A model didactic and clinical substance abuse curriculum developed for schools of nurse anesthesia
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- DIDACTIC UNIT B: Pharmacology - II
- DIDACTIC UNIT C: Prevalence and Patterns of SA
- DIDACTIC UNIT D: Tolerance, Toxicity, and Withdrawal from SA
- DIDACTIC UNIT E: Planning for Intervention, Intervention and Aftercare
- DIDACTIC UNIT F: Central Concepts and Research Issues in SA
- DIDACTIC UNIT G: Assessment and Screening of SA patients
- DIDACTIC UNIT H: Individual, Family, and Group Dynamics related to SA
- DIDACTIC UNIT I: Community resources and treatment options
- CLINICAL UNITS A-I: Increased special skills in clinical planning, recognition, diagnosis, and treatment of SA
- Formative Evaluation of Module 2
MODULE 2DIDACTIC UNIT A: Multisystem physiology in SA - Level IITotal Time: 2 hours Overview: This unit will discuss the physiology related to the stages of substance abuse. The systems will serve as a supplement to the assessment and diagnostic skills segment. Terminal Objective: The student will understand the physiologic basis of the stages of substance abuse. This enhanced knowledge will provide a foundation for supporting the assessment and diagnostic skills of the student. Recommended Teaching Methods: Group Process Lecture Discussion Readings Case examples Course Outline: XXXI. Skeletal A. History of fractures B. Malnutrition C. Osteoporosis D. Joint pain or deformity XXXII. Skin A. Abscesses B. Bruises C. Needle marks D. Scars E. Jaundice XXXIII. Lymphatic System A. Adenopathy XXXIV. Genitourinary A. Venereal diseases B. Renal failure C. Sexual dysfunction References: Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York: Plenum Medical Books Co. Anspaugh, D.J., Hamrick, M.H. & Rosato, F.D. (1991). Wellness: Concepts and applications. St. Louis, MO: Mosby-Year Book. Burton, A.C. (1972). A physiology and biophysics of the circulation. Chicago: Year Book Medical Pub. Clark, W.G. et al. (1988). Goth's medical pharmacology. St. Louis, MO: C.V. Mosby Co. Cohen, S. & Callahan, J. (Eds.). (1986). A specific approach to the treatment of alcohol abusing patients. New York: Hayworth Press. Frances, R.J. & Miller, S.L. (Eds.). (1991). Clinical textbook of addictive disorders. New York: Guilford Press. Ganong, W.F. (1989). Review of medical physiology. Los Altos: Lange Medical Publications. Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York: Macmillan Publishing Co. Goudsouzian, N.G. Karamanian, A. (1984). Physiology for the anesthesiologist. New York: Appleton-Century-Crofts. Guyton, A.C. (1986). Textbook of medical physiology. Philadelphia: W.B. Saunders Co. Kinney, J. & Leaton, G. (1991). Loosening the grip: A handbook of alcohol information. St. Louis, MO: Mosby-Year Book. Michenfelder, J.D et al. (1969). Neuroanesthesia. Anesthesiology. 30, 65. National Institute on Drug Abuse. (1990). NIDA Capsules: CAP01-CAP38. Rockville, MD: National Clearinghouse for Alcohol and Drug Information. Project Cork Institute of Dartmouth Medical School. (1981). Alcohol use and its medical consequences: A comprehensive slide teaching program for biomedical education. Timonium, MD: Milner-Fenwick. Rogers, M.C., Tinker, J.H., Covino, B.G., & Longnecker, D.E. (Eds.). (1993). Principles and practice of anesthesiology. St. Louis, MO: Mosby Year Book. Stoelting, R.K. (1987). Pharmacology and physiology in anesthetic practice. Philadelphia: J.B. Lippincott Co. Waugaman, W.R., Rigor, B.M., Katz, L.E., Bradshaw, H.W. & Garde, J.F. (1988). Principles and practice of nurse anesthesia. Norwalk, Conn.: Appleton and Lange. Substance Abuse Curriculum: MODULE 2 DIDACTIC UNIT B: Pharmacology - IITotal Time: 2-3 hours Overview: This unit serves as a further introduction to the pharmacology of the substances commonly abused. The session is intended to familiarize the participant with the pharmacokinetics and pharmacodynamics of major mood altering drugs. Terminal Objective: The student will understand the pharmacologic basis and principles of many of the commonly abused substances, their characteristics, and clinical manifestations. The student will be able to generally relate these principles to anesthesia. Recommended Teaching Methods: Group Process Lecture Discussion Readings Course Outline: XXXV. Pharmacology of Commonly Abused Substances A. Pharmacokinetics and Pharmacodynamics of substances 1. Alcohol 2. Marijuana 3. CNS stimulants 4. Cocaine 5. CNS depressants 6. Narcotics/Heroin/other controlled substances 7. Opiates 8. Semi-synthetic 9. Synthetic 10. Hallucinogens 11. Phencyclidine (PCP) 12. Volatile Inhalants 13. Nicotine 14. Caffeine 15. Anabolic steroids XXXVI. Metabolism, clearance, and elimination of substances A. Metabolism 1. Hepatic 2. Renal
3. Biliary 4. Metabolic degradation B. Pharmacologic management of withdrawal 1. Intermittent or recurrent withdrawal 2. Complicated withdrawal 3. Unrecognized withdrawal 4. Preanesthetic transition from abuse to withdrawal XXXVII. Variances in individual responses to Pharmacodynamics A. Bioavailability B. Renal function C. Hepatic function D. Age
E. Enzyme activity XXXVIII. Variances in individual response to Pharmacokinetics A. Receptor responsiveness C. Genetics
