675 Substance Abuse Midterm

Created by PadillaJ 

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ABSTINENCE

No alcohol/drug use ever or for past year

EXPERIMENTATION

1. —Use: anything that alters mood, cognition, and/or behavior, whether obtained by legal or illegal means.
2. —Curiosity, no pattern of use develops

social/recreational use

1. One who uses alcohol /drugs simply to enhance the pleasure of normally pleasurable situations. They seek out a known drug and want to experience a known effect, but there is NO established pattern.
2. —Use is: —Irregular, —not too frequent, —has a relatively small impact on the person's life
3. They experience:
+ —No surprises or unpredictability;
+ —No loss of control;
+ —No complaints;
+ —No thoughts of or need for limit setting;
+ —No negative consequences.

ABUSE (Tolerance builds)

1. When drugs/alcohol are used to excess it becomes a drug of ABUSE.
2. The use is now interfering significantly in the person's life.
3. This stage also shows a person building tolerance to the chemical, thus needing more of it to achieve the desired results.
4. They experience
1. —Occasional negative consequences that are not repeated
2. —Limit setting that is adhered to
3. —Promises that are made and kept
4. —Complaints are heard and dealt with

Dependence/Addiction

1. One who uses to celebrate, compensate, or for any other reason, legitimate or not.
2. They Experience
+ —Continued use despite negative consequences;
+ —Loss of control, as in more use than planned (broken limits);
+ —Unpredictability, as in use despite plan not to use (broken promises);
+ —Compulsivity/preoccupation in thinking;
+ —Denial; Use of defenses to maintain denial;
+ —Build up of (or "break" in) tolerance;
+ —Remorse & guilt about use or behavior when using;
+ —Memory loss, mental confusion, irrational thinking;
+ —Family history of addictive behavior;
+ —Withdrawal discomfort (physical, mental, emotional, and/or psychological).

STAGES OF USE

1. Abstinence
2. Experimentation
3. Social/Recreational Use
4. Abuse (tolerance builds)
5. Dependence/Addiction

LEVELS OF TREATMENT

1. Residential/Detox
2. Outpatient
3. Limited Intervention
4. No Treatment Recommended

RESIDENTIAL/DETOX

What level of treatment is recommended for :
-dependency
-use is regular and recent
-long use history
-limited intervention or clean time
-method of use
-withdrawal symptoms

OUTPATIENT

What level of treatment is recommended for :
-dependency
-long history of use
-use is regular/irregular
-period(s) of sobriety, but limited treatment
-IOP-Limited clean time: Intensive outpatient program
-GOP-Longer clean time/binge users: General Outpatient Program

LIMITED INTERVENTION

What level of treatment is recommended for :
-misuse/abuse diagnosis
-irregular use patterns
-long period of sobriety
-use of illicit drugs

NO TREATMENT RECOMMENDED

What level of treatment is recommended for :
-Experimentation or Recreational Use
-Long period of sobriety
-High Functioning in Life

CLASSES OF DRUGS

1. Uppers
2. Downers
3. All Arounders

UPPERS

Are Stimulants:
-meth, amphetamines
-cocaine
-nicotine
-caffeine

CAFFEINE

These are the effects of ...
1. increases alertness
2. dissipate drowsiness or fatigue
3. reduces tension headaches
4. Can trigger nervousness
5. Can make it hard to lose weight
6. Tolerance/withdrawal does occur
7. Most popular stimulant in the world

NICOTINE

These are the effects of ...
1. Suppresses appetite
2. first dose can raise heart rate an average of 10-20 bpm and blood pressure by 5-10 points
3. tolerance develops faster than any other stimulant
4. use is 2-4x times higher with those who have mental health issues (can you guess what form?)
WITHDRAWALS INCLUDE:
1. irritability
2. craving
3. depression
4. anxiety
5. cognitive and attention deficits
6. sleep disturbances
7. increased appetite

AMPHETAMINES

These are the effects of ...
1. mood-elevating euphoria
2. prolonged use induces:
--paranoia,
--twitches,
--increased body temperature
--dehydration,
--malnutrition,
--and heart/blood vessel problems

Problem with youth especially ("pharm parties"), Similar to Cocaine but effects last longer (Amphetamines : Ephedrine, Ritalin, Concerta, Adderall, Dexedrine).

METHAMPHETAMINE (METH)

Effects:
--Stimulate heart,
--Raise blood pressure,
--Energizes muscles,
--Decreases appetite,
--Limited, early use-it can enhance performance,

It is a "WONDER DRUG"

Dangers:
--Once up, will always want to be up , Eventually body cannot replenish own adrenaline and it starts to shut down, Eventually the person will "crash",
--Can cause aggression, paranoia, psychosis

Signs of use in uppers/ stimulants:
--Jerky movements ("tweak"),
--Jaw movements,
--Not sleeping,
--Not eating (rapid weight loss),
--Very talkative,
--Dilated pupils,
--Picking at skin, sores, scabs,
--Mood swings,
--Confused,
--Irritability,
--Paranoia,
--Aggression,
--Heightened sexuality

Withdrawal:
--THE CRASH,
--Marked Depression,
--Apathy,
--Aches/Pains,
--Exhaustion

Treatment Considerations:
--Expect fluctuating motivation,
--Expect lethargy and depression,
--Expect initial inability to process all information,

Explore ways to reduce access to drug, Educate them on cravings and urges, Be redundant.

