Substance Use DIsorders Flashcards
Substance abuse - DSM 4
Maladaptive pattern of use leading to clinically significant impairment or distress for a 12 month period
Substance dependence - DSM 4
Maladaptive pattern of use leading to clinically significant impairment or distress, with at least 3 episodes
Substance use and addictive disorders - DSM 5
Defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual
4 major groupings to diagnose a substance use disorder (SUD)
Impaired control, social impairment, risky use, pharmacological criteria (tolerance and withdrawal)
Diagnostic criteria
2 of the following must occur with a 12 month period: 1. The substance is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance. 3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 4. Craving, or a strong desire or urge to use the substance. 5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
Tolerance
A need for markedly increased amounts of the substance to achieve intoxication or desired effect; a markedly diminished effect with continued use of the same amount of the substance.
Withdrawal
The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance).
Prevalence
20.2 million adults (8.4%) had a substance use disorder when asked about past year’s use. Of these, 7.9 million people had co-occurring mental and substance use disorder
Prevalence - gender difference
When asked about use in the past year - Men aged 12 or older are more likely than women to report illegal drug use (12.8% vs. 7.3%). However, women are more impacted by substance use than their male counterparts
Adolescence and SUDs
9 out of 10 people with SUDs started smoking, drinking, or using others drugs before age 18
Alcohol and adolescence
If adolescence started drinking before age 14, 47% are alcohol dependent. If adolescence started drinking before age 21, 9% are alcohol dependent
Risk factors for SUDs
Biological (genetics, neuroanatomy), psychological (trauma, learned behavior), and environmental
Psychological Risk Factors
Mental illness: self-medication; ADHD, low self-esteem, self-worth, or trauma
Trauma - Psychological Risk Factors
Rhesus monkeys who were stressed more after birth had higher rates of accepting alcohol offered to them (higher levels of cortisol found in the heaviest drinkers); Hx of child abuse and neglect are 1.5x more likely to use illicit drugs, especially marijuana, in middle adulthood; Hx of sexual assault is associated with a 3x greater risk for alcoholism, 4x for drug addiction
Biological Risk Factors
- Addiction is very heritable. Ex: 4x more likely to have alcohol use disorder if parent does.
- Twin studies: 40-60% concurrence of alcoholism
- Adoption studies: adopted to separate homes – both 3-4x’s more likely to have disordered drinking
Stockholm Adoption Study
Alcoholism in at least one birth parent increased the son’s risk of disordered drinking vs. alcoholism in the adoptive parents did not
The Reward Pathway
Reward pathway tries to make sure you repeat the behavior so it connects to regions of the brain that control memory and behavior to signal the brain’s motor center to strengthen the wiring for behaviors that help achieve the reward
Environmental Risk Factors
- Familial, socially, culturally normalized
- Peer pressure
- Interpersonal violence
- Directed advertisement
Alcohol’s impact on health
- Heart health: alcoholic cardiomyopathy, arrhythmia, strokes, hypertension
- Pancreas: pancreatitis
- Cancer: mouth, esophagus, throat, liver, breast
- Immune system: pneumonia & TB, slowed ability to ward off infection
- Head injuries from falls sustained when inebriated
- Cerebrovascular disease
Drugs and alcohol
- Tylenol and alcohol: liver failure, liver damage, yellow skin tone, cirrhosis, immune system breakdown
- Alcohol and sedatives: multiples sedative effect of both
Korsakoff syndrome
Peripheral neuropathy related to lack of vitamin B1
Heroin and opiates impact on health
Physical complications due to neglect, infection (injection, picking)
Cocaine’s impact on health
Cardiovascular disease, destruction of nasal tissue if sniffed
Methamphetamine’s impact on health
Loss of appetite, increased heart rate, blood pressure, body temperature, disturbed sleep patterns, nausea, bizarre, erratic, sometimes violent behavior, hallucinations, hyperexcitability, irritability
Inhalant’s impact on health
Varied effects, increase/decrease HR, headaches, dizziness, loss of sense/smell, lung collapse, and confusion
Nicotine’s impact on health
- Cancer: lung, larynx, oral cavity, esophagus, bladder, kidney and pancreas
- Cardiovascular disease
- Pulmonary disease (COPD)
- Cerebrovascular disease (strokes and dementia)
- Peptic ulcers, osteoporosis in postmenopausal women, and macular degeneration
Alcohol and smoking
- 80-95% of those with alcohol use disorder smoke
- Reduces alcohol effects
- Smokers 10x more likely to develop alcohol use disorder
Ecstasy: long term effects
Liver damage, anxiety disorders, irregular heartbeats, brain damage, depression confusion, paranoia
Impact on health: gender differences
For alcohol, opiates, cocaine, and other drugs, sexual dysfunction differs by gender. For prescription meds, elderly women are more likely to misuse prescribed medications (10% of women misuse)
SUDs impact on others
Prenatal drug exposure on infants and children (neonatal abstinence syndrome), secondhand smoke, spread of infectious disease
Fetal Alcohol Syndrome
CNS problems like mental retardation, hyperactivity, delayed development, problems with learning, and seizures
Advantages of doing assessment
Getting information, matching to counselor, getting insurance reimbursement for diagnosis
Disadvantages of doing assessment
May set up false expectations for specialized treatment, delays actual treatment, may be inappropriate for many minority groups.
Screening instruments
Consists of a few questions to determine nature of the help needed; informal questions like “do you sometimes drink”
Assessment tools
Process for defining the nature of the problem and developing specific treatment recommendations for addressing the problem; CAGE, TWEAK, AUDIT, MAST, SASSI, DriInC
Assessing levels of care
Early intervention, outpatient treatment, intensive outpatient/partial hospitalization treatment, residential treatment
Assessment of someone with co-occurring disorders
- A basic program provides treatment for one disorder but screens for the other.
- An intermediate program focuses primarily on one disorder but addresses some needs of the other.
- Advanced program provide services for both disorders
Assessment of younger clients
- Risk at every life transition (college transition)
- First sexual encounter for girls is usually accompanied by alcohol or drugs
Assessment of older clients
At higher risk for disordered use of prescription drugs
Best treatment practices
Medications and behavioral therapy
Behavioral and cognitive treatments
Types: motivational interviewing, cognitive therapy, contingency management, relapse prevention.
Goals: modify attitudes and behavior, strategies to plan for triggers/relapse, increase life skills/coping techniques
Interactional group - psychotherapy
Alcoholics Anonymous
Medication
Odansteron (zofran) decreases cravings. ZYban (bupropion) reduces cravings and other withdrawal effects. Chantix helps pt produce more dopamine. Naltrexone blocks receptors for getting high. Disulfiram (antabuse) - for alcohol abuse disorder
Holistic treatments
Herbal remedies, hypnosis, acupunture, massage therapy, physical exercise
CAGE
Cut down, annoyed, guilty, eye opener
TWEAK
Tolerance, Worried, Eye Openers, Amnesia, Kut down
AUDIT
Alcohol use disorders identification test, 10 question survery
MAST
The MAST Test is a simple, self-scoring test that helps assess if one has a drinking
problem
DriInC
Drinker inventory of consequences quesionnaire
SASSI
Substance Abuse Screening Inventory
