Quiz 9- Complex Trauma Substance Related and Addictive Disorders
Complex Trauma on Occupational Performance: ADL's
- *Bathing*- for those who were sexually or physically abused - *Toileting*- encopresis and enuresis - *Encopresis*- Passing of feces in appropriate places, such as clothing - *Enuresis* - Repeated voiding of urine and clothing in inappropriate places (Both represent the child only active mechanism of control when they feel like they do not have control over any other parts of their life) - *Feeding and Eating*- refusal, over reactivity, bottle rot, eating disorders, hoarding and hiding food - *Hygiene and Grooming*- Could be due to parental intellectual limitations of possible neglect and sometimes requires CPS - *Sexual activity*- Likely to be preoccupied with sexual organs of themselves or others, 7 times more likely to become substance abusers
Cannabis
- *Most used illicit drug; use before 15 is a serious risk for mental health disorders (depression and conduct disorders)* - Daily consumption in teens can cause appetite changes affect school participation, and lack of violation can also contribute to difficulty with ADHD, such as hygiene - 81% of current illicit drug users - Only drug used by ⅔ of these individuals as it has gained acceptance in society and is legalized in many states
Course and Prognosis of Complex Trauma
- Adverse Childhood Experiences in the first 18 years of life 10 questions related to parental violence, household dysfunction, abuse, and neglect - *Individuals with ACE scores of 6 or higher exhibited a shorter lifespan of almost 20 years compared to ACE scores of 0* - Increased probability to develop cancer, heart disease, diabetes, liver disease, and strokes were associated with depression, alcoholism, drug use, obesity, smoking, sexual promiscuity, and domestic violence - Neurobiologic damage and resiliency factors will affect course and prognosis - Trauma contributes to changes in the chemistry and structures of the brain - Resiliency is the ability of an individual to recover from adverse or traumatic events - Working executive function and exposure to positive praise, nurturing parenting, maternal mental health, consistent home routines and healthy self-care skills, and parents' understanding of trauma
Substance-Related Disorders (10 Classes of Drugs)
- Alcohol - Caffeine - Cannabis - Hallucinogens - Inhalants - Opioids - Sedatives, hypnotics, and anxiolytics - Stimulants - Tobacco - Other substances and non substance (gambling)
Stimulants
- Amphetamines, methamphetamine and cocaine; more common with 12-25 year olds - Can be used for ADHD - Meth and coke are always illicit - Cocaine can lead to severe paranoia and poses a higher risk for a serious overdose
Sedatives, hypnotics, and anxiolytics
- Benzos, Nonbenzo sleep meds, barbiturates - Used in surgery - They have a higher risk of overdose and are not prescribed for anxiety and sleep
Caffeine
- Children/adolescents at risk for intoxication - *Most consumed mind altering substance globally* - Children and adolescents are actually at risk for intoxication from caffeine due to their low body weights and the consumption of soft drinks include restlessness, insomnia, disorganized thinking, excessive energy - Can have withdrawal symptoms
Complex Trauma
- Chronic exposure to *multiple traumatic incidents* that occur within a relational system, often in early childhood, which impact on development and self-awareness - Directly or through observing relational violence, or be the absence of safe caregiving - Given the relational nature of this early trauma, the formation of a *secure attachment is severely compromised.* - Many aspects of a child's healthy physical and mental development rely on this primary source of safety and stability.
Impact Substance Abuse on Occupational Performance: IADL's
- Community management, driving and community mobility, financial management, and home establishment and management - Impacted by cognitive impairments by substances
Tobacco
- Contains stimulant (nicotine) and causes one in every five deaths in the US - Most adolescents experiment with tobacco - By age 20, 20% of become daily users - Shortens one life by 10 years - If someone quits, there is immediate health effects (reduced risk of heart disease, cancer, and strokes)
Complex Trauma on Occupational Performance: Play and leisure
- Decreased play exploration, constructive play, and symbolic play. - May exhibit violent or sexual play. - Can be triggered by environmental stimuli. - Pursuit of leisure interests may be compromised by maladaptive play behaviors
Complex Trauma on Occupational Performance: Social Participation
- Difficulty with social engagement in both the home and community. - May include isolation, physical/emotional conflict, violence, running away, arrests, and convictions.