COCAINE

o Signs of use: Hyperactivity, Restlessness, Twitching, Paranoia ,Red nose, sniffing, Track marks

o Effects: Euphoric (very short lived), Feel really happy, Energetic, Mentally alert, Sensitive to senses, Decrease need for sleep/food, Perform physical and intellectual activities more quickly, Increased libido Addiction, Restlessness, Irritability, anxiety, Paranoia ("coke paranoia"), Rage, Cardiac arrhythmias, Seizures , Bizarre, erratic, violent behavior, Withdrawals can be like a "den of darkness", Overdose/Death

o Withdrawal: Will slide into a depression within minutes of last use (can reach suicidal proportions) Fatigue, Anhedonia, Vivid, intense dreams, Sleep disorders, Anorexia, Intense cravings

o Treatment Considerations: Similar treatment as with other stimulants discussed earlier, Quitting is very difficult, very rewarding drug.

DOWNERS

These drugs are classified as ...

1. Alcohol
2. Opiates
■ heroin
■ oxycotin
■ vicodin
■ demerol
■ methadone
■ morphine
■ coedeine
■ fentenol
■ suboxone
■ percocet

3. Sedative/Hypnotics
(Benzodiazepines (there are a million, there is a list on the ppt for chapter 3 but i doubt we will need to know all the names), Barbiturates, GBH, Quaalude, Rohyponl, )

ALCOHOL

o Effects: CNS depressants, Depress the overall function of the CNS to induce Sedation, muscle relaxation, drowsiness, coma

o Signs of Use: Smell on breath/clothing, Poor coordination, Slurred speech, Hangover effects, Red eyes/nose/cheeks.

o Effects: Euphoria, Removal of inhibitions, Produces relaxation, Sedation, Alcohol poisoning, Damage to every organ, Muscular in-coordination, Lengthened reaction time, Exaggerated emotions, Blood pressure lowered, Sexual performance is diminished, Body heat is lost

o Withdrawal: Symptoms peak within 6-24 hours-can last 7-34 days, Blood pressure and pulse spike during withdrawals, Hangover, Anxiety/depression, Insomnia, Shaky, Irritable, Vomiting/Diarrhea Delirium Tremors (1%) Hallucinations, Seizures

o Treatment Considerations: Seek medical treatment for those that are a heavy, chronic drinker. Risk of death is high. Most difficult addiction to treat ,Treat underlying mental illness', Consider drinking in context of social functioning, Encourage participation in A.A., Teach basic coping skills, Relapse prevention plans are essential, Gateway to other drug use/relapse, Teach them about nutrition and sugar (Higher relapse rates with increase in sugar intake)

SEDATIVES/HYPNOTICS

Effects: Similar effects to alcohol, Very sedating drugs, Impairs memory, Cause of the most overdose and deaths in the ER (accidental and/or intentional)
Benzodiazepine Signs of Use: Euphoria, Slurred speech, Shallow breathing, Fatigue, Disorientation, Poor coordination
• Effects: feel relaxed, really relaxed, feel drowsy, sleepy or tired, feel really good, Calm/Less anxious, Better sleep, Sedation, Muscular relaxation, become confused or dizzy, have mood swings, have little energy, slur your words or stutter, can't judge distances or movement properly have blurred or double vision, can't remember things from just a short time ago. Impaired ability to learn new information, If you take a very high dose of benzodiazepines with other drugs you can go into a coma and/or die.
• Withdrawal: convulsions, disturbed sleep feeling nervous or tense, being confused or depressed, feeling afraid or thinking other people want to hurt you, panicking and feeling anxious, feeling distant or not connected with other people or things, sharpened or changed senses (e.g. noises seem louder than usual), shaking, pain, stiffness or muscle aches or spasms, flu-like symptoms, heavier menstrual bleeding and breast pain in women.
• Treatment Considerations: Seek medical treatment for those who have long use history. Ask them to taper off the medication. Very difficult addiction to treat, Use Cognitive-Behavioral Therapy (CBT), Teach anxiety coping skills, Teach sleep hygiene, Consider more appropriate anti-anxiety, sleep disorder medications (i.e., Lexapro, Paxil, , Trazadone)

OPIATES

(PAIN KILLERS: Heroin,Oxycontin, Vicodin, Demerol, Methadone, Morphine, Codeine, Fentenol, Suboxone, Percocet)

OPIATES (Rx PAINKILLERS)

