Child Psychopathology Chap 10 - Substance Use Disorders
T or F: individuals can be diagnosed with multiple substance use disorders
true
How does a family therapist commonly approach the goal of improving the quality of family functioning
-meet with the family and observe their interactions -point out communication patterns and teach family members to use different, more effective strategies
Which brief screening measure can be given to both parents and youth?
ASSIST
What is the trend like in cigarette smoking?
Decreasing
What is the trend like in drinking alcohol?
Decreasing
Explain how alcohol effects people
Depressant Enhances GABA Blocks glutamate Produces biphasic effect
How is medication most commonly used in SUDs?
to treat comorbid disorders
What is the difference in average tolerance in adults vs. adolescents like?
-adults tend to have tolerance occur after years of frequent drinking (gradual increase) -tolerance develops more rapidly in adolescents
Explain the CRAFT assessment method
-assesses substance use problems most likely to be exhibited by adolescents -if answer yes to any should be further assessed 1. asks if they have used substances in the last 12 mos 2. CRAFT have you ever ridden in a Car driven by someone who had been using do you ever use to Relax, feel better about yourself, or fit in do you ever use alcohol or drugs while you are Alone do you ever Forget things you did while using alcohol or drugs do your family or Friends ever tell you that you should cut down have you ever gotten into Trouble while you were using alcohol or drugs
Explain the hypothesis of the cause for the high comorbidity of SUD and ADHD that proposes it's b/ both disorders are correlated with other disruptive behavior disorders
-children with ADHD show increased chance of developing ODD and CD ODD and CD associated with adolescent substance use problems Possible that ADHD, ODD, CD, and SUD are part of a spectrum of externalizing behavior that unfolds across development
How does a family therapist commonly approach the goal of helping parents manage their adolescent's substance use?
-education about normal and abnormal development -causes and consequences of adolescent substance abuse -role parents play -stress setting limits, fair discipline, parental monitoring
What must you specify when diagnosing substance use disorder?
-in early remission or sustained remission (or neither) -level of severity
Explain the hypothesis of the cause for the high comorbidity of SUD and ADHD that proposes the symptoms of ADHD could increase the probability of substance use problems
-kids with ADHD often show poor decision making, social problem-solving, and peer relations -these can cause peer rejection -rejected kids might use substances to gain acceptance or cope with loneliness
Explain the criticism of the DSM-5 that adolescents show different patterns of alcohol and other drug use
-more episodic -more binges -greater number of substances simultaneously -more likely to show comorbid behavior problems
What are secondary prevention programs?
-prevention for youths at high-risk -most are ecologically based prevention -usually designed for middle-school students who are about to transition from childhood to early adolescence
Explain the criticism that the DSM-5 is developmentally insensitive
-two of the most common signs in adolescent substance use is low grades and truancy but neither are listed -some more developmentally appropriate criteria that some experts now use instead is breaking curfew, lying to parents, showing a reduction in grades
What are the 2 questionnaires often used to screen for substance use disorders in adolescents?
1. CRAFT assessment method 2. Alcohol, smoking, and substance involvement screening test (ASSIST)
List the 4 limitations of the DSM-5 criteria of substance use disorders when they are applied to adolescents or children
1. Developmentally insensitive 2. Overidentified in adolescents 3. Adolescents show different patterns of alcohol and other drug use 4. Adolescents more likely to outgrow their substance use problems
Some intensive secondary prevention programs are effective in reducing both substance use and substance use problems. These programs focus on which 3 components
1. Providing education and refusal skills to adolescents 2. improving parent-child communication and parental monitoring 3. improving schools and communities
What are the 5 ways that medication can be used in the treatment of SUDs?
1. substitution therapy 2. detoxification 3. block the effects 4. aversion therapy 5. treat comorbid disorders
Explain the criticism that some criteria are over identified in adolescents using the DSM-5
1. adolescents more likely to develop tolerance 2. adolescents more likely to spend more time obtaining substances 3. more likely to use in hazardous situations
What are the 5 principles of motivational interviewing?
1. approach in accepting and nonjudgmental way 2. develops discrepancies between adolescent's long-term goals and his current alcohol use 3. rolls with resistance and avoids augmentation 4. supports any commitment to change 5. promotes self-efficacy by pointing out successful change no matter how small
What are the 4 steps to cognitive-behavioral therapy (CBT)?
1. asks adolescent to monitor her substance use and note environmental factors that precede it -- then find ways to avoid triggers 2. asks adolescent to consider consequences of substance use (cost-benefit analysis) 3. teach specific skills to reduce reinforcing effects of alcohol based on their reasons for using 4. examine beliefs adolescent shave about substances ad challenge distorted cognitions
Which 2 objectives do family therapists usually have?
1. help parents manage their adolescent's substance use 2. improve the quality of family functioning
The 11 symptoms of substance use disorder can be clustered into which 4 clusters?
