MH2-Substance use

What are the four categories of diagnostic criteria for a Substance Use Disorder (SUD) according to the DSM-5?

Impaired control, social impairment, risky use of substance, and physical dependence/pharmacological criteria.

Define 'tolerance' in the context of substance use.

The need for more of a substance to obtain the desired effect, or experiencing less effect with the same amount of the substance.

What is 'withdrawal' in the context of substance use?

A range of physical and emotional symptoms (e.g., anxiety, sweating, nausea) that occur when a substance is no longer taken.

How does addiction affect the brain's reward system?

Many drugs alter the brain's ability to produce dopamine, creating a massive increase in dopamine that results in euphoria.

What is 'brain plasticity'?

The brain's ability to modify itself through experience and learning.

What is a 'concurrent disorder'?

The presence of both a mental health issue and a substance use issue in the same individual.

What are the three primary goals of assessment for substance-related disorders?

To associate problems with substance use, educate about substance use, and provide clear information about addiction and treatment.

What does the CAGE screening tool stand for?

Cut down, Annoyed, Guilty, Eye-opener.

What is the clinical significance of a score of 2 or greater on the CAGE or CAGE-AID tools?

It suggests a current or past substance use problem, warranting a more in-depth assessment.

Why is it generally unhelpful to use 'why' questions when speaking with someone about their substance use?

It can be perceived as judgmental or accusatory, potentially causing the individual to become defensive.

Why are labels like 'alcoholic' or 'junkie' considered unhelpful in a clinical setting?

They are stigmatizing and judgmental, which can hinder the development of a trusting therapeutic relationship.

What is a major risk of using pressure tactics or threatening to withdraw a relationship with an individual struggling with addiction?

It may raise anxiety and increase isolation, which can cause the person to use more substances.

What are three helpful strategies when working with an individual with a substance use disorder?

Collaborating without pushing, identifying the Stage of Change, and accepting the individual's right to decide when they are ready for change.

What is the 'Pre-contemplation' stage in the Stages of Change model?

The stage where an individual is not aware of or does not acknowledge that they have a problem.

What is the social work task during the 'Pre-contemplation' stage?

To heighten doubt or ambivalence about the problem behavior.

What characterizes the 'Contemplation' stage?

The individual begins to experience ambivalence regarding their substance use.

What is the social work task during the 'Contemplation' stage?

To review the consequences of changing versus not changing.

What occurs during the 'Preparation' stage?

The individual intends to change and begins to consider steps leading to that change.

What is the social work task during the 'Preparation' stage?

To help the individual consider available change options and their relative advantages.

What defines the 'Action' stage?

The individual uses deliberate strategies to modify their behavior or environment.

What is the social work task during the 'Action' stage?

To provide support in carrying out the change plans.

How long must a change be maintained to reach the 'Maintenance' stage?

At least 6 months.

What is the social work task during the 'Maintenance' stage?

To use positive feedback strategies to help the individual overcome obstacles.

What happens during the 'Relapse' stage?

The individual returns to their former pattern of problem behavior.

What is the social work task during the 'Relapse' stage?

To accept the setbacks and encourage the individual to return to an earlier stage of change.

When treating a concurrent disorder, how should the priority of treatment be determined?

The priority may be determined by the severity of either the mental health issue or the substance use issue.

What are the five stages of change in the context of addiction recovery?

Pre-Contemplation, Contemplation, Preparation, Maintenance, and Termination.

What is the primary focus when working with a client in the Pre-Contemplation stage?

Building trust, respecting the client's position, and maintaining a non-judgmental relationship.

What is the goal of 'developing discrepancy' in the Contemplation stage?

To help the client recognize the gap between their current behaviors and their personal goals.

What are three methods to help a client develop discrepancy?

Looking forward and back, querying extremes, and using scaling questions.

What is the primary focus of the Preparation stage?

Discussing and developing a specific, concrete, and written plan for change.

What is a key strategy for facilitating change during the Preparation stage?

Exploring past successes to identify strengths and resources the client can apply to their current situation.

What are the core components of the Maintenance stage?

Preparing for set-backs, learning from relapses, using positive reinforcement, and adjusting goals to meet SMART criteria.

What is the 'SMART' criteria used for in the Maintenance stage?

Ensuring goals are Specific, Measurable, Achievable, Relevant, and Time-bound.

What are three general counseling strategies for all stages of change?

Actively listening and empathizing, rolling with resistance, and supporting self-efficacy.

Why is it important to provide education about harm reduction supplies?

To help clients manage risks associated with substance use and treatment.

What is the definition of an overdose?

A pathologic level of substance toxicity at a magnitude that overwhelms normal physiological functioning.

Why is it difficult to distinguish between substance use and an overdose?

Because some innate effects of the substance, such as pupillary changes, are present in both situations.

What are common physical signs of withdrawal to monitor?

Trembling, sweating, nausea, vomiting, diarrhea, disorientation, and restlessness.

What are the specific risks associated with alcohol withdrawal?

Heart palpitations, seizures, and delirium tremens (DTs), which can be fatal.

What are the additional risks of benzodiazepine withdrawal?

Seizures, high risk of suicide, and long-term psychological symptoms like anxiety, insomnia, and depersonalization.

How does alcohol affect brain chemistry?

