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Substance Use Disorder (SUD) and its Incidence Across the Generations   Abstract There are many philosophies as to what influences the path of addiction

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Substance Use Disorder (SUD) and its Incidence Across the Generations

 

Abstract

There are many philosophies as to what influences the path of addiction. To further examine the implications of substance use disorder (SUD) in families, a spirit of inquiry was used to cultivate the practice question: In patients with a history of SUD, does a familial pattern of addiction increase the incidence of SUD across the generations? SUD is characterized by alcohol and drug abuse that results in clinically substantial impairment. This impairment may manifest in various ways, including health issues, incapacity, and the inability to fulfill essential obligations at work, school, or home. SUD consists of complex features that can be influenced by both genetics and environment. This paper is based on quality improvement in patients with SUD as it relates to the incidence of a familial pattern of addiction. The DNP project question: In patients with a history of substance use disorder (SUD), does a familial pattern of addiction increase the incidence of SUD across the generations?

 

Keywords: Substance Use Disorder, SUD, continuous quality improvement, quality improvement, addiction, drug use,

 

Substance Use Disorder (SUD) and its Incidence Across the Generations

“The initial journey towards sobriety is a delicate balance between insight into one's desire for escape and abstinence from one's addiction."– Debra L. Kaplan.

Amongst the many recent epidemics, we face as a nation, the opioid epidemic is at the forefront for many researchers, scholars, clinicians, and grieving families that have lost loved ones to overdose. Substance abuse management in some form has become commonplace in many aspects of medicine, albeit it has changed the way we manage acute and chronic pain and has undoubtingly reformed how mental health is viewed and the approach to treatment, particularly for patients with dual diagnoses.  

According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2020) article, Key Substance Use and Mental Health Indicators in the United States found that among people aged 12 or older, 60 percent (or 165.4 million people) used a substance (i.e., tobacco, alcohol, kratom, or an illicit drug) in the past month (p.1). The Centers for Disease Control and Prevention (CDC) The Drug Overdose Epidemic: Behind the Numbers since 1999, released a notice that nearly 841,000 people have died from a drug overdose to which nearly 70% of drug overdose deaths in 2019 involved an opioid (CDC, 2019). 

Progress in the care quality for SUD has lagged behind that of general healthcare despite dependence on drug use being a severe public health issue, with an estimated 8.9% of Americans requiring treatment and substantial social and economic expenses (Hunter et al., 2014). The advanced practice registered nurse (APRN) should be well prepared to measure outcomes that could offer enhanced patient care. In doing so, APRNs must integrate education, management, leadership, and consultation in their clinical settings; quality improvement can be used to measure outcomes (Kleinpell, 2020).

According to Hunter et al. (2014), an approach that includes assistance for establishing quality improvement techniques and increasing evidence-based methods in SUD treatment is a determination process.  The proposed quality improvement process pertains to the nurse practitioner performing a family history survey on admittance to the inpatient detoxification treatment unit. This initiative will establish whether the patient presenting with SUD has a direct family member with addiction disorders, such as a parent, grandparent, or sibling. The data collected is used to assess if there is an incidence of increased risk of SUD in patients with a history of familial SUD. After determination, the nurse can use the continuous improvement strategy (CQI), a multi-faceted strategy to rehabilitate the patient. 

Goals and Outcome

This quality improvement project aims to ensure that the nursing staff can assess whether there is an increased risk of developing a substance use disorder in patients with direct relatives who struggle with addiction. This project will consist of a determination process that will go through the initial assessment for all patients suffering from SUD, followed by an initiative for continuous quality improvement that will detail recovery procedures to assist patients in navigating the recovery process. The quality improvement project can also aid in the preventative care of SUD, with community-focused initiatives to provide earlier drug abuse education to youth with a principal focus on children with a family history of familial SUD. 

According to Prom-Wormley et al. (2017), a person's genetic makeup accounts for as much as half the risk for substance abuse to nicotine, alcohol, or other drugs. These findings are consistent with results from various family research as well, where researchers have discovered that genetics accounts for more than half of the total risk ratio for the predisposition toward SUD in those with a family history of drug dependence or addiction (Prom-Wormley et al., 2017).

