A MODEL DIDACTIC AND CLINICAL SUBSTANCE ABUSE
CURRICULUM DEVELOPED FOR SCHOOLS OF NURSE
ANESTHESIA
Copyright Sept. 1994 by Gary D. Clark
1
A MODEL DIDACTIC AND CLINICAL SUBSTANCE ABUSE
CURRICULUM DEVELOPED FOR SCHOOLS OF NURSE ANESTHESIA
Table of Contents
INTRODUCTION...................................................................................................................................... 6
Suggestions for the Use Of The Model Curriculum ................................................................................................. 6
1.
Provide adequate faculty development ..........................................................................................................6
2.
Select an appropriate didactic and clinical strategy ........................................................................................7
3.
Evaluate the entire curriculum, the learner, and the outcomes of each ........................................................7
4.
Revise the curriculum and the teaching methodology ...................................................................................7
5.
Integration of the substance abuse curriculum should not dilute the content or focus ................................8
6.
Clinical experiences include patient oriented studies and self-evaluation. ....................................................8
NECESSARY RESOURCES...................................................................................................................... 9
Facilities ................................................................................................................................................................. 9
Didactic Facility .........................................................................................................................................................9
Clinical Facility ...........................................................................................................................................................9
An Approach to the Teaching Process and Methodology ..................................................................................... 10
Framework ..............................................................................................................................................................10
Teaching Process.....................................................................................................................................................10
REFERENCES......................................................................................................................................................... 11
PHILOSOPHY ......................................................................................................................................... 13
Professional Responsibilities of the Nurse Anesthetist ........................................................................................ 14
PROGRAM OBJECTIVES...................................................................................................................... 15
SUBSTANCE ABUSE CURRICULUM TERMINAL OBJECTIVES.................................................. 16
GENERAL ORGANIZATION AND PHILOSOPHY OF THE MODULES ...................................... 17
GENERAL LEARNING OBJECTIVES OF THE LEARNING MODULE 1 ...................................... 18
GENERAL LEARNING OBJECTIVES OF THE LEARNING MODULE 2 ...................................... 19
2
GENERAL LEARNING OBJECTIVES OF THE LEARNING MODULE 3 ...................................... 20
USE OF THE MODULES ....................................................................................................................... 21
MEASURES AND METHODS OF EVALUATION............................................................................. 23
INTRODUCTION TO THE MODULES............................................................................................... 24
MODULE 1 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS ..................................... 25
MODULE 2 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS ..................................... 27
MODULE 3 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS ..................................... 29
SUBSTANCE ABUSE CURRICULUM ................................................................................................. 31
MODULE 1 ........................................................................................................................................................... 31
DIDACTIC UNIT 1 A-D: Introduction to the modules ..............................................................................................31
Substance Abuse Pretest....................................................................................................................................32
DIDACTIC UNIT 2A: Introduction to substance abuse and commonly used terms ................................................33
DIDACTIC UNIT 2B: Defining commonly abused substances and their characteristics ..........................................38
DIDACTIC UNIT 2C: Basic pharmacology - I. Acute and Chronic Abuse ..................................................................42
DIDACTIC UNIT 2D: Defining the Diagnostic and Statistical Manual of Mental Disorders .....................................45
DIDACTIC UNIT 2E: Epidemiology of substance abuse ...........................................................................................48
DIDACTIC UNIT 2F: Etiology of substance abuse....................................................................................................51
Substance Abuse Case Presentation #1 .............................................................................................................55
DIDACTIC UNIT 2G: Introduction to the legal, ethical and moral issues of SA .......................................................56
DIDACTIC UNIT 2H: Basic assessment and diagnostic skills in the SA patient .......................................................60
DIDACTIC UNIT 2I: Multisystem physiology in SA - Level I .....................................................................................64
DIDACTIC UNIT 2J: Attitudes and Self-assessment concerning SA .........................................................................66
CLINICAL UNITS A-G: Introduction to clinical assessment and diagnostics of SA ..................................................71
Formative Evaluation of Module 1 .....................................................................................................................75
MODULE 2 ........................................................................................................................................................... 77
DIDACTIC UNIT A: Multisystem physiology in SA - Level II .....................................................................................77
DIDACTIC UNIT B: Pharmacology - II ......................................................................................................................80
DIDACTIC UNIT C: Prevalence and Patterns of SA ..................................................................................................84
DIDACTIC UNIT D: Tolerance, Toxicity, and Withdrawal from SA ..........................................................................88
DIDACTIC UNIT E: Planning for Intervention, Intervention and Aftercare .............................................................92
DIDACTIC UNIT F: Central Concepts and Research Issues in SA .............................................................................98
DIDACTIC UNIT G: Assessment and Screening of SA patients ..............................................................................101
DIDACTIC UNIT H: Individual, Family, and Group Dynamics related to SA ..........................................................105
DIDACTIC UNIT I: Community resources and treatment options .........................................................................109
CLINICAL UNITS A-I: Increased special skills in clinical planning, recognition, diagnosis, and treatment of SA ..113
3
Formative Evaluation of Module 2 ...................................................................................................................118
MODULE 3 ......................................................................................................................................................... 120
DIDACTIC UNIT A: Multisystem physiology in SA - Level III ..................................................................................120
DIDACTIC UNIT B: Pharmacology - III ...................................................................................................................125
DIDACTIC UNIT C: AIDS and Substance Abuse ......................................................................................................132
DIDACTIC UNIT D: Special At Risk Populations......................................................................................................135
DIDACTIC UNIT E: Interprofessional networking ..................................................................................................139
DIDACTIC UNIT F: Methods of prevention for SA .................................................................................................142
DIDACTIC UNIT G: Impaired Practitioners and Recovery ......................................................................................147
CLINICAL UNITS A-I: Advanced clinical medical sequelae, diagnosis, and treatment of SA..................................153
Formative Evaluation of Module 3 ...................................................................................................................158
Summative Evaluation .....................................................................................................................................160
Substance Abuse Post-test ...............................................................................................................................162
4
ACKNOWLEDGEMENT
The author of this manuscript would like to thank and acknowledge several individuals
who eagerly contributed their special skills, personal time, and unlimited efforts to aid in the
development of this curriculum. I would like to extend my deepest appreciation to the faculty of
Nova Southeastern University especially Maria Ligas, Ph.D., Marian Gibney, Ed.D. and Peter
Mills, Ed.D. for their expertise and support throughout this project which was invaluable. I
would like to thank the AANA for their support of this project, especially John Garde, CRNA,
Lorraine Jordan, CRNA and Betty Horton, CRNA who represent the commitment of the AANA
to provide an exceptional educational and training process to all student nurse anesthetists.
My special appreciation and gratitude are given to Howard Armour, CRNA, Rosalyn
Harris-Offut, CRNA and Diana Quinlan, CRNA who are members of the Peer Assistance
Advisors Committee in the AANA. Without their dedication, special knowledge, and skills in
the area of substance abuse this project would have been impossible. Lastly, to Clarence Baskey,
Ed.D., Executive Director of Professional Advancement Programs in Denver, Colorado, Dr.
Elizabeth Burns and Janet Ciccone, MA, of Ohio State University, and Joy Will, CRNA, at
Washington University, St. Louis who aided in the completion of this project, their
recommendations and guidance were of monumental value throughout this process.
It is difficult to list all of those who participated in this project in such limited space so,
for those that I have not mentioned or recognized I apologize and extend my gratitude. They all
freely gave of their talents, their knowledge and their skills toward developing the content of this
curriculum.
5
INTRODUCTION
The purpose of this manuscript is to provide the American Association of Nurse
Anesthetists (AANA) and program administrators of schools of nurse anesthesia a broad model
substance abuse (SA) curriculum. This curriculum provides no one best way to develop or
disseminate a substance abuse curriculum. However, this manuscript offers guidelines and
suggestions for the development and organization of a substance abuse curriculum.
Organizations must discover through assessment and evaluation activities which components
best aid in the development of a substance abuse curriculum.
The contents of this model are based upon extensive research in the area of substance
abuse, curriculum, and curriculum development. Disciplines such as nursing, medicine, social
work, and many other supporting health care professions have been recruited for the best
qualities in substance abuse education. This model can be used in its entirety in order to provide
a comprehensive substance abuse curriculum or in segments to fill current deficits.
Since there are no available curricula for schools of nurse anesthesia, it is suggested that
criteria be established to evaluate one curriculum appropriate for your institution. There are
several suggestions that follow which will aid in the use of this curriculum model.
Suggestions for the Use Of The Model Curriculum
1. Provide adequate faculty development
One of the key elements for effectively providing any curriculum is faculty who are
knowledgeable in substance abuse and adult and clinical educational philosophy. Staff
development can exist at several levels in substance abuse education, and is more than a variety
of workshops. Staff can become teaching faculty or teaching/research faculty. Teaching faculty
includes all the clinical and didactic faculty who contribute to the educational foundation of
student nurse anesthetists. Teaching/research faculty are those faculty who have highly
6
developed skills and knowledge, and conduct research in the topic of substance abuse. Clinical
faculty must not only be well versed in the topic of substance abuse but must also be familiarized
with the educational philosophy of the university and subscribe to the educational foundation for
teaching student nurse anesthetists about substance abuse.
2. Select an appropriate didactic and clinical strategy
In order for students to realize the terminal objectives the modules have been sequenced.
Each should be introduced appropriately into the required curriculum. Know the learners in the
group, determine their learning preferences and styles, and then choose the appropriate modules,
teaching methods, and philosophy for your learners. Arrange for intensive clinical affiliations at
local, regional, state and/or national agencies, treatment centers, or health care institutions.
The facilitator will require information regarding the time of delivery, resources, and
teaching strategies when selecting and utilizing the appropriate curriculum. Recruiting agencies
that specialize in substance abuse prevention will expedite the process.
3. Evaluate the entire curriculum, the learner, and the outcomes of each
Evaluation is a process which should be implemented throughout the entire process.
Eliciting feedback at the end of each session from learners and facilitators will provide valuable
information for effective change. Evaluation of the program, especially during the early stages
of student learning, should include a) evaluation by the instructor of the student's learning
progress, b) evaluation by the student of his/her learning, c) evaluation of the curriculum by the
student and faculty, and d) evaluation and critique of the educational process by an external
consultant.
4. Revise the curriculum and the teaching methodology
The results of the evaluation should be used to change or improve the learning
7
experience. Incorporate suggestions from the learners and the facilitators into the existing
methodology. The revision should also include an update of material and teaching methodology
to reflect current material.
5. Integration of the substance abuse curriculum should not dilute the
content or focus
Integration of the substance abuse curriculum allows the educational institution to utilize
a variety of resources. However, if integration of the substance abuse curriculum is not
specifically focused on the topic of substance abuse the curriculum becomes "watered down" or
"diluted" and may become ineffective in producing the desired outcome. The advice from at
least one consultant with the expertise in curriculum or educational design should be mandatory
in the developmental stages.
6. Clinical experiences include patient oriented studies and self-evaluation.
Clinical experiences provide the opportunity for unique learning experiences and a
foundation for professional practice. Introducing nurse anesthesia students to patients who abuse
substances also offers a wide variety of opportunities. Students can learn about patients who are
chemically dependent as well as use the time for reflection and self-evaluation concerning topics
and issues in substance abuse. Clinical competencies achieved by the student at each clinical site
and during each clinical experience can be assessed using a number of methods including but not
limited to; pre and post-testing knowledge, measuring behavioral changes, and project
demonstrations. The medical personnel or counselors at the clinical sites, in cooperation with
nurse anesthesia faculty, should be responsible for rating the clinical competencies of the
student.
8
NECESSARY RESOURCES
Facilities
Didactic Facility
The didactic component of these modules can be implemented in any environment
conducive to adult learning. An appropriate learning atmosphere with adequate lighting and
temperature and materials such as audiovisual materials, references, chalkboards, flipcharts
should be made available. The adult education philosophy as described by Malcolm Knowles
(1980) provides greater insight into additional requirements for introducing the substance abuse
curriculum.
Clinical Facility
The clinical component of these modules uses local, regional, state, or national sites.
These sites should be active treatment centers or other health care institutions for this clinical
educational process. The centers which best serve the purpose of this curriculum should not be
limited to patients with alcohol abuse. Instead, centers which provide treatment for different
types of chemical dependency should be recruited. The professional medical personnel at these
clinical sites should be well credentialed and have some experience with teaching students. If no
clinical site is available, site arrangements should be made through a representative of the
American Association of Nurse Anesthetists. The clinical experience presents an opportunity for
student nurse anesthetists to learn about patients who are chemically dependent. The clinical
experience should also provide an opportunity for self-evaluation under the direction of a
professional therapist. Self-evaluation and reflection do not constitute treatment during the
clinical experience instead, these experiences provide for an opportunity of growth and
introspection.
9
An Approach to the Teaching Process and Methodology
Framework
The program can be free standing, integrated, or the modules can be offered in total or
separately as a continuing education process. The minimum program framework should include
didactic and clinical instruction each year over the entire span of graduate education for nurse
anesthetists. The level of learning should be progressive throughout the program, from beginner
to advanced. Facilitators should ascribe to the adult education methodology and philosophy.
The didactic and clinical faculty should also possess special knowledge and skills in substance
abuse.
Teaching Process
Students should be given set expectations at the outset of the program and meet with
facilitators for formative progress reports. A summation and an opportunity to share experiences
with the group should close the learning experience for each individual. The amount of time
required for presentation and teaching strategies will vary with each learning experience.
Adequate time should be allowed for learning and learning projects. Clinical time should be
loosely structured allowing enough time for individual and group meetings, extra projects which
may emerge during formative progress sessions, and student contributions to the clinical setting.
Faculty should engage the student in ongoing substance abuse research projects, encourage
projects for presentation at group meetings or aid and encourage publication relative to substance
abuse.
10
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.
American Association of Nurse Anesthetists. (1992). CRNA Peer assistance manual. Chicago,
IL: American Association of Nurse Anesthetists.
American Association of Nurse Anesthetists. (1984). Chemical dependency. Position statement
No. 1.7. Chicago: American Association of Nurse Anesthetists.
American Nurses' Association. (1990). Suggested state legislation: Nursing disciplinary
diversion act. Kansas City, MO: American Nurses' Association.
American Nurses' Association. (1984). Addictions and psychological dysfunctions in nursing:
The profession's response to the problem. Kansas City, MO: American Nurses'
Association.
Bard, R., Bell, C.R., Stephen, L., & Webster, L. (1987). The trainer's professional development
handbook. San Francisco: Jossey-Bass.
Bergquist, W.H. & Phillips, S.R. (1975). Components of an effective faculty development
program. Journal for Higher Education. 46,177-209.
Brookfield, S.D. (1990). Understanding and facilitating adult learning. San Francisco: JosseyBass.
Burns, E.M., Thompson, A., & Ciccone, J.K. (Eds.). (1993). An addictions curriculum for
nurses and other helping professionals. (Vols. 1-2). New York: Springer Publishing
11
Co.
Elias, J.L. & Merriam, S. (1980). Philosophical foundations of adult education. Malabar, FL:
Krieger Publishing Co.
