SW 453 Exam 2

TWEAK

-Tolerance -Worry (others worried about drinking) -Eye Opener -Amnesia (blacked out when drinking) -Kut down (2+ is positive)

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?) -Cut down (felt need to cut down on drinking?) -Eye opener (drink in morning to calm nerves? 2+ is positive)

Contributing factors to SUD in adolescence

-availability (neighborhood, community, school) -use within peer group -family environment (violence, physical/emotional abuse, mental illness, drug use) -genetic vulnerability (personality traits-->poor impulse control, high need for excitement) -mental health conditions (depression, anxiety, ADHD) -belief systems (culture of believing it's cool or harmless) -estimated 60% of adolescents with mental health problems do not receive mental health services -genetics can play a factor (both risk and protective factors)

intervention strategy

-coping skills -self-efficacy -living skills -symptom management -practical support (housing, work) -social support

barriers

-denial or lack of motivation to change (client) -lack of expertise (treater)-->lack of fidelity -system: lack of continuity (communication), limited access, poor treatment quality

Psychological reactions

-difficulty concentrating, slowed thinking, difficulty making decisions -confusion, difficulty with figures, blaming self or others, poor attention span, disorientation, memory difficulties, nightmares, suspiciousness

Social determinants of health

-economic stability -education -social and community context -health and health care -neighborhood and built environment

Alcohol use during pregnancy

-growth deficiencies -craniofacial abnormalities -intellectual disability -attention deficits -hyperactivity -impaired motor development

Things a clinician/treatment team provide

-help person think about role that substances play in their life -offer person a chance to learn more about substances -help person become involved with supported employment and other services that may help recovery process -help person identify and develop recovery goals -provide special counseling specifically designed for people with dual disorders

suggested improvements

-increase treatment options -lengthen treatment -provide residential options -improve quality of life (case management) -support network for treaters?

YWCA Racial Justice Initiative

-intercultural competence -deconstructing racism -creating equitable organizations -exploring privilege

other effects of trauma on youth

-much of what is known about the effects of trauma on children comes from research on child sexual abuse •sexually abused children often have problems with: -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

Marijuana use during pregnancy

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

viewpoint of alcohol industry

-normalize and encourage the consumption of alcohol -minimize gov't checks and regulation on their ability to market, advertise, and distribute -minimize taxes and law violation penalties on the sale of their products -maximize the focus of alcohol control laws on consumer rather than corporate for harm resulting from alcohol use -distance themselves and their product from the problems associated with its use -obscure and misrepresent the causes and effects of those problems in general

common factors of co-occurring disorders

-overlapping genetic vulnerabilities -involvement of similar brain regions -overlapping environmental triggers (stress, trauma, early exposure) -use disorders and other mental illnesses are developmental disorders (meaning they begin in teen years or even younger) -typical use and first signs of MH issues occur in adolescence

Tobacco use during pregnancy

-placental abruption -intrauterine death -decreased birth weight -preterm labor -increased risk of SIDS (sudden infant death syndrome) -hyperactivity -anti-social behavior -learning disabilities and lower IQ

Six key principles of a trauma-informed approach

-safety -trustworthiness and transparency -peer support -collaboration and mutuality -empowerment, voice, and choice -cultural, historical, and gender issues

Emotional reactions

-shock/misbelief, grief, guilt/shame, depression, hopelessness, feeling lost/abandoned, difficulty trusting, increased need for control, mood swings

Wisconsin Statute 48.981: Children's Code

-substance use in pregnancy NOT defined as unborn child abuse in Wisconsin -reporting of substance use is NOT mandatory

Reasons adolescents take drugs

-to fit in -to feel good/better -to do better -to experiment

issues for local and state regulators

1 - national or international businesses are more difficult to work with because their head office or management is out of state in or another country 2 - foreign-owned businesses have no history with the US's unique style of alcohol regulation 3 - small operators - usually in the wine and microbrewery business - are generally responsible operators. they are usually more focused on quality of their product, not quantity of consumption. However, they usually struggle against these larger corporations 4 - associations of licensees are often powerful political forces. since their members have families that live in local communities, they are usually careful not to advocate for something that would clearly offend or be a danger to our communities. typically easier to work within a typical "give and take" arena of politics

