Drugs and Alcohol Exam 2

alcohol prevalence in older adults

- 1-16% of older adults are at-risk or problem drinkers (Barry, 2016) - Differs with sampling approach, definition of older adults, definition of at-risk drinking - Alcohol use problems are the most common substance issue for older adults - May be less identified compared to younger groups - The same standard applied to different age groups - Less likely to self-report

prescription drug use and misuse

- 11% of older adults misuse/abuse medication - Many older adults take multiple medications for a long time - 4.2 prescription drugs in the past month in Wisconsin older adults aged 65 and over (SHOW, 2014-2015) - 25% of older adults use prescription psychoactive medications - Opioids (pain relievers) - Benzodiazapines, Barbituates (to treat anxiety and sleep disorders)

LGBT+ adults

- 15% of LGB adults had a substance use disorder in the last year (8% of heterosexual adults) - 37% of LGB adults had any form of mental illness in the past year (17% of heterosexual adults) - LGB adults more likely than heterosexual adults to seek out services (49% compared to43)

LGBTQIA youth

- 15% of the juvenile detention population but only 6% of the general population - 14.2% report being threatened or injured with a weapon on school property one or more times in the past month - 42.1% in a physical fight one or more times in the past month - 29.4% of LGBTQ students who report dating who reported being physically hurt on purpose by someone they were dating (compared to 6.9%) - 33.9% report being bullied

family SUD

- 26% of people in the United States grew up in a home with one or more parents with a substance use problem - In 2008 alone, 7.3 million - parent with alcohol problems, 2.1 million - parent with drug problems - Over 50% of adults have a close family member who has had problems with alcohol

Health Equity

- Absence of disparities in health between groups with different levels of social advantage or disadvantage - Wealth, power, prestige, or other forms of privilege

Biological issues with older adults

- According to the National Institute on Alcohol Abuse and Alcoholism, at-risk or problem drinking for older adults (aged 65+): - 1⁄2 or 1 drinks on a given day; 7 drinks per week (women) - 2 drinks on a given day; 14 drinks per week (men) - Lower limits for older adults because you metabolize things differently - Increased alcohol sensitivity in central nervous system - Less efficient liver metabolism - Decreased lean body mass - Decreased water in the body

ACE racial disparities

- African-American WI residents are more likely than White WI residents to have experienced ACEs - Youth Risk Behavior Survey (YRBS, 2013) - Students of color are at increased risk of attempting suicide - Hispanic or Latino students 2.6 times more likely than White peers to have attempted suicide - African-American students close to four times as likely than White students - This equates to one in six of all African-American school respondents

dependence within the family

- Alcohol dependence often exists within a dysfunctional family - Evidence suggests that dysfunctional relationships play a role in dependence, but they aren't the only factor

adolescent mental health

- An estimated 60% of adolescents (Howell, 2004) with mental health problems do not receive mental health services - Children and adolescents can have serious mental health challenges and/or SUD - Genetics can play a factor

marketing and branding

- As a whole, the alcohol industry spends in excess of $4.8 billion a year in the U.S. (or $13 million per day) - Milk only spends $70.5 million per year (roughly 1.5 percent) - The entire budget of the National Institute on Alcohol Abuse and Alcoholism in 2005 was $442 million (roughly 10 percent) - Twenty-five percent of the advertising budget is used to purchase mass media ads (known as measured media)

contributing factors in SUD in adolescence

- Availability: Neighborhood, Community, School - Use within peer group - Family environment - Violence - Physical or emotional abuse - Mental illness - Genetic vulnerability, Poor impulse control, High need for excitement - Depression, Anxiety, Attention Deficit Hyperactivity Disorder (ADHD) - Belief systems - Culture of believing it is cool or harmless

baby boomers

- Born between 1946-1964; turn 65 in 2011 - Greater rates of lifetime drug use - Multiple studies projected the increased rates of both licit and illicit drug use among older adults in 2020

