Substance abuse

インデックス作成: 2026-05-16

[00:00:00]Okay, so in today's session, we are focusing on substance abuse and we are still going to look at the June 2025 paper.

[00:00:13]We'll go straight to look at the scenario for today. The scenario says Kalua Keka, a 25-year-old, is brought to your outpatient department by his elder brother who is concerned about his erratic behavior over the past year. Kalua has lost two jobs and his physical appearance has deteriorated.

[00:00:37]On assessment, Kalua admits to daily alcohol consumption and occasional use of cocaine. The team decides to admit him to a rehabilitation unit for structured treatment and monitoring.

[00:00:52]A, define substance abuse. B, explain five predisposing factors to substance abuse. C, describe the role of the community mental health nurse in preventing and dealing with substance abuse.

[00:01:08]D, outline five counseling skills that you would use on Kalua.

[00:01:14]The first one, of course, says defining substance abuse. Now, we can define substance abuse as this is a maladaptive pattern of using a psychoactive substance that leads to significant impairment and distress.

[00:01:31]One of the characteristic we see in substance abuse is that there's continuous use of the substance despite clear evidence of harmful consequences to the individual's physical or mental or social relationship.

[00:01:48]So, when we talk about substance abuse, we are talking of a patient who's abusing any psychoactive substance. It could be they're abusing cocaine, they're abusing morphine, they're abusing uh marijuana, they're abusing alcohol, they're abusing different substances.

[00:02:03]So, when we talk about substance abuse, it is broad. This particular patient may be abusing a number of uh harmful substances.

[00:02:15]Question B said, "Explain five predisposing factors to substance abuse." One of it is genetics and history, family history. This is because having close relatives with alcohol substance use disorders increases vulnerability because this is something that is in the blood of this particular family. You know, this is something that you have seen being normalized in the family and this person may also normalize that particular behavior. Mental health problems like anxiety, depression, post-traumatic stress disorder, attention deficit hyperactive disorder, and other psychiatric disorder often co-occur with substance abuse. Such individuals who abuse substances just to manage whatever mental problem that they already have. Uh personality traits, those with high impulsivity, risk-taking, sensational seeking, and poor coping skills, such individuals with such personality traits may abuse substances.

[00:03:23]Low self-esteem and poor stress management or early onset of use, all these are risk factors of substance abuse. Peer pressure, sometimes we do things because of the influence of our friends, hence it becomes a risk factor.

[00:03:39]Family dysfunction where there are family problems, it could be child neglect, abuse, poor parental supervision, inconsistent discipline, all these may make the child to abuse or an individual to abuse substances because there was no parental control.

[00:03:57]Uh [snorts] cultural norms, uh availability and accessibility of these substances, sometimes individuals abuse substances because they can freely or easily access them. For example, in Zambia, there is a policy that alcohol or other substances may not be sold or should not be sold to someone who's below the age of 18. But now, uh policies are there, but implementation is weak. You find that these bars and other places they will still sell they will be able to sell harmful substances to children because to them it is business as usual. Workplace or school stress, all these are risk factors, uh our social risk factors of substance abuse. Low income or unemployment, homelessness, all these are risk factors. So, when we talk about risk factors of substance abuse, those are the ones that we can discuss.

[00:04:56]Question C said, "Describe five roles of the community mental health nurse in preventing and dealing with substance abuse."

[00:05:09]So, the community mental health nurse can apply or can use certain roles to prevent or deal with substance abuse.

[00:05:17]The first one is the role of health promotion and education. This is where the nurse conducts community outreach programs in schools, workplaces, and community centers just to educate the public about the risk and consequences of substance abuse. This may include teaching the community about the effects of drugs and alcohol, identifying the early warning signs, promoting healthy lifestyle choices as alternatives to substance use. So, the community mental health nurse can use this particular role. The next role is a screening and assessment role. This is where the community mental health nurse plays a role in identifying individuals at risk through screening of various community settings, for example, in clinics or using schools to screen individuals who may show risk of abusing substances. They can also conduct comprehensive assessments to determine the extent of substance use amongst different individuals. Those with co-occurring mental health issues and individuals with physical, social, or occupational functioning or issues, they can facilitate early referral to specialized services and this may help manage or prevent substance abuse.

[00:06:44]Another role is case management role.

[00:06:48]The community mental health nurse can use case management role to individuals, especially like Kaluba, who are in treatment. So, the community mental health nurse acts as a case manager. This will involve coordinating care between different services. It could be rehabilitation units, general practitioners, social workers, family.

[00:07:11]They are coordinating different areas for this particular patient who's receiving care. Because this will ensure that there's continuity of care and also help the client navigate the health care system to access the necessary resources or support that they need.

[00:07:29]Counseling role can also be played by the community nurse, mental health nurse. This is where the nurse applies or employs these therapeutic communication and counseling skills just to support individuals and their families. This may include providing motivational interviews to enhance the readiness for change. You can also the nurse can also promote teaching relapse prevention strategies, facilitate support groups, and also offering family therapy to address the impact of substance abuse on the family system, and also help build a supportive home environment. So, all these are roles that the nurse can play within the community. And of course, advocacy role can also be played by the nurse. The nurse can advocate for the client's rights and access to appropriate services in as much as they abuse substances. This may include maybe housing support, employment assistant, or legal aid.

[00:08:38]Just because they abuse substances, then should not be punished, but they can be helped and properly managed, and then help them return to having a meaningful life.

[00:08:50]And of course, when we go to the last question, the last question says, "Outline five counseling skills you will use on Kalua."

[00:09:00]One is active listening. You can use this active listening skill on Kalua by making sure that you give Kalua the full attention using verbal and nonverbal cues. And of course, you can also use empathy as a skill, and here you can try thrive or strive rather to understand Kalua's situation from his point of view. Do not judge them, but just understand why he's abusing the substance based on what he's going through. From there, you can easily help understand or why the the client is abusing the substance.

[00:09:42]Of course, the other skills you can use are non-judgmental attitude or skills. And this is where you create a safe place or safe space by suspending all personal judgments and criticism regarding the patient's substance use and life choices, but you help them and support them just the way they are. You can also use summarizing and paraphrasing skill. As the patient talks about a lot of points, you can use this particular skill to provide a concise summary of the many themes he's expressed feelings and also his motivations. And this can help in clarifying issues, also consolidating the progress, and seeing a clear direction for the future because the patient may have discussed a number of stuff, but you can use this skill to just give it few content, but with the same meaning of what the patient was saying.

[00:10:45]And of course, the other skill that you can use is still the questioning skill.

[00:10:49]Be able to use open-ended questions.

[00:10:54]Of course, open-ended questions, these cannot be answered with yes or no because they are open in nature. They will allow the patient to give you full information of or more explanations about what is happening or how they are feeling. And closed-ended questions can still be used in certain circumstances where you want to obtain specific factual information. And of course, open-ended question is cardinal because it will encourage exploration and self-discovery of this particular patient, knowing more about them and the problem that they are experiencing. So, these are the skills that you can apply on the last question as requested, but still be able to go through substance abuse specifically at least try to go through also alcohol abuse as a form of substance abuse and how we can manage alcohol abuse because sometimes you may be specifically be asked about alcohol abuse. So, till next time this is where we end today. Goodbye.