Substance Use Disorder

Substance use disorder

a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress. A person with this disorder will often continue to use the substance despite consequences

substance intoxication

the development of a reversible, substance-specific syndrome as a result of the recent ingestion of a substance; must include maladaptive behavior or psychological changes and specific signs of the substance's effects on the nervous system

substance withdrawal

a substance specific maladaptive behavioral change with physiological and cognitive correlates, due to cessation or reduction of heavy or prologned substance use

alcohol intoxication

inappropriate sexual or aggressive behaviors; impaired judgement; slurred speech; emotional lability; incoordination; unsteady gait; involuntary, rhythmic movement of the eyes; impaired attention or memory; stupor; coma

alcohol withdrawal

sweating; tachycardia; hand tremor; insomnia; nausea or vomiting; transient illusions or hallucinations; anxiety; psychomotor agitation; grand mal seizures; delirium tremens (DT's).

Wernicke-Encephalopathy and Wernicke-Korsakoff syndrome

different conditions that often occur together. Both are due to brain damage caused by a lack of vitamin B1 (thiamine).

Wernicke-Korsakoff syndrome

chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The individual may attempt to compensate for memory loss by fabricating memories. It can cause hallucinations and can also lead to personality changes. The prognosis for ______ is generally poor.

Wernicke-Encephalopathy

an acute, life threatening (but reversible) condition that requires emergency treatment. It results from severe acute deficiency of thiamin. Individuals may experience confusion, loss of muscle coordination (leg tremors), and vision changes (abnormal eye movements, double vision, eyelid drooping). The prognosis is good if treated accordingly.

amphetamine/cocaine intoxication

Symptoms: euphoria; anxiety; hyperactivity; grandiosity; confusion; anger; paranoia; auditory hallucinations; tachycardia; elevated or lowered blood pressure; dilated pupils; perspiration or chills; nausea or vomiting; weight loss; psychomotor agitation; muscular weakness; confusion; seizures.

amphetamine/cocaine withdrawal

Symptoms: dysphoric mood; fatigue; vivid and unpleasant dreams; insomnia or hypersomnia; increased appetite; psychomotor agitation or retardation.

caffeine intoxication

symptoms: restlessness; nervousness; excitement; insomnia; flushed face; diuresis; gastrointestinal disturbance; muscle twitches; rambling flow of thought and speech; tachycardia or arrhythmia; periods of inexhaustibility; psychomotor agitation.

caffeine withdrawal

headache (most common); changes in mood (such as depression and anxiety); difficulty concentrating; fatigue; increased appetite.

cannabis intoxication

impaired motor coordination; euphoria; anxiety; sensation of slowed time; impaired judgment; social withdrawal; conjunctival injection (redness of the eyes); increased appetite; dry mouth; tachycardia.

cannabis withdrawal

irritability; anger or aggression; nervousness or anxiety; sleep difficulty (insomnia); decreased appetite or weight loss; restlessness; depressed mood; stomach pain; shakiness/tremors; sweating; fever, chills, and/or headache.

hallucinogens intoxication

perceptual changes; anxiety; depression; ideas of reference; paranoid ideation; pupillary dilation; tachycardia; sweating; palpitations; blurred vision; tremors; incoordination.

hallucinogens persisting perception disorder (flashbacks)

Following the cessation of use, the reexperiencing of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen; this reexperiencing causes significant distress or impairment in social, occupation, or other important area of functioning.

opioids intoxication

initial euphoria followed by apathy or dysphoria; pupillary constriction; drowsiness or coma; slurred speech; impairment in attention and memory.

opioids withdrawal

dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea (runny eyes & nose); pupillary dilation; diarrhea; yawning; fever; insomnia.

substance induced disorders

are disorders that are caused by taking (or ceasing taking) drugs or alcohol.

substance use disorder

the primary area of concern is the use of a substance; it isn't causing another disorder to occur.

substance induced mood disorder

could look like depression that starts after a person begins heavy abuse of alcohol on a regular basis. The depression is induced (caused) by the substance use.

