Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature. Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Include the DOI. Also, be sure you are italicizing titles of online sources.No more than 200 words maximum.

These are the questions my peers had to answer:

• Discuss how you will monitor for misuse of alcohol, prescription drugs, and others substances in your geriatric clients.
• Identify at least 5 evidence-based references to support your plan.
• Tonisha’s Response-
• The misuse of alcohol, prescription drugs and other substances continues as individuals age as these habits are often established during the patient’s youth and early adulthood years. Among older adults, alcohol is the most commonly used substance (Boltz, Capezuti, Fulmer, & Zwicker, 2016). Recommendations for the consumption of alcohol for healthy geriatrics include no more than 3 drinks on a given day and 7 standard alcoholic beverages per week (National Institute on Alcohol Abuse and Alcoholism, 2019). The consumption of more than the recommendations for alcohol use can increase the patient’s risk for adverse reactions. Alcohol use in older patients are associated with an increased sensitivity to alcohol, associated health problems and medication interactions. Alcohol use and dependence may go under-recognize in geriatric populations. As a result, all adult patients should be screened for alcohol use. Patients identified as risky drinkers, those having a drinking pattern that may result in future harmful consequences, should be provided with counseling. Patients reporting regular alcohol consumption may be assessed utilizing The Short Michigan Alcoholism Screening Instrument-Geriatric Version. Patients suspected of or reporting the misuse of alcohol can be evaluated by utilizing the CAGE questionnaire. Patients receiving positive results should be referred for further evaluation and treatment (Naegle, 2019). Prescription misuse can occur among the elderly as patients may be prescribed multiple medications, fail to discard expired medications, trade medications with friends or family members, or combine medications with alcohol (Boltz et al., 2016). While illicit drug use is less prevalent than alcohol and prescription drug misuse, recent trends suggest this may be changing. The effects of prescription misuse and illicit drug can result in overdose, addictive effects, adverse reactions to drugs and adverse drug interactions (Kuerbis, Sacco, Blazer, & Moore, 2014). The SBIRT technique is useful when evaluating patients presenting with illicit drug use and prescription drug abuse. This technique can also be utilized for patients with alcohol use. The SBIRT technique utilizes screening, brief intervention and referral to treatment to decrease dependence symptoms and improve general and mental health (Boltz et al., 2016). To screen for substance use the CAGE-Adapted to Include Drugs (CAGE-AID) can be utilized. Positive responses warrant further evaluation and treatment as indicated. Least intensive treatment options should be explored first. This includes brief intervention followed by intervention, motivational interviewing, and specialized treatment. General approaches to treatment include cognitive behavioral approaches, group based approaches, individual counseling, medical/psychiatric approaches, marital and family involvement/family therapy, and case management/community linked services and outreach (Wu & Blazer, 2011). Boltz, M., Capezuti, E., Fulmer, T., Zwicker, D. (2016). Evidence-based geriatric nursing protocols for best practice (5th ed.). New York, NY.: Springer Publishing CompanyKuerbis, A., Sacco, P., Blazer, D., & Moore, A. (2014). Substance abuse among older adults. Clinic in Geriatric Medicine, 30(3), 629-654. doi: 10.1016/j.cger.2014.04.008 (Links to an external site.)Naegle, M. (2019). Alcohol Use Screening and Assessment for Older Adults. Retrieved from https://consultgeri.org/try-this/general-assessment/issue-17 (Links to an external site.)National Institute on Alcohol Abuse and Alcoholism. (2019). Older Adults. Retrieved from https://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/older-adults (Links to an external site.) Wu, L. & Blazer, D. (2011). Illicit and nonmedical drug use among older adults: A review. Journal of Aging and Health, 23(3), 481-504. doi: 10.1177/0898264310386224
