1. Alcohol and Drug Related Disorders Assessment & Diagnosis SW 593

2. Introduction When assessing adults it is important to consider the possibility of substance related disorders. Fundamental features: –The taking of a drug, medication, drink, or substance in order to experience an altered state; –A cluster of cognitive, behavioral, and physiological symptoms when the substance use is continued, despite problems associated with the use.

3. Introduction Two primary groups: –Substance-use disorders (primarily dependence and abuse) –Substance-induced disorders (intoxication, withdrawal, and mental health consequences of abuse. There are 11 classes of substances mentioned specifically in the DSM-IV-TR; what are they?

4. Clinical syndromes Substance dependence: a maladaptive pattern of substance use that has led to clinically significant impairment or distress. The diagnosis is based on having at least three symptoms occurring at any time during the same 12 month period.

5. Clinical syndromes Tolerance (physiological) Withdrawal (physiological) Loss of control (psychological) Cravings Time spent around substance activity Preoccupation Continuation of usage.

6. Clinical syndromes Substance abuse – includes at least one of the following symptoms: –Failure to fulfill major role obligations –Recurrent use of substance despite physical hazards –Repeated substance related legal problems –Persistent use despite social or relational problems

7. Clinical syndromes Intoxication – a reversible, substance specific set of symptoms related to using a particular substance. The person must display clinically significant maladaptive behaviors or personality changes. Intoxication is not diagnosed when someone simply ingests a substance that has the desired effect and no undesired side effects.

8. Clinical syndromes Withdrawal – generally occurs when use of the substance has been prolonged or heavy. The symptoms must be severe enough to cause clinical levels of distress and/or impaired psychosocial functioning. It should be noted that withdrawal from central nervous systems depressants is a potentially fatal process.

9. Worth Noting Alcohol abuse or dependence is the most common substance related disorder –1 in 5 men; and 1 in 10 women who visit their doctors meet the criteria for at-risk drinking. –Two-thirds men and one-third women have experienced adverse experiences related to alcohol. Unrecognized substance related problems contribute dramatically to treatment “failure” among people with a variety of other mental disorders.

10. Assessment The major complicating factor in diagnosing substance related problems is the tendency for the user to minimize and deny the problem. Many are aware that their usage is socially unacceptable and thereby are quite adept in hiding their addiction.

11. Assessment Assessment instrument: CAGE –Cut down –Annoyed –Guilty –Eye opener

12. Emergency Considerations Assess for those physical withdrawal symptoms that can be life-threatening. Alcohol can be the most fatal while cocaine is virtually harmless. Substance abuse causes a wide variety of medical symptoms and diseases.

13. Common Medical Symptoms Vitamin deficiency Malnutrition Dyspepsia (impaired digestion) Upper gastrointestinal problems Peptic ulcers HepatitisPancreatitisHypertension New-onset arrhythmia CardiomyopathySeizures Peripheral neuropathy AIDS

14. Behavioral, Cognitive, and Emotional Problems StressInsomniaAnxietyDepression Acute psychotic states Impaired cognition Violent behavior

15. Social Problems Marital and family problems Legal difficulties Loss of employment Financial deterioration Suicide risk is frequently present in a substance abusing client particularly as health and psychosocial deterioration is present. Careful screening for self-destructive thoughts and/or impulses is imperative with this population.

16. Cultural Considerations Roughly 3.1 million Americans (1.4%) receive treatment for alcoholism and alcohol related problems in any given year. Treatment peaked among people between the ages of 26-34. Men are three times more likely to become a problem drinker than women.

17. Cultural Considerations Prevalence is highest for both sexes between the ages of 18 – 29. The stressors of poverty, joblessness, homelessness, and mental illness often contribute to substance abuse disorders regardless of racial or ethnic identity. Caucasians – lowest perceived risk of drug usage, generally seeking sensation and have peer models who abuse hard liquor.

18. Cultural Considerations African Americans – highest perceived risk of drug usage, generally have peer models who abuse beer and wine. Latino/Latina – in the middle in perceived risk with many peer models who are pill poppers. This population is generally offered more drugs than any other ethnic group.

19. Social Support Systems More that 50% of today’s alcoholics are the children of alcoholics. Many more are utilizing 12 step programs to end the cycle of abuse.