Week 5: Definition of substance use disorders

Question 1

Substance Use Disorder definition

Answer 1

 Substance Use Disorder
 Different substances
 Alcohol, Cannabis, Opiods, Hallucinogens, Inhalants, Sedatives, Hypnotics, Anxiolytics, Tobacco, Other
 Problematic pattern of substance use leading to clinically significant impairment or distress as manifested by at least two symptoms
occurring within a 12-month period
 Examples:
 Continued alcohol use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by use
 Important social, occupational, or recreational activities are given up or
reduced because of alcohol use
 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

Question 2

Is experimenting with alcohol common?

Answer 2

 Experimentation is 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

Question 3

Adolescence is a Risk Period for Substance Use Problems

Answer 3

 Earlier use starts the more likely it is to become problematic
 15.1% of individuals who start drinking by 14 develop alcohol use disorder, compared to 2.1% of those who start at age 21 or older
 Research trying to disentangle the extent to which early onset is a risk marker versus a risk factor
 Substance use in adolescence is associated with the three leading causes of death for adolescents: accidents, suicide, homicide
 Also, educational problems and legal problems

Even though common, still dangerous

Question 4

Prevalence

Answer 4

 Lifetime prevalence of any substance use disorder
 NCS-A
 Adolescents aged 13 to 18 years: 11.4%
 13-14 year olds: 3.7%
 15-16 year olds: 12.2%
 17-18 year olds: 22.3%
 Rates are higher among youth experiencing other mental health
problems

Question 5

Treatment Models

Answer 5

 Early Brief Interventions
 Outpatient Treatment
 Residential Inpatient Treatment

Question 6

Early, Brief Interventions

Answer 6

 Norm-based interventions for college students
 These target norms about drinking
 Injunctive norms: How much others approve or disapprove of
drinking
 Descriptive norms: How much others actually drink

Question 7

Norm-Based Interventions

Answer 7

 American university students overestimate how much their peers drink
 Incidentally, American high school students overestimate how much sex their peers are having

Brief Alcohol Screening and Intervention for College Students
 Individualized feedback about:
 Actual drinking norms
 Comparison between individual’s drinking pattern and the norm
 1) This is how much you drink
 2) This is how much you think others drink
 3) This is how much others actually drink
 4) Percentile ranking showing where you are relative to others on your campus

Question 8

Norm-Based Interventions (evidence)

Answer 8

 Screened 1115 students
 Identified 481 students who reported at least one heavy drinking episode (5-4 drinks in one sitting for men and women respectively)
 252 students (148 women) took part
 Participants and non-participants did not differ on amount of drinking reported
 Randomly assigned to intervention or control

 Baseline
 Perceived drinking norms
 Drinking behavior
 Intervention
 Received feedback immediately
 Presented on screen for a minute and given a print out to take home
 No interpersonal interaction
 Follow ups at three and six months

Question 9

Norm-Based Interventions results

Answer 9

 At both 3 and 6 months, amount of drinking in the intervention group was reduced, relative to the control group
 At both 3 and 6 months, perceived norms were reduced (intervention group was reporting that peers drink less than control group)
 Changes in perceived norms MEDIATED the association between the intervention and reduced drinking
 Intervention predicted decrease in perceived norms at three months, which predicted decreases in drinking at 6 months

So these were self-reported so possible this is a lie

However self reported and actual observed drinking amounts are correlated

There is no judgement here. No one else is involved. This is a strength

Question 10

Outpatient Treatment

Answer 10

 Family Therapy

 Alcoholics Anonymous (12 Step Programs)

Question 11

Family therapy for substance use

Answer 11

 Multidimensional Family Therapy
 Similar to MST
 Adolescent
 E.g., Use as a means of coping with distress
 Parents
 E.g., increased parental monitoring

Therapist tries to understand why they drink. Who is it benefitting? e.g. if the adolescent is drinking to self-medicate for stress, this will not go away until they have other ways to control stress

 A large number of studies have shown that family therapy results in better substance use outcomes for adolescents, compared to a
number of control conditions, including other types of therapy (e.g.,
group CBT)

Question 12

Alcoholics Anonymous

Answer 12

 Very popular
 People experiencing problematic alcohol use seek out AA more than all
other forms of treatment combined
 12 steps
 Acknowledge that alcohol is a problem
 Recommend abstinence
 Supported by a peer
 Easily accessible
 More than 30 meetings in Montreal today
 Global

This means you can usually find a meeting wherever you are

Question 13

Alcoholics Anonymous (3 hypotheses)

Answer 13

 Participation in AA is associated with less alcohol consumption and fewer substance related problems
 Three hypotheses:
 1) AA attendance → Lower alcohol use
 2) Lower alcohol use → AA attendance
 3) Good prognosis (e.g., better motivation, less co-morbid psychopathology) → Lower alcohol use and AA

Question 14

AA evidence (bad)

Answer 14

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
 However, there are very few well-done studies
 In several of the randomized trials, participants were coerced into treatment (e.g., court referred)

This last point calls into question the external validity of these results

Question 15

AA evidence (good)

Answer 15

 More recently …
 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

 1) AA attendance → Lower alcohol use
 AA involvement at 1 year post treatment predicted less alcohol use at 2 years post treatment
 2) Lower alcohol use → AA attendance
 Alcohol use at year 1 did not predict AA involvement at year 2
 3) Good prognosis (e.g., better motivation, less co-morbid psychopathology) → Lower alcohol use and AA
 Results not explained by alcohol use severity, motivation, or comorbid psychopathology

Which points to AA being causal

IF not evidence based, it is free so why not try it

Question 16

Inpatient substance use treatments

Answer 16

Inpatient
 In-patient treatment
 Short duration (4 to 6 weeks)
 Range of treatment programs
 Individual counselling, family therapy, treatment for comorbid disorders
 Often followed by outpatient

 Very few controlled studies have examined the efficacy of inpatient treatment for substance use

Not great evidence and also VERY expensive