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LMSW Exam > Alcohol and Drug Abuse Diagnosis and Treatment > Flashcards

Alcohol and Drug Abuse Diagnosis and Treatment Flashcards

1
Q

Alcohol Substance Abuse

A

-Alcohol is the most available and most widely used substance which makes diagnosing challenging

-Clients are able to deny their dependence both to themselves and their families and to hide it from employers for long periods

-The progressions of alcoholism dependence often occurs over an extended period of time

-Most alcohol dependent persons are gainfully employed, live with families, and receive little attention until their addiction crosses a threshold, and causes the person to fail in their familial, social, or employment roles

-Since alcohol is a legal substance, its misuse represents a difficult diagnostic problem

-After family members, relatives or employers tire of maintaining the fiction of normative use, alcoholics will be more motivated to begin the process of accepting treatment

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2
Q

Alcohol and Drug Abuse Diagnosis and Treatment: Adverse Consequences

A

injuries or illnesses often result directly from the use of many substances, their methods of administration, or the behaviors that the substance generate

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3
Q

Adverse Consequences: Substance Use

A

can cause physical damage, brain damage, or result in serious organic failure, depending on the drug used and the amounts ingested

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4
Q

Examples of adverse consequences of substance abuse

A

-Drugs and alcohol can cause fetal damage when used by pregnant women
-May lead to the birth of drug exposed babies who require intensive therapy throughout childhood

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5
Q

Adverse Consequences: Method of Administration

A

most illegal drugs are impure and may be adulterated or diluted with harmful substances

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6
Q

Examples of adulterated or diluted harmful substances

A

-Doses are often unknown, leading to drug overdose and death

-The use of contaminated needles can cause staph infections and various types of Hepatitis or HIV/AIDS

-Drugs and alcohol have been demonstrated to alter brain chemistry and can lead tro various forms of permanent brain damage

-Every substance has been shown to effect dopamine

-Inhalants are often toxic and can cause brain damage, heart disease, and kidney or liver failure

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7
Q

Adverse Consequences: Behaviors

A

many substances must be obtained illegally and their use is often associated with minor crimes, crimes against family members and the community, and prostitution

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8
Q

Adverse Consequences: Example of Minor Crimes Associated With Drug Use

A

-Alcohol is associated with domestic violence, child abuse, sexual misconduct and serious automobile accidents, and has been implicated in suicide and criminal activity

-All substances stimulate behavioral problems that may make it difficult to obtain and retain employment, or to sustain normal family relationships

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9
Q

Categories for Abused Substances: Narcotics

A

-Alfentanil

-Cocaine

-Codeine

-Crack Cocaine

-Fentanyl

-Heroin

-Hydromorphone

-Ice

-Meperidine

-Methadone

-Morphine

-Nalorphine

-Opium

-Oxycodone

-Propoxyphene

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10
Q

Categories for Abused Substances: Stimulants

A

-Amphetamine

-Benzedrine

-Benzphetamine

-Butyl Nitrite

-Cextroamphetamine

-Methamphetamine

-Methylphenidate

-Phenmetrazine

-Nicotine

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11
Q

Categories for Abused Substances: Hallucinogens

A

-Bufotenine

-LSD

-MDA

-MDEA

-MDMA

-Mescaline

-MMDa

-Phencyclidine

-Psilocybin

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12
Q

Categories for Abused Substances: Depressants

A

-Amobarbital

-Benzodiazepine

-Chloral Hydrate

-Chlordiazepoxide

-Diazepam

-Glutethimide

-Meprobamate

-Methaqualone

-Pentobarbital

-Secobarbital

-Phenobarbital

-Cannabis

-Lorazepam

-Marijuana

-Tetrahydrocannabinol

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13
Q

Categories for Abused Substances: Alcohol

A

-Ethyl Alcohol

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14
Q

Categories for Abused Substances: Steroids

A

-Dianabol

-Nandrolone

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15
Q

Categories for Abused Substances: Inhalants

A

-Nitrous Oxide

-Ether

-Gasoline

-Cleaning Solutions

-Glues

-Paint Thinners

-Lacquers

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16
Q

Drug Category Profile Narcotics: Opium

A

Dependence: high

Used: oral, smoked

Duration: 3-6 hours

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17
Q

Drug Category Profile Narcotics: Morphine

A

Dependence: high

Used: oral, smoked, injected

Duration: 3-6 hours

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18
Q

Drug Category Profile Narcotics: Codeine

A

Dependence: mod

Used: oral, injected

Duration: 3-6 hours

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19
Q

Drug Category Profile Narcotics: Heroin

A

Dependence: high

Used: smoked, injected, sniffed

Duration: 3-6 hours

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20
Q

Drug Category Profile Narcotics: Hydromorphone

A

Dependence: high

Used: oral, injected

Duration: 3-6 hours

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21
Q

Drug Category Profile Narcotics: Meperidine

A

Dependence: high

Used: oral, injected

Duration: 3-6 hours

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22
Q

Drug Category Profile Narcotics: Methadone

A

Dependence: high

Used: oral, injected

Duration: 12-24 hours

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23
Q

Narcotics: Defining Features

A

-Medicinally used to relieve pain

-High potential for abuse

-Cause relaxation with an immediate “rush”

-Initial unpleasant effects - restlessness, nausea

-Possible Side Effects: euphoria, drowsiness, respiratory depression, constricted (pin-point) pupils

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24
Q

Narcotics: Symptoms of Overdose

A

slow, shallow breathing, clammy skin, convulsions, coma, possible death

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25
Q

Narcotics: Withdrawal Syndrome

A

watery eyes, runny nose, yawning, cramps, loss of appetite, irritability, nausea, tremors, panic, chills, sweating

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26
Q

Narcotics: Indications of Possible Misuse

A

scars (tracks) caused by injections, constricted pin-point pupils, loss of appetite, sniffles, watery eyes, cough, nausea, lethargy, drowsiness, nodding, syringes, bent spoons, needles, etc. (weight loss or anorexia)

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27
Q

Depressants: Barbituates

A

Dependence (Physical/Psychological): high/mod

Use: oral

Duration: 1-16 hours

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28
Q

Depressants: Methaqualone

A

Dependency (Physical/Psychological): high/high

Use: oral

Duration: 4-8 hours

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29
Q

Depressants: Tranquilizers

A

Dependency (Physical/Psychological): high/high

Use: oral

Duration: 4-8 hours

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30
Q

Depressants: Chloral Hydrate

A

Dependency (Physical/Psychological): mod/mod

Use: oral

Duration: 5-8 hours

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31
Q

Depressants: Glutethimide

A

Dependency (Physical/Psychological): high/mod

Use: oral

Duration: 4-8 hours

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32
Q

What’re depressants?