Knowles, M.S. (1980). The modern practice of adult education. New York: Cambridge.
Knox, A.B. (1989). Adult development and learning. San Francisco: Jossey-Bass.
Merriam, S.B. & Caffarella, R.S. (1991). Learning in adulthood. San Francisco: Jossey-Bass.
National Nurses Society on Addictions. (1985). Statement on model diversion legislation for
chemically impaired nurses. Evanston, IL: National Nurses Society on Addictions.
Smith, R.M. (1982). Learning how to learn. Englewood Cliffs, NJ: Cambridge.
Tough, E. (1971). The adult learning project: A fresh approach to theory and practice in adult
learning. Research and Education Series #1. Toronto: Ontario Institute for Studies in
Education.
12
PHILOSOPHY
The purpose of this substance abuse curriculum is to address and influence substance
abuse education at all levels of faculty, nurse anesthesia graduate schools, and adjunct personnel
associated with nurse anesthesia. Substance abuse is a medical disease affecting a large number
of individuals in our society. The abuse of alcohol or any other chemical substance knows no
limitations. This disease creates physical, emotional, mental, and economic stress on the
resources of family, friends, and society. The treatment of this disease requires a number of
strategies. The following three strategies prevention, intervention, and treatment of substance
abuse each should begin using education as a primary frontline strategy. Educational prevention
should then begin with this curriculum.
It is anticipated that each student will bring with them values, behaviors, knowledge, and
clinical abilities learned through past experience. Many of these students lack the basic
knowledge and skills required to deal with substance abuse. It is assumed that these students
also willfully participate in learning and strive for understanding to the extent that substance
abuse issues can be brought into their personal life and practice.
Certified Registered Nurse Anesthetists (CRNAs) encounter substance abuse patients
during their daily practice as well as outside their practice of anesthesia. Certified Registered
Nurse Anesthetists make community contacts with individuals who are substance abusers or who
are considered to be patients "at risk" for substance abuse. The professional organization of
nurse anesthesia the American Association of Nurse Anesthetists and their Peer Assistance
Committee has developed a number of guidelines in a laudable attempt to address substance
abuse within the profession. Based upon information and this author's assessments there are a
substantial number of areas which need to be disseminated to faculty, CRNAs, and student nurse
anesthetists concerning the topic of substance abuse. Armed with these skills to prevent
13
substance abuse the nurse anesthetist can provide educational experiences to a wide population
including peers, patients, other health care providers, and the community. The educational goals
are to introduce students at all levels to the issues of chemical dependency enough to have a
sustained and lasting effect. Producing positive role models impact upon the educational process
in substance abuse.
Professional Responsibilities of the Nurse Anesthetist
Certified Registered Nurse Anesthetists (CRNAs) are highly trained practitioners who
have the unique opportunity and responsibility to educate their patients, peers, and the public in
addition to performing their professional duties and delivering anesthesia. According to the
AANA Position Statement on Chemical Dependency (1984), CRNAs, as responsible health care
providers, are in an important and powerful position to identify, educate, and encourage patients
and/or colleagues to seek professional help for substance abuse while recognizing a safe,
supportive, and confidential environment. Substance abusers fail to work to their full capacity,
burden social health care systems, potentially jeopardize workplace safety, and create
unnecessary stress in the home and workplace. Substance abuse education provides a crucial
step toward the prevention and research of this disease.
In order to achieve the most from this substance abuse curriculum participants must
reflect on their personal morals, values, and ethical beliefs; then make a commitment to learning
about the disease of substance abuse. Facilitators/teachers must remain sensitive to the adult
learner's needs by providing an unobtrusive, entrusting, and nonintimidating learning
environment. With appropriate development, implementation and evaluation of a substance
abuse program, educators can provide an appropriate instructional curriculum. In addition,
learners can adopt the safe, supportive, understanding, and compassionate roles demonstrated by
the well informed CRNA.
14
PROGRAM OBJECTIVES
1. Foster awareness, skills, and knowledge of substance abuse in four areas in nurse anesthesia.
a. Didactic education.
b. Clinical education.
c. Administration/Management.
d. Scholarship/Research.
2. Initiate a network of educators and practitioners that are well informed in substance abuse.
3. Disseminate information on substance abuse.
4. Increase the recognition, diagnosis and sequelae of substance abuse.
5. To provide the basic skills required to aid in prevention, intervention, and treatment of the
patient in a treatment sequence.
6. Initiate an examination of the Nurse Anesthetist's role in the prevention, intervention, and
treatment of substance abuse.
7. To increase the level of clinical and medical knowledge in substance abuse.
8. Facilitate the research component in substance abuse and nurse anesthesia.
15
SUBSTANCE ABUSE CURRICULUM TERMINAL OBJECTIVES
1. Identify familiar behavior patterns in the chemically dependent.
2. Recognize the common medical outcomes of the substance abuser.
3. Discuss the treatment modalities utilized for the chemically dependent.
4. Develop personal insight into values, attitudes, behaviors, and morals concerning substance
abuse.
5. Describe the effects of substance abuse on the family unit and special populations that are
affected by substance abuse.
6. Describe the moral, cultural, ethical, legal, and social considerations in chemical dependency.
7. Demonstrate the basic skills for diagnosis, intervention, and employment of treatment for the
substance abuser.
8. Identify the appropriate collaborative course in the prevention, intervention, and treatment of
substance abusers.
9. Describe the role of the nurse anesthetist in the prevention of substance abuse.
10. Engage effectively in research of substance abuse.
11. Demonstrate an active effort to change personal negative attitudes and stereotypes regarding
chemical dependency and the substance abuser.
12. Evaluate the effectiveness of efforts in prevention, intervention, and treatment of substance
abuse.
13. Formulate steps to respond to chemical abuse patterns.
14. Demonstrate a change in the values, beliefs, perceptions and stereotypical attitudes of the
learner.
15. Demonstrate an active role in the education and dissemination of substance abuse
information in the community.
16
GENERAL ORGANIZATION AND PHILOSOPHY OF THE MODULES
The model course is constructed in three modules with a didactic and clinical component
in each. There are three levels of development. First, there is an introduction to the basic and
fundamental concepts of substance abuse beginning with module one. Second, the teaching
strategy moves toward an intermediate level. The learner should begin to experience more
advanced learning experiences at this stage integrating previous didactic and clinical
experiences. Third, an advanced level is introduced. At the advanced level learners will be
introduced to intermediate and long term treatment, research, and educational methodology for
teaching substance abuse. In each module there is an integration of the didactic with the clinical.
Each module becomes progressively more difficult. The course is presented in these following
modules.
17
GENERAL LEARNING OBJECTIVES OF THE LEARNING MODULE 1
Module 1:
Introduction and General Awareness of Substance Abuse.
Didactic:
Introduction and increased awareness of general concepts, medical
consequences and issues in substance abuse. Ethical, moral and legal issues in substance
abuse.
Clinical:
Familiarity with assessment and diagnosis of substance abuse. Self-
examination and challenge of personal beliefs, prejudices, and attitudes concerning
substance abuse. Exploration of the etiology and the progression of substance abuse.
Ideas for a substance abuse research project. Recognizing substance abuse as a disease.
18
GENERAL LEARNING OBJECTIVES OF THE LEARNING MODULE 2
Module 2:
Increased Special Skills in the Planning, Recognition, Diagnosis and
Treatment of Substance Abuse.
Didactic:
Increased recognition of related sequelae of substance abuse. Increased
appreciation of the biopsychosocial and planning aspects.
Clinical:
Increased assessment and diagnostic skills. Treatment of family, impaired
professionals, and special populations. Planning and basic intervention skills.
19
GENERAL LEARNING OBJECTIVES OF THE LEARNING MODULE 3
Module 3:
Professional Responsibilities, Advanced Knowledge, and Demonstrated
Skills in Substance Abuse.
Didactic:
Advanced knowledge of medical sequelae, etiology, and effects of
substance abuse. Advanced intervention, planning, assessment, and diagnostic skills.
Promotion of scholarship and research topics.
Clinical:
Advanced prevention, assessment, intervention, post intervention and
aftercare skills. Interprofessional collaboration. Demonstrated abilities in substance
abuse education.
20
USE OF THE MODULES
The philosophy and the objectives of this curriculum provide a basic foundation for the
nurse anesthetist. In order for students to learn the topic of substance abuse each module should
be delivered in sequence. If integrated, the content of the modules should be included in the
curriculum in a sequence that is appropriate for each module and the existing curriculum. These
modules are designed to provide independent learning experiences as well as integrated learning
experiences. For students to internalize and grow with the information in this curriculum role
playing, case presentations, problem-based learning, and experiences play a vital role.
The sequence of modules are best offered over the span of the student's graduate study.
Module one should be offered in the first year, module two in the second year, and module three
in the third year. Each course of study should move the student from a basic course of study
toward one that is progressively expanding to a more difficult level. Clinical learning supports
the didactic component in each module. Facilitators should develop teaching strategies using an
adult education philosophy (Knowles, 1980). Since each teacher employs a number of strategies,
these should not be limited.
Clinical experiences should be developed at local, regional, or state institutions involved
with treating substance abuse patients. These clinical experiences are best served when peers are
encountered, interviewed, and observed in the treatment facility. There should be an extensive
opportunity for self-exploration during the implementation of these modules. However, this
should not be to the exclusion of other patients or learning experiences.
The clinical experience should also include patients not yet diagnosed with medical
complications resulting from substance abuse and addiction. These experiences should be
initiated only at the appropriate level and with proper supervision in the substance abuse
education. The Diagnostic and Statistical Manual of Mental Disorders (DSM) from the
21
American Psychiatric Association and the Twelve Steps and Twelve Traditions from Alcoholics
World Services are examples of tools that should be integrated into the clinical learning
experience.
22
MEASURES AND METHODS OF EVALUATION
1. Clinical competence as assessed by faculty and medical staff at the treatment center.
2. Measure attitudinal change.
3. Assess the value of teaching methods, strategies, and material.
4. Pre and Post-tests to measure didactic knowledge and skills as well as some clinical
experiences.
5. Completion of a project (e.g. presentation, poster, publication, or group project) to
demonstrate integrated learning and promote scholarship and research.
6. Follow student involvement in post-graduation activities (e.g. community involvement,
teaching, and research)
7. Perception of change in attitudes concerning substance abuse in the department or
organization.
8. Utilize the Substance Abuse Curriculum Development Questionnaire to measure differences
in interest, competence, and importance of substance abuse.
9. Evaluate networking among program administrators, CRNA faculty, student nurse
anesthetists.
10. Investigation of learning styles, methods and techniques used by students.
11. Evaluate the perception of substance abuse and the educational process by the faculty.
12. Investigate the number of chemically impaired professionals reported to the National Council
of State Boards of Nursing (NCSBN).
13. Utilize student input to evaluate the learning process.
14. Evaluate the community impact of a substance abuse curriculum provided by CRNAs.
15. Initiate continued demographic monitoring of beliefs, attitudes, and knowledge concerning
substance abuse.
23
INTRODUCTION TO THE MODULES
The assumption is that the adult educational methodology will be used and ascribed to in
the implementation of this curriculum. Each of the modules are outlined. Each module is
divided into units and the units contain the following information.
Module outline and name.
Module unit number and approximate time.
Overview of the expectation(s) from the module unit.
Terminal objective(s) for the unit.
Teaching methods, equipment, and supplies for the unit.
Unit outline and references.
Recommended methods of evaluation.
24
MODULE 1 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS
Module 1: Introduction and General Awareness of Substance Abuse (SA).
Didactic Units
I. Introduction to the module
A. Objectives and goals for the module.
B. Syllabus for the module.
C. Content and references for the module.
D. Group introduction.
II. Introduction to substance abuse
A. Commonly used terms
B. Defining commonly abused substances and characteristics
C. Basic Pharmacology - I
1. Acute and Chronic abuse
D. Define DSM IV diagnostic criteria
E. Epidemiology
F. Etiology of SA
G. Introduction to legal, ethical, and moral issues in SA
H. Basic assessment and diagnostic skills
I. Multisystem physiology in SA - I
J. Attitudes and self-assessment concerning SA
25
Module 1: Introduction and General Awareness of Substance Abuse (SA).
Clinical Units
III. Introduction to clinical assessment and diagnostics of SA.
A. Self-examination and challenging personal prejudices, beliefs, and attitudes on SA.
B. Performing basic clinical assessment and diagnostic procedures.
C. Examining the relationship between SA and anesthesia.
D. Familiarization with patient and family dynamics.
E. Listing the predisposing risks and progressive stages of SA.
F. Exploration of the etiology and progression of SA
G. Ideas for SA research project (poster, publication, presentation, etc).
26
MODULE 2 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS
Module 2: Increased Special Skills in the Planning, Recognition, Diagnosis, and Treatment of
SA.
Didactic Units
IV. Planning, Recognition, Diagnosis and Treatment of SA sequelae
A. Multisystem physiology in SA - II
B. Pharmacology - II
C. Prevalence and Patterns of SA
D. Tolerance, toxicity, and withdrawal from SA
E. Planning for intervention, intervention and aftercare
F. Central concepts and Research Issues in SA
G. Assessment and screening of SA patients
H. Individual, family, and group dynamics related to SA
I. Identifying community resources and treatment options
27
Module 2: Increased Special Skills in the Planning, Recognition, Diagnosis, and Treatment of
SA.
Clinical Units
V. Clinical Planning, Recognition, Diagnosis and Treatment of SA sequelae
A. Barriers to accurate assessment and data collection from patient, family and physical
examination
B. Interview techniques for extraction of SA information
C. Identifying signs and symptoms of SA at all levels
D. Appropriate treatment options for all SA stages
E. Demonstrate intervention plan, basic intervention and aftercare skills
F. Demonstrate basic treatment and/or referral skills
G. Examining the importance of the professional role of the nurse anesthetist
H. Reflection of personal attitudes and beliefs concerning SA
I. Solidify SA research project
28
MODULE 3 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS
Module 3: Professional Responsibilities, Advanced Knowledge, and Demonstrated Skills in
Substance Abuse.
Didactic Units
VI. Advanced clinical medical sequelae, diagnosis, and treatment of SA.
A. Multisystem physiology - III
1. Maternal and neonatal
2. Fetal and newborn addiction
B. Pharmacology - III
C. AIDS and SA
D. Special at risk populations
E. Interprofessional networking
F. Methods of Prevention
G. Impaired practitioners and recovery
29
Module 3: Professional Responsibilities, Advanced Knowledge, and Demonstrated Skills in
Substance Abuse.
Clinical Units
VII. Advanced clinical medical sequelae, etiology and effects of SA
A. Development of advanced communication and assessment skills
B. Advanced intervention skills (in anticipation of resistance from family or patient)
C. Development and practice of advanced prevention methods
D. Utilization of knowledge for identification, intervention, and aftercare
E. Demonstration of interprofessional collaboration
F. Demonstrate abilities in SA educational methodology
G. Current and logical discussion of SA
H. Presentation of SA research project
I. Demonstration of attitudinal change concerning SA
30
Substance Abuse Curriculum
MODULE 1
DIDACTIC UNIT 1 A-D: Introduction to the modules
Total Time: 15-30 min
Overview: This unit serves as an introduction for the modules and the educational process in
substance abuse. This exercise should be reintroduced at the beginning of each new group and
meeting site.
