Chronic Care

Considerable investment of money and effort has been directed toward drug abuse prevention programs. Afer a decade of prevention efforts small gains are becoming evident. Treatment programs on the otherhand have proved to be effective in reducing drug abuse. Unfortunately, among dependent substance abusers in all age categories, only about a quarter get treatment.2 Effectiveness of treatment programs range from forty to eighty percent. A program is considered effective if it demonstrates a fifty percent reduction in substance use after six months. Treatment has been shown to be less expensive than incarceration and untreated addiction. Treatment, however, does not cure addiction, it seeks to manage the disease as a chronic, relapsing disorder. 18

Addiction in teenagers may be uncovered during a review of problems, such as lack of motivation and ability to do school work, maintain an active social life, hold a job, or engage in normal social activities. Nurses may encounter teenagers with addictions in a clinic visit for either mental or physical problems. Depression, anxiety, hostility and incoherence are commonly noted by parents of chronic juvenile drug users. A weakening of the immune system leading to frequent viral and bacterial infection is another common observation. Chronic cough and an aggravation of asthma may be traced to smoking. Drug use may have led to the transmission of HIV/AIDS or hepatitis B or C, either through injection or through high risk sexual contact under the influence of drugs. Damaged blood vessels and skin abscesses may have been incurred through self-injections. 19

Marijuana has been linked with lack of motivation in adolescents as well as work-related inconsistency. The causal relationship is uncertain, however, and reverses with discontinuation of use. Long-term effects of regular MDMA use, with its potential for psychological addiction and tolerance, include exhaustion, mood swings, dizziness, vertigo and possible brain damage. LSD users may exhibit mental fragmentation along with the unpleasant occurrences of flashbacks weeks or months later. Nurses need to be aware of these possibilities among adolescents seeking healthcare, while also keeping themselves up-to-date on the prevalence of amphetamine addiction and its devastation on health. These highly addictive and quick tolerance-building substances are typically taken in a cycle of repeated binges for four to five days at a time, followed by exhaustion, round-the-clock sleeping and ravenous eating. Withdrawal symptoms of exhaustion, depression and mental incoherence are severe. Addicts tend to be extremely violent. The long-term effects of amphetamine use are: weight loss, malnutrition, fatal kidney and lung disorders, permanent psychological problems, a weakened immune system and liver damage. Brain damage from chronic use may lead to speech and cognitive disability that includes psychotic features leading to homicidal or suicidal thoughts. With meth abusers, acute lead poisoning is also possible.

In one study of the frequency that student nurses included an assessment of substance abuse in patients, it was found that only 55% of the students asked their patients about alcohol consumption and 20% asked about drug usage without being directed to do so. On prompting, 90% collected information on alcohol use and 80% collected information on drug use.20 This study points out the need for establishing substance abuse assessments as a routine part of collecting a health history. Nurses may need this information about the use of illicit drugs in a hospitalized adolescent experiencing withdrawal symptoms. Also, there may be contraindications regarding the use of such prescription drugs as MAOI inhibitors in a patient who has recently taken street drugs.

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