1. impaired control 2. social impairment 3. risky use 4. pharmacological criteria
What are school and community leaders' 3 reasons for continuing DARE?
1. many claimed they never expected it to reduce substance use in the first place 2. may be beneficial in other ways (relationship with police) 3. some dismissed the research findings and went on based on personal experience
Practitioners of cognitive-behavioral therapy (CBT) view problematic substance use as a learned behavior that is acquired and maintained in which 4 ways?
1. people learn to use substances through operant conditioning 2. through classical conditioning people associate substance use with certain situations or mood states 3. maintained through social learning 4. adolescents' beliefs mediate the relationship between events that trigger substance use and consumption of substances
What are the stages of change that one moves through in motivational enhancement therapy?
1. pre contemplation 2 contemplation 3. action 4. maintenance
Which risk factors do ecologically based prevention programs target simultaneously?
1. provide substance use and abuse info to adolescents 2. provide info about substance use problems and ways to help their child to parents *many programs emphasize working on the parent-child relationship 3. address child's larger social system
What are the strengths of ASSIST?
1. screens for a wide variety of substance use problems 2. can be administered to both youths and their parents
What are the symptoms that cluster under the impaired control category?
1. substance taken in larger amounts or over a longer period than was intended 2. problems cutting down 3. time spent obtaining the substance or recovering from its effects 4. craving
In determining if adopting a harm reduction approach is ethical, which 3 points must we consider?
1. therapists who adopt the must obtain parental consent 2. most therapists who adopt this would say abstinence is the ideal, but any reduction is good 3. need to consider the empirical data (says can be effective)
DSM-5 recognizes which 3 substance induced disorders?
1.) substance intoxication 2.)substance withdrawal 3.) substance-induced mental disorder
Name the 3 hypotheses for the high comorbidity of substance use disorders and ADHD
1.common genetic or biological cause 2. both correlated with other disruptive behavior disorders 3. symptoms of ADHD could increase probability of substance use problems
About ___-___% of adolescents with SUD have comorbid anxiety
10-40%
Which symptoms are under the pharmacological criteria?
10. tolerance 11. withdrawal
Most inpatient programs incorporate ______ philosophies
12-step
What is the most frequently used means of treating SUD's in the U.S.?
12-step programs
About ___-____% of adolescents with ADHD eventually develop a SUD
15-30%
Adults who respond affirmatively to ______ or more CAGE questions should be further assessed
2
Individuals with substance use disorders show at least ____ of ____ possible symptoms within a 12 month period
2 of 11
What does mild severity constitute?
2-3 symptoms
When using DSM-V criteria, prevalence of mild SUD's range from ____-____%
2-9%
About ____-___% of adolescents with substance use problems are depressed
25-50%
About ___% of high school seniors report having used alcohol in the past 30 days
33%
What does moderate severity constitute?
4-5 symptoms
Which symptoms are under the social impairment cluster?
5. recurrent failure to fulfill major role obligations at work. school, or home 6. Continued use despite having persistent or recurring social or interpersonal problems caused by or exacerbated by the substance use 7. important social, occupational, or recreational activities given up
About ____% of adolescents in the community with SUD show at least one other mental disorder
50%
About ___-___% of adolescents with substance disorders have ADHD?
50-75%
About ___% of high school seniors report having used alcohol in the past year
58%
What does severe severity constitute?
6 or more
About ___% of adolescents relapse within 3 months of discharge from inpatient facility
60%
Among adolescents referred to treatment, comorbidity ranges from ___-___%
60-90%
Almost ___% of seniors report having used alcohol in their life
75%
Which symptoms are under the risky use cluster?
8. recurrent use in situations where it is physically dangerous 9. use continued despite knowledge of having persistent or recurrent physical or psychological problem that is likely to have been caused or made worse by use
About ____% of adolescents relapse within 1 year of discharge from inpatient facility
80%
What is substitution therapy?
Administering a med that is designed to eliminate cravings
Explain the hypothesis of the cause for the high comorbidity of SUD and ADHD that proposes they have a common genetic link or biological cause
Adolescents with both disorders display problems with executive functioning and behavioral inhibition
Do mood disorders typically develop before or after substance use problems?
After
What is the criteria for meeting sustained remission?
After full criteria for disorder were met, no criteria have been met at any time during period of 12 months or longer (except craving)
What is the criteria for meeting early remission?
After full criteria for the disorder were met, none of the criteria have been met for at least 3 months but for no less than 12 months (with exception of craving symptom)
What are the most frequently misused prescription meds?
Amphetamines used to treat ADHD and pain meds
How do sedatives, hypnotics, and anxiolytics typically work?
Augment GABA (brain's primary inhibitory neurotransmitter)
What is the common acronym used for adults to assess substance use? What does it stand for?
