Substance Use Flashcards
Substance Use Disorder:
A problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress. A person with this disorder will often continue to use the substance despite consequences.
The person must have at least two of the following for a given substance within the same 12-month period:
- Taking the substance in larger amounts or for longer than the you meant to
- Wanting to cut down or stop using the substance but not managing to
- Spending a lot of time getting, using, or recovering from use of the substance
- Cravings and urges to use the substance
- Not managing to do what you should at work, home or school, because of substance use
- Continuing to use, even when it causes problems in relationships
- Giving up important social, occupational or recreational activities because of substance use
- Using substances again and again, even when it puts you in danger
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
- Needing more of the substance to get the effect you want (tolerance)
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Substance Intoxication:
The development of a reversible, substance-specific syndrome as a result of the recent ingestion of a substance; must include maladaptive behavior or psychological changes and specific signs of the substance’s effects on the nervous system.
Substance Withdrawal:
A substance-specific maladaptive behavioral change with physiological and cognitive correlates, due to cessation or reduction of heavy or prolonged substance use.
Alcohol:
Signs of Intoxication: inappropriate sexual or aggressive behaviors; impaired judgment; slurred speech; emotional lability; incoordination; unsteady gait; involuntary, rhythmic movement of the eyes; impaired attention or memory; stupor; coma.
Signs of Withdrawal: sweating; tachycardia; hand tremor; insomnia; nausea or vomiting; transient illusions or hallucinations; anxiety; psychomotor agitation; grand mal seizures; delirium tremens (DT’s).
Wernicke’s Encephalopathy: caused by thiamine deficiency often associated with alcoholism; symptoms include confusion, loss of muscle coordination (leg tremors), and vision changes (abnormal eye movements, double vision, eyelid drooping).
Korsakoff’s Syndrome: retrograde and anteretrograde amnesia and confabulation (attempts to compensate for memory loss by fabricating memories); hallucinations.
Amphetamines / Cocaine:
Signs of Intoxication: euphoria; anxiety; hyperactivity; grandiosity; confusion; anger; paranoia; auditory hallucinations; tachycardia; elevated or lowered blood pressure; dilated pupils; perspiration or chills; nausea or vomiting; weight loss; psychomotor agitation; muscular weakness; confusion; seizures.
Signs of Withdrawal: dysphoric mood; fatigue; vivid and unpleasant dreams; insomnia or hypersomnia; increased appetite; psychomotor agitation or retardation.
Caffeine:
Signs of Intoxication: restlessness; nervousness; excitement; insomnia; flushed face; diuresis; gastrointestinal disturbance; muscle twitches; rambling flow of thought and speech; tachycardia or arrhythmia; periods of inexhaustibility; psychomotor agitation.
Signs of Withdrawal: headache (most common), changes in mood (such as depression and anxiety), difficulty concentrating, fatigue, and/or increased appetite.
Cannabis:
Signs of Intoxication: impaired motor coordination; euphoria; anxiety; sensation of slowed time; impaired judgment; social withdrawal; conjunctival injection (redness of the eyes); increased appetite; dry mouth; tachycardia.
Signs of Withdrawal: irritability, anger or aggression, nervousness or anxiety, sleep difficulty (insomnia), decreased appetite or weight loss, restlessness, depressed mood, stomach pain, shakiness/tremors, sweating, fever, chills, and/or headache.
Hallucinogens:
Signs of Intoxication: perceptual changes; anxiety; depression; ideas of reference; paranoid ideation; pupillary dilation; tachycardia; sweating; palpitations; blurred vision; tremors; incoordination.
Hallucinogen Persisting Perception Disorder (Flashbacks): Following the cessation of use, the reexperiencing of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen; this reexperiencing causes significant distress or impairment in social, occupation, or other important area of functioning.
Opiods:
Signs of Intoxication: initial euphoria followed by apathy or dysphoria; pupillary constriction; drowsiness or coma; slurred speech; impairment in attention and memory.
Signs of Withdrawal: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea (runny eyes & nose); pupillary dilation; diarrhea; yawning; fever; insomnia.
*Methadone used
Other Important Facts / Considerations
The symptoms of intoxication, withdrawal, and withdrawal delirium for Sedatives, Hypnotics, and Anxiolytics are the same as those associated with Alcohol (see above).
12 Step Programs (AA, NA, etc.) are almost always part of addiction treatment and are based on a disease model (the idea that alcoholism is a disease that cannot be cured but only controlled).
Motivational Interviewing is a treatment model that focuses on resolving ambivalence and using the person’s own values and concerns to elicit change (rather than imposing or “coercing” a person to change behavior).
The Alcoholic Family
1. Dependent: the alcoholic family member
- Enabler: often the spouse; the person who does everything to get the dependent to stop drinking except what might actually work (confrontation or leaving the relationship)
- Hero: the family member who is aware of what is going on and tries to assume responsibility for the family by being successful (often the oldest child)
- Scapegoat: the family member who rejects the family system (often the 2nd child)
- Lost Child: the member who quietly withdraws from the family system (often the 3rd child)
- Mascot: the member who “plays the clown” in order to relieve family tension or their own pain (often the youngest child)
Remission: The following specifiers are used only after NO criteria for Substance Use Disorder except cravings have been met for at least 3 month. (These specifiers do not apply if the person is on agonist therapy [e.g., methadone] or in a controlled environment, [e.g., locked hospital unit].)
- Early Full Remission: None of the criteria for Substance Use Disorder except cravings are met for at least 3 months but less than 12 months.
- Sustained Full Remission: None of the criteria for Substance Use Disorder except cravings have been met for at least 12-month period (or longer).
Screening Tool:
The CAGE questionnaire is a quick screening tool used to assess for alcohol problems specifically. This screener helps determine whether a person drinks in excess and may benefit from alcohol treatment. The CAGE questionnaire asks the following questions:
- Have you ever felt you needed to cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Two or more “yes” responses indicate the individual may have a problem with alcohol and necessitates further assessment. investigated further.
Motivational Interviewing:
Motivational Interviewing works to help individuals move from a place of indecision regarding making change to a place of motivation towards making change and meeting
their goals. While it can be used for a number of presenting problems, it is a common treatment approach for individuals engaging in substance abuse.
The stages of change in Motivational Interviewing are as follows:
- Pre-contemplation: In this stage, the client is not yet thinking about change
- Contemplation: During this stage, the client is thinking about and talking about change. They are considering whether or not to work towards change
- Preparation: The client is actively planning out steps to take in order to make change happen during this stage
- Action: During this stage, the client is taking positive steps to put the plan from the previous stage into practice
- Maintenance: During this stage, the client is maintaining the change that has been made”
Harm Reduction:
Harm reduction is an intervention that aims to reduce the negative effects of alcohol and drug use. It acknowledges that despite prevention and abstinence efforts, some clients will continue to engage in alcohol and drug use. Harm reduction includes things like:
- limiting the number of days you drink per week
- limiting the number of drinks you consume in one sitting
- having a designated driver
- utilizing needle exchange sites
- utilizing injection sites.
Contingency Management:
A type of behavioral therapy that uses incentives to help clients abstain from drugs and alcohol. Clients are encouraged to engage in sobriety and engage in behaviors supporting sobriety. As goals are achieved and behaviors are modified (for example, a clean drug test, participation in groups, good attendance to treatment, etc.), clients receive rewards.
