Addictive Final Exam

What are common eating disorders?

Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.

Differential Susceptibility of Media Effects.....

(DSMM)The effects of media is dependent on personal characteristics (e.g., gender and personality).

MICA - Mentally Ill Chemical Abuser

(Don't use this term as much) Generally refers to the chronically mentally ill, including those with schizophrenia, schizoaffective disorder, bipolar disorder, and severe personality disorders. -Risk of abuse goes up for these difficult to treat serious disorders

Common Treatment Goals

(Identify situations where each of these would apply) -Prevention of Initiation of Drug or Alcohol Use -Prevention of Progression from Use to Abuse or Dependence -Increase Motivation to Change Substance Use Behaviors -Abstinence or Reduction of Drug or Alcohol Use -Reduction of Related Consequences (Harm Reduction) -Increase Functioning in other areas of life -Relapse Prevention (Goals really depend on individual and their individual needs)

Addiction and Self Harm

(Video), Addiction symptoms- "urges, cravings, tolerance, persistent efforts to cut back" etc. & severity categories on table- " None, mild moderate severe". Addiction language- "clean" "relapse" "recovery" etc.

Way of Explaining Motivational Interviewing/ Introducing the Session

(non-judgemental, trying to empower client. all things client has told therapist. Not in trouble. Just here to have a conversation, you will get more out of this if you are open & honest) What we are going to do for the next hour is have a conversation about your experiences with alcohol. And I'm going to provide some information. Some of it may be familiar to you already but some of it will probably be new. What we have found is that more informed drinkers tend to make wiser choices when it comes to their drinking. So hopefully some of this conversation will be interesting to you and what you do with it after today is up to you. OK?And you should know that I am not going to tell you what to do about your drinking. Obviously you know yourself the best, so you know what works for you.I've prepared a guide to structure our discussion today. It is all based on the questionnaires that you filled out last week. Any questions before we get started?

#1 medication strategy for alcohol

Antabuse. (Disulfram) If you mix antabuse with alcohol, you will get very sick, ever small amounts of alcohol.

Screening for drug addiction and eating disorders have a lot of similarities, so doctors look for

--Cravings, rituals, and obsession around an addictive behavior --Giving up other interests and friends to spend more time on an addictive behavior --Inability to stop the addictive or destructive behavior despite numerous attempts --Escalation in frequency or intensity over time --Continued use of substance or behavior despite negative consequences --Family members, friends or loved ones express concern about addictive behavior --Both drug addiction and eating disorders carry a high risk of relapse and require treatment and long-term therapy for best outcomes.

Principals of Effective Treatment

-No single treatment is appropriate for all individuals. -An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs. -Counseling and other behavioral therapies are critical components of effective treatment for addiction. -Medications are an important element of treatment for many patients. -Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.

What are the three main pathways that can contribute to the comorbidity between substance use disorders and mental illnesses

1) Common risk factors can contribute to both mental illness and substance use and addiction 2) Mental illness may contribute to substance use and addiction 3) Substance use and addiction can contribute to the development of mental illness.

Comorbidity

2 or more DISEASES or DISORDERS -General term from the medical literature referring to the presence of two or more diseases or disorders. Any time you have one you are more likely to have another diagnosis Ex. depression & anxiety. Hypertension and diabetes. .

Percentage of those with eating disorders who abuse substances

27% anorexia nervosa, 23% binge eating disorder, 37% bulimia nervosa.

Responding to a Positive Screen

A stepped care approach- 1) Public health programmes- primary prevention (signs you see- safe drinking prevention) alcohol problems= NONE 2) Simple brief interventions in generalist settings (alcohol screening/audit) alcohol problems= HAZARDOUS 3) extended brief interventions in generalist settings (brief advice in a doctor office alcohol problems= HARMFUL DRINKING 4) less-intensive treatment in generalist or specialist settings alcohol problems=MODERATELY DEPENDENT DRINKING 5) more intensive specialist treatment alcohol problems= SEVERELY DEPENDENT DRINKING

National Eating Disorders Association (video about comorbidity between eating disorders and substance abuse disorders)

According to the National Center on Addiction and Substance Abuse= 35% of individuals who abused or were dependent on alcohol or drugs have also had eating disorders a rate 11x higher than the general population. 50% of individuals with eating disorders abused alcohol or illicit drugs a rate 5x higher than the general population. Often once eating disorders subside, substance abuse increases. -- Genetics can be at play, but also ex. Stimulants can curb appetite and sequence an eating disorder like anorexia nervosa whether that be intentional or not. -- Positive attention from losing weight can stimulate an addiction if there are underlying issues around body image.

