Alcohol and drug related disorders
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Alcohol and Drug Related Disorders. Assessment & Diagnosis SW 593. Introduction . When assessing adults it is important to consider the possibility of substance related disorders. Fundamental features:

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Alcohol and drug related disorders

Alcohol and Drug Related Disorders

Assessment & Diagnosis

SW 593


  • 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.


  • 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?

Clinical syndromes
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.

Clinical syndromes1
Clinical syndromes

  • Tolerance (physiological)

  • Withdrawal (physiological)

  • Loss of control (psychological)

  • Cravings

  • Time spent around substance activity

  • Preoccupation

  • Continuation of usage.

Clinical syndromes2
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

Clinical syndromes3
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.

Clinical syndromes4
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.

Worth noting
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.


  • 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.


  • Assessment instrument: CAGE

    • Cut down

    • Annoyed

    • Guilty

    • Eye opener

Emergency considerations
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.

Common medical symptoms

Vitamin deficiency


Dyspepsia (impaired digestion)

Upper gastrointestinal problems

Peptic ulcers




New-onset arrhythmia



Peripheral neuropathy


Common Medical Symptoms

Behavioral cognitive and emotional problems
Behavioral, Cognitive, and Emotional Problems

  • Stress

  • Insomnia

  • Anxiety

  • Depression

  • Acute psychotic states

  • Impaired cognition

  • Violent behavior

Social problems
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.

Cultural considerations
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.

Cultural considerations1
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.

Cultural considerations2
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.

Social support systems
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.