6 guiding principles in treating COD (Co-Occurring Disorders)

1) employ 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 client's cognitive and functional impairments 6) use support system to maintain and extend treatment effectiveness

"Social"

Adverse Childhood Experiences (ACE): serious childhood traumas that result in toxic stress that can harm a child's brain (may prevent child from learning, playing in healthy way with other children, and can result in long-term health problems) -can have 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 ACEs can include: emotional/physical/sexual abuse, emotional/physical neglect, mother treated violently, household substance abuse, household mental illness, divorce, bullying by another child or adult, racism/sexism, being homeless, natural disasters or war -physical abuse and emotional neglect lead in terms of children who experience specific ACE

National Information: LGBTQ+ teens

LGBTQ+ teens may be 2x more likely to be bullied, excluded, or assaulted at school -nearly 40% less likely to have adult in their family to whom they can turn to -may be 2x as likely to experiment with drugs or alcohol 15% of LGB adults had a substance use disorder in the past year (8% of heterosexual) 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 to 43%)

Health Equity

absence of disparities in health between groups with different levels of social advantage or disadvantage (wealth, power, prestige) •equality-->equal (same height box, though some shorter than others) •equity-->fair (give shorter person higher box, and taller person no box so everyone can see the field)

Specialized or Integrated Treatment?

arguments: LGBTQ+ specialized programs are better ->safe place to talk about all aspects of life, all counselors and other clients are familiar with stressors (understands the coming out process) arguments: integrated LGBTQ+ and non-LGBTQ+ programs are better ->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

Screening Assessment

clinical interview (substances, history, consequences, readiness to change) -->available resources

Co-occurring disorders: Treaters

critical points: developing intervention strategies, manage disorders other than SUD, training and continuing education, limited ability of some to benefit from insight-oriented treatment -both rates of MH and SUD diagnoses on the rise -->workforce limitations have not kept up -directly treat the SUD issues along with the MH concerns (motivational interviewing, harm reduction)

Co-occurring disorders: System

critical points: differentiate mental health issues from SUD issues, need to coordinate between systems, stigma, competing for resources, strive for equitable treatment •Co-Occurring Center for Excellence (COCE), part of SAMHSA -purpose: transmit advances in COD treatment, guide enhancements in infrastructure, and foster the infusion and adoption of Evidence-Based Treatment -ensure a continuity of care (consistent, seamless, coordinated) -specific settings SAMHSA is focused on: Criminal Justice System, Homelessness, Primary Care, Veterans and Military Community

CAGE-AID

drinking and drug use -Cut down -Annoyed -Guilty -Eye opener

3 ways we don't want to lead

drinking rates - WI has some of the highest rates in the nation of: underage drinking, binge drinking, chronic/heavy drinking drinking and driving - our adult drinking and driving rates are double the national average, resulting in higher WI deaths and injury rates arrests and citations - our liquor law violations are three times the national average while disorderly conducts arrests total five times the national rate annual economic cost of excessive alcohol use in WI = $6.8 Billion

Eye Movement Desensitization and Reprocessing (EMDR)

emphasizes disturbing memories as the cause of psychopathology -aims to: process distressing memories, reduce lingering effects of said memories, allow clients to develop more adaptive coping mechanisms •eight-phase process including: -clients recalling distressing images while receiving bilateral sensory input (including side-to-side eye movement) -shown to be effective in children who have experienced trauma and complex trauma

Family Stress and LGBTQ+ Substance 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

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

Root of disparities?

identifying as LGBTQ+ DOES NOT CAUSE substance abuse (most likely a result of prejudice) -bullying and harassment -family conflict and rejection -minority stress -childhood abuse (LGBTQ+ are targeted for physical and sexual abuse at higher rates than non-LGBTQ+ identifying children)

Public Health Perspective

includes all etiologies of addiction -a holistic view •3 categories of causal factors (the agent, host, and environment)

injection drug use during pregnancy

infectious complications (HIV, Hepatitis, cutaneous infections, endocarditis)

legal and policy issues

legal substances (tobacco and alcohol) may cause more harm than many illegal substances (cocaine, cannabis) -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)

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

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 -diagnosis might be given when a group has symptoms such as: •disturbing recurring flashbacks •avoidance or numbing of memories of event •hyperarousal •continue for more than a month after the occurrence of a traumatic event