Adger, H., DeAngelis, C., & McDonald, E.M. (1986). Model program and curriculum in alcohol and other drug abuse for pediatric medical students, residents and faculty. (National Institute on Drug Abuse. ADM 281-86-0009). Washington, DC: U.S. Government Printing Office. Ahmad, G. (1987). Abuse of Phencyclidine (PCP): A laboratory experience. Journal of Clinical Toxicology. 25(4), 341-346. American Society of Anesthesiologists Ad Hoc Committee on the Effect of Trace Anesthetics on the Health of Operating Room Personnel. (1974). Occupational diseases among operating room personnel: A national study. Anesthesiology. 41, 321. Barash, P.G., Cullen, B.F. & Stoelting, R.K. (Eds.). (1989). Clinical anesthesia. Philadelphia: J.B. Lippencott Co. Berkowitz, B.A. (1976, Jan.). Relationship of pharmacokinetics to pharmacological activity: Morphine, methadone, naloxone. Clinical Pharmacokinetics. pp. 219-230. Boning, J. (1985). Benzodiazepine dependence: Clinical neurobiological aspects. Advances in Biochemical Psychopharmacology. 40, 185-192. Busto, V. (1986). Patterns of benzodiazepine abuse and dependence. British Journal of Addictions. 81(1), 87-94. Corbett, T.H. (1973). Retention of anesthetic agents following occupational exposure. Anesthesia and Analgesia. 52, 614. Cushman, P. (1986). Sedative drug interactions of clinical importance. Recent Developments in Alcohol. 4, 61-83. Freund, G. (1984). Biomedical causes of alcohol abuse. Alcohol. 1(2), 129-131. Gawin, F.H. & Ellingwod, E.H. (1988). Cocaine and other stimulants: Action, abuse and treatment. New England Journal of Medicine. 318(18), 1173-1182. Goldstein, D.B. (Ed.) (1983). The pharmacology of alcohol. New York: Oxford Press. Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York: Macmillan Publishing Co. Grabowski, J. (Ed.). (1984). Cocaine: Pharmacology, effects, and treatment of abuse, NIDA Research Monograph 50. (National Institute on Drug Abuse. ADM 87-1326) Rockville, MD: National Institute on Drug Abuse. Jacobs, M.R. & Fehr, K.O. (1987). Drugs and drug abuse: A reference text. Toronto, Canada: Addiction Research Foundation. Land, W.E.M. & Zakhari, S. (1990). Alcohol and cardiovascular disease. Alcohol Health and Research World. 14(4), 304-312. Malseed, R. (1985). Pharmacology: Drug therapy and nursing considerations. Philadelphia: J.B. Lippincott. Miller, R.D. (Ed.). (1990). Anesthesia. New York: Churchill Livingstone. Peterson, R.G. & Rumack, B.H. (1977). Treating acute acetaminophen poisoning with acetylcysteine. Journal of the American Medical Association. 237, 2406-2407. Physicians' Desk Reference. (1993). Oradell, NJ: Medical Economics Co. Physician' Desk Reference For Nonprescription Drugs. (1993). Oradell, NJ: Medical Economics Co. Pickens, R.W., Svikis, D.S. (Eds.). (1988). Biological vulnerability to drug abuse, NIDA Research Monograph 89. Rockville, MD: National Institute on Drug Abuse. Rogers, M.C., Tinker, J.H., Covino, B.G. & Longnecker, D.E. (Eds.). (1993). Principles and practice of anesthesiology. St. Louis, MO: Mosby Year Book. Spiker, D.G., et al. (1975). Tricyclic antidepressant overdose: Clinical presentation and plasma levels. Clinical Pharmacologic Therapy. 18(5), 539-546. Sullivan, J.B. et al. (1979). Management of tricyclic antidepressant toxicity. Topics in Emergency Medicine. 1(3), 65-71. Teped, H. (1985). Biochemical basis of alcoholism: Statements and hypotheses of present research. Alcohol. 2(6), 711-788. Wesson, D. & Smith, D. (1977). Barbiturates: Their uses, misuse and abuse. New York: American Science Press. West, R.J. & Russell, M.A. (1985). Dependence on nicotine chewing gum. Journal of the American Medical Association. 256(23), 3214-3215. Substance Abuse Curriculum: MODULE 2 DIDACTIC UNIT C: Prevalence and Patterns of SATotal Time: 1 hour Overview: This unit will discuss the prevalence trends of SA in a variety of age groups. The patterns of use of SA for different age groups will also be discussed. Terminal Objective: The student will understand the prevalence trends and patterns of use of SA through the lifespan. Recommended Teaching Methods: Group Process Lecture Discussion Readings Course Outline: XXXIX. Prevalence and patterns of trends in SA A. Prevalence and patterns of alcohol effects/consumption among 1. Neonates 2. Infancy 3. Childhood 4. Adolescent 5. Young Adult 6. Middle Adulthood 7. Elderly B. Prevalence and patterns of misused and abused prescription and over-the-counter drugs among 1. Neonates 2. Infancy 3. Childhood 4. Adolescent 5. Young Adult 6. Middle Adulthood 7. Elderly C. Trends of commonly misused and abused drugs by 1. Children 2. Adolescents 3. Adults 4. Elderly 5. Tobacco use 6. Caffeine D. Factors which influence use, misuse, and abuse 1. Drug Availability 2. Gender 3. Race
4. Socio-economic 5. Demographics 6. Cultural 7. Religious 8. Adolescent attitudes 9. Family patterns 10. Social patterns 11. Psychological References: American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL: American Association of Nurse Anesthetists. Anderson, E.E. & Quost, W. (1983). Young children in alcoholic families: A mental health needs assessment and intervention/prevention strategy. Journal of Primary Prevention. 3, 174-187. Blechman, E. (1982). Conventional wisdom about familial contributions to substance abuse. American Journal of Drug and Alcohol Abuse. 9(1), 35-54. Burden, D. & Gottlieb, N. (Eds.). (1987). The woman client. London: Tavistock. Elkin, M. (1984). Families under the influence. New York: W.W. Norton. Friensen, V.I. (1983). The family in the etiology and treatment of drug abuse: Toward a balanced perspective. Advances in Alcohol and Substance Abuse. 2(4), 77-86. Fossum, M. & Mason, M. (1986). Facing shame: Families in recovery. New York: W.W. Norton. Giannetti, V. Medication utilization problems among the elderly. Health Social Work. 8(4), 262-270. Glynn, T.J. (1984). Adolescent drug use and family environment: A review. Journal of Drug Issues. 14, 271-298. Hofling, C.K. & Lewis, J. (1980). The family: Evaluational treatment. New York: Brunner/Mazel. Kaufman, E. (Ed.). (1983). Power to change: Family case studies in the treatment of alcoholism. New York: Gardner. Morbidity and Mortality Weekly Review. (1987). Human immunodeficiency virus infection in the United States: A review of current knowledge. MMRW Supplement. 36(S-6). National Council on Alcoholism. (1972). Criteria for the diagnosis of alcoholism. Annals of Internal Medicine. 77, 249-258. National Institute on Drug Abuse. (1990). National household survey on drug abuse: Highlights 1988. (NIDA publication no. ADM 90-1681). Rockville, MD: U.S. Department of Health and Human Services. National Institute on Drug Abuse. (1987). Data from the drug abuse warning network (DAWN), semiannual report, trend data, through January to June 1987, Statistical Series G, Number 20. Rockville, MD: National Institute of Drug Abuse. Orford, J. & Harwin, J. (1982). Alcohol and the family. New York: Martin's. Regan, D.C., Erlich, S. & Finnegan, L. (1987). Infants of drug addicts: At risk for child abuse, neglect, and placement in foster care. Neurotoxicology and Teratology. 