A

drugs used medicinally to relieve anxiety, irritability, tension

high potential for abuse, development of tolerance

produce state of intoxication similar to that of alcohol

combined with alcohol, increase effects, multiple risks

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33
Q

Depressants: Side Effects

A

-Sensory alteration, anxiety reduction, intoxication

-Small amounts cause calmness, relaxed muscles

-Larger amounts cause slurred speech, impaired judgement, loss of motor coordination

-Very large doses may cause respiratory depression, coma, death

-Newborn babies of abusers may show dependence, withdrawal symptoms, behavioral problems, birth defects

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34
Q

Depressants: Symptoms of Overdose

A

-Shallow respiration

-Clammy skin

-Dilated pupils

-Weak and rapid pulse

-Coma

-Death

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35
Q

Depressants: Withdrawal Syndrome

A

-Anxiety

-Insomnia

-Muscles tremors

-Loss of appetite

-Abrupt cessation or reduced high dose may cause convulsions, delirium, death

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36
Q

Depressants: Indication of Possible Misuse

A

-Behavior similar to alcohol intoxication

-Staggering, stumbling, lack of coordination, slurred speech

-Falling asleep while at work, difficulty concentrating

-Dilated pupils

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37
Q

Stimulants: Cocaine

A

Dependence (Physical/Psychological): possible/high

Use: sniffed, smoked, injected

Duration: 1-2 hours (high lasts 5-20 minutes)

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38
Q

Stimulants: Amphetamine

A

Dependency (Physical/Psychological): possible/high

Use: oral, injected

Duration: 2-4 hours

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39
Q

Stimulants: Methamphetamine

A

Dependence (Physical/Psychological): possible/high

Use: oral, injected

Duration: 2-4 hours

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40
Q

Stimulants: Phenmetrazine

A

Dependency (Physical/Psychological): possible/high

Use: oral, injected

Duration: 2-4 hours

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41
Q

Stimulants: Methylphenidate

A

Dependency (Physical/Psychological): possible/mod

Use: oral, injected

Duration: 2-4 hours

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42
Q

Stimulants: Other Stimulants

A

Dependence (Physical/Psychological): possible/high

Use: oral, injected

Duration: 2-4 hours

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43
Q

Stimulants: Ice

A

Dependence (Physical/Psychological): high/high

Use: smoked, oral injec., inhaled

Duration: 4-14 hours

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44
Q

Stimulants: Definition

A

drugs used to increase alertness, relieve fatigue, feel stronger and more decisive, used for euphoric effects or to counteract the “down” feeling of tranquilizers or alcohol

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45
Q

Stimulants: Possible Side Effects

A

-Increased heart and respiratory rates

-Elevated blood pressure

-Dilated pupils and decreased appetite

-High doses may cause rapid or irregular heartbeat, loss of coordination, collapse, may cause perspiration, blurred vision, dizziness, a feeling of restlessness, anxiety, delusions

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46
Q

Stimulants: Symptoms of Overdose

A

-Agitated behavior

-Increase in body temperature

-Hallucinations

-Convulsions

-Possible death

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47
Q

Stimulants: Withdrawal Symptoms

A

-Apathy

-Long periods of sleep

-Irritability

-Depression

-Disorientation

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48
Q

Stimulants: Indications of Possible Misuse

A

-Excessive activity, talkativeness, irritability, argumentativeness or nervousness

-Long periods without sleeping or eating

-Euphoria

-Cocaine, while classified under the Controlled Substance Act (CSA) as a narcotic, is also discussed as a stimulant

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49
Q

Hallucinogens: PCP Angel Dust Loveboat

A

Dependence (Physical/Psychological): unknown/high

Use: smoked, oral

Duration: up to days when injected

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50
Q

Hallucinogens: LSD, Acid, Green/Red Dragon

A

Dependence (Physical/Psychological): none/unknown

Use: oral

Duration: 8-12 hours

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51
Q

Hallucinogens: Mescaline, Peyote

A

Dependence (Physical/Psychological): none/unknown

Use: oral, injected, smoked, sniffed

Duration: variable

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52
Q

Hallucinogens: Designer Drugs, Ecstacy – PCE

A

Dependence (Physical/Psychological): unknown/unknown

Use: oral, injected, smoked

Duration: variable

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53
Q

Hallucinogens: Definitions

A

drugs that produce behavioral changes that are often multiple and dramatic

no known medical use, but some block sensation to pain and use may result in self-inflicted injuries

“designer drugs”, made to imitate certain illegal drugs, are often many times stronger than drugs they imitate

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54
Q

Hallucinogens: Possible Effects

A

-Rapidly changing feelings, immediately and long after use

-Chronic use may cause persistent problems, depression, violent behavior, anxiety, distorted perception of time

-Large doses may cause persistent problems, depression, violent behavior, anxiety, distorted perception of time

-May cause hallucinations, illusions, dizziness, confusion, suspicion, anxiety, loss of control

-Delayed effects - “flashbacks” may occur long after use

-Designer drugs - use may cause irreversible brain damage

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55
Q

Hallucinogens: Symptoms of Overdose

A

longer, more intense “trip” episodes, psychosis, coma, death

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56
Q

Hallucinogens: Withdrawal Syndrome

A

no known withdrawal syndrome

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57
Q

Hallucinogens: Indications of Possible Misuse

A

-Extreme changes in behavior and mood; person may sit or recline in a trance-like state