Signs of use: Preoccupation with meds, Interested only in pain relief not in other rehabilitation activities, Not interested in non-opioid modalities, Will end up 'needing' to see other docs, Failure to comply with non-drug Rx's, Unscheduled earlier requests for medications, "Urgent" office visits, Emergency room visits for Rx, Prescriptions stolen/lost/the dog ate It, S.O. reports overuse/abuse & intoxication, Drugs used to relieve emotional symptoms, Aggressive complaining about the need for higher Doses, Drug hoarding during periods of reduced symptoms, Requesting specific drugs, Prescriptions from other physicians, Unsanctioned dose escalation, Reporting mood altering effect (not intended by the physician)
• MORE signs: Dry mouth, Droopy appearance, as if extremities are "heavy" Alternately wakeful and drowsy, Disorientation, poor mental functioning, Signs of injection; infections, Shallow breathing, Euphoria, Drowsiness, Constricted pupils, Nausea, Unkempt appearance/hygiene issues, Missing cash/valuables, stealing/borrowing money, Change in performance, academic or otherwise, Drug paraphernalia, Apathy and/or lethargy, Possession of unexplained valuables Runny nose, Lying/deception, Change in friends, Little or no motivation, Ignores consequences of chosen behaviors, Withdrawal from usual friends, activities, or interests, Eyes appear "lost" or have faraway look, Slurred speech, Loss of interest in usual, healthy activities, No interest in future plans, Broken commitments, Hostility towards others, Unexplained absences at work, school or family events, Poor self-image, Running away, Difficulty in maintaining employment
• Treatment Considerations: Difficult addiction to treat (i.e, its legal, prescribed, "I have real pain.") Help them find Acceptance (Surrender the quest for a cure and accept that to be completely pain-free is unlikely.) Pain is major trigger, Teach how to manage pain, Teach ESPECIALLY how to manage EMOTIONAL PAIN, Use Behavioral Therapy: Patient identifies activities they fear will worsen their pain or injury, Therapist exposes patient to these activities then compares pain expectation to actual pain experience during tasks. Exercise Stretching-Yoga -Chi, Physical Conditioning- Strength Training- Cor, Physical Therapy, Chiropractic Treatments, Muscle Relaxation, Acupuncture, Needles and blocks, spinal stimulator, Surgery

HEROIN

• Effects: Surge of pleasure, Warm flushing, Followed by drowsiness, Suppression of pain, Addiction, Chronic relapse potential, Painful withdrawals, Sensitive to all pain, Diseases, Abscesses, Collapsed veins, Arthritis/rheumatologic problems.
• Withdrawal: Occurs within few hours (peaks 24-48 hours) Never fatal, Severe cravings, Restlessness, Muscle and bone pain, Increased sensitivity to pain, Insomnia, Diarrhea, Vomiting, Cold flashes, Restless legs
• Treatment Considerations: Some 90% return to use within 6 months, Have empathy -the detoxing person will be very sick and in significant pain, Highly sensitive to pain, Insomnia is significant and trigger for relapse, Cravings are very intense in early sobriety, Refer them to get a medical check up, Consider medications, Very easy to overdose and die upon relapse, Have a solid relapse prevention plan

All Arounders

These drugs are ...

○ Psychedelics (LSD, Spice, Peyote, Acid, Ecstasy, PCP, Mushrooms, Ketamine, Nutmeg)
○ Inhalants
■ adhesives: glue, rubber cement, model airplane glue
■ aerosols
■ anesthetics: nitrous oxide, ether, chloroform
■ cleaning: dry cleaning fluid, spot remover, and degreaser
■ food: vegetable cooking spray, "whippets"
■ Gases: nitrous oxide, butane, propane, helium
■ Solvents: nail polish remover, paint thinner, white out, toxic markers, pure toluene, cigar lighter fluid, gasoline.
○ Marijuana

Effects: intensified sensations, mixed up sensations, illusions, delusions, hallucinations, stimulation, impaired judgment and reasoning

MARIJUANA

Signs of Use: Excessive hunger, Blood shot eyes, trouble with thinking, memory, learning, Loss of coordination, Silliness or giddiness, Sleepiness, Anxiety/panic reactions, Talkative, Clothing/ paraphernalia, Splitting of consciousness
• Effects: Can be felt within seconds to 10 minutes, Reach peak intensity within 30 minutes and decline within 1 hour, Experiences euphoria, Heightened creativity, Relaxation, Changes to thoughts-more profound, Increase in appetite, Slight psychedelic effects Throat/lung irritation, Red eyes, Altered sense of time, Mood swings, Reduced sexual desire, Sexual dysfunctions, Lung disease (exposed to 4x as much tar as cigarette smokers), Heart weakened, Damages white blood cells, Short term memory impairment, Impaired reflexes for 24 hours after its use, Anhedonia (it is debated), Hallucinations, Can develop drug induced anxiety or even panic attacks, Psychosis, Acute depression, Hormonal changes in women and men, Cancer
• Withdrawal: Persists in the body for up to 6 months, These residual amounts can disrupt some physiological, mental, and emotional functions, Addiction develops, Anger or irritability,Aches, pains, chills, Depression, Inability to concentrate, Slight tremors, Sleep disturbances, Decreased appetite, Sweating, Craving
• Treatment Considerations: Wont see themselves addicted to it or a problem, Don't get in a debate with them (you'll lose!), Consider social context of use, Rarely seek treatment for themselves without some sort of coercion, Use Motivation Interviewing, strategies, Help them become motivated to change relationship with the drug, Currently no medications for treating marijuana dependence are available, Treat underlying or residual depression/anxiety, Look at triggers for its use (anger, anxiety, etc.)

Hallucinogens

• Signs of use: Mood swings, Distorted senses, High sensitive to sounds, colors, smells, lights, sounds, Dilated pupils, Giddiness, Bizarre or dangerous behaviors
• Effects: blurred vision, increased breathing rate, euphoria, sense of relaxation and feeling of well-being, hallucinations and distorted sensory processing, including visual, auditory, body, time and space perception, disorganized thoughts, confusion and difficulty concentrating, thinking or maintaining attention anxiety, agitation, paranoia and feelings of panic, Dizziness, impaired co-ordination, increased heart rate and blood pressure, nausea and vomiting, increased body temperature and sweating, which may alternate with chills and shivering; and numbness, Flashbacks. Days, weeks or even years later, some people re-experience the effects of the drug. Tracers, May impair aspects of memory and selected cognitive functions. It may also be linked to personality and mood changes.

