NSG 5720 Substance Use Disorders.pptx

NSG 5720 Psychiatric Management II Substance Use Disorders  SUDs in adolescence include substance dependence and substance abuse Adolescent Criteria for substance abuse involve one or more harmful Substance...

NSG 5720 Psychiatric Management II Substance Use Disorders  SUDs in adolescence include substance dependence and substance abuse Adolescent Criteria for substance abuse involve one or more harmful Substance and repeated negative consequences of substance Use Disorders use over the last 12 months (SUDs) Diagnosis of substance abuse is not given if the individual meets criteria for substance dependence  Adolescent Substance Use Disorders TABLE 13.6: Diagnostic Criteria for Substance Use Disorder A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: Substance is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful effort to cut down or control substance use. A great deal of time is spent in activities necessary to obtain substance, use the substance, or recover from its effects. There is a craving or a strong desire or urge to use the substance. Adolescent Substance Use Disorders (5) Recurrent substance use results in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household). (6) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. (7) Important social, occupational, or recreational activities are given up or reduced because of substance use. (8) There is recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use.)  (9) Substance use is (10) Tolerance, as defined by continued despite knowledge either or both of the of having a persistent or following: recurrent physical or A need for markedly increased psychological problem that is amounts of substance to achieve likely to have been caused or intoxication or desired effect. exacerbated by the Markedly diminished effect with continued use of the same amount substance. of the substance. (11) Withdrawal, as manifested by either of the Adolescent Substance following: The characteristic withdrawal Use Disorders syndrome for a substance. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.  Specify if: In early remission: None of the criteria have been met for at least for 3 months but for less than 12 months (“with the exception of “craving”) In sustained remission: None of the criteria Adolescent have been met at any time during a period of 12 months or longer (“with the exception of “craving”) Substance Specify if: In a controlled environment: This Use Disorders additional specifier is used if the individual is in an environment where access to substance is restricted. Specify current severity: Mild: Presence of two to three symptoms Moderate: Presence of four to five symptoms Severe: Presence of six or more symptoms  Prevalence and Course Alcohol is the most prevalent substance used and abused by adolescents Adolescent cigarette smoking has been declining Daily marijuana use has increased Use of other illicit drugs such as MDMA, opiates, cocaine, and crack has increased Estimated 12% of American adolescents Meet the criteria for substance abuse or dependence Trends in Annual Prevalenc e Use  Age of Onset Some amount of substance use during adolescence is normative behavior Critical risk factor is age of first use The odds of developing alcohol Alcohol use before age 14 is a dependence decreases by 9% for strong predictor of subsequent each year that onset of drinking is alcohol abuse or dependence delayed Illicit Drug Use Among Persons 12 or Older Course Rates typically peak around late adolescence, then decline during young adulthood Alcohol use influences involvement in other high-risk behaviors, especially unsafe sexual activity, smoking, and drinking and driving Girls who report dating aggression are five times more likely to use alcohol than girls in nonviolent relationships; boys are two-and-one-half times more likely Associated Characteristics Using more than one drug simultaneously Poor academic achievement, higher rates of academic failure, and higher rates of delinquency More parental conflict Disruption of neurodevelopmental processes High comorbidity with ADHD and conduct problems Personality Characteristics Increased sensation seeking preference for novel, complex, and ambiguous stimuli Positive attitudes about substance abuse and having friends with similar attitudes Perceiving oneself to be physically older than same-age peers and striving for adult social roles School disconnectedness  Other Causes Family functioning Lack of parental involvement Lower trust between adolescent females and their parents Peers and culture Association with deviant and substance-using peers False consensus (“everyone’s doing it”) Substance use glamorized by peer culture Treatment and Prevention Family-based Motivational approaches that seek interviewing (MI) to: Modify negative interactions between Addresses ambivalence family members, and discrepancies improve A patient-centered and between a person’s communication, and directive approach current values and develop effective behaviors and their problem-solving skills to future goals address areas of conflict Treatment and Prevention Adolescents with more severe levels of abuse, unstable living conditions, or comorbid psychopathology require an inpatient or residential setting Effective approaches address multiple influences (peer, family, school, and community) on the individual