CAGE have you ever tried to Cut down have people Annoyed you by criticizing your drinking have you ever felt Guilty about your drinking have you ever felt you needed a drink first thing in the morning as an Eye opener
Explain the Monitoring the Future Study
Collect data about attitudes towards substances, and their overt behavior 8th, 10th and 12th graders
What is the relationship like between anxiety disorders and SUD's?
Complicated Some precede SUD (social anxiety or trauma) Some follow SUD (generalized anxiety can be used by chronic use of alcohol)
What is the primary goal of motivational enhancement therapy?
Enhance adolescent's desire to reduce his alcohol consumption Often adopt harm reduction approach
How do stimulants work?
Enhance dopaminergic activity in the central nervous system
Which two neurotransmitters does alcohol effect and how does it effect them?
Enhances GABA Blocks glutamate
What is the brain's primary inhibitory neurotransmitter?
GABA
How can meds be used during detox?
Help them cope with withdrawal symptoms (EG: clonidine for opioids)
Which study gives the best data regarding adolescent substance use
Monitoring the Future Study
What might it look like for a therapist to roll with resistance and avoid augmentation in the third principle of motivational interviewing?
If adolescent becomes defensive or angry, the therapist assumes it is because she is not adequately understanding and appreciating the adolescent's perspective
Explain the DSM-5 criticism that adolescents are more likely to outgrow their substance use problems
Many show gradual reduction in substance use by the time they reach early adulthood
What is a 28-day inpatient treatment program?
Most have 3 goals 1) attend to the adolescent's immediate medical needs and to detox 2) help adolescent recognize the harmful effects of the substance on his or her health and functioning 3) improve quality of adolescent's relationships with others
In which type of treatment is the harm reduction approach commonly adopted?
Motivational Interviewing
What did studies of secondary prevention programs find?
Overall found no difference BUT found the high-intensity programs did show differences
What did research about D.A.R.E. find?
Participation in the program did not change their level of substance use in adolescence Some found it increased children's knowledge of substance problems, but did not reduce it
Which symptom cluster can vary greatly depending on the class of the substance and the person using the drug?
Pharmacological criteria
___________ is typically seen as the treatment of choice for adolescents with SUDs
Psychotherapy
What is the trend like in drug use besides alcohol or cigarettes?
Remained stable overall
What are the effects of the 12-step program for adolescents?
Seems effective if done in inpatient facility But very high rates of relapse after release Don't know much about its efficacy outside of inpatient treatment
What is the difference like between prevalence of smoking cigarettes vs. marijuana?
Very similar levels
How can substance use disorders be differentiated from substance use?
a) recurrence b) effects on adolescents functioning --(causing impairment or distress)
Which of these is not one of the clusters that symptoms and substance use disorder can be classified into? 1. impaired control 2. social impairment 3. academic or work drawbacks 4. pharmacological criteria
academic or work drawbacks instead should have been risky use
How do hallucinogens usually work in the brain?
bind to serotonin receptors stimulates the locus coeruleus (area of the brain the regulates many other brain regions)
What does data say about motivational interviewing?
can be effective for high school students at risk for substance use problems
Explain the diagnosis of substance intoxication
disturbance of perception, wakefulness, attention, thinking, judgement, psychomotor and/or interpersonal behavior must cause distress or impairment
Selling prescribed medications is known as _________
diversion
The most extensively studied treatment for adolescent substance use problems is...
family therapy
What does CRAFT stand for?
have you ever ridden in a Car driven by someone who had been using do you ever use to Relax, feel better about yourself, or fit in do you ever use alcohol or drugs while you are Alone do you ever Forget things you did while using alcohol or drugs do your family or Friends ever tell you that you should cut down have you ever gotten into Trouble while you were using alcohol or drugs
time spent obtaining the substance or recovering from its effects is a symptom that falls under which symptom cluster category?
impaired control
Withdrawal is defined as...
needing either of the following: 1. characteristic withdrawal symptom for the substance 2. substance is taken to relieve or avoid withdrawal symptoms
Tolerance is defined as...
needing either of the following: 1. need for markedly increased amounts of substance to achieve desired effect 2. markedly diminished effect with continued use of the same amount
Are substitution therapy or aversion therapy commonly used with adolescents?
no
What is the harm reduction approach?
primary goal of therapy is to help adolescents identify and avoid alcohol use that has great potential for harm
What did research find about the relationship between repeated marijuana use and schizophrenia?
repeated marijuana use may increase the likelihood of psychotic symptoms, especially among those adolescents who have a genetic predisposition toward schizophrenia
What are substance-induced disorders?
substance-specific syndromes caused by either the ingestion of a substance or their withdrawal DSM-5 recognizes 3 substance induced disorders: 1.) substance intoxication 2.)substance withdrawal 3.) substance-induced mental disorder
What does ecologically based prevention mean
target at-risk youths in everyday settings, such as schools and neighborhood community centers