Substance abuse is a major preventable health issue in the United States, responsible for more deaths, illnesses, and disabilities than any other condition. Substance abuse has widespread social consequences and affects all groups in society regardless of age or economic status. The most commonly used substances are alcohol, tobacco, and illicit drugs like marijuana, cocaine, heroin, and prescription medications. Prevention and treatment of substance abuse disorders is a complex issue with no single solution, requiring efforts across multiple levels including education, social support, and tailored treatment programs.

1. Community Health
Chapter 26 Substance Abuse Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc. More deaths, illnesses, and disabilities are attributed to substance
abuse than to any other preventable health conditions in the United States. – Substance
Abuse and Mental Health Services Administration (SAMSHA) Copyright © 2015, 2011,
2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Social Consequences of
lcohol, or both Need
for money to buy substances Specific theft of drugs Almost 75% of inmates report prior
drug use All aggregates in society are potentially affected by substance abuse problems
regardless of age or economic level Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
to explain it ➢Combination of many factors ➢Genetics within families ➢Individual
(impulsivity and ease of disinhibition) ➢Environmental factors ➢Medical models ➢
Biopsychosocial models Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
has gained more social acceptance than other drug use. Public attitudes and governmental
policies have also influenced the history of illicit drug use. Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Historical Overview of Alcohol
and Illicit Drug Use (Cont.) ➢➢➢➢➢➢➢➢Alcohol-
related deaths after lowered drinking age Less tolerant national attitudes toward drinking
Increased societal and legal pressures and actions against drinking and driving Increased
health concerns among Americans Knowledge of addictive properties Counterculture
acceptance of hallucinogens, cannabis, and heroin The “War on Drugs” Renewed interest in
prevention/treatment efforts Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an imprint o –Drug Abuse
Acts of 1986 and 1988 ➢➢➢
the Office of National Drug Control Policy (“drug czar”) Worked on a public health approach
to drug control National Institute on Drug Abuse (NIDA) ➢Science on drug abuse and
addiction • Prevention • Treatment • Decreasing the spread of HIV/AIDS • Other priority
areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
Inc
Services Administration (SAMHSA) ➢Builds and sustains programs, policies, information
and data, contracts, and grants toward helping the nation act on the knowledge that
promotes behavioral health treatment through all levels of prevention Copyright © 2015,

2. 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Prevalence,
➢Slightly more than half
(52.8%) drink alcohol ➢Binge drinking at least once in prior 30 days— (22.6%) ➢Heavy
drinking—6.2% ➢Young adults ages 18-25 had highest prevalence of binge and heavy
drinking—39.8% ➢Drove under the influence of alcohol at least once in past year—11.1% –
SAMHSA (2011) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint
aged 12 or older: ➢ g during the
past month Illicit drugs used ➢➢Marijuana was the most commonly used drug Others
included cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type
psychotherapeutics (pain relievers, tranquilizers, stimulants, and sedatives) used
nonmedically – SAMHSA (2011) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Nonmedical use of prescription-type psychotherapeutics ➢There is a significant increase in
the lifetime nonmedical use of pain relievers—specifically Percocet®, Percodan®,
Vicodin®, Lortab®, Darvocet®, Darvon®, Tylenol® with Codeine, Propoxyphene, or
Codeine Products, Oxycodone, and Hydrocodone – NIDA (2010) Copyright © 2015, 2011,
2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Prevalence, Incidence,
➢LSD (d-lysergic acid
diethylamide) ➢Peyote cactus ➢Psilocybin ➢PCP (phencyclidine) ➢Inhalants of choice are
amyl nitrite, “poppers,” followed by glue, shoe polish, or toluene; correction fluid, degreaser,
or cleaning fluid; gasoline or lighter fluid; and spray paints and other aerosols. Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Prevalence,
➢➢ ➢
likely to be current illicit drug users Female illicit drug use (12 and older) increasing
Highest in West > Midwest > Northeast > South Racial/ethnic groups ➢Highest among
American Indians or Alaska natives > African Americans> whites > Hispanics > Asians –
SAMHSA (2010) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint
of Elsevier Inc. 13 Trends in Substance Abu
clinically defined dependence or addiction. Many are turning to recovery before they have
developed physiological dependence. Need to differentiate between use and misuse/abuse.
Use of harmful substances is indirectly and directly related to all of the leading health
indicators targeted in Healthy People 2020. Copyright © 2015, 2011, 2007, 2001, 1997,
widely produced controlled substance in the United States. Illegal street names of the drug
(crank, crystal, meth, ice, or glass). Can be injected, inhaled, taken orally, or smoked. Used
predominantly by white young persons, with an overrepresentation of females. Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15
levels of dopamine in the brain, leading to increased energy, a sense of euphoria, and
increased productivity. ➢➢ -term effects: increased heart rate, insomnia, excessive
talking, excitation, and aggressive behavior Prolonged use results in tolerance and
physiological dependence Negative consequences range from anxiety, convulsions, and