9(4), 315-319. Stanton, M.D. (1986). Family therapy of drug abuse and addiction. New York: Guilford. Steinglass, P., Bennett, L., Wolin, S., & Reiss, D. (1987). The alcoholic family. New York: Basic Books. Tabakoff, B., Sutker, P. & Randall, C. (1983). Medical and social aspects of alcohol abuse. New York: Plenum Press. U.S. Department of Health and Human Services. (1990). Seventh special report to the U.S. Congress on alcohol and health: From the Secretary of Health and Human Services. (USDHHS Publication No. ADM 90-1656). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Werner, E.E. (1985). Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol. 47(1), 34-40. Wilsnack, S.C. (1987). Drinking and drinking problems in women: A U.S. longitudinal survey and some implications for prevention. In: T. Loberg, W.R. Miller, P.E. Nathan, & G.A. Marlatt. Addictive Behavior: Prevention and Early Intervention. Amsterdam, Netherlands: Swets and Seitlinger. Substance Abuse Curriculum: MODULE 2 DIDACTIC UNIT D: Tolerance, Toxicity, and Withdrawal from SATotal Time: 1 hour Overview: Students will explore in depth the physiological process of tolerance and toxicity of addictive substances, as well as the withdrawal from substances. This unit will aid in further identification of key concepts, physiological responses and treatment in SA. Terminal Objective: The student will understand the concepts of tolerance, cross-tolerance, drug toxicity and withdrawal and as it relates to SA and anesthesia. Recommended Teaching Methods: Group Process Lecture Discussion Readings Course Outline: XL. Tolerance A. Stages of the addiction process leading to tolerance 1. Initial contact with substance a. Reasons (1) Peer Pressure (2) Medication use toward misuse (3) Thrill seeking (4) Self-Medication b. Consider abstinence 2. Experimentation a. Increasing the length and intensity of effects b. Mood altering 3. Excessive use a. Can withdraw or continue misuse b. Risks social, psychological and physical damage to continue substance use 4. Addiction a. Physical and psychological dependence b. Outside help required to reverse process 5. Increased tolerance a. Requires increasing amounts b. Effect of substance becomes diminished with same amounts c. Cross-tolerance (1) Poly substances use 6. Recovery a. Detoxification b. Behavior modification to change lifestyle c. Long term support groups B. Toxicity 1. Assessment a. Intoxication b. Toxic reactions to drugs c. Drug interactions 3. Long-term management a. Recognition of chronic pathology b. Detoxification c. Treatment for chronic physical pathology C. Withdrawal 1. Medical assessment 2. Differential Diagnosis 3. Physiology of withdrawal 4. Half-life and duration of substances 5. Indications for withdrawal 6. Common course of withdrawal for substances 7. Differences in withdrawal patterns 8. Complications of withdrawal References: Adger, H., DeAngelis, C., & McDonald, E.M. (1986). Model program and curriculum in alcohol and other drug abuse for pediatric medical students, residents and faculty. (National Institute on Drug Abuse. ADM 281-86-0009). Washington, DC: U.S. Government Printing Office.
Total Time: 6 hours Overview: Students should be able to effectively plan the intervention process, apply the intervention process, and recommend treatment modalities in recovery. Students should be able to encourage patient and family to initiate and accept treatment by using supportive and unbiased confrontation. Family and patient education and good communication skills will aid the process. Terminal Objective: The student will understand the intervention planning process, how to intervene and the recovery process. Recommended Teaching Methods: Group Process Lecture Discussion Readings Course Outline: XLI. Planning for Intervention A. Prevention 1. Education a. Continuing professional education b. Community education c. Health education and wellness clinics d. Drug free social activities 2. Policy a. Social policy (1) Encourage development of functional family units (2) Education at all levels (3) Education for "high risk" groups (4) Drug free community environments b. Workplace policy (1) support abstinence (2) support education (3) institute employee assistance programs (EAP) c. Family unit policy (1) Clear (a) rules (b) roles (c) rhetoric (communication) (2) Balanced and cooperative efforts to maintain (a) communication (b) power (c) relationships 3. Family interview a.Recognizing dysfunctional family units (1) Arguments (2) Cyclical manipulation (3) Enablers and Caretakers (4) Economic strain (5) Poor interaction (6) Rebellious and alienated (7) History of substance abuse (8) Inadequate parental direction (9) Antisocial behavior b. Impact of substance abuse on (1) Family (2) Colleagues (3) Community (4) Society B. Intervention 1. Goals for intervention 2. Strategies for intervention a. Primary prevention (1) Education with factual information (2) Nonusers (3) Low risk groups (4) Encouraging strong coping attitudes/positive reinforcement b. Intervention with high risk patients (1) Express concern for health (2) Correlate problems with SA (3) Clarify misinterpretations (4) Provide factual information (5) Review all the risks with continued abuse (6) Provide motivation/support for changes (7) Arrange social support (8) Continue relationship for monitoring (9) Negotiate plan for changes in behavior c. Secondary prevention with recovering patient (routine screening reveals abuse) (1) Concern for health (2) Clarify questions (3) Provide factual information (4) Review risks (5) Quantify physical and psychological harm (6) Treatment of medical sequelae (7) Examine social support (8) Counseling for addiction d. Tertiary prevention for relapse (1) Close monitoring (2) Continued education (3) Positive reinforcement of acceptable behavior (4) Continued