Addressing substance use in primary care

COVID-19 Impact on Teaching Substance Use Disorders: A Nursing Curricular Thread

ABSTRACT

Vulnerable populations such as those with substance use disorders (SUDs) are at a higher risk for early morbidities and mortalities yet are less likely to receive primary care and other necessary psychosocial services essential for comprehensive care of these clients. This need has been magnified by the COVID-19 pandemic. Evidence supports an increase in alcohol sales in 2020, and overdoses from illicit drugs have been reported to have more than doubled by May 2020 from the 2018 and 2019 baseline rates, and one reason for these increases is because of COVID-19. The healthcare system is overwhelmed with the cost of treating and addressing the impact of SUDs. Individuals with SUDs often meet providers who are not sufficiently prepared to address their complex issues that include co-occurring mental and physical health disorders. In addition to changes in practice, nursing education must change their curricular approach to meet the challenges in health services across the life span, and nursing education should include lessons being learned during the COVID-19 pandemic. Nurses must be prepared to recognize and screen individuals for SUDs at the undergraduate level as well as assess and treat individuals with SUDs at the advanced practice level in all areas of healthcare services. SUDs should not continue to be siloed and separated into the psychiatric-mental health nursing course within the nursing curriculum but should be addressed in multiple specialties across the curricula and include health responses in regard to the impact that the COVID-19 pandemic is having on SUDs.

Primary Care Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Lebanon: A National Cross-sectional Study

INTRODUCTION

Substance use among adolescents is on the rise globally. Adolescents rarely seek help for problematic substance use and healthcare professionals can easily fail to identify adolescents with risky substance use. There is therefore a significant global need for substance use screening by healthcare professionals followed by appropriate intervention. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice that enables clinicians to determine adolescents' risk for substance use and intervene accordingly. However, little effort has been placed on empowering primary care clinicians to use it in Lebanon. We explored the attitudes, perceptions, and practices of primary care nurses and physicians regarding adolescent SBIRT use.

METHODS

The study used a cross-sectional multisite survey design targeting urban and rural areas in Lebanon. A national sample of 140 physicians and nurses was recruited using random sampling stratified by governorate. Participants completed mailed or online surveys addressing their practices, attitudes, role perceptions, and self-efficacy regarding SBIRT use.

RESULTS

This study revealed that 57.8% of healthcare professionals were not familiar with the SBIRT model and that 76.2% did not practice SBIRT in their setting. The majority addressed the problem of substance use through educating and counseling adolescents about the dangers of substance use (84.2%) and encouraged them to stop (82%) but only 2% reported using standardized instruments for substance use screening. Most participants (88.1%) reported their willingness to use SBIRT in their clinical practice and 92.4% expressed an interest in receiving SBIRT training. Overall, the results showed positive attitudes (M = 4.38, SD = 0.89) and role responsibility (M = 4.47, SD = 1.62) toward addressing substance use in adolescents, in addition to a high level of perceived self-efficacy in addressing substance use (M = 4.04, SD = 0.92). Our results showed minimal differences between nurses' and physicians' perceptions and self-efficacy regarding SBIRT use.

CONCLUSIONS

Our study confirms the lack of a standardized approach toward adolescent substance use screening and intervention by primary healthcare providers in Lebanon but revealed the readiness and willingness to receive training and proper support to adopt an evidence-based approach such as SBIRT.

Screening adolescents for substance use: The role of NPs in school settings

NPs have a key role in screening for adolescent substance use in school settings. This article provides evidence-based information on the prevalence and consequences of adolescent substance use, discusses standardized substance use screening and brief interventions using the CRAFFT tool, and suggests relevant practice and policy implications.

The development of the student pharmacist chemical health scale (SPCHS)

Background: The Student Pharmacist Chemical Health Scale (SPCHS) is a tool designed to evaluate substance use behaviors and risk factors for substance abuse among student pharmacists. Methods: It was administered to a sample of student pharmacists at the University of Georgia (UGA) as a preliminary component of a longitudinal study evaluating student pharmacists nationwide. Results: This final scale was found to have a high degree of internal consistency and showed appropriate content and face validity for the domains tested. Conclusions: Future analyses will center on further validating the SPCHS in known groups of pharmacists with substance use disorders.