Substance use and misuse: A public health perspective

Drug, alcohol and tobacco misuse (generically known as substance misuse) is a universal phenomenon that affects all levels of society. Increasing drug use generally has caused a host of social, behavioural, psychological and physical problems among populations. Substance use and misuse impinges on the five key areas for health promotion outlined in the Health of the Nation document (DoH, 1992): coronary heart disease and stroke, prevention of accidents, cancer, sexual health, mental health. The widespread misuse of psychoactive substances in the general population demands a healthcare workforce that can offer nursing interventions; is capable of providing effective preventive strategies; can offer counselling; and is qualified to give specialist care when necessary to substance misusers and their families. The care of substance misusers is not the domain of any one profession or organisation, although professionals in both primary healthcare and hospital settings are usually the first point of contact for clients who have potential or even early substance use problems. From the late '80s, prevention and treatment have become much higher on the political and service agendas. Public health campaigns have been introduced that maximise awareness of the risks of tobacco smoking, of drink driving, and of the misuse of over-the-counter drugs, alcohol, prescribed and illicit drugs. As a result, the public health triangular model, which involves interaction between the host (the individual), the agent and the environment, has become more prominent. The increase in substance misuse means that research that identifies why nurses and other healthcare workers are unable to identify the factors that lead to substance misuse is of paramount importance. If nurses and other healthcare professionals are to respond to substance misusers, there need to be new models of care from those that have traditionally guided the work of generic healthcare professionals. This paper considers substance misuse in general, but concentrates particularly on drug misuse.