An Introduc+on to Substance Use Disorder€¦ · • The memory of the “high” lasts forever...
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An Introduc+on to Substance Use Disorder Dus+n Chapman Licensed Alcohol and Drug Counselor University of Minnesota Medical Center
Transcript of An Introduc+on to Substance Use Disorder€¦ · • The memory of the “high” lasts forever...
AnIntroduc+ontoSubstanceUseDisorder
Dus+nChapman
LicensedAlcoholandDrugCounselorUniversityofMinnesotaMedicalCenter
Substanceabuseistheintroduc0onofadrugthatcreatesanintense,unnaturalandunsustainablefeelingofeuphoria
Intense
• Incrediblestateofeuphoria • NottobeconfusedwithfeelinggoodorfeelingbeAer
• IsanunforgeAableexperience• Moreintenseif15yearsoldoryounger
Unnatural
• Naturalac+vi+eswillnotproducetheintensityofdrug-inducedeuphoria
• Stageofbraindevelopmentfacilitatesgreatereuphoricexperience
Unsustainable
• Over+me,theintensityoftheeuphoriadiminishes
• Increasedamountsorstrongermorepotentdrugsmaybeusedtore-experiencethehigh
• EventuallytheeuphoriaisnotaAainablebutthebrainishard-wiredtoneedthedrugtonormalizeitself
• Thememoryofthe“high”lastsforever
MythsandFacts
• Myth:peoplebeginabusingdrugsandalcoholtochangehowthey’refeeling
• Fact:peopleusuallybeginabusingdrugsfortheintenseeuphoricexperiencewithnothoughttohowthey’refeelingpriortousingorpoten+alconsequences
• Myth:peopleabusedrugstoescapelife,tocopewithproblemsortoselfmedicate
• Fact:mostpeoplebeginusingasteenagersorpre-teensandareusingfortheeuphoricexperience.Lackofsupervision,guidanceandacaringrela+onshipwithanadultmayleadtoawillingnesstoengageinhighriskbehaviors
• Myth:peoplewhoabusedrugsareweak-willedindividualswhocannothandletheeverydaystressesoflife
• Fact:peoplewhoabusesubstancesareascapableasanyoneincoping.Theirdrugusehasrenderedtheircopingskillsineffec+ve.Theoutwardappearanceisthattheycan’thandlestressandneedanescape
Substanceabuseisnotanescape,acopingmechanismorselfmedica+on.Itbeginsasaverymemorable,funexperienceespeciallyifthepersonusingis15oryounger.Butitcanappeartobeacopingmechanism,especiallyiftheSAischronicWhenweviewortreatSAasasecondarydiagnosisandsolelyasamaladap+vecopingmechanism,wereducethepoten+alforaposi+veoutcome.
Mild/moderateSymptomsofSubstanceuseDisorder
– Recurrentuse;failuretomeetobliga+ons– Recurrentuseinhazardoussitua+onsI.E.DUI,unsafesex,riskatthehandsofothers– Recurrentuseinspiteofpersistentsocialorpersonalproblemscausedbyuse
WhatisSevereSUD?
• SevereSUDisthebrain’sinabilitytoachieveormaintainhomeostasisnaturallyandreliesonthedrugtoachievenormalcy.Everydayoccurrences,goodandbad,maytriggercravingstouse.Con+nuedusebecomesafactorintryingtofeel“normal”andavoidwithdrawalsymptoms
SymptomsofSevereSubstanceUseDisorder
– Usingmorethanintended– UnsuccessfulaAemptstoquitorcutdown– Con+nueduseinspiteofawarenessofaproblem– Agreatdealof+mespentusingorrecoveringfromuse
– Increasedtolerance– Withdrawal
Currenttrendswithchildren
• Firstageofuse=14• Firstdrugused=marijuanaandoralcohol– MarijuanamaybeeasiertoaccessthanETOH
• Drugculturehasgrowninschoolssince1974.Geanghighisanacceptedpartofschoollifewhetherstudentsuseornot
• ETOHiss+llwidelyusedbystudents• Opiatesarebeingusedatanalarmingrate
FactorsinAbuse/Dependence
• Ageoffirstuseismostsignificantdeterminingfactor.Use<15resultsin40%greaterrisktodevelopSUD.Why?Stagesofbraindevelopmentresultinmoreintenseeuphoricexperiencepromp+ngadesiretousewheneverpossible
• Environment:living/socializinginaheavydrinking,drugusingenvironmentencouragesusing
Factors(cont.)