Terminal Objective: The student will understand the objectives, goals, and syllabus for the
modules. In addition the student will be given references and other pertinent information. The
student will have the opportunity to network with others in the group with introductions.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Pre-test - Reference sheet 1.0
Materials:
Syllabus
Pre-test
31
Substance Abuse Pretest
Module 1
Didactic Unit 1
Reference Sheet 1.0
Please rate your skill in performing each of the following clinical duties concerning the
substance abuse (SA) patient and using the following scale.
1-----2-----3-----4-----5
Low Moderate
High
Skill Skill
Skill
Skill Level
_______
1.
Composing a problem list of the physiological concerns of the SA patient.
_______
2.
Discussing the epidemiology of SA.
_______
3.
Identifying the characteristics of commonly abused substances.
_______
4.
The pharmacological principles to consider for SA.
_______
5.
Defining the DSM IV diagnostic criteria.
_______
6.
Discussing the etiology of SA.
_______
7.
Recognizing the legal, ethical, and moral issues in SA.
_______
8.
Demonstrate basic assessment and diagnostic skills for SA.
_______
9.
Recognizing the attitudinal obstacles to good communication with the SA
patient and family.
_______
10.
Dealing with an impaired colleague.
32
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2A: Introduction to substance abuse and commonly used
terms
Total Time: 1 hour
Overview: This unit serves as an introduction for the glossary of SA terms and their definitions.
The unit will also serve as a introduction to organizations and other resources concerning
substance abuse.
Terminal Objective: The student will understand the many of the commonly used terms,
organizations and resources in SA. In addition the student will be given references for further
exploration.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Content Outline:
VIII. Common terms related to SA
A. Addiction
B. Dependence
C. Use vs. misuse
D. Experimentation
E. Tolerance
F. Additional terms
IX. Organizations
A. Local
B. State
C. National
D. International
X. Resources
A. Written materials
B. Audiovisual materials
C. Professional networking
D. Experiential learning
33
References:
American Nurses' Association, Drug and Alcohol Nursing Association, and National Nurses
Society on Addictions. (1988) The care of clients with addictions: Dimensions of nursing
practice. Kansas City, Mo.: American Nurses Association.
American Nurses' Association and National Nurses Society on Addictions. (1988). Standards of
addictions 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.
American Psychiatric Association. (1975). A psychiatric glossary. Washington, DC: American
Psychiatric Association.
Burns, E.M., Thompson, A. & Ciccone, J.K. (Eds.) (1993) An addictions curriculum for nurses
and other helping professionals. Vol. 1 & 2. New York: Springer Publishing Co.
Flynn, S.P., Davis, A.K., & Fleming, M.F. (1989). Teaching about substance abuse: A resource
manual for faculty development. (NIDA & NIAAA No. PH 276). Rockville, MD: U.S. Dept. of
Health and Human Services.
Kalish, R.A. (1982). Late adulthood: Perspectives on human development. Monterey, CA:
Brooks, Cole Publishing Co.
Nelson, J.E., Pearson, H.W., Sayers, M. & Glynn, R.J. (1982) Guide to drug abuse and research
terminology. Research Issue 26. Rockville, MD: National Institute on Drug Abuse.
Rinaldi, R.C., Steindler, E.M. Wilford, B.B., & Goodwin, D. (1988) Clarification and
standardization of substance abuse terminology. Journal of the American Medical Association
259(4), 555-557.
34
Resources for Substance Abuse:
Alcoholics Anonymous
P.O. Box 459
Grand Central Station
New York, NY 10163
(212) 686-1100
American Association of Nurse Anesthetists
222 South Prospect Ave.
Park Ridge, Ill. 60068
(708) 692 7050
American Council for Drug Education
6193 Executive Boulevard
Rockville, MD 20852
(301) 984-5700
American Medical Association
Department of Health Education
535 North Dearborn St.
Chicago, Ill. 60610
(312) 645-5000
Association of Medical Educators in Substance Abuse (AMERSA)
c/o Brown University
P.O. Box G
Providence, RI 02912
(401) 863-1109
Cork Institute on Black Alcohol and Drug Abuse
Morehouse School of Medicine
720 Westview Drive, S.W.
Atlanta, GA 30310
Food and Drug Administration
Office of Consumer Affairs
5600 Fischer Lane
Rockville, MD 20857
(301) 443-6500
Hazelden Educational Materials
Pleasant Valley Road
35
Box 176
Center City, MN 55012
(800)328-9000
Johnson Institute
7151 Metro Blvd.
Minneapolis, MN 55439
(800) 231-5165
National Clearinghouse for Alcohol and Drug Information
Department PP - P.O. Box 2345
Rockville, MD 20852
(301) 469-2600
National Council on Alcoholism
733 Third Ave.
New York, NY 10017
(212) 986-4433
National Council on Alcoholism and Drug Dependence, Inc
12 West 21st St.
New York, NY 10010
(212) 206-6770
National Highway Traffic Safety Administration
793 Elkridge Landing Road
Linthicum, MD 21090
(301) 962-3877
National Library of Medicine
Collection Access Section
8600 Rockville Pike
Bethesda, MD 20894
National Nurses Society on Addictions
5700 Old Orchard Road, First Floor
Skokie, Ill. 60077
(708) 966-5010
Native American Research Information Service (NARIS)
The American Indian Institute
The University of Oklahoma
555 Constitution Ave.
Norman, OK 73037
36
(405) 325-4127
Resources for Substance Abuse (cont.):
Office of Minority Health Resource Center (OMHRC)
P.O. Box 37337
Washington, DC 20013
(800) 444-6472
Project Cork Institute and Resource Center
Dartmouth Medical School
Hanover, NH 03756
(603) 646-7540
Rutgers University, Center of Alcohol Studies
Smithers Hall, Busch Campus
Piscataway, NY 98854
(201) 932-4442
Education and Training
Van Nest Hall, Room 301
New Brunswick, NJ 081903
(201) 932-2190
37
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2B: Defining commonly abused substances and their
characteristics
Total Time: 1-2 hours
Overview: This unit serves as an introductory study of the substances commonly used and their
characteristics. The session is intended to familiarize the participant with the major mood
altering drugs and provide the framework that will allow comparison of the substances of abuse.
Terminal Objective: The student will understand the many of the commonly abused substances,
their characteristics, and clinical manifestations.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Drug Content Area: from Adger, H., DeAngelis, C., & McDonald, E.M.
Course Outline:
XI. Common drugs of abuse
A. Alcohol
B. Marijuana
1. Hashish
C. CNS stimulants
1. Amphetamines
D. Cocaine
1. Crack
E. CNS depressants
1. Barbiturate
2. Non-barbiturate
3. Anti-anxiety agents
F. Narcotics/Heroin/other controlled substances
1. opiates
a. morphine
b. codeine
2. semi-synthetic
a. heroin
b. hydromorphone
3. synthetic
a. methadone
38
b. meperidine
c. fentanyl
d. sufentanyl
G. Hallucinogens
1. LSD
2. Mescaline
3. MDMA
H. Phencyclidine (PCP)
I. Volatile Inhalants
1. Amyl and isobutyl nitrites
J. Nicotine
K. Caffeine
L. Anabolic steroids
M. Over-the-counter drugs
XII. Content Area for each drug
A. Generic and trade name
B. Street names
C. General information
D. Methods of use
E. Clinical manifestations
F. Formulation and Paraphernalia
G. Treatment for acute abuse
39
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.
Ahmad, G. (1987). Abuse of phencyclidine (PCP): A laboratory experience. Journal of Clinical
Toxicology. 25(4), 341-346.
Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York:
Plenum Medical Books Co.
Boning, J. (1985). Benzodiazepine dependence: Clinical neurobiological aspects. Advances in
Biochemical Psychopharmacology. 40, 185-192.
Buffum, J. (1982). Pharmacosexology: The effects of drugs on sexual function. Journal of
Psychoactive Drugs. 14(1-2), 5-44.
Clouet, D.H. (1986). Phencyclidine: An update. (DHHS publication no. ADM 86-1443)
Washington, DC: U.S. Government Printing Office.
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., & Ellingwood, E.H. (1988). Cocaine and other stimulants: Action, abuse and
treatment. New England Journal of Medicine. 318(18), 1173-1182.
Giannini, A.J., Price, W.A., et al. (1986). Contemporary drugs of abuse. American
FamilyPhysician .33(3), 207-216.
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.
National Institute on Drug Abuse. (1990). NIDA Capsules: CAP01-CAP38. Rockville, MD:
National Clearinghouse for Alcohol and Drug Information.
Peterson, R.G. & Rumack, B.H. (1977). Treating acute acetaminophen poisoning with
acetylcysteine. Journal of the American Medical Association. 237, 2406-2407.
Spitz, H. & Rosecan, J. (Eds.) (1987). Cocaine abuse: New direction in treatment and research.
40
New York: Brunner/Mazel.
Stoelting, R.K. (1987). Pharmacology and physiology in anesthetic practice. Philadelphia: J.B.
Lippincott Co.
West, R.J. & Russell, M.A. (1985). Dependence on nicotine chewing gum. Journal of the
American Medical Association. 256(23), 3214-3215.
41
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2C: Basic pharmacology - I. Acute and Chronic Abuse
Total Time: 2-3 hours
Overview: This unit serves as an introductory 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:
XIII. Basic Pharmacology of Commonly Abused Substances
A. Overview of the Effects of drugs
1. Signs and symptoms
2. Tolerance
3. Pharmacologic effects
B. Alcohol
C. Marijuana
1. Hashish
D. CNS stimulants
1. Amphetamines
E. Cocaine
1. Crack
F. CNS depressants
1. Barbiturate
2. Non-barbiturate
3. Anti-anxiety agents
G. Narcotics/Heroin/other controlled substances
1. opiates
a. morphine
b. codeine
2. semi-synthetic
a. heroin
42
b. hydromorphone
3. synthetic
a. methadone
b. meperidine
c. fentanyl
d. sufentanyl
H. Hallucinogens
1. LSD
2. Mescaline
3. MDMA
I. Phencyclidine (PCP)
J. Volatile Inhalants
1. Amyl and isobutyl nitrites
K. Nicotine
L. Caffeine
M. Anabolic steroids
XIV. Origins of drug use, abuse and dependence
A. Addiction
B. Dependence
C. Cross-dependence
D. Vulnerability
E. Clinical characteristics
F. Symptoms
G. Tolerance and withdrawal
43
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.
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.
Miller, R.D. (Ed.). (1990). Anesthesia. New York: Churchill Livingstone.
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.
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.
44
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2D: Defining the Diagnostic and Statistical Manual of Mental
Disorders
Total Time: 1-2 hours
Overview: This unit serves as an introductory to the problem of substance abuse. The session
will provide insight into the nature of substance abuse and familiarize the participant with the
DSM manual.
Terminal Objective: The student will understand the nature and principles of drug use as related
to substance abuse. In addition the student will be able to identify patterns and factors which
predispose one to substance abuse.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Small group role playing
Course Outline:
XV. Introduction to the nature of substance abuse
A. Overview of drug use
1. Healthful
2. Recreational
B. Drugs used and potential for abuse
1. Marijuana
2. CNS stimulants
3. Cocaine
4. CNS depressants
5. Narcotics/Heroin/other controlled substances
6. opiates
7. semi-synthetic
8. synthetic
9. Hallucinogens
10. Phencyclidine (PCP)
11. Volatile Inhalants
12. Nicotine
13. Caffeine
14. Anabolic steroids
XVI. Defining drug use, abuse and dependence
45
A. Individual perceptions
1. Personal beliefs
2. Personal experimentation
3. Circumstances for drug use
4. Vulnerability for abuse
B. Determination of use, misuse, or abuse
1. Personal definition
2. Social definition
3. Medical definition
C. Social perceptions of drug use, abuse or dependence
1. Frequent use
2. Social use
3. Responsible use
4. Substance abuse
5. Drug dependence
a. Physical dependence
b. Psychological dependence
c. DSM diagnostic criteria
D. Patterns for substance abuse
1. Family history and genetic theory
2. Social learning
3. Dysfunctional family
4. Patterns of communication
5. Family role modeling
46
References:
American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL:
American Association of Nurse Anesthetists.
American Nurses' Association. (1988). Standards of addictive nursing practice with selected
diagnoses and criteria. Kansas City, MO: American Nurses' Association.
American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental
Disorders. Washington, DC: American Psychiatric Association.
Anspaugh, D.J., Hamrick, M.H., & Rosato, F.D. (1991). Wellness: Concepts and applications.
St. Louis, MO: Mosby Year Book.
Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York:
Plenum Medical Books Co.
Blechman, E. (1982). Conventional wisdom about familial contribution to substance abuse.
American Journal of Drug and Alcohol Abuse. 9(1), 35-54.
Frances, R.J. & Miller, S.L. (Eds.) (1991). Clinical textbook of addictive disorders. New York:
The Guilford Press.
Kinney, J. & Leaton, G. (1991). Loosening the grip: A handbook of alcohol information. St.
Louis, MO: Mosby Year Book.
Ray, O. & Ksir, C. (1990). Drugs, society, and human behavior. St. Louis, MO: Times
Mirror/Mosby College Publishing.
U.S. Department of Health and Human Services. (1987). Sixth special report to the U.S.
Congress onalcohol and health: From the Secretary of Health and Human Services. (USDHHS
Publication No. ADM 87-1519). Rockville, MD: National Institute on Alcohol Abuse and
Alcoholism.
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.
Wegscheider-Cruse, S. (1989). Another chance: Hope and health for the alcoholic family. Palo
Alto, CA: Science and Behavior Books.
47
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2E: Epidemiology of substance abuse
Total Time: 1-2 hours
Overview: This unit will discuss the incidence, prevalence, morbidity, mortality and
demographics differences regarding substance abuse. The session will provide insight into
prominent patterns of substance abuse.
Terminal Objective: The student will understand the incidence, prevalence, morbidity, mortality,
demographics, and prominent patterns of substance abuse.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Course Outline:
XVII. Epidemiology of substance abuse
A. Overview of the incidence and prevalence of SA
1. Overall trend of alcohol consumption
2. Overall trend of other substance use/abuse
B. Incidence of substance abuse by age groups
1. Addicted Infants
2. Youth (12-18 years)
3. Young adult (19-25 years)
4. Middle Adult (26-34 years)
5. Older Adult (35+ years)
C. Other abused substances
1. Growth of illicit drugs
2. Marijuana use
3. Nicotine
4. Caffeine
D. Trends in substance use, misuse and abuse
1. 1970-1980
2. 1980-1990
E. Morbidity and Mortality of substance abuse
1. Factors which define morbidity
2. Causes of mortality
3. Most common physical findings of the abuser
4. Polysubstance abuse
48
References:
American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL:
American Association of Nurse Anesthetists.
