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Transcript

  • 1. Substance Use Disorders
  • 2. Substance Use Disorders• Substance Dependence – Axis I: Cocaine Dependence• Substance Abuse – Axis I: Cocaine Abuse
  • 3. Substance Dependence: Diagnostic Criteria• At Least 3 Of 7 Symptoms Are Present Over A 12 Month Period – Tolerance – Withdrawal (e.g., Alcohol -> Delirium Tremens) – Larger Amounts Or Longer Period Of Time – Persistent Desire Or Unsuccessful Efforts To Reduce Or End Substance Use – Extensive Time Devoted To Obtaining, Using, And Recovering From From The Substance – Giving Up Social Or Occupational Opportunities In Favor Of The Substance – Continued Use Of Substance Despite Perception That It Has Caused Physical Or Psychological Problems
  • 4. Substance Abuse: Diagnostic Criteria• At Least 1 Of 4 Symptoms Are Present Over A 12 Month Period – Substance Use Impairs Ability To Fulfill Role Obligations (i.e., Good Parent, Spouse, Worker) – Recurrent Use Of Substance In Physically Hazardous Situations – Recurrent Legal Problems Related To The Substance Use – Recurrent Interpersonal Problems Stemming From The Substance Use
  • 5. AlcoholAlcohol Is A CNS depressantIncidence Of Alcohol Use Disorders• 1994 National Comorbidity Study – About 14% Of Adult Americans Could Be Diagnosed With Alcohol Dependence Or Alcohol Abuse Based On Their Current Or Past Drinking-Related Behavior – Gender Difference • Males: 20% Lifetime • Females: 8% Lifetime
  • 6. Physical Consequences Of• Cirrhosis Of The Liver – Enlargement And Abnormal Vascularization Of The Liver – Difficulty Clearing Toxins• Increased Risk Of Some Cancers• Fetal Alcohol Syndrome – Mental Retardation – Physical Anomalies If Heavy Drinking Occurred During First Trimester
  • 7. Physical Consequences Of• Disorders Of Thiamine (Vitamin B) Deficiency – Wernicke’s Disease • Delirium (Disorientation And Impaired Attention) • Motor And Balance Disturbance • Deterioration Of Peripheral Nerves • High Doses Of Thiamine Can Reverse Symptoms – Korsakoff’s Syndrome • A Permanent Dementia (Cognitive Deterioration) With Prominent Anterograde and Retrograde Amnesia – Anterograde Amnesia: Inability To Recall New Information – Retrograde Amnesia: Progressive Loss Of Memories
  • 8. Alcohol Use Disorders: Biological Factors• Siblings Of Alcohol-Dependent Persons Experience Alcohol Dependence Themselves At A Rate 3 To 8 Times Greater Than That Of The General Population• Twin Studies Suggest That The Heritability Of Alcoholism Is 50 To 60 Percent
  • 9. Alcohol Use Disorders: Psychological FactorsNegative Affect (Depression, Anger, Anxiety)• Alcohol (Substance) Abusers Experience Greater Rates Of Negative Affect• Negative Affect Increases The Probability of RelapseExpectancy Model• A Cognitive-Behavioral Model Of Substance Use/Relapse That Involves: – Abstinence-Related Coping Skills – Abstinence-Related Self-Efficacy Beliefs – Expectations About The Effects of Alcohol
  • 10. Expectancy ModelAbstinence-Related Coping Skills• Refusal Skills• Avoidance Skills• Support SkillsAbstinence-Related Self Efficacy (ARSE)• Person’s Confidence In His/Her Ability To Stay Sober• High ARSE Comes From Staying Sober In High Risk Situations• Low ARSE Comes From Losing Sobriety In High Risk SituationsPositive Beliefs About The Substance• e.g., “A Drink Will Relax Me”• e.g., “People Like Me More When I Drink”Abstinence Violation Effect (AVE)• When Persons With Rigid Beliefs About The Dire Consequences Of Substance Use Lose Their Sobriety, They Become Depressed (Other Negative Emotions) Which Increases The Likelihood That They Will Continue To Use The Substance
