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Substance Abuse intervention and treatment, Final 3

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What percentage of homeless people have a substance use disorder?
45-78%
What is the third most common psychiatric problem found in older persons?
AUDs
What trend is expected to happen among AUD/SUD in older age groups?
It is expected to continue to increase
The role of the individual's substance use in the loss of one's home is complex, and there is not always what?
A causal relationship
Elderly make up approximately what percent of the US population?
12%
What ratio of all prescription medications and over the counter medications are used by the elderly?
One third
One half
2-4% of the elderly are thought to have what?
A SUD involving alcohol, drugs, or both
Why are older persons with an AUD overrepresented among those seeking health care?
Alcohol abuse exacerbates or causes many medical disorders for which older persons seek medical treatment
Alcohol use disorders have been identified in what percent of men and what percent of women hospitalized for medical treatment of conditions other than the AUDs
25% to 30%
5% to 12%
Why is it so difficult to detect SUDs in elderly people?
Concurrent medical problems
AUD/SUD often mimics symptoms of other disorders commonly found in the elderly making differential diagnosis difficult
Older drinkers attribute physical complications to the aging process rather than to their alcohol use
Why do older adults tend to experience negative consequences of their chemical abuse at levels that do not raise suspicion in family members or outsiders?
Because older individuals are more vulnerable to the negative effects of alcohol or drugs of abuse
3 beers or mixed drinks consumed by a 60 year old may have the same effect on a drinker as how many consumed by a 21 year old?
12
Consequences of AUD/SUDs in the elderly
Subject to all of the dangers associated with the abuse of alcohol or drugs but compounded by age related bodily changes
Accidental falls, bone fractures, depression, memory problems, liver disease, cardiovascular disorders, sleep problems
Percentage of elderly suicide victims have used alcohol prior to their suicide attempts
25-50%
Easily resulted in misdiagnosis and mistreatment
...
Early onset AUDs are usually from where?
Lower economic levels, have less education, smoke more,socialized with individuals that abused alcohol more often
Late onset AUDs are usually from where?
Higher socioeconomic levels, enjoy higher income levels, and have stronger familial/social support systems on which to call
They also tend to report more negative life events such as retirement, illness or death of a spouse, geographic relocation, loss of lifelong friends, deteriorating health, and depression
10% of elderly misuse prescriptions. What forms does it take?
Intentional overuse
Underuse
Erratic use
Failure of doctor to obtain a complete drug history
Sexual minority groups tend to abuse chemicals more often than who?
General public
What plays a central role in the social lives of LGBT individuals?
Substances
Up to what percent of individuals who are disabled have an alcohol use disorder?
62%
Treatments for this group are limited
Alcohol use is thought to be very widespread, and its death rate is 440% higher than the general public. What minority was just described?
Native Americans
Drinking, especially heavy drinking tend to be a male activity
Hispanics
Women are likely to abstain
Asian Americans
Started heavy drinking later in life than european males
African Americans
In how many states can parents legally give alcohol to children under 21?
31
What percent of HS seniors reported having abused alcohol at least once?
77.4%
Adolescents make up how much of the US alcohol market?
12-20%
How many adolescents consume alcohol each year?
4.3 million
each day?
508000
How many 8th graders have used alcohol at least once? 12 graders?
33%
70%
In 2011 what was the most commonly abused illicit compound?
Marijuana
What percent of HS students report having used a medication prescribed for somebody else?
25%
Adolescents that do this are 50% more likely to develop an AUD later in life
cigarette smokers
Leading cause of mortality and/or having unprotected sex for older adolescents
SUDs
What lags behind the growth in the brain's reward system during adolescence?
Cognitive assessment/control systems of the brain
What is the risk of an adolescent developing an AUD when they drank before the age of 15 compared to 21?
4 to 6x higher
Cigarette smokers in US under 18
3 million
What is the trend for adolescent cigarette smoking in the US during the past decade?
Downward trend
How many children/adolescents smoke their first cigarette each day?
4400
Stages of childhood/adolescents smoking
Preparatory
Initiation
Experimentation
Transition
Children and adolescents abuse of chemicals in these groups are influenced by what?
Genetic heritage
Environmental factors
Life events
5 basic reasons that they use
To feel grown up
To take risks or rebel against authority
To fit into a specific peer group
To relax and feel good
To satisfy curiosity about the drug's effects
Racial/ethnic group membership, as are siblings and vocational/occupational choices
Somehow involved in why children and adolescents abuse chemicals
What gender is more likely to abuse illicit drugs?
Males by a 2 to 1 margin
Relationship between parental substance use during the childhood years and later used of the adolescent
Strong
Reports of high parental monitoring...
lower levels of substance abuse
At what rate do parents underestimate teenaged alcohol consumption?
4 to 1
Adolescents with higher levels of cortisol
more vulnerable to SUDs
Substance use patterns must be viewed within what context?
emotional adjustment in teen years
Known relationship between what disorders and SUDs?
CD and ODD
what percentage of adolescents with diagnosis of CD will develop an SUD at some point?
