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