3. paranoia, to brain damage. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
communities, families, and social networks is considerable. ➢Young children of users are at
risk for abuse and neglect. ➢Prenatal use puts children at risk for developmental problems,
aggression, and attention disorders. ➢Exposure to combustible second-hand fumes. ➢
Associated with increased incidence of violence (e.g., domestic abuse, homicide, and
suicide) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
testosterone ➢➢ used in athletes
and other individuals willing to risk potential and irreversible health consequences to build
muscle Potentially fatal risks ➢➢Blood clots, liver damage, premature cardiovascular
changes, increased cholesterol Increased potential for suicide and aggressive and risky
behaviors Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
➢
pray paints, markers, glues, and
cleaning fluids) Produce a rapid high that may resemble alcohol intoxications; may progress
to loss of sensation and even unconsciousness Irreversible effects: ➢Hearing loss, limb
spasms, CNS or brain damage, or bone marrow damage; may result in death from heart
failure or suffocation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
use during lifetime between 18 and 25 years ➢Teen use of cigarettes and smokeless
tobacco has declined ➢Nearly half of teens try marijuana before they graduate—skepticism
good understanding of drug culture, terminology, and differing signs and symptoms
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20
years, often for political and social reasons rather than for scientific reasons. “Dependence”
or “abuse” What substances can be abused? ➢APA focuses on alcohol, amphetamines,
caffeine, cannabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine,
sedatives, and hypnotics or anxiolytics Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
maladaptive pattern of substance use that is manifested by recurrent and significant
adverse consequences related to repeated use of a substance. ➢➢➢➢Failure to fulfill major
role obligations Repeated use in physically hazardous situations Multiple legal problems
Recurrent social and interpersonal problems Copyright © 2015, 2011, 2007, 2001, 1997,
Dependence: a cluster of cognitive, behavioral, and physiological symptoms that indicate
continued use of the substance despite significant substance-related problems ➢➢➢➢
Pattern of repeated, self-administered use Tolerance, withdrawal, and compulsive drug-
taking behaviors A craving or strong desire for the substance Preoccupation with supply,
money to purchase, and getting through time between periods of use Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Sociocultural and