early substance use

- Children and adolescents With psychiatric diagnosis: Higher likelihood of developing SUD later in life - Early substance use: Increased risk of psychiatric disorders (or accelerating the course)

co occurring disorders as a system

- Co-Occurring Center for Excellence (COCE), part of SAMHSA - Formed 2003 - Transmit advances in COD treatment - Guide enhancements in the infrastructure - Foster the infusion and adoption of Evidence-Based Treatment

continuity of care

- Consistent - Seamless - Coordinated - Specific settings SAMHSA is focused on: Criminal Justice System Homelessness Primary Care Veterans and Military Community

costs of drug use to society

- Deaths - Emergency room visits - Drugs in the workplace and lost productivity - Broken homes, illnesses, shorter lives, etc. - Cost of maintaining habit - Cost of criminal behavior - Cost of treating patients - Fetal alcohol syndrome

barrier with treatment

- Denial or lack of motivation to change (client) - Lack of expertise (treater) - Lack of fidelity (faithfulness) - Lack of continuity (communication) - Limited access - Poor treatment quality

treaters for co occurring disorders

- Developing intervention strategies - Managing disorders other than SUD - Limited ability of some to benefit from insight-oriented treatment - Case management concerns - Training and continuing education

protective factors

- Early detection - Early diagnosis in childhood of ADHD lowers SUD risk - Early treatment of SUD lowers risk of psychiatric diagnosis

ways to reduce stigma

- Educate those who control resources and provide services - Advocate for policy changes - Increase contact with people who have struggled with addiction - Increase understanding of addiction - Education about addiction treatment and successes

ways to help screening and treatment

- Empowerment focused - Deconstruct ageism; Nonjudgmental language - Involvement of family or significant others, if the older adult desires - Age-appropriate components - Be sensitive to the other aging-related health issues - Might include coping with losses and/or rebuilding support network - Linkage with other services (e.g. transportation, physical & cognitive accommodations)

factors for LGBT+ use

- Familial aspects of identity development can cause undue stress on LGBTQ+ youth - Family stress coupled with exposure to heterosexism, unfair treatment can lead to substance use

family involvement in treatment

- Family involvement is clearly better than helping the individual alone - Critical to many aspects of treatment & recovery - Getting the loved one into treatment - Helping with the assessment - Healing in family sessions - Helping the loved one monitor difficulties, successes, and an overall change plan

how does trauma work biologically

- General neurological function and myelination - Activation of the (Limbic)-Hypothalamic-Pituitary- Adrenal Axis, HPA or LHPA axis, Limbic System - The limbic system supports a variety of functions including adrenaline flow, emotion, behavior, motivation, long-term memory, and olfaction. Emotional life is largely housed in the limbic system, and it has a great deal to do with the formation of memories .

Alcohol and pregnancy

- Growth deficiencies - Craniofacial abnormalities - Intellectual disability - Attention deficits - Hyperactivity - Impaired motor development

consumer effects

- Higher rates of homelessness - Higher rates of incarceration - Higher rates of health issues - As many as 6 in 10 with SUD have a MH diagnosis - Affects treatment effectiveness

pituitary gland

- Hormones secreted from the pituitary gland help control: growth, blood, pressure,certain functions of the sex organs,thyroid glands and metabolism as well as some aspects of pregnancy, childbirth, nursing,water/salt concentration and the kidneys, temperature regulation and pain relief.

statistics on co occurring disorders

- In 2004, 4 million individuals met criteria for diagnosable MH and SUD - In 2002, 23.2% of those with diagnosable MH dependent on or abused alcohol/illicit drugs - Adults without SMI, 8.2% - In 2002, 20.4% of those with SUD also had diagnosable MH - Adults without SUD, 7% - Both rates of MH and SUD diagnoses on the rise - Workforce limitations have not kept up

marketing in australia

- In December 2012, tobacco packaging required to cover 75% of the front surface of the pack and 90% of the back surface with pictorial health warnings - In November 2011, Australia became the first country in the world to pass plain packaging regulations. - Tobacco products required to be sold in dull, brown packages - No company logos - Australia prohibits the terms "light" and "mild" from appearing on packages.

