Week 4c: Assessments

Question 1

Assessment

F MASHUP

Answer 1

Most important = determine family history of drug abuse/addiction

• members may deny extent of family use/history
• education about drug use/abuse may be necessary

Following information needed

• Medical history
• Age of initial drug and alcohol use
• Stage of current use
• History of negative consequences
• Use of medications, coffee, cigarettes
• Patterns of use, binges, periods of nonuse (integrated?)
• Frequency of use, amounts used, set and setting of use

Question 2

11 Questions to help identify adolescent SUD

CCC LMM PPRNS

Answer 2

• —Community: Been in trouble with or caused concern in community?
• —Criminal justice problems: Had legal problems? Drugs & antisocial behaviour highly correlated
• —Changes: Significant changes in choice of friends, grades, dress, general hygiene, and responsibilities?
• —Lying, stealing, and cheating: Things missing? Compulsive lying?
• Mood: Extremely moody/more upset than usual?
• —Motivation: Noticeable decreased motivation, interest, activity? (marijuana use)
• —Parents: Do parents justify child’s behaviour? Believe behaviour!!
• —Physical signs: Physical signs of drug use present?
• —Responsibility: More irresponsible. Commitments/disregarding rules?
• Negative activities: Engaged in activities not healthy/productive? Usually seek out similar friends
• —School: Signs of school problems? Often 1st sign of neg consequences. Related to drugs?

Question 3

10 Questions about Suicide

AA FF HH SPR 1-10

Answer 3

• Anything would prevent suicide?** (essential if suicidal)
• Anything that makes life worth living?
• Family history of drug problems, suicide or depression?
• Feelings: Do you use alcohol/drugs to:
  
  • Overcome bad/shameful feelings?
  • address sleeping problems, depression, stress?
  • Quiet suicidal or self-destructive thoughts?
• How will you do it?
• ​How much do you want to die/live?
• Suicidal thoughts?
• Previous suicidal thoughts or attempted suicide before?
• Role of drugs related to suicide? Make / Less likely commit?
• 1-10, how likely are you to suicide?

Question 4

Jellinek’s Types of Addict

ABDEG

Answer 4

Types of people with substance use disorders suffer through different declining stages of functioning:

• Alpha αtype = psychological dependence: drug increasingly used to address problems
• Beta βtype: physical problems but no physical/psychological dependence
• Gamma γ type – physical addiction (withdrawal), loss of control, severe damage to all life aspects, but periods of abstinence
• Delta Δ type – similar to γ, but abstinence impossible due to severe dependence. Intake controlled.
• Epsilon type = periodic, unpredictable binges

Question 5

Assessment: Individual Vulnerability

Answer 5

• Evidence of individual vulnerability?
  
  • addiction/other disorder in the family
  • psychosis
  • rejection/insensitivity to behaviour norms
• —What is individual’s attitude toward drug use?
  
  • favorable, unfavorable, nonexistent
• —What are environmental factors?
• —Are drugs available?
• —Other significant problems
  
  • behavioural disorders, financial problems, etc.

Question 6

Vulnerability to Relapse

Answer 6

Relapse: return to drug abuse or addiction

• —During recovery, individuals vulnerable to relapse. Vulnerability assessment important.
• —longer, more structured treatment program, better long term outcomes: 6-9 month inpatient most effective, followed by min 1 year outpatient aftercare
• —Education & counseling necessary

Question 7

Consequences of Use

Answer 7

Following areas should be explored:

• —Physical – heart problems, headaches, weight loss
• —Psychological – irritability, depression, suicidal thoughts
• —Sexual – loss of sex drive, high risk behavior
• —Relationship/Social – loss of friends and/or partner
• —Job/Financial – lost job, in debt, less productive
• —Legal – arrested, car accident, theft

_______

• Assessment: very important; questions targeting this aspect of addiction.
• Pointing out severe consequence a tool to break denial

Question 8

Defense Mechanisms

Answer 8

Denial: a major factor—

Rationalization: making something seem consistent with/based on reason

—Minimization: reducing something to least possible amount or degree

Question 9

Adolescent Brain

Answer 9

• brain develops through life. Most during adolescence:
  
  • seeking out new experiences
  • very responsive to rewards
• Prefrontal cortex: Last region to develop (into 20s)
  
  • impulse control, behaviour/emotion regulation
• Striatum: key component of reward system
  
  • involves dopamine (reward chemical)
  • more responsive (activated) to rewards than adults
• Prefrontal cortex & striatum connected
  
  • connections in adolescence between risk-taking & reward strongest

Question 10

Nonuse by Children (Stage)

Children less likely to develop drug addiction later if parents:

(MAPPED)

Answer 10

• Model healthy behavior
• Are sensitive to children’s feelings (about boundaries)
• Promote positive alternative activities to drug use
• Provide structure, discipline, consistency
• Encourage participation in developmental activities
• Develop a climate of discussion

​It’s all about the parents. Kids must learn active coping strategies, not passive

Question 11

Nonuse by Adolescents (Stage)

To help their at-risk adolescents, parents should:

Answer 11

• establish clear, consistent rules
• model nonuse of drugs
• clearly establish the hazards and potential harm
• encourage alternative, active (vs passive) activities
• promote social involvement
• promote trust & healthy boundaries (relationships)

Huge developmental phase: Individuation/identity development must be supported/encouraged!!