17 SUBSTANCEABUSE 425
about how others perceive their interaction or ability
to listen.
The nurse also can help clients to find ways to re-
lieve stress or anxiety that do not involve substance
use. Relaxation, exercise, listening to music, or en-
gaging in activities may be effective. Clients also may
need to develop new social activities or leisure pur-
suits if most of their friends or habits of socializing
involved the use of substances.
The nurse can help clients to focus on the present
not the past. It is not helpful for clients to dwell on
past problems and regrets. Rather, they must focus on
what they can do now regarding their behavior or re-
lationships. Clients may need support from the nurse
to view life and sobriety in feasible terms—taking it
one day at a time. The nurse can encourage clients to
set attainable goals such as “What can I do today to
stay sober?” instead of feeling overwhelmed by think-
ing, “How can I avoid substances for the rest of my
life?” Clients need to believe that they can succeed.
Evaluation
The effectiveness of substance abuse treatment is
based heavily on the client’s abstinence from sub-
stances. In addition, successful treatment should re-
sult in more stable role performance, improved inter-
personal relationships, and increased satisfaction
with quality of life.
COMMUNITY-BASED CARE
Many people receiving treatment for substance abuse
do so in community-based settings such as outpatient
treatment, freestanding substance abuse treatment
facilities, and recovery programs such as AA and Ra-
tional Recovery. Follow-up or aftercare for clients in
the community is based on the client’s preferences or
the programs available. Some clients remain active in
self-help groups. Others attend aftercare program
sessions sponsored by the agency where they com-
pleted treatment. Still others seek individual or fam-
ily counseling. In addition to formal aftercare, the
nurse also may encounter recovering clients in a clinic
or physician’s office.MENTAL HEALTH PROMOTION
A person only has to watch television or read a mag-
azine to see many advertisements targeted at the pro-
motion of responsible drinking or encouraging par-
ents to be an “antidrug” for their children. Increasing
public awareness and educational advertising have
not made any significant change in the rates of sub-
stance abuse in the United States (National Institute
for Mental Health, 2002). Two populations currently
identified for prevention programs are older adults
and college-aged adults.
Menninger (2002) describes drinking problems
among older adults as falling into two distinct pat-
terns: early-onset alcoholism (two-thirds)—clients
who have been drinking all their lives; and late onset-
alcoholism (one-third)—clients who develop alcohol-
ism late in life. Late-onset alcoholism is usually milder
and more amenable to treatment, yet health care
professionals overlook it more frequently. Menninger
suggests use of a screening tool, such as AUDIT, in
all primary care settings to promote early identifica-
tion of older adults with alcoholism. He believes that
brief intervention at an early stage will arrest or pre-
vent the development of late-onset alcoholism in this
population.
The College Drinking Prevention Program, which
is government-sponsored, is a response to some of the
following statistics about college students between 18
and 24 years of age (National Institute on Alcohol
Abuse and Alcoholism, 2002):- 1400 students die annually from alcohol-
related unintentional injuries. - 500,000 students are unintentionally injured
while under the influence of alcohol. - 600,000 students are assaulted by another
student under the influence of alcohol. - 70,000 students are victims of alcohol-
related assault or date rape. - 25% of students report academic conse-
quences of their drinking.
This prevention program was designed to help college
students avoid the “predictable” or expected binge
drinking common at U.S. colleges and universities.
Some campuses offer alcohol and drug-free dormito-
ries for students, and some college-wide activities no
longer allow alcohol to be served. Educational pro-
grams (about the above statistics) are designed to
raise student awareness about excessive drinking.
Students who wish to abstain from alcohol are en-
couraged to socialize together and to provide support
to one another for this lifestyle choice.
◗ NURSINGINTERVENTIONS FOR
CLIENTSWITHSUBSTANCEABUSE- Health teaching for the client and family
- Dispel myths surrounding substance abuse
- Decrease codependent behaviors among family
members - Make appropriate referrals for family members
- Promote coping skills
- Role-play potentially difficult situations
- Focus on the here-and-now with clients
- Set realistic goals such as staying sober today