Exam #2 Substance Use Disorder

Common Types of Substance Use Disorders

Alcohol Use Disorder (AUD) Tobacco Use Disorder Cannabis Use Disorder Stimulant use disorder Hallucinogen Use Disorder Opioid Use Disorder

Tobacco Use Disorder

CDC estimates that more than 480,000 deaths each year are caused by cigarette smoking. Tobacco use and smoking do damage to nearly every organ in the human body, often leading to lung ca, respiratory disorders, heart disease, stroke and other illnesses. In 2014, an estimated 66.9 million Americans aged 12 or older were current users of tobacco products (25.2%). Young adults aged 18 to 25 had highest rate of current use of a tobacco product (35%)

Overdose with Opioids

Overdoses with opioid pharmaceuticals led to almost 17,000 deaths in 2011. Since 1999, opiate overdose deaths have increased 265% among men and 400% among women.

Long term effects of hallucinogens

Persistent psychosis and flashbacks are two long-term effects associated with some hallucinogens. Evidence indicates that certain hallucinogens can be addictive or that people can develop a tolerance to them.

Hallucinogens are a diverse group of drugs that alter the following:

alter perception (awareness of surrounding objects and conditions), thoughts, and feelings. They cause hallucinations, or sensations and images that seem real though they are not. Hallucinogens can be found in some plants and mushrooms (or their extracts) or can be human-made. People have used hallucinogens for centuries, mostly for religious rituals.

The most commonly abused stimulants are:

amphetamines, methamphetamine, and cocaine Stimulants can be synthetic (such as amphetamines) or can be plant-derived (such as cocaine). They are usually taken orally, snorted, or intravenously.

Symptoms of hallucinogen use disorder include:

craving for hallucinogens, failure to control use when attempted, continued use despite interference with major obligations or social functioning, use of larger amounts over time, use in risky situations like driving, development of tolerance, and spending a great deal of time to obtain and use hallucinogens.

Some symptoms of cannabis use disorder include:

disruptions in functioning due to cannabis use, the development of tolerance, cravings for cannabis, and the development of withdrawal symptoms, such as the inability to sleep, restlessness, nervousness, anger, or depression within a week of ceasing heavy use.

Some of the physical symptoms of heroin are:

euphoria, drowsiness, respiratory depression, constricted pupils, nausea, and dry mouth

Along with hallucinations, other short-term general effects of hallucinogens include:

increased heart rate nausea intensified feelings and sensory experiences changes in sense of time

Hallucinogens can interfere with the brain chemical glutamate which regulates:

pain perception responses to the environment Emotion learning and memory

Stages of Change Model includes 4 stages

1) Precontemplation, 2) contemplation, 3) preparation and 4) action to accomplish change Intervention strategies match the thoughts, beliefs, and readiness for change at each stage***

Motivational interviewing - The clinician practices motivational interviewing with five general principles in mind:

1. Express empathy through reflective listening. 2. Develop discrepancy between clients' goals or values and their current behavior. 3. Avoid argument and direct confrontation. 4. Adjust to client resistance rather than opposing it directly. 5. Support self-efficacy and optimism.

Opioid Use Disorder: an Epidemic

4.3 million Americans engaged in non-medical use of prescription painkillers in the last month. Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year. 1.4 million people used prescription painkillers non-medically for the first time in the past year. The average age for prescription painkiller first-time use was 21.2 in the past year.

Heroine statistics

4.8 million people have used heroin at some point in their lives. Among people between the ages of 12 and 49 years, the average age of first use was 28. 212,000 people aged 12 or older used heroin for the first time within the past 12 months. Approximately 435,000 people were regular (past-month) users of heroin

Common hallucinogens include the following:

Ayahuasca is a tea made from one of several Amazonian plants DMT is a powerful chemical found in some Amazonian plants. Manufacturers can also make DMT in a lab. The drug is usually a white crystalline powder. A popular name for DMT is Dimitri. D-lysergic acid diethylamide (LSD) is one of the most powerful mood-changing chemicals. It is a clear or white odorless material made from lysergic acid, which is found in a fungus that grows on rye and other grains. 4-phosphoryloxy-N,N-dimethyltryptamine (psilocybin) comes from certain types of mushrooms found in tropical and subtropical regions of South America, Mexico, and the United States. Dextromethorphan (DXM) is a cough suppressant and mucus-clearing ingredient in some over-the-counter cold and cough medicines Ketamine is used as a surgery anesthetic for humans and animals. Phencyclidine (PCP) was developed in the 1950s as a general anesthetic for surgery. Salvia divinorum (salvia) is a plant

Behavioral Interventions

Changing any behavior is complex and challenging, and requires internal motivation, commitment, and a realistic understanding of the steps of change.

