Parental Substance Abuse: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). 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.

Drugs & the BrainStructures

Brain stemLimbic systemCerebral cortexBrain communicationHow drugs work in the brain?Long term affects

DSM IV TR Criteria- AbuseA 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.

DSM IV TR Criteria- DependenceAddiction (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:

ToleranceWithdrawalSubstance taken in larger amounts or over a longer period than

intendedPersistent 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)

High index of concern for substance use in persons with: Family history of substance use disorder Recent stressful life events and lack of social

supportsChronic pain or illness, trauma Mental illness (e.g., depression, bipolar disorder,

etc.) Drug-seeking behaviorsPhysical and cognitive disabilities Started alcohol use before age 15 Medical condition associated with substance use

Addiction & DiseaseTHIQ & alcoholOpiates & serotoninCocaine & reward systemCross addiction

Levels of CareDetox versus treatment28 day programs

25-35% of people who complete addiction treatment will be readmitted to treatment within 1 year &

50% will be readmitted within 5 yearsCommunity based treatment programs

Relapse & RecoveryFirst 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

Screening & Assessment:General observationsBehavior

MoodCo-occurring mental illnesses, dual diagnosis

Daily routine

Screening & Assessment: If it SOUNDS like and excuse, it IS an excuse

Checklist HandoutQuestions and follow-up

The most reliable info is in response to our follow-up questions

Red FlagsAA/NA: The program and the excuses

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.

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

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

Resourceshttp://www.drugabuse.gov/

scienceofaddiction/

NIDA.gov

SAMHSA.gov

http://webcampus.drexelmed.edu/nida/module_1/default.htm