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Effects of Substance Use on Individuals: IRB Submission

Substance use is a global problem. In 2012, about 17 million individuals used cocaine and 34 million people used amphetamines (Carney et al., 2017). Approximately 39% of adolescents abuse alcohol (Espelage, Low, Rao, Hong, & Little, 2014). In the United States alone, about 30% of the total population suffers from substance use disorder (SUD) (Flanagan, Korte, Killeen, & Back, 2016). Substance abuse is not only associated with morbidity and mortality to an individual but also an economic burden to society. For instance, Campbell et al. (2014) has affirmed that in the US, around $193 billion was used in the management of SUD. The purpose of this paper is to present a proposal for an evidence-based project (EBP) about the effectiveness of psychological interventions in the treatment of substance abuse.

Background

Substance use is prevalent among the youths. The abuse of substances has doubled from the year 2009 to 2013 (Carney et al., 2017). Indeed, it is acknowledged that substance abuse prevalence is 1.8%, 1.2%, 1.5%, and 1% in North America, South America, Oceania, and Europe respectively (Espelage et al., 2014). The incidence of substance abuse in individuals older than 14 years has increased from about 1.6% in 2007 to 2.1% in 2010 (Jhanjee, 2014). Cannabis is the most commonly abused drug worldwide, seconded by amphetamines (Minozzi, de Crescenzo, Saulle, & Amato, 2015). Among the youths, alcohol and cannabis are the substances most abused and there is an increasing trend in this context (Carney et al., 2017). The increased incidence of substance use among the youths is alarming, thus, creating the need for prevention and management strategies.

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The hazardous effects of substance abuse are that it alters the physical, social, psychological, and emotional wellbeing of an individual. Alcohol is the leading cause of preventable injuries and mortality (Klimas et al., 2014). However, it is difficult to control substance use due to the unavailability of strict preventive measures in most countries (Jhanjee, 2014). The interventions directed at SUD are psychosocial and pharmacological in essence. Some researchers report that psychosocial therapies are effective in comparison to pharmacological ones (Campbell et al., 2014). On the contrary, other researchers ascertain that pharmacological therapy should be used as a combination with psychosocial therapies for the increased effectiveness (Flanagan et al., 2016). The most effective psychosocial interventions include cognitive-behavioral methods, contingency approach, community therapy, motivational therapy, interpersonal remedy, and psychodynamic (Minozzi et al., 2015). In this way, there is a gap regarding the most effective interventions for the management of SUD, hence, creating the need for this study.

Clinical Significance

Addressing the issue of SUD is significant to the individuals who abuse substances, health care providers, and hospital settings. To the individual who abuses substances, one will get quality care, thus, quick recovery with subsequent improvement in the quality of life. The physical wellbeing of the individual will improve. As a result, one can perform activities of daily living unaided. Also, social wellbeing will improve and an individual will be able to interact freely with others and engage in economic activities. At the same time, the psychological wellbeing will improve as episodes of depression, and anxiety will be alleviated by psychosocial interventions. To the health care providers, the physical burden associated with the provision of care to patients will reduce, and thus, more time can be spent in providing care to other patients suffering from terminal and critical illnesses. The hospital will benefit by reducing the cost associated with the management of individuals with SUD.

Purpose

1. To find out the effectiveness of psychosocial interventions in the management of substance abuse.

2. To collect evidence if psychosocial intervention should be used as a combination therapy with pharmacological interventions.

The PICOT question is: Among youths who abuse substances (P) does psychosocial interventions (I) compared with either pharmacological intervention or combined therapy of psychosocial and pharmacological (C) improve the wellbeing of an individual (O) within the shortest time possible (T)?

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Literature Review

A thorough literature review was conducted using the following keywords: substance abuse, psychosocial interventions, pharmacological interventions, the effectiveness of psychosocial interventions, and impact of psychosocial interventions. The databases that were searched are EBSCOhost, Medline, and Consumer Health. The search was limited to articles that are less than five years old. Five articles were selected to be included in this study and are summarized below.

Stockings et al. (2016) conducted an integrated review to establish the effect of preventing substance abuse, prompt interventions, reducing harm, and treatment of substance-associated problems. The scholars found out that: (a) the prevailing situation makes it difficult to control and alleviate substance use among people; (b) social norms are not highly significant in reducing substance use among individuals, and (c) drug testing along the roads followed by implementation of measures that reduce the harm associated with injections has moderate effects. Moreover, effective interventions are peer-based self-help organizations, psychosocial techniques, the use of drugs, family therapy, and specialized services, such as cognitive-behavioral therapy. The purpose of this study was to investigate the effectiveness of psychosocial interventions in managing people who misuse psychostimulants. This research adopted an integrated review method.

To compare, Minozzi et al. (2015) have specified that the psychosocial interventions found to be effective include cognitive-behavioral methods, contingency approach, community therapy, motivational therapy, interpersonal remedy, and psychodynamic. The main purpose of this study was to investigate the impact of psychosocial interventions among those people who abuse alcohol together with other illegal drugs. A systematic review was the research design. Also, Klimas et al. (2014) have specified that there is inadequate data to support the use of the specific psychosocial interventions and there is a need for more research that is specific to a particular psychosocial intervention to increase the reliability of the evidence on the topic. It is also reported that alcohol abuse can be managed effectively if interventions are instituted early, before the worsening of the condition. The purpose of this study was to outline the interventions that do not only focus on managing substance abuse but also post-traumatic stress disorder (PTSD). The research design was a systematic review.