American Nurses' Association. (1988). Standards of addictive nursing practice with selected
diagnoses and criteria. Kansas City, MO: American Nurses' Association.
Anspaugh, D.J., Hamrick, M.H., & Rosato, F.D. (1991). Wellness: Concepts and applications.
St. Louis, MO: Mosby Year Book.
Haack, M.R. & Harford, T.C. (1984). Drinking patterns among student nurses. International
Journal of Addictions. 19(5), 577-583.
Haberman, P.W. (1987). Alcohol use and alcoholism among motor vehicle driver fatalities.
International Journal of the Addictions. 22(11), 1119-1128.
Kinney, J. & Leaton, G. (1991). Loosening the grip: A handbook of alcohol information. St.
Louis, MO: Mosby Year Book.
Knox, J.M. (1988). Drinking, driving and drugs. New York: Chelsea House Publications.
National Center for Health Statistics. (1981). National health interview survey: Current
estimates, United States, 1981. Washington, DC: U.S. Government Printing Office.
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.
Pinto, R.P., Abrams,D.B., Monti, P.M. & Jacobus, S.I. (1987). Nicotine dependence and
likelihood of quitting smoking. Addictive Behaviors. 12(4), 371-374.
Ray, O. & Ksir, C. (1990). Drugs, society, and humanbehavior. St. Louis, MO: Times
Mirror/Mosby College Publishing.
Sanchez,-Craig, M. (1985). Patterns of alcohol use associated with self-identified problem
drinking. American Journal of Public Health. 75(2), 178-180.
Seigel, R.K. (1982). Cocaine and sexual dysfunction: The course of mama coca. Journal of
Psychoactive Drugs. 14(1-2), 17-74.
U.S. Department of Health and Human Services. (1987). Sixth special report to the U.S.
Congress on alcohol and health: From the Secretary of Health and Human Services. (USDHHS
Publication No. ADM 87-1519). Rockville, MD: National Institute on Alcohol Abuse and
49
Alcoholism.
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.
Wechsler, H. & Rohman, M.E. (1981). Patterns of drug use among New England college
students. American Journal of Drug and Alcohol Abuse. 8(1), 27-37.
Williams, G.D., Gant, B.F., Stinson, F.S., Zobeck, T.S., Aitken, S. S. & Noble, J. (1988). Trends
in alcohol-related morbidity and mortality. Public Health Reports. 103(61), 592-597.
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.
50
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2F: Etiology of substance abuse
Total Time: 2-3 hours
Overview: This unit will discuss the predisposing risk factors for the substance abuser as well as
some of the mechanisms for reducing these at risk populations. The session will delve into
environmental influences, genetic influences, and the dysfunctional family as possible
relationships to prominent patterns of substance abuse.
Terminal Objective: The student will understand the various valid theories predisposing patients
to substance abuse.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Case Presentation # 1
Reference Sheet 1.1
Course Outline:
XVIII. Etiology of substance abuse
A. Factors which may contribute to SA behavior
1. Individual/Personal
a. genetic
b. family pressures
c. living patterns
d. personal reflection
2. Environmental
a. demographics of use and availability
b. cultural patterns
c. socioeconomic patterns
d. profession/occupation
3. At risk behavior
a. dysfunctional families
b. stress
c. personality
d. healthy coping strategies
B. Methods for reducing the incidence of SA for the at risk patient
1. exercise
2. nutrition
3. smoking cessation
51
4. reducing drug and alcohol intake
5. reducing the incidence of AIDS
6. stress reduction
a. biofeedback
b. hypnosis
c. reflexology
d. support groups
e. directions in problem-solving
7. community support
8. self-help
C. Health education in SA
1. Needs assessment
2. Goal formulation
3. Plan for implementation
4. Adult education philosophy
5. Implementation
6. Evaluation
D. Personal reflection and self-evaluation
1. Case presentation # 1
2. ethical issues concerning SA
3. stereotypical assessment of SA
52
References:
American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL:
American Association of Nurse Anesthetists.
American Nurses' Association. (1988). Standards of addictive nursing practice with selected
diagnoses and criteria. Kansas City, MO: American Nurses' Association.
Clarke, M. (1984). Stress and coping: Constructs for nursing. Journal of Advanced Nursing. 9, 313.
Clarke, C. (1986). Wellness: Concepts, theory, research and practice. New York: Springer
Publishing.
Eckhardt, M.J., Harford, T.C. et. al. (1981, April). Health hazards associated with alcohol
consumption. Journal of the American Medical Association. 246(6), 648-666.
Gallagher, W. (1986, August). The looming menace of designer drugs. Discover. pp 24-35.
Goodstadt, M.S. (1986). School-based drug education in North America: What is wrong? What
can be done? Journal of School Health. 56(7), 278-281.
Haack, M.R. & Harford, T.C. (1984). Drinking patterns among student nurses. International
Journal of Addictions. 19(5), 577-583.
Haberman, P.W. (1987). Alcohol use and alcoholism among motor vehicle driver fatalities.
International Journal of the Addictions. 22(11), 1119-1128.
Hilton, M.E. (1987). Regional diversity of U.S. drinking patterns. Berkeley, CA: Institute of
Epidemiology and Behavioral Science.
Hutchinson, S. (1988). Self-care and job stress. Image. 19, 192-196.
Knox, J.M. (1988). Drinking, driving and drugs. New York: Chelsea House Publications.
Lexy, S. (1983). Managing the drugs in your life: A personal guide to the responsible use of
drugs, alcohol, medicine. New York: McGraw-Hill.
References:
McDonough, J.P. (1990). Personality, addiction, and anesthesia. Journal of the American
Association of Nurse Anesthetists. 58(3), 193-200.
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
53
Human Services.
Pinto, R.P., Abrams,D.B., Monti, P.M. & Jacobus, S.I. (1987). Nicotine dependence and
likelihood of quitting smoking. Addictive Behaviors. 12(4), 371-374.
Ray, O. & Ksir, C. (1990). Drugs, society, and human behavior. St. Louis, MO: Times
Mirror/Mosby College Publishing.
Sanchez,-Craig, M. (1985). Patterns of alcohol use associated with self-identified problem
drinking. American Journal of Public Health. 75(2), 178-180.
Scott, C. & Hawk, J. (1986). Heal thyself: The health of health care professionals. New York:
Brunner/Mazel.
Seigel, R.K. (1982). Cocaine and sexual dysfunction: The course of mama coca. Journal of
Psychoactive Drugs. 14(1-2), 17-74.
Summerfield, L.M. (1991). Drug and alcohol prevention education. ERIC Digest (Office of
Educational Research and Improvement. RI 88062015). Washington, DC: Department of
Education
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.
Wechsler, H. & Rohman, M.E. (1981). Patterns of drug use among New England college
students. American Journal of Drug and Alcohol Abuse. 8(1), 27-37.
Williams, G.D., Gant, B.F., Stinson, F.S., Zobeck, T.S., Aitken, S. S. & Noble, J. (1988). Trends
in alcohol-related morbidity and mortality. Public Health Reports. 103(61), 592-597.
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.
54
Substance Abuse Case Presentation #1
Module 1
Didactic Unit 2F
Reference Sheet 1.1
Jay Johnson, is a 23 year old graduate of a leading school of nurse anesthesia and presents with
complaints of stress and requests something to help him relax. He is an anesthesia practitioner
working full-time and studying for an advanced degree in the evenings. He has little time for
socialization and is currently divorced and has one child.
His parents are divorced and his father has had a chronic drinking problem. Jay has also recently
been named in litigation. He has two brothers, one which has had frequent history of DWI and a
second which used illicit drugs while in the service.
Jay does not drink or use street drugs. He clearly states his position as an anti-drinker and antidrugs. He attends Al-Anon meetings every couple of months.
Risk Factors to consider for this Young Adult:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Exposure to drug users in social and work environments
Marital and work stability
Unemployment
Divorce
Psychological or psychiatric difficulties or distress
Low self-esteem
Depression
Peer support
Substance abuse by parents
55
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2G: Introduction to the legal, ethical and moral issues of SA
Total Time: 2-3 hours
Overview: This unit will discuss the legal, ethical and moral issues of SA. This will include
discussion of the impaired professional.
Terminal Objective: The student will understand the various ethical, legal, and moral issues
related to substance abuse.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Role Playing
Field trips to agencies for observation and/or limited interaction
Course Outline:
XIX. Legal issues related to SA
A. Roles of State Boards of Nursing
B. Disciplinary actions
C. Diversion of controlled substances
D. Professional/administrative responsibilities
E. Knowledge of Drug enforcement agencies
F. Screening for recovering abuser
G. Criminal and civil liabilities
H. Patient confidentiality
XX. Ethical issues related to SA
A. AANA code of ethics
B. AANA Peer Assistance statement
C. Professional codes
D. Ethical considerations for reporting
E. Ethical considerations for intervention
F. Impaired professionals
G. Other issues related to SA
XXI. Moral issues related to SA
A. Impaired professionals
1. Prevalence of SA
2. Attitude of professionals
3. Availability of substances for abuse
56
4. Behaviors of impaired professionals, employers,
co-workers, and family which encourage SA.
5. Recovery of impaired professionals
6. Returning impaired professionals to work
XXII. Peer Assistance
A. SA Education
B. Intervention for SA of colleague
C. Intervention organizations and treatment
D. Aftercare and employment
1. Department policies and procedures
2. Motivation of abusers to seek treatment
3. Support groups
4. Peer assistance
E. Changing attitudes toward impaired professionals
57
References:
American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL:
American Association of Nurse Anesthetists.
American Nurses' Association. (1988). Standards of addictive nursing practice with selected
diagnoses and criteria. Kansas City, MO: American Nurses' Association.
Bissell, L. & Haberman, P. (1984). Alcoholism in the professionals. New York: Oxford
University Press.
Bissell, L. & Royce, J. (1987). Ethics for addiction professionals. Center City, MN: Hazelden
Foundation
Cannon, B.L. & Brown, J.S. (1988). Nurses' attitudes toward impaired colleagues. Image,
Summary 20, 9-101.
Caracci, K.O. (1992). The relationship between alcohol use and knowledge among nurses.
Journal of Alcohol and Drug Education. 37(3), 66-73.
Clarke, M. (1984). Stress and coping: Constructs for nursing. Journal of Advanced Nursing. 9, 313.
Connell, C.C. & Murphy, J.F. (1987, Aug.). New dimensions of regulating the practice of
professional nursing. Nursing Management, 18(8), 62-64
Dogoloff, L. & Angarola, R. (1985). Urine testing in the workplace. New York: American
Council for Drug Education.
Foster, S.D. & Jordan, L.M. (Eds.). (1994). Professional aspects of nurse anesthesia practice.
Philadelphia: F.A. Davis Co.
Gallagher, W. (1986, August). The looming menace of designer drugs. Discover. pp 24-35.
Gerber, L.A. (1983). Married to their careers: Career and family dilemmas in doctor's lives. New
York: Tavistock Publications.
Haack, M.R. & Harford, T.C. (1984). Drinking patterns among student nurses. International
Journal of Addictions. 19(5), 577-583.
Hutchinson, S. (1988). Self-care and job stress. Image. 19, 192-196.
Hutchinson, S.A. (1987, Nov./Dec.). Toward self-integration: The recovery process of
chemically dependent nurses. Nursing Research. 36(6), 339-343.
58
Kilty, K. (1975). Attitudes toward alcohol and alcoholism among professionals and nonprofessionals. Journal of Studies on Alcohol. 35(3), 327-347.
Leiker, T. (1989). The role of the addictions nurse specialist in a general hospital setting.
Nursing Clinics of North America. 24(1), 137-149.
Lexy, S. (1983). Managing the drugs in your life: A personal guide to the responsible use of
drugs, alcohol, medicine. New York: McGraw-Hill.
McDonough, J.P. (1990). Personality, addiction, and anesthesia. Journal of the American
Association of Nurse Anesthetists. 58(3), 193-200.
Moore, G. & Hogan, R.L. (1987). Substance abuse and the nurse: A legal and ethical dilemma.
Journal of Professionals Nursing. 3(1), 5.
Naegle, M. (1985, Apr./May). Impaired nursing practice: Ethical and legal issues. Imprint. 32(2),
48-56.
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.
Ray, O. & Ksir, C. (1990). Drugs, society, and human behavior. St. Louis, MO: Times
Mirror/Mosby College Publishing.
Sanchez,-Craig, M. (1985). Patterns of alcohol use associated with self-identified problem
drinking. American Journal of Public Health. 75(2), 178-180.
Scott, C. & Hawk, J. (1986). Heal thyself: The health of health care professionals. New York:
Brunner/Mazel.
Swenson, I., Havens, B. & Chamagne, M. (1989). State boards and impaired nurses. Nursing
Outlook. 37(2), 94-96.
Twerski, A.J. (1982). It happens to doctors, too. Center City, MN: Hazelden Co.
Wechsler, H. & Rohman, M.E. (1981). Patterns of drug use among New England college
students. American Journal of Drug and Alcohol Abuse. 8(1), 27-37.
59
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2H: Basic assessment and diagnostic skills in the SA patient
Total Time: 2-3 hours
Overview: This unit will discuss the skills related to clinical assessment and diagnosis of the SA
patient.
Terminal Objective: The student will understand the various basic techniques required to obtain
a history and physical from substance abuse patients. These basic interviewing skills will enable
the student to obtain the groundwork for planning, treatment or referral of the SA patient.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Role Playing
Field trips to agencies for observation and/or limited interactions
Case examples
Course Outline:
XXIII. Defining addiction
A. Dependence
1. Psychological
2. Physiological feelings
B. Addiction
1. Manifestations
a. Physiological changes
b. Tolerance
c. Cross tolerance
d. Multiple or dual diagnosis
2. Behavioral effects
a. Gambling
b. Sexual disorders
c. Physical problems
d. Emotional
e. Professional
f. Social
g. Family
C. The disease concept of addiction
1. Impairment
60
a. Early
b. Middle
c. Late
2. Denial of addiction
a. Family support for denial
b. Social support for denial
c. Professional support for denial
D. Diagnosis of addiction
1. Acute medical sequela
a. Physical findings
2. Chronic medical sequela
a. Physical findings
3. Engaging patient
a. Patient who accepts disease
b. Patient who denies disease
4. Establishing a supportive relationship
a. Using interviewing skills
b. Showing respect and empathy for patients
5. Understanding the impact of SA
6. Things to avoid during an interview
a. Comparisons
b. Value-laden terms
c. Scare tactics
d. Arguments
e. Hostility
f. Enabling
61
References:
Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York:
Plenum Medical Books Co.
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.
Cananough, R.M. (1986). Obtaining a personal and confidential history from adolescents. An
opportunity for prevention. Journal of Adolescent Health Care. 7(2), 118-122.
Chappel, J.N., Veach, T.L., Krug, R.S. (1985). The substance abuse attitude survey: An
instrument for measuring attitudes. Journal of Studies on Alcohol. 46, 48-52.
Donovan, D. & Marlatt, G. (1988). Assessment of addictive behaviors. New York: The Guilford
Press.
Ewing, J.A. (1984). Detecting alcoholism: The CAGE questionnaire. Journal of the American
Medical Association. 252, 1905-1907.