  • 11. Expectancy Model Effective High High Probability Of Coping ARSE Staying SoberHigh RiskSituation Low Ineffective ARSE/ Initial Use AVE Coping Positive Thoughts
  • 12. Treatment Of Substance Use Disorders• 12 Step Model – Alcoholics Anonymous – Narcotics Anonymous• Relapse Prevention Model (harm reduction model) – Alan Marlatt – Empirically Based
  • 13. 12 Step ModelHistorical Context• Two Alcoholic Physicians Wrote “Alcoholics Anonymous” (“The Big Book”) In The 1930s• Prior To The Big Book, Most Persons Felt Moral Weakness Caused Substance AbuseElements Of The 12 Step Model• Disease Focus – “Alcoholism Is A Disease, Not Simply The Result Of Moral Weakness”• Powerlessness – “Alcoholics Are Powerless Against Alcohol”• Spirituality – “Only With The Help Of My Higher Power, I Can Stay Sober”
  • 14. 12 Step ModelElements Of The 12 Step Model (Cont.)• Social Support – “Sponsor” (Possibly Multiple Sponsors) – “ As A Sponsor” – Helps Maintain Sobriety – Hotline: Someone To Drive You To A Meeting• Meetings – Meetings Available 24 Hours – “40 In 40” – First 40 Days Of Recovery• Recovery – The Abstinent Alcoholic Should Consider Himself Or Herself To Be In A Never-Ending State Of Recovery (Never Cured) – The Abstinent Alcoholic Should Be Constantly Vigilant For Precursors Of Relapse• Relapse Vs Slip – No Distinction Between Relapse And Slip – All Use Is RelapseActive Ingredients Of The 12 Step Model• Social Support, Accountability
  • 15. Possible Shortcomings Of The 12- Step Model• Spirituality – Many Persons Have Issues With Religion And Spirituality• Social Element – Much Of The Benefit Of A 12-Step Program Stems From One’s Ability To “Fit In” And Form Relationships – Socially Avoidant Persons Or Persons With Poor Social Skills Are Less Likely To Reap The Benefits Of A 12-step Program• Powerlessness – Persons With Internal Locus Of Control May Object
  • 16. Relapse Prevention Model• Acknowledges That Relapse Is Common In Addiction (50 – 90 Percent)• Psychoeducation – _______________________• Relapse Vs Slip – ________________________________________ – Relapse • Severe Interpersonal, Financial, And Vocational Consequences – Slip • Brief _____________________ That Does Not Involve Severe Interpersonal, Financial, And Vocational Consequences – Contingency Planning To Prevent A Slip From Becoming A Relapse • Although Abstinence Is Emphasized, The Therapist Also Emphasizes That, Should The Client Slip, The Client Should ________________________________
  • 17. Relapse Prevention Model• Developing Coping Skills – _________________ – _________________ – _________________ • Qualities Of A Good Support Person – Someone Who Knows You And Cares About You – Someone Committed To Your Sobriety – Someone Available To You 24 Hours A Day• Increase Awareness Of – _____________________ • Thoughts, Emotions, Persons, And Situations That Have Led To Substance Use In The Past – _____________________ • Situations That Increase The _____________________________
  • 18. Relapse Prevention Model• “__________” – Anything You Do That Makes It ___________ That You Will Use A Substance When Confronted With A High Risk Situation• Increase “__________________” – Pleasurable Activities That Are Good For You, i.e. Activities That ______________________
  • 19. Medication Treatment Of Alcohol Abuse• ____________ (Disulfiram) – Administered Daily – About 30 Minutes After Alcohol Consumption, The Patient __________________________Reaction That May Include • ___________ • ___________ • Headache • Chest Pain • Weakness • ___________• What Are Two Weaknesses Of Antabuse?