counseling for recovery e. Promotion of personal health and prevention (1) Promoting health education (2) Social supports which limits SA (3) Community sponsored prevention (4) Provide factual information (5) Reinforce existing plan f. Identification of resources available (1) Therapy (2) Education (3) Evaluation (4) Medical (5) Laboratory testing (6) Interdisciplinary team (7) Professional responsibility of the CRNA (8) Referral resources g. Identification of treatment settings available (1) Support groups (2) Outpatient facilities (3) Inpatient facilities (4) Therapeutic community h. High Risk individuals (1) Quantify risk factors (2) Education and counseling available for family (3) Follow reactions in family (depression, hostility) (4) Immediate referral for therapy (5) Long-term follow-up/monitoring i. Engaging (1) Identify substance(s) being abused (2) Preparation of all participants for effective intervention (3) Collection of data to confront severity of SA disease (4) Team collaboration in diagnosis and planning (5) Implement plan and initiate support for medical consequences (withdrawal, overdose) (6) Initiate treatment (7) Educate individual, colleagues, family, support group (8) Refer patient for long term recovery C. Aftercare/Recovery 1. Motivation of Recovery 2. Referral to support groups 3. Continued education 4. Frequent laboratory testing 5. Promotion of Wellness 6. Positive reinforcement
American Psychiatric Association. (1997). Diagnostic and statistical manual (DSM-IV). Washington, DC: APA, American Psychiatric Association. Bartlett, E. (1981). The contribution of school health education to community health promotion: What can we reasonably expect? American Journal of Public Health. 71(12), 1384-1391. Beattie, M. (1989). Beyond codependency and getting better all the time. San Francisco: Harper/Hazelden. Bell, C. & Battjes, R. (1985). Prevention research: Deterring drug abuse among children and adolescents. (NIDA Research Monograph No. 63). (DHHS Publication No. ADM 87-1334). Rockville, MD: Department of Health and Human Services, Public Health Service. Bomar, P. (Ed.). (1989). Nurses and family health promotion: Concepts, assessment and interventions. Baltimore: Williams and Wilkins. Dryfoos, J. (1990). Adolescents at risk: Prevalence and prevention. New York: Oxford University Press. Elkin, M. (1984). Families under the influence. New York: W.W. Norton. Fawzy, F.I., Combs, R.H. et.al. (1983). Generational continuity in the use of substances: the impact of parental substance abuse on adolescent use. Addictive Behavior. 8(2), 109-114. Frances, R. & Miller, S. (Eds.). (1991). Clinical textbook of addictive disorders. New York: The Guilford Press. Fossum, M. & Mason, M. (1986). Facing shame: Families in recovery. New York: W.W. Norton. Gawin, F.H. & Ellingwod, E.H. (1988). Cocaine and other stimulants: Action, abuse and treatment. New England Journal of Medicine. 318(18), 1173-1182. Goldstein, D.B. (Ed.) (1983). The pharmacology of alcohol. New York: Oxford Press. Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York: Macmillan Publishing Co. Goplerud, E. (1991). Preventing adolescent drug use: From theory to practice. (DHHS Publication No. ADM 91-1725). Rockville, MD: U.S. Department of Health and Human Services Jones, C. & Battjes, R. (1985). Etiology of drug abuse: Implications for prevention. NIDA Research Monograph 56. (DHHS Publication No. ADM 87-1335). Rockville, MD: Department of Health and Human Services. Kunpfer, K. & Turner, C. (1991). The social ecology model of adolescent substance abuse: Implications for prevention. The International Journal of the Addictions. 25(4A), 435-463. Moskowitz, J. (1989). The primary prevention of alcohol problems: A critical review of the research literature. Journal of Studies of Alcohol. 50(1), 54-88. Nowinski, J. (1990). Substance abuse in adolescents and young adults: A guide to treatment. New York: W.W. Norton and Co. Office for Substance Abuse Prevention. (1991). Parent training is prevention: Preventing alcohol and other drug problems among youth in the family. (DHHS Publication No. ADM 91-1715). Rockville, MD: U.S. Department of Health and Human Services. Pender, N. (1987). Health promotion in nursing practice. Norwalk, Conn.: Appleton and Lange. Rankin, S. & Duffy, K. (1983). Patient education: Issues, principles, and guidelines. Philadelphia: J.B. Lippincott Co. Stuart, G. & Sundeen, S. (1991). Principles and Practice of Psychiatric Nursing. St. Louis, MO: Mosby Year Book. Sullivan, E., Bissell, L., & Williams, E. (1988). Chemical dependency in nursing: The deadly diversion. Menlo Park, CA: Addison-Wesley Publishing. Tanner, E. (1991). Assessment of a health-promotive lifestyle. Nursing Clinics of North America. 26(4), 845-854 U.S. Department of Health and Human Services, Public Health Service. (1990). Healthy people 2000: National health promotion and disease prevention objectives. (DHHS Publication No. PHS 91-50213). Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office. Varcarolis, E. (1990). Foundations of psychiatric mental health nursing. Philadelphia: W.B. Saunders. Verebey, K., Martin, D.M. & Gold, M.S. (1987). Interpretation of drug abuse testing: Strengths and limitations of current methodology. Psychiatric Medicine. 3, 287. Substance Abuse Curriculum: MODULE 2 DIDACTIC UNIT F: Central Concepts and Research Issues in SATotal Time: 2 hours Overview: Students should be introduced to current problems and issues related to SA. This should allow for active discussion of issues and aid in the development of a research project. Terminal Objective: The student will be able to identify current issues and problems related to SA. The discussion of these issues should lead the student to explore ideas toward the development of a research project. Recommended Teaching Methods: Group Process Lecture Discussion Readings Course Outline: XLII. Policy issues A. Social policy 1. Development of substance abuse legislation a. Local b. Regional c. National d. International 2. SA Education effectiveness at all levels 3. General Testing for SA 4. AIDS and SA B. Workplace policy 1. Who is responsible? 2. How should SA be handled in the workplace? C. Family unit policy 1. Balanced and cooperative efforts for a. communication a. power
