Midterm 2 Flashcards
What are the 10 different substances found in the DSM-5 for Substance-Use Disorder?
○ Alcohol
○ Caffeine
○ Cannabis
○ Hallucinogens
○ Inhalants
○ Opioids
○ Sedatives
○ Stimulants
○ Tobacco
○ Other substances
Substance use in adolescence is associated with what 3 leading causes of death for adolescents?
- Accidents/injuries
- Suicide/self-harm
- Interpersonal violence
- Also, educational problems and legal problems
What age period is a risk period for substance use problems?
- Adolescence
- Earlier use = higher risk for problematic use
- Earlier you start, the more likely you are to have significant impairment
- Ex: ~15% of kids who start drinking by 14 develop
AUD -> compared to only ~2% who start at 21+
What’s the prevalence of high school students in the US that reported drinking alcohol in the past year?
In the US, 2/3 of students in Grade 12 and nearly 1⁄2 of students in Grade 10 report drinking alcohol in the past year
What’s the lifetime prevalence of any substance use disorder according to the NCS-A (national comorbidity survey – adolescent)?
- Adolescents aged 13 - 18yrs: 11.4%
- 13-14 yrs: 3.7%
- 15-16 yrs: 12.2%
- 17-18 yrs: 22.3%
- Big jump from 13-14 to 17-18
Describe the Monitoring the future study and their findings
- Study of American youth
- Asking children questions about substance use
- Can track patterns of use over the years
- Found that substance use went down in teens during the pandemic (lockdown) -> they were at home with parents and had less interaction with peers
- Found that these numbers stayed down -> even with lockdown ending
- Substance use hasn’t grown much since (still below pre-pandemic levels)
What are the 3 treatment models for SUD?
- Early Brief Interventions
- Outpatient Treatment
- Residential Inpatient Treatment
Describe Early Brief Interventions for SUD
- Use of norm-based interventions for college students
- Online training provided by school (ex: Alcohol EDU)
- Understanding norms about drinking
- Injunctive norms: how much others approve or disapprove of drinking
- Descriptive norms: how much others actually drink
- Popular culture -> people have a sense that everyone in university is drinking and going out all the time
Describe Lewis & Neighbours (2004) findings for norm-based interventions for SUD
- They asked people the amount of drinks they have per week vs what they think the amount of drinks other people have per week is
- Perceptions are much higher than reality
- Big discrepancy between what people are actually doing and what their peers are actually doing
- People are overestimating how much their peers drinks
Describe Neighbours, Larimer, & Lewis (2004) brief alcohol screening and intervention for college students
- They provided college students’ with individualized feedback about actual drinking norms and a comparison between individual’s drinking pattern and the norm
- Ex:
1) This is how much you drink
2) This is how much you think others drink
3) This is how much others actually drink
4) Percentile ranking showing where you are relative to others on your campus - This provided college students with an accurate depiction of drinking norms on campus
- Found that the impact that these interventions have on people’s drinking are mediated by changes in people’s perceived norms -> see the lower number of drinking and change their drinking habits to conform to others
- Changes in perceived norms may mediate treatment effects
Describe Hennessy et al. (2019) study on the effectiveness of norm-based interventions for college students
- Network meta-analysis of 7 manualized brief alcohol interventions
- Found that most programs generally worked well in reducing drinking frequency & quantity for 0-6+ months post-interventions
What are the different types of outpatient treatment for SUD?
- Family Therapy
- Alcoholics Anonymous (12 Step Programs)
Describe the outpatient treatment approach of family therapy for SUD
- Multidimensional Family Therapy -> similar to multi-systemic treatment
- Much more intensive outpatient treatment
- Working with parents and adolescent
- Adolescent (ex: use as a means of coping with distress or negative emotions)
- Parents (ex: increased parental monitoring)
- Number of studies have supported the efficacy for multidimensional family therapy
Describe the outpatient treatment approach of Alcoholics Anonymous for SUD
- Very popular -> people experiencing problematic alcohol use seek out AA more than all other forms of treatment combined
- 12 steps program
- Acknowledge that alcohol is a problem
- Recommend abstinence
- Supported by a peer
- Easily accessible (worldwide program)
- Participation in AA is associated with less alcohol consumption & fewer substance related problems
What are the 3 hypotheses for why participation in AA is associated with less alcohol consumption & fewer substance related problems?
- AA attendance -> going to meetings can lead to lower substance use
- Lower alcohol use is associated with AA attendance -> higher alcohol use makes you less likely to attend because AA promotes abstinence which seems impossible for more severe cases. Also can recover quicker with lower severity.
- People with good prognosis (less general risk factors and more productive factors) use less alcohol and are more likely to attend AA and benefit from AA
Describe the results for the randomized trials comparing AA to another form of treatment or to a no treatment control group
- Results suggest AA does not do better and may do worse
- However, there are very few well-done studies -> because it’s anonymous and a helpful resource that can be used whenever they want -> people less likely to want to be part of a study when they go to AA
- In several of the randomized trials, participants were coerced into treatment (ex: court referred)
Describe the recent study on men seeking treatment for alcohol use at the Veterans Association hospital
- Study examining 2000 men seeking treatment for alcohol use at VA hospital
- All met criteria for a diagnosis of AUD
- Received treatment
- After finishing treatment, researchers followed them and collected data about their substance use and their attendance at AA meetings
Hypotheses & Findings:
1) AA attendance → Lower alcohol use - AA involvement at 1 year post treatment predicted less alcohol use at 2 years post treatment
2) Lower alcohol use → AA attendance - Alcohol use at year 1 did not predict AA involvement at year 2
3) Good prognosis (ex: better motivation, less co-morbid psychopathology)→lower alcohol use and AA - Results not explained by alcohol use severity, motivation, or co-morbid psychopathology
- Findings in support of 1st hypothesis but not 2nd and 3rd
Describe the inpatient treatment approach for SUD
- Inpatient = in the hospital
- Some might self-select into inpatient treatment
- For children, parents may put them into these facilities
- Short duration (4 - 6 weeks)
- Range of treatment programs
- Individual counselling, family therapy, treatment for comorbid disorders
- Often followed by outpatient -> after you leave you may come back once or 2x a week
- High level of monitoring in these facilities
- Inpatient treatments are relatively common and have a good rationale -> have to change daily environment because there are probably many triggers in that environment
- Very few controlled studies have examined the efficacy
of inpatient treatment for substance use
What disorders comprise internalizing symptoms?
