Substance Use Part 2 Flashcards
– At least 1 drink in the past year
– At least 12 drinks during lifetime
current drinker
– ≥5 drinks on the same occasion at least once per month
binge drinker (10%)
– Men: >14 drinks per week
– Women: >7 drinks per week
heavy drinker
– Men: ≤ 2 drinks per day
– Women: ≤ 1 drink per day
– Both genders: ≤ 5 days per week
reccomendations for low risk drinking
standard drink is 10 grams of alcohol
for each mL of ethanol, there are .79 grammes of pure thanol
rates of alcohol use vary based on
– Ethnicity
• Any drinking: European Americans highest and Asian Americans lowest
• Binge drinking: Native Americans highest
– Age:
• Current: Adults 25-44 years highest; olderadults lowest
• Binge & heavy: 18-24 years
– Gender
• Men > women
– Education
• Current: Increases with education
• Binge & heavy: decreases with education
– Physical addiction to alcohol
– Withdrawal symptoms when abstaining from alcohol
– High tolerance for alcohol
– Little ability to control drinking
• Problem drinkers: may not have symptoms listed above, but do have substantial social, medical or psychological problems resulting from alcohol
alcoholic
CAGE (in the last 12 months)
– felt you should Cut down on your drinking?
– Have people Annoyed you by criticizing your drinking?
– ever felt bad or Guilty about your drinking?
– ever had a drink first thing in the morning to “steady your nerves” or get ride of a hangover “Eye Opener”?
• CONSUMPTION
– On avg, days per week do you drink alcohol?
– On a typical day how many drinks do you have?
– maximum number of drinks on any occasion during the last month?
• SCREEN IS POSITIVE IF:
– A positive response on 1 or more questions from CAGE and/or
Consumption:
• Men > 14 drinks/week or > 4 drinks/occasion
• Women and both sexes > 7 drinks/week
• over 65 years of age > 3 drinks/occasion
CAGE Screening Tool
THEN ASSESS FOR:
Medical problems: Black outs, depression,
hypertension, injury, abdominal pain, liver dysfunction, sleep disorders
-Laboratory
-Behavioral problems
-Alcohol Dependence
If at-risk drinker:
-Advise patient of risk.
-Set drinking goals.
-Provide referral to primary care.
If alcohol dependent drinker:
-Assess acute risk of intoxication/withdrawal.
-Negotiate referral i.e. detoxification, AA and primary care.
-Continue exploring Pros & Cons and Assessing
Readiness to Change if appropriate.
Reference: The Physician’s Guide to Helping Patients with Alcohol Problems. National Ins
cage screening tool
• In your body 2 enzymes turn alcohol into vinegar
(acetic acid)
– Alcohol dehydrogenase
• Enzyme in liver that converts alcohol to aldehyde (very toxic)
– Aldehyde dehydrogenase
• Enzyme that converts it to acetic acid
• 3 health-related outcomes
– Increase in lactic acid → anxiety
– Increase in uric acid → gout
– Increase of fat in liver and blood
– In part body weight
– Men’s brains are more strongly affected than
women’s
– Women’s stomach’s absorb more efficiently
• Tolerance, dependence, addiction, abuse
effects of alcohol in gender
Alcohol-related unintentional injuries:
– 40% of traffic-related deaths related to alcohol
• Increases other risky behaviors & intentional
injuries
– Aggression, crime, sex, assault, homicide, suicide
– Make more risky decisions
• There is a U- or J- shaped relationship between
alcohol use and mortality
– Light to moderate drinkers (1-5 drinks/day)have the best
heath
• Reduced cardiovascular mortality
– (increases HDL and decreases clotting)
• Reduced risk for ischemic strokes but increased risk for hemorrhagic strokes
• Also lowers risk for
– Diabetes, gallstones, H. pylori infection, Alzheimer’s disease
health benefits of NONalcohol usage
why do ppl drink?
• Genetic factors appear to be involved (20-30%)
– Twins studies
– Frequency of alcoholism in sons of alcoholics
– Gene variant can’t break down alcohol, produces unpleasant
flushing, & decreases risk of abuse
• Men traditionally were at greater risk
– With changing norms, women are “catching up”
• Physiological, behavioral, and sociocultural factors are involved
• Alcoholism is tied to the drinker’s social and cultural environment.