PCP

Effects: Psychosis, Sensory deprivation, Creates messages, Tracers, Feel very slow, Deadens pain

MDMA (Ecstasy)

o Signs of use: Nausea, Anxiety, Blurred vision, Insomnia, Paranoia, Convulsions, Enhanced intimacy
o Effects: Mental stimulation, Emotional warmth, Happiness, Clarity, peace, Empathy toward others, Sense of well being, Decreased anxiety, Long endurance/energy, Sensory enhancement, Anxiety, Agitation, Recklessness, Nausea, Chills, Sweating, Involuntary teeth clinching, Blurred vision, Panic attacks, Seizures (high dose), Unconsciousness, Heart failure, Kidney failure, Arrhythmia, High blood pressure, Faintness, Panic attacks, Seiures, Hyperthermia, Extensive brain damage
o Withdrawal: Serotonin is depleted and its receptors retreat into its cell membrane to avoid damage leading to mood changes in the person, Can lead some to depression, suicidal ideation, and acute anxiety, Can take up to a week to re-experience similar feelings had prior to use, Flashbacks
o Treatment Considerations: Brain damage is significant, Help person find new ways to express themselves creatively and socially

o Effects: Mental stimulation, Emotional warmth, Happiness, Clarity, peace, Empathy toward others, Sense of well being, Decreased anxiety, Long endurance/energy, Sensory enhancement, Anxiety, Agitation, Recklessness, Nausea, Chills, Sweating, Involuntary teeth clinching, Blurred vision, Panic attacks, Seizures (high dose), Unconsciousness, Heart failure, Kidney failure, Arrhythmia, High blood pressure, Faintness, Panic attacks, Seiures, Hyperthermia, Extensive brain damage
o Withdrawal: Serotonin is depleted and its receptors retreat into its cell membrane to avoid damage leading to mood changes in the person, Can lead some to depression, suicidal ideation, and acute anxiety, Can take up to a week to re-experience similar feelings had prior to use, Flashbacks
o Treatment Considerations: Brain damage is significant, Help person find new ways to express themselves creatively and socially

Inhalants

Effects :Dizziness, lightheadedness, giddiness, impaired coordination, headache, distorts senses , slurred speech, nausea, rapid pulse, disoriented, unpredictable, Hearing loss—spray paints, glues, dewaxers, dry-cleaning chemicals, correction fluids, Peripheral neuropathies or limb spasms—glues, gasoline, whipped cream dispensers, gas cylinders, Central nervous system or brain damage—spray paints, glues, dewaxers, Bone marrow damage—gas
• Signs of Use: Slurred speech, Drowsiness, Unconsciousness, Runny nose/watery eyes, Loss of muscle control, Traces of paint or other substances on face/hands, Chemical odors on breath or clothing, Hidden empty containers and paraphernalia, Loss of appetite, Excitability, Irritability/depression
• Treatment Considerations: Majority of users are youth- involve family/supports in treatment, Educate about risks of death involved in using this drug, Have family/living environment remove or lock up chemicals, Remove and/or hide chemicals in your treatment environment/office

Steroids

• Effects: Rapid weight gain, Muscle gain, Bone weakness, Tendon injury, Cancer, Sexual problems, Feminization in males/ masculinization in women, Aggression/rage, Men: Reduced sperm count, Impotence, Development of breasts, Shrinking of the testicles, Difficulty or pain while urinating, Nipple changes Women: Facial hair growth, Deepened voice, Breast reduction, Menstrual cycle changes Both: Acne, Bloated appearance, Rapid weight gain, Clotting disorders, Liver damage, Premature heart attacks and strokes, Elevated cholesterol levels, Weakened tendons
• Withdrawal: Similar to cocaine withdrawal, Depression, Insomnia, Fatigue, Restlessness, Anorexia, Headaches, Lowered libido
• Treatment Considerations: Hormonal imbalances cause emotional deregulation (medical supervision),Treat depression and assess for suicidal ideation during early recovery, Treat self esteem/self concept issues, Nutritional counseling, Teach how to enhance body strength without using chemicals.

Stages of Change

1. Precontemplation: building readiness
2. Contemplation: increasing commitment
3. Preparation: getting started
4. Action: stabilizing change
5. Maintenance

Precontemplation (building readiness)

1. Normalize ambivalence
2. Weigh pros/cons of drug use and sobriety (decision balance sheet)
3. Explore future with and without drug use.
4. Help client understand how chemical use has affected their life.
5. Explore ambivalence and decrease and break through barriers to sobriety.
6. Explore conflicts between substance abuse and personal values/goals.
7. Give encouragement in the ability to change

Preparation (getting started)

1. Nurture the change process-strengthen commitment.
2. Clarify goals and strategies for accomplishing them
3. Offer available resources/services to help and a plan of how to go about seeking treatment that is best for them.
4. Offer encouragement, support, feedback, gentle confrontation, humor, and validation for their struggles/successes.
5. Help the client enlist social support
6. Lower barriers to change
7. Write down goals, make list of motivating statements

Action (stabilizing change)