b. relationships 2. Educate family members? D. Dysfunctional family units 1. Treatment of dysfunctional units and components? XLIII. Impact of substance abuse on A. Family B. Colleagues C. Community D. Society E. Adequate utilization of resources? XLIV. Evaluation of SA policy A. Methodology References: Ackerman, R.J. (1987). Children of alcoholics: A bibliography and resource guide, Third Edition.Holmes Beach, FL: Learning Publications, Inc. American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL: American Association of Nurse Anesthetists. American Nurses' Association. (1988). Standards of addiction nursing practice with selected diagnoses and criteria. Kansas City, MO: American Nurses' Association. Foster, S.D. & Jordan, L.M. (Eds.). (1994). Professional aspects of nurse anesthesia practice. Philadelphia: F.A. Davis Co. Googins, B. (1989). Two parallel plans of attack: Drug testing at the workplace. Employee Assistance.1(8), 1 & 45. Kurtz, N.R., Goggins, B. & Howard, H. (1984). Occupational alcoholism: An annotated bibliography. Toronto, Canada: Addiction Research Foundation. Office of Substance Abuse Prevention. (1990). A practical guide for high-risk youth prevention programming. Rockville, MD: Office of Substance Abuse Prevention. Olson, S. & Gerstein, D.R. (1985). Alcohol in America: Taking action to prevent abuse. Washington, DC: National Academy Press. Schuster, C.R. (1987). The United States' drug scene: An overview. Clinical Chemistry. 33(11B), 7B-12B. Simpson, D.D., George, W.J., & Lehman, W.E.K. (1988). Addiction careers: Summary of students based on the DARP (Drug Abuse Reporting Program) 12 Year Follow-up. Rockville, MD: National Institute on Drug Abuse. Vaillant, G.E. (1983). The natural history of alcoholism. Cambridge, MA: Harvard University Press. Substance Abuse Curriculum: MODULE 2 DIDACTIC UNIT G: Assessment and Screening of SA patientsTotal Time: 2 hours Overview: This unit will aid in the development of skills in assessing and screening patient patterns of behavior for substance abuse Terminal Objective: The student will understand the clinical diagnostic criteria and screening methods in SA patients. Recommended Teaching Methods: Group Process Lecture Discussion Readings Demonstration Course Outline: XLV. Diagnostic Criteria and assessment of problems in the lifespan. A. Signs and symptoms of SA 1. General appearance a. Tremor b. irritability c. excitability d. Jaundice 2. Mouth
a. Periodontal disease b. coated tongue 3. Face and Hands a. Rosacea, seborrheic dermatitis b. Parotid swelling c. spider nevi d. finger clubbing e. Dupuytren's contracture f. Multiple surgical scars 4. Miscellaneous a. Trauma b. Random blood alcohol > 65 mmol/l c. Random urine testing d. Specific laboratory testing (1) serum y-glutamyl transpeptidase level is raised 70-80% in alcoholic patients (a) one of the best early indicators (2) mean corpuscular volume is raised 75-90% in alcoholic (3) Serum high density lipoprotein cholesterol level is raised 50-80% in alcoholic (4) Serum glutamate dehydrogenase level demonstrates lever disease in alcoholic (5) Serum transferrin level is elevated in 80% of alcoholic patients (6) Ratio of z-amino-n-butyric acid to leucine is dependent on patient and nutrition but raised in alcoholic. B. Screening procedures for SA are appropriate during 1. History and physical a. H & P should begin with nonthreatening habits like tobacco use, exercise, alcohol use, then illegal drug use. b. direct communication and observation to determine drug use c. CAGE Questions/MAST/SMAST d. Recognizing Acute illnesses induced by SA e. Recognizing Chronic illness associated with SA 2. Hospital admissions 3. Trauma 4. When symptoms suggest SA 5. Family problems a. Identify family members that may help or abuse 6. Anytime C. Determine patterns of use and establishing diagnosis 1. social use a. Loss of control of drug use 2. physiological need a. tolerance b. withdrawal symptoms c. blackouts d. family history of SA 3. multiple drug use 4. SA
a. adverse effects on patient, family, community b. patient's feelings about SA D. Required Communication skills 1. Coping with patient behaviors which influence obtaining an accurate history 2. Encouraging self-disclosure 3. Establishing a relationship 4. Teaching patient and family about SA
American Nurses' Association. (1988). Standards of addiction nursing practice with selected diagnosis and criteria. Kansas City, MO: ANA Baird, M.A. (1980). Chemical dependency: A protocol for involving the family. Family Systems Medicine. 3, 216-220. Barash, P.G., Cullen, B.F. & Stoelting, R.K. (Eds.). (1989). Clinical anesthesia. Philadelphia: J.B. Lippencott Co. Barnes, H.N., Aronson, M.D. & Delbanco, T.L. (Eds.). (1987). Alcoholism: A guide for the primary care physician. New York: Springer-Verlog Bates, B. (1983). A guide to physical examination. Philadelphia: Lippincott. Brodsley, L. (1982). Avoiding a crisis: The assessment. American Journal of Nursing. 82(12), 1865-1871. Brown, S.A., Christiansen, B.A. & Goldman, M.S. (1987). Alcohol expectancy questionnaire: An instrument for assessment and adult alcohol expectancies. Journal Studies on Alcohol. 48(5), 483-491. Clark, W.D. (1985, Nov.). The medical interview: Focus on alcohol problems. Hospital Practice. pp. 59-68. Clark, W.D. (1981). Alcoholism: Blocks to diagnosis and treatment. American Journal of Medicine. 71, 275-286. Cohen, S. & Gallant, D.M. (1981). Diagnosis of drug and alcohol abuse. Medical Monograph Series. 1(6). Ewing, J.A. (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association. 252, 1905-1907. Gallant, D. (1987). Alcoholism: A guide to diagnosis, intervention, and treatment. New York: W.W. Norton and Co. Holt, S., Skinnor, H.A. & Israel, Y. (1981). Early identification of alcohol abuse: 2. Clinical and Laboratory indicators. Canadian Medical Association Journal. 