Pharmacotherapy for Alcoholism

Alcohol withdrawal can be fatal, and serious cases require medical treatment. Benzodiazepines are effective in treating several aspects of alcohol withdrawal, including seizures and Delirium Tremors. Acute phases, medication can be beneficial

What is Binge Eating Disorder?

Binge Eating Disorder is the most common eating disorder in the United States. It occurs when a person has recurrent episodes of binge eating, described as eating a quantity of food that is much higher than what a normal person would typically eat. In these episodes, patients typically feel a loss of control, eating until they are uncomfortable, and feeling shame and guilt afterwards. Contrary to Bulimia Nervosa, Binge eating disorder is not associated with purging or other unhealthy methods to "get rid" of the calories consumed during the binge.

Higher prevalence of smoking among patients with mental disorders

Bipolar disorder is 3x as likely to be a smoker vs. no mental illness. Impulsivity & sensation seeking. Current smokers are more likely to engage in sensation seeking. -- Cigarettes can give you initial boost of dopamine and relieve some symptoms of depression/ feel normal & not want to go through withdrawal. Smoking relieves stress and mental disorders increase stress.

Why is addiction treatment evaluated differently?

Both require ongoing care. "Does treatment work?" -relapsing occurs.

Other drugs for heroin dependence

Buprenorphine (Suboxone)- reduce cravings, and prevent users from getting high from heroin

Relapse Prevention/Cognitive Behavioral Therapy

CBT was developed for the treatment of problem drinking and adapted later for cocaine addicts. Based on the theory that learning processes play a critical role in the development of maladaptive behavioral patterns. Individuals learn to identify and correct problematic behaviors. Specific techniques include exploring the positive and negative consequences of continued use, self-monitoring to recognize drug cravings early on and to identify high-risk situations for use, and developing strategies for coping with and avoiding high-risk situations and the desire to use. A central element of this treatment is anticipating the problems patients are likely to meet and helping them develop effective coping strategies. No questions on Demo part 6 or 7

Feedback content across interventions (BMI)

Collecting data & providing feedback on your drinking. US norms, campus norms.

Eating Disorders as an addiction, The Three C's

Compulsive Use, Loss of Control, Continued use despite adverse consequences.

Symptoms & Effects of Antabuse

Disulfiram plus even small amounts of alcohol can produce:flushing, throbbing in head and neckthrobbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, hyperventilation, tachycardiamarked uneasiness, weakness, vertigo, blurred vision, confusion. In severe reactions, there may be:respiratory depression cardiovascular collapse, arrhythmias myocardial infarctioncongestive heart failure unconsciousness convulsions death  The duration of the reaction is variable, from 30 to 60 minutes in mild cases, up to several hours in more severe cases or as long as there is alcohol remaining in the blood. Removing positive incentive for drinking takes out all the fun and reducing chances of relapsing.

Substance use and addiction can contribute to the development of mental illness

Drug use often predates onset of mental illness ***Correlation does not equal Causation*** Sequencing can be there, but substance use could be related to ex. Environmental stress.

Most popular social media platforms in 2022

Facebook 2.91 billion (highest), youtube, WhatsApp, Instagram, WeChat, TikTok, Messenger, DuoYin, QQ, Sina Weibo (573 million)

Common risk factors can contribute to both mental illness and substance use and addiction

Genetic Vulnerability Epigenetics Brain regions Environmental influences/Stress/Trauma

Eating Disorder Treatment (Video)

How is this similar to substance use treatment? How is it different?

Advantages of stepped care

Individualized treatment Conserves resources Gradual intensification of treatment for non-responders increases contact with treatment providers Provides treatment of wide range of symptom severity Variety of available interventions

What are the main outcomes

Key Findings: Alcohol use... increased over time almost same for boys and girls higher when parental monitoring low correlated with SS and urgency SoMe use... increased over time correlated with SS and urgency Higher for girls and when parental monitoring low Alcohol use and SoMe correlated at all 4 time points

Social Learning Theory (SLT)

Learning new behaviors typically occurs through observation and imitation, by observing the consequences experienced by others, or by description and instruction.

