Substance Use Part 2 Flashcards by Julie T

– At least 1 drink in the past year

– At least 12 drinks during lifetime

current drinker

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– ≥5 drinks on the same occasion at least once per month

binge drinker (10%)

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– Men: >14 drinks per week

– Women: >7 drinks per week

heavy drinker

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– Men: ≤ 2 drinks per day
– Women: ≤ 1 drink per day
– Both genders: ≤ 5 days per week

reccomendations for low risk drinking

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standard drink is 10 grams of alcohol

for each mL of ethanol, there are .79 grammes of pure thanol

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rates of alcohol use vary based on

– Ethnicity
• Any drinking: European Americans highest and Asian Americans lowest
• Binge drinking: Native Americans highest
– Age:
• Current: Adults 25-44 years highest; olderadults lowest
• Binge & heavy: 18-24 years
– Gender
• Men > women
– Education
• Current: Increases with education
• Binge & heavy: decreases with education

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– Physical addiction to alcohol
– Withdrawal symptoms when abstaining from alcohol
– High tolerance for alcohol
– Little ability to control drinking
• Problem drinkers: may not have symptoms listed above, but do have substantial social, medical or psychological problems resulting from alcohol

alcoholic

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CAGE (in the last 12 months)
– felt you should Cut down on your drinking?
– Have people Annoyed you by criticizing your drinking?
– ever felt bad or Guilty about your drinking?
– ever had a drink first thing in the morning to “steady your nerves” or get ride of a hangover “Eye Opener”?
• CONSUMPTION
– On avg, days per week do you drink alcohol?
– On a typical day how many drinks do you have?
– maximum number of drinks on any occasion during the last month?
• SCREEN IS POSITIVE IF:
– A positive response on 1 or more questions from CAGE and/or
Consumption:
• Men > 14 drinks/week or > 4 drinks/occasion
• Women and both sexes > 7 drinks/week
• over 65 years of age > 3 drinks/occasion

CAGE Screening Tool

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THEN ASSESS FOR:
Medical problems: Black outs, depression,
hypertension, injury, abdominal pain, liver dysfunction, sleep disorders
-Laboratory
-Behavioral problems
-Alcohol Dependence
If at-risk drinker:
-Advise patient of risk.
-Set drinking goals.
-Provide referral to primary care.
If alcohol dependent drinker:
-Assess acute risk of intoxication/withdrawal.
-Negotiate referral i.e. detoxification, AA and primary care.
-Continue exploring Pros & Cons and Assessing
Readiness to Change if appropriate.
Reference: The Physician’s Guide to Helping Patients with Alcohol Problems. National Ins

cage screening tool

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• In your body 2 enzymes turn alcohol into vinegar
(acetic acid)
– Alcohol dehydrogenase
• Enzyme in liver that converts alcohol to aldehyde (very toxic)
– Aldehyde dehydrogenase
• Enzyme that converts it to acetic acid

• 3 health-related outcomes
– Increase in lactic acid → anxiety
– Increase in uric acid → gout
– Increase of fat in liver and blood

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– In part body weight
– Men’s brains are more strongly affected than
women’s
– Women’s stomach’s absorb more efficiently
• Tolerance, dependence, addiction, abuse

effects of alcohol in gender

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Alcohol-related unintentional injuries:

– 40% of traffic-related deaths related to alcohol
• Increases other risky behaviors & intentional
injuries
– Aggression, crime, sex, assault, homicide, suicide
– Make more risky decisions

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• There is a U- or J- shaped relationship between
alcohol use and mortality
– Light to moderate drinkers (1-5 drinks/day)have the best
heath
• Reduced cardiovascular mortality
– (increases HDL and decreases clotting)
• Reduced risk for ischemic strokes but increased risk for hemorrhagic strokes
• Also lowers risk for
– Diabetes, gallstones, H. pylori infection, Alzheimer’s disease

health benefits of NONalcohol usage

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why do ppl drink?