"Social" - Socioeconomic Status (SES)

measured as combination of education, income, and occupation -PTSD has negative consequences for income and employment -declines in academic attainment are common after exposure to or experience of violence

ethnographic perspective

not always plausible to have immerse experience -value of peer specialists -importance of empathy higher disparities-->higher likelihood of stress/trauma-->higher likelihood of SUD

"Bio"

physical reactions (what would you identify as physical reactions to stress/anxiety/trauma?) -sleep/appetite disturbance -fatigue, angry outbursts, withdrawal/isolation -nausea/upset stomach, decrease of humor, weakness, fainting •How does this work in your body? -general neurological function and myelination -activation of (Limbic)-Hypothalamic-Pituitary-Adrenal Axis (HPA or LHPA axis) -chronic stress/trauma have been shown to create physical changes in the hippocampus -->part of limbic system, thought to be instrumental part of inhibitory control, memory, and spatial abilities -those with 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

Health Disparities

population-specific differences in presence of disease, health outcomes, or access to (quality) health care -often results from systemic, avoidable, and unjust social and economic policies and practices

does punishment inhibit criminal behavior?

principle - people engage in criminal acts because crime pays -to reduce crime, increase the costs of crime to the criminal

Trauma Informed Care (TIC)

program, organization, or system that is trauma-informed: -realized the widespread impact of trauma and understands potential paths for recovery -recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system -responds by fully integrating knowledge about trauma into policies, procedures, and practices -seeks to actively resist re-traumatization •trauma-informed approach that can be implemented in any type of service setting •trauma-specific intervention programs generally recognize the following: -survivor's need to be respected, informed, connected, and hopeful regarding their own recovery -the interrelation between trauma and symptoms of trauma (substance abuse, eating disorders, depression, anxiety) -the need to work in a collaborative and empowering way with: survivors, family and friends of survivor, and other human service agencies

societal trend

racial disparity in prisons -more likely to be incarcerate for drugs (black 5.6x more likely than whites, Latino 1.8x more likely than whites) -lifetime projections to be sent to prison (1 in 3 black, 1 in 6 latino, 1 in 17 white)

why stigmatize?

reinforce norms, keep people away, reinforce social hierarchy, concepts (labeling, stereotyping, separation, status loss and discrimination)

prejudiced 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) stigma •Ancient Greece: literally to mark or brand people who were criminals, traitors, or those who had been enslaved •today: 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 stigma and prejudice are stressful

Adrenal Glands

release cortisol (stress hormone), functions include regulation of glycogen and lipid metabolism and immune system suppression

stigma

set of negative and often unfair beliefs that a society or group of people have about something (creates negative, socially-constructed identities) -->reduces an individual to a label rather than an individual

co-occurring disorders: consumers

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 critical points: 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 tobacco smoking: those with MH diagnosis: 2x as likely to smoke, 28% of population, consume 44% of all cigarettes smoked connection with SUD and MH not fully understood (each can contribute to the other) -->children and adolescence: with psychiatric diagnosis, higher likelihood of developing SUD later in life (early substance use-->increased risk of psychiatric disorders •research continuing to try to find causation (data analysis, neuroimaging, genotyping) -protective factors: early detection (early diagnosis in childhood of ADHD lowers SUD risk, early treatment of SUD lowers risk of psychiatric diagnosis) -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

Limbic System

supports adrenaline flow, emotion, behavior, motivation, long-term memory (emotional life largely housed in limbic system, and great deal to do with formation of memories)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

systematic, evidence-based treatment for traumatized children and their families -most effective approach for treating children aspects of TF-CBT: -child may talk about memory of trauma -TF-CBT helps lower worry and stress -child may learn how to assert themselves -learn to change thoughts/beliefs about the trauma that aren't true -child can be taught at their own pace, and can learn they do not have to be afraid of their memories

Play Therapy

used for young children with PTSD who are not able to deal with the trauma more directly -uses games, drawings, and other methods to help children process traumatic memories

trauma

used to describe experiences or situations that are emotionally painful and distressing, and that overwhelm people's ability to cope, leaving them powerless -reference to circumstances that are outside the realm of normal human experience (doesn't always hold true) -for some groups, trauma can occur frequently and become part of the common human experience "overwhelm the ordinary human adaptations to life"