Frances, R. & Miller, S. (Ed.). (1991). Clinical textbook of addictive disorders. New York: The
Guilford Press.
Jack, L. (Ed.). (1990). The core curriculum of addictions nursing. Skokie, IL: Midwest Education
Association, Inc.
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.
McLellan, A., Luborsky, L. Woody, G., & O'Brien, C. (1980). An improved diagnostic
instrument for substance abuse patients: The addiction severity index. Journal of Nervous and
Mental Disorders. 168, 26-33.
Mumford, E., Anderson, R. Cuerden, T. & Scully, J. (1984). Performance-based evaluation of
medical student' interviewing skills. Journal of Medical Education. 59, 133.
Pokovny, A.D., Miler, B.A., & Kaplan, H.B. (1972). The brief MAST: A shortened version of
the Michigan alcohol screening test. American Journal of Psychology. 129, 342-345.
Selzer, M.L., Vinokur, A., & van Rooijen, L. (1975). A self-administered short Michigan
alcoholism screening test (SMAST). Journal of Studies on Alcohol. 36, 117-126.
62
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.
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.
63
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2I: Multisystem physiology in SA - Level I
Total Time: 2 hours
Overview: This unit will discuss the physiology related to the early stages of substance abuse.
The systems will be introduced in an extensive manner as a supplement to the assessment and
diagnostic skills segment.
Terminal Objective: The student will understand the physiologic basis of the early 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
Pathology
Case examples
Course Outline:
XXIV. A. Cardiovascular
1. Cardiac response to selected drugs
2. Hematologic changes
3. Vascular changes
B. Digestive system
1. Esophagus
2. Stomach
3. Small bowel
4. Large bowel
C. Endocrine
1. Pancreas
2. Liver
3. Spleen
4. Immunologic
D. Pulmonary
E. Neuromuscular
References:
Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York:
64
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.
GuytoPhiladelphia: 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.
65
Substance Abuse Curriculum: MODULE 1
DIDACTIC UNIT 2J: Attitudes and Self-assessment concerning SA
Total Time: 1 hour
Overview: Students should be sensitive to the influence CRNAs attitudes have on recognition,
patient relationships, and diagnosis of SA. They should recognize SA as a disease process and
their professional role in providing prevention.
Terminal Objective: The student will understand their professional responsibility concerning
SA. They will provide a nonjudgmental and nonmoralistic approach to SA. Establish
appropriate optimism about their prognosis. Can accept substance abusers as appropriate to
provide medical attention.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Case examples
Course Outline:
XXV. Contemporary Issues of drug use
A. History of substance use, misuse, and abuse.
B. Legal addictive substances
1. Alcohol
2. Caffeine
3. Nicotine
C. Societal patterns of drug use
D. Drug use among special populations
E. Aging and substance use
F. Life use patterns
XXVI. Reasons for Using drugs
A. Peer pressure
B. "Euphoric Seeking" or "Pain Relief"
C. Choices concerning use
XXVII. Attitudes concerning the topic of SA
A. Biased and non-biased attitudes
B. The disease model of SA
C. Influence of attitudes on patient relationships
D. Influence of attitudes on patient care
E. Attitude development
66
1. Personal
2. Family
3. Society
4. Cultural
F. Stereotypes
XXVIII. Impaired professionals
A. Patterns for CRNAs
B. Factors which determine impairment
C. Legal implications
D. Willingness to learn about substance abuse
XXIX. Employing methods for inducing positive attitudes and recognizing negative attitudes.
A. Evaluation of personal attitudes, values, morals and beliefs
B. Learning about the SA disease model
C. Recognize and practice prevention
D. Understand that your professional role places you in a powerful position for producing
change
67
References:
American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL:
American Association of Nurse Anesthetists.
American Nurses' Association. (1988). Standards of addictive 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.
American Psychiatric Association. (1975). A psychiatric glossary. Washington, DC: American
Psychiatric Association.
Barber, J.G. & Grichting, W.L. (1987). Assessment of drug attitudes among university students
using the short form of drug attitudes scale. International Journal of Addictions. 22(10), 10331039.
Baum, C.D., Kennedy, M. & Jones, J. (1984). Drug use in the United States. Journal of the
American Medical Association. 251(10), 1293-1297.
Bluhm, J. (1987). When you face the chemically dependent patient: A practical guide for nurses.
St. Louis, MO: Ishiyaku EuroAmerica, Inc.
Bureau of National Affairs. (1986). Alcohol and drugs in the workplace: Costs, controls, and
controversies. Washington, DC: Bureau of National Affairs.
Cafiso, J., Goodstadt, M.S., Garington, W.K., et al. (1982). Television portrayal of alcohol and
other beverages. Journal on Studies on Alcohol. 43, 964-989.
Califano, J.A. (1979, Feb. 19). How alcohol damages America. Life and health.
Chappel, J., Veach, T.L. & Krug, R. (1985). The substance abuse attitude survey: An instrument
for measuring attitudes. Journal of Studies on Alcohol. 46(1), 48-52.
Cohen, S. (1982). Cannabis and sex: Multifaceted paradoxes. Journal of Psychoactive Drugs.
14(2), 55-58.
Cook, J. & Fontaine, K. (1991). Essentials of mental health nursing. Menlo Park, CA: AddisonWesley.
Cornish, R.D. & Miller, M.V. (1976). Attitudes of registered nurses toward the alcoholic. Journal
of Psychiatric Nursing and Mental Health Services. 14(2), 19-22
68
Foster, S.D. & Jordan, L.M. (Eds.). (1994). Professional aspects of nurse anesthesia practice.
Philadelphia: F.A. Davis Co.
Hanna, E. (1978). Attitudes toward problem drinkers. Journal of Studies on Alcohol. 1, 98-109.
Hatterer, L. (1979). The pleasure addicts: The addictive process, food, sex, drugs, alcohol, work
and more. South Brunswick, NJ: Barnes, Co.
Hingson, R.W. (1983). Impact on legislation raising the legal drinking age in Massachusetts
from 18-20. American Journal of Public Health. 73, 163-170.
Lyttle, T. (1988). Drug based religions and contemporary drug taking. Journal of Drug Issues.
18(2), 271-284.
Jack, L. (Ed.). (1990). The core curriculum of addictions nursing. Skokie, IL: Midwest Education
Association, Inc.
Jellinek, E.M. (1952). Phases of alcohol addiction. Quarterly Journal for the Study of
Alcoholism. 13, 673-684.
Jones, C. & Battjes, R. (Eds.). (1985). Etiology of drug abuse: Implications for prevention.
(DHHS Publication No. ADM 87-1335). Washington, DC: U.S. Government Printing Office.
Kamerow, D.B., Pincus, H.A. & Macdonald, D.I. (1986). Alcohol abuse, other drug abuse, and
mental disorders in medical practice. Prevalence, costs, recognition, and treatment. Journal of the
American Medical Association. 255(15), 2054-2057.
Keltner, N., Schwecke, L., & Bostrom, C. (1991). Psychiatric nursing: A psychotherapeutic
management approach. St. Louis, MO: Mosby-Year Book.
McAndrew, M. (1990). People who depend upon substances other than alcohol. In: E.
Varicarolis. Foundations of psychiatric mental health nursing. Philadelphia: W.B. Saunders Co.
pp. 632-676.
Nurco, D.N., Shaffer, J.W., Hanlon, T.E., Kinlock, T.W. Duszynski, K.R. & Stephenson, P.
(1987). attitudes toward narcotic addiction. The Journal of Nervous and Mental Disease.
175(11), 653-660.
Peele, S. (1982). Love, sex, drugs and other magical solutions to life. Journal of Psychoactive
Drugs. 14(1-2), 125-131.
Richman, J. (1988). Sociological perspectives on illegal drug use: Definitional, reactional and
etiologic insights. Behavioral Sciences of the Law. 3(3), 249-258.
69
Sadler, D. (1984, June/July). Physicians' attitudes on alcohol abuse are changing. American
Medical News.
Stabenau, J. (1990). Addictive independent factors that predict risk for alcoholism. Journal of
Studies on Alcohol. 51(2), 164-174.
Stephens, R. (1985). The sociocultural view of heroin use: Toward a role-theoretical model.
Journal of Drug Issues. 15(4), 433-446.
Swanson, A. & Hurley, P. (1983). Family systems: Values and value conflicts. Journal of
Psychosocial Nursing and Mental Health Services. 21(7), 25-30.
Szasz, T. (1974). Ceremonial Chemistry. New York: Doubleday.
Turner, T.B. Bennett, V.L. & Hernandez, H. (1981). Beneficial side of moderate alcohol use.
Johns Hopkins Medical Journal. 148(2), 53-63.
Vaillant, G. (1970). The natural history of narcotic drug addiction. Seminars in Psychiatry. 2,
486-498.
Voss, H. & Clayton, R. (1987). Stages in involvement with drugs. Pediatrician. 14, 25-31.
Wechlser, H. McFadden, M., & Bohman, M. (1980). Drinking and drug use among college
students in New England. Journal of the American College Health Association. 18, 275-279.
Werch, C.E. & Gorman, D.R. (1987). Relationship between self-control consumption patterns
and problems of college students. Journal of Studies on Alcohol. 49(1), 30-36.
70
Substance Abuse Curriculum: MODULE 1
CLINICAL UNITS A-G: Introduction to clinical assessment and diagnostics of SA
Total 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 also 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.
Terminal Objective: a) The student will be able to conduct a basic screening, history, and
physical for the SA patient. b) Discuss the diagnosis of SA. c) Recommend support groups for a
basic prevention and intervention process. d) Examine personal values, beliefs, and attitudes
concerning SA. e) Begin the development 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.
Second hour includes an introduction to the methods for history and physical using a
variety of instruments (e.g. CAGE).
Third hour is for taking the Short MAST or other SA self-examination and for
demonstrating techniques used for obtaining a history and physical (consider role playing
with variety of patients).
Fourth hour through the ninth hour provides contact with patients in the clinical setting
for structured learning experiences.
Tenth hour provides an opportunity for students to discuss and research ideas for the SA
research project.
Eleventh hour through the fifteenth hour provides the student an opportunity to share
time with a clinical counselor.
Course Outline:
XXX. Introduction to clinical assessment and diagnostics of SA
A. Self-examination and challenging personal prejudices, beliefs, and attitudes on SA
B. Performing basic clinical assessment and diagnostic procedures
71
C. Learning the relationship between SA and anesthesia
D. Familiarization with patient and family dynamics
1. Observation and participation in prevention and treatment programs
2. Learn the role of support groups in treating substance abuse
E. Listing the predisposing risks and progressive stages of SA
1. Physical responses
2. Psychosocial responses
3. Physiological responses
4. Cognitive changes
F. Exploration of the etiology and progression of SA
G. Ideas for SA research project
72
References:
Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York:
Plenum Medical Books Co.
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.
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.
Ewing, J.A. (1984). Detecting alcoholism: The CAGE Questionnaire. Journal of the American
Medical Association. 252, 1905-1907.
Holt, S. Skinner, H.A. & Israel, Y. Early identification of alcohol abuse: Clinical and laboratory
indications. Canadian Medical Association Journal. 124, 1279-1299.
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.
Milhorn, H.T. (1988). The diagnosis of alcoholism. American Family Physician. 37, 175-183.
73
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.
Tiebout, H.M. (1953). Problems of addiction and habituation. New York: Grune and Stratton.
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.
74
Formative Evaluation of Module 1
Substance Abuse Curriculum
Reference Sheet 1.3
Using the following scale please rate your accomplishments of the objectives in Module 1
including the didactic and clinical components of the substance abuse curriculum.
1-------2-------3-------4-------5
Low
Moderate High
Accomplishment
Level of Accomplishment
____Understanding the objectives, goals and syllabus for the modules.
____Recognizing commonly used terms, organizations, and resources in the field of substance
abuse.
____Recognizing the commonly abused substances, their characteristics and clinical
manifestations.
____Understanding the pharmacologic basis and principles of many commonly abused
substances.
____Identifying patterns and factors which predispose one to substance abuse.
____Relating the incidence, prevalence, morbidity, demographics and prominent patterns of
substance
abuse.
____Recognizing valid theories predisposing patients to substance abuse.
____Discussing the ethical, legal, and moral issues related to substance abuse.
____Applying basic techniques for obtaining a history and physical and interviewing a substance
abuse patient.
____Implementing a plan for treatment and referral of the substance abuse patient.
____Discussing the physiology of the early stages of substance abuse.
____Understanding professional responsibilities concerning substance abuse.
75
____Enhanced clinical skills in diagnosing substance abuse.
____Examining personal beliefs, values and attitudes concerning substance abuse.
Additional Comments:
76
Substance Abuse Curriculum
MODULE 2
DIDACTIC UNIT A: Multisystem physiology in SA - Level II
Total 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
77
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.
78
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.
79
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT B: Pharmacology - II
Total 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
80
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
B. Drug concentration
C. Genetics
81
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.
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.
82
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.
83
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT C: Prevalence and Patterns of SA
Total 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
84
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
85
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, 174187.
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), 262270.
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.
86
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.
87
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT D: Tolerance, Toxicity, and Withdrawal from SA
Total 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
88
(1) Poly substances use
6. Recovery
a. Detoxification
b. Behavior modification to change lifestyle
c. Long term support groups
B. Toxicity
1. Assessment
2. Acute management
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
89
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.
Ahmad, G. (1987). Abuse of Phencyclidine (PCP): A laboratory experience. Journal of Clinical
Toxicology. 25(4), 341-346.
American Psychiatric Association. (1997). Diagnostic and statistical manual (DSM-IV).
Washington, DC: APA, American Psychiatric Association.
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.
Dole, V. (1988, Nov.). Implications for methadone maintenance for theories of narcotic
addiction. Journal of the American Medical Association. 260, 20.
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.
90
Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York:
Macmillan Publishing Co.
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.
91
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT E: Planning for Intervention, Intervention and Aftercare
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)
92
(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
93
(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)
94
(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
95
References:
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
96
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.
97
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT F: Central Concepts and Research Issues in SA
Total 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
98
B. Colleagues
C. Community
D. Society
E. Adequate utilization of resources?
XLIV. Evaluation of SA policy
A. Methodology
99
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.
100
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT G: Assessment and Screening of SA patients
Total 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
e. poor appearance
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
101
(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 5080% 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
102
References:
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
103
Internal Medicine. 77, 249-258.
Podrosky, D.L. & Sexton, D.L. (1988, Spr.). Nurses' reaction to difficult patients. Image. 26, 1620.
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.
104
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT H: Individual, Family, and Group Dynamics related to SA
Total 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
105
E. Educational intervention
F. Prenatal teaching
G. Economic ramifications
106
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.
107
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, 1620.
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.
108
Substance Abuse Curriculum: MODULE 2
DIDACTIC UNIT I: Community resources and treatment options
Total 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
109
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
110
References:
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.
111
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.
112
Substance Abuse Curriculum: MODULE 2
CLINICAL UNITS A-I: Increased special skills in clinical planning, recognition,
diagnosis, and treatment of SA
Total 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.
