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Facts

P arental S ubstance A buse: Assessment & impact on the child Balancing facts to find the best interest. Facts. In 2008, an estimated 20.1 million Americans aged 12 or older were current (past-month) illicit drug users. (8.0% of the population).

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Facts

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  1. Parental Substance Abuse:Assessment & impact on the childBalancing facts to find the best interest

  2. Facts • In 2008, an estimated 20.1 million Americans aged 12 or older were current (past-month) illicit drug users. (8.0% of the population). 23.1 million persons w12 or older needed treatment for illicit drug or alcohol use (9.2% of the population) (2008 SAMSHA National Survey on Drug Use and Health report) 2.3 million received treatment at a specialty facility (0.9%) • Substance use disorders affect 45% of patients who present for medical care but are routinely unrecognized by healthcare providers. • The use of structured screening and assessment strategies (e.g. CAGE Questionnaire) is essential in the assessment of substance use disorders • Staging the severity of addiction, calibrating patients’ readiness to change behaviors, and willingness to access professional help are crucial • Patients are more likely to follow plans that are negotiated in partnership with treaters and renegotiated at follow-up visits. • Sustained recovery requires many resources. To achieve treatment goals, physicians should become comfortable referring patients to resources such as self-help groups, professional treatment programs, and psychiatrists to treat co-morbid psychiatric disorders.

  3. Drugs & the Brain • Structures • Brain stem • Limbic system • Cerebral cortex • Brain communication • How drugs work in the brain? • Long term affects

  4. DSM IV TR Criteria- Abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, within a 12-month period: • Recurrent substance use resulting in failure to fulfill major role obligations at work, school or home related to use; substance-related neglect of children or household • Recurrent use in situations in which it is physically hazardous • Recurrent substance-related legal problems (DUI, disorderly conduct) • Continued use despite persistent or recurrent social or interpersonal problems caused or worsened by effects of the substance.

  5. DSM IV TR Criteria- Dependence Addiction (dependence, per APA): maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following, within a 12-month period: • Tolerance • Withdrawal • Substance taken in larger amounts or over a longer period than intended • Persistent desire or unsuccessful efforts to cut down or control use. • Great deal of time spent obtaining, using or recovering from use. • Important social, occupational or recreational activities are given up or reduced to accommodate use. • Use despite knowledge of persistent physical or psychological problems are likely to have been caused or worsened by use. Can occur with or without physiological symptoms of tolerance & withdrawal (psychological addiction)

  6. High index of concern for substance use in persons with: • Family history of substance use disorder • Recent stressful life events and lack of social supports • Chronic pain or illness, trauma • Mental illness (e.g., depression, bipolar disorder, etc.) • Drug-seeking behaviors • Physical and cognitive disabilities • Started alcohol use before age 15 • Medical condition associated with substance use

  7. Addiction & Disease • THIQ & alcohol • Opiates & serotonin • Cocaine & reward system • Cross addiction

  8. Levels of Care • Detox versus treatment • 28 day programs • 25-35% of people who complete addiction treatment will be readmitted to treatment within 1 year & • 50% will be readmitted within 5 years • Community based treatment programs

  9. Relapse & Recovery • First 3-6 months greatest likelihood of relapse, HOWEVER people can relapse at any time, even after many years • Recovery/sobriety is not just an absence of symptoms • Relapse is not fully stabilized until 4-5 years of sustained recovery. Interview w/ someone in recovery http://webcampus.drexelmed.edu/nida/module_1/default.htm

  10. Screening & Assessment:General observations • Behavior • Mood Co-occurring mental illnesses, dual diagnosis • Daily routine

  11. Screening & Assessment: If it SOUNDS like and excuse, it IS an excuse Checklist Handout • Questions and follow-up • The most reliable info is in response to our follow-up questions • Red Flags • AA/NA: The program and the excuses

  12. Now that we have additional info, how do we apply it to find best interest? Impact of parental/caretaker substance abuse on children; the importance of environment.

  13. Impact on kids at every age & stage- psychological & physical

  14. 8.3 million (11%) children live w/ at least one parent in need of treatment • 1 in 4 kids under 18 lives in a home where alcohol & drug abuse is a fact of daily life • Children whose parents abuse alcohol & drugs are 3 times more likely to be verbally, physically or sexually abused & 4 times more likely to be neglected

  15. Resources • http://www.drugabuse.gov/scienceofaddiction/ • NIDA.gov • SAMHSA.gov • http://webcampus.drexelmed.edu/nida/module_1/default.htm

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