  • 20. The Neurophysiology Of “Getting High”• Mesolimbic Dopamine System – The Brain’s “_________________” – Upper _____________ (Upper Brainstem) -> Nucleus Accumbens (Limbic System) -> Frontal Cortex – Evolutionary Adaptive • ________________________ – Many Substances Stimulate The Dopaminergic Neurons In The _________________________
  • 21. Stimulants• Cocaine – Almost 1% Of Persons Use Cocaine At Least Once Monthly – Snorted, Smoked, Or Intravenous (IV) – Compared To Amphetamines, The Stimulating Effects Of Cocaine Are _______________________________ – Moderate Doses • _______________________________ – Higher Doses • ____________________________________ – Risk Of Tachycardia And Heart Attack – Withdrawal • ________________________________________________
  • 22. Stimulants• Amphetamine (“_________”) – Oral and Intravenous (IV) Administration – ______________________________________________ – Tolerance Within ___________________ – Psychotic Symptoms May Develop • ________________ • ________________ • Bugs Crawling On Skin – Withdrawal Sxs (“Crashing”) For 2 Weeks • ________________ • ________________ • ________________ • Disturbed Sleep
  • 23. Cannabis• Active Substance In Cannabis – THC (Delta-9-Tetrahydrocannibol)• Forms Of Cannabis – _______________ • From The Dried Leaves Of The Marijuana Plant – _______________ • From The _____________________________________ • Contains Higher Levels ____________• Administration – MJ May Be _________________________• When MJ Is Smoked – Peak Levels ______________________ – Subjective Effects ________________________________ After Smoking – High Lasts For ______________________
  • 24. Cannabis• Metabolites Of THC Remain In The Body For 8 Or More Days• “High” Produced By MJ – ___________________ – Heightened ______________________ – Increased Awareness Of _______________________And Internal Stimuli• Negative Consequences Of MJ – ________________ – Risk Of Cancer (Lung Cancer) – __________________________
  • 25. Hallucinogens• Cause Unusual Perceptual Experiences, _______________,• _________________________________• Sometimes Auditory Hallucinations And Auditory Illusions• Can Produce Negative Psychological Changes – _______________ – _______________ – Ideas Of Reference – _______________ – _______________ – Post-use Psychosis• Hallucinogen Persisting Perception Disorder (DSM-IV) – ________________________________________ – ________________________________________
  • 26. HallucinogensTypes Of Hallucinogens• Lysergic Acid Diethylamide (“LSD”, “Acid”) – ________________________ – Produces Hallucinations And Euphoria – __________________________• Psilocybin (In Hallucinogenic Mushrooms) – _________________________________________• ____________ (Peyote)• STP (Serenity, Tranquillity & Peace)• _____________________________• PCP (“Angel Dust”; Phencyclidine) – ____________________________________ – In Low Doses: ____________________________________ – In High Doses: ______________________________ And The Environment Sometimes Leading To Aggressive And/Or Irrational Behavior – ______________________________________________________________ __________________________________________________
  • 27. Opioids• Types Of Opioids – Naturally Occurring Opioids (Opium And Morphine) Come _____________________________ – Semisynthetic Opioids (Heroin) Are Produced By _______ ___________________________________ – Synthetic Opioids (___________________________) Are Chemically Manufactured To Have __________________• Heroin – _____________________________________________ – _______________________ – Fatal And Near Fatal Overdoses Are Common Due To Variability In The Potency Of The Heroin – Immediate Euphoria Can Be Accompanied By ______________________________________________ ______________________________________________
  • 28. Opioids• Withdrawal From Heroin – Begins ______________________________ – ____________________________________________ __________________________________• Treatment For Heroin Addicts – Methadone and LAAM • Neither _________________________ When Correctly Prescribed • Reduce The Euphoric Rush Caused By ____________ • Duration Of Therapeutic Effect – __________________________________ – __________________________________
  • 29. Sedatives-Hypnotics-Anxiolytics• ______________________________________________ ____________________________________• ____________________• All Have ______________________• Intoxication On Sedatives, Hypnotics, or Anxiololytics – _____________________________________ – ______________________ – ______________________ – Slurred ___________ – Unsteady Gait – Impaired ____________________ – ______________________
  • 30. Sedatives-Hypnotics-Anxiolytics• Withdrawal From Sedatives, Hypnotics, or Anxiolytics Shakiness – ______________ – ______________ – Sweating – Psychomotor Agitation – ______________ – Transient Illusions Or Hallucinations – ___________________• Anxiolytics – _____________________________________ • Produce Relaxation By Increasing ________________ – Withdrawal Symptoms • ____________________ • ____________________ • Irritability • ____________________ • Muscle Tension • ____________________