Similarly, Flanagan et al. (2016) have provided evidence that interventions that treat both substance abuse and PTSD are the use of drugs, such as serotonin selective reuptake inhibitors, and non-adrenergic reuptake inhibitors, as well as psychosocial interventions, for instance, cognitive-behavioral therapies (CBT). A systematic review was conducted to find out the effectiveness of psychosocial interventions, specifically CBT, contingency approach, motivational interviews, and the brief technique. An intervention was termed to be effective if it resulted in a behavior change of abstaining from the use of substances. In this respect, Jhanjee (2014) has found out that the most effective psychosocial interventions are CBT, relapse prevention, and motivational interviews. It was also realized that to enhance the effectiveness of psychosocial interventions, these should be used in combination with pharmacological therapy.

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In summary, the literature review revealed that different therapies focus on the psychosocial wellbeing of an individual. Most researchers proved that psychosocial strategies are effective in the management of substance use. The gap that needs to be addressed is whether the psychosocial intervention is effective when used as a single therapy or in combination with pharmacological interventions. The proposed study aims to fill the above-mentioned gap since it aims to compare the psychosocial interventions with pharmacological therapy and a combination of pharmacological and psychosocial therapies.

Theoretical Framework

The Health Belief Model (HBM) developed by Hochbaum, Rosenstock, and Kegeles has been chosen as a framework for the EBP proposal. HBM is a suitable theory because of its focus on behavior change. The HBM is utilized to analyze an individual's behavior, and thus, is helpful in the implementation of the appropriate health prevention and promotion measures. HBM is highly significant in alleviating addictive disorders (Jones, Smith, & Llewellyn, 2014). Substance abuse is an addictive disorder; an implication that the application of the HBM will play a great role in reducing substance addiction.

The HBM is based on 6 principles used to outline one's health behaviors. The six principles of the HBM are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy (Shojaei et al., 2014). The six principles provide an overview of the factors that influence an individual's change of behavior, and understanding of the constructs will help the health care provider develop ways of helping the person easily adopt a healthy lifestyle. In the context of substance abuse, the health care provider needs to analyze the individual motivation towards abusing substances; a situation that is enhanced by utilization of the HBM. According to Jones et al. (2014), the utilization of the HBM has been proven to be effective in promoting the adoption of healthy behaviors. The model motivates people to adopt healthy behaviors because behaviors that are not healthy are associated with negative consequences to an individual. The HBM is effective in reducing drug addiction among students (Shojaei et al., 2014). The effectiveness of the HBM further portrays the need for adopting the theory for the EBP proposal.

Methods

Research Design

The project will adopt a quantitative research design and an experimental approach, specifically, the randomized controlled trial will be used.

Sample

The study population will be youths who abuse substances.

Inclusion criteria. A youth who abuses substances and is diagnosed with SUD is seeking services at the psychiatry outpatient clinic, between 18 years to 35 years, fully conscious, and has insight.

Exclusion criteria. A youth who abuses substances but is not yet diagnosed with SUD is seeking services at the psychiatry outpatient clinic, between 18 years to 35 years, unconscious, and has no insight.

Participants recruitment. A simple random sampling will be used to recruit the study participants. To help improve the study validity, recruitment will be conducted for a week.

The number of participants and justification. The sample size will be 134 participants and a power analysis will not be used. The justification of 134 participants is that it has been calculated by the Fishers formula as shown below.

image1.png

n = is the sample size.

N = the target population which is 200 and it was obtained from an annual review of the records and a mean monthly attendance calculated since the recruitment process will last for a week.

E = the level of precision which is 0.05

n = 200 = 133.3

1 + 200(0.05) 2

Therefore, the sample size is 134 participants.

Control group. The study will have a control group involving the participants who will be receiving the pharmacological therapy alone and the combination therapy.

Setting

The study setting will be a psychiatric outpatient clinic. A letter will be written to the psychiatric clinic to seek approval to carry out the study.

Research Protocol

The potential participants who meet the inclusion criteria will be identified at the psychiatric clinic and randomly selected. After informed consent is given, the selected study participants will be randomized into three groups which will receive different interventions. One of the groups will have psychosocial interventions, the second group pharmacological interventions, and the third group will receive both psychological and pharmacological interventions. The participants will be followed for a month and a survey conducted. A pilot study will be conducted to enhance the validity and reliability of the survey tool. Upon approval by the IRB, the project will be conducted within 8 weeks.

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Data Analysis

SPPS software will be used for the data analysis. The data will be analyzed by both descriptive and inferential statistics. The descriptive statistics will include mean and percentages. The inferential statistics with include correlation and linear regression.

Timeline

The project will be conducted within 8 weeks.

Week 1 Proposal review and approval by the IRB

Week 2 Recruitment of study participants

Week 3 to 6 Data collection

Week 7 Data analysis, interpretation, and discussion

Week 8 Dissemination of the findings

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