Substance Use Part 2

Question 1

– At least 1 drink in the past year

– At least 12 drinks during lifetime

Answer 1

current drinker

Question 2

– ≥5 drinks on the same occasion at least once per month

Answer 2

binge drinker (10%)

Question 3

– Men: >14 drinks per week

– Women: >7 drinks per week

Answer 3

heavy drinker

Question 4

– Men: ≤ 2 drinks per day
– Women: ≤ 1 drink per day
– Both genders: ≤ 5 days per week

Answer 4

reccomendations for low risk drinking

Question 5

standard drink is 10 grams of alcohol

Answer 5

for each mL of ethanol, there are .79 grammes of pure thanol

Question 6

rates of alcohol use vary based on

Answer 6

– 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

Question 7

– 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

Answer 7

alcoholic

Question 8

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

Answer 8

CAGE Screening Tool

Question 9

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

Answer 9

cage screening tool

Question 10

• 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

Answer 10

• 3 health-related outcomes
– Increase in lactic acid → anxiety
– Increase in uric acid → gout
– Increase of fat in liver and blood

Question 11

– 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

Answer 11

effects of alcohol in gender

Question 12

Alcohol-related unintentional injuries:

Answer 12

– 40% of traffic-related deaths related to alcohol
• Increases other risky behaviors & intentional
injuries
– Aggression, crime, sex, assault, homicide, suicide
– Make more risky decisions

Question 13

• 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

Answer 13

health benefits of NONalcohol usage

Question 14

why do ppl drink?

Answer 14

• 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

Question 15

– People have free will and choose to drink

Answer 15

Moral Model

Question 16

Alcoholism has a genetic component

Answer 16

Medical Model

Question 17

– 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

Answer 17

Disease Model

Question 18

– 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

Answer 18

Alcohol Dependency Syndrome

Question 19

– 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

Answer 19

• Evaluation of the Disease Model

Question 20

• Drink to relax
• Not supported by research
• Expectations determine tension reduction associated with
drinking

Answer 20

tension reduction hypothesis(Cognitive-Physiological Theories)

Question 21

• 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

Answer 21

– Stress response dampening (SRD) [cog physiological theory]

Question 22

• 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

Answer 22

Alcohol Myopia[cog physiologocal theory]

Question 23

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

Answer 23

Social Learning Model

Question 24

– 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

Answer 24

“Maturing Out” of Alcoholism

Question 25

• Hard-Core Alcoholics
– Detoxification
– Short-term, Inpatient Therapy
– Continuing Outpatient 
Treatment
• Self-Help Groups are most 
commonly sought source of 
help(AA)

Answer 25

Treatment Programs (700,000ppl)
goal=abstinence

Question 26

• 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

Answer 26

Profile of Alcoholics Anonymous

Question 27

• 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

Answer 27

Psychotherapy

Question 28

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

Answer 28

Chemical Treatments

Question 29

• 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

Answer 29

Social Engineering

Question 30

Can Recovered Alcoholics Drink again?

Answer 30

• 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

Question 31

• 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

Answer 31

drinking college student

Question 32

– Identify circumstances when drinking to excess
occurs
– Placebo drinking
• Consuming nonalcoholic beverages while others are drinking
• Alternating alcoholic and nonalcoholic drinks

Answer 32

skills training for college student

Question 33

• 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

Answer 33

Treatment Programs: Relapse

Prevention

Question 34

FDA classifies drugs into 5 schedules based on their

potential for abuse and medical benefits

Answer 34

– 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

Question 35

– 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)

Answer 35

Sedatives

Question 36

– 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)

Answer 36

Stimulants

Question 37

– 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

Answer 37

Marijuana

Question 38

– 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

Answer 38

Anabolic Steroids

Question 39

• 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

Answer 39

treatment for drug abuse

Question 40

– Assume that people will use but act to reduce harm
– Harm reduction strategy
• Needle exchange
• Designated drivers

Answer 40

Control the harm of drug use

Question 41

Prevention programs for children and adolescents aimed

at delaying or prohibiting use

Answer 41

– 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