Substance Use Disorder.docx

Substance Use Disorder According to DSM 5 the essential feature of a Substance Use Disorder (SUD)is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substancerelated problems (DSM 5, 2013). •

The DSM -5 has given the following Substance Use Disorders namely Alcohol Use Disorder, Cannabis Use Disorder, Phencyclidine Use Disorder, Inhalant Use Disorder, Tobacco Use Disorder, Opioid Use Disorder, Sedative, Hypnotic, or Anxiolytic Use Disorder and Stimulant Use Disorder.

•

Diagnostic Criteria of Substance Use Disorder (DSM-5) are given as follows:

•

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Substance is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control substance use. 3. A great deal of time is spent in activities necessary to obtain substance use it, or recover from its effects. 4. Craving, or a strong desire or urge to use substance. 5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home 6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of substance use. 7. Important social, occupational, or recreational activities are given up or reduced because of substance use. 8. Recurrent substance use in situations in which it is physically hazardous. 9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that it likely to have been caused or exacerbated by substance. 10. Tolerance, are defined by either of the following: a) A need for markedly increased amounts of substance to achieve intoxications or desired effect. b) A markedly diminished effect with continued use of the same amount of substance.

Treatment/ Management •

Pharmacotherapy- Eg. Detox

•

Psychotherapy/ Counseling

•

Motivational Interviewing

•

MET

•

Relapse Prevention/Relapse Management

STAGES OF CHANGE – Prochaska, Di Clemente 1. Pre-contemplation: the person does not believe they have a problem or does not want to change. 2. Contemplation: the person is beginning to evaluate their use and starts to think about changing their pattern of use. 3. Determination: the person decides that they do want to change their pattern of use. 4. Action: the person changes their use by cutting down or quitting. 5. Maintenance: the person tries to keep to their reduced level or abstinence.

Relapse: the person returns to increased use. 6. Identifying high risk situations- people, places, mood etc 7. Manage high risk triggers / situations 8. It's useful to think of high risk triggers/situations using the Drug, Individual, Environment - DIE model: 9. Drug - Availability, advertising, drug talk, use of a drug, etc. 10. Individual - negative emotional states, celebrating, negative thinking, drug thoughts, etc. 11. Environment - drug using friends, relationship/family problems, money (too much or too little) etc.

Explain the difference between Lapse & Relapse: Lapse = a brief slip or lapse in resolution Relapse = reinstatement of former behaviour or collapse in resolution Prepare the client for the possibility of a lapse or relapse. Using the analogy of a fire drill, (preparation, even though it may not happen) may help reassure the client of your faith in him/her. However, explain that trying new things may involve occasional mistakes which can be useful to learn from.

Coping With Craving •

Understanding Craving

Experiencing some craving is normal and quite common. Does not mean something is wrong or that patient really wants to resume drug use. Important to convey time-limited nature of alcohol or other drug craving, that is, conditioned craving usually peaks and dissipates in less than an hour, if not followed by alcohol or other drug use •

Describing Craving

What is craving like for you? How bothered are you by craving? How long does craving last for you? How do you try to cope with it? •

Identifying Triggers