• Heredity:mayincreasechanceofabuse/dependenceregardlessofageoffirstuse
• Trauma+c,AdverseChildhoodExperiencesmaynega+velyaffectbraindevelopmentthatinturnproducesrewardingeffectsifETOH/drugsareused.Theremaybetraumarelatedgene+cchangesthatcanbepassedon
TheBrain
• Onlyorgandirectlyimpactedbysubstanceusealthoughsubsequentorgansmaybeaffected
• Maytake5ormoreyearsofabs+nence,dependingonthesubstancesusedanddura+onofuse,forthebraintoreturntosomesemblanceofnormalfunc+oning
• Onaverage,individualsaAemp+ngabs+nencewillrelapse6+mesbeforelong-termrecoverytakeshold
Sleep
• Thebrainistheonlypartofthebodythatneedssleep
• SUdisruptssleepcycles.Eventhoughapersonappearstobesoundasleep,notallareasofthebrainareregenera+ngthroughsleep
• Individualfeelsmorestressandislesscapableoftolera+ngstress
• Braincravesdrugstonormalize
Opiates
• StateofMNisexperiencingfirstseriousheroinepidemicever
• Profileofopiateuserischangingfromstereotypicalbackstreetaddicttosuburban,students/employedindividuals
• Opiateaddic+onislikelyrelatedtotheincreaseofover-prescribingofvariousopiatemedica+ons.
Opiates(cont.)
• UnusedandforgoAenprescrip+onsaretakenbyteens/youngadultswhowanttogethigh
• Whensupplyrunsouttheyfindtopurchaseonthestreetmaycost$200-$300whereheroinmayonlycost$10-$25ini+ally
• MNhasthepurest(52%)andcheapestheroininthecountry
• Urbanlegend:ifyousnortanddon’tinjectyoucan’tgetaddicted
What’sbeingdone?
• MNLegislaturepassedlawallowingfirstrespondersandci+zenstoadministerNaloxone
• Insomestates,includingMinnesota,CVSissellingNaloxoneOTC
• Pharmacistgivesinstruc+ononuseaswithaPx
• Immunityforpeoplewhocall911toreportanoverdose
ProfessionalAwareness
• BeaAunedtopa+entdiscomfortandwhatisreasonable/unreasonable
• Developanawarenessofopiateprescrip+onsandpersonalaatudestowardsthem
• Consideraconserva+veapproachtoprescribingopiates
• ConsideraddingSUandMHscreeningstointakeforms
PrimaryCareandtheACA
• Emphasizes“nowrongdoor”philosophyforiden+fyingMIandSAissuesandemphasizesfirstepisodeinterven+ons
• WillrequirementalhealthandsubstanceusescreeningasprotocolsinprimaryclinicsandincludeMH/SAprofessionalsaspartofexamteam
• Willrequireclinicstoaddresourcestoini+allyaddressanddofollow-upwithissuesviatelephoneandofficevisits
• Clinicsu+lizingSBIRT-typescreeningtoolsandfollow-upmayreducerepeatsubstanceabuseby43%
• DentalclinicsaddSBIRT?MaintaincontactswithhealthcarehomesorcommunityresourcesforMH/SAreferrals
Whatisintegratedcare?
• Formingrela+onshipswithprovidersofnon-dentalservices.Sharingofficespace,stafforotherresources
• Warmhand-offstoothercareprofessionals• Integratedprimarycaretoeventuallyincludedental?
• Dentalservicesavailableincommunity-basedprograms
AlcoholicsAnonymous
• Foundedin1935inAkron,Ohio• 12Steps– Acknowledgepowerlessness– Acknowledgeandiden+fyahigherpower– Selfawareness– Selfacknowledgement– Stepstorepairone’slife
• Mostrecoveriesofanyprogram
RecommendedReadings
• BigBook,AA• Broken,Wm.Moyers
• Drinking:ALoveStory,CarolineKnapp• Tweak,NicSheff
Ques+ons?