Impact of Substance Abuse on Occupational Performance: ADL's
- Hygiene, grooming, sexual activity - Lack of volition due to cannabis use can decrease one's interest in grooming or hygiene activities - Some substance are more likely to cause risky sexual behaviors while some might limit sex drive
Other substances and nonsubstance (gambling)- similar symptoms
- Impulsivity, unsuccessful attempts to cut down, preoccupation, attempts to hide negative pacts on relationships and job functioning and persistent participation - Develops gradually over many years - Seen in men more than women
Impact Substance Abuse on Occupational Performance: Social Participation
- Inability to regulate emotions, impaired relationships and roles with family, friends, co-workers, peers, and community - May self isolate due to embarrassment associated with their use
Opioids
- Include narcotics developed to block or reduce pain or produce drowsiness - Users seek relaxation and have a low tolerance for pain and anxiety, and they often begin with prescription drugs but change to heroin because it is cheaper and more readily available than prescribed medications - Overdoses from heroin often result from suppression of breathing which results in hypoxia (lack of oxygen in brain)
Impact Substance Abuse on Occupational Performance: Play and leisure
- Interrupt developmental milestones in play exploration and development of leisure - Money that could be spent on play and leisure is being spent on the substance
Hallucinogens
- LSD, PCP, K2, Ecstasy - Ecstasy is a hallucinogen and a stimulant - Some of these can be found in plants and mushrooms - LSD is one of the most powerful - PCP has may adverse effects of violence and suicide due to the intense feelings of strength, power, and vulnerability - K2 is sold cheaply to appeal to the youth, easily accessible at tobacco/smoke shops as potpourri and labeled as not meant for consumption, similar structure to carcinogenic substances - Usually associated with experimentation and have high recovery rates
Complex Trauma on Occupational Performance: Work
- Often poor employment-seeking skills or vocational interests - Less education, difficulty maintaining hygiene or social skills, impaired coping strategies
Polyvictimization contributes to comorbid mental health disorders:
- PTSD - Depression - ADHD - Oppositional defiant disorder - Anxiety - Bipolar - Dissociative disorder - Personality disorder
Inhalants
- Popular with teens; include legal, inexpensive, everyday substances - Inhaled through the nose and open mouth - Include inexpensive everyday substances like glue, paint thinner, nail polish remove, hair spray - Even with the first use can leave debilitating or lethal effects, such as cardiac seizures, brain damage, and death
Interventions for comorbid mental health disorders include:
- Psychotherapy - Self-management/coaching - Family therapy - Play therapy - Expressive therapies- art or music - Pharmacotherapy- medecine - Community outreach
Impact Substance Abuse on Occupational Performance: Rest and Sleep
- Rest, sleep preparation, and sleep participation - Nightmares and insomnia can occur
Impact Substance Abuse on Occupational Performance: Health Management
- Taking meds, managing stress, managing nutrition, and using person care devices - Safety awareness and concerns due to the individual's use that will impact all of these areas
Incidence and Prevalence of Complex Trauma
- The majority (92%) of maltreated children are victimized by one or both parents - Children less than 1 are most vulnerable to maltreatment. - Nearly 61% of maltreated children were victims of neglect, and nearly 71% of all child fatalities were due to neglect. - Mothers are more likely than fathers to be perpetrators of neglect; males are more likely than females to be perpetrators of sexual abuse - Girls are more likely to experience sexual abuse, emotional abuse, and neglect - Boys are more likely to experience physical trauma and have a higher fatality rate
Impact Substance Abuse on Occupational Performance: Education and Work
- Truancy/absenteeism, tardiness, accidents, poor performance, lack of volition, poor follow through - Employment may not be pursued due to possible failed drug tests
Alcohol- Fetal alcohol spectrum disorders (FASDs)
- When women use alcohol during pregnancy, putting their children at risk for physical, mental, behavioral, and learning disorders - *MOST PREVENTABLE cause of developmental disabilities in children* - Delirium tremens occur in approximately 5% of people with chronic alcohol disorders who terminate their drinking (can lead to death)
Incidence and Prevalence of Substance Abuse
- Young adults (18-25) use illicit drugs at the highest rate - Alcohol and illicit drug dependence among male and female youths is almost the same - Whites experience the highest risk for alcohol use disorders - Underserved people of color face more discrimination, stronger legal consequences, and increased incarceration when they use drugs recreationally than do Caucasian youth - High prevalence of co-occurring mental health disorders (Depression, Bipolar disorder, PTSD, Personality disorder)
Risk Factors Related to Complex Trauma
