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Addiction :champagne::beer::wine_glass::smoking: (Substance abuse disorder…
Addiction :champagne::beer::wine_glass::smoking:
Low yield for any tests, but useful in clinic
will go over DSM-V changes for substance abuse disorder & mnemonics for screen/treat
go over how addiction is not just substance abuse
Use/abuse/dependence are no longer terms used; 1 disorder w/ diff severity
Go by checklist for Dx (11); challenging in real life; esp if pt is high functioning
On shelf/step it must be overt/obvious, impairment, florid, crisis, rock bottom
Substance abuse disorder
Control
Too much
going waaay overboard
Inability to cut down
Spending time trying to get substance
Craving
feeling you
must
do substance
Social Impairment
Inability to fulfill obligations
@ work/school
partying until 7am before a shelf; dropping the ball big time 2/2 partying
Social impairment
(friends/lovers/family)
Having a relationship
they wanted to maintain
, but substance comes first/ led to end of relationship b/c of substance
Activities
(used to do things, but now just do substance)
Risk
(marker for someone who has a problem)
Using in hazardous conditions
during sex
(including sex for substance)
while driving
(putting themselves and others in danger while on substance)
Complications
have health or legal issues, but still use
Physical (pharmacological changes)
Tolerance
need more to feel the same
Withdrawal
= using way too much
treated equal to other criteria in DSM-V
Pt: Someone who has hit rock bottom
Dx: Clinical
Screen
CAGE
High yield
C
ut down:
"have you ever tried cutting back?"
A
ngry:
"ever get angry when ppl talk to you about substance?"
G
uilt:
"R u guilty of the things you've done while using/Feel guilty about using?"
E
ye opener: :red_flag: red flag (withdrawal):
"Need to use to start the day?"
Am. Acad. of Peds: CRAFFT (for kids :boy::skin-tone-2:, like Mac n' cheese)
Lower yield
:pencil2: It's
more than normal for kids to use marijuana & alcohol
:beer:
(experiment w/ friends only)
CRAFFT to
catch kid who might
be developing substance abuse disorder
most kids who do drugs/EtOH
don't develop substance abuse
Earlier a :boy::skin-tone-2: is exposed
to substance abuse = more likely they will develop substance abuse disorder
Gateway drugs (easy to get) progressing to hard core drugs is real
C
ar:
"Ever use while driving? :blue_car:"
R
elax: :red_flag:
"use to relax?"
A
lone: :red_flag:
"use while alone?"
F
riends:
"Lost friends bc of substance?
F
orget:
"forgotten stuff you've done while using?
T
rouble:
"been in trouble w/ Law/Parents/Teachers?"
Determine Severity
Add up points on checklist
2-3 = mild
4-5 = moderate (abuse)
≥6 = severe (dependence)
:pencil2:This can be an activity too: Gambling :mahjong: & Sex :female_sign::male_sign:
Tx:
± Pharm
most don't have Rx tx
common abuses do: :smoking:, :beer:, opioid
:stars:
Group therapy
(best tx)
programs like AA
Psychotherapy
any sort of therapy to stay clean
:pencil2: 50-90% of people who get clean will relapse.
F/u: Educate pt:
"Relapse is OK!
"
Can fall off the wagon
Importantly: need to get back on the wagon
Psychotherapy
FRAMES
how to interact w/ ppl w/ substance abuse
most ppl deny it
ppl who admit, get judged by other people
F
eedback: Give ± feedback based on their decisions/actions
R
esponsibility: Ensure pt accepts responsibility for staying clean/relapsing
"You know this is all on you, and its OK"
A
dvice
M
enu of options
no 1 advice works better than others
work w/ pt to find which works best for them
E
mpathy :stars:(most imp):
Ppl will be judged by everyone, constant contempt
"Scum!, Doing it to yourself!"
Family gives up
difficult to treat (emotionally) as a doc
demonstrating empathy may burn you :fire:, but you may get someone clean
Stages of Empathy
Precontemplative (denial)
Contemplative (acceptance)
Preparation (1st steps: ready)
Action (actual change of behavior)
Maintenance (sustained behavior w/o relapse)
one goes back and forth between maintenance and action; reinforce good behavior
Understand the disease of Addiction
Use/Abuse
: some sort of
impairment
Addiction
:
disease
, neurobio predilection to require substance to feel normal
S
elf efficacy:
Showing person by being clean = theyre doing better
Graphical digression about addicts
"normal" people get drunk/do drugs and reset to baseline
addicts use 1st time and feel
reaaaally good
reset to lower baseline: feel like crap when not using
next use will never reach the same high as 1st time
Come down: worse than ever
Eventually
use just to feel normal
= the way everyone else is while sober
