Transcript Screening for Alcohol and Substance Abuse

®
“Preparing Our Communities”
Welcome!
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Faculty Disclosure
• For Continuing Medical Education (CME) purposes as
required by the American Medical Association (AMA)
and other continuing education credit authorizing
organizations:
– In order to assure the highest quality of CME programming,
the AMA requires that faculty disclose any information relating
to a conflict of interest or potential conflict of interest prior to
the start of an educational activity.
– The teaching faculty for the BDLS course offered today have
no relationships / affiliations relating to a possible conflict of
interest to disclose. Nor will there be any discussion of off
label usage during this course.
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®
Psycho-Social Aspects of
Terrorism and Disaster
Chapter 7
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Mission of Terrorism….
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D-I-S-A-S-T-E-R
for Psychological Issues
• Detect Prevalence of Effects and…
Anticipate Resources Required to Mitigate
• Incident Command
• Security and Safety
• Assessment of Psychological Hazards
• Support from State & Federal Assets
• Triage and Treatment
• Evacuation / Disposition
• Recovery & Resilience
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Detection
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in Butler, Panzer, Goldfrank, 2003
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Magnitude of Problem
vs. Availability of Resources
• Transient Distress Symptoms > 50%
• Behavior Changes / Substance Abuse 10-25%
• Anxiety Disorders in “Exposed” Persons
Children:
Prevalence of War-Related PTSD in 12Adults:
Disaster-Related PTSD in 5 - 80%
Military:
“Combat Stress Response” in 10
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60%
- 30%
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Risk Factors
Factors Increasing Rate of Psychosocial Problems:
•Degree of Exposure
•Exhaustion
•Physical Harm
•Loss of Someone Close
•History of Mental Disorder
…Associated with Depression / Suicide
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Incident Command
• Need Formally-Designated Leader,
Accountable
for Coordination and
Communication among Potential Providers
• Need Training and Practice
• Need Integration of Volunteers
• Therefore, Need a Prospective Plan
Integrated with State/Local Plans
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Volunteers
Need to Address…
• Credentialing
• “Just-in-Time” Training
• Management: logistics, supervision,
transportation, medical & other care needs
• Well-Meaning Volunteers Can…
Overwhelm, Interfere, Confuse,
Burden & Even Endanger
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Security and Safety
of Responders
• Responders Can Have Same
Psychological Responses as Others
• Exposure to the Trauma of Disasters
Often Worse than Past Experiences
• Even “Veteran” Responders Affected…
esp. If Co-Workers Become Victims
• Acute & Subsequent Post-Traumatic
Stress Disorders Both Common
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Post
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D
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a
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t
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Counseling
Services
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Interventions
for Responders
• Refer Identified Affected Responders to
Professionals Trained in Both CognitiveBehavioral &
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Haddon Matrix
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in Butler, Panzer, Goldfrank, 2003
Triage/Treatment
• Efficient Triage of Persons with Normal vs.
Abnormal Responses
and those with symptoms from co-morbid conditions
•
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Normal Responses
A Threat Normally Induces….
• A Sense of Apprehension, Worry, Edginess &
Difficulty Concentrating
• Rational (and Irrational) Attempts to
Remove the Threat or Escape It
• On a Social Scale…Altruistic Behaviors
Intended to Ameliorate the Situation
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Normal Responses
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Normal Responses
A Disaster Normally Induces….
• Guilt
• Manifested in Many Ways
• Results in Zealous Volunteerism
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Prevalent Syndromes
Sub-Diagnostic Distress (“worried well”)
• Some Symptoms of Distress
• Multiple Concerns / Anxious
• Somatization (physical complaints)
Do Not Meet Diagnostic “Thresholds” for
Psychiatric Disorders
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Treatment of Sub-Diagnostic Distress
• Normalize Responses (reassurances)
While Empathizing with Distress
• Supportive Counseling & Sx Reduction
Through Relaxation Techniques
• If Symptoms Such as Insomnia are
Debilitating, Treat Symptomatically
• Generally, Role of Anxiolytics is Slight
• Monitor for Persistence / Dissociation
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Psychological First Aid
•
•
•
•
•
•
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Protect Survivors from Further Harm
Reduce Physiological Arousal
Get Support for Most Distressed
Keep Families Together
Facilitate Reunions of Family / Friends
Provide Reassurance & Education with
Effective Risk Communication Methods
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Abnormal Responses
A Substantial Problem Exists if
Symptoms are Greater in:
 Intensity and Duration
 Resulting Impairment or Disability