Contingency Management

Contingency management (CM) is an intervention strategy that, using the principles of operant conditioning, provides reinforcing consequences for substance-abusing individuals who meet treatment goals. Several studies support its effectiveness in reducing substance use, improving treatment attendance, and reinforcing medication compliance and tx goals. A CM program typically provides vouchers that can be redeemed for desirable items, such as bus tokens, clothing, movie passes, or even more expensive electronics when treatment goals are met (e.g., clean urine sample).

Barrier to contingency management

Costs can be a barrier to use, however, and Petry (2006) describes an alternate system at about half the cost in which patients have an opportunity to receive a prize-based on a drawing.

Alcohol Use Disorder (AUD) statistics

Data from the National Survey on Drug Use and Health - 2014 show that in 2014, slightly more than half (52.7%) of Americans ages 12 and up reported begin current drinkers of ETOH. However, of those 176.6 million ETOH users, an estimated 17 million have AUD. Many Americans begin drinking at an early age. In 2012, about 24% of 8th graders and 64% of 12th graders used ETOH in the past year.

Immediate effects of Marijuana's use include:

Distorted perception Difficulty with thinking and problem solving, Loss of motor coordination

Alcohol Use Disorder (AUD)

Excessive alcohol (ETOH) use can increase a person's risk of developing serious health problems in addition to those issues associated with intoxication behaviors and alcohol withdrawal symptoms.

12-Step Group participation

Given that the majority of people who received help for their substance use disorders get it from self-help groups, OTs should familiarize themselves with groups such as Alcoholics Anonymous (AA), Cocaine Anonymous (CA), and Narcotics Anonymous (NA), as well as their locations, frequency of meetings, and traditions, so they can encourage access to this fellowship of support for recovery. 12-Step programs are often referred to as being based on spirituality and social support, both of which are understood as important to reviery.

Hallucinogen Use Disorder

Hallucinogens can be chemically synthesized (as with lysergic acid diethylamide or LSD) or may occur naturally (as with psilocybin mushrooms, peyote). These drugs can produce visual and auditory hallucinations, feelings of detachment from one's environment and oneself, and distortions in time and perception. In 2014, approximately 246,000 Americans had a hallucinogen use disorder.

Heroin

Heroin is a powerful opiate drug. Heroin looks like a white or brownish powder, or as the black sticky substance known on the streets as "black tar heroin." It is diluted with other drugs or with sugar, starch, powdered milk, or quinine before injecting, smoking, or snorting.

Cannabis Use Disorder

In 2014, about 22.2 million people ages 12 and up reported using marijuana during the past month In 2014, 2.6 million people in that age range had used marijuana for the first time within the past 12 months. People between 12 and 49 years report first using the drug at an average age of 18.5** In the past year, 4.2 million people ages 12 and up met criteria for substance use disorder based on marijuana use.

Stimulant use disorder statistics

In 2014, an estimated 913,000 people ages 12 and older had a stimulant use disorder because of cocaine use, and an estimated 476,000 people had a stimulant use disorder as a result of using other stimulants besides methamphetamines. In 2014, almost 569,000 people in the United States ages 12 and up reported using methamphetamines in the past month.

Tobacco Use Disorder - highest use among?

In 2014, the prevalence of tobacco products was 37.8% for American Indians or Alaska Natives, 30.6% for Native Hawaiians or other Pacific Islanders, 27.6% for whites, 26.6% for African Americans, 18.8% for Hispanics, and 10.2% for Asians. Why american indians and alaska natives more likely to smoke? - Can be apart of their religion - Isolation

Long term effects of Marijuana

Long-term use of the drug can contribute to respiratory infections, impaired memory and exposure to cancer-causing compounds. Health marijuana use in youth has also been linked to increased risk for developing mental illness and poorer cognitive functioning.