124, 1279-1299. Milhorn, H.T. (1988). The diagnosis of alcoholism. American Family Practice. 37, 175-183. National Council on Alcoholism. (1972). Criteria for the diagnosis of alcoholism. Annals of Internal Medicine. 77, 249-258. Podrosky, D.L. & Sexton, D.L. (1988, Spr.). Nurses' reaction to difficult patients. Image. 26, 16-20. Rogers, M.C., Tinker, J.H., Covino, B.G., & Longnecker, D.E. (Eds.). (1993). Principles and practice of anesthesiology. St. Louis, MO: Mosby Year Book. Schuckit, M. (1979). Drug and Alcohol Abuse: A clinical guide to diagnosis and treatment. New York: Plenum Press. Stoelting, R.K. (1987). Pharmacology and physiology in anesthetic practice. Philadelphia: J.B. Lippincott Co. Tennant, F.S., Day, C.M. & Ungerleider, J.T. (1977). Screening for drug and alcohol abuse in general medical population. Journal of the American Medical Association. 242, 533-535. Substance Abuse Curriculum: MODULE 2 DIDACTIC UNIT H: Individual, Family, and Group Dynamics related to SATotal Time: 2 hours Overview: This unit will aid in the understanding of the impact of SA on the individual, family, and group processes. Identification of problems which lead to SA and poor communication methods will be reviewed. Terminal Objective: The student will understand factors which place individuals at risk for SA. They will be able to describe the correlation between dysfunctional family communication and SA. They will be able to identify critical and common patterns of group communication and education. Recommended Teaching Methods: Group Process Lecture Discussion Readings Demonstration Course Outline: XLVI. Individual communication patterns A. Impact of SA on Individual communications B. Maladaptive patterns C. Marital relationships 1. Domestic violence 2. Child abuse D. Enablers E. Roles of children F. Rituals XLVII. Family communication patterns A. Impact of SA on family communication B. Health Problems C. SA and children D. Theories of family or genetic risk E. Role modeling XLVIII.Group communications patterns A. Support Groups intervention and communication B. Children with HIV C. Emotional support for families of SA patients D. Roles and coping strategies for groups E. Educational intervention F. Prenatal teaching G. Economic ramifications References: Ackerman, R.J. (1987). Children of alcoholics: A bibliography and resource guide, Third Edition. Holmes Beach, FL: Learning Publications, Inc. American Nurses' Association. (1988). Standards of addiction nursing practice with selected diagnosis and criteria. Kansas City, MO: ANA Anderson, E.E. & Quost, W. (1983). Young children in alcoholic families: A mental health needs assessment and intervention/prevention strategy. Journal of Primary Prevention. 3, 174-187. Baird, M.A. (1980). Chemical dependency: A protocol for involving the family. Family Systems Medicine. 3, 216-220. Barnes, H.N., Aronson, M.D. & Delbanco, T.L. (Eds.). (1987). Alcoholism: A guide for the primary care physician. New York: Springer-Verlog Bartlett, E. (1981). The contribution of school health education to community health promotion: What can we reasonably expect? American Journal of Public Health. 71(12), 1384-1391. Blechman, E. (1982). Conventional wisdom about familial contributions to substance abuse. American Journal of Drug and Alcohol Abuse. 9(1), 35-54. Brown, S.A., Christiansen, B.A. & Goldman, M.S. (1987). Alcohol expectancy questionnaire: An instrument for assessment and adult alcohol expectancies. Journal Studies on Alcohol. 48(5), 483-491. Elkin, M. (1984). Families under the influence. New York: W.W. Norton. Ewing, J.A. (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association. 252, 1905-1907. Fisk, N.B. (1986). Alcoholism: Ineffective family coping. American Journal of Nursing. 896(5). 586-587. Fossum, M. & Mason, M. (1986). Facing shame: Families in recovery. New York: W.W. Norton. Gallant, D. (1987). Alcoholism: A guide to diagnosis, intervention, and treatment. New York: W.W. Norton and Co. Holt, S., Skinnor, H.A. & Israel, Y. (1981). Early identification of alcohol abuse: 2. Clinical and Laboratory indicators. Canadian Medical Association Journal. 124, 1279-1299. Kaufman, E. (Ed.). (1983). Power to change: Family case studies in the treatment of alcoholism. New York: Gardner. Milhorn, H.T. (1988). The diagnosis of alcoholism. American Family Practice. 37, 175-183. National Council on Alcholism. (1972). Criteria for the diagnosis of alcoholism. Annals of Internal Medicine. 77, 249-258. Orford, J. & Harwin, J. (1982). Alcohol and the family. New York: Martin's. Podrosky, D.L. & Sexton, D.L. (1988, Spr.). Nurses' reaction to difficult patients. Image. 26, 16-20. Rogers, M.C., Tinker, J.H., Covino, B.G., & Longnecker, D.E. (Eds.). (1993). Principles and practice of anesthesiology. St. Louis, MO: Mosby Year Book. Schuckit, M. (1979). Drug and Alcohol Abuse: A clinical guide to diagnosis and treatment. New York: Plenum Press. Stoelting, R.K. (1987). Pharmacology and physiology in anesthetic practice. Philadelphia: J.B. Lippincott Co. Tabakoff, B., Sutker, P. & Randall, C. (1983). Medical and social aspects of alcohol abuse. New York: Plenum Press. Tennant, F.S., Day, C.M. & Ungerleider, J.T. (1977). Screening for drug and alcohol abuse in general medical population. Journal of the American Medical Association. 242, 533-535. Substance Abuse Curriculum: MODULE 2 DIDACTIC UNIT I: Community resources and treatment optionsTotal Time: 1 hours Overview: This unit will discuss the planning, diagnosis and treatment sequence for SA patients. Terminal Objective: The student will be able to recognize, diagnose, as well as plan intervention, treatment, and aftercare. They will be able to discuss diagnosis of substance abuse in their patients. Students will be able to formulate and utilized treatment modalities in the treatment of SA. Recommended Teaching Methods: Group Process Lecture Discussion Readings Role Playing Course Outline: XLIX. Review DSM IV and ICD diagnostic criteria L. Planning A. Subjective B. Objective C. Use of consultants D. Prevention 1. Education 2. Avoidance 3. Recognition of high-risk populations E. Acute management 1. Intoxication 2. Withdrawal 3. Overdose 4. Toxic reactions F. Long-term planning 1. Relationships 2. Types of treatments 3. Pharmacotherapy 4. Collaboration LI. Treatment A. Consequences of routes of administration B. Chronic pathology C. Trauma D. Effects of SA on Mother and Fetus E. Influence on family, work and social environment F. Psychotic response G. Anxiety reaction H. Organic Brain syndrome LII. Community resources available A. Prevention and education B. Treatment and assistance C. Recovery and restoration to productive role in society