4. political conditions of potential users Cultural conditions create ambiguity in clearly
determining when a problem exists. Competing value systems lead to cultural disintegration
and a sense of powerlessness and hopelessness. Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an imprint of Elsevier Inc. 24 Course of Substance-
Path from initiation to dependency is multidimensional. ➢
context/environment Progression varies—from initiation to continuation, transition to
abuse, and finally, addiction and dependency Critical point is transition from use to abuse
Addiction/dependency marked by changes in both behavior and cognition Once addiction is
established, withdrawal symptoms are strong motivators to continue use Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Legal and
sale of illicit drugs ➢➢➢
driving, working while intoxicated Impact on fetus (FAS) Modes of intervention ➢➢➢➢
Limit access Media campaigns Educational programs National organizations that promote
community education, research, and support Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an i
prevention ➢➢➢➢➢➢➢➢ -risk situations and
potential problems Decriminalization and legalization of drugs(?) Community-based
programs Training of health professionals Faith-based initiatives Volunteer consumer
groups Organized sports programs Employer programs Often overshadowed by “War on
Drugs” Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
Inc. 27 Prevention Strategies (C ➢➢➢➢Screening and finding
resources • CAGE: an alcoholism screening test • Clinical Institute Withdrawal Assessment
(CIWA) • Use evidence-based programs Efforts should be specific to aggregates, rather than
directed at the “general public” Incorporate culturally sensitive and appropriate
interventions and strategies Work toward improving individuals’ general competencies,
communication skills, and selfesteem Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an impr ➢Cultural
and educational background ➢Resources of the person ➢Attitudes of significant others ➢
Degree of invasiveness of the effects of the substance use The existence of alternatives ➢
Relapse prevention Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
programs ➢May or may not include detoxification component ➢Voluntary vs. compulsory
➢Pharmacologically based vs. drug free ➢
Assessment process is of primary importance. Therapeutic relationship based on trust is
essential. Physical examination is a valuable tool. Nonjudgmental attitude minimizes
defensiveness. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
➢Group and individual
therapy and counseling ➢Motivational interviewing ➢Family counseling ➢Education ➢
Socialization into 12-step mutual self-help groups ➢Integrate psychotherapy with
pharmacotherapy ➢May include other strategies: • Hypnosis, occupational therapy,
confrontation, assertiveness training, blood alcohol level discrimination training, behavior
modification approaches Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an

5. ➢
➢ treatment for
coexisting disorders Operate through face-to-face supportive interaction focusing on a
mutual goal; AA was first Harm reduction ➢Elimination of the more harmful effects of
substance use through behavior and policy modifications Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Social Network Involvement
Family and friends ➢Highly influential or aid and abet ➢Codep
Effects on the family ➢➢
burdens Professional enablers ➢➢Treatment of symptoms by medication Reluctant to
bring up this taboo subject Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
-image, alienation,
and insecurity Use of legal substances (e.g., tobacco, alcohol) almost always precedes use of
illegal drugs. Poor school performance and drug use among peers are strongest predictors
of subsequent drug involvement, followed by lack of strong family bond. The younger the
initiation, the greater the probability of prolonged and accelerated use. Feeling of
powerlessness; selling drugs seen as a viable economic solution to poverty. Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Vulnerable
Aggregates: Preadole ➢➢➢
➢➢➢➢Advocating for these vulnerable children Educating teachers on the vital
importance of maintaining a validating, nonjudgmental attitude toward these students
Supporting strong families in the community Improving knowledge through education and
media Early detection of predisposing factors Providing structured clubs and organizations
Facilitating school success, career skills, family communication skills, and conflict resolution
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35
➢Diminished physiological tolerance ➢
Increased use/misuse of medically prescribed drugs ➢Cultural and social iso
Misuse of prescription drugs may be the most common form of drug abuse among the
elderly ➢Use prescription medications approximately three times as frequently as general
population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
much differently than men. Women absorb and metabolize alcohol differently. ➢➢Body
composition differences and production of less gastric alcohol dehydrogenase Metabolize
alcohol at a different rate Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
from economic, social, and cultural factors. ➢Marginalization of certain groups ➢History of
child abuse ➢Physical and medical problems related to reproductive systems ➢Use during
pregnancy has long-term developmental consequences for the newborn Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 38 Vulnerable
Americans—increased risk for substance abuse. ➢➢➢➢➢➢
disenfranchised groups Discrimination and racism Socioeconomic, political, and historical

