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Flashcards in Week 5: Definition of substance use disorders Deck (16)
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1
Q

Substance Use Disorder definition

A

 Substance Use Disorder
 Different substances
 Alcohol, Cannabis, Opiods, Hallucinogens, Inhalants, Sedatives, Hypnotics, Anxiolytics, Tobacco, Other
 Problematic pattern of substance use leading to clinically significant impairment or distress as manifested by at least two symptoms
occurring within a 12-month period
 Examples:
 Continued alcohol use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by use
 Important social, occupational, or recreational activities are given up or
reduced because of alcohol use
 Use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or
exacerbated by alcohol

2
Q

Is experimenting with alcohol common?

A

 Experimentation is very common
 In the United States, 2/3 of students in Grade 12 and nearly ½ of
students in Grade 10 report drinking alcohol in the past year

3
Q

Adolescence is a Risk Period for Substance Use Problems

A

 Earlier use starts the more likely it is to become problematic
 15.1% of individuals who start drinking by 14 develop alcohol use disorder, compared to 2.1% of those who start at age 21 or older
 Research trying to disentangle the extent to which early onset is a risk marker versus a risk factor
 Substance use in adolescence is associated with the three leading causes of death for adolescents: accidents, suicide, homicide
 Also, educational problems and legal problems

Even though common, still dangerous

4
Q

Prevalence

A
 Lifetime prevalence of any substance use disorder
 NCS-A
 Adolescents aged 13 to 18 years: 11.4%
 13-14 year olds: 3.7%
 15-16 year olds: 12.2%
 17-18 year olds: 22.3%
 Rates are higher among youth experiencing other mental health
problems
5
Q

Treatment Models

A

 Early Brief Interventions
 Outpatient Treatment
 Residential Inpatient Treatment

6
Q

Early, Brief Interventions

A

 Norm-based interventions for college students
 These target norms about drinking
 Injunctive norms: How much others approve or disapprove of
drinking
 Descriptive norms: How much others actually drink

7
Q

Norm-Based Interventions

A

 American university students overestimate how much their peers drink
 Incidentally, American high school students overestimate how much sex their peers are having

Brief Alcohol Screening and Intervention for College Students
 Individualized feedback about:
 Actual drinking norms
 Comparison between individual’s drinking pattern and the norm
 1) This is how much you drink
 2) This is how much you think others drink
 3) This is how much others actually drink
 4) Percentile ranking showing where you are relative to others on your campus

8
Q

Norm-Based Interventions (evidence)

A

 Screened 1115 students
 Identified 481 students who reported at least one heavy drinking episode (5-4 drinks in one sitting for men and women respectively)
 252 students (148 women) took part
 Participants and non-participants did not differ on amount of drinking reported
 Randomly assigned to intervention or control

 Baseline
 Perceived drinking norms
 Drinking behavior
 Intervention
 Received feedback immediately
 Presented on screen for a minute and given a print out to take home
 No interpersonal interaction
 Follow ups at three and six months
9
Q

Norm-Based Interventions results

A

 At both 3 and 6 months, amount of drinking in the intervention group was reduced, relative to the control group
 At both 3 and 6 months, perceived norms were reduced (intervention group was reporting that peers drink less than control group)
 Changes in perceived norms MEDIATED the association between the intervention and reduced drinking
 Intervention predicted decrease in perceived norms at three months, which predicted decreases in drinking at 6 months

So these were self-reported so possible this is a lie

However self reported and actual observed drinking amounts are correlated

There is no judgement here. No one else is involved. This is a strength

10
Q

Outpatient Treatment

A

 Family Therapy

 Alcoholics Anonymous (12 Step Programs)

11
Q

Family therapy for substance use

A
 Multidimensional Family Therapy
 Similar to MST
 Adolescent
 E.g., Use as a means of coping with distress
 Parents
 E.g., increased parental monitoring

Therapist tries to understand why they drink. Who is it benefitting? e.g. if the adolescent is drinking to self-medicate for stress, this will not go away until they have other ways to control stress

 A large number of studies have shown that family therapy results in better substance use outcomes for adolescents, compared to a
number of control conditions, including other types of therapy (e.g.,
group CBT)

12
Q

Alcoholics Anonymous

A
 Very popular
 People experiencing problematic alcohol use seek out AA more than all
other forms of treatment combined
 12 steps
 Acknowledge that alcohol is a problem
 Recommend abstinence
 Supported by a peer
 Easily accessible
 More than 30 meetings in Montreal today
 Global

This means you can usually find a meeting wherever you are

13
Q

Alcoholics Anonymous (3 hypotheses)

A

 Participation in AA is associated with less alcohol consumption and fewer substance related problems
 Three hypotheses:
 1) AA attendance → Lower alcohol use
 2) Lower alcohol use → AA attendance
 3) Good prognosis (e.g., better motivation, less co-morbid psychopathology) → Lower alcohol use and AA

14
Q

AA evidence (bad)

A

Results of randomized trials comparing AA to another form of treatment or to a no treatment control group suggest AA does not do better and may do worse
 However, there are very few well-done studies
 In several of the randomized trials, participants were coerced into treatment (e.g., court referred)

This last point calls into question the external validity of these results

15
Q

AA evidence (good)

A

 More recently …
 Study examining 2000 men seeking treatment for alcohol use at VA
hospital
 All met criteria for a diagnosis of alcohol use disorder
 Received treatment
 After finishing treatment, researchers followed them and collected data about their substance use and their attendance at AA meetings

 1) AA attendance → Lower alcohol use
 AA involvement at 1 year post treatment predicted less alcohol use at 2 years post treatment
 2) Lower alcohol use → AA attendance
 Alcohol use at year 1 did not predict AA involvement at year 2
 3) Good prognosis (e.g., better motivation, less co-morbid psychopathology) → Lower alcohol use and AA
 Results not explained by alcohol use severity, motivation, or comorbid psychopathology

Which points to AA being causal

IF not evidence based, it is free so why not try it

16
Q

Inpatient substance use treatments

A
Inpatient
 In-patient treatment
 Short duration (4 to 6 weeks)
 Range of treatment programs
 Individual counselling, family therapy, treatment for comorbid disorders
 Often followed by outpatient

 Very few controlled studies have examined the efficacy of inpatient treatment for substance use

Not great evidence and also VERY expensive

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