Long-Term Residential Treatment

Long-term residential treatment provides care 24 hours a day, generally in non-hospital settings. The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months. TCs focus on the "resocialization" of the individual and use the program's entire community—including other residents, staff, and the social context—as active components of treatment. Addiction is viewed in the context of an individual's social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is highly structured and can be confrontational at times, with activities designed to help residents examine damaging beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others. Many TCs offer comprehensive services, which can include employment training and other support services, onsite. Research shows that TCs can be modified to treat individuals with special needs, including adolescents, women, homeless individuals, people with severe mental disorders, and individuals in the criminal justice system.

Environmental Strategies

Minimum Legal Drinking Age Price Alcohol Outlet Density Compliance Checks Responsible Beverage Service Keg Registration Campus Alcohol Bans Class Schedule Alcohol-Free and Alternative Activities Social Norm Marketing Campaigns

#1 medication for heroin/opiate

methadone. -long-lasting mu-opiod agonists. (heroin is short acting) -blocks effects of heroin, blocks opioid receptors

Naloxone vs. Naltexone

Naloxone= (Narcan) - reverse effects of an opioid overdose. Nasal injection. Immediately removes opioid drugs from receptors and reverses opioid overdose. Naltrexone= assists opioid addicts in recovery and prevents cravings. pill. attached opioid receptors in brain and prevent cravings.

Does correlation equal causation with drug use and mental illness?

No, not always. There is increase risk (cannabis increases risk of psychosis, but does cannabis CAUSE psychosis? You can't say).

Student Receive Personal Feedback on

Normative drinking rates How their drinking compares to other students Blood Alcohol Content Risk factors/Alcohol related consequences Time spent drinking versus other activities Calories consumed from alcohol Money spent on alcohol/drugs Drug and Medication Interactions

When is antabuse prescribed?

Not first line. Not for college students. For chronic alcoholics

BASICS (Brief Alcohol Screening & Intervention for College Students)

Not necessarily a need to force abstinence. Counselor tends to be flexible and supportive rather than confrontational.

Who were the participants in this study?

People from Norway

What is Bulimia Nervosa?

People with Bulimia Nervosa will commonly binge eat in an uncontrolled manner, then purge to try to get rid of the calories. People with Bulimia typically live in fear of gaining weight and are preoccupied with body image. They typically perpetuate a cycle of loss of control around eating, with binge eating sessions followed by forcing themselves to exercise or vomit to get rid of the calories they consumed. Can use laxatives. It's a cycle.

Mental illness may contribute to substance use and addiction

Self-medication Biological changes lead to vulnerability

What are the differences between inpatient vs outpatient treatment?

Slide 15 Treatment and prevention NIDA

Personalized Feedback Example

Statistics of norms nationwide and campus. You told us that you drank "X" amount, do these numbers look accurate? open ended questions to facilitate conversation. -Levels of intoxication. -BAC feedback -Alcohol-related consequences (which consequences make them want to make changes) -Always try to include tips for safer drinking (local resources available

Dual diagnosis

Substance Use + ____(disease or disorder)___ -More specific term from the substance use literature referring to the presence of a substance use disorder and another disease or disorder. One disorder doesn't have to cause the disorder, but they overlap each other.

What is SUIT?

Substance Use Intervention Team- designed for people who seek out substance abuse/ alcohol abuse treatment (more for people who want this). 8 hours. Weekly random drug tests. Components- Weekly relapse prevention sessions Weekly check-in appointments Weekly attendance at a support group meeting, along with the completion of a written reflection Weekly random drug tests

High prevalence of drug abuse and dependence among individuals with mood & anxiety disorders

Substance disorder percentages go up with mood/anxiety disorder. Ex. of comorbidity. -high prevalence of drug abuse and dependence among mood disorders and marijuana/any drug. Anxiety disorders are 2nd.

What were some of the primary goals or hypotheses of the study?What were the researchers trying to accomplish?

The aim of the current study was to examine if time spent on SoME is longitudinally associated with alcohol use among adolescents. We examined...growth of alcohol and SoMe over four years in a large sample of Norwegian adolescents who were between 13 and 15 years old at baseline.Also examined is the strength of the associations were attenuated by including...parental monitoring, sensation seeking, and positive and negative urgency...and gender.

What is Anorexia Nervosa?

