmed by the current stock of knowledge, they have not addressed the health needs of drug abusers, with many scholars suggesting that the plans are rigid in their approach, whereas the substance abuse trends are highly evolving. The supposition is supported by the contemporary effects of drug addiction, where they continue to have a significant toll on individual health and social functions in spite of massive public health spending (Degenhardt et al., 2013).
The prevalence of substance abuse has remained persistently high. The trend is explained by Alhyas et al. (2015) in their suggestion that the current generation is using psychoactive materials for the desired outcome, unlike the 20th-century abusers who did not understand the effects of indulging in drugs. The 21st-century youths are abusing substances as part of the exploratory behavior, even when they have full knowledge of the side effects. The trend has resulted in legislative measures where some states are legalizing previously outlawed substances such as Marijuana (Huddleston, 2016). However, the strategies only address the socioeconomic implications and not drug-usage complications and deaths. Against this backdrop, practitioners are starting to embrace harm reduction strategies to offset both socioeconomic and adverse health effects at both individual and community level. Harm limiting strategies are evidence-based approaches of keeping up with the dynamics of drug abuse. With the traditional methods having failed to address relative risks linked with substance abuse, focusing on offsetting the adverse effects and complications does not only offer a promising future, but also reduced mortality, negative behaviors, and morbidity rates (Toumbourou et al., 2007).
The problem-oriented approach is congruent with the principles of evidence-based practice where the focus should not only be embracing proven policies and interventions, but also adopting methods and procedures that are linked to the dynamism of the problem. Its focus is informed by trends in substance abuse, where many people continue to use drugs with full knowledge of its negative implications for the physical and psychosocial functioning (Sederer, 2016). The behavioral trend has led to a scholarly conclusion that drug will remain part of the humanity, where users will keep furthering their experiments to exploit perceived benefits such as enhancing pleasure and easing discomfort (Coon & Mitterer, 2013). The surmise is supported by recent trends, where the rate of use of opioids for non-medical purposes has been on the rise (Longo, Compton, Jones, & Baldwin, 2016). Although the impact of the misuse is a well-understood subject, individuals continue to use opioids. The trend is against the natural responses when human beings avoid harmful substances. Schatz (2016) associates the trend to Hollywood culture, where drug-related phenomenon such as sexual prowess, curiosity, enjoyment, boldness, confidences, and sound sleep are praised. With the concept of global village scenario having been realized through advanced transport and communication system, Manza (2016) suggest that the number of drug users will keep increasing as advanced technologies have resolved inaccessibility. The trend necessitates the need for a change in focus from limiting the use of substance abuse to harm minimizing strategies (van Amsterdam & van den Brink, 2013).
Harm Minimization Strategies as Evidence-Based Interventions for Drug and Substance Abusers
One of the evidence-based approaches to addressing adverse health effects and social dysfunction associated with drug abuse is harm minimization strategies. The interventions focus on empowering substance users and cushioning them against complications and the risk of contracting illnesses (Ruan et al., 2013). Harm minimization procedures entail neutralizing risks in drug taking as well as addressing elements that can affect the quality of life. The evidence-based practices are effective in addressing unprecedented effects of substance abuse such as blood-borne viruses, overdose, unintentional injury, premature drug-related death, septicemia, and dental health among others (Hickman, De Angelis, Vickerman, Hutchinson, & Martin, 2015). The issues calls for revisiting drug policies, where harm minimizing approaches should be integrated into comprehensive care plans for drug abuse treatments (van Amsterdam & van den Brink, 2013).
Harm reduction approaches entail embracing practical ideas and strategies to offset the risk and negative health impacts arising from drug use. Like other patient-centered public health and psychosocial interventions, harm minimizing strategies adopts a non-judgmental approach with drug users and the community being active participants in shaping procedures and programs around substance abuse (Harmreduction.org, 2016). The evidence-based and cost-conscious practices do not only focus on drug use control but also improving the quality of life of involved parties. The harm minimization model is informed by a widely explored supposition that substance abuse is a behavior that is influenced by a myriad of factors. The underlying elements are utilized in the execution of the activities such as peer education, counseling, overdose prevention, need and syringe programs, voluntary HIV testing, wound care, enlisting in substance abuse treatment programs, pharmacotherapy for addiction cases, and primary health care including treatment for STIs and viral diseases.
The rationale for the set of interventions is informed by Roizen’s 4-L model, where harm minimization action plans are structured to address livelihood aspects, health effects, legal issues, and relationship issues emanating from substance abuse (Hussein, 2008). Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008). Based on the two theoretical frameworks, harm minimization approaches focus on the three behavioral levels of 1) substance acquisition, 2) usage, and 3) withdrawal stage. At the acquisition level, harm minimization approaches focus on addressing violence and criminality associated with accessing psychoactive materials from the market.
