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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

Rehab Counseling

Substance Abuse Class 05

Markus Dietrich LMHC,CRC,CAAP

Shands Healthcare

dietrmk@shands.ufl.edu

drug use scope
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

drugs use marijuana
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.
therapeutic drugs
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
drugs cont
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%)
drugs variables
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.
alcohol
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
alcohol variables
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
employment
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
significant others
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.
effects on business
Effects on Business
  • decreased productivity
  • increased on-the-job accidents
  • increased absenteeism
  • turnover
  • increased health care cost
economic impact
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

social impact
Social Impact

Alcohol and drug abuse correlate positively

with:

  • Domestic Violence
  • Child abuse and neglect
  • Separation and divorce
  • Healthcare cost
  • Criminal behavior
trends
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
slide16
Addiction is an independent disorder distinguished from drinking that is merely heavy, problematic, ill advised or socially unacceptableAddiction 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.

slide17

Functional Imaging

SPECT – single photon emission computed tomography

PET – positron emission tomography

fMRI – functional magnetic resonance imaging

slide20

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

the rat brain
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
slide23

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

brain of the addicted is fundamentally different
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)
what s inherited
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
developing brain
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)
slide27

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)

slide28

Cocaine 2 yrs

Alcohol 25 yrs

Normal

SPECT

(blood flow)

Marijuana 12 yrs

assessment and diagnosis
Assessment and Diagnosis
  • Bio-psycho-social-spiritual Assesment
  • DSM-IVR:

Seven Criteria

Two dimensions-

Obsession and Compulsion.

slide31

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

facilitate change motivational enhancement therapy
Facilitate ChangeMotivational Enhancement Therapy

Key Factors for Change for the Counselor:

  • Style
  • Style
  • Style
key concepts
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.
stages of change prochaska declemente 1982
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

helper tasks
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