Alexander, B.K. & Hadaway, P. (1982). Opiate addiction: The case for adaptive orientation. Psychological Bulletin. American Nurses' Association. (1988). Standards of addiction nursing practice with selected diagnoses and criteria. Kansas City, MO: American Nurses' Association. American Psychiatric Association. (1997). Diagnostic and statistical manual (DSM-IV). Washington, DC: APA, American Psychiatric Association. Barbarin, O. (1979). Recidivism in drug addiction: A behavioral analysis. Addictive Behaviors. 4(2), 121-132. Bennett, G., Vourakis, C., & Woolf, D. (1983). Substance abuse: Pharmacological, developmental and clinical perspectives. New York: John Wiley. Blume, S.B. (1987). Confidentiality of patient records in alcoholism and drug treatment programs. New York: American Medical Society on Alcoholism and Other Drug Dependencies, Inc. and National Council on Alcoholism, Inc. Bready, L.L. & Smith, R.B. (1987). Decision making in anesthesiology. Toronto, Canada: B.C. Decker, Inc. Brill, L. (1977). The treatment of drug abuse: Evolution of a perspective. American Journal of Psychiatry. 134(2), 157-160. Cadoret, R.J. (1986). An adoption study of genetic and environmental factors in drug abuse. Archives of General Psychiatry. 43(12), 1131-1136. Childress, A.R., McLellan A.T. & O'Brian, C. (1985). Behavioral therapies for substance abuse. International Journal of American Psychiatric Association: Addictions. 20(6 & 7), 947-969. Cooper, J.R., Altman, F., Brown, B.S., Czechowicz, D. (Eds.). (1986). Research on the treatment of narcotic addiction: State of the art. Rockville, MD: National Institute on Drug Abuse. DeLem, G. (1987). Alcohol use among drug abusers: Treatment outcomes in a therapeutic community. Alcoholism: Clinical and Experimental Research. 11(5), 430-436. Dole, V. (1988, Nov.). Implications for methadone maintenance for theories of narcotic addiction. Journal of the American Medical Association. 260,20. Donovan, J.M. (1986). An etiologic model of alcoholism. American Journal of Psychiatry. 143(1), 1-11. Douglas, D.B. (1986). Alcoholism as an addiction: The disease concept reconsidered. Journal of Substance Abuse Treatment. 3(2). Jacobs, P., Laurie, A. & Cuzzi, L. (1983). Coordination of services to methadone mothers and their addicted newborns. Health Social Work. 8(4), 290-298. Raffoul, P.R. (1986). Drug misuse among older people: Focus for interdisciplinary efforts. Health Social Work. 11(3), 197-203. Substance Abuse Curriculum: MODULE 2 CLINICAL UNITS A-I: Increased special skills in clinical planning, recognition, diagnosis, and treatment of SATotal Time: 15 hours Overview: The clinical units will provide the student with the experience to apply scientific knowledge in caring for the SA patient. There will be an extensive opportunity for analyzing and challenging personal attitudes concerning SA. Additionally, there will be an opportunity to engage in multidisciplinary collaboration for SA. One important component of this module is to delve extensively into the interview, diagnosis, treatment and recovery process of the substance abuse patient. Terminal Objective: a) The student should be able to conduct an interview, history, and physical extracting important information from the SA patient. b) Discuss the interview, diagnosis, and treatment options for SA patients. c) Recommend supportive therapy and groups for the prevention, intervention, and recovery process. d) Examine personal values, beliefs, and attitudes concerning SA. e) Identify and begin solidification of a SA research project. Recommended Teaching Methods: Group Process Lecture Discussion Readings Videos
Role Playing Case presentations Instructional Activity Sequence: First hour is dedicated to conference time conducted by a clinical faculty member examining the barriers to accurate assessment and collection of data from patients, family and during the physical examination. Second and third hours include a review and demonstration (one-on-one) of the methods for an extensive interview, history and physical using a variety of criteria (DSM IV) and instruments. Fourth hour is for SA self-examination with a clinical counselor. Fifth hour provides the opportunity for recognition of signs and symptoms of SA and discussion of the appropriate treatment plan. Sixth hour allows demonstration of a plan for intervention, basic intervention, and the aftercare process. Seventh hour students should be expected to demonstrate basic treatment and referral skills for the SA patient. Eighth through thirteenth hour provides the student an opportunity to share time with a clinical counselor in the clinical setting examining appropriate cases. Fourteenth hour is a debriefing and discussion of preceding activities and a review of techniques, methods, philosophy, and clinical experiences. Fifteenth hour allows research and solidification of SA research project. Course Outline: LIII. Clinical assessment and diagnostics of SA A. Self-examination and challenging personal prejudices, beliefs, and attitudes on SA B. Performing clinical assessment and diagnostic procedures C. In depth exploration of the relationship between SA and anesthesia D. Familiarization with barriers to patient, family dynamics and physical examination 1. Participation in prevention and treatment programs 2. Discuss and utilize support groups in treating substance abuse E. Utilizing the planning, recognition, diagnostic, and treatment skills in SA 1. Early recognition of SA 2. Diagnosing SA 3. Planning treatment for SA 4. Treatment of SA F. Recognition and management of withdrawal syndromes G. Clinical presentations of appropriate cases for review H. Solidification of research project in SA References: Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York: Plenum Medical Books Co. Baird, M.A. (1985). Chemical dependency: A protocol for involving the family. Family Systems Medicine. 