- a person who abuses an illicit drug has an Ý chance of having other disorders: Lifetime prevalence of an alcoholic disorder 47%; Lifetime prevalence of a psychiatric disorder 53%
Alcoholism
- primary chronic disease with genetic, psychosocial and environmental factors
often progressive and frequently fatal; characterized by impaired control over drinking, preoccupation with alcohol, use continues despite adverse consequences, distortions of thinking
Þ denial
Belief: "Do the same thing with the expectation of a different outcome"
Four Categories of Addiction
Use, Misuse, Abuse, Dependence
Clinical Presentation
Risk factors determined by DSM-IV signs and symptoms (see below)
but signs and symptoms do not have to be obvious or even present; disease can even kill before it becomes apparent
chronic course - remains with patient for life
if a patient relapses after abstaining for a period of time, the signs and symptoms return much faster
Classification of Addictive Drugs
All addictive drugs can be divided into four catagories: A1, A2, B1, and B2
A = Non-intoxicating, no impairment in ADL's, variable links to other drugs; B = Intoxicating, impairs ADL's, strong link to other drugs
A1 and B1 = serious long term consequences; A2 and B2 = no or unclear long term consequences
Examples:
A1 - nicotine
A2 - caffeine
B1 - alcohol, cocaine, heroin
B2 - LSD, mescaline
DSM-IV Diagnostic Criteria for substance-related disease
Substance Dependence
: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by AT LEAST THREE of the following within a twelve month period:
(1) Tolerance
(2) Withdrawal
(3) Substance is often taken in larger amount or over a longer period than intended
(4) Persistent desire or unsuccessful efforts to cut down or control substance use
(5) A great deal of time is spent in activities to obtain, use or recover from the substance
(6) Social, occupation or recreation activities are effected
(7) Continued substance use despite knowledge of having had persistent or recurrent physical or psychological problem
Substance Abuse
: A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by AT LEAST ONE of the following occurring at any time during a twelve month period:
(1) Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home
(2) Recurrent substance use in situations in which it is physically hazardous
(3) Recurrent substance-related legal problems
(4) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
Additionally, patient must never have met the criteria for substance dependence for this class of substance
Treatment
In order for a treatment plan to be effective, three things must be changed:
(1) Remove Agent (the substance itself) and all intoxicating substances