SUD

Question 1

Classification SUD

Answer 1

2+ of 11 symptoms within 12-month period:
- Taking more than planned
- Desire to cut down use
- Excessive amount of time acquiring/using/recovering
- Craving
- Role disruption (eg work)
- Give up Important activities
- Relationship problems (continue use anyway)
- Use in physically hazardous situations eg driving
- Continued use despite physical/psychological harm
- Tolerance
- Withdrawal

Question 2

Assessment

Answer 2

• Interview:
• Assessment must be non-confrontational

o Self-reports are prone to inaccuracy - use collateral

o Official records/ Chemical tests: * Urinalysis, Blood tests, Saliva

o Impact: social, occupational, Time, extent of impairment, intervention

o Can assess brain function

Pros and cons of SUD

Functional analysis
- ABC’s
- risk situations/ triggers
- thoughts/feelings/physical during/after
- reinforcers

Question 3

Models

Answer 3

Cognitive Developmental Model
- Early life events (eg abuse, trauma)
- Schemas and beliefs (self and substance related eg drinking not so bad)
- Exposure to drugs (eg parent, peers, experimentation)
- Drug-related beliefs (eg drinking is cool/makes me confident)

• Continued use
  Maintenance:
• Activating stimuli (eg stress)
• Drug beliefs (eg drink will relax me)
• Automatic thoughts (eg i’ll just have one)
• Craving
• Facilitating beliefs (eg everyone does it)
• Focus on instrumental strategies/action (eg ill get beer from fridge/call dealer)
• Continued use/relapse

Barlow, Durand and Hofmann Integrative Model of Substance related Disorders

Exposure to drug use (e.g. parents, peers) + with social and cultural expectations for use (e.g., binge culture)

= in initial drug use.

positive and negative reinforcement = maintain

Drug use then = psychosocial stressors (e.g., relationship or financial difficulties)

along with biological and psychological influences (e.g. sensitivity to drug, comorbid mood or anxiety disorders)

= increases the likelihood of substance use disorder.

Question 4

Causes

Answer 4

GENETIC
- genetic difference in dose response, particularly with alcohol
- 40-70% of variance

FAMILY/ EARLY LIFE EXPERIENCE
- avoidant and anxious attachments
- stressful life events
- Parents who abuse, don’t monitor children’s use, household with inconsistent discipline and attachment, or neglect and trauma

NEUROBIOLOGICAL
- drugs impact “pleasue pathway”
- prolonged alochol increases brains sensitivity to alcohol-related dopamine release therefore, other activities become less reinforcing
- Brain learns that the best way to get dopamine is through drinking.

• Chronic alcohol use affects brain’s reactivity to stress
• lower levels of self-control —related to neural inhibitory mechanisms

ROLE OF LEARNING
- Get a high (positive reinforcement) for early use
- Later maintained through seeking escape from withdrawal/crash (negative reinforcement)

COPING MECHANISM

PEERS/MEDIA
- Peer attitude
- Cravings triggered by mood, environment etc
- Family, peers, media are avenues to exposure to drugs
- Some cultures expect heavy drinking at certain social occasions

Question 5

Intergrative model

Answer 5

Question 6

Treatment

Answer 6

General Points

RISK/OVERDOSE
- social service needs (housing, legal issues & food)

HARM REDUCTION
- If you’re going to do drugs, lets do them safely. ( not restrict or prohibit)
- E.g., take less alcohol to party, organise someone to pick them up, eating enough food, staying hydrated

MI: may not be ready - Eliciting and strengthening their motivation to change

3. NEGOTIATE CONSUMPTION/GOALS
   - may not be abstinence straight away but at least Controlled use
   * Debate but some evidence to suggest that moderate drinking is an outcome for some (likely not suitable for those with alcohol dependence)
4. Prepare for RELAPSE -
   e.g., “I’ll never be able to do it”
5. CBT

• Psychoeducation (harms, what is ‘normal’, short term gains v long term consequences)
• Build up other coping strategies (eg relaxation, social support)
• Problem solving (re life issues that are likely triggers)
• Self monitoring
• Behavioural chain analysis (eg what are triggers)
• Avoiding situations/people that trigger use
• Evaluating drug related beliefs (eg need it to fit in, have fun etc)
• Behavioural experiments (eg test belief)
• Reinforcement (eg - antibuse, or + reward system for not using)

FAMILY THERAPY
- 1. review negatives of drinking and positives of not drinking - MI

2. reinforce/reward abstinence from drugs and alcohol.
3. Positive Request: Involves the youth and youth’s significant others’ learning to positively request desired actions from one another.
4. restructure their environment to facilitate interaction with people and activities that are associated with a substance-free lifestyle,
   Pleasant family activities are also planned
5. teach to identify and manage (triggers)

Question 7

Psychometric

Answer 7

• CAGE: Cut down, Annoyed, Guilty, Early (eye opener) (screener 2+ possible dependence)
• Alcohol Use Disorders Identification Test (AUDIT) (20+ = possible dependence)
• Leeds Dependence Questionnaire (any SU, 20+ = severe dependance validated for Pakeha, Maori and Pasifika)
• Substances and choice scale (13-18) developed in NZ