The patient family history will be noted and used in the continuous quality improvement to enable the nurse practitioners to utilize enhanced correct procedures for recovery. The proposed outcome from this project implementation is to have 95% of nurses more competent and knowledgeable in determination procedures of identifying increased risks of SUD in patients with direct relatives with addiction issues; based on that information, the nurse will determine increased or decreased risk, if any. 

Shareholders and Responsibilities

The project will require the following shareholders' nurse practitioners, staff nurses, and the addiction medicine organization.

Nurse Practitioner

Nurse practitioners are essential participants in this initiative because they perform the determination process involving performing risk assessment, investigating the genetic influence of SUD risk, and having conversations about the influence of risk on the healthcare management of people and their families (Finnell et al., 2019). Patients who are striving to overcome their addictions to drugs, alcohol, or other addictive substances are treated by nurse practitioners who specialize in substance abuse. Because they are the clinicians who assist in determining the patients' risks for SUD, these nurses must be made aware of the significance of this project and provided with the resources necessary to provide a reliable assessment.

Floor Nurse

The floor nurse’s responsibility is to understand the steps needed to get the quality improvement survey completed and to better understand the risks of developing SUD. Staff nurses are accountable for evaluating and managing SUD patients in addiction medicine treatment centers. They are responsible for performing assessment and data gathering in an ongoing and methodical manner, primarily focusing on patients' physiological, psychological, and cognitive status (Finnell et al., 2019). Teaching, learning opportunities, and emotional support are provided to substance abusers and their families, given that the project aims to better understand SUD in patients with immediate relatives who struggle with addiction. 

Addiction Medicine Organization

The organization considers the cost of implementation and any challenges related to the organization and the patient. Across a range of care, this data is used to determine the right processes and protocols to implement when providing patient care (Ayu et al., 2016). The organization is to expand access to and enhance the quality of addiction treatment and educate the patient, medical professionals, and the public. The addiction medicine organization's role is also to support research and prevention efforts and promote the appropriate role of medical professionals in the care of patients who suffer from addiction.

IPC impact on the project

Team collaboration and buy-in is necessary for a successful execution of this quality improvement project. The team established the SUD program to improve the knowledge and practices of nurse practitioners, floor nurses, and addiction medicine organization members. Interprofessional cooperation is essential for the successful implementation of the quality improvement project. The team developed the implementation of learning directly to patient care, which improved the overall results of patients' recoveries.

The nursing practitioner and the floor nurses gained experience in counseling patients who were struggling with SUD. During these sessions, the team demonstrated a capacity to provide behavior change counseling to patient populations and promote readiness among patients given interventions to obtain follow-up treatment for their SUD.

Quality Model

The determination process will benefit from a fundamental and continuous approach to quality improvement, which Plan-Do-Study-Act (PDSA) process will offer. The PDSA framework is straightforward to implement, regardless of the size or resources of the practice (Vordenberg et al., 2016). The shareholders will continuously investigate new ways to enhance quality improvement determination procedures and processes already in place as long as continuous quality improvement is ingrained in the culture of the practice.

Plan 

In this step, the team will identify the process that needs improvement, which will be the determination process. The facility potentially had SUD patients, but there was no determination process to assess for a history of familial SUD and risk for an increased incidence of SUD. Therefore, adding an admission survey to determine the relationship between SUD among family members is essential. This step will identify where the improvement is needed and how it will be enacted. 

Do

In this step, the team is prepared to put effort behind the quality improvement project using strategy and collaboration. After the new procedure has been established, it is essential to have frequent meetings to discuss the transition to the new procedure. This will assist the team in determining whether the adjustment produced the expected results. This step will also use the SMART approach to clarify the procedure. In the SMART approach, the specific step will enable the team to know the exact percentage of patients with increased risk.

The measurable will allow the team to understand the materials to document the project question's results. Achievable will enable the team to have a particular number of people with the increased risk of SUD and how to intervene. Relevant will show the team the gap in increased and decreased risk in patients with relations with addiction issues. Time factor will enable the team to understand when they will be able to answer the project question.