1. Optimize opportunities for growth
2. Be alert to signs that the client is unable to handle the perceived level of stress
3. Encourage client to begin process of building a substance free support system
4. Help client handle emotional roller coaster they may experience
5. Help the client to be realistic about his/her progress
6. Relapse prevention work
7. Serve as a mentor, guide, cheerleader
8. Reinforce goals and plans of action

Maintenance

1. Ensure stability for change
2. Work on emotional issues that lead to drug use behaviors and/or could threaten their recovery
3. Continue with relapse prevention work
4. Redefine long term sobriety maintenance plans/goals
5. Increase skills for coping with life sober.
6. Identify issues that may threaten long term sobriety
7. Reinforce importance of not testing willpower

What motivates people to use drugs

-At first it's curiosity or desire to have fun/experiment, feel in control of life, experience positive effects of drug.
-Keep using because - lose control, normal life is less pleasurable than life w/drugs, need to take more and more (b/c tolerance), essentially take drugs to feel normal.

Models to explain drug abuse

1. Moral
2. Bio-psycho-social
3. Spiritual
4. Medical

Moral Model

moral weakness, self-centered, willful misbehavior (user's choice to use), lack values & goals, branded as "losers" and "sinners"

Bio-psycho-social Model

Biological (medical: genetics, addicted brain, medical symptoms, progressive), Psychological (mental: mental health/shame, moods/thinking), Sociological (environments, learned behavior, economics)

Spiritual Model

addict has slipped from intended path in life, AA sees addiction as spiritual illness (false pride), recovery rests on foundation of honesty

Medical Model

use based on biological predispositions, genetic heritage, brain physiology, etc.

What motivates people to stop using

§ They become interested and concerned about the need for change
§ They become convinced the change is in their best interest or will benefit them more than cost them
§ They organize a plan of action that they are committed to implementing
§ They take the actions to make the change and sustain the change

Why people seek treatment

o Severity of substance abuse problem
o Severity of consequences because of their problem
o Length of use
o 5-8 years of dependence
o 10-19 years of heavy abuse
o Substances of greater levels of impairment
o Cocaine, heroin

Denial

mental process of not believing the reality of the situation. Denial's thinking errors include

Minimization

Saying it is not as bad as it seems. Making a mole hill out of a mountain.

Justifying

Making up excuses that make your behaviors seem okay after you do them

Rationalizing

Making up excuses to do things you know you shouldn't

Blaming

You hold other people responsible for your pain and the way you act; or you blame yourself for every problem

Hostility

When others confront you with your problems you blow up at them so that they won't pursue it anymore. This helps you feel like you don't have a problem

Mental Avoidance

Keeping yourself so busy with less-important tasks that you don't have time to focus on fixing your problems

Not learning from past mistakes

Feeling that you can do life in exactly the same way that you have been doing it and get different results this time

Diversion

When confronted by your problems, you begin to change the subject to get the heat off you. In this way you don't have to face your problems.

Withdrawal

Isolating from those who can recognize that you need help and can help you get it is a way of doing denial. If no one is telling you that you have a problem, it is easier to ignore the problem

Projection

You can see the problems that you have in everyone else, buy you can't see them in yourself

Comparing

Comparing yourself to someone who is farther down the road of addiction can you give you the false illusion that you are okay

Filtering

You take the negative details and magnify them while filtering out all the positive aspects of the situation

Polarized Thinking

Things are black and white; good or bad; all or nothing. There is no middle ground.

Overgeneralization

You come to a general conclusion based on a single incident or piece of evidence. If something bad happens once you expect it to happen again and again

Mind reading

Without their saying so, you know what people are feeling and thinking, and why they act the way they do

Catastrophizing

You expect disaster. You notice or hear about a problem and start "what ifs" : (He doesn't call you back after the date, "What if he has another girlfriend?").

Personalizing

Thinking that everything people do or say is some kind of reaction to you

Control Fallacies

If you feel externally controlled, you see yourself as helpless, a victim of fate. The fallacy of internal control has you responsible for the pain and happiness of everyone around you.

Fallacy of Fairness

You feel resentful because you think you know what's fair but other people won't agree with you

Fallacy of change

You expect that other people will change to suit you if you just pressure or cajole them enough. You need to change people because your hopes for happiness seem to depend entirely on them

Shoulds

You have a list of ironclad rules about how you and other people should act. People who break the rules anger you, and you feel guilty if you violate the rules

Emotional Reasoning

You believe that what you feel must be true automatically. If you feel stupid and boring, then you must be stupid and boring

Global Labeling

You generalize one or two qualities into a negative global judgment

Being right

You are continually on trial to prove that your opinions and actions are correct. Being wrong is unthinkable and you will go to any length to demonstrate your rightness

I Can't

You state "I can't" to express a lack of willingness to do something when you actually mean "I won't". This is the way to be free of any responsibility, not because you can't, but because you don't want to

I need

You state "I need" to express things or items you are convincing yourself and/or others of being a NEED, when it is not a need at all. It is something you want.

