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Rehab Counseling

Rehab Counseling . Substance Abuse Class 05 Markus Dietrich LMHC,CRC,CAAP Shands Healthcare dietrmk@shands.ufl.edu. Drug Use-Scope. In 2001 an estimated 15.9 million Americans 12 or older used illicit drugs. This represents 7.1% of this population.

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Rehab Counseling

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  1. Rehab Counseling Substance Abuse Class 05 Markus Dietrich LMHC,CRC,CAAP Shands Healthcare dietrmk@shands.ufl.edu

  2. Drug Use-Scope • In 2001 an estimated 15.9 million Americans 12 or older used illicit drugs. This represents 7.1% of this population. • This a 0.8% increase from 6.3% in 1999 and 2000. • Increases were noted for: Marijuana 4.8% to 5.4% Cocaine 0.5% to 0.6% Pain Relievers 1.2% to 1.6% Tranquilizers 0.4% to 0.6% National Household Survey 2001

  3. Drugs Use- Marijuana • Marijuana is the most commonly used drug used by 76% of the drug users • 56% of drug users use only marijuana • 20% use Marijuana and another drug. • 24% use illicit drugs but not marijuana.

  4. Therapeutic Drugs Of the 4.8 million users of therapeutic drugs, • 3.5 million use pain relievers • 1.4 million use tranquilizers • 1 million uses stimulants • 0.3 million use sedatives

  5. Drugs cont. • In 2001 an estimated 1.7 million (0.7%) Americans age 12 or older were current cocaine users and 406,000 (0.2%) were current crack users • 1.3 million (0.6%) used hallucinogens • 957,000 used Oxycontin non medically (four times as much as 1999) • Heroin use is reported to be 123,000 (0.1%)

  6. Drugs- Variables • Men are more likely to report drug use than women (8.7 vs. 5.5%) • Rates and patterns of drug use vary by age, peaking among 18-20year olds • Drug use is correlated with education. Rate for H.S graduates is 7.6% vs. 4.3 percent for four year college graduates, even though college graduates were more likely to have tried drugs.

  7. Alcohol • 109 million ( 48.35%) Americans age 12 or older report being current drinkers • Approximately one fifth (20.5%) reported bingeing at least once in last 30 days • 5.7%reported heavy drinking

  8. Alcohol variables • Age: highest prevalence of alcohol use is between 18 and 25. Rate drops slightly between 25 and 60. • Men are more likely to drink than women • likelihood of drinking alcohol increases with education, however, binge drinking and heavy drinking were least prevalent among college graduates

  9. Employment Unemployment is highly correlated with drug and alcohol use however, • 6.9% of illicit drug users are full-time employed • 9.1% of drug users are part-time employed • Among the 43.9 million adult binge drinkers, 35.4 million (81%) are full-time or part-time employees. • 9.8 million (80%) of the heavy drinkers are also employed

  10. Significant Others • Non-alcoholic members of alcoholic’s families use 10 times as much sick leave as in families where alcohol is not a factor. • More than half of all family members of alcoholics who are employed (80%) report their ability to function is impaired as a result or living with an alcoholic.

  11. Effects on Business • decreased productivity • increased on-the-job accidents • increased absenteeism • turnover • increased health care cost

  12. Economic Impact • Cost to society associated with drug and alcohol abuse is estimated to be $294 billion. • The largest impact is on lost productivity. • The health care cost for alcohol abuse is about twice that for drug abuse. Samsha 2001

  13. Social Impact Alcohol and drug abuse correlate positively with: • Domestic Violence • Child abuse and neglect • Separation and divorce • Healthcare cost • Criminal behavior

  14. Trends • The NHSDA showed increases among Americans in rates of use of several substances, including marijuana and cocaine and the non-medical use of pain relievers and tranquilizers. Alcohol use also increased, although binge drinking and heavy use remained unchanged between 2000 and 2001

  15. Addiction and the Brain

  16. Addiction is an independent disorder distinguished from drinking that is merely heavy, problematic, ill advised or socially unacceptable Addiction is a brain disorder Abuse - intentional overuse in cases of celebration, anxiety, despair, self-medication, other mental health disorders or ignorance. Tends to decline with consequences or adequate treatment of other mental health disorder.

  17. Functional Imaging SPECT – single photon emission computed tomography PET – positron emission tomography fMRI – functional magnetic resonance imaging

  18. Dopamine Pathways – Pleasure pathways alcohol heroin alcohol benzodiazepins barbiturates cocaine heroin nicotine amphetamines opiates THC PCP ketamine striatum hippocampus frontal cortex substantia nigra/VTA nucleus accumbens

  19. THE RAT BRAIN • What “turns on” the dopamine in a rats brain….. • SEX-200% increase in dopamine • COCAINE-300% increase in dopamine • METHAMPHETAMINE-1100% increase in dopamine

  20. The explanation for why people respond differently! Inherited genes or altered expression abnormal proteins malfunction MFB enzymes receptors responses impaired control Early exposure to drugs

  21. Brain of the addicted is fundamentally different: • Gene expression (Liu, Nickolendko 1994; Daunais & McGinty 1995) • Glucose metabolism (Volkow, Gillespie, 1996) • Responsiveness to environmental cues (O’Brien, Childress, 1993; Kilgus & Pumariega, 1994)

  22. What’s inherited??? • Temperament • Initial sensitivity to rewarding or aversive qualities (like or dislike of the drug) • Tolerance • Rates and routes of metabolism • Taste preferences • Response to memories related to use

  23. Developing brain • Individuals who begin drinking before age 15 are 4 times more likely to develop alcohol dependence during their lifetimes than those who begin drinking at age 21. (Grant & Dawson 1997; Journal of Substance Abuse 9:103-110) • Earlier drinking more likely to result in alcohol dependence independent of family history (Grant, 1998)

  24. 1-2 Min 3-4 5-6 6-7 7-8 8-9 9-10 10-20 20-30 PET scan after cocaine use Your Brain on Drugs YELLOWshows places in brain where cocaine goes (Striatum)

  25. Cocaine 2 yrs Alcohol 25 yrs Normal SPECT (blood flow) Marijuana 12 yrs

  26. Assessment and Diagnosis • Bio-psycho-social-spiritual Assesment • DSM-IVR: Seven Criteria Two dimensions- Obsession and Compulsion.

  27. Job is last to go!

  28. Addiction Abuse Cravings, preoccupation Bad judgment, poor morals, self will Abnormal brainchemistry Normal brain chemistry No specific personality Frequent character or personality pathology Significant consequences May have significant consequences Unable to stop because of consequences – loss of control Likely to stop as consequences progress Progressive course Usually self-limited

  29. Facilitate ChangeMotivational Enhancement Therapy Key Factors for Change for the Counselor: • Style • Style • Style

  30. Key Concepts • Motivation: the probability that a person will enter into, continue and adhere to a specific change strategy. • Resistance: the result of interacting with one’s environment- not a characteristic. • Ambivalence: the heart of the problem, not pathological.

  31. Stages of ChangeProchaska & DeClemente 1982 • Pre-contemplation What problem? • Contemplation Is it a problem? • Preparation What can I do? • Action I am doing something • Maintenance I am successful

  32. Helper Tasks • Pre-contemplation Raise Doubt • Contemplation Evoke reasons for change • Preparation Help client find best course of action • Action Support steps toward change • Maintenance Relapse Prevention

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