Substance Use Disorders Flashcards
10 Different substances
- Alcohol
- Cannabis
- Opioids
- Hallucinogens
- Inhalants
- Sedatives
- Hypnotics
- Anxiolytics
- Tobacco
- Others
In the ‘remission’ specifiers of SUD, the ‘craving’ symptom doesn’t count, why?
Psychological cravings might not go away over time
In the ‘early remission’ specifiers of SUD, the benchmark in 3 months, why?
Data showed that there are better outcomes for those who retained in treatment for ~3 months
=> If you make it that far, seems to be a good marker of a more probable positive outcome
What’s the relationship between onset use and problematic use?
Earlier onset of use = higher risk for problematic use
=> 15.1% of kids who start drinking by 14 develop alcohol use disorder
=> Only 2.1% of those who start at 21+
We are not sure if early onset of use is a … or a …
risk marker, risk factor
Risk marker
Biological/physiological traits associated with genetic tendency towards developing an illness
Risk factor
‘Causal’ factor of later problems
Substance use in adolescence is associated with the three leading causes of death for adolescents: (3)
(1) Accidents/injuries
(2) Suicide/self-harm
(3) Interpersonal violence
-> Also, educational problems and legal problems predicted by SUD
… is much more common than actual SUD
Experimentation
-> Very common.
-> In the United States, 2/3 of students in Grade 12 and nearly ½ of students in Grade 10 report drinking alcohol in the past year
How are the rates of substance USE (=/ SUD) going in the past 5 years?
DECREASE across any type of substance use in teens in the past 5 years
-> COVID led to lower level of substance use (across most categories): between 2020 and 2021. Since, decreases have been maintained across time
-> Lowered even more in 2024 (even though rise of new drugs e.g. delta)
Treatment Models for SUD (3)
- Early Brief Interventions
- Outpatient Treatment: Family Therapy and Alcoholics Anonymous
- Residential Inpatient Treatment
Early/brief interventions (aka Norm-based interventions): Injunctive vs Descriptive norms
=> Injunctive norms: How much others approve or disapprove of drinking
=> Descriptive norms: How much others (in your social context, e.g. uni) actually drink
In Norm-based Interventions, people receive Individualized feedback about: (4)
(1) How much YOU drink
(2) How much you THINK others drink
(3) How much others ACTUALLY drink
(4) Percentile ranking showing where you are relative to others on your campus
… may mediate treatment effects!
Changes in perceived norms
=> Program → Change in perceived norms (more accurate social norms) → Treatment effects
Norm-Based Interventions – Do they work?
Most programs generally worked well in reducing drinking frequency & quantity 0-6+ months post interventions
Outpatient Treatment: Family Therapy
Multidimensional Family Therapy
- Similar to multisystemic therapy
- Targeting both teen (e.g. use as means of coping w distress) & parents (e.g. increase parental monitoring)
Outpatient Treatment: Alcoholics/Narcotics Anonymous – characteristics (4)
(1) 12 Steps
(2) Main ones: Acknowledge that alcohol is a problem; Strong recommend abstinence
(3) Supported by a peer
(4) Easily accessible
3 hypotheses of why/how Alcoholics Anonymous works
(1) The more you go to AA, the less you use substances
(2) Lower substance use leads to more AA attendance
(3) Having good prognosis, more AA attendance
Alcoholics Anonymous: Does it work?
We don’t rly know? Seems like it does?
=> Results of randomized trials comparing AA to another form of treatment or to a no treatment control group suggest AA does NOT do better and may do WORSE (but study = poor quality)
- Not a lot of good research on AA program bc it’s anonymous (very important to functioning of these programs). Hard to study in systematic way.
- In several of the randomized trials, participants were coerced into treatment (e.g., court referred)
- More recently, shows that it’s quite good
Recent study:
Study examining 2000 men seeking treatment for alcohol use at VA hospital. All met criteria for a diagnosis of alcohol use disorder.
Received treatment.
After finishing treatment, researchers followed them and collected data about their substance use and their attendance at AA meetings.
Results?
(1) AA attendance → Lower alcohol use: AA involvement at 1 year post-treatment predicted less alcohol use at 2 years post-treatment
(2) Alcohol use at year 1 did NOT predict AA involvement at year 2
(3) Results NOT explained by alcohol use severity, motivation, or co-morbid psychopathology
Inpatient Treatment: characteristics
(1) Short duration stay (4 to 6 weeks) in some type of treatment facility
(2) Range of treatment programs: Individual counselling, family therapy, treatment for comorbid disorders
(3) Often followed by outpatient
=> Very few controlled studies have examined the efficacy of inpatient treatment for substance useIN YOUTH (but good individual cases)