opioids and pregnancy

- Include prescription pain meds (oxy,hydrocodone, morphine) and heroin - Fetal/childhood effects - No physical deformities - Possible cognitive/behavioral issues - Lower verbal, math, reading abilities (age 3)

improvements to care

- Increase treatment options - Lengthen treatment - Provide residential options: Thresholds, Oxford House, Jessie Crawford Recovery Center - Improve quality of life (case management) - - Support network for treaters (?) - the longer the less likely for relapse

LGBT+ teens

- LGBTQ+ teens may be 2x more likely to be bullied, excluded, or assaulted at school - Nearly 40% less likely to have an adult in their family to whom they can turn - May be 2x as likely to experiment with drugs and alcohol - 1.3x heavy alcohol use, 1.6x marijuana use, 2.9x IV drug use, 3.3 cocaine use

structural stigma

- Lack of healthcare and insurance coverage - Affordable Care Act-Currently in jeopardy - Drug convictions and restriction of student financial aid - Restriction of housing, employment, nutrition, and other benefits assistance

policies on pregnancy and SUD

- Legal substances (tobacco and alcohol) may cause more harm than many illegal substances (cocaine, cannabis, etc.) - Unintended adverse consequences of punitive and mandatory reporting policies, Example: if use by pregnant women, reluctance to seek prenatal care - 15 states consider substance use during pregnancy to be child abuse under child welfare statutes (civil, not criminal) - Incarceration does not affect drug use rates - Reporting requirements in this setting create adversarial relationship between patient and professional - Deters women from seeking prenatal care

social risk factors in older adults

- Loss (status, people, vocation, health, etc.) - Social isolation, loneliness - Major financial problems - Changes in living/care situations

risk factors

- Lower socioeconomic status (SES) - Military veterans - Those with more general medical illnesses - Research has clearly demonstrated that SUD treatment of those with co-occurring disorders can be beneficial

Paper triggers

- Madison's Trauma Informed Care Advisory Council purchased copies that have been donated to Madison Public Library - Following six students over the course of a school year - New approach to discipline: one based on understanding and treatment rather than judgment and suspension. - Striving for equitable treatment of youth

social stigma

- Many people support public restrictions against people who struggle with SUD - Those with SUD are:, Unpredictable, Dangerous, Irresponsible, Bad character, At fault for their own struggles - Attitudes against those dealing with SUD are worse than those with other MH issues - No evidence that increasing stigma will stop people from beginning or continuing to use alcohol and drugs in unhealthy ways

youth PTSD

- May put events of trauma in wrong order - have not fully developed brain - May believe there were signs that this trauma was going to happen - Egocentric behavior - Could then become hypervigilant to watch for signs of potential future trauma - May show signs of PTSD in their play and/or daily lives - For Teens more likely than younger children or adults to show impulsive and aggressive behaviors

alcohol and medication

- Most older adults take 1+ medications that interact with and intensify the effects of alcohols (~88% in 2011) ~ 20% take both alcohols & medications - Complications of using alcohols esp. when mixed with medications - Higher risks of falls (losing balance), serious injuries, and even death - Mixing with psychoactive medications are particularly dangerous

marijuana and pregnancy

- No fetal growth effects - No physical abnormalities - Subtle withdrawal (autonomic,state regulation) - Daily use greater than 1 joint/day associated w/some subtle academic deficits (reading, spelling), but no impact on IQ - Adolescent depression (?)

