Part 2 Flashcards
Family systems theory of addiction
Family members are in constant contact and when one of the members in the system is affected, they are all affected
What is an analogy for the family system theory
A mobile
The addicted family is _______
malfunctioning
People with SUD are often Under-functioning, what does that mean in a family context
The person is no longer carrying out their responsibilities, so the family needs to figure out how to compensate
Where does family fall under the bio-psycho-social model?
Under social
Is family only blood relationships?
No, its also partners and people who are “family” by behaviour
Other cultures’ concept of family
Many other cultures view family more broadly and extended family have more of a role
What is the primary social support network for most people
Family
The trend of children living with two parents in the home is going up or down
Down
It can be argued that the people around the person with the SUD are in what level of pain?
As much as or more than
- Because the addicted person is numbed out
Each part of the bio-psycho-social model is a potential path to ______
recovery
About what percent of the pop will qualify for an addiction at some point?
10%
For every person with an SUD there are about how many people who are deeply affected by it?
4
**What factors can influence the impact of a SUD in the home on a child? (8)
- # of people using chemicals
- Family role of person using
- Duration of the use
- Severity and level of dysfunction
- Age and developmental stage
- Presence of good role model
- Resilience and level of functioning of other family members
- Nature of family boundaries
Each dimension of the bio-psycho-social model os an avenue for what (3)?
Risk
Resilience
Care pathway
Care pathway
Avenue for treatment
Factors that contribute to resilience
- Optimism
- Self regulate emotions
- See failure as feedback
- Having caring and supportive relationships
Family boundaries: Enmeshed family
Spouses are estranged, one chiles is enmeshed with the father, one with the mother
> often a lot of disrespect and an inability to say no
Family boundaries: Isolated family
Lack of cohesion and social support. Each member is protected by a all of defences
> Avoid intimacy and do not ask for help
Family boundaries: Healthy family
All are touching but their boundaries are not overlapping
> respect and value of one another’s individuality
Consequences of a family dealing with a SUD (11)
- Ineffective parenting: roles re-allocated
- Impaired communication
- Social events may be ruined
- Financial instability
- Depression, anxiety and other mental health disorders
- Family abuse
- Drug related crimes
- Loss of custody of children
- Marital conflict
- Jail
- High ACE scores for children
Often when there is an under functioning parent due to a SUD the older kids step up to fill in some of their role. What is a common impact of this on the child?
They are at higher risk for mental illnesses like anxiety and depression
Often will exhibit behavioural issues
> the chronic stress takes a physical and mental tole
Risk factors of children of incarcerated parents
- Higher risk of committing crimes
- ## Poorer mental and physical health
3 “rules” of addiction in a family
- Don’t see - pretend not to see the drug use, lose trust in own perception
- Don’t feel - learn that they cannot be honest about what they are experiencing, lose touch with emotions
- Don’t trust -
Long term repercussions for adults who experienced addiction in their household as a child
The difficulty they may experience in developing functional relationships with other healthy people as adults as a result of how they needed to cope as a child
5 common roles in families with addiction
- Manager - person who over functions to compensate for the under functioning person to keep the family working
- Hero - copes by being an over achiever and highly competent, but start to feel loved by what they accomplish instead of who they are
- Mascot - clown that provides comic relief to the family
- Scapegoat - gets blamed for everything, irresponsible behaviour gets them in trouble
- Lost Child - lives in a fantasy world, does not cause trouble for the family because they are withdrawn and works to not be noticed
Not using stigmatizing language for SUDs is especially important for what age group?
Adolescents
What is seen when a child in the family is struggling with an SUD
- Parents might be blamed for addiction
- Puts strain on marriage
- Sibling upset
- Inadequate support and resources
When you are partnered with a person with an SUD
- Substance becomes a priority
- High rates of anxiety and depression for the non-addicted partner
- Risk of intimate partner violence
Who typically cares for people with a SUD
The family
> they provide housing, funding, and practical support (act like case managers)
Challenges of families dealing with a person with an SUD
- Isolation
- Exhaustion
- Hopelessness
- Guilt or resentment
- Fear of stigma
Treatment when there is a SUD in the family is usually focused on who?