Victim stance

When you are held accountable for your irresponsible actions, you blame other and make yourself a victim of circumstance

Uniqueness

You work very hard to see the circumstances in your life, and you as a person, as being different from anyone else. 'one of kind'. Advice may relate to others, but not to you. Your situation is/will be different. This entitles you not to listen nor act upon suggested feedback. This also includes the thinking that no one understands me, so no one can help me

Entitlement

You're something special and therefore excluded from a particular responsibility. You also think that you are owed, and expect others to comply

Failure to make an effort to endure adversity

You give only so much effort and time (usually minimal) before abandoning recovery to return to addictive living. You believe you should only try for so long and only if it isn't too hard

Overconfidence/super optimism

Because you are feeling good about recovery, you feel that everything will be alright. You know everything you need to know and do to make it work. You believe no other efforts are needed to be successful

Compartmentalization

You put things into categories and believe they have no relation. For example a meth addict believes he is only addicted to meth and therefore is safe to drink alcohol

Lying

Lying is any attempt to mislead, deceive, or distort the truth. You lie by omission, commission, being false, or telling half truths.

Intellectualizing

Taking an objective viewpoint. You use intellect to reason your way out of responsibility and feeling of emotions

Displacement

Redirecting emotions to a substitute target

Anger

You are angry much of the time. You feel resentful towards the world and feel the world is unjust

Self-pity

You feel sorry for yourself, but do nothing to fix the problems you are facing in life

Loner

You isolate yourself from the people that can help you. You wear other people out to the point that they no longer want to be around you or try to help you. You feel that it is the responsibility of others to reach out to you

Judged by my intentions

A great deal of people think that no matter what they behavior or end result of something is, their intentions are what they should be judged by and held accountable for.

Us vs. Them

Always thinking that counselors, family, the law, and other authority figures are people to defy instead of realizing that they can help you if you let them

Procrastination

You put important things off so you can pursue less important activities. You never get back to completing the important tasks, but if you do, you only do mediocre work on it

Refusal to depend/accept help

You refuse to lean upon others for support or help. You see it as a weakness to be dependent.

Purpose of Assessments

Assessments are to determine if there is evidence of a substance abuse disorder, its severity and the most appropriate form of treatment for that individual

Process of assessment

1. screening test
2. Interview
3. Diagnosis/refferal

Reliability of tests

all testing relies on clients' self report and may factors can affect reporting (setting, reason for referral, lack of understanding of confidentiality, fear, denial, memory, consequences, lack of awareness/education

Assessments

Each of these are ...

CAGE
MAST
POSIT
SASSI
ASI
TWEAK
AUDIT

CAGE

developed by John Ewing and Beatrice Rouse and is the shortest screening device. If they say yes to 1, question further, if they say yes to 2 have dependency
- Have you ever felt you should Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt bad or Guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)?

MAST

(Michigan Alcoholism Screening Test) has good validity and reliability, is made up of 24 items on the test and can be found easily online.

POSIT

(Problem Oriented Screening Instrument for Teenagers) is used with youth

SASSI

(Substance Abuse Screening Inventory)

ASI

(Assessment Severity Index)

TWEAK

(Instrument for assessing women)

AUDIT

(Alcohol Use Disorders identification Test) over 90% effective in detecting women with a drinking problem. But it tends to miss active drinkers over 65 and it is not appropriate for adolescent drinkers.

Interview Skills

● Important to gather data from variety of sources: from client and/or provider, formal agencies, informal persons (family, parents, coworkers, employer), BCI, DOPL, UA test
● Solid Assessment Skills Needed:
- Knowledge of substance use disorders and stages of change
- Ability to establish rapport
- Ability to reduce defensiveness and resistance; start with least threatening questions
- Validating
- Nonjudgmental; give respect; ask if they have questions
- Let it FLOW
- Explanation of assessment process and confidentiality
- Use confidentiality forms to obtain outside info (Collaboration)
- Accept that they will underreport
- Person has right to privacy and what to answer and how
- Use of motivational interviewing skills
● At the end of the ASSESSMENT, should be in the position to answer 4 Questions:
- Does the client seem to have a substance abuse problem
- How severe is the problem
- What is the individual's motivation to change
- What factors seem to contribute to further substance use by the individual
● Asking the Right Questions: ask open-ended questions, assume you don't know the answers, be curious

Assessment Interview Format

Area 1 Circumstances of Referral;
Area 2 Drug and Alcohol use Patterns;
Area 3 Legal History;
Area 4: Education/Vocational History;
Area 5: Developmental/Family History;
Area 6: Psychiatric History;
Area 7: Medical history;
Area 8: Previous Treatment/Counseling history education;
Area 9: Client's strengths

Relapse

a return to the signs and symptoms of a particular disease. A "Return to active abuse of a chemical after period of abstinence; an end product b/c of drug exposure, stress exposure, cue reexposure.

● Relapse is the most predictable treatment outcome—our job is to help them navigate relapses not necessarily get rid of them 100%.
- In 90 days 2/3 relapse; 80% in one year—have to teach this to families b/c they often have black and white thinking about it
- Relapse is a PROCESS (not an event) that begins long BEFORE USE OCCURS—changes seen in thinking attitudes, emotions, behavior
- Overtime, these cognitive and behavioral changes become so natural/rational, a return to chemical use makes sense.
- Relapse is: a choice, predictable, avoidable, educational
● Relapse rates are similar to other chronic illnesses.

Pitfalls of Recovery

Negative emotional states (38%); Peer pressure (18%), Interpersonal conflict (18%); Craving for drugs/alcohol (11%); Testing personal control (9%); negative physical states (3%); Celebration (3%).

Relapse Prevention Plan (RPP)

a self-management program to assist individual in arresting his or her addiction to the best degree possible. The prevention program must be learned through behavioral rehearsal procedures.
● Recovery: a highly individualized process that requires abstinence from all mood altering substances, except those that are appropriately prescribed and taken. Also include the pursuit of spiritual, emotional, mental and physical well-being.

