substance abuse

intoxication
abuse
addiction
withdrawl

single episodes of substance abuse during which behavior is affected

12 month period

-emotional distress or impairments in functioning directly due to efforts to stop using a substance
-medically unstable in acute withdrawl phase
-irrational thinking, cognitive disabilities evident

psychological and physical need for a substance

-drug displaces the neurochemical for pleasure or naturally occuring endorphins
-later the body decides to shut down production of the endorphins because the individual is externally proficing the brain with the chemical
-if you do not provide the endorphin receptors with the chemical you have craving

-the younger the age of onset of drinking or drug use, the greater the chance of developing alcoholism or drug addiction
-youth who begin drinking before age 15 are 4 times more likely to develop alcohol dependence than those who begin after age 21.
-those who become addicted are emotionally paralyzed at the age they began using drugs or alcohol

-decreased norepinephrine (craves sweets, sugar, candy)
-decreased serotonin (craves alcohol, patries, bread, carbs)

-attitudes, behaviors, beliefs that are used to maintain the addictive process
(denial, rationalization, minimization, blaming, charming, aggression)

a period of substance free living

more than abstinence byt a style of livng without drugs or alcohol and the person engages in ways to present future use

process of regaining important life roles, routines, habits that support abstinence and sobriety

description of behavior of others that allows the user to continue his of her substance using behaviors without logical consequences

suspicion
insecurity
guilt
fear
disappointment
isolation
embarrassment
resentment

denial
illusion
intimacy and relationship problems
shame and guilt
family rules about controlling the situation

emotional unavailability
secret keeping
abuse
chaos
emotional roller coaster
dysfunctional roles

user (victim)
chief enabler
scapegoal/problem child
family hero
lost child
mascot/clown
prince/princess
saint/priest/nun/rabbi
the common denominator in the family is PAIN

Risk factors for substance abuse and addiction
Identification and expression of emotions
Examining unhealthy relationships and roles
Coping with peer influences
Styles of problem solving and decision making
Examining communication within the family and promoting clear, open, and honest communication
Psychoeducation about substance abuse and addiction
Promoting resiliency and nurturance
Exploring healthy occupations and leisure interest
Re-establishing productivity without the use of drugs and alcohol

it is a therapeutic style with a focus on empathy, promoting self efficacy, and facilitating personal choice

those in detox or serious medical withdrawl

skills training (social skills and examination of volition)

Express empathy (reflective listening, acceptance)
Develop discrepancy (present behavior vs goals, client articulates the reason for change)
Roll with resistance (client generates resources or solutions)
Support self efficacy (client must believe in the possibility for change as a motivator for action, client is responsible for deciding what to change and carrying out that change, therapist must have strong belief that the client has the ability to change and the therapist to help providing skills to make that change)

Use open ended questions
Identify circumstances or events leading to treatment
Explore motivation to continue substances
Review past successful efforts to change
Discuss accurate information about use
Reinforce client’s efforts to change
Imagine the future if continuing to use substances
Establish or co-create concrete goals

-evaluation tool for persons who use alcohol or drugs
Do you drink/take drugs to RELAX , feel better about yourself or fit in
Do you ever drink/take drugs while you are ALONE?
Do any of your close FRIENDS drink/take drugs?
Does a close FAMILY member have a problem with drugs/alcohol?
Have you ever gotten in TROUBLE from drinking/taking drugs?

Alcohol Use Disorders Identification Test

The client will participate in 3 leisure interests by discharge * that does not involve drinking and are conducive to abstinence
The client will identify four factors in his/her environment that will support a clean and sober lifestyle
The client will practice 3 new coping skills that will assist in responding to cravings or high risk situations
The client will evaluate parenting skills and identify two stress management techniques to deal with the stress of parenting without drinking

Leisure groups
Social skills training
Stress management
Communication skills training
Vocational planning
Expressive therapy
Task groups such as cooking

Note: I always prefaced this for clients with: “engaging in these activities clean and sober”

Description of an exercise I commonly used for evaluation and/or treatment to gain more information about the family system of the client

Community reintegration
Development of a strong support system
What is AA? What is Alanon? What is NA? What is Alateen?

A pathological condition focusing on dependence on others
Not in DSM IV TR
Original term focused on persons whose lives were affected as a result of a strong involvement with someone else who was alcoholic or chemically dependent

don't talk
don't trust
don't feel

placator
martyr
rescuer
victim
ultimate enabler

Adopting new healthy behaviors
Re-parenting skills
Learning to take responsibility for self
Establishing personal values
Redefining roles

Stops saying “How long will it take before I recover from this pain?”
Instead begins to say:
“What do I need to do to get myself better?”
“I have choices”
“I can set healthy boundaries”

Clark and Stoffel (1992)
Health care professionals are very prone to co-dependency habits due to the desire to help others
Burnout is high among health care professionals due to these need to help others
Taking care of yourself while you take care of others

Substance abuse can occur parallel to other psychiatric disorders
Often this is terms dual diagnosis
Sometimes dual diagnosis is referred to as developmental disabilities and psychiatric disorders
Resource article by Roush on treating co-occurring disorders and occupational therapy in resource folder
Note in the case study: Leonard has a family history of substance abuse