-Client may appear fearful

-Chills, irregular breathing, sweating, trembling hands

-Changes in sensitivity to light, hearing, touch, smell and time

-Increase in blood pressure, heart rate and blood sugar

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58
Q

Cannabis: Marijuana

A

Dependence (Physical/Psychological): unknown/moderate

Use: smoked, oral

Duration: 2-4 hours

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59
Q

Cannabis: Tetrahydrocannaboinol

A

Dependence (Physical/Psychological): unknown/moderate

Use: smoked, oral

Duration: 2-4 hours

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60
Q

Cannabis: Hashish

A

Dependence (Physical/Psychological): unknown/moderate

Use: smoked, oral

Duration: 2-4 hours

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61
Q

Cannabis: Hashish Oil

A

Dependence (Physical/Psychological): unknown/moderate

Use: smoked, oral

Duration: 2-4 hours

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62
Q

Cannabis: Definition

A

-Hemp plant from which marijuana and hashish are produced

-Hashish consists of resinous secretions of the cannabis plant

-Marijuana is a tobacco-like substance

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63
Q

Cannabis: Possible Effects

A

-Euphoria followed by relaxation

-Increased appetite, impaired memory, concentration, knowledge retention, loss of coordination; more vivid sense of taste, sight, smell, hearing

-Stronger doses cause fluctuating emotions, fragmentary thoughts, disoriented behavior

-May cause irritation to lungs, respiratory system; may cause cancer

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64
Q

Cannabis: Symptoms of Overdose

A

fatigue, lack of coordination, paranoia

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65
Q

Cannabis: Withdrawal Syndrome

A

-Insomnia

-Hyperactivity

-Sometimes decreased appetite

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66
Q

Cannabis: Indications of Possible Misuse

A

-Animated behavior, loud talking, follow by sleepiness

-Dilated pupils, bloodshot eyes

-Distortions in perception; hallucinations

-Distortions in depth and time perception; loss of coordinationAl

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67
Q

Alcohol: Ethyl Alcohol

A

Dependence (Physical/Psychological): possible/possible

Use: oral

Duration: 1-4 hours

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68
Q

Alcohol: Ethanol

A

Dependence (Physical/Psychological): possible/possible

Use: oral

Duration: 1-4 hours

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69
Q

Alcohol: Definition

A

-Liquid distilled product of fermented fruits, grains and vegetables

-Used as solvent, antiseptic and sedative

-High potential for abuse

-Small to moderate amounts taken over extended periods of time have no negative effects and may have positive health consequences

70
Q

Alcohol: Possible Effects

A

-Intoxication

-Sensory alteration

-Anxiety reduction

71
Q

Alcohol: Symptoms of Overdose

A

-Staggering

-Odor of alcohol on breath

-Loss of coordination

-Slurred speech, dilated pupils

-Coma, respiratory failure

-Fetal alcohol syndrome (in babies)

-Nerve and liver damage

72
Q

Alcohol: Withdrawal Syndrome

A

-Sweating, tremors, altered perception

-Psychosis, fear, auditory hallucincations

73
Q

Alcohol: Indications of Possible Misuse

A

-Confusion, disorientation, loss of motor nerve control

-Convulsions, shock, shallow respiration

-Involuntary defecation, drowsiness

-Respiratory depression, possible death

74
Q

Steroids: Dianabol

A

Dependence (Physical/Psychological): possible/possible

Use: oral

Duration: days - wks

75
Q

Steroids: Nandrolone

A

Dependence (Physical/Psychological): possible/possible

Use: oral

Duration: days - wks

76
Q

Steroids: Definition

A

-Synthetic compounds available legally and illegally

-Drugs that are closely related to the male sex hormone, testosterone

-Moderate potential for abuse, particularly among young males

77
Q

Steroids: Possible Effects

A

-Increase in body weight

-Increase in muscle mass and strength

-Enhanced athletic performance

-Increased physical endurance

78
Q

Steroids: Symptoms of Overdose

A

-Quick weight and muscle gains

-Extremely aggressive behavior or “Roid rage”

-Severe skin rashes

-Impotence, reduced sexual drive

-In females, development of irreversible masculine traits

79
Q

Steroids: Withdrawal Syndrome

A

-Significant weight loss

-Depression

-Behavioral changes

-Trembling

80
Q

Steroids: Indications of Possible Misuse

A

-Increased combativeness and aggressiveness

-Jaundice

-Purple or red spots on body; unexplained darkness of skin

-Persistent unpleasant breath odor

-Swelling of feet or lower legs

81
Q

Substance Use Disorders: General Treatment Principles and Alternatives: Stages of Treatment

A
  1. Assessment Phase
  2. The treatment of intoxication and withdrawal when necessary
  3. Development and implementation of an overall treatment strategy
82
Q

Three General Treatment Strategies

A

-Drug free

-Substitution, use of alternative medications that inhibit the use of illegal drugs

-Harm reduction

83
Q

Diagnosis: Disease Definition, Epidemiology, and Natural History

A

-Major public health problem, costing society in excess of $300 billion annually, including the costs of treatment, related health problems, absenteeism, lost productivity, drug-related crime and incarceration, and efforts in education and prevention

-The motivation for using any psychoactive substance is, in part, related to the acute and chronic effects of these agents on mood, cognition, and behavior

-In some individuals the subjective changes that accompany substance intoxication are experienced as highly pleasurable and lead to repetitive use

-About 15 percent of regular users become psychologically dependent in that they come to believe that they are unable to function optimally in social, work, or other settings without experience some degree of substance intoxication

84
Q

DSM-5 Criteria for Substance Dependence and Abuse: Criteria for Substance Dependence

A
  1. A maladaptive pattern os substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following occurring at any time in the same 12-month period (look below)
  2. Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect; (b) markedly diminished effect with continued use of the same amount of the substance
  3. Withdrawal, as manifested by either of the following: (a) the characteristic withdrawal syndrome for the substance; (b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
  4. The substance is often taken in larger amounts or over a longer period than was intended
  5. There is a persistent desire, or unsuccessful efforts to cut down or control substance use
  6. The individual’s activities are disproportionately dedicated to acquiring the substance, use the substance, or recover from its effects
  7. Important social, occupational, or recreational activities are given up or reduced because of substance use
  8. The 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 the substance
85
Q