• Genetic factors appear to be involved (20-30%)
– Twins studies
– Frequency of alcoholism in sons of alcoholics
– Gene variant can’t break down alcohol, produces unpleasant
flushing, & decreases risk of abuse
• Men traditionally were at greater risk
– With changing norms, women are “catching up”
• Physiological, behavioral, and sociocultural factors are involved
• Alcoholism is tied to the drinker’s social and cultural environment.
– Window of vulnerability: Ages 12 to 21
– Window of vulnerability: Late middle age

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– People have free will and choose to drink

Moral Model

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Alcoholism has a genetic component

Medical Model

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– People drink excessively because they have the
disease of alcoholism
– Dominant view in medically oriented treatment
programs but not in psychologically oriented programs
– Jellinek identified two types:
• Gamma alcoholism: loss of control once drinking begins
• Delta alcoholism: inability to abstain
– Variation: Alcohol Dependency Syndrome

Disease Model

– A group of concurrent behaviors that accompany alcohol dependence
– Impaired control versus loss of control
– Used for diagnosis of substance abuse dependency in the DSM
– Seven essential elements:
• Narrowing of drinking repertoire
• Salience of drink-seeking behavior
• Increased tolerance
• Withdrawal symptoms
• Avoid withdrawal symptoms by further drinking
• Subjective awareness of the compulsion to drink
• Reinstatement of dependence after abstinence

Alcohol Dependency Syndrome

– Too simplistic to view alcoholism as an incurable unitary disorder
– Doesn’t answer why people begin or why people drink in moderation
– The key concept of loss or impaired control is not supported in the research
– Many effects of alcohol are due to expectations rather than pharmacological effects

• Evaluation of the Disease Model

• Drink to relax
• Not supported by research
• Expectations determine tension reduction associated with
drinking

tension reduction hypothesis(Cognitive-Physiological Theories)

Describes the phenomenon that occurs when people who have been drinking do not respond as strongly to physiological or psychological stressors
Use alcohol to buffer stressful situations
A large SRD effect is associated with higher risk for problem drinking

– Stress response dampening (SRD) [cog physiological theory]

• Alcohol produces a myopia by blocking out insightful cognitive processing and altering thoughts related to the self, stress, and social anxiety
• Drunken excess: behave more excessively
• Self-inflation: inflate self-evaluations
• Drunken relief: worry less & pay less attention to worries
• Research supports this theory that information is processed in a
limited way depending on environmental cues rather than general inhibition
– Focus on arousal – less likely to use condom
– Focus on risks of sex – more likely to use condom

Alcohol Myopia[cog physiologocal theory]

Acquire drinking behavior just like any other behavior through
• positive reinforcement – pleasure of taste, social interaction, mood enhancement
• negative reinforcement – avoid withdrawal
• modeling– observe others
• cognitive mediation – consistent with personal standards
– Offers explanations for all three questions of why people begin or drink in moderation or excess
– Useful for treatment

Social Learning Model

– Spontaneous remission
– 10 to 20% of alcoholics stop drinking on their own
– 32% of alcoholics can stop with minimal help
• Can be treated successfully through cognitivebehavioral modification
But
– High rate of relapse– as high as 60%
– Alcoholic’s environment must be considered
• Without employment or social support, prospects for recovery
are dim

“Maturing Out” of Alcoholism

``` • Hard-Core Alcoholics – Detoxification – Short-term, Inpatient Therapy – Continuing Outpatient Treatment • Self-Help Groups are most commonly sought source of help(AA) ```

``` Treatment Programs (700,000ppl) goal=abstinence ```

• Philosophy – The best person to reach an alcoholic is a recovered alcoholic – Immersion: Attend 90 meetings in 90 days • Recovery depends on staying sober • Members provide social reinforcement for one another's abstinence • Alcoholism – A disease that can be managed, never cured – Alcohol plays no part in the person’s future

Profile of Alcoholics Anonymous

• Often combined with detoxification • Many techniques can be used and are effective • Self-Monitoring – Person begins to understand situations that give rise to drinking • Contingency contracting – Person agrees to a costly outcome (financial or psychological) in the event of failure • Medications that block alcohol-brain interactions • Stress management techniques • Motivational interviewing – Keeping the client motivated with individualized feedback about his/her efforts

Psychotherapy

``` Administer drugs that interact with alcohol to produce unpleasant effects or decrease reward • Disulfram (Antabuse) – Aversion therapy • Naltrexone – Blocks opiates in brain • Acamprosate – Affects GAMA neurotransmitter in brain – Reduces craving and relapse ```

Chemical Treatments

• Social engineering may represent the best approach – Banning alcohol advertising – Raising the legal drinking age – Strictly enforcing the penalties for drunk driving • These approaches reach the untreated majority

Social Engineering

Can Recovered Alcoholics Drink again?