The person with the SUD
The rest of the family usually does not get attention and does not know how to support the person in their recovery
Why should the family be involved in SUD treatment?
- THey are already involved
- They may need help
- Helps them know how to support their loved one
- The better the family is at supporting, the better the outcome for the person in recovery
Psychoeducation as a part of family therapy for SUDs
Information on substance use and related problems to help families cope, problem solving, social support, and crisis management
What is the goal of psychoeducation
To reduce stress in the family and help them feel empowered to move forward
Philosophies of families ability to influence the addicts substance use in Al-Anon and CRAFT
Al-Anon = you are powerless CRAFT = you have influence through your reinforcement of behaviour
How is enabling problematic in SUD relationships
You make it easier for the person to use the substance by helping the person avoid the natural consequences of their substance use
How are natural consequences beneficial
Because it can make people think twice before making a bad decision they have made before
What is a codependent relationship
Relationship pattern where the partner of the person with a SUD is overly involved or enmeshed, and is unable or unwilling to set limits
Why might enmeshment or codependency develop?
May be rooted in a fear of abandonment
A mechanism of coping with the stress of living with a person with an SUD
Is co-dependency a mental illness
no
“Codependence” in other cultures
Other cultures have different expectations of involvement in each other’s lives, so to automatically call it a negative thing is not culturally sensitive
What is the intention of an Intervention? How?
To get a person with an SUD into treatment
Family gathers with the support of a trained professional to read the proposed consequences ot the person if they do not enter treatment
What is the thought behind Interventions
Breaks through the denial of the person with a SUD and communicates to them in no uncertain terms the reality and impacts of their use
Treatment outcomes of going into treatment caused by an intervention
The person may feel that they are being coerced, can lead to resentment
Many of them drop out of treatment
Transtheoretical model of change (6)
Pre-contemplation Contemplation Preparation Action Maintenance Relapse
Why can family therapy be really difficult
Each family member might be at a different stage of change
What is a cannabis overdose
You cannot die, but taking too much can make you paranoid, vomit or pass out
Hyper emesis
Uncontrollable vomiting in chronic cannabis users
What is stronger, hash (plant resin) or cannabis?
Hash
CCSA
Canadian Centre for Substance use and Addiction
About what percent of people who use cannabis products use for medial reasons?
~25 %
Danger of edibles
Takes a long time to kick in so people often have too much
Plus, who just has one brownie?
What is the most common and fastest route of administration for marijuana?
Inhalation
>need to worry about carcinogens
What is the benefit of the inhalation route of administration?
You are better able to gage and control your dosing
Is there any benefit to using water bongs? are they safer?
no
T/F, the potency of weed has been increasing
True
Is the lung function alteration caused by cannabis permanent?
If you stop using it goes away
Which has more tar and carcinogens: cigarettes or blunts (weed)
blunts
Dangers of second hand cannabis smoke
Just as bad or worse than cigarette smoke but it will not make you high
Why does TCH stay in the body for so long?
It is lipid soluble and is stored in your fat cells
> So metabolites can be detected in your urine up to a month later
Location of the CB1 and CB2 receptors
CB1 = brain CB2 = immune system
Regular cannabis use makes a person __x more likely to develop schizophrenia (especially when they use young)
2 times
3 possible explanations for the link between cannabis and psychosis
- Cannabis use causes psychosis
- Psychosis causes cannabis use (self-medication)
- Cannabis use is a trigger or stressor for those at high-risk for developing psychosis (diathesis-stress)
Cognitive effects of cannabis use (short term)
- Impaired short term memory
- Altered perception of time
- Decreased attention
- Flight of ideas
- Feelings of unreality
What is the main reason people consume cannabis
For the mood alterations
Positive and negative emotional effects of cannabis
Positive: makes you happy and relaxed
Negative: makes people agitated, anxious, paranoid and delirious
T/F: people are more aggressive when using cannabis?
