412 Substance Use

Question 1

10 substances in SUDs

Answer 1

• alcohol
• cannabis
• opioids
• hallucinogens
• inhalants
• sedatives and hypnotics
• anxiolytics
• tobacco
• stimulants
• other/unknown

Question 2

SUDs diathesis-stress model

Answer 2

• risk-seeking tendencies could act as a diathesis (strong reward neural pathway)

Question 3

correlates of SUDs

Answer 3

• associated with 3 leading causes of death in adolescents: accidents/injuries, suicide/self-harm, interpersonal violence
• legal and educational problems
• comorbidity with other disorders
• earlier use (14 vs. 21) linked with more substance-related impairment later (risk marker, not causal)

Question 4

prevalence of substance use and SUDs

Answer 4

• a lot of variability in adolescents, gets more common with age
• experimentation very common (normative)
• SUDs roughly 11.4% 13-18 years
• substance use rates decreased during COVID and remained low

Question 5

Early brief interventions for SUD

Answer 5

• norm-based interventions for college students (helping people realize how much others are actually drinking - shift toward descriptive norms)
• large discrepancy between perceptions of peer substance use and what actually happens (overestimating)
• informing about how much you drink (ranked with peers), your perception of others, and how much your peers drink (shift in perceived norms = changing your behaviour according to the norm)
• help reduce frequency and quantity of drinking, but not many studies of efficacy in long-term

Question 6

injunctive norms

Answer 6

• how much others approve/disapprove of a behaviour like drinking

Question 7

descriptive norms

Answer 7

• how much others are actually engaging in a behaviour like drinking

Question 8

outpatient treatment for SUDs

Answer 8

• family therapy
• alcoholics anonymous

Question 9

family therapy

Answer 9

• multidimensional
• working with caregivers to increase parental monitoring
• working with teens to improve coping strategies or fix risk-taking behaviour
• good efficacy (maybe better than CBT)

Question 10

alcoholics anonymous

Answer 10

• very popular and common worldwide (easily accessible)
• acknowledge that alcohol is a problem, abstinence is the goal, supported by a peer
• 12-step program
• has other equivalents for various drugs (nicotine not as supported)

Question 11

3 hypotheses in AA

Answer 11

(1) attendance itself leads to reduced substance use (meetings help you use less)
(2) lower alcohol use is associated with more AA attendance (less severe = more likely to use AA and more likely to recover)
(3) better prognosis (more motivated, less comorbidity, more protective and less risk factors) = lower alcohol use and benefit from AA

Question 12

how does evidence support AA

Answer 12

• RCTs show a lack of efficacy (but studies aren’t well done, participants are coerced instead of self-selected into treatment)
• following Ps who received Tx at a hospital, then attended AA = support for efficacy (lower alcohol use at follow-up)

Question 13

support for 3 hypotheses of AA

Answer 13

(1) AA involvement at 1-year post-treatment predicted lower alcohol use at 2-year post-treatment
(2) alcohol use at year 1 didn’t predict AA involvement at year 2 (people using less don’t attend AA more)
(3) results not explained by AUD severity, comorbidity, or motivation (not a good prognosis that mediates the results)

Question 14

inpatient treatment for SUDs

Answer 14

• short duration (4-6 weeks)
• individual counselling, family therapy, treatment for comorbidities
• often followed by outpatient treatment
• can get very expensive, especially for teenagers who need multiple stints
• good rationale (changing the environment and losing access to substances) but very few controlled studies about efficacy