It suppresses glutamate (excitatory) and increases dopamine (happiness) and GABA (inhibitory) when combined with benzodiazepines.

Why is the combination of alcohol and benzodiazepines dangerous?

It leads to significantly slowed heart rate and respiration, increasing the risk of death.

What should a counselor do if a client experiences a 'slip' or relapse?

Normalize the experience, use it as a learning opportunity, and adjust strategies for the future.

What is the purpose of 'amplified reflection' in counseling?

It is a technique used to roll with resistance by reflecting the client's statement back to them in an exaggerated way.

What is the role of 'self-efficacy' in the stages of change?

Promoting client confidence by identifying past successes and strengths.

What questions can facilitate contemplation regarding the future?

Asking what life would look like if the client reduced or stopped substance use.

What is the purpose of a 'decisional balance' exercise?

To explore the pros and cons or costs and benefits of changing versus continuing substance use.

What is the recommended approach to treatment planning?

Recognizing that no single treatment works for everyone and tailoring the approach to the specific substance and individual needs.

What is the first step in helping a client find appropriate treatment?

Having them meet with a trained counselor or mental health and addictions worker to identify problems and required support levels.

What are the psychological symptoms of benzodiazepine withdrawal?

Anxiety, panic attacks, insomnia, depression, irritability, confusion, and depersonalization.

What is the primary reason for accidental overdose?

Taking a regular dose after tolerance has lowered, taking a stronger dose than accustomed to, or combining substances.

What is the primary distinction between intentional and unintentional overdoses?

While some overdoses are intentional, the majority are unintentional.

Why is an overdose considered a medical emergency?

Prompt medical attention is critical to prevent lasting health consequences or death.

What legal protection does the Ontario Good Samaritan Act provide?

It legally protects both the person experiencing the overdose and those who call 911 to report the emergency.

Why does intravenous (IV) drug use carry a higher risk of overdose?

Injected drugs take effect much more quickly than those that are smoked, snorted, or ingested.

List four physical symptoms of a potential drug overdose.

Passing out/unresponsive loss of consciousness, difficulty breathing, pinpoint pupils, and skin color changes.

What auditory signs might indicate an overdose?

Coughing, gurgling, or snoring sounds.

How does the opioid crisis relate to the illegal drug supply?

Strong opioids like fentanyl are contaminating the illegal drug supply, leading to higher rates of overdose and death.

What are the immediate steps to take if you suspect someone is overdosing?

Call 911 immediately, stay with the person if it is safe to do so, and administer naloxone if available and you are trained.

What is the core philosophy of harm reduction?

It involves policies and practices that aim to reduce the harms associated with substance use by 'meeting people where they are at' rather than requiring immediate abstinence.

What are three principles of harm reduction?

Non-judgmental approach, treating individuals with dignity and compassion, and opposing the stigmatization of substance use disorder.

Why does harm reduction view behavior change as an incremental process?

People are more likely to take multiple small, manageable steps toward health than one or two large, difficult steps.

Provide three examples of harm reduction strategies.

Needle and syringe programs, supervised consumption sites, and nicotine replacement therapy.

What is the purpose of a supervised consumption site?

To provide a safe, clean environment for drug use, reduce public drug use, prevent overdose deaths, and connect individuals to health services.

What is the goal of Motivational Interviewing (MI)?

To help clients explore and resolve ambivalence about changing their behavior.

What are the four core skills of Motivational Interviewing?

Expressing empathy, avoiding arguments, developing discrepancy, and supporting self-efficacy.

When is Cognitive Behavioural Therapy (CBT) most effective in the context of addiction?

It is most effective during the preparation, action, and maintenance stages of change.

What is the focus of Behavioural Couples Therapy in addiction treatment?

It removes environmental conditions that support substance use and uses positive reinforcement and consequences to modify behavior.

What is the primary focus of Family Therapy for substance-related disorders?

Building communication skills, family activities, caring behaviors, and the expression of feelings.

What are the 12 steps of Alcoholics Anonymous primarily centered on?

A spiritual approach to admitting powerlessness, making a moral inventory, making amends, and helping others.

What are aversive pharmacological treatments for addiction?

Medications like Antabuse that create an unpleasant physical reaction when the substance is consumed.

What is the function of naloxone in opioid treatment?

It acts as an antagonist to reverse the effects of an opioid overdose.

What is the purpose of the London Drug Treatment Court (LDTC)?

To provide court-supervised addiction treatment and rehabilitation for individuals who have committed non-violent, substance-related crimes.

What is 'urge surfing'?

A technique used to manage cravings by observing them without acting on them until they pass.

How does harm reduction promote public health beyond the individual?

By reducing the transmission of infectious diseases and decreasing public health issues like needle waste.

What is the difference between an anticraving medication and a substitution medication?

Anticraving medications (e.g., Naltrexone) reduce the desire for the substance, while substitution medications (e.g., Methadone) replace the illicit drug with a safer, controlled alternative.

Why is it important to include individuals with lived experience in harm reduction policy?

To ensure that policies and practices are shaped by those who are most impacted and understand the reality of substance use.

What does 'rolling with resistance' mean in Motivational Interviewing?

Reframing resistance as ambivalence and recognizing that a person may want to change but does not know how.