Adolescents and young adults in the household have the greatest prevalence of substance dependence. Individuals with a history of drinking or substance dependence in the household are often more likely to face alcohol-related problems (Freeman, 2001). It has long been established that family members of a substance addict are more likely to develop alcohol addiction issues. Health profiles in family substance addiction suggest that the accumulation of alcohol dependency in the family is partially related to hereditary factors (Freeman, 2001). There is also documentation of an increased family mix of psychoactive drug abuse and misuse (Grant & Litvak, 1997). A number of research have reported higher levels of alcohol dependency and/or misuse among family members of drug offenders relative to family members of alcohol-dependent hereditary disorders play a major role in substance dependence, depending on the health features of family alcohol violence. Twin, adoption and family studies endorse the family transition of opioid and alcohol dependency and the resulting genetic variables (Stelle & Scott, 2007).
Epidemiological research has demonstrated that alcohol dependence is often aggravated by comorbid psychiatric disorders (Freeman, 2001). It has been discovered that 47 percent of alcohol abusers have another mental problem, and a large fraction of this comorbidity is attributed to substance abuse (Freeman, 2001, 62). Individuals with mental health disorders, like bipolar disorder, depression, or anxiety are also classified as high risk, since alcohol may be exploited as a way to self-medicate (Stelle & Scott, 2007). Lastly, alcohol addiction includes all the signs of alcohol abuse, yet it also includes another component: physical addiction to alcohol (Stelle & Scott, 2007). If an individual depends on alcohol to live or sense a physical urge to consume alcohol, s/he is considered an alcoholic.
The introductory section already presented a summary of the health profile of the high-risk family group. The following sections will discuss the assessment of familial alcohol abuse using the nursing theories of Dorothea Orem and Jean Watson, the appropriate nursing intervention strategies using different components of the family systems theory, and the role of the advanced practice nurse as a case manager of familial alcohol abuse.
Applying Dorothea Orem’s and Jean Watson’s Theories in the Assessment of Familial Alcohol Abuse
According to Dorothea Orem, when there is a possibility to adequately care for oneself and the person has the capacity to fulfill the possibility, self-care is feasible. If, on the contrary, the need or pressure is greater than the ability of the individual to satisfy it, a discrepancy arises and this is referred to as self-care deficit (Freeman, 2001). The self-care deficit theory is the heart of the grand theory of nursing of Orem for it defines when nursing is required. Nursing is needed when an adult does not have the capacity to provide continuous needed self-care (Grant & Litvak, 1997). Orem’s theory then can be applied to the assessment of familial alcohol abuse in several ways.
In order to discern self-care capacity of a family member experiencing alcohol dependency, a thorough assessment should also determine aspects in the person’s life that are more prone to motivate excessive alcohol consumption. These aspects, usually quite permanent and fixed personal features may give the background situation that compels individuals toward alcohol dependency, varying drinking behavior, and capably enhanced risk of regression (Grant & Litvak, 1997). From a clinical point of view, putting emphasis on these background situations may aid in determining individuals who have the capacity to self-care. A vital background feature in relation to this is an encouraging family history of alcohol dependency, which could stand for such a motivating factor. This factor may affect the strength and nature of self-care capacities among young alcohol abusers (Freeman, 2001). The absence of alcoholism in the family history may also be a predisposing variable to an alcoholic self-care having considerably different drinking behaviors and associated difficulties and different developmental path.
As Jean Watson has argued, a consistent practise in mindfulness may be a very powerful means of moving viewpoints from disjointed units of perception and time to a linear, comprehensive, constant view of the network of lives (Sitzman, 2002). She argues that “[With mindfulness] we can appreciate the wonders of life, and, at the same time, act with firm resolve to alleviate suffering. Too many people distinguish between the inner world of our mind and the world outside, but these realities are not separate” (Sitzman, 2002, 118). Therefore, Watson’s philosophy of human treatment should be extended to the measurement of family substance dependence in the sense of familiarity and a linear network of lives validated by the application of mindfulness. A comprehensive evaluation, including an assessment of strong points and a self-directed assessment of needs, can be given to alcoholic-dependent family members with intricate needs.
Promotion and Disease Prevention Objectives of Healthy People 2020
There are three Safe People 2020 promotion and illness reduction goals linked to high-risk substance misuse. The first aim is to raise the amount of youth and young adults taking part in extracurricular activities (Coordinated School Health Components, 2009). Converting the interest of youth and young adults in the household to more positive work will better reduce substance dependency and/or violence. Much of the time, alcohol consumption may contribute to addiction and violence that sometimes people, particularly teenagers, are unaware of the challenges or difficulty that their alcohol use presents to their families.