Psychological First Aid (PFA)

used with school-aged children and teens that have been through violence where they live -can be used in schools and traditional settings -provides: comfort, support, help children know their reactions/feelings are normal, teaches calming and problem solving skills, also helps caregivers manage changes in their child

"Social" - Disparities in diversity

vast majority of WI youth identify as non-Hispanic white -minorities are disproportionately represented in the WI JJ system (AA, Hispanic, Southeast Asian, and Native American in order) -one can conclude that 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 •ACE disparities - African-American WI residents are more likely than White WI residents to have experienced ACEs

addiction stigma

we learn stereotypes about SUD and MH as we grow -negative representation in media ("perceived stigma"), innocuous (harmless) for people without problems --->results in concealment, secrecy, and social withdrawal

why we regulate drugs

we want to protect society from the dangers of some types of drug use (legitimate social purpose)

Minority Stress Model

when disparities exist, how might unique stressors explain them? -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+ person, and women

policy focus: alcohol

why focus primarily on alcohol? -Wisconsin's rates of alcohol use and misuse have been among the highest - if not the highest - in the nation -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 -WI is a county-run system

LGBTQ+ Disparities

•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 •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

What can be done? (to stop use during pregnancy)

•Screening: tobacco, alcohol (T-ACE, TWEAK), other drugs (DAST-10, CAGE-AID) -screening DOES NOT EQUAL diagnosis

stigma's affect on environment

•Structural: lack of healthcare and insurance coverage -drug convictions and restriction of student financial aid -restriction of housing, employment, nutrition, and other benefits assistance •Social: many people support public restrictions against people who struggle with SUD -->social attitudes - those with SUD are: unpredictable, dangerous, irresponsible, at fault for own struggles, attitudes worse than towards those with other MH issues •Individual: internalized stigma -in research we see: reduced help seeking, lower rates of recovery, less perceived social support and more isolation, more depression and anxiety symptoms -->no evidence that increasing stigma will stop people from beginning or continuing to use alcohol and drugs in unhealthy ways

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

SUD in adolescents: contributing factors

•availability (neighborhood, community, school) •use within peer group •family environment (violence, physical/emotional abuse, mental illness, drug use)

stimulants use during pregnancy

•cocaine: reduced placental blood flow (abruption), preterm delivery, intrauterine growth retardation (IUGR), no physical abnormalities, mild behavioral issues (subtle attention deficits) •meth: limited knowledge/studies, low birth weight, increased stress, decreased achievement •amphetamines for ADHD-->no known effects •opioids: include prescription pain meds (oxy, morphine) and heroin --> no physical deformities, possible cognitive/behavioral issues (age 3, lower verbal, math, reading abilities) -->neonatal abstinence syndrome: not clearly related to dose, onset 48-72 hours and some symptoms last weeks, features: excessive crying and irritability, erratic sleep, startle, yawning, vomiting, sneezing, seizure

Etiologies of addiction

•personal responsibility model: failure of self-control •agent model: drug itself is responsible •dispositional model: places control on the individual, though not a fault of self control (ex-->disease model) •social learning model •sociocultural model

adolescent mental health and SUD

•risk factors: family members living with conditions, co-occurring conditions, trauma, issues with sexual identity, in juvenile justice system, low socio-economic status •protective factors: family stability, higher socio-economic status, supportive relationship from natural supports

what PTSD looks like in youth

•school-aged children (age 5-12) -may put events of trauma in wrong order -may believe there were signs that this trauma was going to happen (egocentric behavior) -may show signs of PTSD in their play and/or daily lives •Teens (ages 12-18) -more likely than younger children or adults to show impulsive and aggressive behavior -similar to normal definition of PTSD

interventions to reduce stigma

•structural stigma - educate those who control resources and provide services, advocate for policy changes •social stigma - increase contact with people who have struggled with addiction, increase understanding of addiction •education about addiction treatment and successes

family coping responses to substance use

•tolerant coping - putting up with the problem •engaged coping - standing up to the problem •withdrawal coping - withdrawing from the problem and gaining independence -family involvement is clearly better than helping individual alone -family support or pressure is cited as most common reason the loved one overcame their addiction -addiction can push family apart, but can also bring them together