An alcohol and drug education program for nurses

AORN Journal, Nov, 1997 by Bernadine T. Markey, Joan B. Stone

Alcoholism and drug abuse are serious problems in the United States. Alcoholism is a widespread biophysiologic and psychosocial problem with serious implications for the alcoholic's physical health, economic well-being, psychological equilibrium, and family and social relationships. Consider these startling statistics.

* Approximately 43% of all American adults have been exposed to alcoholism in the family.(1)

* It is estimated that 10% of the population in the United States are problem drinkers.(2)

* There are approximately 10 to 13 million alcoholics in this country, with an estimated seven million alcohol abusers.(3)

* As a result of alcohol abuse, problem drinkers suffer impaired performance on the job, accidental injuries, and medical disorders.

* Fifty percent of hospital beds are occupied by people whose illness is -- in some way -- associated with alcohol abuse or alcoholism, and 40% of the admissions to psychiatric hospitals are because of various psychological and psychiatric ramifications of alcoholism.(4)

* The prevalence of alcoholism places family members at risk for development of highly dysfunctional patterns, a variety of dependencies, and emotional illnesses.(5)

* Alcoholism is involved in 60% of reported cases of child abuse and in the majority of cases of spousal abuse.(6)

* It is estimated that there are 38 million people who are children of alcoholics.(7)

The statistics concerning drug use and abuse in the United States is also dramatic, with American society being described as a drug-oriented, addicted, and chemically dependent.(8) It is estimated that 60% of the world's production of illegal drugs is consumed in the United States.(9) The American drug problem involves the use of legal medications, illegal drugs, and the recreational use of drugs intended for medicinal purposes. Social consequences of drug abuse are similar to those of alcohol abuse (eg, crime, violence, homelessness, automobile injuries and deaths, falls, drownings, suicides, abuse and neglect in families, early sexual activity, adolescent pregnancies, sexually transmitted diseases with AIDs being specific for drug users). Drug abuse is believed to have surpassed mental illness as the most serious health problem plaguing the urban homeless.(10)

USING AND ABUSING POPULATIONS

Substance abuse spans all geographic regions, ethnic groups, and social classes.(11) Overall, in terms of general alcohol abuse, the following has been found to be true.

* Men are more than four times more likely to be heavier users than women.

* People 44 years of age and older are more likely to be abstainers than younger people.

* Caucasians, more than any other ethnic group, have the highest proportion of members who consume alcohol.

* Alcohol use increases for both men and women with higher levels of education than people with lower education levels.

* The proportion of drinkers in a family rises with family income.(12)

Multiple substance abusers. Today, multiple substance abuse -- which refers to simultaneous abuse of different mood-altering drugs, either with one another or in combination with alcohol -- is becoming the norm for alcoholics and drug abusers.(13) Caucasian males have the highest lifetime use of cigarettes, alcohol, stimulants, and hallucinogens. Rates of the use of illicit drugs are greater among African-Americans than for either Caucasians or Hispanics in all age groups except for people 12 to 17 years of age.(14) It has been reported that in US households 37% of the population 12 years of age and older have used illicit drugs one or more times in their lives.(15) Alcohol is the intoxicant most widely used, followed by marijuana, which has been used at least once by 25% of the US population.(16)

Adolescents. Adolescents are a population for whom substance use and abuse is a significant problem. The following statistics illustrate this fact.

* Two out of three adolescents try nicotine.

* At least 92% of adolescents have used alcohol at least once.

* Forty-seven percent of adolescents try marijuana, 20% try cocaine, and 10% to 15% try sedatives.(17)

Other. Alcohol-related mortality and fetal alcohol syndrome is higher for Native Americans than for all other groups, and alcoholism is 5% greater in this group than in the general population.(18) It should be noted that more people die annually from prescription drugs obtained legally but used improperly than from all illegal substances combined.(19)

NURSES AND SUBSTANCE ABUSE

Nurses are not immune to the ravages of substance abuse, either in themselves or in their colleagues, their family members, or their neighborhoods. The precise number of chemically dependent nurses is difficult to ascertain due to the associated social stigma and to denial, which is a characteristic defense.(20) Although there are no accurate statistics on the prevalence of alcohol abuse among nurses, the incidences of alcoholism or alcohol-related problems have been estimated to include 6% to 20% of all practicing nurses; instances of drug dependency have been estimated to include 3% to 5% of practicing nurses.(21) Some health care professionals who have easy access to legal medications (eg, nurses, physicians, pharmacists) are guilty of obtaining these medications to alter their moods.(22) These professionals use multiple medications in an effort to achieve different and particular states of feeling (eg, they use stimulants in the morning to awaken; depressants at night to unwind; other medications counteract fatigue, promote sleep, or just feel better).