The disorder is characterized by an unrealistic body image, intense fear of becoming overweight, and emotional challenges. Symptoms of Anorexia Nervosa include refusal to eat, attempts to lose weight even when body weight is low, and low body mass index. Can be life threatening, things like heart attacks can occur because of malnutrition.

Opiate Substitution Therapy

The primary medically assisted withdrawal method for narcotic addiction is to switch the patient to a comparable drug that produces milder withdrawal symptoms, and then gradually taper off the substitute medication.

Tradition Substance Abuse Views

Traditionally abstinence was the only way to stop drug abuse. Sometimes using drugs to treat drug abuse makes sense. Some people benefit from medicine- they can be used to maintain abstinence and prevent relapse. Be open minded and use evidence & options that are out there.

Journal Article

What is the core social, clinical, or basic scientific issue that this study is trying to address? Interested in alcohol and risk factors, future prevention methods, how does social media serve? How do teenagers use social media longitudinally? What is the primary theory behind the research? -Social & Culture= what we learn around us influences our behavior. -Psychodynamic & Personality= * -Cognitive= * -In Norway, 99% use SoMe, 80% use everyday, and spend 2.6 hours per day on average.

Psychology of TikTok

Why is TikTok so reinforcing? Reinforcement Theory- Positive Reinforcement & Negative Reinforcement. Positive Reinforcement = It's fun! Leads to laughs, positive feelings./ Negative Reinforcement = Self-medication, avoidance. Why is it so reinforcing? = Immediacy of Reinforcers. Consequences are quickly delivered, relative to other activities. Unpredictability of Reinforcers. You will not like every video, which prevents boredom and extinction. Variety and Novelty of Reinforcers. Prevents satiation. Always evolving with new trends. Response Effort and Magnitude of Reinforcers. So easy to engage with. Algorithm is always learning. Low effort, high reinforcement

College Drinking Is a Culture

a lot of people associate alcohol with some level of drinking and drug use. Excessive drinking affects everyone- all students, increases institutional costs, & hurts town-gown relationships. Research-based strategies are more effective than quick fixes & produce quantifiable results Effective programs improve student health and safety and contribute to a meaningful legacy How can we take action? "3-in-1" framework. What are you doing for individuals (including at-risk and dependent drinkers), what are you doing for student population as a whole, and what are you doing for community? Ex. Informational is not very effective. -CBT + norms clarification + motivational enhancement intervention is effective for individuals

Common shared risk factors of eating disorders and substance abuse

brain chemistry, family history, low self-esteem, depression, anxiety, social pressures. -These patterns of substance abuse, self harm, smoking, losing weight, etc. are learned. Social pressures and the group you are in can co-occur with the patterns you participate in.

What are Brief Motivational Interventions (BMIs)?

client-centered, enhancing intrinsic motivation for resolving ambivalence (mixed feelings about drinking). NOT "Just Say No". Regardless of legality (you can be underage), it tries to focus on EMPATHY and listening. Tries to resolve ambivalence to help figure out what you do what out of drinking.

Stepped care a.k.a. "adaptive intervention" or "dynamic treatment regime"

different levels of intensity - Assignment to different steps of care based on: Individual characteristics Past treatment failure or success Clinical judgment- not a formula, just guides decision making

Higher prevalence of mental disorders among patients with drug use disorders

high statistic/percentage for drug use disorder among mood and anxiety disorders.

Stepped care

is basically BRIEF INTERVENTIONS / you don't automatically start with 2-8 sessions of group therapy with people who are first offenders with alcohol

What is "A call to Action"

it is an evidence based approach to college aged drinking. Changing the culture of drinking at U.S. colleges.

Medication can be used to accomplish a number of goals

prevention of overdose suppression of withdrawal reduction of cravings reduction of psychiatric symptoms

Principles of drug addiction treatment book

research-based guide, widely available treatments.

Compared to bulimic women who are not also alcohol-dependent, bulimic women who were alcohol-dependent reported a higher rate of

suicide attempts, anxiety, personality & conduct disorders, other drug dependence

What is TESI?

tiger education screening intervention. brief personalized feedback/ brief motivational intervention services at auburn. 1, 2, or 3 sessions

Percentage of patients who relapse

type 1 diabetes, drug addiction, hypertension, asthma. Percentages show similarities- All have relapse. Similar to substance use disorders, there are biological reasons that put you at risk, you can often require treatment help