6. realities Myths and stereotypes Social support—positive effect on treatment/outcome
Environmental cues and conditioned reinforcement Treatment poses special challenges.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 39
psychopathological problem in the general population. ➢➢➢➢Dual-diagnosis individuals •
Psychiatric disorder + substance abuse disorder Risk for multiple vulnerabilities in one
individual Impact of substance abuse on STDs Substance abuse among health care
professionals Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
experiences and prejudices. Routinely assess substance use patterns when performing
client histories. Be alert to environmental cues in the home that indicate substance abuse.
Increase the individual’s and family’s awareness of the problem. Involve the social network
in getting the client into treatment. Develop a caring nursing relationship. Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 41 Other
Health teaching regarding addictive
illness and addictive effects of different substances Advocating that EBP treatment works in
special populations through problem-solving courts (drug courts), specialized adolescent
treatment, and other community case management programs. Providing direct care for
abuse- and dependencerelated medical problems Educating clients and families about
problems related to substance abuse Collaborating with other disciplines to ensure
continuity of care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint
Coordinating health care services for the client to prevent prescription drug abuse and
avoid fragmentation of care Providing consultation to nonmedical professionals and lay
personnel Facilitating care through appropriate referrals and follow-up Knowing how to
use community resources for working with substance abuse, mental health, and other
issues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
Inc. 43 Chapter 27 Violence Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc. Overview of Violence Violence is a national public health
es violence as “the intentional use of physical force or power,
threatened or actual, against oneself, another person, or against a group or community
which either results in or has a high likelihood of resulting in injury, death, psychological
harm, malde
intentional injuries. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
unemployment, economic dependency Substance abuse Dysfunctional family and/or social
environment and lack of emotional support Mental Illness Media influence (e.g., violent
video games, television shows, and movies) Access to firearms Political and/or religious
ideology Intolerance and ignorance Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
➢In the Bible, Cain killed his brother Abel out of jealousy and anger ➢Audience pleasure
(e.g., gladiators in Rome) ➢Infanticide—if child was female, a twin, sickly, or deformed ➢
Children, especially firstborn, sacrificed for religious reasons Copyright © 2015, 2011,

7. 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 History of Violence
➢➢➢
➢➢➢
First legal protection in the United States in 1874 “Rule of thumb” “Wives be subject to your
husband” (Ephesians, 5:22) Assault against women not explored until 1960s Elder abuse ➢
➢Often undetected because of lack of awareness of HCP Lack of mandatory reporting
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5
Interpersonal Violence (IPV) is about control, not anger. Includes: ➢Homicide and suicide ➢
Intimate partner violence ➢Child maltreatment Copyright © 2015, 2011, 2007, 2001, 1997,
Homicide ➢One of the leading causes of death in the United States. • For black males aged
15 to 34, homicide is the leading cause of death. ➢➢Young people, women, and African
American and Hispanic males at higher risk than the general population. African Americans
were more likely to commit homicide than whites and were more likely to be victims of
homicide than whites (2010 data) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
leading cause of death for all Americans in all age groups (2010) More people die from
suicide than homicide. ➢➢
Americans and Alaska Natives, suicide is the second leading cause of death in persons 15 to
34 years of age. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
➢
Psychiatric disorders such as major depression, bipolar disorder, and/or schizophrenia ➢
Substance abuse ➢Posttraumatic stress disorder (PTSD) ➢Bulimia or anorexia nervosa ➢
Past history of attempted suicide ➢Genetic disposition to suicide ➢Age, such as elderly, and
white males (highest rate) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc. 9 Interpersonal Violence: Partner
(IPV) ➢➢➢A pattern of coercive behaviors perpetrated by someone who is or was in an
intimate relationship with the victim May include battering, resulting in physical injury,
psychological abuse, and sexual assault to progressive social isolation and intimidation of
the victim Typically repetitive and often escalates in frequency and severity Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10
k factors for IPV ➢Low self-esteem ➢Poverty
➢Risky sexual behavior ➢Eating disorders and/or depression ➢Substance abuse ➢Trust
transgenerational pattern of normal behavior Copyright © 2015, 2011, 2007, 2001, 1997,
Pregnancy ➢➢May increase stress within the family All pregnant women should be
routinely screened for abuse for commons sign of IPV • Delay in seeking prenatal care •
Unexplained bruising or damage to breasts or abdomen • Use of harmful substances
(cigarettes, alcohol, drugs) • Recurring psychosomatic illnesses • Lack of participation in
prenatal education Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an

