Overview and Summary: Substance Use Disorders and Related Concerns: Perspectives from Nurses

The neuro-anatomy of mental health and substance use disorders (SUD; behavioral health) and the phenomena of reward-based learning in the setting of substance use are complex. These conditions place people, especially youth, at high risk for developing adverse physical and mental health effects, victimization with subsequent trauma, life-long dependence, and premature death.

Epidemic levels of tobacco and opioid use disorder in the United States (US) result in millions of people suffering from the physical, mental, social, and financial effects of smoking tobacco [16 million] (Centers for Disease Control, 2019a) and opioid use disorder [2.1 million] (National Institute on Drug Abuse, 2018). They also account for more than a half million lives lost each year from tobacco-related diseases[(480,000] (Centers for Disease Control and Prevention, 2019b) and opioid overdose [47,000] (Hedegaard, Minino, & Warner, 2018). Primary behavioral disorders and mental illness are common contributors to these SUD, with the prevalence of any mental illness highest [25.8%] in young adults aged 18-25 (National Institute of Mental Health, 2019). Furthermore, the presence of these disorders in either parent or themselves are contributing factors for vulnerable children who fall victim to commercial sexual exploitation (Goldberg et al., 2017) with an estimated 100,000 to 300,000 at risk in the US (Egyud et al., 2017).

Nurses are called upon to protect and improve the health and well-being of their communities. This work includes addressing SUD and the commercial sexual exploitation of children (CSEC), representing public health risks to some of the most vulnerable people in our communities. Behavioral and mental health disorders exist at all points across the healthcare continuum and are often spurred or spawned by substance use.

Foundations of nursing include health promotion and patient education. As the demands of healthcare and patient needs continue to evolve, nurses are fulfilling critical roles as first-responders, counselors, treatment experts, and educators. These roles require added awareness and knowledge of particular conditions and the ability to identify risk factors keenly. For effective public health measures and benefits to occur, nurses must also possess specific skills to screen for and detect an array of disorders, and facilitate early intervention, treatment, and referral for such conditions.

This OJIN topic spearheads tobacco and opioid use disorder and criminal sexual exploitation of children. These articles effectively identify and illustrate the urgency of these concerns and specific areas where nurses may intervene and impact these devastating disorders. Special attention is given to the coordinated and actionable implementation of interventions by nurses and their multidisciplinary partners.

Tobacco Use: The Current State of Affairs and How Nurses Can Help Patients Quit, launches this series of publications as Fathi examines the prominent history of tobacco and its influence on the broad dissemination, use, and abuse of tobacco products. The populations at the highest risk for tobacco dependence, the harmful health effects from tobacco use, particularly from smoking, and related health disparities, and the dangers of vaping, are discussed. Perhaps most important, the author reviews current evidence that supports successful cessation outcomes and how nurses may take action in the war against tobacco.

As rates of opioid use disorder (OUD) and related overdoses surge, nurses are beckoned to understand these disorders and safely respond to opioid overdoses that arrive for care outside the Emergency Department by private vehicles. The Be-SAFE: A Guide for Emergency Department Nurses Responding to Opioid Overdoses in Personal Vehicles article shows how authors Clark and colleagues used stakeholder input to determine the educational needs for emergency department nurses in this setting and disseminate relevant content through innovative educational means. They research the impact this educational intervention has on nurses’ knowledge and explore the feasibility of trained nurses to disseminate the knowledge further through teaching other nursing staff.

In the article, Development of a Novel Behavioral Intervention for Opioid Use Disorders authors Mumba et al. address the opioid crisis. They outline the criticality of targeting the opioid crisis through effective interventions that address addiction and the underlying behavioral conditions as significant contributors. These authors dive deep into the literature to understand the treatment needs of those affected by SUD and mental health illness and current resource gaps. This work culminates in developing a treatment manual for therapeutic counseling sessions with those suffering from OUD.

May, Baumgartner, and Garrety, in their article, Deterrents to Integrating the Prescription Drug Monitoring Program into the Electronic Health Record, review their project in Washington State that focuses on leveraging health information technology to protect patients from the risk of developing opioid dependence or harm from the propagation of misuse and abuse of prescription opioids. This article demonstrates how state-based policy can influence efforts to combat the opioid crisis through widespread integration of a prescription drug monitoring program (PDMP) into the electronic health records across health agencies, facilities, and systems. The primary goal of this project was to identify current barriers to uptake and integration with the end-goal of promoting patient safety and health outcomes by preventing prescription opioid overdoses through universal uptake and consistent use of a PDMP.

Commercial sexual exploitation of children is more common than initially thought (Orme & Ross-Sheriff, 2015). Despite federal and state legislation that aims to protect children from the victimization of sex trafficking, this elusive crime against children persists. Contributors to CSEC are revealed in the Sex Trafficking of Minors in the United States: A Perspective for Nurses by Jaeckl and Laughon. This work supports insight into the intricate contributing factors and the health consequences of this criminal activity against children, typical signs and symptoms that should trigger nurses and other healthcare providers to screen for CSEC, and implications for future practice.

Finally, in Screening, Intervention, and Referral in the Clinical Setting, Beynor, Stanfield, and Zucker identify adolescent substance use as a national priority issue and endorse screening for SUDs in schools and primary care practices utilizing the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach. Given the evidence that screening and counseling approaches such as motivational interviewing, cognitive behavioral therapy, and SBIRT are effective in the treatment of SUDs, and the relatively low uptake and utilization of SBIRT, the authors conducted a project in which the need for training and implementation of SBIRT in clinical nursing was evaluated. Focus group work and subsequent results and data analysis revealed implications for future education and key individual and systems-level considerations in consistent and effective implementation of SBIRT for the betterment of patients who are affected by SUDs.

The journal editors invite you to share your response to this OJIN topic addressing Substance Use Disorders. Please consider writing a Letter to the Editor or submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.

Author

Joelle T. Fathi, DNP, RN, ARNP, ANP-BC, CTTS, NCTTP is a Professor of Nursing and leads the adult gerontology acute care nurse practitioner program in the Department of Biobehavioral Nursing and Health Informatics at the University of Washington School of Nursing, Seattle, WA. She is a board-certified and practicing adult nurse practitioner and certified tobacco treatment specialist. Joelle serves as co-chair of the Tobacco Treatment Task Group for the National Lung Cancer Roundtable, American Cancer Society. She also serves on the International Association for the Study of Lung Cancer, Tobacco Control and Smoking Cessation Committee, and the Tobacco Task Force for the American Thoracic Society.