3, 216-220. Block, M.R. & Coulehan, J.L. (1987, Jan.). Teaching the difficult interview in a required course on medical interviewing. Journal of Medical Education. 62(1), 35-40. Bluhm, J. (1987). When you face the chemically dependent patient: A practical guide for nurses. St. Louis, MO: Ishiyaku EuroAmerica, Inc. Cavanaugh, R.M. (1986, Mar.). Obtaining a personal and confidential history from adolescents. An opportunity for prevention. Journal of Adolescent Health Care. 7(2), 118-122. Chappel, J.H., Veach, T.L. & Krug, R. (1985). The substance abuse attitude survey: An instrument for measuring attitudes. Journal Studies of Alcohol. 46(1), 48-52. Clark, W.D. (1985, Nov.). The medical interview: Focus on alcohol problems. Hospital Practice. pp. 59-68. Clark, W.D. (1981). Alcoholism: Blocks to diagnosis and treatment. American Journal of Medicine. 71, 275-286. Cox, A. (1981). Training guidelines and workbook for the behavioral management of intoxicated and disruptive clients. Toronto, Canada: Addiction Research Foundation. Craig, R.J. (1988). Diagnostic interviewing with drug-abusers. Professional Psychological Research Practice. 19(1), 14-20. Cyr, M.G. & Wartman, S.A. (1988). The effectiveness of routine screening questions in the detection of alcoholism. Journal of the American Medical Association. 259, 51-54. Deveny, P. & Saunders, S. (1986). Physicians' handbook for medical management of alcohol and drug related problems. Toronto, Canada: Addiction Research Foundation. Ewing, J.A. (1984). Detecting alcoholism: The CAGE Questionnaire. Journal of the American Medical Association. 252, 1905-1907. Gitlow, S.E. & Peyser, H.S. (1980). Alcoholism: A practical treatment guide. New York: Grune and Stratton. Holt, S. Skinner, H.A. & Israel, Y. Early identification of alcohol abuse: Clinical and laboratory indications. Canadian Medical Association Journal. 124, 1279-1299. Johnson Institute. (1987). How to use intervention in your professional practice. Minneapolis: Johnson Institute. Johnson Institute. (1979). Chemical dependency and recovery are a family affair. Minneapolis: Johnson Institute. Johnston, L.D., O'Malley, P.M. & Bachman, J.G. (1987). National trends in drug use and related factors among American high school students and young adults, 1975-1986. (DHHS Publication No. ADM 87-1535). Washington, DC: U.S. Government Printing Office. Keltner, N., Schwecke, L., & Bostrom, C. (1991). Psychiatric Nursing: A psychotherapeutic management approach. St. Louis, MO: Mosby-Year Book. Lipkin, M., Quill, T.E. & Napodano, R. (1984). The medical interview: A core curriculum for residencies in internal medicine. Annals of Internal Medicine. 100, 277. Manno, J.E. (1986). Interpretation of urinalysis results. Urine Testing for Drugs of Abuse. Research Monograph Series, No. 73. Rockville, MD: National Institute on Drug Abuse. Milhorn, H.T. (1988). The diagnosis of alcoholism. American Family Physician. 37, 175-183. Miller, M.R. & Hester, R.K. (1986). Inpatient alcoholism treatment: Who benefits? American Psychologist. pp. 794-805. Mumford, E., Anderson, R. Cuerden, T. & Scully, J. (1984). Performance-based evaluation of medical student' interviewing skills. Journal of Medical Education. 59, 133. National Council on Alcoholism. (1972). Criteria for the diagnosis of alcoholism. Annals of Internal Medicine. 77, 249-258. Skinner, H.A., Holt, S., Schuller, R., Roy, J., & Israel, Y. (1984). Identification of alcohol abuse using laboratory tests and a history of trauma. Annals of Internal Medicine. 101, 847-851. Stillman, P.L., Burpeace-DiGregorio, M.Y., Nicholson, G.I., Sabers, D.L., & Stillman, A.E. (1983). Six years of experience using patient instructors to teach interviewing. Journal of Medical Education. 58, 941. Tarter, R. & Hegedus, A. (1991). The drug use screening inventory. Alcohol Health and Research World. 15(1), 65-75. Taylor, R.B. (1982). Health promotion: A guide to clinical practice. Norwalk: Appleton-Century-Crofts. Tiebout, H.M. (1953). Problems of addiction and habituation. New York: Grune and Stratton. Washton, A.M. & Gold, M.S. (Eds.) (1987). Cocaine. New York: Guilford Press. Weinberg, J.R. (1974). Interview techniques for diagnosing alcoholism. American Family Physician. 9, 107-115. Werner, A. & Schneider, J.M. (1974). Teaching medical students interactional skills: A research based course in the doctor-patient relationship. New England Journal of Medicine. 290, 1232. Formative Evaluation of Module 2Substance Abuse Curriculum Reference Sheet 1.4 Using the following scale please rate your accomplishments of the objectives in Module 2 including the didactic and clinical components of the substance abuse curriculum. 1-------2-------3-------4-------5 Low Moderate High Accomplishment
Reference Sheet 1.4 (cont.) ____Identifying common patterns of group communication and education. ____Diagnosing, planning for intervention, treatment, and aftercare of the substance abuse patient. ____Formulating and utilizing treatment modalities in the treatment of substance abuse. ____Conducting an extensive interview, history and physical, extracting important information from the substance abuse patient. ____Collaborating with multiple disciplines concerning substance abuse. ____Recommending supportive therapy and groups. ____Examine personal values, beliefs, and attitudes concerning substance abuse. ____Solidification of research project for the topic of substance abuse. Additional Comments: Substance Abuse Curriculum Download 0.69 Mb. Share with your friends:
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