Study

In this stage of the PDSA process, the team will assess the effectiveness of the process change by using the process or outcome measurements chosen by the PDSA team during the planning phase. A run chart is a time-tested method that may be used to graphically depict changes that have occurred over time. Run charts can be shown publicly in a designated place for teams or frequently discussed in gatherings. The PDSA team will consider the many aspects of the situation that might have led to the conclusions. 

Act

The group may now choose to adjust at this point. The PDSA cycle is intended to be an ongoing process; even the most excellent methods team uses have room for improvement and may become more consistent with time. By going through the cycle, the group may make even more improvements to its procedures. The team must decide what course of action to pursue at this stage, which is the culmination of the PDSA cycle.

Types of measure (Dependent Variables)

Independent and dependent variables are the two categories that might be encountered in research. The independent variable is often understood to be that which we anticipate would affect the dependent variables. In contrast, the dependent variable is understood to be that which occurs directly from the independent variable (Ledford et al., 2018). The dependent variables in this project are SUD and risk. SUD is a dependent variable because its causes can be attributed to patient relations. The risk is also a dependent variable because it varies from a decrease to an increase based on their relations. 

Logic Model

Logic models may be used in designing new programs or determining whether an existing program's architecture is still logical in light of the present situation. Correspondingly, a logic model may verify that the collection of already existing performance metrics covers crucial features throughout the performance range. Logic models are valuable tools that aid in planning, implementing, managing, evaluating, and reporting on programs. They contribute to the definition of a program's anticipated impact and objectives, the order in which desired effects are to occur, which activities are to create, which influence, and where to concentrate results and process assessments. The logic model for the SUD quality improvement project is shown below;

 

Shareholders     Activities              Results

Nurse Practitioners         Performing the Determination Process  Practical and tailored questions to patients.

Floor Nurses      Managing and evaluating SUD patients  Patients understanding their risks of substance use in connection to genetics

Addiction Medicine Organization.

                Rehabilitated the patient             Patient understanding to control their drug use.

 

 

 

Reliability and Validity

This project will accurately measure the patient's increased risk of SUD since the patient and their families will assess their relations. The family will be assessed if they are experiencing drug addiction or if any of their relations have had a drug addiction. This will give accurate information because the patient's consent will be obtained, and they will be informed that it is for their recovery process. The results will be reliable because the team will track the patient for a while, and the assessment will only be done when the patient is comfortable with it.

Benchmarks for DNP project

The quality improvement benchmarking tools will be available to program the shareholders involved in the determination process. The presentation will cover an array of clinical, operational, and financial performance metrics, all of which will concentrate on determining the risk factor for SUD patients. Participating patients will, via the help of a nurse practitioner, answer questions about their relatives and environment, which will provide data that is readily accessible. Personalized benchmarking reports will be prepared, which will compare the performance of the patients to that of national standards.

In-state comparisons will also be offered. The benchmarking program that national institutions carry out is based on the principle that all processes can progress using comparison methods. The purpose of the effort needs to be established on standards for the sector. The program assists providers in identifying whether areas of their processes are fulfilling expectations while avoiding a "pass-fail" approach (Lefkovitz et al., 2009).

Time frames for Implementation

The implementation of this project is scheduled to take place between February 12th, 2023, and August 12th, 2023. To boost the number of participants who finish the survey, the determination assessment will be encouraged among all SUD patients. The goal of this project is to serve as the first action item in a more comprehensive strategy for a determined effort. Real-time assessments may not be feasible due to the unpredictable nature of individuals getting treatment for SUD.

After the implementation, the group intends to evaluate the patients within two months for good measuring. The quality plan has been included in the organization's strategic plan because of its importance and primary concentration on the well-being of patients. At the quality improvement project, it is anticipated that nurses will be more knowledgeable and self-assured in their ability to determine patients during assessment sections and advise appropriate intervention.

Conclusion

In conclusion, determining the familial role in SUD is an essential first step in searching for intervention for people with SUD. A better understanding of how genes produce biological variations might lead to the developing of more effective therapies for SUD. Each newly found gene associated with addiction is a possible drug target. Researchers may concentrate on the product of the gene and create a medication to affect the protein's function targeting to repair the routes or signals to restore normal functioning.

 

 

 

 

 

 

 

References

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