Alcohol and Substance Use Disorder Flashcards
Substance-Related and Addictive Disorders are divided into what two categories?
- Substance Use
- cocaine, ALCOHOL, stimulants, hallucinogens, inhalents, opiods, sedatives, tobacco
- Substance Induced
- intoxiccation, withdrawal, ‘other’ (psychosis/bpd/depression etc)
Overall, the dsm diagnosis of a substance use disorder is based on
a pathological pattern of behaviors related to use of the substance.
DSM Criteria Afor a substance use disorder
Criterion A criteria can be considered to fit within overall groupings of impaired control, social impairment, risky use, and pharmacological criteria.
- The individual may take the substance in larger amounts or over a longer period than was originally intended (Criterion 1)
- The individual may express a persistent desire to cut down or regulate substance use and may report multiple unsuccessful efforts to decrease or discontinue use (Criterion 2)
- The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 3)
- Craving (Criterion 4) is manifested by an intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug previously was obtained or used.
DSM Criteria 5-7 for Substance use disorder
Social impairment
- Recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home (Criterion 5).
- The individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (Criterion 6).
- Important social, occupational, or recreational activities may be given up or reduced because of substance use (Criterion 7).
DSM criteria 8-9 for substance use disorder
Risky Behaviour
- This may take the form of recurrent substance use in situations in which it is physically hazardous (Criterion 8).
- The individual may continue substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (Criterion 9).
DSM criteria 10-11 for substance use disorder
Pharmacological
- Tolerance (Criterion 10) is signaled by requiring a markedly increased dose of the substance to achieve the desired effect or a markedly reduced effect when the usual dose is consumed.
- Withdrawal (Criterion 11) is a syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance.
What do you want to assess from someone with substance related disorders?
- What? – alcohol, cannabis, party drugs, solvents
- How much?
- Past use: age of first use, use over time
- Current use: where, who, when, amount (30-day check), typical day, route, effects, why, abstinence, screening instruments
- Abuse, dependence or any induced disorders
- Identify co-morbidity
- Risk issues (who with, bingeing, route, sex, driving
- Motivation to change
- • Understand substance use within the context of person’s life
–What? – alcohol, cannabis, party drugs, solvents
– How much? – amount, potency, frequency, bingeing
– When? – time of day, week, year
– How taken? – drink, eat, smoke, snort, inject
– Effects? – high, calming, ‘out of it’, alertness
– Why taking? – stress, mood, a buzz, boredom, hooked
– Where? – school, home, parties, friend’s place, work
– With whom? – alone, partner, mates, family
What is the LLLL impact of substance related disorder
- Health (Liver)
- Relationships w friends/family/partner (Lover)
- School/work function (Livelihood)
- Legal issues (Legal)
Ways to talk about use
The decisional balance
- What are the good things about using?
- What are the less good things about using? •
Typical session/day
- Tell me about a usual day/session and how your drug use fits into this? •
Exploring concerns
- Does this stuff ever make you worried?
Looking backwards and forward
- How are things now, compared to then?
- How would you like things to be?
Describe the ‘Stages of Change”
- Precontemplation
- Contemplation
- Determination
- Action
- Maintenence
- Relapse
CAGE screen for _____
What are the questions?
Alcohol Dependence
C - Cut Down – have you ever wanted to cut down your drinking but been unable to ?
A – Annoyed – have you felt annoyed when people criticise your drinking?
G – Guilty – do you feel guilty about your drinking?
E – Eye Opener – have you ever need a drink on waking?
What Brief Intervention you can try for alcohol use
FRAMES
- Feedback about risk
- Responsibility is with the individual
- Advise and educate
- Menu of strategies and options
- Empathetic approach is neccessary
- Self-efficacy and optimism
Why do we use ‘Harm Reduction’ over abstinence
What does Harm Reduction involve?
Recognises abstinence as an ideal outcome but accepts alternatives that reduce harm, promotes low-threshold access to services
- Safety planning
- Reducing levels of use
- safe levels of use, number of occasions of use, postponing, potency of substance used
- Changing to safer mode of use
- Education around decrec health risks
- Environmental factors - planning ahead
- Legal
- Reducing levels of use
- Decrease unsafe practices
- Driving/ Safe sex/Needle Exchange
- Education
- About substances and their impact /About addiction and its implications/ About treatment
- Treat and manage co-existing/complications
- Medical /Psychiatric
- Targeted specialist interventions
- Methadone/benzodiazepine maintenance /Other/wet hostels,
Two types of Treatment for Alcohol Use Disorder
Biological – Medication, detoxification, abstinence
Psychological and Social – Therapy/counselling, AA/NA, residential programmes