12 Step Programs

are almost always part of addiction treatment and are based on a disease model (the idea that alcoholism is a disease that cannot be cured but only controlled).

dependent

the alcoholic family member

enabler

often the spouse; the person who does everything to get the dependent to stop drinking except what might actually work (confrontation or leaving the relationship)

hero

the family member who is aware of what is going on and tries to assume responsibility for the family by being successful (often the oldest child)

scapegoat

the family member who rejects the family system (often the 2nd child)

Lost Child

the member who quietly withdraws from the family system (often the 3rd child)

Mascot

the member who "plays the clown" in order to relieve family tension or their own

pain (often the youngest child)

Remission

The following specifiers are used only after NO criteria for Substance Use Disorder except cravings have been met for at least 3 months. (These specifiers do not apply if the person is on agonist therapy [e.g., methadone] or in a controlled environment, [e.g., locked hospital unit].)

early full remission

None of the criteria for Substance Use Disorder except cravings are met for at least 3 months but less than 12 months.

sustained full remission

None of the criteria for Substance Use Disorder except cravings have been met for at least a 12-month period (or longer).

CAGE questionnaire

quick screening tool used to assess for alcohol problems specifically. This screener helps determine whether a person drinks in excess and may benefit from alcohol treatment.

Naltrexone, Disulfiram (Antabuse), and Acamprosate

Most common drugs for alcohol (medication interventions)

Naltrexone

blocks the euphoric effects and feelings of intoxication. can also be used for opioid use disorder. While it's used in pill form for alcohol, for opioid use disorder it's available as an extended-release injectable. Like its

use with alcohol use disorder, it blocks the euphoric effects and feelings of intoxication.

Disulfiram (Antabuse)

works by creating an unpleasant reaction to alcohol. Use of disulfiram requires medical supervision.

Acamprosate

can reduce the desire to drink alcohol by stabilizing chemical signaling in the brain that could otherwise be disrupted during withdrawal from alcohol.

Methadone, Naltrexone, and Buprenorphine

Most common drugs for opiods (medication interventions)

Methadone

most often used. It works by reducing cravings and withdrawal and blunts

or blocks the effects of opioids.
considered a form of “agonist therapy”

Buprenorphine

suppresses and reduces cravings for opioids.

Motivational Interviewing

is a treatment model that focuses on resolving ambivalence and using the person's own values and concerns to elicit change (rather than imposing or "coercing" a person to change behavior). It helps individuals move from a place of indecision regarding making change to a place of motivation towards making change and meeting their goals. While it can be used for a number of presenting problems, it is a common treatment approach for individuals engaging in substance abuse

pre-contemplation

contemplation

preparation

action

maintenance

stages of change in Motivational Interviewing

pre-contemplation

In this stage, the client is not yet thinking about change.

Contemplation

During this stage, the client is thinking about and talking about change. They are considering whether or not to work towards change.

Preparation

The client is actively planning out steps to take in order to make change happen during this stage.

Action

During this stage, the client is taking positive steps to put the plan from the previous stage into practice.

Maintenance

During this stage, the client is maintaining the change that has been made.

relapse

some models add an additional stage as often occurs and can be viewed as another step in the process as opposed to a failure in the treatment process.

harm reduction

is an intervention that aims to reduce the negative effects of alcohol and drug use. It acknowledges that despite prevention and abstinence efforts, some clients will continue to engage in alcohol and drug use.

● limiting the number of days you drink per week

● limiting the number of drinks you consume in one sitting

● having a designated driver

● utilizing needle exchange sites

● utilizing injection sites

harm reduction includes things like

Contingency management

is a type of behavioral therapy that uses incentives to help clients abstain from drugs and alcohol. Clients are encouraged to engage in sobriety and engage in behaviors supporting sobriety. As goals are achieved and behaviors are modified (for example, a clean drug test, participation in groups, good attendance to treatment, etc.), clients receive rewards.