 Avoidance of Certain Situations
or Objects, Impairing Daily Life
 An Unusual and Significant
Pattern of Symptoms
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Prevalent Disorders
• Anxiety Disorders
• Acute Stress Disorder
• Post-Traumatic Stress Disorder
• Affective Disorders
• Major Depressive Disorder
• Dysthymic Disorder
• Bereavement Evolves into
Major Persistent Depression
• Substance Dependence and/or Related Mood &
Anxiety Disorders
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Medical Community Re-Focuses…
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Anxiety Disorders
due to General Medical Conditions
• Interruption of Care for Chronic Conditions
– Inability to Get Medications
– Change in Priorities (for Physicians and Patients)
– Lack of Monitoring and Communications
– Lack of Access to Emergent Care
• Affects on Undiagnosed Medical Conditions
– Hyperthyroid States and Angina
– Parental Relationships
– Irritable Bowel Syndrome
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Reactions of Children
Ages < 5 :
• Separation Fears
• Nightmares
• Regression of Behavior
Ages 6 – 11:
•
•
•
•
Atypical Disruptive Behaviors
Withdraw from People, Daily Activities
Irritability and Difficulty Concentrating
Lower Grades at School
Adolescents Similar to Adults
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Common Stress Disorders
• Re-Experiencing Events
(nightmares, flashbacks, intrusive thoughts)
• Emotional Numbing
(depersonalization, derealization, disoriented)
• Avoidance
(negative conditioning to event- related stimuli)
• Autonomic Arousal
• Disruptions of Life
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Temporal Pattern of Stress
Disorders
Onset
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Acute
Stress
Acute
PTSD
Chronic
PTSD
Within
28 days
Immediate
Immediate
(or Anytime
Thereafter)
(or Anytime
Thereafter)
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Temporal Pattern of Stress
Disorders
Acute
Stress
Acute
PTSD
Chronic
PTSD
Onset
Within
28 days
Immediate
Immediate
(or Anytime
Thereafter)
(or Anytime
Thereafter)
Duration
2-28 days
Up to
3 Months
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Greater
than
3 Months
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Screening with SNAP
• Startle
• Numbness
• Arousal / Avoidance
• Persistence
Derived from Davidson et al, J Nerv Mental Dis 1989
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Screening for Depression
Screening Question:
“In the past two weeks….
•Have You Had a Depressed
Mood Most of the Day?
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Screening for Depression
Screening Questions:
“In the past two weeks….
• Have You Had a Depressed Mood
Most of the Day?
• Have You Had a Loss of Interest or
Pleasure in Most Activities?”
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Screening for Suicide
Screening Questions:
“Have You had Recent Thoughts that Life is Not Worth
Living or That You’d Be Better Off Dead?”
• “This Past Week… Have You Had Thoughts about
Hurting Yourself or Even Killing Yourself?”
• If Answer is “Yes”….
“What Have You Thought About?”
“Have You Actually Done Anything to Hurt Yourself?
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I Know It’s Still Morning…
…But I Badly Need a Drink
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Screening for Alcohol and
Substance Abuse
• Have You Ever Had a Problem with
Drugs?
• Do You Drink Alcohol? If “yes”, then
CAGE:
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Screening for Alcohol and
Substance Abuse
• Have You Ever Had a Problem with
Drugs?
• Do You Drink Alcohol? If “yes”, then
CAGE:
–Have You Felt You Should Cut Down
on Your Drinking?
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Screening for Alcohol and
Substance Abuse
• Have You Ever Had a Problem with Drugs?
• Do You Drink Alcohol? If “yes”, then CAGE:
–Have You Felt You Should Cut Down
on Your Drinking?
–Have People Annoyed You by
Criticizing Your Drinking?
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Screening for Alcohol and
Substance Abuse
• Have You Ever Had a Problem with Drugs?
• Do You Drink Alcohol? If “yes”, then CAGE:
–Have You Felt You Should Cut Down
on Your Drinking?
–Have People Annoyed You by
Criticizing Your Drinking?
–Have You Felt Guilty About Drinking?
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Screening for Alcohol and
Substance Abuse
• Have You Ever Had a Problem with Drugs?
• Do You Drink Alcohol? If “yes”, then CAGE:
– Have You Felt You Should Cut Down
on Your Drinking?
– Have People Annoyed You by
Criticizing Your Drinking?
– Have You Felt Guilty About Drinking?
– Have You Had to Drink in the Morning to Get
Rid of a Hangover (“Eye-opener”) ?
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Evacuation
• Pre-Event Hazards Assessment:
–Can Capacity of Infrastructure
Accommodate Demand Surges ?
• Transportation, communication, healthcare, etc
– Is Public Confident with Respect to PreEvent and Event-Related Security and
Capacity of Infrastructure ?
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Evacuation
Event & Post-Event:
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Evacuation
Event & Post-Event:
Care/Control of Persons Who Panic
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Evacuation
Event & Post-Event:
Care/Control of Persons Who Panic
Care of Displaced Persons
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Evacuation
Event & Post-Event:
Care/Control of Persons Who Panic
Care of Displaced Persons
Coordination with Red Cross and
Clinical Triage/Treatment Teams
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