Substance Use

Question 1

What is addiction?

Answer 1

Expanded to include more than just substances → now incorporates idea of “compulsive behaviours” or the drive to engage in the activity regardless of the harm that it causes
- Primary, chronic disease of brain reward, motivation, memory and related circuitry → dysfunction in these circuits leads to characteristic physiological, psychological, social, and spiritual manifestations
- Pursue aware or relief by substance use and other behaviours

Question 2

What is interdisciplinary treatment?

Answer 2

The adaptation in the brain that results from chronic substance exposure is long lasting → addiction interventions need to reflect its chronic and relapsing nature
It is a model that is similar to what is used for other chronic conditions
Rates of recovery and discontinuation of treatment result in similar rates of relapse as chronic conditions

Question 3

What is harm reduction?

Answer 3

An approach that is aimed at reducing the harmful consequences of drug use and other high-risk activities (i.e. safe injection sites)

Question 4

What are the principles of matching treatment?

Answer 4

Treatment should be offered on the least restrictive level of care that is proven to be safe and likely to be effective
Patients are matched to the most appropriate level of care based on availability along with the assessment of their condition and comorbidities and with respect to the individual’s preferences

Question 5

What are psychoactive substances?

Answer 5

Drugs, alcohol, plant material, and chemical that cause noticeable changes in mental function
Substances may be: eaten, drunk, snorted, inhaled, dissolved under the tongue, absorbed through the skin, injected, or inserted through the anus or urethra

Question 6

Examples of psychoactive substances

Answer 6

1) alcohol
2) caffeine
3) cannabis
4) hallucinogens
5) inhalants
6) opioids
7) sedatives
8) hypnotics
9) stimulants (amphetamine-type substances such as cocaine)
10) tobacco

Question 7

Biological theories

Answer 7

Genetic predisposition but looking at a confluence of events, not just genetic predisposition
Interplay between environment and genetics (epigenetics)
Also trauma, pre- and post-natal stress, ACES study
Changes in the brain that persist even after an individual no longer uses

Question 8

Psychological theories

Answer 8

Family situation/history
Coping strategies
Stress exposure/management
History of trauma or abuse
Strong association with other mental disorder
Self-confidence, self-esteem

Question 9

Social theories

Answer 9

Social determinants of health
Cultural issues
Availability and access to resources

Question 10

Spiritual theories

Answer 10

Where does the individual derive meaning? → individuals who have recovered form addiction often mention spiritual experiences or motivation as a major contributory factor in theri recovery

Question 11

What are potential problems with classifying addiction as a brain disease?

Answer 11

The individual is viewed as a helpless victim of their own hijacked brain – there is not hope for real recovery
The idea of brain disease precludes an individual’s capacity to have control over their own behavior
Offers false belief that it is a medical condition that can be treated, or ‘fixed’ medically
The paradox of having neural circuitry hijacked … yet being able to control your urges in some situations (“Spontaneous recovery” or the tipping point when a person decides they are going to stop using drugs)
Recovery is a project of the heart and the mind

Question 12

What is the relationship between mental health diagnosis and substance use disorders?

Answer 12

Higher risk for those with a mental health diagnosis – 30-40% of those with a mental health dx develop a substance use disorder
Vice versa – people with substance use disorder at risk to develop a mental illness

Question 13

What is “shame proneness”?

Answer 13

The idea that there is no redemption from addiction

Question 14

Biological assessments

Answer 14

physical assessment; eating; sleeping; weight loss/gain; chronic pain; OTC medication; lab results

Question 15

Psychological assessments

Answer 15

family situation/history; coping strategies; stress management; history of trauma or abuse; self-confidence; self-esteem

Question 16

Social assessments

Answer 16

SDoH; cultural issues

Question 17

Spiritual assessments

Answer 17

where does the individual derive meaning in life?

Question 18

Approaches for treatment

Answer 18

1) harm reduction
2) the stages of change
3) Motivational interviewing
4) CBT
5) self-help groups
6) group therapy
7) family therapy

Question 19

Harm reduction

Answer 19

reduce the risk for adverse consequences of the behaviour while recognizing that abstinence is the ideal

Question 20

The stages of change

Answer 20

Precontemplation: user has no intention of quitting anytime soon (encourage consideration of the benefits/risks of continued usage)
Contemplation: aware that a problem exists and seriously thinking about quitting at some point but has not made a plan yet to do so (reinforce the reasons for quitting and explore some new ones)
Preparation: individual has made a decision to quit soon and prepares to do so (identify the barriers to stopping and eliciting some solutions)
Action: individual has quit and is actively applying cessation skills (ask how the individual is doing and advise regarding relapse)
Maintenance: individual has quit for a while now (remain supportive, asking how the individual manages risk situations)

Question 21

Motivational interviewing

Answer 21

being aware of ambivalence is important
- Avoid arguing
- Express empathy: accept where they are at
- Develop discrepancy: discrepancies between present behaviour and personal goals
- Roll with resistance: acknowledge that change is hard and that you are there to support them through it
- Support self-efficacy: reinforce the patient’s belief in their ability to succeed (strengths-based approach)

Question 22

Self help groups

Answer 22

12 step programs

Question 23

What is the main point to remember regarding treatment for substance-related disorders?

Answer 23

It is a multimodal meaning that a variety of treatment approaches and options are necessary in order to help people struggling with addictive behaviour have better outcomes (psychodynamic and pharmacological)
- multidisciplinary (gov, fed, prov, municipal, individual)

Question 24

What are the 4 principles to of the perspective of multimodal/multidisciplinary perspective?

Answer 24

1) emphasis on illness prevention – stopping the development of an illness before it starts (upstream intervention)
2) emphasis on health promotion – focus effort on resiliency-building activities that strengthen a population’s resistance to illness and diminish susceptibility to health problems
3) perspective focused on the population instead of the individual – focus on the bigger picture
4) effort to address health equity – recognition of the influene of the SDoH on health outcomes (effots directed at improving population health outcomes by decreasing the social gap between rich and poor)