Lecture 4: Comorbidity & The Role Of Family And Friends Flashcards
How many clients in substance use treatment suffer from another mental disorder
50%
What are the 4 most prevalent comorbid disorders with SUD
Mood disorders, anxiety disorders, ADHD, personality disorders
What are 5 explanatory hypotheses for the connection between substance use and comorbid disorders
- Self-medication hypothesis = mental disorder > excessive use of substance because substances are used to control emotional pain
- High-risk hypothesis = excessive use of a substance > mental disorder by leading to behavior that increases the risk for, for example, trauma exposure
- Susceptibility hypothesis = excessive use of a substance > mental disorder; eg. through biological processes introduced by the substance use that render them more susceptible to developing PTSD following exposure to trauma
- Bidirectional hypothesis = substance use and other mental disorders may also influence each other/have bidirectional interrelations
- Third-factor hypothesis = there is no direct relationship, but the association occurs because SUD and other mental disorders share the same cause/risk factors
T/F: in order to be able to diagnose psychological symptoms, a client must first always quit using substances
True, with exceptions of ADHD and PTSD
What can indicate that depression is substance-induced
When the emergence of the symptoms happens during/after a change in consumption
What are 5 explanations for why substance use and PTSD co-occur
- At-risk hypothesis = substance use increases the risk of trauma (eg. because of the external environment or more risky behavior)
- Self-medication hypothesis
- No habituation trauma due to being under the influence
- Substance use triggers symptoms
- Underlying causal factor (eg. genetic predisposition/vulnerability)
Why is the diagnosis of substance use comorbid with bipolar disorder challenging
Because of overlap with symptoms of substance-induced intoxication
What are 4 interventions for close relatives (CRs) of addicts and explain them
- Johnson intervention = addict is unexpectedly confronted by CRs/friends —> radical, direct, very confronting; last chance to reach out
- Al-Anon = based on 12 step AA; help CRs accept that they’re powerless/shouldn’t try to influence their behavior and help them detach from addict
- Community Reinforcement and Family Therapy (CRAFT) = CRs are supported by practitioner to adjust behavior in order to motivate addict to start treatment —> improve CR’s quality of life; based on CBT/MI
- Behavioral Couple Therapy (BCT) = CR is actively involved in treatment; aims to 1) teach ways to cope with substance-related situations, 2) teach partner to reinforce/support behavior change/sobriety, 3) improve relationship satisfaction and reduce stress
What are 6 important elements of CRAFT
- functional analysis together with CR (bc they have much knowledge on triggers/sustaining factors)
- emergency plan for aggression/domestic violence and prevention
- positive reinforcement of desired behavior by CR
- not rewarding unwanted behavior and allowing negative reinforcement; CR shouldn’t try to protect addict from natural negative consequences of substance abuse
- improving quality of life (of the CR)
- proposing to start treatment to the addict (the CR does this)
What are 5 consequences of comorbidity
- more severe symptoms
- lower treatment compliance
- higher drop-out
- worse treatment outcome
- higher probability of relapse
What are the psychological symptoms of alcohol use (5)
- depressed mood
- fear
- confusion
- mood swings
- sleep problems
What are the psychological symptoms of alcohol withdrawal
<8-12 hrs
- general sick feeling
- headache/nausea/vomiting
- not eating/fear
12-36 hrs
- insomnia
- restlessness/agitation
- tremors
- sweating
48 hrs
- withdrawal feeling
- sweating
- tremors
- agitation
- slight fever
- hypertension
What are the psychological symptoms of cannabis use (4) and withdrawal (3)
Use:
- concentration issues
- memory impairment
- fear
- suspicion/paranoia/psychosis
Withdrawal:
- insomnia
- depressed mood
- agitation
What are the psychological symptoms of cocaine use (5)
- lack of energy
- depressed mood
- insomnia
- fear/panic
- suspicion/paranoia
What are 3 reasons for comorbidity between anxiety disorders and SUD
- self-medication hypothesis
- long-term use/withdrawal can induce anxiety symptoms
- repeated withdrawal syndromes may trigger anxiety disorders
What are 3 reasons why being a CR or loved one of an addict can be hard
- emotions such as shame, guilt, sadness, anger, powerlessness, frustration
- risk of conflicts, domestic violence, financial problems, disrupted relationship with children
- relationship problems, low satisfaction, sexual issues, 4x higher divorce rate
What are 8 specific interventions of BCT
- Sobriety contract
- Behavioral contract to use disulfiram
- Relationship aspects as part of FA
- Shifting negative selective attention in relationship
- Increase of positive activities
- Communication training
- Discuss relationship problems
- Fallback and emergency plan
What are the differences and similarities between the 4 interventions and how does CRAFT compare to Al-Hanon and Johnson
- all involve CRs
- Al-Hanon & CRAFT focus on empowering CRs to support their loved ones while also taking care of themselves
- Johnson & BCT are more direct interventions involving structured sessions and professional guidance (Johnson = confrontational, BCT = collaborative)
—> Craft produced 3x more patient engagement than Al-Hanon and 2x more than Johnson
In the general population, how many people have ever suffered from a SUD (1) and how many suffered from one in the past 12 months (2)
1) 19.1%
2) 5.6%
