Substance Use Disorder

substance use disorders (SUD)

A person has taken enough of a substance (1of 9 according to the DSM-V) to create clinically important distress or impaired function.

diagnostic criteria

Use is problematic

• Pattern and repetition is apparent and predictable

• “Clinically Significant” behavior- has come to the attention of authorities or professionals

• Causes distress and/or impairment in the person’s life

• Compromises at least 2 of 11 life factors as listed in the DSM-V

diagnostic info

over 300 SUDs. 100s more with specifiers/qualifiers. specify the substance, type of problem, onset of behavior (not always necessary for Dx)

commonalities for all SUD’s

effects the CNS in some capacity and results it perception distortion

specifiers/qualifiers

withdrawal, intoxication, use disorder, mild, moderate/severe

based upon duration, differential, and disability by substance

major classes of commonly abused substances

1. Alcohol (ETOH)

2. Amphetamines/stimulants (meth, cocaine)

3. Caffeine (not considered to be clinically significant)

4. Cannabis

5. Hallucinogens (PCP, LSD, Shrooms, etc.)

6. Inhalants (whip-its, computer cleaner)

7. Opioids (Rx- Vicodin, Percocet, OxyContin; Non-Rx- Heroin)

8. Sedatives (Benzodiazepines- valium, Xanax, clonazepam)

9. Tobacco (Nicotine)

gambling

not a drug, but is located in this area of DSM

symptoms of SUD (level of diagnosis)

mild (2-3 criteria)

moderate (4-5)

severe 6+

symptoms of SUD: loss of control

1. More use than intended

2. Attempts to stop but can’t

3. Lots of time taken to obtain/use

symptoms of SUD: negative consequences

1. Shrinking obligations

2. Social problems

3. Reduced activity

4. Use despite risks

5. Use despite contraindications

symptoms of SUD: cravings

1. Cravings

2. Tolerance

3. withdrawals

withdrawal symptoms

mood alteration, abnormal motor activity, sleep disturbance, other physical symptoms (nausea, vomiting, etc.)

intoxication symptoms

Motor coordination loss, inability to sustain attention, impaired memory, drowsiness, Autonomic nervous system responses (dry mouth, heart problems, gastro-intestinal, BP, HR)

inpatient settings

28 day residential

acute detox

outpatient settings

individual counseling, intensive outpatient, partial hospitalization, support group

basic TR skills

• Therapeutic Rapport

• Meet the client where the client is at (stages of change)

• Challenge faulty thinking (CBT)

• Create a safe group environment (establish the group rules)- stick to them even when it’s hard

• Encourage group discussion/feedback/accountability (80/20 rule)

• Non-shaming, non-judgmental- they already feel more guilt and shame than you can imagine

problem areas

• Leisure has become saturated with using

• Lacks effective emotional/stress coping mechanisms to stay sober

• Limited leisure skills

• Limited leisure awareness

• Limited leisure resources

• Poor self-esteem/worth/confidence/image

• Pessimistic view of the future

• Difficulty regulating emotions/mood

• Unmanageable depression/anxiety

role of leisure

maintaining sobriety, hopeful leisure, corrective leisure experiences

hopeful leisure

can experience pleasure and fun without using

corrective leisure experiences

re-experience chosen leisure activities and explore through debriefing

leisure as an intervention

• Maintaining Sobriety through Leisure Education

• Self-esteem groups

• Assertiveness Training

• Coping Skill Development

• Stress management

• Anger management

• Emotions management

• Model concepts (Transthoeretical, 12-step, etc.)

• Self-awareness

• CBT

• Social Supports

• Positive Psychology

sample psychoeducational group

• Problem area: Poor Self-Worth/Esteem

• Topic: Self Forgiveness

• Objective: When prompted by the CTRS, the client will be able to identify 1 negative past behavior and reframe as a life lesson, identifying 1 thing learned from the consequence.

• Intervention: Positive Psychology-Based TR Intervention

• Modality- Ultimate Forgiveness Football