DSM-IV TR Criteria
The criteria for substance abuse or substance dependence are the symptoms exhibited by an individual who abuses substances such as alcohol or drugs. The diagnosis for alcohol or substance abuse is prescribed when three or more of three DSM-IV TR criteria are exhibited by the substance abuser. Here, the seven DSM-IV TR criteria are divided into two types which are physiological dependence and compulsive use of substances. Physiological dependence on alcohol leads to greater medical and psychological problems that may lead to the withdrawal of an individual while on the other hand Compulsive abuse leads to behavioural and cognitive problems brought about by the continued use of alcohol (APA, 2000).
The criteria that best reflect Samâs substance abuse disorder are the âphysiological dependence criteria oneâ and the compulsive use of substances criteria sixâ and âsevenâ of the DSM-IV-TR diagnostic. Criteria one deals with tolerance which states that tolerance is a need to consume large amounts of alcohol in order to achieve intoxication, and it is the diminished effect that the substance abuser experiences with the continued intake of the same amounts of alcohol. Tolerance is developed with the recurring abuse of substances which leads to the abuserâs body becoming accustomed to the substances. If the desired level of intoxication is not achieved, the user takes large amounts of alcohol or drugs to achieve the desired intoxication levels (APA, 2000).
Criteria six states that; important occupational and social activities are interfered with because of the continued abuse of alcohol. Samâs occupational activities are affected because he comes to work late, he is unable to complete his work, he drinks while at work and he is involved in verbal confrontations with his workmates. He got fired because he displayed symptoms of alcohol intoxication which are; slurred speech, unsteady gait, poor judgement and lack of attention. His social life was impacted when his wife left him because of his drinking problem. Criteria seven states that the abuser continues to drink or abuse substances despite being aware of the physical or psychological problems that are caused by their continued use (First et al, 2004). Sam experienced psychological problems that stemmed from his childhood. His poor relationship with his father and witnessing him beating up his mother was a factor that contributed to his alcohol abuse. Sam also experienced physical problems which were his slurred speech, irritability and anger outbursts that scared his wife and children to leave him.
Epidemiology of substance abuse disorder in Australia
The population groups in Australia which are noted to experience greater risks of alcohol or drug consumption are the Aborigine and Torres Strait Islander groups, young adults, pregnant women, employees and prisoners. A 2005 survey conducted by the Australian Secondary Studentsâ Alcohol and Drug Survey showed that most students abused alcohol and smoked cigarettes. The statistics showed that 90% of secondary children smoked and consumed alcohol.
The number of indigenous community members that consumed alcohol was 32% of the indigenous community members aged 15 years and above. 52% of the Aborigine and Torres Strait Islander community aged 15 years and over had smoked tobacco while 23% had smoked Marijuana. 20% of pregnant women were reported to have smoked according to data from the National Drug Strategy Household Survey (NDSHS). 60% of prisoners in Australia had a history with drug abuse. 17% of employees in the hospitality industry consumed alcohol on a weekly basis while 24% of miners consumed alcohol on a yearly basis (NCETA, 2004).
The cause of alcohol and drug abuse for most of these groups is societal pressure to conform and the high standards of living in Australia. The number of alcohol and drug abusers hospitalised between 1998 to 2005 increased from 23,490 to 35,152. The highest hospitalization rate was for people with alcohol related illnesses. The estimated financial burden of alcohol and drug misuse to the Australian community amounted to $7.6 billion (NDARC, 2003).
Causes and psychodynamics
The psychodynamics of substance abuse are the psychological problems that drive people to abuse alcohol or drugs despite their devastating effects. Psychodynamics focuses on the psychological structure of an individual to determine their compulsion to use and depend on addictive drugs. Most studies have shown that substance abuse is mostly initiated by psychological suffering by the abuser. Individuals addicted to substances pursue feelings of relaxation, pleasure, control and happiness when they take the drugs or alcohol thereby making the substances to act as a self correction agent (Lowinson et al 2005).