Steps of RPP

1. must address path of relapse, red flags, triggers, high risk situations,
2. learned skills to cope with urges/cravings,
3. develop support system,
4. find healthy activities for sobriety

First step of RPP

identify the warning signs (triggers—anything that makes a person want to use; red flags—any behavior that a person engages in or does not engage in that shows that they are on a path to relapse; high risk situations—75% of all relapses involved the failure to deal successfully with a high-risk situation; described as any person, place, or situation connected with using drugs, being around the drug, or a situation associated with high stress)
- Cope with triggers by identifying them, avoid them, interrupt them, extinguish them, talk about them
- Have them map out their path—should include attitudes, emotions, thoughts, behaviors; starting with sue and work backwards. Then, for each flag have them identify ways to interrupt the path at that stage and return to recovery.

Second step of RPP

deal with urges/cravings (urge—less intensive than a craving and more of a cognitive experience; cravings—intense subjective emotional and physical experience)
- An urge to use is a learned response to the discomfort of withdrawal, to use when unhappy/uncomfortable, desire to enhance positive experiences, external cues occur and the limbic part of the brain remembers.
- Urges lead to cravings that are natural. Learn techniques for reducing a craving—don't dwell on the craving. Do something else, delay fulfilling urge, relax, phone a friend, challenge inner voice, play the tape out, talk to someone responsible, pull out self-soothing KIT.

Third step of RPP

should be there when need it, involve more than one person, should provide emotional, but not financial support and provide accurate feedback about your behavior and your attitude.

Fourth step of RPP

activities previously enjoyed before abandoned for drug; identify new activities, activities can do when feel like using; engage in service activities; engage in activities sober that only previously engaged in altered.

Clinical Interventions

_____________ should facilitate physical, emotional, social, and spiritual well-being.

Physical well-being

This aspect of clinical interventions involves:

HALT (hungry, angry, lonely, tired); reinforce importance of physical health—warn about certain foods and medicines that impact sobriety; need for doctor dental check ups

Emotional well-being

This aspect of clinical interventions involves:

individual/family counseling; identification/coping skills for emotions; 12 step meeting groups and self-help groups; address mental health; participate in aftercare; personal work on issues

Social well-being

housing, healthy hobbies, new friends or old healthy abandoned friendships, employment, schooling.

Spiritual well-being

source of inspiration outside of self, identify values, 12 step work, service, meditation, read spiritual materials, do inspiring and uplifting activities

Use specific assignments

__________________such as:
1. What I will do if I have relapsed,
2. What I want my (family) to do if I relapse and won't ask for help,
2. Create a list of your support team,
3. Create path of relapse with intervention steps,
4. Close back doors,
5. Make immediate and long term goals,
6. Letter written from sober self to you when feel like using/or have relapsed,
7. Create memory of pain reminders,
8. Play the tape assignment,
9. Create schedule week,
10. distractions list,
11. benefits/costs of using,
12. Reasons want to stay sober

Reasons for relapse

● ¨Maladaptive Thoughts (especially denial, including minimization, overconfidence, etc)
● ¨Behavioral Issues
● ¨Social pressure
● ¨Emotional states (especially negative)
● ¨Spiritual Issues
● ¨Psychiatric-Psychological Issues
● ¨Physiological Issues (and negative physical states)
● ¨Substitute Addictions (cross addiction): substituting a new addiction for the old one
● ¨Dual addictions
● interpersonal conflict
● cravings
● testing personal control
● celebration
● unresolved issues
● limited tools
● resentments
● narrow view of recovery
● noncompliance
● treatment drop out

Relapse risks for adolescents

● involvement with peers
● presence of comorbid psychiatric disorders
● denial
● subconsciously arranging one's life to be in proximity to alcohol and to other drugs
● Top adolescent triggers:
○ Being in social places where drugs are available
● ¨Being socially isolated
● ¨Being around drugs or using any mood-altering substances
● ¨Stress
● ¨Overconfidence
● ¨Complacency
● ¨Mental or physical illness/pain
● ¨Reminiscing about drug use, telling "war stories"
● ¨Boredom
● Self-pity

Urge

Less intense than a craving. More a COGNITIVE experience. Thinking about how chocolate sounds really nice...
○ learned response to the discomfort of withdrawal (more thinking about how they want to end the discomfort)
○ use when unhappy or uncomfortable
○ when external cues occur
○ Individual's desire to enhance positive experiences (Doweiko p. 368)
○ Limbic part of the brain "remembers" (Urschel, p. 21)

Craving

an intense subjective emotional and physical experience that varies in intensity from one person to the next
○ LOW LEVEL:
■ vivid dreams
■ intrusive thoughts
■ euphoric recall
○ HIGH LEVEL:
■ selective memory
■ planning how to get/use the drug
■ acute drug hunger

Dealing with urges/cravings

these help with ____________.

○ Do something else (distract)
○ delay fulfilling the urge
○ relax deeply
○ phone a friend
○ challenge your inner voice (and thinking errors)
○ visualize the consequences (play the tape!)
○ talk to someone responsible
○ pull out self soothing kit

PAWS

Post Acute Withdrawal Syndrome

■ symptoms experienced in EARLY recovery that put a person at risk to use.
■ it is caused by 1)damage to brain (CNS) 2) stress of coping without chemicals.