DSM 5 Criteria for Substance Dependence and Abuse: Criteria for Substance Abuse

A
  1. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

a. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home

b. Recurrent substance use in situations in which it is physically hazardous

c. Recurrent substance-related legal problems

d. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

e. The symptoms have never met the criteria for substance dependence for this class of substance

86
Q

DSM 5 Criteria for Substance Dependence and Abuse: The DSM 5 Criteria of Substance Dependence

A
  1. Physiological dependence
  2. Without physiologic dependence
  3. Clients may be variously classified as currently manifesting a pattern of abuse, or dependence, or as in remission
87
Q

Definitions of Remission of Substance Dependence

A

-Four Categories: full, early, partial, sustained, and sustained partial-on the basis of whether any of the criteria for abuse or dependence have been met and over what time frame

-The remission category can also be used for clients receiving agonist therapy or for those living in a controlled drug-free environment

88
Q

Disease Definition and Diagnostic Features: Cross-Sectional Features

A

-Clients presenting for treatment of a substance use disorder frequently manifest signs and symptoms of substance-induced intoxication or withdrawal

-The clinical picture varies with the substance used, its dosage, the duration of action, the time elapsed since the last dose, the presence or absence of tolerance, and/or other clinical emotional factors

-The expectations of the client, his or her styles or response to states of intoxication or physical discomfort, and the setting in which intoxication or physical discomfort, and the settings in which intoxication or withdrawal takes place also play a role

-Clients experiencing substance-induced intoxication generally manifest changes in mood, cognition, and/or behavior

89
Q

Symptoms of Substance Induced Intoxication

A

-Mood-related changes may range from euphoria to depression, with rapid mood changes in response to, or independent of external events

-Cognitive changes may include shortened attention span, impaired concentration, and disturbances of thinking and/or perception

-Behavioral changes may include wakefulness or somnolence, lethargy, or hyperactivity

-Impairment in social and occupational functioning is also common in intoxicated individuals

90
Q

Disease Definition and Diagnostic Features: Other Cross-Sectional Diagnostic Features

A

clinical disorders commonly found in such clients include conduct disorder in children and adolescents, depression, bipolar disorder, schizophrenia, anxiety disorders, eating disorders, pathological gambling, antisocial personality disorder, PTSD, and other personality disorders

91
Q

Other Cross-Sectional Diagnostic Features: Associated Medical Problems

A

-Cardiac problems resulting from acute cocaine intoxication, respiratory depression and coma in severe opioid overdose and alcohol abuse, and hepatic cirrhosis after prolonged heavy drinking

-General medical conditions frequently associated with opioid-dependent individuals who administer opioids by injection include bacterial infections, HIV, and hepatitis

-Clients whose substance dependence is accompanied by poor self-care and/or high levels of risk-taking behavior are at increased risk of malnutrition, physical trauma, and HIV infection

92
Q

Longitudinal Features of Clients with Substance Use Disorders

A

-Long history of repeated episodes of intoxication and withdrawal interspersed with attempts to remain substance free

-Episodes of intoxication may be sporadic and brief, rarely requiring general medical or clinical intervention

-Repeated episodes of intoxication lasting weeks or months, interrupted by voluntary or involuntary periods of self-managed, or medically managed, withdrawal

-Partial or complete withdrawal from abused substances may be followed by variable periods of self-imposed or involuntary abstinence, often ending in relapse to substance use and, eventually, resumption of dependence

93
Q

Multi Substance Use

A

-Replacement of one form of substance dependent by another may occur

-Many individuals who abuse alcohol or illicit substances maintain their ability to function in interpersonal relationships and in the work setting

-Peer relationships often focus extensively on obtaining and using illicit drugs or alcohol

-The risk of accidents, violence, and suicide is significantly greater than for the general population

94
Q

General Treatment Principles and Alternatives

A
  1. Initial experiences with substance use usually occur before puberty; casual users who go on to develop a substance use disorder are generally indistinguishable from their peers with respect to the type and frequency of substance use
  2. Early or regular use of “gateway” drugs, such as alcohol, marijuana, or nicotine, and early evidence of aggressive behavior, intra familial disturbances, and associating with substance use and the subsequent emotional and mental health problems
  3. In adolescents, growing preoccupation with substance use, frequent episodes of intoxication, use of drugs with greater dependence liability, and a preference for routs of administration that result in quicker onset of drug effects and for more rapidly acting preparations presage the development of substance dependence

-In most cases, the onset of substance abuse occurs in the teens and early 20s, some individuals settle on a “drug of choice” early on

95
Q

How is drug preference shaped?

A

-Current fashion, availability, peer influences, and individual biological and psychological factors

-Gender-specific differences in drug preference have diminished somewhat over the last two decades

-Familial predisposition to disorders that predispose individual memebers

-Genetic factors are associated with alcoholism, particularly in males with biological male relatives who are also alcoholic and, to a lesser extent, in females with strong gamily histories of the disorder

96
Q

Chronic Course of Substance Abuse

A

-Some individuals can abstain for long periods without formal treatment

-Abstinence or periods of greatly reduced substance use are more likely when there is active participation in regular treatment and/or self-help groups

-Clients who experience a severe life crisis are generally more motivated to seek treatment, but most still require external support to maintain their motivation to continue in treatment beyond the initial stages

97
Q

12 Months After the Onset of Remission

A

-Many experience several cycles of remission and relapse before they acknowledge that “controlled” substance use is not possible for them

-Frequency, intensity, and duration of treatment participation are positively correlated with improved outcomes

98
Q

Substance Disorder Treatment Statistics

A

-Majority of clients (up to 70 percent in some studies) are eventually able to stop compulsive use and either abstain from abused substances entirely or experience only brief episodes of substance use that do not progress to abuse or dependence

-Only a minority of clients exhibit a pattern of chronic relapse requiring repetitive intervention

-Of those who remain abstinent for 2 years, almost 90 percent are substance free at 10 years have a very high likelihood of being substance free at 20 years

-Prolonged abstinence, accompanied by improvement in social and occupational functioning, is more apt to occur in those who have lower levels of psychopathology, demonstrate the ability to develop new relationships, and consistently make use of self-help groups

99
Q

Is substance abuse related to other forms of psychopathology?