Intervening at the drug abuse stage entails offsetting complications that are related to drug use. A key area of focus at the usage level is dosage and route of administration. The centrality of the two aspects is evidence-based, where the current body of literature reveals that most of the complications are contributed by the dosage as well as the route of administration. For instance, intravenous injections have been classified as the riskiest strategy as it compromises the integrity of the skin as a primary line of defense, exposing victims to opportunistic pathogens. It also leads to open wounds, vein problems, and abscesses (Del Giudice, 2004). The stage is linked to viral infections such as Hepatitis B and C and HIV/AIDs, making awareness campaigns and health education a critical cog. The health promotion methods create awareness on disease transmission and ways of effective prevention and educate users on safety procedures such as disposal of sterile and well as non-sterile materials. Uses of injectable are discouraged to offset the spread of blood-borne infections.
Harm minimization at the withdrawal level seeks to address physical symptoms as well as psychosocial aspects associated with quitting drugs. The stage focuses on establishing supportive tools and environment where professional, families and drug users interact to modify behaviors. To prevent withdrawal complications and setbacks, the intervention provides alternatives such as pharmacological antagonist drugs (Farr?, Galindo, & Torrens, 2014). The drug-substitution approach does not only reduce address usage-related risks but also initiates the road to recovery.
Identification of Measurement Outcomes for Identified Interventions
The rationale of the health promotion is ingrained in the Ron Roizen?s model, where effects of psychoactive substances are abbreviated as 4Ls (Liver, Lover, Livelihood, and Law). The four categories will be the parameters of monitoring and evaluation procedures to assess the level of efficacy of the health promotion intervention. The four categories are informed by the WHO definition of health, where it?s a state of holistic mental, physical, and social well-being and not the absence of disease or infirmity. Evaluating the four pillars is thus critical in assessing the effectiveness of the intervention in attaining complete wellbeing.
The liver category captures all aspects of personal health. The primary measurement areas are physical parameters such as engagement in activities of daily living, diet and nutrition, sleep patterns, and temperament. Visual aspects such as bodily injuries and hygiene are also important in assessing the impacts of the intervention on the health of the victims.
Lover and livelihood focus on psychosocial effects of substance abuse. A critical issue is interactional behaviors between the victim and friends, intimate partners, and family members. Another livelihood measurement outcome is engagement in activities of daily living, including professional practices and non-professional aspects. The legal issues explore observable behavioral trends such as violence.
Utilization of epidemiology principles and terminology
a) Prevalence has been used to describe the extensiveness of drug abuse as well as effects such as drug-related deaths and blood-borne diseases.
b) Incidence has been adopted to highlight new patterns of viral diseases such as Hepatitis C, Hepatitis B, HIV/AIDS, wound botulism, and tetanus infections. The terminology is used to highlight the risk of contracting the disease when one is a drug abuser.
c) Risk has been used to describe the potential of substance abuse in increasing susceptibility to bloodborne diseases
d) The rate has used to predict a downward change in frequency of the current mortality, negative behaviors, and morbidity cases if harm minimization strategies are fully embraced.
e) Mortality rate has been used to describe deaths emanating from drug abuse and associated complications
Implications of the project for the APN clinical practice
The health promotion project offers a valuable learning experience on sociomedical realities. The elements explored challenges the traditional perspective of disease causation, where only pathogens were considered in the etiopathophysiology of infections. The project offers valuable lessons on the expansiveness of the public health, where history, social, and political issues are also determinants of health. The contribution of social issues in therapeutic area challenges advanced practice nurses to adopt a broad perspective of caregiving, where history and culture should be the epicenter of nursing research and interventions to empower the community to take control over their lives. The realization that holistic functioning can be affected by an array of issues informs area of future engagement to assess impacts of sociomedical subjects such as sexuality, homelessness, immigration, and aging in the public health.
The project has also offered invaluable lessons on the importance of inter-professional collaborations in public health. While the health promotion intervention focuses on adverse health outcomes of drugs abuse, the models and proposition adopted to inform the arguments of the project are informed by anthropological, psychological, and well as sociological postulations.
References
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Coon, D. & Mitterer, J. (2013). Psychology (p. 210). Boston: Cengage Learning.
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Ruan, Y., Liang, S., Zhu, J., Li, X., Pan, S., & Liu, Q. et al. (2013). Evaluation of Harm Reduction Programs on Seroincidence of HIV, Hepatitis B and C, and Syphilis Among Intravenous Drug Users in Southwest China. Sexually Transmitted Diseases, 40(4), 323-328. http://dx.doi.org/10.1097/olq.0b013e31827fd4d4
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