8. aggressive behavior in an intimate relationship that takes the form of emotional, verbal,
physical, or sexual abuse ➢➢ May involve the use of date rape drugs Studies have linked
alcohol with dating violence Stalking—a pattern of repeated and unwanted attention,
contact, harassment, or any type of conduct directed at a person that instills fear Bullying—
a repeated oppression, psychological or physical, of a less powerful person by a more
powerful person or group of persons Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an imprint of Elsevier Inc. 13 Wheel of Power and Control Figure 27-1 Developed
by the Domestic Abuse Intervention Project. 206 West Fourth Street, Duluth, MN 55806.
Used with permission. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
➢
➢➢ Chronic fatigue and tension Disturbed sleeping and eating patterns Vague
gastrointestinal and genitourinary complaints Misdiagnosis often occurs because of the
obscurity of symptoms and/or failure to adequately assess Victims stay in abusive
relationships because of cultural, religious, and economic factors Copyright © 2015, 2011,
2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Impact of Interpersonal
➢Have
resources and power ➢No children ➢No personal history of abuse (themselves or their
relationship ➢More likely to be killed at this time than any other time in the relationship
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16
➢Most child maltreatment occurs
within the family. ➢More often abused by parents than other relatives or caregivers. ➢
More commonly seen in families in poverty, families in disorganization, or with parents who
are younger and who are substance abusers. Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an imprint of Elsevier Inc. 17 Interperso
Child maltreatment ➢Risk factors include but are not limited to • Special needs children •
Children less than 4 years of age • Family history of violence • Substance abuse • Poverty •
Social isolation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
➢Four types of
child abuse: 1. Neglect 2. Physical abuse • • Includes beating, burning, biting, and bruising
Abusive head trauma/shaken baby syndrome is leading cause of death in the United States
from abuse 3. Emotional abuse 4. Sexual abuse Copyright © 2015, 2011, 2007, 2001, 1997,
abuse ➢Society fails to recognize the cruelty many older adults experience. • Elders are an
“invisible” segment of the population. ➢Reasons for underreporting of elder abuse • Shame
on part of victim • Social and physical isolation from resources • Failure of health care
provider to routinely assess during points of contact • No uniform reporting system
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20
➢Types of abuse and neglect •
Physical abuse • Psychological-emotional abuse • Sexual abuse • Neglect • Financial
exploitation • Health care fraud and abuse Copyright © 2015, 2011, 2007, 2001, 1997, 1993
unity violence
usually occurs suddenly and without warning and can potentially destroy entire segments

9. of the population Community violence includes ➢Workplace violence ➢Youth violence ➢
Gang-related violence ➢Hate crimes ➢Terrorism Copyright © 2015, 2011, 2007, 2001,
1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Community Violence: Workplace
Workplace violence includes physical assaults, muggings, and verbal and written threats
Risk factors include: ➢Increasing number of acute and chronically mentally ill patients ➢
Working alone ➢Availability of drugs at worksite ➢Low staffing levels ➢➢➢➢➢Poorly lit
parking areas and corridors Long waits for service Inadequate security Increasing number
of substance abusers Access to firearms Copyright © 2015, 2011, 2007, 2001, 1997, 1993
-Related
Violence ➢➢➢➢Concentrated in minority communities and inner cities, causing a
disproportionate burden on these communities Adolescents and youth increasingly use
violence to settle disputes. Even when taught peaceful ways of resolving differences, learn
by what they observe at home, on television, and in movies. Schools have become common
sites for violence. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint
of Elsevier Inc. 24 Risk Factors for Youth Violence (from Textbook, Table 27-3) Individual
Risk Factors Involvement with drugs, alcohol, or tobacco Antisocial beliefs and attitudes
Low IQ History of violent victimization History of early aggressive behavior Community
Risk Factors Diminished economic opportunities High concentration of poor residents High
level of family disruption Low levels of community participation Socially disorganized
neighborhoods Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 25 Risk Factors for Youth Violence (from Textbook, Table 27-3—Cont.)
Individual Risk Factors Attention deficits, hyperactivity, or learning disorders Poor
behavioral control Deficits in social, cognitive or information-processing abilities Exposure
to violence and conflict in the family High emotional distress History of treatment of
emotional problems Community Risk Factors High level of transiency Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Risk Factors for
Youth Violence (from Textbook, Table 27-3—Cont.) Family Risk Factors Poor family
functioning Low emotional to parents of caregivers Low parental education and income
Parental substance abuse or criminality Poor monitoring and supervision of children Harsh,
lax, or inconsistent disciplinary practices Authoritarian childrearing practices Peer/Social
Risk Factors Association with delinquent peers Involvement in gangs Social rejection by
peers Lack of involvement in conventional activities Poor academic performance Low
commitment to school and school failure Copyright © 2015, 2011, 2007, 2001, 1997, 1993
s that
young people join gangs: ➢Believe that gangs will protect them ➢Peer pressure ➢The need
for respect ➢
throughout the United States ➢Crimes include illegal alien smuggling, armed robbery,
assault, auto theft, drug and weapon trafficking, identity theft, and murder. Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Community
➢➢➢➢The United States has one of the world’s highest
rates of incarceration Inmates are both victims and perpetrators of violence. Includes
allegations of physical abuse and reports of rape by corrections officers and inmates Little
sympathy for this population for a variety of reasons, including indifference, disbelief, and