False, they are less aggressive
A-motivational Syndrome (cannabis)
Apathy, loss of ambition, decreased sense of goals, decreased effectiveness, difficulty attending and concentrating
> Role of cannabis is unclear
Research does not support the existence of this syndrome
Tolerance with cannabis
Findings are inconsistent in humans
Sensitization (reverse tolerance) with cannabis
After repeated exposure to the drug, your response is enhanced
Is there physical dependence with cannabis?
People with sustained heavy use can experience “cannabis withdrawal syndrome” which is evidence for physical dependence
Who is eligible for medical marijuana?
Category 1: to treat symptoms for end of life care or specific medical conditions
Category 2: Treatment for debilitating conditions that haven’t responded to other treatments
Harm Reduction def
anything that decreases the harms associated with substance use
How is harm reduction different than abstinence programs?
It tries to get people to cut down on their use, not stop all together right away.
It acknowledges that behaviour change is difficult and tries to meet people where they are at
Who are central to harm reduction efforts
Peers
“Lived and Living” experience + role in harm reduction
People who were or still are drug users helping support their peers
There is increased collaboration with healthcare providers and researchers
What is the aim of needle exchange programs
Attempt to reduce sharing dirty needles and the spread of infection
Do needle exchange programs increase drug use
No
What are supervised injection sites (SIS)/ safer consumption sites (SCS)
Provide a supervised location for intravenous drug users to inject or consume drugs where clean equipment is provided
2 types of agonist replacement therapies. What type of drug do they treat
Methadone and buprenorphine
Treatment for opioid addiction
What are the benefits to methadone treatment (3)
- They have large retention rates
- Taken orally so decreases the risk of infection
- Makes withdrawal more manageable
What are the benefits to buprenohpine treatment? (2)
- Relives withdrawal symptoms and prevents relapse
- Safer than methadone, less chance of an overdose
When is prescription heroin used in treatment?
When NOTHING else has worked
“Wet” shelters
A glass of wine is served once an hour to help people reduce their consumption and engage in less risky behaviour
Managed alcohol programs
Permanent supportive housing for people in recovery from an alcohol use disorder though a medically regimented alcohol administration
Harm reduction for tobacco
Smokeless tobacco produces like E-cigarettes, patches, and gum to reduce cancer risks
Drug checking
people submit a sample of a street drug they have bought to test what is in it before they take it
>results in minutes
2 main drug checking methods
Fentanyl test strips
FTIR Spectrometer
Recommendations when a sample tests positive for contamination after drug testing
- Throw away contaminated drugs
- Use less
- Don’t use alone
- Get a naloxone kit
What is CENDU and what do they do?
A national surveillance network that monitors the drugs in use.
They aim to identify the presence of new drugs and inform health care providers to ensure they are prepared to deal with it
Client-treatment matching
Matching the intensity of the care/treatment for the severity of the addiction
Community offerings for drug help (5)
- Community self help groups
- Public education
- Prevention programs (often school based
- Early intervention programs
- Driver intervention programs
4 drug treatment settings
- Outpatient services
- Intensive outpatient/ day treatment
- Residential or inpatient
- Aftercare programs
What is a treatment plan
You have done an assessment and have a diagnosis
They are roadmaps for treatment
Why are treatment plans important for both the therapist and client
- Makes sure they are on the same page
- Tracks progress
- keeps care on track
How is the treatment plan made?
In collaboration with the client in language they can understand. It is individualized with measurable goals
Goal vs objective
Goal = the end point of treatment in general terms to know when treatment is finished Objective = specific steps in achieving that goal
What does it mean that the treatment plan is a living document
That it is flexible and it should evolve with the client throughout treatment
Where do objectives come from?
They focus on reducing symptoms and increasing function
For every objective in the treatment plan, there needs to be at least one ________
treatment intervention plan from the therapist
5 elements that a treatment plan needs to include
- builds on client strengths
- incorporates “recovery capital”
- identifies who is responsible for what
- allows tracking of progress. change direction as needed
- reflects the client’s degree of readiness for change `
there is overlap between recovery capital and what
the social determinants of health
