Substance Use Disorder

Substance Use

taking moderate amounts of a substance that does not interfere with functioning

Substance intoxication

a physical reaction to a substance

Substance dependence

tolerance and withdrawal

Tolerance 

needing more of a substance to get the same effect or a reduced effect from the same amount 

Withdrawal

physical response when substance is discontinued after regular use

Substance Use Disorder

pattern of substance use leading to significant impairment and distress

Impaired control symptoms 

taking more of the substance than intended 

desire to cut down use or unsuccessful effort to quit

excessive time spent, using, acquiring, or recovering from use 

craving for the substance 

Social impairment Symptoms

recurrent use that interferes with fulfillment of obligations

continues use despite interpersonal problems

gives up alternative activities in order to use

Depressants

result in behavioral sedation (alcohol, anxiolytic drugs)

Stimulants 

increase alertness and elevate mood (caffeine, cocaine, nicotine) 

Opiates

reduce pain and produce euphoria (heroin, morphine)

Hallucinogens

alter sensory perception, can produce delusions/paranoia and layered sensory perception (LSD, marijuana)

Other drugs 

inhalants and steroids 

Polysubstance use

use of more than one substance

Disease Model: Neurobiological changes

repeated use alters bra'in’s reward system (cravings, tolerance, withdrawal)

like other chronic diseases that alter the body’s normal functioning (diabetes, hypertension)

Disease Model: Genetic predisposition 

genetic risk factors for all mood-altering substances 

specific genes are still being explored 

Disease Model: Chronic nature

dependency/cravings can persist over time

requires ongoing management to prevent relapse

parallels treatment management of other chronic diseases, like asthma to manage the symptoms and prevent relapse 

Disease Model: Psychological dependency

compulsive drug seeking and drug taking behaviors

use persists despite negative consequences

behaviors are driven by changes in brain’s reward and decision-making circuits

Disease Model: Impact of physical and mental health

serious consequences for physical/mental health

leads to a range of health problems

like other diseases, can have a significant impact on a person’s overall wellbeing

Biopsychosocial Causes of SUD: Biological factors 

genetics influence susceptibility to developing substance use disorder and are implicated in predicting which treatments may effectively help in reducing substance misuse or recovering from a substance use disorder 

Psychoactive substances affect the “____ ____” in the brain through a variety of neurotransmitter systems

pleasure pathway

Biopsychosocial Causes of SUD: Psychological factors (Reinforcement) 

positive and negative 

Positive reinforcement 

pleasure 

Negative reinforcement

coping

Biopsychosocial Causes of SUD: Psychological factors (Expectancies)

“Drinking improves mood and makes activities more pleasurable”

“Drinking makes people more socially effective”

Biopsychosocial Causes of SUD: Social Factors

parental use, parental monitoring, and peer use

cultural norms also help us define what is use versus misuse

Treatment of SUD: How many principles of effective treatment are there? 

13 principles 

Treatment of SUD: No single treatment is ___ for all individuals

appropriate

Treatment of SUD: Treatment needs to be ____ ____

readily available

Treatment of SUD: ____ ____ attends to multiple needs of individuals, not just drug use

Effective treatment

Treatment of SUD: An individual’s treatment and services plan must be assessed ____ and ____ as necessary to ensure that the plan meets the person’s changing needs

continually; modified 

Treatment of SUD: Remaining in treatment for an adequate period of time is ____ for treatment effectiveness

critical

Treatment of SUD: ____ and other behavioral therapies are critical components of effective treatment

counseling

Treatment of SUD: _____ are an important element of treatment for many patients, especially when combined with counseling

Medications

Treatment of SUD: Those with coexisting mental health disorders should have 

both treated concurrently 

Treatment of SUD: ____ _____ is only the first stage of substance use disorder treatment and by itself does like to change long-term substance use

Medical detoxification

Treatment of SUD: Treatment does not need to be ____ to be effective

voluntary

Treatment of SUD: Possible substance use during treatment must be 

monitored continuously 

Treatment of SUD: Treatment programs should provide assessment for infectious diseases and counseling to help patients? 

modify or change behaviors that place themselves or others at risk 

Treatment of SUD: ____ from substance use can be a long-term process and frequently requires multiple episodes of treatment

Recovery

Treatment of SUD: What is the substance treatment goal for nicotine addiction?

reduce withdrawal symptoms and cravings

Treatment of SUD: What is the treatment approach for nicotine addiction? 

nicotine replacement therapy (patch, gum, lozenge) 

Treatment of SUD: What is the substance treatment goal for alcohol/opioids?

reducing reinforcing effects of alcohol and opioids

Treatment of SUD: What is the treatment approach for alcohol/opioids?

Naltrexone

Treatment of SUD: What is the substance treatment goal for opioids? 

maintain abstinence 

Treatment of SUD: What is the treatment approach for opioids?

methadone and buprenorphine

What are some examples of psychological treatments for SUD?

cognitive behavioral therapy, motivational interviewing, contingency management, and relapse prevention

Cognitive Behavioral Therapy 

identify triggers, challenge cognitions, develop coping strategies 

Contingency management

reinforcement-based system using vouchers/rewards for abstinence or treatment attendance

Relapse prevention 

identify high-risk situations, coping planning, and lapse versus relapse distinctions 

Motivational interviewing

collaborative, goal oriented therapeutic approach designed to help clients resolve ambivalence about behavior change 

What are the four parts of motivational interviewing?

Engaging, focusing, evoking, and planning

Motivational Interviewing: Engaging

building rapport and trust (“You’ve had a lot going on lately…I appreciate you being here.”)

Motivational Interviewing: Focusing

agreeing on what to discuss (“what feels most important for us to talk about today?”)

Motivational Interviewing: Evoking

eliciting change talk (“what worries you about how much you’ve been drinking?”)

Motivational Interviewing: Planning

collaboratively developing next steps (“What’s one small thing you might try this week?”)

Treatment of SUD: Social Treatments (Alcoholics Anonymous) 

the goal is abstinence 

led by peer counselors to work through the twelve steps 

spiritual in nature/Research is mixed 

Treatment of SUD: Harm Reduction

emphasizes reducing the quantity and frequency of consumption; can be a bridge to recovery

safe injection strides, fentanyl test strips, opioid overdose prevention

What is the goal of harm reduction?

help people use less, cause less harm to themselves versus abstinence

Treatment of SUD: New Treatments 

vaccines and immunization with antibodies work by binding to the drug in the blood and preventing it from entering the brain