A

Yes

approximately one-third of hospitalized mentally ill clients manifest associated nonnicotine substance use disorders

100
Q

Clinical Social Work Management: Definition

A

foundation of treatment for clients with substance use disorders

101
Q

What are the specific objective of clinical management?

A
  1. Establishing and maintaining a therapeutic alliance
  2. Monitoring the client’s clinical status
  3. Arranging and monitoring services and programs for the individual and the family
  4. Assessing the client’s need for continued services and monitoring their effectiveness
  5. Providing direct clinical social work services
  6. Remaining alert to intoxication and withdrawal states
  7. Facilitating adherence to a treatment plan
  8. Preventing relapse
  9. Providing education about substance use disorders
  10. Insuring the availability of medical care to reduce the morbidity and sequelae of substance use disorders
102
Q

Clinical Social Work Management: Combined Treatment

A

combined with specific treatments carried out in a collaborative fashion with professionals of various disciplines at a variety of sites, including community-based agencies, clinics, hospitals, detoxification programs, vocational rehabilitation and residential treatment facilities

103
Q

Specific Treatments: Pharmacologic Treatments

A

-Medications to treat intoxication and withdrawal states

-Medications to decrease the reinforcing effects of abused substances

-Medications that discourage the use of substances by inducing unpleasant consequences through a drug-drug interaction or by coupling substance use with an unpleasant, drug-induced condition

-Agonist substitution therapy

-Medications to treat associated clinical conditions

104
Q

Specific Treatments: Psychosocial Treatments

A

-Essential components of a comprehensive treatment program

-Studies few in number and have major design limitations

-The following are effective for substance abuse treatment: CBT, behavioral therapies, psychodynamic/interpersonal, group and family therapy, participation in self-help groups

105
Q

What does a treatment plan include in substance abuse treatment?

A

-Clinical Management

-A strategy for achieving abstinence or reducing the effects or use of illicit substances

-Efforts to enhance ongoing compliance with the treatment program, prevent relapse, and improve functioning

-Additional treatments necessary for clients with associated conditions

106
Q

Treatment Settings: Definition

A

vary with regard to the availability of specific treatment modalities, the degree of restriction to access to substances that are likely to be abused, the availability of medical, psychiatric and social work care, and the overall milieu and treatment philosophy

107
Q

What’re commonly available treatment settings?

A

-Hospitals

-Residential Treatment Facilities

  • Partial Hospital Care

-Outpatient Programs

108
Q

Who is hospitalization appropriate for?

A

-Clients with drug overdose who cannot be safely treated in an outpatient or emergency room setting

-Clients at risk for severe or medically complicated withdrawal syndromes

-Clients with general medical conditions that make ambulatory detoxification unsafe

-Clients with a level of mental health problems that would markedly impair their ability to participate in, comply with, or benefit from treatment or whose associated disorder would by itself require hospital-level care

-Clients manifesting substance use or other behaviors that constitute an acute danger to themselves or others; or clients who have not responded to less intensive treatment efforts and whose substance use disorder(s) poses and ongoing threat to their physical and mental health

109
Q

Who is residential treatment appropriate for?

A

indicated for clients who do not meet the clinical criteria for hospitalization, but whose lives and social interactions focus predominantly on substance use, and who lack sufficient social and vocational skills and drug-free social supports to maintain abstinence in an outpatient setting

residential treatment of 3 months or more is associated with better long-term outcome in such clients

110
Q

Who is partial hospitalization appropriate for?

A

clients who require intensive care but have a reasonable probability of refraining from illicit use of substances outside a restricted setting

clients who are leaving the hospital or residential settings and who remain high risk for relapse

clients who are thought to lack sufficient motivation or social and familial supports to continue in treatment, clients with severe mental illness and/or a history of relapse to substance use in the immediate post hospital or post residential period, and those returning to high-risk environments who have limited psychosocial supports for remaining drug free

partial hospital programs are also indicated for clients who are doing poorly in intensive outpatient treatment

111
Q

Who is outpatient treatment appropriate for?

A

clients whose clinical condition or environmental circumstances do not require a more intensive level of care

monitoring for substance use should be intensified during periods of high risk of relapse, including early stages of treatment, times of transition to less intensive levels of care, and the first year following cessation of active treatment

112
Q

What clinical features that influence treatment?

A

-Reflect consideration of associated mental and general medical conditions, gender-related factors, age, social milieu and living environment, cultural factors, and family characteristics

-High prevalence of associated mental illness and the diagnostic distinction between substance use symptoms and other disorders should receive particular attention, and specific treatment for associated disorders should be provided

113
Q

Alcohol Use Disorders: Treatment Settings

A

-Clients with alcohol withdrawal must be detoxified in a setting that provides for frequent clinical assessment and the provision of any necessary treatments

-Some outpatients settings can accommodate these requirements and may be appropriate for clients deemed to be at low risk of a complicated withdrawal syndrome

-Those who have a prior history of delirium tremens, whose documented history of very heavy alcohol use and high tolerance places them at risk for a complicated withdrawal syndrome, who are concurrently abusing other drugs, who have a severe associated general medical or mental health disorder, or who repeatedly fail to cooperate with, or benefit from, outpatient detoxification are more likely to require a residential or hospital setting that can safely provide the necessary care

-Clients in severe withdrawal require treatment in a hospital setting

-Most treatments for clients with alcohol dependence or abuse can be successfully conducted outside of the hospital

-Client who are unlikely to benefit from less intensive or less restrictive alternatives may need to be hospitalized at times during their treatment

114
Q

Alcohol Disorders: Pharmacologic Treatments

A

-Effective treatments are not well established

-Naltrexone may attenuate some of the reinforcing effects of alcohol, but there are limited data regarding the long-term efficacy for clients with alcohol use disorders

-Disulfiram is an effective adjunct to a comprehensive treatment program in reliable, motivated clients whose drinking may be triggered yb events that suddenly increase alcohol craving