views of alcohol industry

- Normalize and encourage the focus of alcohol consumption of alcohol - Minimize government checks and regulation on their ability to market, advertise, and distribute - maximize control laws on consumer rather than corporate for harm resulting from alcohol use - Minimize taxes and law violation penalties on the sale of their product - Distance themselves and their product from the problems associated with its use - obscure and misrepresent the causes and effects of those problems in general

opioids and neonatal abstinence syndrome

- Not clearly related to dose - Onset 48-72 hours & some symptoms last weeks - Excessive crying and irritability, Erratic sleep, startle, - continuous Tremor, Yawning, Vomiting, Sneezing, Poor feeding, seizure

ageism

- Overlooked by healthcare professionals, families and friends - Unspoken assumptions - "It's not worth treating older adults for substance use disorders" - "Waste of health care resources" - "You can't teach an old dog new tricks" - Might be confused with changes associated with aging - "Well, they always liked to drink... and now they are just getting older" (after fall at family gathering)

PTSD

- PTSD may develop after a person is exposed to one or more traumatic events, such as major stress, sexual assault, terrorism, or other threats on a person's life - The diagnosis may be given when a group of symptoms, such as disturbing recurring flashbacks, - avoidance or numbing of memories of the event, - and hyperarousal, continue for more than a month after the occurrence of a traumatic event

influences on use

- Peers more important in predicting marijuana use - Parental influences more important with illicit and other drug use - Early stages of use - parental behaviors important - Later stages - quality of relationship important - Depression and lack of closeness associated with progression to marijuana and other drug use - sud and mental health coincide

Tobacco and Pregnancy

- Placental abruption - Intrauterine death - Decreased birth weight - Preterm labor/delivery - Increased risk of SIDS(sudden death) - Hyperactivity - Anti-social behavior, conduct disorder, Learning disabilities and lower IQ

health disparities

- Population-specific differences in the presence of disease, health outcomes, or access to (quality) health care - Often result from systemic, avoidable, and unjust social and economic policies and practices

Minority Stress Model

- Prejudiced events, Perceived stigma, Internalized oppression - Empirical evidence indicates this model is valid to explain disparities in mental health and substance use outcomes experienced by persons of color, LGBTQ+ persons, and women

strategies for interventions

- Prevention and education integrated into primary care/social service setting - Group-based approaches - Mobile health approaches - Esp. for those who are homebound or have mobility limitations - Less stigma

how to reduce disparities

- Prevention in a bio-psycho-social manner - Increasing protective factors and treatment - Early social development/systems contact in schools

does punishment help?

- Principle - people engage in criminal acts because crime pays - Therefore,to reduce crime,increase the costs of crime to the criminal - However, if the type and severity of official punishment has any effect on recidivism, it appears less is better than more

individual stigma/ internalized

- Reduced help seeking - Lower rates of recovery - Less perceive social support and more isolation - More depression and anxiety symptoms

prejudice events

- Rejection, discrimination, and violence - Minority stress model: Experiences of these events - Can include positive prejudice - Continue to create a sense of separation (us/them) - impact is greater than intent

adrenal glands

- Release Cortisol (stress hormone) - functions include regulation of glycogen and lipid metabolism and immune system suppression

trauma effect on SES

- Research finds that PTSD has negative consequences for income and employment - Individuals with untreated PTSD had significantly lower long-term income and employment rates than those receiving treatment - Research finds that declines in academic attainment are common after exposure to or experience of violence - Abused and neglected children showed significantly lower levels of academic attainment in adulthood

LGBT specialized programs argument

- Safe place to talk about all aspects of life - All counselors and other clients are familiar with stressors - Experience addressing the needs that substance use fills in the LGBTQ+ community - Understands the coming out process and its potential relationship to substance use - Understands conflicts with religion

HBO series addiction

- Saturday night in a Dallas ER - Highlights the societal and medical implications of substance use - perceptions of doctors tend to be extremes - they see the drugs as causing all of the problems

LGBTQIA Integrated

- Separate programs may reinforce alienation - Integrated treatment corresponds to "real world" - Healing for LGBTQ+ clients to receive social approval from "real world" individuals and witness ally behavior

LGBT integrated arguments

- Separate programs may reinforce alienation from the rest of society - Integrated treatment corresponds to the complexity of the "real world" and may prepare clients for those hardships -Healing for LGBTQ+ clients to receive social approval from non-LGBTQ+ persons; witness ally behavior