113
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
114
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.
115
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.
116
Taylor, R.B. (1982). Health promotion: A guide to clinical practice. Norwalk: Appleton-CenturyCrofts.
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.
117
Formative Evaluation of Module 2
Substance 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
Level of Accomplishment
____Discussing the physiologic basis of the stages of substance abuse.
____Understanding and discussing the pharmacologic basis and principles of many of the
commonly abused substances, their characteristics and clinical manifestations as related to
anesthesia.
____Recognizing the prevalence, trends and patterns of substance abuse through the lifespan.
____Understanding the concepts of tolerance, cross-tolerance, drug toxicity, and withdrawal as it
relates to substance abuse and anesthesia.
____Planning for intervention, how to intervene and the recovery process.
____Discussing issues and problems related to substance abuse.
____Developing a research project for the topic of substance abuse.
____Developing clinical diagnostic criteria and screening methods for the substance abuse
patient.
____Describing the correlation between dysfunctional family communication and substance
abuse.
____Recognizing at risk populations.
118
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:
119
Substance Abuse Curriculum
MODULE 3
DIDACTIC UNIT A: Multisystem physiology in SA - Level III
Total Time: 2 hours
Overview: This unit will discuss the detailed physiology related to the central nervous system,
maternal and the neonatal patient, fetal and newborn addiction, and SA in children addiction.
The unit will serve to assist the student in the assessment and diagnostic skills of SA.
Terminal Objective: The student will understand the physiologic basis of maternal and fetal
addiction, neonatal and newborn addiction, and SA in children. 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:
LIV. Central nervous system
A. Neuroanatomy and physiology
B. Neural cell
C. Neural synapse and transmitters
D. Brain
1. Physiology
2. Function
a. cognitive
b. psychomotor
c. affective
3. Gerontologic changes
4. Substance abuse
a. specific agents of abuse
(1) sites of action
b. mechanism of action
c. effects
5. SA related Behavior
6. Nutrition
E. Psychiatric disorders
120
LV. Maternal and neonatal
A. Substance use, misuse, and abuse
1. During pregnancy
2. Post partum
3. Nursing mothers
B. Fetal physiological effects of SA
C. Neonate drug effects
1. Alcohol syndrome
2. Maternal SA
3. Withdrawal
4. Drugs and fetal development
LVI. Children and SA
A. Growth and development related to SA
B. Substances commonly abused by children
1. Inhalants
2. Tobacco
3. Alcohol
4. Marijuana
5. Cocaine
6. Caffeine
121
References:
Abel, E.L. (1984). Pharmacology of alcohol relating to pregnancy and lactation. New York:
Plenum Press.
Acker, D., Sachs, M.D., Tracy, K.J. & Wise, W.E. (1983). Abruptio placenta associated with
cocaine use. American Journal of Obstetrics and Gynecology. 146(2), 120-221.
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.
Barten, J. & Talbott, S. (Eds.). (1989). Primary prevention in psychiatry: The state of the art.
Washington, D.C.: American Psychiatric Press.
Beauvais, F. & Oetting, E.R. (1988). Inhalant abuse by young children. research Monograph, No.
85. (DHHS Publication No. ADM 88-1577). Washington, D.C.: National Institute for Drug
Abuse.
Bonagura, J.A., Rhonehouse, M. & Bonagura, E.W. (1988). Effectiveness of four school health
education projects upon substance use, self-esteem, and adolescent stress. Health Education
Quarterly. 15(1), 81-92.
Burns, E.M., Thompson, A. & Ciccone, J.K. (Eds.). (1993). An addictions curriculum for nurses
and other helping professionals. (Vol. 1 & 2). New York: Springer Publishing Co.
Burton, A.C. (1972). A physiology and biophysics of the circulation. Chicago: Year Book
Medical Pub.
Chasnoff, I.J., Burens, W.J., Schroll, S.H. & Burns, K.A. (1985). Cocaine use in pregnancy. The
New England Journal of Medicine. 313(11), 666-669.
Chasnoff, I.J., Schroll, S.H., Burns, W.J., & Burns, D. (1984). Maternal non-narcotic substance
abuse during pregnancy: Effects on infant development. Neurobehavioral Toxicology and
Teratology. 6(4),
277-280.
Clark, W.G. et al. (1988). Goth's medical pharmacology. St. Louis, MO: C.V. Mosby Co.
Clarren, S.K. (1982). The diagnosis and treatment of fetal alcohol syndrome. Comprehensive
Therapy. 8, 41.
Cohen, S. & Callahan, J. (Eds.). (1986). A specific approach to the treatment of alcohol abusing
122
patients. New York: Hayworth Press.
Coles, C.D., Smith, I.E., Lancaster, J.S. & Flaek, A. (1987). Persistence over the first month of
neurobehavioral differences in infants exposed to alcohol prenatally. Infant Behavior and
Development. 10(1), 23-37.
Fox, N.L., Sexton, M.J. & Hebel, R.J. (1987). Alcohol consumption among pregnant smokers:
Effects of smoking cessation intervention program. American Journal of Public Health. 77(2),
211-213.
Fried, P.A., Buchingham, M. & Von Kuloniz, P. (1983). Marijuana use during pregnancy and
perinatal risk factors. American Journal of Obstetrics and Gynecology. 146(8), 992-994.
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.
Golden, N.L., Kuhnert, B.R., Sokol, R.J., Martier, S. & Bagby, M.S. (1984). Phencyclidine use
during pregnancy. American Journal of Obstetrics and Gynecology. 148(3), 254-259.
Goldstein, D.B. (Ed.). (1983). Pharmacology of Alcohol.
New York: Oxford University Press.
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.
Horowitz, J. (1988). Anesthetic implications of substance abuse in the parturient. Journal of the
American Association of Nurse Anesthetists. 56, 510.
James, J.E. & Paul, I. (1985). Caffeine and human reproduction. Reviews on Environmental
Health. 5(2), 151-167.
Lee, M.I., Stayker, J.C. & Sokol, R.J. (1985). Perinatal care for narcotic-dependent gravidas.
Perinatology-Neonatology. 9(6), 135-140.
Kinney, J. & Leaton, G. (1991). Loosening the grip: A handbook of alcohol information. St.
Louis, MO: Mosby-Year Book.
123
Michenfelder, J.D et al. (1969). Neuroanesthesia. Anesthesiology. 30, 65.
Miller, R.D. (1990). Anesthesia. New York: Churchill Livingstone.
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.
Rementeria, J.L. (1977). Drug abuse in pregnancy and neonatal effects. St. Louis, MO: C.V.
Mosby.
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.
Rosett, H.L. & Weiner, L. (1984). Alcohol and the fetus: A clinical perspective. New York:
Oxford University Press.
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.
124
Substance Abuse Curriculum: MODULE 3
DIDACTIC UNIT B: Pharmacology - III
Total Time: 2-3 hours
Overview: This unit serves as a final consolidation of pharmacological principles and the
pharmacology of the substances commonly abused. The session is intended to familiarize the
participant with the substance abuse as it relates to anesthesia.
Terminal Objective: The student will understand the pharmacologic basis and principles of
abused substances, their characteristics, and clinical manifestations as they relate to the
administration of anesthesia. They will be able to describe the anticipated interaction of abused
drugs with anesthetics as well as the effects from polysubstance substance use/abuse.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Clinical patient case
Course Outline:
LVII. Pre Anesthetic considerations for SA
A. Laboratory tests
1. Toxicology assays
2. Liver function tests
3. CBC
4. Electrolyte
5. Hepatitis
6. HIV
7. Systemic infections
a.Cultures
b.Tuberculosis
c.Syphilis
d.Sepsis
8.Neuroreceptors and transmitters
a.Kappa/Mu/others
b.Alpha2-receptor agonists
B. Drug dependence and premedication
1. Alcohol dependence
2. Opioid dependence
3. Nicotine dependence
125
4. Other drug dependencies
5. Recovering addict
6. Use of Disulfiram (Antabuse) and Naltrexone
7. Use of AZT
C.Pharmacokinetic and Pharmacodynamic considerations of abused substances and
anesthesia
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
LVIII. Metabolism, clearance, and elimination of substances with regards to anesthesia
A. Metabolism
1. Hepatic
2. Renal
3. Biliary
4. Metabolic degradation
5. GABA receptors
B. Pharmacologic management of withdrawal
1. Intermittent or recurrent withdrawal
2. Complicated withdrawal
3. Unrecognized withdrawal
4. Preanesthetic transition from abuse to withdrawal
5. Unrecognized medical events interpreted as withdrawal
LIX. Anesthetic technique (Drugs used for anesthesia)
A. Pharmacologic considerations for anesthetic selection
B. Nonpharmacologic intervention (TENS)
C. Limitations of the anesthetic technique
D. Anesthetic requirements for SA patients
LX. Post anesthetic considerations
A. Post operative pain control
1. Use of naloxone
2. Methadone use
126
3. Patient controlled analgesia (PCA) units
4. Nonsteroidal antiinflammatory drugs (e.g. Ketorolac)
5. Agonists/Antagonists
a. Dezocine
b. Butorphanol
c. Nalbuphine
d. Pentazocine
6. Pharmacologic cross-tolerance
B. Recovery and Relapse with pharmacologic intervention
1. Neurochemical mechanisms
2. Psychological mechanisms
a.Fear of pain
b.Pleasure seeking
c.Stress
C. Medical care in recovery
1. Treatment strategies
a. American Society of Addiction Medicine (ASAM) for medical care in
recovery
2. Treatment of Chronic Pain
a.Discharge medication
b.In active SA patient
c.In Recovering SA patient
127
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.
Adler, G.R., Potts, F.E., Kirby, R.R. et al. (1985). Narcotics control in anesthesia training.
Journal of the American Medical Association. 253, 3133.
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.
Angell, M. (1982). The quality of mercy. New England Journal of Medicine. 306, 98.
Antelman, S.M. (1981) Amitriptyline provides long-lasting immunization against sudden cardiac
death from cocaine. European Journal of Pharmacology. 69, 119.
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.
Bruce, D.L. (1983). Alcoholism and anesthesia. Anesthesia and Analgesia. 62, 84.
Buckley, M.M.T., Brogden, R.N. (1990). Ketorolac: A review. Drugs. 39, 86.
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.
DeLander, G.E., Porthoghese, P.S. & Takemori, A.E. (1984). Role of spinal mu opioid receptors
128
in the development of morphine tolerance and dependence. Journal of Pharmacologic
Experimental Therapy. 231(1), 91.
Elliot, H.W. (1975). Effects of street drugs on anesthesia. International Journal of Clinical
Pharmacology. 12, 134.
Fabiani, C.A. (1991). From coca chewing to cocaine smoking. Resident Staff Physician. 37, 101.
Farley, W.J. & Talbott, G.D. (Eds.). (1983). Anesthesiology and addiction. Anesthesia and
Analgesia. 62, 465.
Filshie, J. (1988). The non-drug treatment of neuralgic and neuropathic pain of malignancy.
Cancer Survey. 7(1), 161.
Freund, G. (1984). Biomedical causes of alcohol abuse. Alcohol. 1(2), 129-131.
Frost, E.A. (Ed.). (1988). Pre-anesthetic assessment. Boston: Birkhauser.
Gawin, F.H. & Ellingwod, E.H. (1988). Cocaine and other stimulants: Action, abuse and
treatment. New England Journal of Medicine. 318(18), 1173-1182.
Gerard, D.L., Saenger, G. & Wile, R. (1962). The abstinent alcoholic. Archives of General
Psychiatry. 6, 83.
Gold, M., Pottash, A., Sweeney, D. et al. (1980). Opiate withdrawal using clonidine. A safe,
effective, and rapid non-opiate treatment. Journal of the American Medical Association. 243(4),
343.
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.
Guiffrida, J.G., Bizzarri, D.V., Saure, A.C. et al. (1970). Anesthetic management of drug
abusers. Anesthesia and Analgesia. 49(2), 272.
Jacobs, M.R. & Fehr, K.O. (1987). Drugs and drug abuse: A reference text. Toronto, Canada:
Addiction Research Foundation.
129
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.
McQuay, H. (1988). Pharmacologic treatment of neuralgic and neuropathic pain. Cancer Survey.
7(1), 141.
Millan, M. (1986). Multiple opioid systems and pain. Pain. 27, 303.
Miller, R.D. (Ed.). (1990). Anesthesia. New York: Churchill Livingstone.
O'Brian, J., Benfield, P. (1989). Dezocine: A preliminary review of its pharmacodynamic and
pharmacokinetic properties and therapeutic efficacy. Drugs. 38(2), 226.
Orkin, L.R. & Chen, C.H. (1977). Addiction, alcoholism and anesthesia. Southern Medical
Journal. 70, 1172.
Osborne, N.N. (1977). Naloxone alters pain perception and somatosensory evoked potentials in
normal subjects. Nature. 270, 620.
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.
Scott, L.E., Clum, G.A., & Peoples, J.B. (1983). Preoperative predictors of postoperative pain.
Pain. 15, 283.
Spiker, D.G., et al. (1975). Tricyclic antidepressant overdose: Clinical presentation and plasma
levels. Clinical Pharmacologic Therapy. 18(5), 539-546.
Stuart, G. & Sundeen, S. (Eds.). (1986). Principles and practice of psychiatric nursing. St. Louis,
130
MO: C.V. Mosby.
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.
131
Substance Abuse Curriculum: MODULE 3
DIDACTIC UNIT C: AIDS and Substance Abuse
Total Time: 1 hour
Overview: This unit will discuss the physiologic basis, prevention, precautions and
considerations for the HIV positive patient.
Terminal Objective: The student will recognize the primary elements in the process of
immunosuppression and the cascade of events leading to the deactivation of the immune
response. They will be able to identify factors which predispose the substance abuser to AIDS.
Students will be able to formulate and utilize preventative treatment modalities for AIDS.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Role Playing
Course Outline:
LXI. Immune response
A. Cellular Invasion
B. AIDS virus
C. Symptoms of AIDS
D. At risk populations
1. Cultures
2. Socioeconomic groups
E. Spread of AIDS virus
1. Sexual
2. Contaminated needles
3. Suppressed immune system
4. Breast feeding
5. Mother to fetus
F. Ethical considerations
G. Economic impact
LXII. Education
1. Prevention
2. Avoidance
3. Recognition of high-risk populations
4. AIDS resource centers
132
References:
AIDS called 'Most threatening' illness in history. (1987, May). U.S. Medicine.
Alexander, B.K. & Hadaway, P. (1982). Opiate addiction: The case for adaptive orientation.
Psychological Bulletin.
American Medical Association. (1987). Prevention and control of AIDS: An interim report.
Chicago, IL: Report of the Board of Trustees, AMA
American Medical Association. (1972). Human sexuality. Chicago, IL.: AMA Committee on
Sexuality.
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.
Associated Press. (1987, June 15). AIDS treatment costs
by mid-1991. Houston Chronicle.
estimated at more than $37 Billion
Awe, R.J. et al. (1987). AIDS: A guide for survival. Houston, TX: Harris County Medical
Society and The Houston Academy of Medicine.