- Anxiety disorders
- Mood disorders
- Cluster of interrelated problems (anxiety and mood disorders are highly related - comorbidity is very high)
What’s the developmental psychopathology framework for internalizing symptoms?
- We evaluate what’s abnormal in the context of what’s typical for children of a specific age
- Fear and sadness are important emotions
- “Normal” fears come and go over development
- Anxiety and fluctuating mood can be normal
Describe the impairment associated with anxiety disorders
- Associated with significant impairment
- Social impairment: excluded, unliked, victimized, lower popularity
- Academic impairment: test anxiety, with SOC afraid to speak up to ask questions in class
Describe the service utilization with anxiety disorders
- Low service utilization
- Anxiety problems often go untreated
- Most youth with mental health problems don’t receive treatment
- According to the National Comorbidity Survey – Adolescent, Percentage of Adolescents Who Report Using MH Services, adolescents with any anxiety disorder have the lowest usage of mental health services
- Girls with anxiety are more likely to receive services than boys with anxiety
- Older adolescents are more likely to receive services for anxiety
What are 3 reasons that potentially explain why youth with any anxiety disorder have the lowest usage of mental health services
1) Some Fear and Anxiety is Normal
- Nearly all 1yr-olds become distressed when separated from mom
- Most children have short-lived specific fears
- ~1/2 of children aged 6-12 have 7 or more fears
- As long as it’s not causing disability, distress, or risk
2) Some Anxiety is Adaptive
- Some situations might and should provoke anxiety
- Ex: stranger anxiety in young children, test anxiety, excessive checking of homework and assignments
- Moderate levels of anxiety might lead to the highest level of performance (being too anxious may impede your performance and being too nonchalant may make you not try as hard)
3) May not be as upsetting to adults
- May not be causing as much disruption and may be associated with favourable characteristics (ex: less aggression)
What are the core features of anxiety disorders?
- Focus on threat or danger
- Future-oriented (“anxious apprehension”) -> differs from fear (present-oriented)
- Strong negative emotion or tension, displayed as:
- Physical sensations
- Cognitive shifts (ex: worries)
- Behavioural patterns (ex: strong fight or flight response)
What are the 7 different DSM-5 anxiety disorders?
- Separation Anxiety Disorder (SAD)
- Generalized Anxiety Disorder (GAD)
- Specific Phobia
- Social Anxiety Disorder
- Panic Disorder (PD)
- Agoraphobia
- Selective Mutism
How do the DSM-5 anxiety disorders differ from one another?
- Vary on focus/content of threat
- Vary on balance of symptoms (ex: worry-based vs physical)
Describe Specific Phobia
- Fear of specific situations or things
- Common type of anxiety disorder (ex: at least 20% of children are affected by specific phobia at some point in their lives)
- Some grow out of these and some don’t
- More common in girls than boys
- Onset: middle childhood (7-9 yrs old)
- Clinical phobias are more likely to persist overtime (contrary to just fears)
Describe Separation Anxiety
- Separation from or harm coming to loved ones
- Don’t want to be separated from parents
- Worrying about events that might separate them from parents
- Occurs in 4-10% of children
- More prevalent in girls than in boys
- Usually see this around school ages
- Has high levels of comorbidity
- Ex: 2/3 of children with separation anxiety have some other anxiety disorder
- 1/3 of children have features from separation anxiety that persist into adulthood (move from parents to new figure in that person’s life)
Describe Social Anxiety
- Fear of negative evaluation by others
- Fear of social situations in which person will be evaluated (ex: going to a party with friends)
- For children, must occur in peer settings (not just with adults -> ex: teachers or parents)
Describe Selective Mutism
- Failure to speak in specific situations and contexts in which speaking is expected, even though they may speak in other settings
- Reclassified as an anxiety disorder in DSM-5, but not clear that all children with selective mutism are anxious
Describe Generalized Anxiety Disorder
- Excessive, uncontrollable anxiety and worry
- Worrying can be episodic or almost continuous
- Worry excessively about minor (or important) everyday occurrences
- Somatic (physical symptoms as well)
- More global/broad/general type of anxiety disorder -> makes it more difficult to treat
- Equally common in boys and girls -> tend to see similar levels in both
- GAD tends to onset in adolescence
- Older children tend to have more symptoms than younger children with GAD
What’s a panic attack?
- Short period of intense fear or discomfort that develops abruptly and is accompanied by at least 4 symptoms (ex: sweating, shortness of breath, choking feeling, chest pain, nausea)
- A lot of people when they have their first panic attack, they go to the ER because they feel like they’re having a heart attack
- You can have panic attacks and not have panic disorder