Sam is noted as saying that his alcohol consumption makes him feel relaxed and good. His family history provides a psychological dynamic and cause to his increased alcohol abuse. Samâs father was also an alcoholic and when he was drunk he would hit Samâs mother. Such an environment left Sam with feelings of insecurity, guilt, hopelessness and despair. His self esteem was also low because he viewed himself as being worthless. He therefore abused alcohol to try and forget these bad feelings developed from his childhood as well as to cope with stress from work and the departure of his family.
Three major mental health issues
Depression is a mental disorder that leads to feelings of guilt, low self esteem, and negative moods. These feelings might become severe leading to the individual becoming impaired or at worst committing suicide (WHO, 2010). A person with a significant alcohol problem is likely to develop depression and negative moods or emotions. A substantial increase in alcohol consumption will increase the severity of depression which will in turn increase the possibility of committing suicide (NSW Department of Health, 2005).
The nursing interventions that can be used to deal with these mental issues are non-pharmaceutical interventions such as motivational interviewing, early and brief interventions and self help groups (Elder et al, 2005). The pharmacological interventions that can be used to deal with alcoholism are the use of Disulfiram (Antabuse) which produces an ethanol reaction on alcohol levels in the body and Benzodiazepines which are used to minimise the symptoms of withdrawal from alcohol dependence (Dawes et al, 2002).
Nursing Interventions
Motivational interviewing is based on the 1983 trans-theoretical model developed by Prochaska and DiClemente. It deals with determining the stage of readiness to change that the substance abuser is in after which information is provided to move the individual to the next stage. It is useful because it encourages abusers to determine whether the consequences of alcohol or drug abuse outweigh the benefits (Barker, 1997). Early interventions involve talking to people in the early stages of their substance abuse which will prevent later complications that might arise with the use of the drugs while brief interventions involve talking to the patients in 5 to 15 minute sessions about their alcohol or drug addictions. The most commonly used nursing interventions are rehabilitation services that include self help groups such as the Alcoholics Anonymous and Narcotics Anonymous. These groups provide interventions in the form of group or individual counselling sessions as well as pharmacotherapy like methadone maintenance for individuals addicted to opiate (Elder et al, 2005).
References
American Psychiatric Association (APA) (2000). Diagnostic and statistical manual of psychiatric disorders (DSM-IV TR). Washington: American Psychiatric Association.
Barker, P.J. (1997). Assessment in psychiatric and mental health nursing: in search of the whole person. Cheltenham, UK: Stanley Thornes Publishers Ltd
Dawes, S., Loxton, N.J., Hides, L., Kavanagh, D.J. & Mattick, R.P. (2002). Review of diagnostic screening instruments for alcohol and other drug use and other psychiatric disorders, 2nd Edition. NSW, Australia: Publications Production Unit, Department of Health and Ageing.
Elder, R., Evans, K., & Nizette, D. (2005). Psychiatric and mental health nursing. Marrickville: Elsevier Australia.
First, M.B., Frances, A. & Pincus, H.A. (2004). DSM-IV-TR guidebook. 4th Edition. Arlington: American Psychiatric Publishing Inc.
Lowinson, J.H., Ruiz, P. & Millman, R.B. (2005). Substance abuse: a comprehensive textbook. Philadelphia, US: Lippincott Williams & Wilkins.
National Centre for Education and Training on Addiction (NCETA) (2004). Alcohol and Other Drugs: A Handbook for Health Professionals. Australian Government: Department of Health and Ageing.
National Drug and Alcohol Research Centre (NDARC) (2003). The Treatment of alcohol problems. Canberra: Publications Production Unit.
NSW Department of Health (2005). Framework for suicide risk assessment and management for NSW health staff. North Sydney: Better Health Centre-Publications Warehouse.
World Health Organization (WHO) (2004). Management of mental disorders: Treatment Protocol Project. Darlinghurst, NSW: World Health Organization Collaborating Centre for Evidence in Mental Health Policy.