Transcript Rehab Counseling 05 - University of Florida

Rehab Counseling
Substance Abuse Class 05
Markus Dietrich LMHC,CRC,CAAP
Shands Healthcare
[email protected]
Drug Use-Scope
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In 2001 an estimated 15.9 million Americans 12 or
older used illicit drugs. This represents 7.1% of
this population.
This a 0.8% increase from 6.3% in 1999 and 2000.
Increases were noted for:
Marijuana
4.8% to 5.4%
Cocaine
0.5% to 0.6%
Pain Relievers 1.2% to 1.6%
Tranquilizers 0.4% to 0.6%
National Household Survey 2001
Drugs Use- Marijuana
Marijuana is the most commonly used drug
used by 76% of the drug users
 56% of drug users use only marijuana
 20% use Marijuana and another drug.
 24% use illicit drugs but not marijuana.
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Therapeutic Drugs
Of the 4.8 million users of therapeutic drugs,
 3.5 million use pain relievers
 1.4 million use tranquilizers
 1 million uses stimulants
 0.3 million use sedatives
Drugs cont.
In 2001 an estimated 1.7 million (0.7%)
Americans age 12 or older were current
cocaine users and 406,000 (0.2%) were
current crack users
 1.3 million (0.6%) used hallucinogens
 957,000 used Oxycontin non medically
(four times as much as 1999)
 Heroin use is reported to be 123,000 (0.1%)
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Drugs- Variables
Men are more likely to report drug use than
women (8.7 vs. 5.5%)
 Rates and patterns of drug use vary by age,
peaking among 18-20year olds
 Drug use is correlated with education. Rate
for H.S graduates is 7.6% vs. 4.3 percent for
four year college graduates, even though
college graduates were more likely to have
tried drugs.
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Alcohol
109 million ( 48.35%) Americans age 12 or
older report being current drinkers
 Approximately one fifth (20.5%) reported
bingeing at least once in last 30 days
 5.7%reported heavy drinking
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Alcohol variables
Age: highest prevalence of alcohol use is
between 18 and 25. Rate drops slightly
between 25 and 60.
 Men are more likely to drink than women
 likelihood of drinking alcohol increases
with education, however, binge drinking
and heavy drinking were least prevalent
among college graduates
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Employment
Unemployment is highly correlated with drug and
alcohol use however,
 6.9% of illicit drug users are full-time employed
 9.1% of drug users are part-time employed
 Among the 43.9 million adult binge drinkers, 35.4
million (81%) are full-time or part-time
employees.
 9.8 million (80%) of the heavy drinkers are also
employed
Significant Others
Non-alcoholic members of alcoholic’s
families use 10 times as much sick leave as
in families where alcohol is not a factor.
 More than half of all family members of
alcoholics who are employed (80%) report
their ability to function is impaired as a
result or living with an alcoholic.
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Effects on Business
decreased productivity
 increased on-the-job accidents
 increased absenteeism
 turnover
 increased health care cost
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Economic Impact
Cost to society associated with drug and
alcohol abuse is estimated to be $294
billion.
 The largest impact is on lost productivity.
 The health care cost for alcohol abuse is
about twice that for drug abuse.
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Samsha 2001
Social Impact
Alcohol and drug abuse correlate positively
with:
 Domestic Violence
 Child abuse and neglect
 Separation and divorce
 Healthcare cost
 Criminal behavior
Trends
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The NHSDA showed increases among
Americans in rates of use of several
substances, including marijuana and cocaine
and the non-medical use of pain relievers
and tranquilizers. Alcohol use also
increased, although binge drinking and
heavy use remained unchanged between
2000 and 2001
Addiction and the Brain
Addiction is a
brain disorder
Addiction is an independent disorder
distinguished from drinking that is merely
heavy, problematic, ill advised or socially
unacceptable
Abuse - intentional overuse in cases of
celebration, anxiety, despair, self-medication,
other mental health disorders or ignorance.
Tends to decline with consequences or adequate
treatment of other mental health disorder.
Functional Imaging
SPECT – single photon emission
computed tomography
PET – positron emission tomography
fMRI – functional magnetic
resonance imaging
Dopamine Pathways – Pleasure pathways
striatum
frontal
cortex
hippocampus
alcohol
substantia
nigra/VTA
cocaine
nucleus
heroin
nicotine
accumbens
amphetamines
opiates
THC
PCP
ketamine
heroin
alcohol
benzodiazepins
barbiturates
THE RAT BRAIN
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What “turns on” the dopamine in a rats
brain…..
– SEX-200% increase in dopamine
– COCAINE-300% increase in dopamine
– METHAMPHETAMINE-1100% increase in
dopamine
The explanation for why people respond differently!
Early exposure to drugs
Inherited genes or
altered expression
malfunction MFB
abnormal proteins
enzymes
receptors
responses
Brain of the addicted is
fundamentally different:
 Gene
expression
(Liu, Nickolendko 1994; Daunais &
McGinty 1995)
 Glucose
metabolism
(Volkow, Gillespie, 1996)
 Responsiveness
to
environmental cues
(O’Brien, Childress, 1993; Kilgus &
Pumariega, 1994)
What’s inherited???
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Temperament
Initial sensitivity to rewarding or aversive qualities
(like or dislike of the drug)
Tolerance
Rates and routes of metabolism
Taste preferences
Response to memories related to use
Developing brain
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Individuals who begin drinking
before age 15 are 4 times more
likely to develop alcohol
dependence during their lifetimes
than those who begin drinking at
age 21.
(Grant & Dawson 1997; Journal of Substance Abuse 9:103-110)
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Earlier drinking more likely to
result in alcohol dependence
independent of family history
(Grant, 1998)
Your Brain on Drugs
YELLOW shows
places in brain
where cocaine
goes (Striatum)
1-2 Min
3-4
5-6
PET scan after cocaine use
6-7
7-8
8-9
9-10
10-20
20-30
SPECT
(blood flow)
Normal
Alcohol 25 yrs
Cocaine 2 yrs
Marijuana 12 yrs
Assessment and Diagnosis
Bio-psycho-social-spiritual Assesment
 DSM-IVR:
Seven Criteria
Two dimensionsObsession and Compulsion.
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Job is last to go!
Addiction
Abuse
Cravings, preoccupation
Bad judgment, poor morals, self
will
Abnormal brain chemistry
Normal brain chemistry
No specific personality
Frequent character or personality
pathology
Significant consequences
May have significant
consequences
Unable to stop because of
consequences – loss of control
Likely to stop as consequences
progress
Progressive course
Usually self-limited
Facilitate Change
Motivational Enhancement Therapy
Key Factors for Change for the Counselor:
 Style
 Style
 Style
Key Concepts
Motivation: the probability that a person
will enter into, continue and adhere to a
specific change strategy.
 Resistance: the result of interacting with
one’s environment- not a characteristic.
 Ambivalence: the heart of the problem, not
pathological.
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Stages of Change
Prochaska & DeClemente 1982
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Pre-contemplation
What problem?
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Contemplation
Is it a problem?
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Preparation
What can I do?
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Action
I am doing something
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Maintenance
I am successful
Helper Tasks
 Pre-contemplation
Raise Doubt
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Contemplation
Evoke reasons for change
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Preparation
Help client find best course of action
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Action
Support steps toward change
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Maintenance
Relapse Prevention