50-80%
More likely to be a planned behavior than a response to external constraints
Abstinence from alcohol or drugs
Peer groups are always negative
False
Who has a strong influence on fundamental issues in adolescence?
Parents
Peer groups may influence initiation of substance use, but what about continued use?
Not as influential in supporting continued use
Who do adolescents gravitate towards?
Peer groups with similar views towards substance abuse
What are more reasons that adolescents abuse chemicals?
Telecommunications
Religious affiliation
Music selection
Personal values
Rebellion
Insomnia
Abuse history or victimization (abuse in childhood may relate to later SUD development)
Employment
More cost effective than treating after the development
Prevention
Childhood
Early onset alcohol use (before 13) might reflect a genetic predisposition
Only 11% abstain from all chemicals throughout
adolescence
What are the stages of adolescent substance abuse
...
Adolescent addiction to chemicals
...
What problems in diagnosis and treatment of adolescent SUDs?
Diagnostic standards derived from adult SUD
Lack tools needed to separate those adolescents that abuse from those who are addicted
1.1 million adolescents meet criteria for admission to treatment but only 1 in 10 ever admitted
There is a difference between screening and assessment tools
...
Assessment Instruments
CRAFFT
TWEAK
Drug Use Screening Inventory-Revised
The Drug and Alcohol Problem Quick Screen
Problem Oriented Screening Instrument for Teenagers
Substance Abuse Subtle Screening Inventory 3
What are possible indicators that should be looked for?
Having a friend or close sibling who uses alcohol or drugs
Social problems
Poor impulse control
Engaging in risk-taking behaviors
Poor parental supervision and/or inconsistent discipline
Trauma (including parental divorce)
Victimization
Poor academic performance
Parental alcoholism
Those under 21 are thought to consume how much?
17-20% of all alcohol in the US
Also use
Cocaine, Hallucinogens, Inhalants, Marijuana, Meth
Number of teens that used marijuana in 2008
4.5 million
How many that smoke marijuana will become addicted?
33-40%
Tobacco is used by how many middle school students? HS students?
660,000
3 million
Issue of child/adolescent abuse of this is of special concern since the abuse of these compounds is growing in popularity
Opioids
There is a need for what?
adolescent substance abuse rehab programs
Who would make referrals?
Drug courts
Adolescents substance treatment, is it a cause for optimism?
every year the delay of initiation drops risk for developing SUD by 5%
Financial incentive for over-diagnosis?
many treatment facilities are for profit
Danger of under diagnosis?
SUDs play significant role in teen suicide
College provides a transitional environment. To some degree protects from larger society
Provides sense of community
Isolated environment with minimal parent supervision
What are students forced to do?
learn to function independently, develop social networks and deal with feelings of separation from home
relationship with alcohol and illicit drugs also changes
What does college mean for many HS relationships?
Dissolution of them, building of new ones
Those with the strongest motives to attend college are more likely to what?
Reach out to others with similar values and least likely to abuse alcohol or drugs
What about other undergrads?
find heavy alcohol use facilitates the establishment of social relationships with other heavy users
Role in the college environment remains static
False
Students relationship with alcohol also related to
ethnic heritage
familial pressures to perform well in the college environment and advance socially following graduation may
inhibit the use of alcohol
College students were typically less likely to be what in HS than their non college peers?
Binge drinkers, but this pattern reverses itself after they enter college
Which is more likely to drink with goal of intoxication?
College students
Student may find that they focus on what?
Finding a partner
What percentage of college undergrads engage in heavy episodic drinking at least once every two weeks
40%
When of most college students drink?
On weekends and on holidays they are not required to be in school
How many in Frats drink?
86%
How many college students were current alcohol users
61%
How many were binge drinkers
40.5%
Heavy drinkers?
16.3%
certain colleges have the reputation of being what?
party schools, where alcohol use seems to be higher
What percentage of college students abuse illicit drugs (usually marijuana)?
20.2%, a rate similar to that in their non-college bound peers
how many college students are the victim of alcohol related sexual assault or date rape per year?
over 70 thousand
How many suffer accidental injuries each year while intoxicated?
over 599000
How many admit that alcohol use had negatively affected their academic performance?
25%
What is normally seen as a rite of passage?
alcohol use
In a college age population, what is the consequence of an SUD
Brains are still being molded so continued alcohol use can cause impairments
adolescent brain is 4-5x more vulnerable to alcohol-induced brain damage as the adult brain
binge drinking can contribute to neurological dysfunction, may have life long consequences for the abuser
Energy drinks, CNS stimulants, and tobacco
...
30% of college students have used what when compared to 1% of the general population?
CNS stimulants
Use is lower in college students than in the general population
tobacco, 26.6% in college students, general population 34%
Some individuals continue the substance use patterns that they established in their undergrad program while others begin to what?
mature out
how many medial students were excessive drinkers and how many met the criteria for alcohol abuse,
Oddly, these students appeared to perform better than their non drinking peers
11%
18%
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