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.