Chapter 4

1. Chapter 4 Definitions of Substance Abuse, Dependence, and Addiction

2. Diagnostic Categories • Substance-Abuse Disorders • Substance-Dependent Disorders

3. Substance Abuse – Definition A DSM-IV-TR Definition • A maladaptive pattern of substance abuse use, leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

4. Substance Abuse cont’d • Recurrent substance use, resulting in a failure to fulfill major role obligations at work, school, or home • Recurrent substance use in situations in which it is physically hazardous • Recurrent substance-related legal problems • Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

5. Substance Abuse – Definition B DSM-IV-TR Definition B. The symptoms have never met the criteria for substance dependence for this class of substances.

6. Substance Dependence DSM-IV-TR Definition • A maladaptive pattern of substance abuse, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

7. Substance Dependence cont’d 1. Tolerance, as defined by either of the following: • A need for markedly increased amounts of the substance to achieve intoxication or desired effect • Markedly diminished effect with continued use of the same amount of the substance 2. Withdrawal, as manifested by either of the following: • The characteristic withdrawal syndrome for the substance • The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

8. Substance Dependence cont’d 3. The substance is often taken in larger amounts or over a longer period that was intended 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use 5. A great deal of time is spent in activities necessary to obtain the substance (e.g. visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

9. Substance Dependence cont’d 6. Important social, occupational, or recreational activities are given up or reduced because of substance use 7. The substance abuse is continued despite having knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

10. Substance Withdrawal Substance withdrawal is described by the following diagnostic criteria (APA 2000): A. The development of substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged

11. Substance Withdrawal cont’d B. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The symptoms are not due to general medical condition and are not better accounted for by another mental disorder

12. Functional Definition of Addiction The Three “C”s (from David Smith, MD) Compulsion – Obsession with alcohol/drugs Control – inability to stop using alcohol/drugs Consequences – continued use despite adverse consequences

13. DENIAL = D – E – N – I – A – L Don’t Even kNow I Am Lying

14. Mood Responsibility Motivation School Negative Activities Lying, stealing & cheating Defense mechanisms: Rationalization, minimization Community Physical signs Parents Criminal justice problems Adolescent behavior (i.e. moodiness) sometimes mimics alcohol/drug induced behaviors Changes Identification of Adolescent Alcohol/Drug Problem

15. Age of initial drug and alcohol use Frequency of use, amounts used, set and setting of use Patterns of use, binges, periods of nonuse Do any of your family members (esp. mother or father) have an alcohol/drug problem? Use of medications, coffee, cigarettes Medical history: conditions that might be affected by drug use History of negative consequences: physical, psychological, financial, familial and spiritual Stage of current use Alcohol/Drug Assessment

16. The following stages are found in Richard Fields, Ph.D.model of stages of alcohol/drug use • Experimental • Non-use • Periodic excessive

17. Screening for What? • The purpose of a screening tool is to: • FIRST determine if an alcohol/drug problem exists, not the extent of the use • Some symptoms can mimic drug use so you have to first determine that drugs are the reason for the behaviors

18. Preventing Suicide • According to the American Association of Suicidology: • Suicide is preventable. • Most suicide victims do not want to die. • More than 80 percent of people communicate their intent to suicide before they attempt to suicide.

19. Suicide Assessment Questions • Is there a family history of alcohol/drug problems, suicide or depression? • Do you use alcohol/drugs to: • Overcome bad/shameful feelings? • Deal with sleeping problems, depression or stress? • Quiet suicidal or self-destructive thoughts? • Do you have suicidal thoughts? (continued)

20. Assessment Questions cont’d • How will you do it? Do you have a plan? (Assess the availability or means to commit suicide and the lethality of the means). • Have you previously had suicidal thoughts and have you attempted suicide before? How frequently do these thoughts occur? • What role does alcohol/drug use have in relation to suicide? Does it make you more likely or less likely to follow through? (continued)

21. Assessment Questions cont’d • On a scale of 1 to 10, how likely are you to kill yourself? • How much do you want to die? To live? • What would prevent you from committing suicide? • What might occur to make life worth living?