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Unformatted text preview: Substance Abuse Things to know & think about:
Things to know: What are the major psychoactive substances? What is the history of substance abuse and treatment in the U.S., current use rates, and treatment options? What are the theoretical models of substance abuse, and how are they similar & different from each other? Can you delineate / diagnose abuse versus dependence? What are common substance abuse issues in the family & how do we treat different family members? What are the stages of recovery, as well as different treatment options? Things to think about: What are the range of consequences associated with substance use? What types of prevention programs do we implement to address this? Do we implement a responsive range of prevention & intervention programs? What do you think about the way that abuse & dependence are currently diagnosed? Psychoactive Substances Legal substances CNS stimulants CNS depressants Psychedelics Inhalants & steroids Most common: marijuana, psychotherapeutic drugs, cocaine, hallucinogens & inhalants Part of the human condition Ancient times (14,000 BC)! Colonial America – pervasive alcohol use Mid 1800s Prohibition Pure Food & Drug Act of 1906 – FDA Harrison Act, 1914 – medical use 18th amendment (1919 1933) AA – Dr. Bob & Bill W., 1935 SAMHSA 1992 Data (SAMHSA, 2004 survey of the US population) 50% use alcohol 22% have engaged in binge drinking 6% meet criteria for abuse of or dependence on alcohol 8% use illegal drugs 3% meet criteria for abuse of or dependence on illegal drugs Modern Addiction Tx Continuum of care: Medical model Prevention use abuse detoxification Private health insurance Alcohol & substance abuse tx combined Consequences of substance use? Theoretical models Medical model Behavioral/Environmenta l – – – – – – Abstinence Experimentation Social / recreational use Habituation Abuse Addiction Academic model – Psychological dependence – Tolerance – Withdrawal – Tissue dependence Addiction and the Family System Adolescents – Prevention, identification & intervention – Brief Strategic Family Therapy (BSFT) Family systems approach ID patterns of interaction Interventions target patterns Adults Other Family – Clinical intervention – Motivational interview – Wet vs. dry – Enabling & codependence vs. “Detachment with love” – Acceptance of problem – Hitting bottom Stages of recovery
Goal: Abstinence plus a return to full physical, psychological, social, and spiritual health (Gorkski, 1989). Harm Reduction Abstinence Relapse Prevention Substance Abuse Treatment
Shortterm Inpatient – Detoxification – Treatment Residential Treatment – Intermediate – Longterm residential – Social recovery model Outpatient Services – Outpatient group – Intensive outpatient group – Day treatment – Self help programs Narcotic Services – Methadone Maintenance – Methadone Detoxification Substance abuse disorders
The American Psychiatric Association has developed strict criteria for the clinical diagnosis of substance abuse and dependence. The Diagnostic and Statistical Manual IV (DSMIV) Substance Abuse
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following Recurrent substance use causing:
1. Failure to fulfill major role obligations at work, school, home 1. Physically hazardous situations 1. Substancerelated legal problems 1. Persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance 1. Symptoms have never met the criteria for Substance Dependence for this class of substances A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12month period: 1. 2. 3. 4. 5. 6. 7. Substance Dependence tolerance withdrawal taken in larger amounts or over a longer period than was intended persistent desire or unsuccessful efforts to cut down or control substance use a great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects important social, occupational, or recreational activities are given up or reduced because of substance use continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance ...
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- Spring '09