Understanding Alcoholism: Individual & Population Approaches - Allen Flashcards
What are the three population health components that need to be considered when understanding substance use?
- Substance
- Set
- Setting
What are the DSM-5 substance use disorder criteria for alcohol use disorder?
- Alcohol is often taken in larger amounts or over a longer period of time than intended.
- There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving, or a strong desire or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use in situations where it is physically dangerous.
- Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
- Tolerance, as defined by either:
- A need for marked increased amounts of alcohol to achieve intoxication or desired effect.
- A marked diminishing effect with continued use of the same amount of alcohol.
- Withdrawal, as manifested by:
- The characteristic withdrawal syndrome for alcohol.
- Alcohol is taken to relieve or avoid withdrawal symptoms.
What are the recent changes or NEW criteria for alcohol use disorder?
Two major change in DSM-5 were the removal of
- legal problems as diagnostic criteria - the distinction between “abuse” and “dependence”
What the epidemiology patterns of alcohol use?
- Men drink more than women
- Whites have the highest rates of alcohol use, Asian Americans the lowest
- The majority of American Indian people did not drink last month
- Increasing education is associated with increasing use; people who did not finish high school drink the least
- American Indian people have highest rates of binge and heavy use
What factors make patients at risk for alcohol use?
- Enrollment in college
- Family history of alcoholism
- Male sex
- Comorbid psychiatric disorders
- Loss of spouse
What are protective factors for alcohol use?
- Flush response
- Living in a stable and nurturing home
- Having basic life needs met
What is the basis of AA treatment for alcohol abuse?
Alcoholics Anonymous (AA):
- self-help approach (paired with sponsor) - 12 step program - Spiritual basis - abstinence based
What is the basis of Motivational Interviewing treatment for alcohol abuse?
Motivational Interviewing (MI):
- A person-centered, goal-oriented method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence. - Stages of Change: Precontemplation, Contemplation, Determination/Preparation, Action, Maintenance - Define success by the movement from one stage to the next
What is tolerance?
A reduced sensitivity requiring higher quantities of alcohol be consumed in order to achieve the same effects.
What is withdrawal?
A set of symptoms that can occur when an individual reduces or stops alcoholic consumption after long periods of use.
Alcohol withdrawal syndrome–at least two of the following symptoms:
- increased hand tremor
- insomnia
- nausea or vomiting
- transient hallucinations (auditory, visual or tactile)
- psychomotor agitation
- anxiety
- tonic-clonic seizures
- autonomic instability
What is a craving?
Desire or urge to consume alcohol:
- Physical
- Psychological
How do you specify the severity of Alcohol Use Disorder according to the DSM-5 Criteria?
Mild: 2-3 symptoms.
Moderate: 4-5 symptoms.
Severe: 6 or more symptoms.
What is the “CAGE” assessment for alcohol abuse?
Have you ever felt you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt bad or Guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
What is the basis of Relapse Prevention treatment for alcohol abuse?
Relapse Prevention (RP):
- maintenance of the habit change process - prevent the occurrence of initial lapses after embarking on habit change - prevent any lapse from escalating into total relapse - addictive habit patterns can be changed through application of self-management or self-control procedures
What are the Stages of Change according to the Transtheoretical Model?
Precontemplation Contemplation Determination/Preparation Action Maintenance
- Approximately 80% of people with substance use disorders are in precontemplation or contemplation
- Define success by the movement from one stage to the next.