-Clients with impulsive behavior, psychotic symptoms, or suicicdal thoughts are poor candidates for disulfiram treatment

-In clients with clearly established associated mental illness, treatment specifically directed at these disorders is indicated

115
Q

Alcohol Disorders: Psychosocial Treatments

A

-CBT

-Behavioral Therapies

-Psychodynamic/Interpersonal Therapies

-Brief Interventions

-Marital and Family Therapy

-Group Treatment

-Participation is self-help groups, such as Alcoholics Anonymous, is frequently helpful

116
Q

Alcohol Disorders: Management of Alcohol Intoxication and Withdrawal

A

-Monitored and maintained in a safe environment

-Alcohol withdrawal typically begins within 4-12 hours after cessation or reduction of alcohol use, peak in intensity during the second day of abstinence, and generally resolve within 4-5 days

-Serious complications include seizures, hallucinations, and delirium

117
Q

Alcohol Disorders: Other Clinical Features Influencing Treatment

A

treatment of pregnant women with alcohol use disorders is complicated by the risk of fetal alcohol syndrome and the corresponding urgency of minimizing the intake of alcohol

118
Q

Cocaine Use Disorders: Treatment Settings

A

clinical and research experience suggests that intensive outpatient treatment, in which a variety of treatment modalities are simultaneously used and in which the focus is maintenance of abstinence, is effective for most clients with cocaine use disorders

119
Q

Cocaine Use Disorders: Pharmacologic Treatment

A

those who fail to respond to psychosocial treatment may be considered for treatment with medications

120
Q

Cocaine Use Disorders: Psychosocial treatments

A

treatments focusing on abstinence are effective for most clients

regular participation in self-help groups may improve the outcome for selected clients with cocaine use disorders

121
Q

Cocaine Use Disorders: Management of Cocaine Intoxication and Withdrawal

A

-Hypertension

-Tachycardia

-Seizures

-Paranoid Delusions

-Depression

-Cravings

122
Q

Cocaine Use Disorders: Other Clinical Features Influencing Treatment

A

pregnant women with cocaine use disorders is complicated by increased risk of prematurity, low birth weight, stillbirth, and sudden infant death syndrome and the corresponding urgency of minimizing the intake of cocaine

123
Q

Opioid Use Disorders: Treatment Settings

A

-Standard treatment settings

-Therapeutic communities

124
Q

Opioid Use Disorders: Pharmacologic Treatments

A

maintenance on methadone or LAAM is appropriate for clients with a prolonged history (>1 year) of opioid dependence

naltrexone is an alternative treatment strategy whose utility is often limited by lack of client compliance and low treatment retention

125
Q

Opioid Use Disorders: Psychosocial Treatments

A

-CBT

-Behavioral therapies

-Psychodynamic Psychotherapy

-Group and Family Therapies

-Self-Help Groups

126
Q

Opioid Use Disorders: Effective Strategies

A

-Methadone substitution with gradual tapering

-Abrupt discontinuation of opioids, with the use of medications to suppress withdrawal symptoms

-Monitoring for the presence of other substances is essential because the concurrent use of or withdrawal from other substances can complicate the treatment of opioid withdrawal

127
Q

Opioid Use Disorders: Other Clinical Features Influencing Treatment

A

-Treatment of mental health issues and substance abuse can be difficult

-Those who use opioids are at a higher risk of medical complications from bacterial endocarditis, hepatitis, HIV infection, and tuberculosis

-Treatment of pregnant women with opioid use disorders is complicated by the increased risk of low birth weight, prematurity, neonatal abstinence syndrome, stillbirth, and sudden infant death syndrome and the corresponding urgency of minimizing the intake of opioids

128
Q

Phases of Treatment

A
  1. Assessment phase
  2. Treatment of intoxication or withdrawal
  3. Development and Implementation of an overall treatment strategy
  4. Treatment strategy may emphasize the individual’s need to remain drug-free, or substitution of a safer drug
129
Q

Goals of Treatment: Long-Range Goals

A

-Reduction in the use and effects of abused substances

-The achievement of abstinence

-Reduction in the frequency of relapses, and rehabilitation

130
Q

Goals of Treatment: Reduction in the Frequency and Severity of Relapse

A

-May be an intermediate goal of treatment since abuse is chronic and subject to relapse

-Help clients to identify situations that place them at high risk for relapse

-Develop responses to stress other than substance use

131
Q

What’re examples of high-risk situations regarding relapse?

A

craving physiologic responses to the substance and, for some, interpersonal or social situations constitute risk factors

132
Q

What does an assessment include?

A

-Degree of associated intoxication

-Severity of associated withdrawal syndromes

-Time elapse since most recent use

-The mode of onset

-Pattern of use

-General medical and mental illness history, including a complete physical and mental status examination, to ascertain the presence or absence of general medical or mental disorders, as well as signs and symptoms of intoxication or withdrawal

-In some cases, psychological or neuropsychological testing may be indicated

-History of prior treatment (if relevant)

-Qualitative and quantitative blood and urine screening for drugs of abuse and laboratory tests for abnormalities that may accompany acute or chronic substance use

-Screening for infectious and other diseases often found in substance-dependent persons

133
Q

Assessment: History of Prior Treatment

A
  1. Setting, context, modalities used, compliance, duration, and short (3-month), intermediate (1-year), and longer-term outcome as measured by subsequent substance use
  2. The level of social and occupational functioning achieved, and other outcome variables
  3. Prior efforts to control or stop substance use outside of a formal treatment setting should be discussed, as well as the client’s attitudes toward his or her previous treatment experiences
  4. Complete family, social, and substance use history including: familial substance use disorders or other mental illness, familial factors contributing to the development or perpetuation of substance use disorders
  5. School or vocational adjustment, peer relationships, and financial or legal problems
  6. Impact of the client’s current living environment
134
Q

