Substance Use Disorders

The US is ___ % of the world’s presentation, but it consumes ___% of the world’s drugs.

4%; 60%

What drug is most consumed by Americans?

alcohol

What are the immediate direct consequences and indirect consequences of drug use?

Immediate Direct Consequences: increased HR, body temp. regulation, psychosis, overdose/death

Indirect Consequences: impaired judgment/driving, risky sex, disease transmission

What are the long-term health effects?

Hypertension, liver disease, cancer, heart disease, fetal effects, SUD

What are the long-term social and economic impacts

Long-Term Social Impacts: reduced productivity, higher cost of healthcare, interpersonal

Economic Impact:~$249 billion for alcohol and ~$193 billion for other drugs annually

True/False: There are more drug-involved overdose deaths for men than women

True

True/False: Alcohol has the most drug involved overdose deaths

False, it’s fentanyl.

What does the DSM 5 say about Substance Use Disorder?

What are the two main categories that make up substance use disorder?

Behaviors and consequences

What is tolerance?

Our systems adapt so that more quantities are necessary to achieve the same effect

What is withdrawal?

Severe psychological and physiological symptoms that occur after stopping or reducing the drug use
ex. getting the shakes, hallucinations, seizures; hangover is a short-term withdrawl

True/False: You can have an addiction without tolerance or withdrawl

True

What are the classes of drugs?

What is the history of addiction treatment?

What are the pharmacological treatments?

• Substitution​; replace the drug wigth something else

• Prevention/Antagonistic​: drug receptor blockers

• Aversive Therapy​: pairs the drug with making them feel sick; negative reinforcement— doesnt work long-term

What are the psychosocial treatments?

• Mutual help groups​: ex. AA

• CBT​: Thoughts, emotions, and behavior— starts with understanding what triggers drug use.

• CM​ (contingency management): incentives for engaging in a behavioral change; get a reward for not using a substance

• Motivational (Motivational Interviewing (MI)):​

  Helping clients break through the ambivalence about changing behavior​

What does recovery look like?

• Early remission​

  • 3 to 12 months without symptoms (except craving)​

• Sustained remission​

  • >12 months without symptoms (except craving)​

What doesn’t work as treatment?

• shame

• stigma

• blaming

Why do people develop an addiction?

• genetics account for 40-60% of heredity

• adverse childhood experience (environment)

Why don’t people stop?

Do drugs have a deep history in the US?

• “Public Enemy number 1” – Nixon ‘71​

• “The War on Drugs” – Reagan ‘82​

• - Anti Drug Abuse Act – “minimum mandatory sentences for drug offenses”​

• ​

• SAMHSA: Substance Abuse Mental Health Services Administration​

• NIDA: National Institute on Drug Abuse​

• NIAAA: National Institute on Alcoholism and Alcohol Abuse​

What are the three levels of stigma?

Public, Institutional, and Internalized/self stigma

What does self stigma look like?

True/False: people with minoritized identities experience less SUD stigma

False, they experience more stigma

What are some ways to combat SUD stigma?

Change the language surrounding it

What are the forms of stigma?

• Stereotypical beliefs​

  • Someone with an addiction is… (unmotivated, dangerous, etc.)​

• Attributional beliefs​

  • Someone with an addiction is in control​

  • Someone with an addiction is responsible for this​

• Expectations for recovery​

  • Someone with an addiction will be able to… (find a job, maintain a relationships, etc.)​

• Social distance​

  • I would be willing to have someone with an addiction… (live next door, sit next to me on a train, be in a relationship with my kid)​

How does stigma impact someone with an SUD?

• An estimated 28% of those who do not seek treatment (but recognize the need), report reasons related to stigma for not accessing or engaging in care.​

• Less treatment seeking​

• Poorer Prognosis, non-completion of treatment​

• Lower self-esteem​

• Less perceived empowerment to make change​

• Social alienation – employment, housing, connectedness​

  • 10% of people with SUD don’t seek treatment because it will impact community’s opinion of them​

  • 8% don’t seek treatment due to concerns about impact on job​

How does stigma impact clinicians?

• Lower individual regard​

• Decreased motivation​

• Feelings of dissatisfaction, resentment, powerlessness​

• Perceptions that people with SUDs are amotivated, manipulative, etc.​

• Decreased likelihood of offering some care (e.g., pain management)​

How can we bust the stigmas?

Increase compassion

• increase contact between people with substance use disorders and the larger population​

• Communication standards that eliminate stigmatizing language​

• Widespread access to treatment – no wrong door​

• Understanding and balancing the disease model, heritability, contextual models and that people do get better​

• Recovery-oriented care – what is the goal of our treatment? ​

• Get feedback from people with SUDs about their experiences​