Substance-Related and Addictive Disorders Flashcards
10 classes of substances
- Cannabis
- Tobacco
- Alcohol
- Stimulants
- Hallucinogens
- Inhalants
- Sedatives, hypnotics, anxiolytics
- Opioids
- Caffeine
- Other/unknown
Substance Use Disorders criteria
2+ symptoms within 12-month period
Can be diagnosed for all classes except caffeine
Substance Use Disorders specifiers
- Severity (based on number of symptoms)
- Early or sustained remission
- On maintenance therapy
- In a controlled environment
Substance-Induced Disorders categories
- Intoxication
- Withdrawal
- Substance-induced mental disorder
Alcohol Intoxication criteria
- Problematic behavioral and psychological changes
- 1+ symptoms (slurred speech, incoordination, unsteady gait, nystagmus, impaired attention or memory, stupor, coma)
Alcohol Withdrawal criteria
- 2+ symptoms (autonomic hyperactivity, hand tremors, insomnia, nausea, hallucinations or illusions, anxiety, psychomotor agitation, seizures)
- Symptoms develop within hours to a few days of reduced or ceased alcohol use
Alcohol-Induced Major Neurocognitive Disorder criteria
- Significant decline in 1+ cognitive domains
- Affects daily living
Alcohol-Induced Major Neurocognitive Disorder types
- Amnestic-confabulatory type (primarily affects memory), also called Korsakoff syndrome
- Nonamnestic-confabulatory type (primarily affects other domains)
Korsakoff syndrome
- Alcohol-Induced Major NCD (amnestic-confabulatory type)
- Linked to thiamine deficiency
- Involves retrograde amnesia and confabulation
Opioid Intoxication criteria
- Problematic behavioral or psychological changes
- Pupillary constriction
- 1+ symptoms (drowsiness, coma, slurred speech, impaired attention or memory)
Can occur with or without perceptual disturbances
Opioid Withdrawal criteria
- 3+ symptoms (dysphoric mood, nausea, muscle aches, diarrhea, yawning, fever, insomnia)
- Symptoms develop after ceased use or after use of opioid antagonist
Stimulant Intoxication criteria
- Problematic psychological and behavioral changes
- 2+ symptoms (tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea, weight loss, psychomotor agitation or retardation, respiratory depression or cardiac arrhythmia, seizures, coma)
Stimulant Withdrawal criteria
- Dysphoric mood
- 2+ symptoms (fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation)
- Symptoms develop within hours to several days of ceased stimulant use
Tobacco Withdrawal criteria
- 4+ symptoms (irritability, anger or anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia)
- Symptoms develop within 24 hours of reduced or ceased tobacco use
Typical course of tobacco withdrawal
- Symptoms develop within 24 hours
- Symptoms peak from 48-72 hours
- Symptoms gradually decrease over several weeks
- Cravings last longer than withdrawal symptoms (can lead to relapse)
Hallucinogen Persisting Perception Disorder criteria
- Re-experiencing 1+ symptoms that were experienced while intoxicated (visual disturbances most common)
Hallucinogen Persisting Perception Disorder episodes
- Also called “flashbacks”
- Often very brief
- Can recur for up to months (or longer)
- Reality testing intact
Factors to consider when treating substance-related disorder
- Substance type
- Severity
- Comorbidities
- Client preference
Typical components of treatment for substance-related disorders
- Individual
- Family
- Group
- Medications
Combined interventions are most effective
Evidence-based interventions for substance-related disorders
- CBT
- MI
- Contingency management (VBRT)
- Family behavior therapy
- CRA
- PNF
- Texts
- RPT
- 12-step
Most effective components of treatments for tobacco-related disorders
Therapy:
1. Critical thinking skills training
2. Social support
Medication:
1. Nicotine nasal spray
2. Varenicline
Community Reinforcement Approach (CRA)
- Based on operant conditioning
- Finding reward in a drugfree life
Community Reinforcement and Family Training (CRAFT) overview
- Created from CRA
- Designed for those who refuse to seek treatment for substance use
- Working with CSO = concerned significant other (relative, friend)
CRAFT primary goals
- Help the CSO influence client to enter treatment
- Teach the CSO strategies to reduce client substance use
- Help CSO make life changes to help client (w/ or w/o treatment)
Voucher-Based Reinforcement Therapy (VBRT) overview
- Contingency management
- Give clients vouchers to exchange for reinforcers
- Some support for standalone, others suggest combination is more effective
VBRT v. CBT
VBRT = better for initial abstinence, effects fade when vouchers discontinue
CBT = worse for initial abstinence, better for long-term effects
Personalized Normative Feedback (PNF) overview
- Adjusting perceptions related to normalcy of client’s substance use
- Developed as brief intervention for heavy alcohol use among college students
- Effective as standalone and combined with MI
Text Messages functions
- Appointment and medication reminders
- Healthcare information
- Support
- Self-monitoring
Text Messages effectiveness related to smoking cessation (meta-analysis results)
- Texts alone were more effective than minimal support
- Texts alone had similar effectiveness to other standalone treatments
- Texts combined with other interventions were more effective than other interventions standalone
Relapse Prevention Therapy (RPT) overview
- Cognitive-behavioral approach
- Views relapse as response to high-risk situation (based on “learned habit pattern”)
- Focuses on coping skills to manage high-risk situations
Project MATCH (multisite clinical trial) overview
- Compared CBT, MET, 12-step for alcohol use
- Considered effectiveness of client-treatment matching
- Follow-ups at 1 year and 3 years
Project MATCH (multisite clinical trial) results
- All treatments effective (12-step slightly more effective) in reducing alcohol use
- Some support for client-treatment matching
Project MATCH support for client-treatment matching
At 3-year follow-up:
1. Social networks supportive of drinking = 12-step most effective
- High anger = MET most effective
DSM-5 categories of substance use symptoms
- Impaired control
- Social impairment
- Risky use
- Pharmacological criteria (tolerance and withdrawal)
