Chapter 12 Substance Use PDF

Chapter 12 Substance Use and the Health of Communities Copyright ©2024 F.A. Davis Company  Substance Use  This refers to the use of psychoactive substances that have...

Chapter 12 Substance Use and the Health of Communities Copyright ©2024 F.A. Davis Company  Substance Use  This refers to the use of psychoactive substances that have a pharmacological effect on the brain and central nervous system (CNS).  Effects of these substances on an individual include altered mood, perception, and level of consciousness. Copyright ©2024 F.A. Davis Company  Substance Use and Health  Classes of substances Stimulants Depressants Inhalants Dissociative anesthetics Narcotics Hallucinogens Cannabis Copyright ©2024 F.A. Davis Company  Measures of Use and Risk  Quantity: the amount consumed, the dose  Frequency: how often the substance is consumed: daily, weekly, or monthly  Pattern: whether the use is consistent or occurs in an episodic manner, usually referred to as binging  Duration: how long over a lifetime the use has occurred Copyright ©2024 F.A. Davis Company  Barriers to Prevention of Substance Use and Related Harm  Lack of economic resources reduces the ability to develop or enforce policies. Advocating for policies to prevent substance use and related harm requires ‒ An understanding of the context in which substance use occurs ‒ An understanding of the extent of the burden of disease ‒ Evidence-based approaches that work across the continuum of use and the life span Copyright ©2024 F.A. Davis Company  Substance Use Related Harm  Defined as use that is linked to health-related harm: Physical Mental Socioeconomic harm  Includes the full spectrum of use or behavior from low risk to a diagnosable substance. Copyright ©2024 F.A. Davis Company  Substance Use and Risk  Increases the risk for injury, crime, and adverse health issues, and poses a risk for other individuals through environmental factors.  Consequences range from low to high risk of diagnosis of a substance use disorder (SUD). From fetal exposure to the last decades of life ‒ Acute harm ‒ Chronic harm Copyright ©2024 F.A. Davis Company  Measurement, Surveillance, and Risk  The first step in conducting surveillance is defining how substance use is measured.  Classification of use Abstinence: no use of the substance Low-risk or moderate use: use of the substance that places the user at little or no risk of harm Harm-related use: use associated with harm to the individual, family, or community Copyright ©2024 F.A. Davis Company  Other Substances and Harm- Related Use  The distinction between low-risk use and risky use is less clearly defined.  Any use of tobacco or illegal substances is at-risk use.  Use of prescribed psychoactive substances: harmful use when not in alignment with the prescription.  There is no acceptable level of use during pregnancy. Copyright ©2024 F.A. Davis Company  Substance Use and Health  National surveillance surveys on substance abuse are conducted regularly in the United States.  There are 11 different surveys. Examples: Behavioral Risk Factor Surveillance System (BRFSS) National Survey on Drug Use and Health (NSDUH) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Copyright ©2024 F.A. Davis Company  Excessive Alcohol Use  Heavy drinking: exceeding the recommended number of drinks per week For adult men: 15 or more drinks For women and adults over 65: eight or more  Binge (episodic heavy) drinking: exceeding the recommended number of drinks per occasion For adult men: five or more drinks For women or adults over 65: four or Copyright ©2024 F.A. Davis Company  Understanding Risk Across the Life Span  Fetal alcohol spectrum disorders (FASD) occur because of exposure to alcohol in utero.  Alcohol use and adverse effects occur on the adolescent brain.  For older adults, a change in the ability to metabolize alcohol increases risk.  Duration of use over a lifetime increases risk for alcohol-related adverse outcomes such as liver Copyright ©2024 F.A. Davis Company  Person-Centered Approach  Shift from calling a person an addict to referring to that person as someone who has an SUD.  Harm-related substance use is the preferred term because it focuses on harm rather than on a clinical diagnosis. Copyright ©2024 F.A. Davis Company  SUD Occurs Across a Continuum  Severity, evidence of physiological dependence, and course of treatment used to classify Physiological dependence: evidence of tolerance to or withdrawal from a foreign substance Tolerance: an adaptation of the body to a drug that results in needing more of the drug to achieve a certain effect Withdrawal: drug-specific physical or mental symptoms occur when use of the drug is stopped* Copyright ©2024 F.A. Davis Company  Substance Use and Health  Health and Medicine Division prevention model  Clearly separates prevention from treatment  Three levels of prevention: ‒ Universal level: identified populations at risk ‒ Selective level: specific subgroups at a higher risk ‒ Indicated level: subgroups at the highest risk Copyright ©2024 F.A. Davis Company  Harm Reduction Model  Any program, policy, and/or intervention that Seeks to reduce the harm related to at- risk substance use Does not focus solely on attainment of abstinence  Aim for safer use or abstinence  Goal of reducing harm at the community and population levels Copyright ©2024 F.A. Davis Company  Prevalence of Tobacco Use  Prevalence of tobacco use differs among countries. Declining in the United States Increasing globally, especially in low- income countries  Almost 80% of smokers live in middle- or low-income countries. Copyright ©2024 F.A. Davis Company  Screening and Treatment for Tobacco Use  Screening for tobacco use Assessment of quantity and frequency What type of tobacco is used History of past use Duration of use  Smoking cessation Brief help by a health-care provider, counseling, behavioral therapies, mobile phone-assisted treatment, and medications Copyright ©2024 F.A. Davis Company  Medication-Assisted Treatment (MAT)  MAT, in conjunction with other treatments, is an effective treatment for both opioid use disorders and alcohol use disorders (AUDs).  It is seen as part of a more comprehensive treatment plan that includes behavioral treatment. Copyright ©2024 F.A. Davis Company  Consequences of Drug Use  Consequences of drug use vary based on the pharmacokinetics of the drug used.  Once the drug has left the system, the person experiences a rebound effect. In cocaine use, an understimulation of the CNS results in depression and decreased energy.  There is increased risk for comorbid mental disorders, sexually Copyright ©2024 F.A. Davis Company  Drug Use and Vulnerable Populations Across the Life Span  The variation of the adverse effects again relates to the pharmacokinetics of the drug used. Maternal and infant risks Effects on adolescent brain development Increased use in older adults Copyright ©2024 F.A. Davis Company  Screening and Treatment for Drug Use  Screening The Drug Abuse Screening Test (DAST-10) National Institute on Drug Abuse (NIDA) ASSIST tool  SBIRT for drug use Substance Abuse and Mental Health Services (SAMHSA) guide SAMHSA recommends the use of the SBIRT framework to address drug use in the same way it is used for those with at-risk alcohol use. Copyright ©2024 F.A. Davis Company  Substance Use and Communicable Diseases  Occurs across multiple levels  Increased risk of transmission  Poorer outcomes  Less apt to be engaged in care Copyright ©2024 F.A. Davis Company  Substance Use and Stigma  Stigma is defined as a mark of disgrace or reproach.  Moral views of substance use vary based on ethnic culture, social practices, the specific substance in question, and the gender of the substance user.  It can be a barrier to treatment. Copyright ©2024 F.A. Davis Company