Substance Use Disorder Assessment Notes

These flashcards cover important vocabulary and concepts related to Substance Use Disorder (SUD) assessment, treatment, and management.

Substance Use Disorder (SUD)

A chronic disease that disrupts healthy functioning of the body and increases the risk of developing other health conditions.

Stigmatisation

The negative labeling of individuals with SUD, often leading them to refuse care and leave their disorder untreated.

Primary Care Provider (PCP)

A medical professional who identifies and addresses unhealthy substance abuse/misuse in patients.

Screening tools

Evidence-based instruments used to identify at-risk patients for substance use or misuse.

AUDIT

A screening tool used to assess alcohol use and related problems.

Behavorial Health Specialist

A professional who conducts further assessment and therapy for individuals with substance use issues.

Cognitive Behavioral Therapy (CBT)

A treatment method that helps patients recognize and change maladaptive behaviors related to substance use.

Dialectical Behavioral Therapy (DBT)

A treatment approach focusing on reducing cravings and avoiding situations that trigger substance use.

Biopsychosocial assessment

An integrated approach to assessment that considers biological, psychological, and social factors affecting the patient.

Intensive Outpatient Program (IOP)

A type of treatment that provides structured support without 24-hour supervision.

low risk/abstain

• the patient scores in Zone I on the full screens, which is an AUDIT score between 0 and 6 for women and between 0 and 7 for men between 18 and 65 years old, and/or a DAST score of 0.

• Providing the patient with a positive health message which reinforces low-risk use is in this case usually enough;

risky

• the patient scores in Zone II on the full screens, which is an AUDIT score between 7 and 15 for women and between 8 and 15 for men between 18 and 65 years old, and/or a DAST score between 1 and 2.

• In this case, brief interventions - small conversations with feedback and advice, can be used. It might also be useful to hand the individual off to a BH specialist for further assessment;

harmful or severe

• the patient scores either in Zone III on the full screens, which is an AUDIT score between 16 and 19,

• In this case, the individual should be handed off to a BH specialist for further assessment, and in some cases could be referred to specialized treatment

first level of treatment

• early intervention;

• This level of care also includes primary care support for self-management

• harm reduction attempts to minimise negative consequences of drug use at the level of the patient’s recovery, for example prescribing Naloxone

second level of treatment

• outpatient services, which includes pharmacotherapy, behavioral therapy and peer support groups.

meds for alcohol use

• Acamprosate - to avoid a relapse after detoxification

• Disulfiram - discourages drinking by causing unpleasant effects after consumption; and

• Naltrexone - which locks the euphoric effects

meds for opiod use

• Buprenorphine - partially activates opioid receptors and reduces drug use

• Methadone - fully activating opioid receptors and blocks the effects of heroin

• Naltrexone -no overdose risk

• Naloxone - reverses the effects of opioids during an overdose

cognitive behavioural therapy

• teaches patients to recognize and change maladaptive behaviour

dialectical behavioural therapy

• focuses on reducing cravings

rational emotive behaviour therapy

• helps with understanding one’s own thoughts and how it can lead to more positive and rational coping ways;

the matrix model

• combines reinforcement techniques of promoting self-esteem, dignity and feelings of self-worth.

third level of treatment

• Intensive Outpatient Program (IOP) / Partial Hospitalisation Program (PHP).

• This includes a short-term, intense day or evening

fourth level of treatment

• residential/inpatient services.

• Such services include providing help to those with unique conditions like severe mental disorders or cognitive impairments, homeless people, or ex-convicts.

• They provide 24-hour service with residential settings and trained counselors.

fifth level of treatment

• Medically Managed Intensive Inpatient Services.

• Such services include medical detoxification and stabilisation for those with high-risk withdrawal symptoms, with 24-hour medical care, medications and counseling

dsm-5

• a diagnosis requires endorsing two or more criteria within the past 12 months.

• Severity of SUD is indicated by the number of criteria endorsed, with different levels representing mild (2-3), moderate (4-5), and severe SUD (>6).

  DSM-5 criteria:

  • Using substances in larger amounts or over a longer period than initially was intended;

  • A persistent desire or unsuccessful efforts to quit or lessen use;

  • Spending a large amount of time acquiring, using, or recovering from substance use;

  • Cravings or strong desires to use the preferred substance(s);

  • Ongoing use despite a persistent issue

  • Failure to fulfil obligations

  • Continued use despite persevering social or interpersonal problems;

  • Giving up important activities

  • Repeated use in situations that pose a physical risk;

  • Tolerance:

  • A need for markedly increased amounts

  • A markedly diminished effect

  • The characteristic withdrawal syndrome

  • The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

limitations of dsm-5

a lack of attention to the etiology of the disorder.

prevalence

• Among individuals aged 12 to 17, approximately 1.6% had any DSM-5 SUD in the past year

• among individuals aged 18 or older, approximately 10.1% had any DSM-5 SUD in the past year.

AARDoC Framework

• synthesises research into three higher-order mechanistic domains: reward/incentive salience, negative emotionality, and cognitive control/executive function;

PhAB Initiative

• focuses on neurofunctional domains such as metacognition, interoception, executive function, incentive salience, negative emotionality, and sleep;

ETOH Framework

• aims to provide a comprehensive understanding of the etiology of alcohol use disorder

• Reward domain emphasises mechanisms involved in transforming neutral stimuli into attractive and wanted stimuli.

• Cognitive control domain which includes mechanisms related to executive functioning

• Negative valence/emotionality domain which describes mechanisms related to negative emotionality

• Social and environmental factors are not always included in modern conceptualizations, but social and environmental factors such as racism-related stress and family functioning are also relevant.

course

• increase during adolescence, peak between ages 18 and 22, and begin to decrease in prevalence in young adulthood, continuing to decrease over the adult lifespan.

three primary pathways to sud

• deviance proneness (higher level of impulsivity → more engagement in risky behavior),

• stress/negative affect (early stress/trauma → coping with the use of substances), and

• pharmacological effects (difference in sensitivity to effects of substances → more risk for addiction and continued use).

protective factors

positive parental influence, prosocial adolescent social supports and relationships, and positive bonds to community and school are associated with less substance use and disorder.

pathways to disistance

• What makes an individual successful in recovery

• These include maturing personality and role development,

• as well as natural recovery

comorbidity

• externalising disorders, personality psychopathology, and internalising disorders.

assessment targets in studies

• The choice of participants depends on the following factors:

• the goal of the assessment

• contextual factors such as the setting

• and research that is community-oriented.

screening tools

• self-report measures and brief clinical interviews.

study results on assessment article

• Suggestions include delaying or breaking up assessments to ensure patients are in a better state to participate and considering peer-support counsellors who can maintain ongoing relationships with patients.