CURRENT DRUGS TRENDSNURING EDUCATION

SUBSTANCE ABUSE

R. Neela Devi MA, Ms.c, MBA

National Statistics

• Alcohol (21.4%) was the primary substance used (apart from tobacco) followed by cannabis (3.0%) and opioids(0.7%).

• Seventeen to 26% of alcohol users qualified for ICD 10 diagnosis of dependence, translating to an average prevalence of about 4%.

• Current use ranged from a low of 7% in the western state of Gujarat (officially under Prohibition) to 75% in the North-eastern state of Arunachal Pradesh. Tobacco use prevalence was high at 55.8% among males, with maximum use in the age group 41-50 years.

NURSING TRENDS

Academic institutions responsible for preparing the next generation of nurses.

Transformations taking place in nursing and nursing education have been driven by major socioeconomic factors, as well as by developments in health care delivery and professional issues that are unique to nursing.

Dopamine Pathways

Functions

•reward (motivation)

•pleasure,euphoria

•motor function

(fine tuning)

•compulsion

•perserveration

•decision making

Serotonin Pathways

Functions

•mood

•memory

processing

•sleep

•cognition

nucleus

accumbens

hippocampus

striatum

frontal

cortex

substantia

nigra/VTA

raphe

Functions

• Principles of Behavior Dynamics

Behavior Tracts Compete for Expression

Expression is Determined by (i) Dominance of Tracts,(ii) Strength of Prefrontal Cortex to Select, (iii) Relevance orsaliency (orbitofrontal cortex)

A

B

C

PrefrontalCortex Cbehavior

expressed Bbehaviorexpressed

Activation of Dopamine reward pathway initiates a behaviortrack

dopamine initiated

(Miller & Cohen, Annu. Rev. Neurosci. 24 [2001] 167)

Orbito-frontal cortex

Drug Disorder

Cocaine andMethamphetamine

Schizophrenia, paranoia,anhedonia, compulsivebehavior

Stimulants Anxiety, panic attacks,mania and sleep disorders

LSD, Ecstasy & psychedelics Delusions and hallucinations

Alcohol, sedatives, sleep aids& narcotics

Depression and mooddisturbances

PCP & Ketamine Antisocial behavior

Targets of Medication

• Methadone, LAAM and Buprenorphine

Activate opioid receptors

• Nicotine gum/patch

Activate nicotinic receptors

• Naloxone

Block opioid receptors

Recent innovations

• Which is better for drug and alcohol recovery facilities: Traditional methods or new adaptations? Recent innovations in treatment plans used at drug and alcohol addiction recovery facilities have shed new light on how new levels of complete recoveries can be achieved.

• While some of them bypass traditional methods altogether, more of these new plans have shown that alternative methods have validity, and perhaps should be instituted at centers across the country because of their success rates.

Contd.

• Focused on speeding up the withdrawal process for patients undergoing rehab through state funded care.

• During this method, the patient is given drugs to chemically speed up the withdrawal process, forcing the body to process the addictive drugs quicker, and eliminate them from the body faster

Contd.

• Holistic methods

• More acceptable changes that have come about in programs dealing with the treatment of both alcohol and drug abuse patients is the addition of holistic methods for dealing with both detox and recovery. Practitioners of the holistic method concentrate on the patient’s diet during the detoxphase, encouraging changes in food and nutrition to counteract the physical toll that detox can take on the human body

Holistic Method

As the patient transitions into recovery, the holistic method that had been tried successfully with teenage addictions, implementing customized counseling that targets building self-esteem, positive thinking, and social interactions

New innovations

• Nurses of the 21st century need to be skilled in the use of computer technology. Already, distance learning modalities link students and faculty from different locales and expand the potential for accessible continuing professional education.

Trends & New Innovations

• Structure Of Care: Focus on organization and delivering of nursing care.

• Process Of Care: Focus on the nature and the amount of care provided.

• Outcome: Focus on the effect of interactions between nursing staff and client.

• Nursing practice, education and research must open up and respond to these changing demographics: focus on spiritual health and psychosocial health of the population

Contd.

• Nursing education and research must become more internationally focused to disseminate and benefit from the multicultural experience

• Increases in the diversity of the populationaffects the nature and the prevalence of illnessesand diseases. • It requires changes in practice thatreflect and respective diverse values and beliefs.• Disparities in morbidity, mortality, and access tocare among population sectors have increased,even as socioeconomic and other factors haveled to increased violence and substance abuse.

Reasons for New Innovations

Nursing Trends

• Nursing research has the potential to enhance knowledge regarding healing therapy.

• Nursing education and practice must expand to include the implications of emerging therapy from both genetic research and alternative medicine.

• Technological advancement in the treatment of illness and disease have created new modalities that extended life.

Nursing Trends

• New settings for care, such as inpatient and home-based hospice, and new forms of care, including pain management, spiritual practices, and support groups and bereavement counseling, are now likely to be part of well-developed health care systems.

Nursing Trends

• Providing services for defined groups "covered" by managed care will demand skills and knowledge in clinical epidemiology, biostatistics, behavioral science, and their application to specific populations.

• Nurses must demonstrate management skills at both the organizational and patient care levels.

• These concepts must be incorporated into the nursing curriculum.

Nursing Trends

• More research is needed to demonstrate the value to the health care delivery system, as well as the cost effectiveness, of health education, health promotion, and advanced nursing practice. Nursing education programs must prepare students at all levels for roles in case management and employment in the managed care environment.

Two Major Trends

• First, there will be an increase in state and federal regulation as costs rise and managed care continues to expand. Along with regulation, there will be attempts to shift to less expensive settings and apply market forces to restrain costs.

• Second, Nursing schools, scholars, executives, and professional nursing organizations must more actively contribute to the development of health policy and regulation.

Contd.

• Team-based, interdisciplinary approaches have been shown to be highly effective for improving clinical outcomes and reducing cost.

• Teaching methods that incorporate opportunities for interdisciplinary education and collaborative practice are required to prepare nurses for their unique professional role and to understand the role of other disciplines in the care of patients.

Types Of Alternative Therapies• Folk medicine• Herbal medicine• Nutritional Therapy• Homeopathy• Faith healing• New age healing• Chiropractic• Acupuncture• Naturopathy• Massage• Music therapy

MassageAcupunctureWarm soaksExercise therapy

Japanese arrowroot

No cure