Chapter 12 3 e Substance Use Student(1)

Learning Outcomes

• Impact of substance use on population health

• Definition of disease burden related to substance use

• Application of evidence-based interventions for harm prevention

• Population-level strategies for substance use prevention and treatment

Substance Use and the Opioid Epidemic

• 2021: Over 100,000 U.S. deaths from opioid overdoses

• Alcohol accounts for over 5% of global disease burden

• 22.3% of the global population uses tobacco

• Substance Use Defined: Use of psychoactive substances affecting the CNS leading to altered mood and perception.

Social, Cultural, and Economic Context

• Substance use varies by:

  • Quantity and type of consumption

  • Cultural norms

  • Socioeconomic status

  • Quality of substances (e.g., toxic illicit alcohol)

Classes of Substances

• Categories:

  • Stimulants

  • Depressants

  • Inhalants

  • Dissociative anesthetics

  • Narcotics

  • Hallucinogens

  • Cannabis

Continuum of Use Across the Life Span

• Stages include:

  • Abstinence

  • Low Risk Use

  • At Risk Use

  • Substance Use Disorder

  • Adverse Health Consequences

Barriers to Prevention

• Economic resources limit prevention policy enforcement.

• Advocate understanding of context, disease burden, and evidence-based interventions.

Substance Use and Associated Risks

• Increases risks for health issues, crime, and adverse environmental factors.

• Range of harms: Acute (immediate effects) and Chronic (long-term effects).

Acute and Chronic Harm Examples

• Acute Harm:

  • AlcoAlcohol: Liver diseasehol: Poisoning, impaired judgment

  • Opioids: Overdose, respiratory depression

  • Cocaine: Heart attacks

  • Methamphetamine: Psychosis

• Chronic Harm:

  • Opioids: Addiction

  • Cocaine: Heart disease

Measurement, Surveillance, and Risk

• Substance use measurement includes:

  • Abstinence

  • Low-risk use

  • Harm-related use

  • Risk is not clearly defined.

National Surveys of Substance Abuse

• Key U.S. surveys:

  • Behavioral Risk Factor Surveillance System (BRFSS)

  • National Survey on Drug Use and Health (NSDUH)

  • National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Alcohol Use Guidelines

• Excessive Use:

  • Men: >15 drinks/week

  • Women/Adults >65: >8 drinks/week

• Heavy Drinking:

  • Men: >5 drinks/occasion

  • Women/Adults >65: >4 drinks/occasion

• No safe level of alcohol during pregnancy.

Risk Across the Life Span

• Fetal alcohol spectrum disorders (FASD) occur from prenatal exposure.

• Risks vary by age due to metabolic changes.

Populations at Risk

• Influencing factors include:

  • Environment

  • Gender

  • Socioeconomic status

• Preference to view substance use disorder (SUD) as harm-related rather than purely clinical.

Substance Use Disorder (SUD) Definition

• Maladaptive substance use causing significant impairment or distress, classified as moderate or severe based on:

  • Physiological dependence

  • Tolerance

  • Withdrawal symptoms

Levels of Prevention for SUD

• Primary Prevention: Education programs, public awareness campaigns, and legislation.

• Secondary Prevention: Screening, early identification, and harm reduction strategies.

• Tertiary Prevention: Rehabilitation, support groups, and social support services.

Harm Reduction Model

• Aims to reduce harm related to at-risk substance use without solely focusing on abstinence.

• Strategies target community-level impact.

Example: Supervised Injection Sites

• Facilities that provide a safe environment and medical supervision for drug use to prevent overdose and disease transmission.

• Benefits include reduced overdose rates and increased treatment access.

Alcohol Use Effects

• Linked to over 200 conditions and responsible for 5.3% of global deaths.

• Affects vulnerable populations, including pregnant women and older adults.

A-SBIRT (Alcohol Screening, Brief Intervention, Referral for Treatment)

• Universal screening method for alcohol use harm.

SBIRT Components

• Screening: Assessment of substance use patterns.

• Brief Intervention: Short conversations to encourage behavior change.

• Referral to Treatment: Connecting individuals to specialized treatment options.

Tobacco Use and Nicotine Vaping

• Responsible for over 8 million deaths annually.

• Preventable death leading cause in the U.S. from smoking and exposure to secondhand smoke.

Screening and Treatment for Tobacco Use

• Assessment includes quantity, frequency, and history of use.

• Cessation strategies involve healthcare provider support and counseling.

Policy to Reduce Tobacco-Related Harm

• WHO's MPOWER framework outlines actions to reduce tobacco use at individual and population levels.

Drug Use Prevalence

• Rising opioid overdose rates noted (100,306 deaths in 2021).

• Medication-Assisted Treatment (MAT) effective for OUD and AUD in comprehensive treatment settings.

Medication-Assisted Treatment (MAT)

• Integrates medication with counseling to treat SUD, emphasizing improved survival rates and reduced illicit use.

Example: Methamphetamines

• Easily manufactured, associated with severe health consequences, including mental illness and environmental impact.

Consequences of Drug Use

• Vary by drug type; rebound effects are common post-use, increasing risks for comorbid disorders and adverse consequences.

Core Themes

• Principles of community care, types of substance use, and prevention methods.