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.
Broder, S. (1987). Identification of therapies against the retroviruses. Annals of Internal
Medicine. pp.569-574.
Clark, M. & Gonzalez, D.L. (1987, July). The mosquito AIDS scare. Newsweek.
Conant, M.S. (1987, June). Confronting AIDS in primary care. Patient Care.
DeVita, V.T. (1987). Developmental therapeutics and the acquired immunodeficiency syndrome.
Annals of Internal Medicine. 106, 56-71.
133
Drew, L. (1987, June). The problem with testing. Newsweek.
Fischl, M.A. (1987). Evaluation of heterosexual partners, children and household contacts of
adults with AIDS. Journal of the American Medical Association. 257(5).
Gordon, S. & Gordon, J. (1983). Raising your child conservatively in a sexually permissive
world. New York: Simon and Schuster.
Groopman, J.E. (1987, June). Taking care of AIDS patients. The Internist.
If your test for antibody to the AIDS virus is positive... (1986, Oct.). American Red Cross.
Jabs, C. (1987, Jan.). Safe sex. Self.
Kaus, M. (1987, July 13). The small health problem' of AIDS. Newsweek.
O'Brien, K.J. (1987, Apr.). Will the nation's health insurers survive the AIDS epidemic. The
Internist.
Smilgis, M. (1987, Feb. 16). The big chill: Fear of AIDS. Time.
Stengel, R. (1985, Dec. 9). Children having children. Time.
134
Substance Abuse Curriculum: MODULE 3
DIDACTIC UNIT D: Special At Risk Populations
Total Time: 2 hours
Overview: This unit will discuss the populations who are at risk for substance abuse. The unit
will aid in the implementation of educational and preventative programs for a Drug free
environment.
Terminal Objective: The student will formulate and implement an educational and preventative
programs for their community. They will be able to identify factors which predispose the
individual to substance abuse.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Role Playing
Course Outline:
LXIII. Educating Role of the CRNA in the community and for "At Risk" Populations
A. Defining basic terms for the community
B. Discussing drugs and drug effects commonly used
C. Relating reasons for SA
D. Describing ethnic and age differences in SA
E. Reviewing physical illnesses related to SA
F. Reviewing psychological illnesses related to SA
G. Listing support groups and community organizations that aid in the prevention of SA
and the substance abuser
H. Commenting on the ethical, moral, and legal considerations regarding SA
I. Denoting the economic impact of SA
J. Encouraging the use of counseling and treatment to reduce incidence
LXIV. Education about critical patterns of SA
A. Behaviors
B. Family and social influences
C. Growth and development patterns
D. Child health
1. Well baby clinics
2. School SA program
References:
American Medical Association. (1987). Prevention and control of AIDS: An interim report.
135
Chicago, IL: Report of the Board of Trustees, AMA
American Medical Association. (1972). Human sexuality. Chicago, IL.: AMA Committee on
Sexuality.
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.
Arkin, E.B. & Funkhouser, J.E. (Eds.). (1990). Communicating about alcohol and other drugs:
Strategies for reaching populations at risk. Rockville, MD: U.S. Department of Health and
Human Services, Office for Substance Abuse Prevention.
Arneson, S.W., Triplett, J.L. Schweer, K.D. & Snider, B.C. (1983). Children of alcoholic
parents: Identification and intervention. Children's Health Care. 11, 107-112.
Associated Press. (1987, June 15). AIDS treatment costs estimated at more than $37 Billion by
mid-1991. Houston Chronicle.
Awe, R.J. et al. (1987). AIDS: A guide for survival. Houston, TX: Harris County Medical
Society and The Houston Academy of Medicine.
Baily, G.W. (1989). Current perspectives on substance abuse in youth. Journal of the American
Academy of Child and Adolescence Psychiatry. 28, 151-162.
Barbarin, O. (1979). Recidivism in drug addiction: A behavioral analysis. Addictive Behaviors.
4(2), 121-132.
Barten, J. & Talbott, S. (Eds.). (1989). Primary prevention in psychiatry: The state of the art.
Washington,D.C.: American Psychiatric Press.
Beck, K.H. (1990). Monitoring parent concerns about teenage drinking and driving: A random
digit dial
telephone survey. American Journal of Drug and Alcohol Abuse. 16, 109-124.
References:
Bennett, G., Vourakis, C., & Woolf, D. (1983). Substance abuse: Pharmacological,
developmental and clinical perspectives. New York: John Wiley.
Beauvais, F. & Oetting, E.R. (1988). Inhalant abuse by young children. Research Monograph
No. 85. (DHHS Publication No. ADM 88-1577). Washington, D.C.: National Institute on Drug
Abuse.
136
Black, C. (1982). It will never happen to me. Denver: MAL Books.
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.
Bonagura, J.A., Rhonehouse, M. & Bonagura, E.W. (1988). Effectiveness of four school health
education projects upon substance use, self-esteem, and adolescent stress. Health Education
Quarterly. 15(1), 81-92.
Broder, S. (1987). Identification of therapies against the retroviruses. Annals of Internal
Medicine. pp.569-574.
Brown, S.A., Christiansen, B.A. & Coldman, M.S. (1987). The alcohol expectancy
questionnaire: An instrument for the assessment of adolescent and adult alcohol expectancies.
Journal of Studies on Alcohol. 48, 483-491.
Caudill, B. (1989). Project impact: A national study of high school substance abuse intervention
training. Journal of Alcohol and Drug Education. 35, 61-74.
Clark, M. & Gonzalez, D.L. (1987, July). The mosquito AIDS scare. Newsweek.
Crumley, F.E. (1990). substance abuse and adolescent suicidal behavior. Journal of the American
Medical Association. 263, 3051-3056.
DeVita, V.T. (1987). Developmental therapeutics and the acquired immunodeficiency syndrome.
Annals of Internal Medicine. 106, 56-71.
Drew, L. (1987, June). The problem with testing. Newsweek.
Fischl, M.A. (1987). Evaluation of heterosexual partners, children and household contacts of
adults with AIDS. Journal of the American Medical Association. 257(5).
Globetti, G. (1988, Winter). alcohol education and minority youth. Journal of Drug Issues. pp.
115-129.
Gordon, S. & Gordon, J. (1983). Raising your child conservatively in a sexually permissive
world. New York: Simon and Schuster.
Greenspan, S.I. (1985). Research strategies to identify developmental vulnerabilities for drug
abuse. Research Monograph No. 56. Washington, D.C.: National Institute for Drug Abuse. pp
136-154.
137
Grenier, C. (1985). Treatment effectiveness in an adolescent chemical dependency treatment
program: A quasiexperimental design. International Journal of the Addictions. 20, 381-391.
Jabs, C. (1987, Jan.). Safe sex. Self.
Lewis, C.E. & Lewis, M. (1984). Peer pressure and risk-taking behaviors in children. American
Journal of Public Health. 74, 580-584.
McDonald, D.I. (1989). Drugs, drinking, and adolescents. Chicago: Year Book Medical
Publishers.
Natapoff, J. & Weiczorek, R.R. (Eds.). (1990). Maternal child health policy: A nursing
perspective. New York: Springer.
National Institute on Drug Abuse. (1991). National household survey on drug abuse: Main
findings 1990. (DHHS Publication No. ADM 91-1788). Rockville, MD: U.S. Department of
Health and Human Services.
Pentz, M.A., Dwyer, J.H., Mackinnon, D.P., et al. (1989). A multicommunity trial for primary
prevention of adolescent drug abuse. Journal of the American Medical Association. 261, 32593266.
Riley, K. & Klockars, A.J. (1984). A critical reexamination of the adolescent alcohol
involvement scale. Journal of Studies on Alcohol. 45, 184-187.
Stengel, R. (1985, Dec. 9). Children having children. Time.
U.S. Department of Education. (1988). Drug prevention curricula: A guide to selection and
implementation. Washington, D.C.: Office of Educational Research and Improvement.
Wegscheider, S. (1981). Another chance. Palo Alto, CA: Science and Behavior Books.
138
Substance Abuse Curriculum: MODULE 3
DIDACTIC UNIT E: Interprofessional networking
Total Time: 1 hour
Overview: This unit will introduce the student to professionals who practice outside their
clinical settings. They will participate in discussions that plan education and treatment for
communities, professional groups and SA patients.
Terminal Objective: The student will be able to participate with professionals outside the
immediate clinical setting and provide education for communities and professional groups. They
will be able to discuss available resources regarding substance abuse. Students will be able to
formulate a collaborative network of professionals in the area of substance abuse.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Site visits
Course Outline:
LXV. Individual experiences for collaboration in SA
A. Recognizing, isolating, and identifying professionals in the clinical setting.
1. Professional teachers in the clinical setting.
2. Professionals in collaboration with the clinical faculty.
3. Personnel who provide support services to the clinical setting.
4. Use of consultants for collaborative purposes
B. Leadership roles in the field of SA as a professional
1. Commitment to a profession
LXVI. Group experiences for collaboration in SA
A.Recognizing, isolating, and identifying professionals in community groups
1. Networking and socialization within the community
2. Developing an identity as a successful leader in groups
3. Methods for conducting meetings and collaborative networking within the
community
4. Use of community groups for collaboration
LXVII. Community resources available for networking
A. Education
B. Prevention
C. Treatment and assistance
D. Recovery and restoration to productive role in society
139
References:
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.
Bard, R., Bell, C.R., Stephen, L. & Webster, L. (1987). The trainer's professional development
handbook. San Francisco: Jossey-Bass.
Batten, Joe D. Tough-minded Leadership. New York: AMACOM, 1989.
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.
DeLem, G. (1987). Alcohol use among drug abusers: Treatment outcomes in a therapeutic
community. Alcoholism: Clinical and Experimental Research.
11(5), 430-436.
DePree, Max. Leadership is an Art. New York: Dell Publishing, 1989.
Dole, V. (1988, Nov.). Implications for methadone maintenance for theories of narcotic
addiction. Journal of the American Medical Association. 260, 20.
Gardner, John. On Leadership. New York: The Free Press, 1990.
140
Jacobs, P., Laurie, A. & Cuzzi, L. (1983). Coordination of services to methadone mothers and
their addicted newborns. Health Social Work. 8(4), 290-298.
Kotter, John P. A Force for Change: How Leadership Differs from Management. New York:
The Free Press, 1990.
Kran, K.E. (1984). Mentoring at work: Developmental relationships in organizational life.
Glenview, IL: Scott, Foresman.
Levinson, D.J. (1978). The seasons of a man's life. New York: Knopf.
Lipnack, J. & Stamps, J. (1982). Networking: People connecting with people, linking ideas and
resources. New York: Doubleday.
Raffoul, P.R. (1986). Drug misuse among older people: Focus for interdisciplinary efforts.
Health Social Work. 11(3), 197-203.
Smith, L & Wagner, P. (1980). The networking game. Denver: Network Resources.
141
Substance Abuse Curriculum: MODULE 3
DIDACTIC UNIT F: Methods of prevention for SA
Total Time: 2 hours
Overview: Students should be able to effectively identify and plan the prevention process, apply
the prevention process, and recommend modalities in prevention. Students should be able to
encourage patient, families, groups, and communities to initiate prevention by using sound and
supportive educational methods.
Terminal Objective: The student will understand the preventative process, how to implement
preventative methodologies, and evaluate the outcomes of those techniques.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Course Outline:
LXVIII. Planning for Prevention
A. Prevention
1. Education
a. Continuing professional education
b. Participating in community education
c. Health education and wellness clinics
d. Drug free social activities
2. Promoting health
a. Developing goals for improved community health
b. Education concerning the safe use of drugs and alcohol
c. Teaching safe sex
d. Describing good nutritional habits
e. Encouraging exercise
f. Aiding in smoking cessation exercises
g. Teaching relaxation techniques
(1) Hypnosis
(2) Biofeedback
(3) Reflexology
(4) Touch Therapy
(5) Acupuncture
(6) Time management
h. Teaching conflict resolution
142
(1) Problem-solving methods
(2) Support groups
i. Supporting the use of community support groups and resources
3. Community educational participation
a. Supporting community action
b. Participating in community support groups and agencies
c. Improving social perception and laws related to SA
d. Creating a network of professionals
e. Support drug free environments
f. Aid institutions in developing a rational substance free environment
143
References:
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.
Clarke, M. (1984). Stress and coping: Constructs for nursing. Journal of Advanced Nursing. 9, 313.
Clarke, C. (1986). Wellness: Concepts, theory, research and practice. New York: Springer
Publishing.
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.
Fossum, M. & Mason, M. (1986). Facing shame: Families in recovery. New York: W.W.
Norton.
Goldstein, D.B. (Ed.) (1983). The pharmacology of alcohol. New York: Oxford Press.
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
Haberman, P.W. (1987). Alcohol use and alcoholism among motor vehicle driver fatalities.
International Journal of the Addictions. 22(11), 1119-1128.
Hutchinson, S. (1988). Self-care and job stress. Image. 19, 192-196.
Jones, C. & Battjes, R. (1985). Etiology of drug abuse: Implications for prevention. NIDA
144
Research Monograph 56. (DHHS Publication No. ADM 87-1335). Rockville, MD: Department
of Health and Human Services.
Knopping, P., & Maultsby, M. (1977). Rational self-counseling: Primary prevention for alcohol
abuse. Alcohol Health and Research World. 2(1), 31-35.
Knox, J.M. (1988). Drinking, driving and drugs. New York: Chelsea House Publishers.
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.
Lexy, S. (1983). Managing the drugs in your life: A personal guide to the responsible use of
drugs, alcohol, and medicine. New York: McGraw-Hill.
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.
Nurse, A.R. (1982). The role of alcohol in relationship to intimacy. Journal of Psychoactive
Drugs. 14(1-2), 159-162.
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.
Pinto, R.P., Abrams, D.B., Monti, P.M., & Jacobus, S.I. (1987). Nicotine dependence and
likelihood of quitting smoking. Addictive Behaviors. 12(4), 371-374.
Rankin, S. & Duffy, K. (1983). Patient education: Issues, principles, and guidelines.
Philadelphia: J.B. Lippincott Co.
Rindor, I. (1978). The effects of marijuana: A social-psychological interpretation. Psychiatry. 41,
202-206.
Sanchez-Craig, M. (1985). Patterns of alcohol use associated with self-identified problem
drinking. American Journal of Public Health. 75(2), 178-180.
Scott, C., & Hawk, J. (1986). Heal thyself: The health of health care professionals. New York:
Brunner/Mazel.
145
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.
146
Substance Abuse Curriculum: MODULE 3
DIDACTIC UNIT G: Impaired Practitioners and Recovery
Total Time: 3-4 hours
Overview: This unit will discuss the health care practitioner population who are impaired. The
unit will aid in placing into perspective the historical components, implications, and the recovery
process of impaired professionals. The unit will also address the symptoms, planned
intervention, intervention, and recovery process.