Symptoms of PAWS

■ inability to think clearly
■ memory problems
■ emotional labiality (this is the up and down of emotions that can take place within hours of eachother)
■ sleep problems (hyper or hyposomnia) often it is an inability to sleep so people use a downer so they can sleep.
■ physical coordination problems
■ stress sensitivity.
○ PAWS takes place for about the first 18-24 months of clean time.

Lapse

one time use and then seeking out support/help

Relapse

return to active abuse of a chemical after a period of abstinence

The two brains

■ Limbic: Emotional (Dumb) and memory part of the brain
■ Pre-frontal: Rational brain

Limbic system

(the gas of the car)

■ Basic instincts: It wants water, air, food, sex
■ Three Primal Directives: Survival, Avoid Pain, Seek Pleasure
■ This part has NO guilt and NO shame
■ IT's job is not to be rational but to survive

Parts of the Limbic System

■ Septum: Contains pleasures centers especially sexual
■ Fornix: connects hypothalumus to cerebrum (fornixcation)
■ Amygdala: Fight or Flight
■ Thalamus: Sensory info
■ Hippocampus: memory

Pre-frontal cortex

■ Higher functioning & reasoning
■ Can distinguish morals-right & wrong (So... this doesn't develop before age 25? Sweet!)
■ Guilt/Remorse etc.'
■ Pre-frontal cortex is slower and always playing catch up to the limbic system

Impact of drugs on the Limbic System

DRUGS BECOME A SURVIVAL INSTINCT and trump other survival needs
● Olds did a study where he injected cocaine into mousey brains. The mice got high but moved on with their lives if the drugs went anywhere in the brain UNTIL the drugs got into the limbic system. If the drugs got into the mousey limbic system, Mickey turned into a junky. The mouse was willing to die (give up food, water, sex, safety) to get a hit. :(
● IN other words users' limbic brains replace the drug with other survival instincts and so they will do things that hurt their own survival to get the drug. They need the drug like air/water/food/etc.
● The drugs go in high jack the pre-frontal cortex and light up the midbrain
○ Neocortex: memorize every experience in life
■ Remember reinforcers and where and how you got them (like drugs)
■ Neocortex and limbic system get together to create memory pathways to avoid pain.
■ Limbic must get permission from the neocortex to act (neo can say no)
■ You can manage the limbic if you notice it.
● Since the Limbic is the Emo part of your brain- being Bored, Lonely, Angry, Stressed or Tired (Blast!) has big risks of using

Addiction

is due to physical dependency created by altered neurotransmitter balances, and is driven by millions of new living, functioning active neurological pathways which have been established to sustain the condition in the addicts brain. These new neurological pathways are permanent and will not just disappear with recovery/abstinence. The person has become an addict when brain has literally been changed by this chronic use of the drug (these brain changes get translated into behavior changes)

general impact of drugs on the brain

● Drugs work in the brain by tapping into the brain's communication system and interfering with the way nerve cells normally send, receive and process info.
● They act on nerve cells to release abnormally large amounts of natural neurotransmitters or prevents the normal recycling of these brain chemicals
● All drugs directly or indirectly target the brain's reward system by flooding the circuit with dopamine (up to 2-10x more than natural rewards), thus overstimulating the brain and producing the high.
● If use high does long/frequent enough these drugs CHANGE:
- the way the brain works
- the way nerve cells communicate
- structure of synapses and shapes of brain cells
- permanent physical neurological changes based in the brain and nervous systems

4 C's

cornerstone of addiction

Loss of control
Compulsive drug use
Cravings for drugs
Continued use

Methadone

Synthetic narcotic; an agonist drug
● —Used for opiate detoxification, long term chemical dependency treatment; —intended for those with severe opiate dependence

● Helps in 2 ways:
○ 1)controls withdrawal discomfort
○ 2)blocks the craving for additional narcotics
● —Offers the addict a chance for life stabilization

Methadone Maintenance Treatment (MMT)

substitutes heroin with a medically safe long-acting medication of a known purity, potency, and quantity, taken orally once daily combined with biopsychosocial treatment services.
○ 80% will relapse to heroin within first 12 months if methadone treatment is withdrawn

a HARM reduction treatment
○ —Because incarceration does little to reduce the harms that ever-present drugs cause to our society, a harm reduction approach favors treatment of drug addiction by health care professionals over incarceration in the penal system
○ —A harm reduction approach advocates lessening the harms of drugs through education, prevention, and treatment.
○ —Harm reduction seeks to restore basic human dignity to dealing with the disease of addiction.
● —Extremely cost effective
● —Most effective when it includes individual and group counseling

Pros of MMT

○ —Acts on body for 24-36 hours
○ —Effectively stabilizes patient
○ —Does not produce euphoric effects
○ —Decrease in anti-social behaviors
○ —Decrease in cravings
○ Decrease in disease transmission
○ Retention in addiction treatment programs
○ —Increase in social productivity
○ —Empirical evidence supports its safety and efficacy.

Cons of MMT

○ Abuse/dependence potential
○ —Risk of overdose (can be fatal)
○ —True abstinence and sobriety?
○ —Does not prevent addict from abusing other chemicals (50-90%)
○ —It is transmitted to unborn child and this child will have to detox upon birth
○ —Programs are very lax about enforcing co therapeutic interventions

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