10. denial Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
public health issue. Involves: ➢Prostitution ➢Sexual exploitation ➢Forced labor ➢Slavery
➢Removal of organs Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
motivated by An individual’s race*1 ➢Sexual orientation*3 ➢Religious beliefs*2 ➢Ethnic
background ➢National origin ➢*Rank—
include ➢Murder ➢Rape ➢Sexual or physical assault ➢Harassment ➢Attacks on homes or
on places of worship ➢Vandalism Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce
or to intimidate governments or societies in the pursuit of goals that are generally political,
key elements—violence, fear, and intimidation. Copyright © 2015, 2011, 2007, 2001, 1997,
gun in the home… • …triples the risk for homicide in the home • …increases the risk for
suicide 3 to 5 times • …increases risk for accidental deaths by 4 ➢Firearms are the number
one weapon of choice in homicides in the United States. ➢Direct and indirect costs are
staggering. ➢“Right to bear arms” arguments persist. ➢Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Factors Influencing Violence
➢➢➢
games …music and music videos that depict date rape or violence …virtual violence that
allows subscribers to harm or kill victims Repeated exposure to media violence leads to
emotional desensitization to real-life violence Copyright © 2015, 2011, 2007, 2001, 1997,
Mental illness is considered by many to be a major factor in violence. ➢
inconclusive that all violence is committed by mentally unstable persons. Increasing push
for legislation to fund public health strategies that identify and treat mental illness across
the country ➢Funding issues have forced states to eliminate or reduce availability of mental
health services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
challenged to go beyond its traditional programs to include prevention and management of
violence. Efforts being made with ➢➢➢
Local, state, and federal governments Addressed by Healthy People 2020 Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Prevention of
Education may include life skills training: ➢➢➢ amily wellness Anger
management Conflict resolution Nurses should: ➢➢➢Increase awareness of violence
Identify cases Work with the community Copyright © 2015, 2011, 2007, 2001, 1997, 1993
by Saunders, an imprint of Elsevier Inc. 37 Prevention of Violence: Primary Prevention
transgenerational aspect of abuse ➢➢
lifespan Mentoring and peer programs to promote healthy relationships and decrease

11. conflict Work with high-risk individuals Copyright © 2015, 2011, 2007, 2001, 1997, 1993
Goal: assess, diagnose, and treat victims and perpetrators of violence. ➢
of safety of potential victim is critical Begins with assessment Once identified, victims must
be offered… ➢➢Resources to increase their safety Legal options and how to access them
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 39
questions ➢➢➢
physically hurt by someone? Since you’ve been pregnant, have you been hit, slapped, kicked,
or otherwise physically hurt by someone? Within the last year, has anyone forced you to
have sexual activities? Intervene when essential Interdisciplinary approach leads to optimal
outcomes. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
rehabilitation of individuals, families, groups, or communities and includes both victims and
perpetrators of violence May take months or even years Nurses must work in conjunction
with a variety of mental health professionals and social service agencies to provide
coordinated care ➢Self-care and recognition of own limitations and needs Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 41