ACE's

- Serious childhood traumas that result in toxic stress that can harm a child's brain. - This may prevent the child from learning, from playing in a healthy way with other children, and can result in long-term health problems - Can have a serious effect on one's health - Frequent or prolonged exposure to ACEs can create toxic stress which can damage the developing brain of a child and affect overall health - study showed 64% have at least one

overlapping genetic vulnerabilities

- Several regions of the human genome have been linked to increased risk of both drug use disorders and mental illness - Involvement of similar brain regions

family member experiences

- Shame - Own mental health is affected - Addiction can push the family apart, but it can also bring them together - Family support or pressure is cited as the most common reason the loved one overcame their addiction

barriers to screening and treatment in older adults

- Society: Stigma, negative bias to older persons (Ageism) - Older adults: Being reluctant to report; masking presentation of abuse symptoms via somatic symptoms - Lack of awareness of severity by older adults and family members - Alcohol use is their "one last pleasure" - Foreshortened sense of future

overlapping environmental triggers

- Stress - Trauma - Early exposure - Use disorders and other mental illnesses are developmental disorders - Meaning they begin in the teen years or even younger - Typically use and first signs of MH issues occur in adolescence

trauma for adolescents

- Stress and trauma have a cumulative effect - ACEs study - Trauma is carried throughout the body, Including how our genes are expressed and read - it is subjective

co occurring disorders

- Substance Use Disorders are a mental illness - - Resulting behaviors from an SUD are very similar to hallmarks of other mental illnesses - Self-medication - Depressed patient using marijuana to numb the pain - Suffering from social anxiety and drinking to feel more comfortable in social situations - Someone who struggles with panic attacks and takes Xanax to calm the symptoms - stigmatization within the community

SUD and pregnancy

- Substance use during pregnancy is common (tobacco is most used and then alcohol) - Associated with adverse maternal and fetal outcomes - Associated with childhood environmental risk - Associated with developmental issues in childhood

Wisconsin statute: children's code

- Substance use in pregnancy not defined as unborn child abuse in Wisconsin - Reporting of substance use is not mandatory - Required reporting in other states

protective factors for older adults

- Supportive family and other social supports (esp. late-onset abuse) - More screening opportunities by a primary care physician - Early intervention and access to services - Compared to younger cohorts, better treatment outcomes due to longer duration of care and more use of self-help

family coping strategies

- Tolerant coping: Putting up with the problem - Engaged coping: Standing up to the problem - Withdrawal coping: Withdrawing from the problem and gaining independence

lifetime/early onset drinking

- Use began <50 yrs - Have used services for years

late onset drinking

- Use began >50 yrs - Usually being healthier and having more social support - Have begun using alcohol to cope with loss/negative life events in later life - Have shown better treatment outcomes (e.g. completion of treatment, recovery)

Racial disparities in Juvie

- Vast majority of WI youth identify as non-Hispanic White - Minorities are disproportionately represented in the WI JJ system - African-American, Hispanic, Southeast Asian, and Native American (order of prevalence). - 60% of juvenile detentions in 2013 were youth of color - 47% of total detentions were youth identifying as African-American - White non- Hispanic youth are more likely to be filtered out of the juvenile correction system, while African-American and American Indian youth are more likely to be filtered in

why are drugs regulated

- We want to protect society from the dangers of some types of drug use - Legitimate social purpose - Some laws are not developed as part of a rationally devised plan, and may not be realistic or effective - Many current laws

policy on alcohol in wisco

- Wisconsin's rates of alcohol use and misuse have been among the highest - if not the highest - in the nation. - politically, one of the most visible for years - Relative to other states, alcohol is our "worst" problem - It is legal to obtain - Two other most deadly substances, tobacco and prescription opioids, are also legal to obtain - Prevention strategies used with alcohol can be extrapolated to other substances as well - Wisconsin is a county-run system

