13 (p1). substance-use disorders

substance-use disorders (SUDs)

involve self-administration of any of the 10 substances that alters mood, perception, or brain functioning, resulting in substance abuse or substance dependence

psychological dependence

the subjective feeling of needing the substance to adequately function

physical dependence

when the body adapts to the substance’s constant presence

tolerance

requiring more of the substance to experience an effect once obtained at a lower dose

withdrawal

an adverse physiological symptom that occurs when consumption of a used substance is ended abruptly and is thus removed from the body

criteria for all SUDs + the 4 groupings of the 11 symptoms

an adolescent must show 2 or more significant clinical signs of distress for at least 12 months

• impaired control (1-4)

• social impairment (5-7)

• risky use (8-9)

• pharmacological criteria (10-11)

what is the most prevalent substance used/abused by adolescents?

alcohol

how does age at onset influence SUD development?

we have an adolescent sensitive period that encourages the dev of risk-taking traits, but they can lead to vulnerability to drug use, which can cause neurobiological changes that further increase risk of SUDs

what is a strong predictor of subsequent alcohol abuse/dependence

alcohol use before age 14

4 categories of causes for SUDs

• personality and developmental factors

• family history

• family functioning

• peer involvement

examples of personality and developmental factors

• significant adjustments in sleep-wake cycle during adolescence alters reward-related brain functions

• critical neurocognitive abilities, like executive functioning and inhibitory control, are impaired by sleep difficulties → increased risk-taking and sensation-seeking

• perceiving oneself to be physically older than same-age peers

• striving for adult social roles

• how connected they feel to their school community

family-based approach to treatment

seek to modify negative interactions btwn family members, improve communication btwn members, and develop effective problem-solving skills to address areas of conflict

multisystemic therapy (MST)

involves intensive intervention that targets family, peer, school, and community systems - ESPECIALLY effective in the treatment of SUDs among delinquent adolescents

• parents have step-by-step guidelines for implementing contingency management to control adolescent substance use: familiar cognitive-behavioral interventions like behavioral contacts and contingencies to reinforce abstinence, as well as ways to overcome common roadblocks to treatment

motivational interviewing (MI)

a patient-centered and directive approach that addresses the ambivalence and discrepancies btwn a person’s current values and behaviors and their future goals

Life Skills training

emphasizes building drug-resistance skills, personal and social competence, and altering cognitive expectancies around substance use

SUD in early remission

none of the criteria have been met for at least 3 months but for less than 12 months (w the exception of "craving”)

SUD in sustained remission

none of the criteria have been met at any time during a period of 12 months or longer (w the exception of “craving”)

mild, moderate, and severe criteria

mild - presence of 2-3 symptoms

moderate - 4-5

severe - 6+

CAGE questionnaire + score

C - have you felt you should cut down on your drinking?

A - have people annoyed you by criticizing your drinking?

G - have you ever felt bad or guilty abt your drinking?

E - have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

“yes” = 1 point

• 0 pts - low risk

• 1 pt - possible concern, warrants further discussion

• 2+ pts - indicates a likely alcohol problem; further assessment recommended

• 3-4 pts - high likelihood of alcohol dependence

CRAFFT questionnaire + when it’s used + scores

used if there’s a problematic pattern of use in 12 months

C - have you ever ridden in a car driven by someone (including yourself) who was high or had been using alcohol or drugs?

R - do you ever use alcohol or drugs to relax, feel better abt yourself, or fit in?

A - do you ever use alcohol or drugs while you’re alone?

F - do you ever forget things you did while using alcohol or drugs?

F - do your family or friends ever tell you that you should cut down on your drinking or drug use?

T - have you ever gotten into trouble while you were using alcohol or drugs?

“yes” = 1 pt

• 0 - low risk

• 1 - medium risk; brief intervention and continued monitoring recommended

• 2+ - high risk; further assessment and possible referral to treatment needed

3 developmental pathways that predict SUDs according to the biopsychosocial model

1. the enhanced reinforcement pathway

2. the negative affect pathway

3. the deviance-prone pathway

describe the deviance-prone pathway

describe the negative affect model

describe the enhanced reinforcement pathway

DARE

school-based program that increases children’s knowledge of substance use problems

primary prevention programs

attempt to stop the problem before it starts via education

secondary prevention programs

attempts to treat the disorder/risk factors that are already there