14 - substance use Flashcards
What does the Canadian survey repeated every 2 years check?
- Survey of Canadian students aged 12 - 18 that is repeated every 2 years (grade 7 - 12), and gives us a sense of use of alcohol and drugs in kids of different ages
- They’ll distinguish between these 3:
1) lifetime use: have you ever had alcohol
2) in the last 12 months
3) then in the last 30 days
What did the Canadian report from 2018 reveal?
- High risk drinking behaviour is pretty common among canadian youth
→ close to 25% of youth in grades 7-12 engage in high risk drinking behaviour - Opioid related hospitalization has been increasing among young adults in past 5 years
- The majority of youth use substances because it feels good, and to be sociable
- A much smaller group say that it helps relieve stress, and we’re much more concerned about this subgroup
→ This group is more likely to experience negative health and social consequences
What are some reasons why youth use substances?
The most common reasons in relation to cannabis and alcohol are having fun and being social; and a smaller group report using substances to deal with stress or emotional pain (greater risk of problematic substance use)
- Fun and social:
–> Mainly because they enjoy the taste and it is a part of being sociable with their friends – same with cannabis
–> For cannabis specifically, youth report using it to be more creative and original
- Stress and emotional pain
–> Students who reported poor mental health were more likely to also report using substances as a coping strategy or because they feel down, or want to escape reality
–> Youth who used alcohol as a coping strategy were more likely to report difficulties from their alcohol use, such as fights, arguments with friends & family, and problems with school
–> Those who use cannabis as coping are also more likely to report memory loss, lower productivity and difficulty sleeping
When meeting with young people, if an adolescent discloses to their psychologist that they’re using substances frequently, what should the psychologist do?
A psy wouldn’t break confidentiality for it unless there’s a major risk to the client or others
→ there’s lots that confidentiality covers, even if it’s illegal it doesn’t mean the psy should break confidentiality
→ often a mental health worker is a neutral person for an adolescent to discuss their substance use with
What is the DSM-5 criteria for substance use disorder?
A. A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1 - Control
- Substance is often taken in larger amounts or over a longer period than was intended
- There is a persistent desire or unsuccessful efforts to cut down or control Substance use.
- A great deal of time is spent in activities necessary to obtain Substance, use Substance, or recover from its effects
2 - Cravings
- Craving, or a strong desire or urge to use Substance.
3 - Consequences
- Recurrent Substance use resulting in a failure to fulfill major role obligations at work, school, or home
- Continued Substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of Substance.
- Important social, occupational, or recreational activities are given up or reduced because of Substance use.
- Recurrent Substance use in situations in which it is physically hazardous.
- Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by Substance.
4 - Physiological changes
- Tolerance, as defined by either or both of the following:
→ A need for markedly increased amounts of Substance to achieve intoxication or desired effect.
→ A markedly diminished effect with continued use of the same amount of Substance.
- Withdrawal, as manifested by either of the following:
→ The characteristic withdrawal syndrome for Substance
→ Substance (or a closely related substance such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms
True or false: We often see a combination of substance use and a mental health theme.
True: substances can fit into a cycle in all kinds of ways
True or false: It is perfectly safe to stop alcohol intake without supervision.
False: it’s dangerous to stop alcohol intake without supervision because of withdrawal side effects
→ you need medical oversight to stop using if usage is really high
There are ___ interventions that can reduce cravings for alcohol and opioids.
Pharmacological
Give examples of how substances can interact with mental health?
- Drinking alcohol to avoid panic attacks
→ p.ex: somebody was drinking alcohol all the time, but why? For him, he had had a panic attack, didn’t understand what it was and didn’t wanna have another, so he drank for the effects that would lower anxiety constantly
→ then developed a high tolerance – didn’t even like drinking - Drinking alcohol to quell social fears (get out of your head)
→ to feel more in the moment in a social situation
→ can be a powerful safety behaviour when going into social situations
→ can lead to important thoughts of “i can only enjoy myself in a social situation if i drink alcohol” - Cannabis for sleep; pain management; PTSD
→ cannabis to stop intrusive memories or dreams remembering the event - Others
→ psychedelic use as an early player in OCD (similar to the way that sometimes people develop OCD through a dream)
→ p.ex: in the dream, I stabbed a family member, became terrified because I thought I actually wanted to stab someone, so I avoided knives
→ cannabis use can trigger psychotic episodes or psychotic disorders
What is the proposed criteria for internet gaming disorder?
Persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by 5 (or more) of the following in a 12-month period
A. Preoccupation with internet games (thinking about previous gaming activity, anticipating next games)
B - Withdrawal symptoms when gaming is taken away (irritability, anxiety or sadness)
C - Tolerance, the need to spend increasing amounts of time engaged in games
D - Unsuccessful attempts to control the participation of games
E - Loss of interest in previous hobbies and entertainment as a result of, and with the exception of, internet games
F - Continued excessive use of internet games despite knowledge of psychosocial problems
G - Has deceived family members, therapists, or others regarding the amount of internet gaming
H - Use of internet games to escape or relieve a negative mood
I - Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of I-games
What is motivational interviewing?
- Motivational interviewing is about ambivalence
→ often, in the short term, you feel good about it, but in the long-term, it doesn’t fit with your other goals
→ p.ex: being a student, on the one hand you get an education with fun classes, on the other hand you have to pay a lot of money and spend lots of time on schoolwork
→ the assumption is that the person feels ambivalent about their substance use
→ so we want to reinforce the part of the person that wants to stop using, while avoiding the reinforcement of the part that wants to keep using - Conversation about change in which you strategically reinforce another person’s motivation to change in the context of a respectful, empathetic relationship
- Strategically reinforce change talk (reasons for making changes to substance use)
- Strategically downplay or reframe sustain talk (reasons for continuing to use substances problematically)
How would we describe the motivational interviewing style?
- “Empathic, concerned, non-authoritarian, and nonjudgmental style”
- Avoid disapproving and reassuring statement about behaviour
- Pros AND cons
→ ask them “what do you like about drinking?”
→ then ask if there are things they don’t like about it, and they might be more willing to divulge - Personalized feedback
How do we evoke change talk in motivational interviewing?
- We first explore the benefits of stopping (advantages of change)
→ p.ex: can improve relationships with family, or gf or bf, physical health can improve, etc.
→ how would you like things to be different? what would you like your life to look in 5 years? - Then list the costs of NOT stopping
→ often just the opposite of the benefits: p.ex: strained relationship with family, relationship with gf might end, get kicked out of sports, etc.
→ what worries you about your current situation? what difficulties or hassles have you had in relation to your drug use? - Then present optimism about change and intention to change
→ What encourages you that you can change if you want to? What would you be willing to try?
Substance use plays on ___ ___ systems, so there’s already a motivational aspect that’s pushing you in that direction
Positive reward systems:
→ this is tough (to stop) because it’s already in a reinforcement loop
→ it’s difficult to intervene with, especially since substance use has very individual reactions depending on physiology and other cognitive processes
→ it can even be negatively reinforcing to not drink alcohol before a social event if you have social anxiety
→ part of you is seeing the subjective positive side of the use, but at the same time there are parts of you that don’t want to continue using, so there’s an internal struggle
What is the righting reflex?
- The desire to fix what seems wrong with people and set them promptly on a better course, relying in particular on directing
→ we have a temptation to try and resolve others problems for them, and tell them the right thing to do to correct the situation
→ the problem is that people will often push this back and not want to listen
→ putting it into perspective can help though; p.ex: showing them that they’re above the norm in their substance use (sometimes they think that they’re using the same as everyone else), which can especially helpful in adolescents since they’re so influenced by others
What are the 3 rulers we can use during change talk?
The willingness ruler
- Measures how willing a person is to take an action
The confidence ruler
- Measures how confident a person is in their ability to perform or take the action
The readiness ruler
- Measures how ready the person is to take the action
→ p.ex: “on a scale of 1 to 10, how likely are you to spend less time on your phone this week” THEN ask “why didn’t you rate yourself lower?” which will evoke change talk of an explanation why they believe in themselves
What are the stepping stones to taking action?
1) Precontemplation
→ if in precontemplation, you can’t really force it, but you can evoke change talk which can lead someone towards the next steps
2) Contemplation
3) Preparation
4) Action
5) Maintenance
6) Relapse
What are the basic skills of motivational interviewing?
- Ask open-ended questions
- Make affirmations
- Use reflections
- Use summarising
What is the RAAM clinic?
- The Rapid Access Addiction Medicine (RAAM) Clinic offers services for people who may have concerns about their alcohol and/or opioid use. We help by:
→ reviewing your treatment goals with you,
→ providing medication (if needed) for opioid and/or alcohol problems,
→ providing brief individual counselling, and
→ connecting you with the right community resources for your needs.
True or false: Substance use is common, especially in adolescents
True
We have both ___ and ___ interventions that are used in different combinations.
Biological; psychological
