Zelan: Diagnosis of Substance Abuse

Question 1

Give an example of a co-morbidity with substance abuse disorder

Answer 1

borderline personality disorder

Question 2

Lifetime prevalence rates of alcohol use disorder up to (blank)%

Answer 2

30%

Question 3

Why worry about alcoholism?

Answer 3

medical complications
alcohol use correlates to violence
suicide
motor vehicle accidents/trauma

**these factors lead to increased morbidity and mortality and make these patients harder to provide care for

Question 4

Number one prescribed drug in the US

Answer 4

Vicodin

Question 5

What has happened to the non-medical use of prescription opioids, heroin, narcotics, etc? Why has this happened?

Answer 5

it is increasing

**teens believe prescription drugs are easier to get than beer

misunderstanding of “addiction” - “addiction” is a misused term

Question 6

Often correlates to physical signs of dependence and tolerance.
However, can also be suspected based on behavioral signs of compulsive use.
Signs of compulsive use include: use despite harmful consequences, use that is escalating, pervasive urges to use, high risk behaviors, failed attempts to stop or reduce use.

Answer 6

addiction

Question 7

Taken in larger amounts than intended.
Failed attempts to control or stop.
Excessive time given to use or recovery.
Strong urges to use.
Functional impairment.
Ignoring harmful consequences. 
High risk behaviors. 
Withdrawal or efforts to avoid withdrawal. 
Tolerance: escalating use/ diminishing effects.

Answer 7

DSM5 criteria for substance abuse disorder

**there are high functioning addicts

Question 8

What is the DSM5 severity spectrum?

Answer 8

mild severity: 2-3 symptoms

moderate: 4-5 symptoms
severe: 6+ symptoms

Question 9

How do you screen for substance abuse disorder?

Answer 9

CAGE

Cut down? (Ever felt the need to cut down use?)
Annoyed of people asking?
Guilty?
Eye-opener (Ever need to use the substance as an eye-opener?)

Question 10

the proportion of cases that return true positives

Answer 10

sensitivity

Question 11

the proportion of non-cases that return true negatives.

Answer 11

specificity

Question 12

Screening tests usually designed for high (blank).

Confirmatory tests usually designed for high (blank).

Answer 12

sensitivity; specificity

Question 13

proportion of test positives that are true positives?

proportion of test negatives that are true negatives?

Answer 13

positive predictive value; negative predictive value

Question 14

T/F: Behavioral illness, like addiction, must be viewed as both a congenital and acquired condition. It is highly heritable, but environmental triggers are also relevant.

Answer 14

True

Question 15

In what ways is addiction an illness?

Answer 15

it’s chronic, multifactorial, relapsing/remitting

Question 16

Motivation is defined as a history of being (blank) for a behavior.

Answer 16

reinforced

**if I’m reinforced for behavior X, I’m motivated for it

Question 17

T/F: Motivation is relative to context (environment) and must be measured on a continuous spectrum

Answer 17

True

Ex: It’s easy to sign up for a weight loss program after eating a big meal

Question 18

Why is change slow? Why don’t clients change after their first DUI?

Answer 18

Because motivation is context dependent, clients are not “in charge,” at least not in the beginning stages of treatment.
The fast, emotional parts of the brain are overwhelming the slower, rational (wiser) parts of the brain.
Logic can’t just “over-rule” emotion!
You can’t “logic” your way out of emotions!

Question 19

T/F: Behavioral health treatments are lengthy treatments that must pass through specific stages of treatment

Answer 19

False, studies have shown that brief interventions are also effective

Question 20

T/F: The type of treatment delivered is less important than the expertise of the health care provider.

Answer 20

False, community treatment by experts was not superior to DBT

Question 21

Sometimes what you think will be punishing, is actually rewarding, and vice versa. Give an example.

Answer 21

Being “uncaring” with someone might actually reinforce the behavior you would like to see less of.
Being “validating” (not necessarily nice) to someone often results in less of unwanted behavior.

Question 22

T/F: Validation means approving or rewarding someone for their hostile behaviors.

Answer 22

False!

Question 23

What is a negative reward?

Answer 23

A “negative reward” is a reward that results from relief of something (usually painful or unpleasant).

**Most drugs of abuse provide quick and easy access to rewards through relief of pain or unpleasantness.

Question 24

What is emotional vulnerability?

Answer 24

some emotions just get going more quickly for some people than for others! some people can resolve their emotions much more quickly

Question 25

T/F: Emotional vulnerability can be increased or decreased

Answer 25

True

• *Ex: increased after a traumatic incident
• *Ex: goal of treatment is to decrease it

Question 26

Negative reward schedules also teach (blank)

Answer 26

avoidance

**not talking about the issue

Question 27

What are two behavioral extremes you might see with addiction?

Answer 27

dysregulation

suppression

Question 28

What are some assumptions we make about patients with addiction?

Answer 28

patients are doing their best

patients need more motivation for doing better

Question 29

What are some skills Dr. Zelan wants us to use in cases of addiction?

Answer 29

Maintain your emotions at an even level
Radically accept the other person’s emotions
Be assertive and compassionate
Exude self respect
Self respect is not knowing all the answers
Avoid power struggles, practice ignoring skills

Question 30

What is the best treatment for addictive illness?

Answer 30

multiple treatment modalities
dual diagnosis programs (co-occurring)

**team treatment is essential

Question 31

T/F: It’s important to realize that these pts didn’t cause their problems, but they have to solve them anyway

Answer 31

True

Question 32

Any behavior that gets in the way of effective treatment, or doesn’t actively support effective treatment.

Ex: angering, bullying, ignoring, shaming, challenging

Answer 32

therapy interfering behavior

Question 33

T/F: Addictive illnesses tend to “draw in” those around the identified patient, and “trap” them in the illness.
Often, those around the using person (including the doctor) may be as miserable, or more miserable, than the drug user.

Answer 33

True

Question 34

What things do you need to accept about these illnesses?

Answer 34

no one intervention is going to work
recovery is sloooow and painful
motivation waxes and wanes - lack of motivation is part of the illness
docs have a duty to not give up

Question 35

T/F: Getting friends and family involved is a positive aspect of treatment for pts with addictive, pervasive illness.

Answer 35

True

Question 36

Important aspects of clinical compassion?

Answer 36

understand why they want to do their substance
understand how they got to point where they are at
understand how their behaviors are real efforts to cope or solve problems