Hallucinogen - Ecstasy

MDMA, also known as Ecstasy or, more recently, Molly, is similar to both the stimulant amphetamine and the hallucinogen mescaline. SAMHSA's 2014 National Survey on Drug Use and Health (NSDUH) (PDF | 3.4 MB) found that 609,000 people aged 12 or older reported using Ecstasy in the past month.

the most-used drug after ETOH and tobacco in the U.S?

Marijuana

Definitions of the different levels of Alcohol use:

Moderate - 1 drink per day for women and up to 2 drinks per day for men Binge - Drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days. Binge drinking is a pattern of drinking that produces blood alcohol concentrations of > 0.08 g/dl. This usually occurs after 4 drinks for women and 5 drinks for men over a 2-hour period. Heavy - Drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30.

Occupational therapy interventions

Most effective interventions for substance-related dependence are a combination of psychosocial and pharmaceutical approaches. The psychosocial therapies address the beliefs, coping/stress management techniques, and social skills necessary to function without reliance on substances. Behavioral interventions have been found to be helpful for substance use disorders.

Opioid Use Disorder

Opioids reduce the perception of pain but can also produce drowsiness, mental confusion, euphoria, nausea, constipation, and, depending upon the amount of drug taken, can depress respiration. Illegal opioid drugs, such as heroin and legally available pain relievers such as oxycodone and hydrocodone can cause serious health effects in those who misuse them.

Heroin availability

Other users have switched from prescription opiates to heroin as a result of availability and lower price. Because of variable purity and other chemicals and drugs mixed with heroin on the black market, this also increases risk of overdose.

To be dx'd with AUD, criteria that needs to be met include:

Problems controlling intake of ETOH Development of a tolerance for ETOH Drinking that leads to risky situations or the development of withdrawal symptoms

Hallucinogens can interfere with serotonin

Research suggests that hallucinogens work at least partially by temporarily disrupting communication between brain chemical systems throughout the brain and spinal cord. Some hallucinogens interfere with the action of the brain chemical serotonin, which regulates: Mood sensory perception Sleep Hunger body temperature sexual behavior muscle control

Responses to opioids

Some people experience a euphoric response to opioid medications, and it is common that people misusing opioids try to intensify their experience by snorting or injecting them. These methods increase their risk for serious medical complications, including overdose.

A model for changing health behaviors such as addictions is the:

Stages of Change Model (DiClemente & Prochaska, 1998), also referred to as the Transtheoretical Model. It is often used in research and intervention programs for substance-related disorders to better understand and use different interventions at various points in the pattern of substance use. The model proposes that individuals go through a series of Stages

Stimulant use disorder

Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. They include a wide range of drugs that have historically been used to treat conditions, such as obesity, attention deficit hyperactivity disorder and, occasionally, depression. Like other prescription medications, stimulants can be diverted for illegal use.

Substance use disorders

Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school or home.

Substance use disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Ed. (DSM-5) no longer uses the terms "Substance Abuse" or "Substance Dependence." Now, we refer to it as substance use disorder, which is defined as mild, moderate, or severe.

Effects of hallucinogens

The effects of hallucinogens can begin within 20 to 90 minutes and can last as long as 6 to 12 hours.

True/False Hallucinogens can cause severe visual disturbances.

True

True/False There are no government-approved medications to treat addiction to hallucinogens.

True

Symptoms of stimulant use disorders include:

craving for stimulants, failure to control use when attempted, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use stimulants, and withdrawal symptoms that occur after stopping or reducing use, including fatigue, vivid and unpleasant dreams, sleep problems, increased appetite, or irregular problems in controlling movement.

Stoffel and Moyers, 2004

provide examples of how OT practitioners might apply the stages of change model in their interventions with persons who struggle with their use of substances to facilitate their readiness to change. For ex., when someone is in the contemplation stage, he might be aware of how his alcohol or drug use has caused problems in his life. The OT might have him explore the full set of good and not so good things associated with his substance use as a means to explore a life without the substance, thereby facilitating movement from contemplation to preparation for change.

A heroin overdose causes:

slow and shallow breathing, blue lips and fingernails, clammy skin, convulsions, coma, and can be fatal.

Symptoms of opioid use disorders include:

strong desire for opioids, inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.