  Sarah’s Response-Motioning for Substance Use Historically, elderly adults have not displayed high rates of alcohol or drug use when compared to younger adults, but this may be a misconception because there is substantial evidence that suggests that substance use among older adults has been underidentified for decades (Kuerbis, Sacco, Blazer, & Moore, 2014). This is especially true for current times because the aging population consists of the baby boom generation where many were exposed to alcohol and substances. Inclusive assessments, the utilization of screening tools, consistent open communication and using established drug monitoring programs are all ways to monitor patients for the misuse of alcohol, prescription drugs, and others substances.Assessment The healthcare provider should always assess patients for the use of alcohol, prescription drugs, and other substances. Clinicians should monitor patients for excessive daytime sleeping, declines in personal grooming and hygiene, and withdrawal from family, friends, and normal social activities (Trevisan, 2014). These are some behaviors that are red flags for substance use and misuse. One clever strategy that is particularly useful for assessing substance use among older adults is the “brown bag” technique, where the patient is asked to fill a brown paper bag with everything they regularly take including prescription pills, ointments, over-the-counter medications, and supplements (Giles, 2017). There are also diagnostics that can reveal evidence of alcohol misuse. High mean corpuscular volume (MCV) and elevated gamma-glutamyl transpeptidase (GGT) are commonly used as simple biological screening instruments for alcohol misuse (Trevisan, 2014).Screening Tools Utilizing screening tools such as the Cut-Annoyed-Guilty- Eye (CAGE) and the Michigan Alcohol Screening Test-Geriatric Version (MAST-G) can be utilized by providers to help assess for alcohol use and abuse. The MAST-G is a useful instrument designed to identify alcohol habits and was developed specifically for the elderly (Kuerbis, Sacco, Blazer, & Moore, 2014). The Comorbidity-Alcohol Risk Evaluation Tool is a screening instrument that identifies at-risk older adults and takes into account their quantity and frequency of alcohol use, presence of comorbid disorders, high-risk behaviors and concomitant use of other medications, with a good face, content, and criterion validity in older adults (Lal & Pattanayak, 2017). Another valuable assessment instrument is the Alcohol, Smoking and Substance Involvement (ASSIST) tool. The World Health Organization suggest utilizing the ASSIST screening tool, which covers alcohol, tobacco, and other drugs (Giles, 2017). Depending on the patient, these tools can be particularly useful for healthcare providers. Open Communication Practicing open communication with patients creates a safe space for them to have honest conversations with their healthcare provider. Older adults who recognize that their substance use is problematic may feel reluctant to share that sensitive information, having been ingrained with stigmatized attitudes about addiction or drug use (Giles, 2017). Displaying empathy and being nonjudgmental are required behaviors when a provider attempts to have an open dialogue about lifestyle and substance use. Discussions of alcohol, drugs and other substance use should occur in the context of an overall assessment and in reference to the presenting problem with the goal of health promotion and a complete understanding of behaviors (Giles, 2017). Collaboration with other healthcare professionals such as addiction specialists and psychologists also may be beneficial for some patients.Utilize the Database System Utilizing prescription drug monitoring programs and the implementation of the national pharmaceutical database helps to regulate prescription drugs (Ferrera, 2017). Knowing how many providers a patient is receiving medications from is also an important fact to establish. Providers should not only utilize the database system but intervene and be proactive to identify and help eliminate barriers for these patients. Taking the time to properly assess the patient, allowing therapeutic communication to occur, and treating the patient as a whole can help ensure that prescriptions are properly prescribed and monitored (Ferrera, 2017).ReferencesFerrera, S. (2017). What nurse practitioners can do in the opioid crisis. Retrieved from https://dailynurse.com/author/stephenferrara/Giles, L. (2017). Older adults deserve healthcare that considers substance use. Retrieved from Ireta: https://ireta.org/resources/older-adults-deserve-h…Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adults. Clinics in geriatric medicine, 30(3), 629–654. doi:10.1016/j.cger.2014.04.008Lal, R., & Pattanayak, R. D. (2017). Alcohol use among the elderly: Issues and considerations. Journal of Geriatric Mentla Health(4), 4-10. Retrieved from http://www.jgmh.org /article.asp?issn=2348-9995;year=2017;volume=4;issue=1;spage=4;epage=10;aulast=LalTrevisan, L. A. (2014). Elderly alcohol use disorders: Epidemiology, screening, and assessment issues. Psychiatric Times, 31(5). Retrieved from https://www.psychiatrictimes.com/alcohol- abuse/elderly-alcohol-use-disorders-epidemiology-screening-and-assessment-issues/page/0/1