Second objective is to ‘increase the percentage of adolescents who are connected to a parent or other positive adult caregiver’ (Coordinated School Health Components, 2009, 10). Parents or primary caregivers are crucial to the development of alcoholism among adolescents and young adults in the family. These young people should be able to open up their problems with adults in the family so that they would not resort to alcohol as a way out. This objective requires parents to take part in activities and events where in their youngsters also take part.
The third goal is to ‘increase the number of parents using positive parenting and to interact positive parenting with their physicians or other health care providers (Coordinated Student Health Elements, 2009, 10).’ It is essential for parents to speak with medical providers regarding the prevention, signs and effects of alcohol dependence and/or violence in the household. The aim therefore requires parents to maintain a supportive or productive interaction with their child, to interact freely with their child, to carry out innovative tasks with their child, and to receive information from their health care providers if they have issues with their children’s behaviour and learning.
Nursing Intervention Strategies Using Family Theories
Developing a treatment plan governed by a family theory needs systematic procedure and thinking. Presently, according to Hester and Sheehy (1990 as cited in Grant & Litvak, 1997, 44), there are eight theories of alcohol dependency and abuse. The theories that put emphasis on alcohol dependent and abusers and their families are the biological model, the general systems paradigm, and the disease model. Proponents of the biological theory of alcohol dependency and abuse put emphasis on studies reporting that alcoholism is in part genetic. Hence, if several family members of an alcohol dependent are also alcohol abusers, other biological members are prone to become alcohol dependents (Grant & Litvak, 1997). Thus, biological theory would require a treatment plan that does not only help the alcohol dependent to discontinue consuming excessive alcohol, but also preventing other family members from resorting to alcoholism.
General systems theory of alcohol dependency and abuse claims that a family where in one individual is addicted to alcohol is in fact an alcohol-dependent family, a system where in there are imperceptible rules, roles and limits that each relative plays, that contribute to the sustenance of alcohol dependency in the family (Freeman, 2001). Hence, the treatment plan should require talking to or working with a family therapist and determining the family mechanisms that motivate (Grant & Litvak, 1997) an alcohol dependent to continue excessive drinking.
The disease theory of alcohol dependency and abuse has been introduced by the Alcoholics Anonymous (Grant & Litvak, 1997). Members of the self-help group believe that alcohol addiction was derived from a physical hypersensitivity to alcohol, aggravated by spiritual and emotional difficulties (Grant & Litvak, 1997). Hence, the treatment plan should include continuous mentoring and support from family members throughout the recovery process.
Role of the Advanced Practice Nurse
Nurses are widely associated with their technical role, such as administrating medication, checking blood pressure, etc. However, the vocation of nursing, particularly that of the advanced practice nurse entails much more. It is the role of the nurse to display abilities as a helpful asset for families and patients. The advanced practice nurse has the ability to offer among other roles, psychotherapy, involving concise, continuous, group and individual (Freeman, 2001). The nurse is trained to keenly listen to patients and through this process formulate a treatment plan where development and learning arises. Establishing objectives and advancing in a gradual and systematic way, is attained within this nurse-patient relationship (Freeman, 2001).
The advanced practice nurse uses her/himself as a therapeutic medium through face-to-face, individualized, or group interactions, in casual or formal sessions and in the psychosocial and physical features (Freeman, 2001) of care.
Family dynamics and family members may contribute greatly to regression during recovery, since family problems may induce relapse to alcoholism. On the contrary, family members may fulfill a significant function in enabling the recovery process and success of the treatment plan. The combination of family counseling and recovery process has been reported to be productive. Moreover, family-oriented treatment plans with adolescent and young adult alcohol dependent and/or abuser are becoming more successful than group or individual treatment models.
- Coordinated School Health Components (2009). ‘Proposed Healthy People 2020 Objectives,’ pp. 1-11.
- Freeman, E. (2001). Substance Abuse Intervention, Prevention, Rehabilitation, and Systems Change Strategies: Helping Individuals, Families, and Groups to Empower Themselves. New York: Columbia University Press.
- Grant, M. & Litvak, J. (1997). Drinking Patterns and their Consequences. UK: Taylor & Francis.
- Sitzman, K. (2002). “Interbeing and Mindfulness: A Bridge to Understanding Jean Watson’s Theory of Human Caring,” Nursing Education Perspectives, 23(3), 118+
- Stelle, C. & Scott, J. (2007). Alcohol Abuse by Older Family Members: A Family Systems Analysis of Assessment and Intervention. New York: The Haworth Press