hippocampus

- chronic stress changes this - part of the Limbic system - Thought to be instrumental part of inhibitory control, memory, and spatial abilities. - Those with an altered hippocampus tend to be hyperactive, often have difficulty learning to inhibit responses that they have previously been taught, especially if the response requires remaining quiet as in a passive avoidance test. - Patient H.M. had his hippocampus destroyed in surgery, resulted in amnesia

physical and mental risk factors for older adults

- complex medical issues - Sensory deficits - Reduced mobility - Cognitive impairments - Impaired self-care - Chronic Pain - Psychiatric symptoms, mental disorders (depression)

risk factors in mental health adolescence

- family members living with conditions - Co-occurring conditions - Trauma - Issues with sexual identity - In juvenile justice system - Low socio-economic status (SES)

protective factors in mental health for adolescence

- family stability - Higher socio-economic status (SES) - Supportive relationships from natural supports

sexually abused children

- fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on them, low self-worth, and not being able to trust others - Behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol

Capitalizing on external pressures

- legal involvement (drug courts, family therapy), trying to get momentum - shouldn't be the only thing that motivates them because it can be removed

hypothalamus

- located below the thalamus,just above the brainstem - stimulates or inhibits the secretion of pituitary hormones - controls body temperature,hunger,important aspects of parenting and attachment behaviors, thirst, fatigue, sleep, and circadian rhythms.

stigma

- negative, socially-constructed identities which reduce an individual from a whole and usual person to a tainted, discounted one - Perceived stigma: vigilance maintained towards expectations of rejection, discrimination, and violence - if you always have trauma than your stress levels are always on

the invisible epidemic

- older adults and substance abuse - Less likely to be in the workforce or in trouble with the law - May be homebound - Cohort effects - Stigma - Hesitant to ask for help

LGBTQIA Specialization

- safe place to talk about all aspects of life - All counselors and other clients are familiar with stressors - Experience addressing the needs that substance use fill in the LGBTQ+ community - Understands the coming out process and its potential relationship to substance use - Understands conflicts with religion

sports marketing

- sponsorships of professional and collegiate sports, concerts, community events and groups, educational and art institutes - Product tie-ins such as clothing and recreational paraphernalia, product placement in movies and TV - Special contests

risks of heavy alcohol use

- stroke (with Overuse) - Impaired motor skills (e.g., driving) with low level use - Falls and other injuries - Cognitive dysfunction and dementia - Suicide - Low intake (no more than one drink per day) was associated with improved cognitive and physical functioning

ethnographic research

- study of people in their own environment - Participant observation: "...participation in daily lives...with simultaneous observation..." (Carlson, 2006)

6 principles of samhsa

1) employ a recovery perspective 2) adopt a multi problem viewpoint 3) develop a phased approach to treatment 4) address specific real life problems early in treatment 5) plan for the client's cognitive and functional impairments 6) use support systems to maintain and extend treatment effectiveness.

racial disparities in arrests

2005 - approximately 1.5 million men in state and federal prisons - 40% Black (~12%) - 35% White (~72%) - 20% Latino (~15%) More likely to be incarcerated for drugs - Black, 5.6x more likely than White - Latino 1.8x more likely than White

personal responsibility model

A failure of self-control

race disparities in drug use

African Americans ages 12 to 20 past-month alcohol use - 17.3% compared to national average of 22.8% - Past-month underage binge drinking - 8.5% compared to national average of 13.8% - Natives - of the highest rates of SUD and MH disorders compared to other racial or ethnic groups, higher suicide rates - Asians have lowest rates of binge drinking

contributing factors for SUD in adolescents

Availability Neighborhood Community School Use within peer group Family environment Violence Physical or emotional abuse Mental illness Drug use

