An Introduction to Community and Primary Health Care

Introduction

Substance use has always been a feature of societies with the use of alcohol and plants with psychoactive properties for medicinal, recreational, religious, cultural and ceremonial purposes. While the use of substances is common, and some substances such as those used as medicines can be helpful, the use of alcohol and other drugs also causes physical, psychological, social, family and community harm. Working in the area of substance use and the treatment of substance use disorders (SUD) can be confronting. For health practitioners, there are often competing moral and ethical dilemmas. An understanding of the impact of substance use and awareness of one's own attitudes towards substance use is important if nurses are to be effective in assessing the impact of substance use and ensuring that individuals and families have access to appropriate and timely care. This chapter focuses on this specialised area of nursing practice.

The context of alcohol, tobacco and other drugs nursing practice

Drug or substance use is common, with two in five Australians having used tobacco, consumed alcohol at risky levels or used an illicit drug (Australian Institute of Health and Welfare [AIHW], 2014). There is no level of alcohol consumption that is completely safe or risk free; however, drinking no more than two standard drinks per day, or less than four standard drinks on any one occasion, reduces the risks associated with alcohol (see National Health and Medical Research Council, 2016 for guidelines on standard drinks and safer drinking). Similarly, high rates of substance use are reported in New Zealand with one in six adults having used a drug for recreational purposes (Ministry of Health, 2010) and one in eight having consumed alcohol at risky levels (Ministry of Health, 2014). The most commonly consumed substance in both Australia and New Zealand is alcohol (78.2% and 79.1% of the population respectively), followed by tobacco (15.8% and 17.6%) and cannabis (10.2% and 14.6%) (AIHW, 2014; Ministry of Health, 2010; 2014). Substance use is a serious and complex problem contributing to significant physical illness and mental health problems, injury and death, social and family disruption, workplace concerns and unemployment, family and public violence, crime and community safety issues (AIHW, 2014; Degenhardt, Whiteford & Hall, 2014; Ministerial Council on Drug Strategy, 2011). Problematic substance use can contribute to and reinforce social disadvantage and exclusion (AIHW, 2014).