Terminal Objective: The student will be able to describe the symptoms and patterns of use for
an impaired professional. They will be able to describe the legal, moral and ethical implications
of an impaired professional as related to the individual, the community, and society. The student
will be able to formulate and implement a plan for intervention and recovery of impaired
practitioners.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Role Playing
Course Outline:
LXIX. Historical components of substance abuse by health practitioners
A. Substance abuse and the Ancients
B. European medical professionals and drug experimentation
C. Early American use and abuse of drugs
D. Literature reviewing SA among CRNAs
LXX. Prevalence of SA among professionals
A. Predisposition to SA by professional practitioners
B. Talbott's "Conspiracy of Silence"
C. Critical patterns of SA
1. Disciplinary actions
2. Voluntary treatment
3. Intervention and Recovery
D. Impaired professionals and punitive outcomes
LXXI. Substance abuse the "Disease"
A. Symptoms of addicted professionals
1. Behaviors
2. Physical signs
3. Economic problems
147
B. Occupational hazards concerning SA
1. Availability of drugs
2. Stress
3. Limited socialization
LXXII. Administration and SA
A. Responsibilities of Management
B. Policies and procedures for SA
C. Behavior
1. Recording patterns
2. Administrators response
3. Colleagues response
4. Family response
D. Intervention for the impaired professional
E. Recovery and aftercare of the impaired professional
F. Employee Assistance Programs (EAP)
G. Referral for colleagues
H. Contracts for colleagues returning to work
LXXIII. Ethical, moral and value conflicts of the impaired professional
A. AANA and ANA Professional codes for SA
B. Ethical dilemmas for reporting colleagues
C. Ethical concerns for patient safety
LXXIV. Peer Assistance and Recovering professionals
A. Role and responsibility
B. Continuing education in SA
C. Support groups for
1. Impaired professional
2. Colleagues
3. Family
D. Networking
148
References:
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.
American Nurses' Association. (1984). Addictions and psychological dysfunctions in nursing.
Kansas City, MO: American Nurses' Association.
American Psychiatric Association. (1997). Diagnostic and statistical manual (DSM-IV).
Washington, DC: APA, American Psychiatric Association.
Anthony, W. A. (1972). Societal rehabilitation: Changing society's attitudes toward the physical
and mentally disabled. Rehabilitation Psychology. 19, 117-126.
Assareh, S. (1987). Substance abuse testing in the workplace: A review. American Association
of Occupational Health Nursing Journal. 35(5), 204-209, 246-248.
Barten, J. & Talbott, S. (Eds.). (1989). Primary prevention in psychiatry: The state of the art.
Washington,D.C.: American Psychiatric Press.
Bennett, G., Vourakis, C., & Woolf, D. (1983). Substance abuse: Pharmacological,
developmental and clinical perspectives. New York: John Wiley.
Bissell, L. & Jones, R.W. (1976). The alcoholic physician: A survey. American Journal of
Psychiatry. 133, 1142-1146.
Bissell, L. & Jones, R.W. (1981). The alcoholic nurse. Nursing Outlook. 29(2), 96-101.
Bissell, L. & Haberman, P. (1984). Alcoholism in the professionals. New York: Oxford
University Press.
Bissell, L. & Royce, J. (1987). Ethics for addiction professionals. Center City, MN: Hazelden
Foundation.
Black, C. (1982). It will never happen to me. Denver: MAL Books.
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.
Bok, S. (1987). Whistleblowing and professional responsibilities. New York University
149
Education Quarterly. 11(4), 2-10.
Burkhalter, P. (1975). Alcoholism, drug abuse and addiction: A study of nursing education.
Journal of Nursing Education. 14, 30-35.
Cannon, B.L. & Brown, J. S. (1988). Nurses' attitudes toward impaired colleagues. Image.
Summary 20, 9-101
Carter, A.J. (1983). Nurses: Alcohol and drug abuse training in nursing schools. Alcohol Health
and Research World. 8, 24-29.
Clark, M. (1988). Preventing drug dependency: Part I, recognizing risk factors. Journal of
Nursing Administration. 191(1), 21-26.
Clark, M.D. (1988). The recovering nurse: The employment interview. Nursing Management.
19, 33-37.
Clement, S. (1986). The identification of alcohol-related problems by general practitioners.
British Journal of Addiction. 81, 257-264.
Cross, L. (1985). Chemical dependency in our ranks. Nursing Management. 16, 15-16.
Dogoloff, L. & Angarola, R. (1985). Urine testing in the workplace. New York: American
Council for Drug Education.
Drew, L. (1987, June). The problem with testing. Newsweek.
Estes, N.J. & Heinemann, M.E. (Eds.). (1986). Alcoholism: Development, consequences, and
interventions. St. Louis, MO: C.V. Mosby.
Greenspan, S.I. (1985). Research strategies to identify developmental vulnerabilities for drug
abuse. Research Monograph No. 56. Washington, D.C.: National Institute for Drug Abuse. pp
136-154.
Gurel, M. (1976). An alcoholism training program: Its effect on trainees and faculty. Nursing
Research. 25, 127-132.
Haack, M. & Hughes, T. (1987). Addiction in the nursing profession: Approaches to intervention
and recovery. New York: Springer Publishing.
Helwick, S. A. (1985). Substance abuse education in medical school: Past, present, and future.
Journal of Medical Education. 60(9), 707-711.
150
Hoffman, A.L. & Estes, N.J. (1986). A tool for measuring body and behavioral experiences.
Alcohol Health and Research World. 11(1), 26-29.
Holder, J.P. (1986). The effects of clinical education setting on student anxiety levels. Journal of
the
American Association of Nurse Anesthetists. 54, 537.
Holmes, P.R. (1975). The many faces of alcoholism. Supervisor Nurse. 6(9), 16-19.
Kilty, K. (1975). Attitudes toward alcohol and alcoholism among professionals and non
professionals. Journal of Studies on Alcohol. 36(3), 327-347.
Lewis, C.E. & Lewis, M. (1984). Peer pressure and risk-taking behaviors in children. American
Journal of Public Health. 74, 580-584.
Long, P. Gelfand, G., & McGill, D. (1991). Inclusion of alcoholism and drug abuse content in
curricula of varied health care professions. Journal of the New York State Nurses Association.
22(1), 9-12.
McAuliffe, W.E. (1984). Nontherapeutic opiate addiction in health professionals: A new form of
impairment. American Journal of Drug and Alcohol Abuse. 10, 1-22.
McDonough, J.P. (1990). Personality, addiction and anesthesia. Journal of the American
Association of Nurse Anesthetists. 58(3), 193-200.
Murphy, S.A. (1991). An empirically based substance abuse course for graduate students in
nursing. Journal of Nursing Education. 30(6), 274-277.
Naegle, M. (1985). Creative management of impaired nursing practice. Nursing Administration
Quarterly. 9(3), 16-26.
National Institute on Drug Abuse. (1991). National household survey on drug abuse: Main
findings 1990. (DHHS Publication No. ADM 91-1788). Rockville, MD: U.S. Department of
Health and Human Services.
Norris, J., Pierson, F. & Waugaman, W. (1988). Critical factors associated with substance abuse
and chemical dependency in nurse anesthetists. Journal of Alcohol and Drug Education. Winter,
6-11.
Smith, D.E. & Seymour, R. (1985). A clinical approach to the impaired health professional.
International Journal of Addictions. 39, 1327-1332.
Siegal, H. & Rudisill, J.R. (1983). Teaching medical students about substance abuse in a
weekend intervention program. Journal of Medical Education. 58(4), 322-327.
151
Spencer, F.L. (1988). Attitudes of registered nurses toward their peers who are perceived as
substance abusers: Abstract. Association of Black Nursing Faculty in Higher Education
Newsletter. 1(4).
Sullivan, E.J., Bissell, L. & Williams, E. (1987). Chemical dependency in nursing: The deadly
diversion. Redwood City, CA: Addison-Wesley Publishing.
Swenson, I. Havens, B. & Champagne, M. (1987). Interpretations of state board criteria and
disciplinary procedures regarding impaired nurses. Nursing Outlook. 35, 108-110.
U.S. Department of Education. (1988). Drug prevention curricula: A guide to selection and
implementation. Washington, D.C.: Office of Educational Research and Improvement.
Ward, C.E. (1983). Drug use in anesthesia training programs. Journal of the American Medical
Association. 250, 922-926.
Wegscheider, S. (1981). Another chance. Palo Alto, CA: Science and Behavior Books.
152
Substance Abuse Curriculum: MODULE 3
CLINICAL UNITS A-I: Advanced clinical medical sequelae, diagnosis, and
treatment of SA
Total Time: 15 hours
Overview: The clinical units will provide the student with advanced experience to apply
scientific knowledge in caring for the SA patient. There will be an extensive opportunity for
employing knowledge and skills concerning the SA patient. Additionally, there will be an
opportunity to engage in multidisciplinary collaboration and networking of community
organizations for the treatment of SA. One important component of this module is to delve
extensively into the diagnosis, intervention, treatment and recovery process of the substance
abuse patient.
Terminal Objective: a) The student should be able to conduct an interview, history, and
physical, screening questions and follow-up history, evaluation of laboratory data to establish a
diagnosis of SA. b) Conduct a family interview to establish and discuss the diagnosis and work
with denial of SA. c) Initiate a referral for further assessment and treatment to a local community
resource. d) Participate in a formal intervention session under the supervision of a trained SA
professional. e) Present and disseminate the SA research project.
Recommended Teaching Methods:
Group Process
Lecture
Discussion
Readings
Videos
Role Playing and videotaped sessions
Case presentations
Instructional Activity Sequence:
First hour is dedicated to conference time conducted by a clinical faculty member
examining the process of relating the diagnosis, intervention and working with denial.
Second and third hours include a participation in the methods for an extensive interview,
history and physical using a variety of criteria, mnemonics, laboratory tests, and other
instruments.
Fourth through the seventh hours are for participating in advanced or upper level group
sessions under the direction of a clinical faculty counselor.
Eighth through tenth hours provides the opportunity to present a diagnosis of SA,
intervene, and work with denial.
Eleventh through twelfth hours allow demonstration of a plan for intervention, basic
intervention, referral skills and the aftercare process.
153
Thirteenth and Fourteenth hours allow students to disseminate results from research
projects.
Fifteenth hour students should be debriefed for the previous activities allowing for
expression of feelings and supporting reflection into areas needing improvement.
Course Outline:
LXXV. Clinical assessment and diagnostics of SA
A. Performing clinical assessment and diagnostic procedures
B. Advanced exploration of the interpretation of data concerning SA
C. Participating in family intervention
1. Planning the process
2. Intervention
3. Working with denial
4. Recovery and aftercare contracts
D. Utilizing diagnostic, and treatment skills in SA
1. Detailed history and physical for SA
2. Diagnosing SA
3. Detailed history from family
4. Planning Treatment for SA
5. Referral of SA patient
6. Follow-up history
E. Presentations of appropriate cases for review
F. Presentation of SA research project
G. Debriefing concerning experiences in SA education
154
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.
Chappel, J.N. (1973, May 14). Attitudinal barriers to physician involvement with drug abusers.
Journal of the American Medical Association.
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.
155
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.
156
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-CenturyCrofts.
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, 329.
157
Formative Evaluation of Module 3
Substance Abuse Curriculum
Reference Sheet 1.5
Using the following scale please rate your accomplishments of the objectives in Module 3
including the didactic and clinical components of the substance abuse curriculum.
1-------2-------3-------4-------5
Low
Moderate
High
Accomplishment
Level of Accomplishment
____Understanding the physiologic basis of maternal and child, fetal, neonatal and newborn
addiction.
____Discuss the pharmacologic basis and principles of abused substances, their clinical
manifestations as they relate to anesthesia.
____Anticipating interactions of abused drugs and polysubstance abuse with anesthetics.
____Recognizing the primary elements in the process of immunosuppression and deactivation of
the immune response.
____Identifying factors which predispose substance
abusers to AIDS.
____Formulating preventative treatment modalities for AIDS.
____Developing and presenting educational and prevention programs for communities
concerning substance abuse.
____Networking with professionals outside the immediate clinical setting, discussing resources
available and formulating a collaborative network of professionals in the area of substance abuse.
____Implement preventative methodologies and evaluate the outcomes.
158
Reference Sheet 1.5 (cont.)
____Diagnosing the symptoms and patterns of use in the impaired professional.
____Describing the legal, moral, and ethical implications of the impaired professional and how
they relate to the individual, the community, and society.
____Implementing a plan for intervention, treatment and recovery of the impaired professional.
____Conducting an interview, history, physical, interpretation of laboratory data, screening
questions, and follow-up history
____Conducting a family interview discussing diagnosis and working with denial.
____Initiate referral for future assessment and treatment to local community resources.
____Participation in formal intervention sessions with trained substance abuse professionals.
____Presenting and disseminating the substance abuse research project.
Additional Comments:
159
Summative Evaluation
Substance Abuse Curriculum
Reference Sheet 1.6
Using the scale please rate your level of accomplishment for the learning objectives for the entire
substance abuse curriculum.
1--------2--------3--------4--------5
Low
Moderate
High
Accomplishment
Level of Accomplishment
____Identifying familiar behavior patterns in the chemically dependent.
____Recognizing the common medical outcomes of the substance abuser.
____Discussing the treatment modalities utilized for the chemically dependent.
____Developing personal insight into values, attitudes, behaviors, and morals concerning
substance abuse.
____Describing the effects of substance abuse on the family unit and special populations that are
affected by substance abuse.
____Describing the moral, cultural, ethical, legal, and social considerations in chemical
dependency.
____Demonstrating the basic skills for diagnosis, intervention, and employment of treatment for
the
substance abuser.
____Identifying the appropriate collaborative course in the prevention, intervention, and
treatment of substance abusers.
____Describing the role of the nurse anesthetist in the prevention of substance abuse.
____Engaging effectively in research of substance abuse.
160
Reference Sheet 1.6 (cont.)
____Demonstrating an active effort to change personal negative attitudes and stereotypes
regarding
chemical dependency and the substance abuser.
____Evaluating the effectiveness of efforts in prevention, intervention, and treatment of
substance abuse.
____Formulating steps to respond to chemical abuse patterns.
____Demonstrating a change in the values, beliefs, perceptions and stereotypical attitudes of the
learner.
____Demonstrating an active role in the education and dissemination of substance abuse
information in the community.
Additional Comments:
161
Substance Abuse Post-test
Module 3
Reference Sheet 1.7
Please rate your skill in performing each of the following clinical duties concerning the
substance abuse (SA) patient and using the following scale.
1-----2-----3-----4-----5
Low Moderate
High
Skill Skill
Skill
Skill Level
_______
1.
Composing a problem list of the physiological concerns of the SA patient.
_______
2.
Discussing the epidemiology of SA.
_______
3.
Identifying the characteristics of commonly abused substances.
_______
4.
The pharmacological principles to consider for SA.
_______
5.
Defining the DSM IV diagnostic criteria and performing intervention.
_______
6.
Discussing the etiology of SA.
_______
7.
Recognizing the legal, ethical, and moral issues in SA.
_______
8.
Demonstrate basic assessment and diagnostic skills for SA.
_______
9.
patient and family.
Recognizing the attitudinal obstacles to good communication with the SA
_______
Dealing with an impaired colleague.
10.
162