``` • Alcoholics Anonymous Philosophy An alcoholic is an alcoholic for life • Drinking in moderation seems possible – For young, employed problem drinkers – Who have not been drinking for long – Who live in supportive environments • Drinking in moderation – May be a more realistic goal for college students – May prevent high dropout rates in more traditional programs • Not for everyone ```

• Most U.S. college students drink alcohol – 15%-25% are heavy drinkers – 45% engage in occasional binge drinking • Successful interventions: – Encourage students to gain self-control over drinking rather than eliminating alcohol – Self-monitoring often reduces drinking

drinking college student

– Identify circumstances when drinking to excess occurs – Placebo drinking • Consuming nonalcoholic beverages while others are drinking • Alternating alcoholic and nonalcoholic drinks

skills training for college student

• Relapse rates – 65-75% relapse within 1 year after treatment – 50% or more relapse within first 3 months • Helpful for problem drinkers to know – An occasional relapse is normal – Relapse doesn’t signify failure • Important relapse prevention skills – Learning “drink-refusal skills” – Learning nonalcoholic beverage substitutions

Treatment Programs: Relapse | Prevention

FDA classifies drugs into 5 schedules based on their | potential for abuse and medical benefits

– Schedule I: High abuse potential, no medical use, illegal • Examples: Heroin, LSD, marijuana – Schedule II: High abuse potential, can cause physiological or psychological dependence, but have some medical use • Examples: Opiates, some barbiturates, amphetamines, cocaine – Schedule III: moderate or low physical dependence or high psychological dependence but have accepted medical uses • Examples: Some opiates, some tranquilizers – Schedule IV: Low abuse potential, limited dependence, accepted medical uses • Examples: Phenobarbital, most tranquilizers – Schedule V: Lowest abuse potential • Examples: Over-the-counter medications

– Induce relaxation and sometimes intoxication by lowering the activity of the brain, the neurons, the muscles, and the heart, and decreasing metabolic rate • Low doses: relaxation and euphoria • High doses: Coma and death • Alcohol, barbiturates, tranquilizers (benzodiazepines), opiates (morphine, heroin, cheese, methadone, oxycodone, hydrocodone)

Sedatives

– For some, more alert, energetic, able to concentrate, and able to work long hours – For other, feel jittery, anxious, and unable to sit still – Similar to norepinephrine • Amphetamines, cocaine, cocaethylene, crack cocaine, Ecstasy (MDMA)

Stimulants

– Most commonly used illegal drug in US – Intoxicating ingredient is delta-9 tetrahydrocannabinol (THC) that comes from the resin of the Cannabis sativaplant – Acts in brain to induce altered thought processes, memory impairment, relaxation, euphoria, increased appetite, coordination impairment, increased heart rate – Direct health risks are fewer than other drugs, but at increased risk for respiratory problems and lung cancer – Increases risk for injury – Beneficial effects of decreasing nausea and vomiting associated with chemotherapy, analgesic properties, decrease in glaucoma

Marijuana

– Endogenous (cortisone, estrogen, testosterone) – Exogenous – Medically used to decrease inflammation – Abused most by athletes and bodybuilders • Increase muscle bulk and decrease body fat – Potentially dangerous • Shut off body’s own steroids, alter immune and reproductive functioning, increase CVD, affect liver, stunt growth, • Behavioral problems such as moods swings, aggression, confusion, distractibility, euphoria

Anabolic Steroids

• Similar to treatment of alcohol abuse, both in the philosophy and administration of treatment • Goal: total abstinence • Self-help groups[ Narcotics Anonymous] • Inpatients treatment programs – Detoxification tailored to type and severity of withdrawal effects • High relapse rate – Aftercare and booster session are important

treatment for drug abuse

– Assume that people will use but act to reduce harm – Harm reduction strategy • Needle exchange • Designated drivers

Control the harm of drug use

Prevention programs for children and adolescents aimed | at delaying or prohibiting use

– Programs similar to ones for smoking – Life Skills Training program teaches social skills to help resist social pressure and increase personal competence – Ineffective programs are those who rely on scare tactics (DARE), moral training, factual information about risks