Substance Use Flashcards
At risk populations within the United States with a higher prevalence of substance use disorders (SUD include:
- survivors of emotional, physical and sexual abuse
- those with military combat service
- people with physical cognitive or sensory disabilities
- people who live with chronic pain
- people with depression
- unemployed with low socioeconomic status
Integrated treatment approaches for SUD
CBT Contingency Management Mindfulness MI- Motivational Interviewing Couples and Family Therapy EMDR Pharmacotherapy
Definition of Addiction
A chronic and progressive yet treatable disease of the brain that involves the interaction of brain reward circuits, genetics, and environmental experiences.
Must have a maladaptive pattern of substance use or behavior that leads to clinically significant impairment or distress occurring at any time in the same 12 month period and at least 2/11 diagnostic criteria
DSM V Criteria for Substance related or Addictive disorders
2 out of the 11 below:
Failure to fulfill major role obligations at work, school, or home
Recurrent substance use or behavior in situations in which it is physically hazardous
Continued substance use or behavior despite persistent recurrent social or interpersonal problems
Tolerance
Withdrawal
Substance use in larger amounts or substance/behavior used over longer periods than intended
Persistent desire or unsuccessful efforts to cut down or control use
Great deal of time spent obtaining or pursuing substance/behavior
Cravings or urges to engage in behavior or use substance
Important social, occupational, or recreational activities are given up or reduced
Behavior or substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that interferes with functioning
Recovery
A lifelong process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential
Relapse
The recurrence or return to substance use or additive behaviors after periods of abstinence.e
It is a persistent risk in addiction that can be triggered by exposure to
- the addictive/rewarding substance
- conditioned environmental cues
- emotional stressors that trigger increased activity int he brain circuitry and neurotransmitters
Relapse is not a treatment failure but an indicator that renewed and tailored intervention is needed
AIP- adaptive information processing
posits that addictions are disorders of memory, learning, and chronic affect dysregulation associated with maladaptive neuroplasticity.
Factors contributing to etiology of SUD
Addiction is recognized as a primary disease of the brains neurocircuitry
Multiple interacting factors-
- -Genetic factors
- Environmental factor
- Culture
- Individual personal resilience
Neurobiology of the reward circuit in the brain
VTA projections through median forebrain (MFB) and terminate in teh nucleus accumbent (NA). or the pleasure center of the brain where there is a proliferation of DA dopamine neurons.
components of comprehensive drug abuse treatment
Family services Child care services vocational servcies Mental Health Services Medical Services Educational Services HIV/AIDS serivces Legal Services Financial Services Housing/Transportation Services
Person- centered care Treatment Approach
integrates individual assets, wishes, abilities, and personal choices.
Goals include:
promote an understanding and awareness of teh detrimental cause of sustained drug use
mitigate drug use
facilitate a drug free lifestyle
attain an optimal level of functioning
Person centered care for Women- facts
Women are more likely than men to have experienced traumatic events and present with untreated PTSD
women are more apt than men to continue treatment once it begins, esp if trx is supportive, collaborative and includes childcare
more likely to participate in group therapy and seek professional MH services than men
Person Centered Care for Older Adults: Factors in Dev Treatment Plan
Biological, cognitive, and neurobiological changes
age and drug related changes in cognitive function
Disability/reduced physical stamina
sensory deficits
financial constraints
interactions between psychoactive drugs and meds
impact of aging on learning
social support networks
Impaired driving and transportation issues
SUDs are predicted to rise significantly in the net 20 years in older adult with use of nonprescription opioids.
Studies indicate that older adults require lower doses of meds, have fewer legal problems, and remain in treatment longer than young patients.
Trauma Informed Care
Those who have experienced child abuse, neglect or violence have higher risk for SUD
12-step program Peer Support Groups
SBIRT
MI
SBIRT
is a public health effort to train the healthcare workforce to deliver screening and early intervention to individuals with and at risk for SUDs
Intended for widespread use in primary care centers, hospitals, EDs, trauma centers, and other community settings, it provides early interventions to at-risk substance users before more severe consequences occur.
For individuals who screen positive for risky alcohol and drug use, healthcare providers can use an MI approach in ongoing brief periodic interactions to engage the patient in steps to reduce his or her risky substance use over time
Contingency Management
CM is a behavioral reinforcement based approach within the CBT model that uses positive or reward reinforcement
CM has proven efficacy in the treatment of SUD’s with positive outcomes that include-
- reduced substance ue
- increased group participation
- improved adherence to medication regimens
CM is usually incorporated into an integrated treatment plan
Integrated Family Therapy
When integrated into the treatment plan for SUNd, couples and family therapy plays a key role in:
- restoring interpersonal relationships
- improving social and occupational functioning
- moderating substance use
- s rooting higher levels of relationship satisfaction
- improving child and marital functioning
- reducing family and partner violence
- sustaining sobriety
- facilitating community integration
EMDR
Facilitates adaptive reprocessing of pathological memories
FSAT feeling sate addiction therapy- dev. for SUD and uses EMDR
Cognitive Behavioral Coping Skills and Relapse Prevention
To prevent relapse, patients are taught to
-identify relapse triggers
-develop coping strategies to successfully avoid or manage different triggers without reverting to substance use or addictive behavior patterns
Mindfulness is often part of an integrated plan of care.
-This approach requires awareness of triggers and high-risk situational cues and the readiness to take action.
-Awareness and readiness enable individuals to explore and develop relapse prevention strategies.