Management: Objectives

A

-Establishing and maintaining a therapeutic alliance

-Monitoring the client’s clinical status

-Managing intoxication and withdrawal states

-Developing and facilitating adherence to a treatment plan

-Preventing relapse

-Providing education about substance use disorders

-Reducing the morbidity and sequelae of substance use disorders

135
Q

Management: Establishing and Maintaining a Therapeutic Alliance

A

-Obtains necessary diagnostic and treatment-related information

-Gains the confidence of the client and significant others

-Important in time of crisis

-Strength of the therapeutic alliance is a significant predictor of outcomes

136
Q

Management: Monitoring Clinical Status

A

-Ongoing evaluation of safety is critical

-Important to monitor for emergence of suicidal or homicidal thoughts, or of treatment-emergent side effects

-Need to monitor clinical status to ensure that client is receiving appropriate treatment

-Relapse is common and is inconsistently self-reported by clients

-Laboratory monitoring through breath, blood, saliva, and urine testing for drugs of abuse

-Need to monitor validity and reliability of results

137
Q

Management: Strategies to Increase Motivation

A

-Participation in self-help or professionally led groups that include recovering individuals

-Encouraging the development of a substance-free peer group and lifestyle

-Helping the client develop techniques to improve interpersonal relationships in family, work, and social settings

-Encouraging the client to seek new experiences and roles consistent with a substance-free existence

-Discouraging the client from instituting major life changes that might increase the risk of relapse

-Helping clients anticipate and avoid drug-related cues

-Training clients in self-monitoring affective or cognitive states associated with increased craving and substance use

-Contingency contracting

-Teaching desensitization and relaxation techniques to reduce the potency of drug-related stimuli and modulate craving intensity

-Helping clients develop alternative, nonchemical coping responses to uncomfortable feelings and situations

-Providing coping and social skills training to help clients become involved in satisfying drug-free alternative activities

138
Q

Cognitive Behavioral Therapies: Definition

A

focuses on altering the cognitive processes that lead to maladaptive behaviors in substance users (intervening in the behavioral chain of events that lead to substance use, helping clients deal successfully with acute or chronic drug craving, promoting and reinforcing the development of social skills and behaviors compatible with remaining drug free)

139
Q

Cognitive Behavioral Therapies: Cognitive Therapy

A

the foundation of cognitive therapy is the belief that by identifying and subsequently modifying maladaptive thinking patterns, clients can reduce or eliminate negative feelings and behavior

140
Q

Cognitive Behavioral Therapies: Relapse Prevention

A

-Help client gain better self-control

-Discussing ambivalence

-Identifying emotional and environmental triggers of craving and substance use

-Developing and reviewing specific coping strategies to deal with internal or external stressors

-Exploring the decision chain leading to resumption of substance use

-Learning from brief episodes of relapse about triggers leading to relapse and developing effective techniques for early intervention

141
Q

Cognitive Behavioral Therapies: Motivational Enhancement Therapy

A

client-centered, systems, and social-psychological persuasion techniques are used

characterized by an empathic approach in which the therapist helps to motivate the client by asking about the pros and cons of specific behaviors, by exploring the client’s goals and associated ambivalence about reaching these goals, and by listening reflectively

142
Q

Cognitive Behavioral Therapies: Operant Behavioral Therapy

A

involves operant rewarding or punishing of clients for desirable behaviors

example: exchange clean urine sample for movie tickets

143
Q

Cognitive Behavioral Therapies: Contingency Management

A

treatment based on the use of predetermined positive or negative consequences to reward abstinence or punish drug-related behaviors

144
Q

Cognitive Behavioral Therapies: Cue Exposure Treatment

A

based on Pavlovian extinction paradigm involves exposure of the client to cue that induce drug craving while preventing actual drug use and, therefore, the experience of drug-related reinforcement

cue exposure can also be paired with relaxation techniques and drug refusal training to facilitate extinction of calssically conditioned craving

145
Q

Cognitive Behavioral Therapies: Aversion Therapy

A

coupling drug or alcohol use with an unpleasant experience, is used in certain specialized facilities

controlled trials have mixed results

146
Q

Individual Psychodynamic/Interpersonal Therapies: Individual Psychodynamic Psychotherapy

A

sometimes used in combination with other treatment modalities

clients antisocial personality disorder are poor candidates for psychodynamic psychotherapy

147
Q

Individual Psychodynamic/Interpersonal Therapies: Individual Interpersonal Therapy

A

focuses on difficulties in current interpersonal functioning by using psychodynamic principles and techniques with some modifications, i.e., including limit setting and using advice and suggestions

148
Q

Group Therapies: Types of Group Therapy

A

-Modified Psychodynamic

-Interpersonal, Interactive

-Rational Emotive

-Gestalt

-Psychodrama

149
Q

Group Therapies: Family Therapies

A

-Dysfunctional families are associated with poor short-and long-term treatment outcomes

-Goals include encouraging family support and monitoring abstinence

-Theoretical orientations include structural, strategic, psychodynamic, systems, and behavioral approaches

-Interventions can be focused on the nuclear family; the client and spouse; on concurrent treatment for clients, spouses, and siblings; on multifamily groups; and on social networks

-Family interventions are used when abstinence upsets a previously well-established but maladaptive style of family interaction in which members need help adjusting to a new set of individual and familial goals, attitudes, and behaviors

-Couple and family therapy are useful for promoting psychological differentiation of family members, providing forum for the exchange of information and ideas about the treatment plan, developing behavioral management contracts and ground rules for continued family support, and reinforcing behaviors that help prevent relapse and enhance the prospects for recovery

150
Q

Group Therapies: Self-Help Groups

A

-Generally based on the 12-step approach of AA and related groups, such as Narcotics Anonymous and Cocaine Anonymous

-Rational Recovery Smart Recovery

-Faith Community Supported Programs

-Receive group support and repeated reminders of the consequences of alcohol or other drug use and the benefits of abstinence and sobriety

151
Q

Treatment Settings: Hospitals

A

programs include detoxification, assessment, and treatment of general medical and mental illness conditions; groups, individual, and family therapies; psycho education, and motivational counseling

152
Q

What types of clients are hospital settings used for?