Root of these disparities

Bullying and harassment Family conflict and rejection minority stress Childhood abuse LGBTQ+ children are targeted for physical and sexual abuse at higher rates than non-LGBTQ+ identifying children

assessment

Clinical interview - Substances - History - Consequences - Co-morbidity (medical and psychiatric) - Readiness to change - Environment (housing, support, financial) Available resources this is different than screening

other stimulants and pregnancy

Cocaine - Reduced placental blood flow --> abruption, preterm - labor/delivery, intrauterine growth retardation (IUGR), No physical abnormalities - Mild behavioral issues (?) - Subtle attention deficits, impulsivity - Likely ameliorated by appropriate care/environment Methamphetamine - Limited knowledge/studies - Low birth weight, increased stress, decreased achievement Amphetamines for ADHD à no known effects

CAGE-AID

Cut down,Annoyed,Guilty,Eye-opener

peer influence

For most LGBTQ+ teens, their LGBTQ+ friends are a crucial source of support However, they are looking for support from a demographic statistically more likely to use

gender stereotypes

Gender non-conforming - someone who acts or appears in ways that defy gender expectations Some evidence that being GNC is a risk factor for adolescent substance use and abuse

Miller - Public Health perspective

Includes all etiologies of addiction - A holistic view - 3 categories of causal factors: The agent, The host, The environment

complications with injection drug use

Infectious complications - HIV - Hepatitis - Cutaneous infections - Endocarditis

Chasing the Scream - TED

Johann Hari - "almost everything we know about addiction is wrong" - experiment of rats in cage - difference between rats in an empty cage and rats in rat park - addiction is an adaptation to environment - Portugal has decriminalized drugs - spend the money on reconnecting them to society, injecting drug use is down - disconnection is a major driver of addiction - intervention strategies threaten to disconnect even more as a threat which can be even worse. - he seemed to brush off the idea of the chemical hooks when we should be thinking of it as a both and situation.

ethnographic perspective

Not always plausible to have immersive experience Value of peer specialists Importance of empathy

Dispositional model

Places control on the individual, though not a failure of self control the disease model - they cant help themselves

screening

Screen ≠ diagnosis Remember what you are screening for

Agent Model

The drug itself is responsible

tobacco and other disorders

Those with MH diagnosis: - 2x as likely to smoke - 28% of population - Consume 44% of all cigarettes smoked Those with schizophrenia diagnosis - 75-95% smoke - Controlling symptoms of schizophrenia reduces smoking intensity and nicotine addiction

T-ACE

Tolerance - How many drinks before you feel high? Greater than 3 is positive Annoyed - Have you been annoyed by people criticizing your drinking? Cutdown - Have you felt you need to cut down on your drinking? Eye opener - Have you had a drink in the morning to calm nerves? 2+ is positive

TWEAK

Tolerance Worry - Have others worried about your drinking? Eye opener Amnesia - Have you blacked out when drinking? Kutdown - 2+ tries is positive

Justified Anger

Vision statement - The Greater Madison community will become a place where African American children, adults and families thrive and succeed personally and professionally, and feel valued. Mission statement - To eliminate racial disparities and create opportunities that empower the African American community to achieve its full potential and prosper.

benefits and risks of specialized approach

benefits: easier for people to connect, people respond to who they look like, minority stress model Risks: bias of power, all minorities are worse off being pushed into a label or specified group

Maia - journalist

drug policy based in racism harm reduction - what policy will most reduce the harm related to drugs, focusing on harm rather than moral issues punishment doesn't fix addiction, just stigmatizes people The opioid epidemic only became an epidemic when it became a issue with the Chinese, White people had been using it.

motivational interviewing

helping people find the motivation to change - also use harm reduction strategies - help the person think about the role that substances play in their life - offer the person a chance to learn more about substances - how they interact with mental illnesses and medication - how to discuss their own use

Social Learning Model/ Sociocultural Model

identify people by different culture

racism and the war on drugs

it is about who was perceived to use these drugs media reporting these as facts white people knew that if they criminalized a vice that was used by a minority pop. the laws would not be enforced toward them. not science based, based in how people feel

babies in the river

public health should be about preventing disease than simply treating it.