Substance Abuse: Alcohol

Question 1

Monitoring the future: Inhalant Use (3)

Answer 1

1. Inhales any gas or fumes for purpose of getting high
2. Common substances
   a. Glue
   b. Cleaning solvents
   c. Gasoline
   d. Nail polish remover
   e. Propellants
3. More common in younger teen

Question 2

DSM V Criteria for Substance Abuse (11)

Answer 2

A problematic pattern of substance use leading to a significantly impairment or distress by at least 2 of the following over the previous 12 months

1. Taken in large amounts or over longer period than intended
2. Persistent desire or unsuccessful efforts to cut down or control use
3. Great deal of time spent obtaining, using, or recovering from effects
4. Craving or strong desire to use the substance
5. Recurrent use resulting in failure to fulfill major role obligations
6. Continue use despite related personal or interpersonal problems
7. Important activities given up or reduced because of use
8. Recurrent use in situations in which it is physically hazardous
9. Continued use despite related physiological or psychological problems
10. Tolerance (more and more use of the drug leads to decreased effect)
11. Withdrawal

Question 3

Severity of Substance Use (5)

Answer 3

1. Mild: 2-3 symptoms
2. Moderate: 4 to 5 symptoms
3. Severe: 6 or more symptoms
4. Early remission: criteria no longer met ≥ 3 month and < 12 months except for possible craving
   * No longer have any symptoms between these periods
5. Sustained remission ≥ 12 months, except possible craving
   * No longer craving it and don’t have symptoms for over a year

Question 4

Genetic Risk Factors for Substance Abuse (3)

Answer 4

1. Inherited predisposition
2. Brain biology
3. Presence of or personal history of a substance use disorders puts the person at greater risk for a second disorder

Question 5

Psychological Risk Factors for Substance Abuse (3)

Answer 5

1. ADHD
2. Factors that effect self esteem
3. Suicidal thoughts increase use of substances of abuse

Question 6

Social Risk Factors for Substance Abuse (4)

Answer 6

1. Community standard
2. Low level of supervision
3. Peer tolerance of deviant behavior
4. Income level

Question 7

Teen Alcohol Dictionary (3)

Answer 7

1. Big red cup –> It is 16 ounces and therefore if filled with beer is 1.3 standard drinks
2. A forty = 40 ounces
   * 3.5 standard drinks if it is beer
   * 5 standard drinks if it is malt liquor
3. A fifth =17 standard drinks

Question 8

Neurobiology of Alcohol: Frontal Lobe (3)

Answer 8

1. Adolescent brain development
2. Sculpting process with connections being fine tuned and pruning of the grey matter
3. Frontal lobe is responsible for
   - Response inhibition
   - Emotional regulation
   - Planning and organization

Question 9

Prefrontal Cortex

Answer 9

Aids in the information refilling and suppression of inappropriate actions

Question 10

Neurobiological Effects of Alcohol (4)

Answer 10

1. Adolescents with an alcohol use disorder use fewer strategies to learn and demonstrate reduced memory skills
2. Repeated exposure may permanently change brain structure, chemistry, and function
3. Immaturity of the brain confers greater vulnerability to toxic and additive actions of drugs
4. Drug use may increase the magnitude of risk taking during adolescence

Question 11

Assess for Alcohol Use Disorders (1d,2g)

Answer 11

1. In the last 12 months, if your patient’s drinking repeatedly caused or contributed to one or more of the following this is considered alcohol abuse.
   a. Risk of bodily harm
   b. Relationship trouble
   c. Role failure
   d. Run-in with the law
2. In the last 12 months, has your patient has 3 or more of the following traits, the patient has alcohol dependence:
   a. Not been able to stick to drinking limits
   b. Not been able to cut down or stop
   c. Shown tolerance
   d. Shown signs of withdrawal
   e. Kept drinking despite problems
   f. Spent a lot of time drinking
   g. Spent less time on other matters

Question 12

National Institute on Alcohol Abuse and Alcoholism (NIAAA) Four Step Guide

Answer 12

1. Advantages
   a. Quick (2 questions)
   b. Ask about alcohol use
   c. Assess for alcohol use disorders
   d. Advice and assist
   e. At follow up continue support
   The four As ^
2. Empirically validated
3. Screens down to age 9
4. Most children use alcohol before they use other drugs

Question 13

Cautions with Substance Abuse (3)

Answer 13

1. If the teen doesn’t agree to abstinence, challenge them about how parents will react.
2. When talking with parents focus on what the teen IS willing to do
3. Protect details to build a therapeutic relationship.