A

-Drug overdose clients who cannot safely be treated in an outpatient or emergency room setting

-Client in withdrawal who are either at risk for a severe or complicated withdrawal syndrome

-Clients with acute or chronic general medical conditions that make detoxification in a residential or ambulatory setting unsafe

-Clients with documented history of not engaging in, or benefitting from, treatment in a less intensive setting

-Clients with marked mental illness who are a danger to themselves or others

153
Q

Treatment Settings: Residential Treatment

A

indicated for clients whose lives and social interactions are largely dedicated to substance use and who lack sufficient motivation and/or drug-free social supports to remain abstinent in an ambulatory setting, but who do not require hospitalization

provide individual, group, and vocational counseling programs but use partial hospital or outpatient programs to supply psychosocial and psycho pharmacologic treatment

154
Q

Treatment Settings: Therapeutic Communities

A

-Clients with opioid, cocaine, or polysubstance use disorders may benefit from referral to a residential therapeutic community

-Programs reserved for clients unsuitable for outpatient treatment

-Designed to resocialize for a drug-free lifestyle

155
Q

Treatment Settings: Partial Hospitalization

A

provides and intensive and structured treatment experience for clients with substance dependence who require more services than those available in traditional outpatient settings

156
Q

Treatment Settings: Outpatient Settings

A

-Treatment should encourage and integrate self-help programs

-High rates of attrition are a problem in the early phase

-Intermediate-and long-term outcomes are highly correlated with retention

-Efforts should be directed toward motivating clients to remain in treatment

-Efforts may include the use of legal, family, or employer-generated pressure where available

157
Q

Treatment Settings: Clinical Risks

A

-Risk of suicide attempts and completed suicides (incidence of complete suicide is approximately 3-4 times that found in the general population; major depressive disorder increase the suicide risk)

-Risk for homicide and other forms of violence

-Substances whose use may be associated with aggression include cocaine, hallucinogens, phencyclidine (PCP), and alcohol

-Substances that lead to withdrawal syndromes associated with a risk of violence include alcohol, opioids, and hypnotic sedatives

-Marijuana or hallucinogens can create a state of paranoia and anxiety and may inadvertently commit violent acts on the basis of their faulty perception

-The diagnosis of substance use disorders in all individuals who present with a history of suicide or other form of violence

158
Q

Treatment Settings: Other Disorders Associated with Substance Abuse

A

-Personality disorders

-Increased risk for suicide

159
Q

What can treatment be complicated by?

A

-Simultaneous intoxication or withdrawal from two or more drugs

-Varying time frames for experiencing withdrawal symptoms in clients using multiple drugs

-Need to detoxify the client from more than one drug

-Potential interactions between an abused substance and medications used to treat a substance use disorder

160
Q

General Medical Disorders: Alcohol Related Disorders

A

-Gastrointestinal and Central Nervous System

-Severe CNS injury-affect cognition, behavior and ability to comply

-Increased risk of accidents and death from automobiles, suicide homicide and falls

161
Q

General Medical Disorders: Injected Drugs

A

-The most important of these are HIV infection, tuberculosis, hepatitis-C, and sexually transmitted diseases

-Approximately 30-40 percent of inner-city intravenous drug users test positive for HIV

162
Q

Pregnancy: Health of the Pregnant Woman

A

-High risk for sexually transmitted diseases, hepatitis, anemia, tuberculosis, hypertension, and preeclampsia

-Woman’s ability to maintain a healthy lifestyle, including proper nutrition, and obtain needed health care

163
Q

Pregnancy: Course of Pregnancy

A

greater than average risk for spontaneous abortions, and early and prolonged labor, in addition to complications of other general medical conditions that may be due to the substance use

164
Q

Pregnancy: Fetal Development

A

-Some substances, including opiates, cocaine, and alcohol, are known to directly affect the health of the fetus

-Health effects may occur at any stage of development, but is particularly likely during the third trimester

-Fetal concentrations of abused substances average 50-100 percent of maternal blood levels can be higher; the circulation of active drug metabolites is another source of fetal exposure to potentially toxic substances

-Higher risk of birth defects, cardiovascular problems, impaired growth and development, prematurity, low birth weight, and stillbirth

-After delivery, the infant may suffer from withdrawal

165
Q

Pregnancy: Child Development

A

some substances are associated with long-term negative effects on physical and cognitive development

166
Q

Pregnancy: Parenting Behavior

A

mothers with substance use disorders are frequently in need of education and training in parenting skills, social services, nutritional counseling, assistance in obtaining health and welfare entitlements, and other interventions aimed at reducing the likelihood of child abuse or neglect

167
Q

Gender and Age-Related Factors: Why Are Women at Such High Risk for Substance Abuse Disorders

A

-Psychological and financial barriers prevent many women from seeking treatment

-Women’s perception of greater social stigma associated with their abuse of drugs and alcohol

-Women have a higher prevalence of depressive and anxiety disorders

-Many women with substance abuse disorders have a history of physical and/or sexual abuse which may influence treatment

-Female clients with family responsibilities need more help with family-related problems

168
Q

Gender and Age-Related Factors: Children and Adolescents

A

-More likely to have abuse rather than dependence disorders

-Less likely to appreciate the need for entering and remaining in treatment

-Assessment and treatment must take into account possible impairments in the child’s cognitive, social, and psychological developmental

169
Q

Children and Adolescents: Role of Substance Use Disorders in Impeding Successful Attainment of Developmental Milestones

A

-A sense of autonomy

-Ability to form interpersonal relationships

-General integration into society

-Emphasis on evaluating the adolescent’s adaptive functioning, such as academic progress, school behavior and attendance, and social functioning with peers and family members

-Treatment should also address the ability of parents to communicate and set appropriate behavioral limits

170
Q

Legal and Confidentiality Issues: Effect of Legal Pressure on Treatment Participation and Outcome

A

-Outcome studies in therapeutic communities show that individuals who enter treatment under legal compulsion stay longer and do as well as comparable clients who enter treatment voluntarily

-Higher rates of treatment compliance with narcotic antagonists are reported for court-mandated clients and for professional at risk of losing their professional licenses should they fail to comply

-Contingency contracting approaches are used such as not participating would be reported to a board

LMSW Exam (15 decks)

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