Approximately 10% of the U.S. population meets the diagnostic criteria for substance use disorders.[i] These disorders are not only common but they take a profound toll on individuals, their families, their employers, and the communities in which they live. For the person using substances, prolonged drug and alcohol use may interfere with his or her normal activities, including social, recreational, or work responsibilities, while at the same time creating health complications. Many individuals will seek treatment for health issues without readily acknowledging their substance use history due to stigma, embarrassment, or fear. Therefore, health providers, including outreach workers, need to be prepared to identify when a patient’s substance use is causing psychological and physical health problems. For community health centers that provide mental health and substance abuse services, outreach programs can play a critical role in the identification of possible substance use disorders. Further, outreach workers need appropriate training and preparation to effectively help identify possible substance-related issues.
Outreach is often the bridge between the communities seeking services and the health provider. Given the trusting relationships outreach workers build with members of the community, they are well-positioned to gather important information about individuals who seek medical services. More importantly, these personal relationships may yield more information about a sensitive topic, like substance use, than a screening tool or a direct line of questioning would in a clinical setting. Helping outreach workers understand substance abuse and dependency and how to communicate any relevant information obtained in the field to the care team may prove to be an effective strategy.
The Basics of Substance Use
In order to maximize the use of outreach programs in identifying substance use disorders, outreach workers need to have a basic understanding of substance use and its common health-related consequences. According to the Diagnostic Manual (DSM-IV) published by the American Psychiatric Association, both substance abuse and substance dependency are characterized by a pattern of use that causes significant impairment or distress for the individual. However, there is a key difference between abuse and dependency. Not everyone that abuses substances is physically addicted. Dependency, commonly referred to as addiction, is frequently characterized by the following:
1) Physical tolerance: an increase in the individual’s body to tolerate the substance being used;
2) Withdrawal symptoms: the presence of physical symptoms when an individual stops using or withdraws from the substance.
Thus, over time, an individual’s body develops an increased tolerance and will need to take in more of the substance to experience its intoxicating effects. Further, as the substance is leaving the body, a person may experience physical symptoms of withdrawal, such as shakiness, headaches and/or vomiting.
While it may not be necessary for outreach workers to know the diagnostic criteria of substance-related disorders, it is important that they understand the basics of addiction and why it could be causing problems for the individuals they encounter. There are a variety of resources available online that can be used to help increase understanding of addiction, including The National Institute on Drug Abuse’s Drugs, Brains, and Behaviors: The Science of Addiction. The booklet is available in both English and Spanish via NIH’s website at http://www.drugabuse.gov/publications/science-addiction.
A few basic key points include:
- Addiction is a disease that has consequences on the body and on a person’s behavior.
- Addiction changes the way the brain functions.
- Addiction is characterized by a need to continue to use the substance even when the person understands that using that substance will have negative consequences.
- There are a variety of reasons that people use drugs and alcohol. Sometimes it is to feel good or to simply cope with life circumstances.
- There are a variety of factors that influence whether or not someone will develop an addiction to a substance. Every individual is different.
- Addiction can be treated but not cured. Like many chronic conditions, it can be managed.
- Addiction has consequences on an individual’s physical health.
Understanding the link between substance use and physical health
Outreach staff needs to understand the link between substance use and physical health. Specifically, some of the most common long-term health consequences related to prolonged substance use include cardiovascular disease, stroke, cancer, lung disease and an increased rate of HIV or Hepatitis B and C. There are many other health-related conditions that can be caused or exacerbated by substance use as well. Although it is not necessary for outreach workers to know about all the possible health consequences, they need to understand the relationship that substance use has on the individual’s mental and physical health. In addition, outreach workers need to understand why it is so important for health care providers to know about a person’s substance use history. Active substance use and abuse may have important treatment ramifications. Identifying an individual’s pattern and frequency of use may significantly assist the care team in making important decisions about a patient’s treatment.
How outreach workers can address substance use
Building a basic understanding of use, abuse, and dependency and its health consequences is only the beginning. It is equally important to consider how an outreach worker’s increased understanding should be used. Substance use can be a sensitive subject matter for many people. Outreach workers need to approach the subject without judgment while showing compassion. They need to understanding that people use substances for a variety of reasons including to help cope with life circumstances. In order to be effective, outreach workers need skills, cultural competence, and confidence. Thus, outreach workers need to be properly prepared to address these delicate issues by building appropriate skills and establishing clear guidelines or protocols regarding when and how to communicate with patients about substance use. Special attention should also be given to the development of clear systems for outreach workers to document and communicate any relevant information obtained from a patient to the care team. For example, this may be done via entries in the client health record or communicating directly during a care team meeting.
A significant number of individuals struggle with substance use disorders and these conditions can have serious health consequences. A variety of methods from formal screening to maximizing outreach workers can help to identify substance use disorders among the patient population. Accurate identification can allow health care providers to offer the best treatment possible. In order to fully utilize outreach workers, it is vital to provide proper training to establish a basic understanding of addiction and its relationship to health, while building the skills necessary to apply this knowledge.
[i] Grant, et al. “Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders.” http://pubs.niaaa.nih.gov/publications/arh29-2/107-120.pdf