Question 14

Screening About Alcohol Use: Elementary School ages 9-11 (2)

Answer 14

1. Do you have friends who drinks?

2. Have you ever drank alcohol?

Question 15

Screening About Alcohol Use: Middle School ages 12-14 (2)

Answer 15

1. Do you have friends who drink?

2. In the past year, how often did you drink alcohol?

Question 16

Screening About Alcohol Use: High School (5)

Answer 16

1. In the past year, how often did you drink alcohol?
2. How many drinks do your friends usually have per occasion?
3. No past use in the past year: PRAISE AND ENCOURAGEMENT
4. You have made a smart decision not to drink alcohol?
5. If friends drink: consider probing

Question 17

Risk score for alcohol use ages 12-15 (2)

Answer 17

1. Moderate Risk: less than or equal to 6 times per year

2. High Risk: over 6 times per year

Question 18

Risk score for alcohol use ages 16-17 (3)

Answer 18

1. Low risk: less than 6 times per year
2. Moderate risk: 6-12 times per year
3. High risk: over or equal to 12 times per year

Question 19

Risk score for alcohol use ages 18+ (3)

Answer 19

1. Low risk: at 18 years old, less than 12 times per year
2. Moderate risk: less than 12 times per year
3. High risk: over 52 times per year

Question 20

Moderate Risk of Alcohol Abuse Assessment (6)

Answer 20

1. Assess safety risk
2. Ask about associated problems
3. Have you ever gotten into trouble?
4. Done something you regretted because of drinking?
5. Sergeant Friday interview style Closed ended questions—facts
6. Lieutenant Columbo: ask open ended questions with mutual discovery with problem solving empathy- What happened? Why?

Question 21

Interventions of High Risk Alcohol Use Behaviors (3)

Answer 21

1. Give clear advice
   a. Recommend that you quit entirely for the sake of your health; brain is still developing and alcohol can interfere with how smart you will be
   b. A black out means you drank enough to poison your brain cells, at least temporarily
2. Brief advice: “I recommend you stop drinking entirely; your brain is still developing and alcohol can interfere.
3. Kids often do things they later regret when they drink. I would hate to see alcohol interfere with your future.”

Question 22

Practice Pearls (4)

Answer 22

1. Be knowledgeable about the prevalence of alcohol use
2. Screen all adolescents for alcohol use at all visits
3. Give brief advice to low risk, follow – up the moderate risk; and refer the high risk patient
4. Know where the referral sources

Question 23

Natural History of Substance Abuse – Four Stages: Stage 1

Answer 23

Experimentation

1. Starts with parties due to peer pressure
2. Understand that there are negative consequence if caught

Question 24

Natural History of Substance Abuse – Four Stages: Stage 2

Answer 24

Seeking of mood swing

1. Coping mechanism for negative feelings
2. Change in peer group
3. Not in serious trouble but there are changes in school performance

Question 25

Natural History of Substance Abuse – Four Stages: Stage 3

Answer 25

Preoccupation with mood swing

1. Enjoys altered state
2. Not limited to social occasions
3. Hang out with drug peer group
4. Polydrug use
5. Not a secret—gets into trouble

Question 26

Natural History of Substance Abuse – Four Stages: Stage 4

Answer 26

Dependence on Mood swing

1. Change in neurotransmitters so user does not feel normal without drug
2. User fails to quit on own
3. power of addiction

Question 27

Substance Use History (6)

Answer 27

1. Interview adolescents privately
2. Ask informative questions, not yes or no
3. Assure conditional confidentiality
4. Use a structured screening method
5. Consider comorbid mental health disorder
6. Refer to community resources for substance abuse

Question 28

Screening Tools (5)

Answer 28

1. Single question screening test for unhealthy alcohol use
   - How many times in the past year have you had X or more drinks a day (X-5 for men, 4 for women)
2. Single question for drug use
   - How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reason
3. A response ≥ 1 is positive
4. DRUG ABUSE SCREENING TEST-20 (DAST-20)
5. CRAFFT

Question 29

CRAFFT Screening Tool (6)

Answer 29

Using the CRAFFT Screening tool

• Contract for life to facilitate communication between your people and parents
• Helps young people make healthy choices

1. Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
2. Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
3. Do you ever use alcohol/drugs while you are by yourself, ALONE?
4. Do you ever FORGET things you did while using alcohol or drugs?
5. Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
6. Have you gotten into TROUBLE while you were using alcohol or drugs?