– Window of vulnerability: Ages 12 to 21
– Window of vulnerability: Late middle age
– People have free will and choose to drink
Moral Model
Alcoholism has a genetic component
Medical Model
– People drink excessively because they have the
disease of alcoholism
– Dominant view in medically oriented treatment
programs but not in psychologically oriented programs
– Jellinek identified two types:
• Gamma alcoholism: loss of control once drinking begins
• Delta alcoholism: inability to abstain
– Variation: Alcohol Dependency Syndrome
Disease Model
– A group of concurrent behaviors that accompany alcohol dependence
– Impaired control versus loss of control
– Used for diagnosis of substance abuse dependency in the DSM
– Seven essential elements:
• Narrowing of drinking repertoire
• Salience of drink-seeking behavior
• Increased tolerance
• Withdrawal symptoms
• Avoid withdrawal symptoms by further drinking
• Subjective awareness of the compulsion to drink
• Reinstatement of dependence after abstinence
Alcohol Dependency Syndrome
– Too simplistic to view alcoholism as an incurable unitary disorder
– Doesn’t answer why people begin or why people drink in moderation
– The key concept of loss or impaired control is not supported in the research
– Many effects of alcohol are due to expectations rather than pharmacological effects
• Evaluation of the Disease Model
• Drink to relax
• Not supported by research
• Expectations determine tension reduction associated with
drinking
tension reduction hypothesis(Cognitive-Physiological Theories)
- Describes the phenomenon that occurs when people who have been drinking do not respond as strongly to physiological or psychological stressors
- Use alcohol to buffer stressful situations
- A large SRD effect is associated with higher risk for problem drinking
– Stress response dampening (SRD) [cog physiological theory]
• Alcohol produces a myopia by blocking out insightful cognitive processing and altering thoughts related to the self, stress, and social anxiety
• Drunken excess: behave more excessively
• Self-inflation: inflate self-evaluations
• Drunken relief: worry less & pay less attention to worries
• Research supports this theory that information is processed in a
limited way depending on environmental cues rather than general inhibition
– Focus on arousal – less likely to use condom
– Focus on risks of sex – more likely to use condom
Alcohol Myopia[cog physiologocal theory]
Acquire drinking behavior just like any other behavior through
• positive reinforcement – pleasure of taste, social interaction, mood enhancement
• negative reinforcement – avoid withdrawal
• modeling– observe others
• cognitive mediation – consistent with personal standards
– Offers explanations for all three questions of why people begin or drink in moderation or excess
– Useful for treatment
Social Learning Model
– Spontaneous remission
– 10 to 20% of alcoholics stop drinking on their own
– 32% of alcoholics can stop with minimal help
• Can be treated successfully through cognitivebehavioral modification
But
– High rate of relapse– as high as 60%
– Alcoholic’s environment must be considered
• Without employment or social support, prospects for recovery
are dim
“Maturing Out” of Alcoholism
• Hard-Core Alcoholics – Detoxification – Short-term, Inpatient Therapy – Continuing Outpatient Treatment • Self-Help Groups are most commonly sought source of help(AA)
Treatment Programs (700,000ppl) goal=abstinence
• Philosophy
– The best person to reach an alcoholic is a recovered alcoholic
– Immersion: Attend 90 meetings in 90 days
• Recovery depends on staying sober
• Members provide social reinforcement for one
another’s abstinence
• Alcoholism
– A disease that can be managed, never cured
– Alcohol plays no part in the person’s future
Profile of Alcoholics Anonymous
• Often combined with detoxification
• Many techniques can be used and are effective
• Self-Monitoring
– Person begins to understand situations that give rise to drinking
• Contingency contracting
– Person agrees to a costly outcome (financial or
psychological) in the event of failure
• Medications that block alcohol-brain interactions
• Stress management techniques
• Motivational interviewing
– Keeping the client motivated with individualized feedback
about his/her efforts
Psychotherapy
Administer drugs that interact with alcohol to produce unpleasant effects or decrease reward • Disulfram (Antabuse) – Aversion therapy • Naltrexone – Blocks opiates in brain • Acamprosate – Affects GAMA neurotransmitter in brain – Reduces craving and relapse
Chemical Treatments
• Social engineering may represent the best
approach
– Banning alcohol advertising
– Raising the legal drinking age
– Strictly enforcing the penalties for drunk driving
• These approaches reach the untreated majority
Social Engineering
Can Recovered Alcoholics Drink again?