- Young or single parents - Less than high school education - Dysfunctional home life - Adults with psych disorders (Depression and bipolar disorder) - Unrealistic expectations of infant/child development - Perpetrator's childhood (80% of offenders were abused themselves) - Substance abuse - Lack of family support systems - Children who are overly fussy or have chronic conditions, diseases, or disabilities - Trigger events - Poverty - Difficulty bonding with newborns - Parental criminal activity - Multiple nonbiological, transient caregivers in the home - Age of the child (under the age of one are at the most risk) - Adopted and foster children
Factors that explain the origins of substance-related disorders
1. *Biological and genetics* - Dopamine reward pathway has changed - Prefrontal cortex becomes impaired - Variety of genes that makes a person vulnerable to substance abuse, like alcoholism 2. *Temperament* - Difficulty with self regulation - Psychological - Classical conditioning - Drinking and drug use can be linked to a person, location, or type of day 3. *Social cognitive theory* - Young users learn substance use behaviors from observing and imitating what others are doing 4. *Sociocultural and environmental* - There is relationship between alcohol and drug use and family peer and social relationships - Peers (from mid to late adolescents) - Availability of cheap substances for coping 5. *Age* - College age and older adults are most at risk for drinking - Males from 18-25
Pharmacological criteria includes:
1. *Tolerance*-requiring increased amounts of the substance in order to get the desired effect or a significantly reduced effect when usual dosage is consumed 2. *Withdrawal*- syndrome that occurs when blood or tissue concentrations decline in a person who has used heavily, which make him or her more likely to consume again to relieve symptoms
Signs and Symptoms of Complex Trauma
7 Domains of impairment - *Attachment and Relationships*- Children that have experiences complex trauma are at much higher risk for insecure attachment patterns (avoidance, ambivalent, and disorganized) - *Physical health*: Body and Brain- Children often live in a chronic fear of stress, altering the brain - *Emotional Responses*- Alexithymia (ones impaired capacity to describe emotions or bodily states like recognizing signs of hunger or that they need to go to the bathroom - *Dissociation*- Predominant attribute of someone that has experienced trauma. It is a protective response to trauma (freeze response and detachment) - *Maladaptive Behavior* - *Cognition*: Thinking and Learning - *Self-concept and Future Orientation*- Many children feel unsuccessful, powerless, helpless, incompetent, and unlovable
Complex Trauma on Occupational Performance: Education
Academic problems and behavior problems - Need for trauma-sensitive classrooms that refrain from blaming the child
Risky Use
Consuming the substances even when it is physically hazardous and despite knowing that the substance use is causing persistent physical, legal, and/or psychological difficulties
Substance Use
Consumption of the substance by any of the following means: orally, smoking, inhaling, or intravenously
Cravings
Desire for the drug that precludes thinking of anything else, is associated with specific reward pathways in the brain, and occur more likely in an environmental context of previous use
Complex Trauma on Occupational Performance: Rest and Sleep
Hypervigilant and overactive which contributes to sleep disturbances, increased bed wetting
Substance Use Disorder
Irreversible brain circuit changes in severe disorders and repeated behavioral relapses and strong cravings in the presence of substance-related stimuli
Complex Trauma on Occupational Performance: Health Management
Locating and accessing services to support physical and mental health needs
Medication-induced Disorders
OTs need to be aware of medications that can *cause CNS side effects because the cognitive, behavioral, and physical symptoms that they cause may occur in any acute, rehabilitation, and community practice site* - Antipsychotics can result in related movement disorders - Evidence-based intervention strongly suggests the combined used of medications and psychosocial support for the most effective treatment of substance-related disorders
Complex Trauma on Occupational Performance: IADL's
Parentification - A common occurrence among a group of children i an abusive and neglectful environment is for one child that is usually the oldest to take on the role of the parent
Social Impairment
Persistent substance use associated with the inability to carry out key occupational roles, serious social and interpersonal problems, and withdrawal from leisure and other family activities
Intoxication Disorder
Short-term symptoms associated with current use of the substance, including the problematic behaviors and psychological changes
Withdrawal Disorder
Symptoms that cause suffering and problematic functioning and occur immediately and for a longer period after a client who has been heavily using a substance stops ingesting- symptoms that cause suffering and problematic functioning and occur immediately and for a longer period after a client who has been heavily using a substance stops ingesting
Impaired Control
Taking larger amounts than intended over time, many unsuccessful attempts to reduce use and also a persistent desire to decrease or discontinue, and one's daily activities revolve around obtaining the substance and recovering from its use
Addiction
When a person experiences both the symptoms of tolerance and withdrawal
Co-occurring Disorders
When a person is diagnosed with a substance use disorder and other psychiatric conditions