• Alcoholics Anonymous Philosophy An alcoholic is an alcoholic for life • Drinking in moderation seems possible – For young, employed problem drinkers – Who have not been drinking for long – Who live in supportive environments • Drinking in moderation – May be a more realistic goal for college students – May prevent high dropout rates in more traditional programs • Not for everyone
• Most U.S. college students drink alcohol
– 15%-25% are heavy drinkers
– 45% engage in occasional binge drinking
• Successful interventions:
– Encourage students to gain self-control over drinking rather than eliminating alcohol
– Self-monitoring often reduces drinking
drinking college student
– Identify circumstances when drinking to excess
occurs
– Placebo drinking
• Consuming nonalcoholic beverages while others are drinking
• Alternating alcoholic and nonalcoholic drinks
skills training for college student
• Relapse rates
– 65-75% relapse within 1 year after treatment
– 50% or more relapse within first 3 months
• Helpful for problem drinkers to know
– An occasional relapse is normal
– Relapse doesn’t signify failure
• Important relapse prevention skills
– Learning “drink-refusal skills”
– Learning nonalcoholic beverage substitutions
Treatment Programs: Relapse
Prevention
FDA classifies drugs into 5 schedules based on their
potential for abuse and medical benefits
– Schedule I: High abuse potential, no medical use, illegal
• Examples: Heroin, LSD, marijuana
– Schedule II: High abuse potential, can cause physiological or psychological dependence, but have some medical use
• Examples: Opiates, some barbiturates, amphetamines, cocaine
– Schedule III: moderate or low physical dependence or high psychological dependence but have accepted medical uses
• Examples: Some opiates, some tranquilizers
– Schedule IV: Low abuse potential, limited dependence, accepted
medical uses
• Examples: Phenobarbital, most tranquilizers
– Schedule V: Lowest abuse potential
• Examples: Over-the-counter medications
– Induce relaxation and sometimes intoxication by lowering the activity
of the brain, the neurons, the muscles, and the heart, and decreasing metabolic rate
• Low doses: relaxation and euphoria
• High doses: Coma and death
• Alcohol, barbiturates, tranquilizers (benzodiazepines), opiates (morphine,
heroin, cheese, methadone, oxycodone, hydrocodone)
Sedatives
– For some, more alert, energetic, able to concentrate, and able to work long hours
– For other, feel jittery, anxious, and unable to sit still
– Similar to norepinephrine
• Amphetamines, cocaine, cocaethylene, crack cocaine, Ecstasy (MDMA)
Stimulants
– Most commonly used illegal drug in US
– Intoxicating ingredient is delta-9 tetrahydrocannabinol (THC) that comes from the resin of the Cannabis sativaplant
– Acts in brain to induce altered thought processes, memory
impairment, relaxation, euphoria, increased appetite, coordination impairment, increased heart rate
– Direct health risks are fewer than other drugs, but at increased risk for respiratory problems and lung cancer
– Increases risk for injury
– Beneficial effects of decreasing nausea and vomiting associated with chemotherapy, analgesic properties, decrease in glaucoma
Marijuana
– Endogenous (cortisone, estrogen, testosterone)
– Exogenous
– Medically used to decrease inflammation
– Abused most by athletes and bodybuilders
• Increase muscle bulk and decrease body fat
– Potentially dangerous
• Shut off body’s own steroids, alter immune and reproductive functioning, increase CVD, affect liver, stunt growth,
• Behavioral problems such as moods swings, aggression,
confusion, distractibility, euphoria
Anabolic Steroids
• Similar to treatment of alcohol abuse, both in the philosophy and administration of treatment
• Goal: total abstinence
• Self-help groups[ Narcotics Anonymous]
• Inpatients treatment programs
– Detoxification tailored to type and severity of
withdrawal effects
• High relapse rate
– Aftercare and booster session are important
treatment for drug abuse
– Assume that people will use but act to reduce harm
– Harm reduction strategy
• Needle exchange
• Designated drivers
Control the harm of drug use
Prevention programs for children and adolescents aimed
at delaying or prohibiting use
– Programs similar to ones for smoking
– Life Skills Training program teaches social skills to help resist social pressure and increase personal competence
– Ineffective programs are those who rely on scare tactics (DARE),
moral training, factual information about risks
