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Facts

In 2008, an estimated 20.1 million Americans aged 12 or older were current (past-month) illicit drug
users. (8.0% of the population).
23.1 million persons w12 or older needed treatment for illicit drug or alcohol use (9.2% of the
population) (2008 SAMSHA National Survey on Drug Use and Health report)
2.3 million received treatment at a specialty facility (0.9%)

Substance use disorders affect 45% of patients who present for medical care but are routinely
unrecognized by healthcare providers.

The use of structured screening and assessment strategies (e.g. CAGE Questionnaire) is essential
in the assessment of substance use disorders

Staging the severity of addiction, calibrating patients’ readiness to change behaviors, and willingness
to access professional help are crucial

Patients are more likely to follow plans that are negotiated in partnership with treaters and
renegotiated at follow-up visits.

Sustained recovery requires many resources. To achieve treatment goals, physicians should
become comfortable referring patients to resources such as self-help groups, professional
treatment programs, and psychiatrists to treat co-morbid psychiatric disorders.
Drugs & the Brain
 Structures
 Brain stem
 Limbic system
 Cerebral cortex
 Brain communication
 How drugs work in the brain?
 Long term affects
DSM IV TR Criteria- Abuse
A maladaptive pattern of substance use leading to clinically significant
impairment or distress as manifested by one (or more) of the following,
within a 12-month period:
 Recurrent substance use resulting in failure to fulfill major role
obligations at work, school or home related to use; substance-related
neglect of children or household
 Recurrent use in situations in which it is physically hazardous
 Recurrent substance-related legal problems (DUI, disorderly conduct)
 Continued use despite persistent or recurrent social or interpersonal
problems caused or worsened by effects of the substance.
DSM IV TR Criteria- Dependence
Addiction (dependence, per APA): maladaptive pattern of substance use
leading to clinically significant impairment or distress as manifested by
three (or more) of the following, within a 12-month period:
 Tolerance
 Withdrawal
 Substance taken in larger amounts or over a longer period than
intended
 Persistent desire or unsuccessful efforts to cut down or control use.
 Great deal of time spent obtaining, using or recovering from use.
 Important social, occupational or recreational activities are given up or
reduced to accommodate use.
 Use despite knowledge of persistent physical or psychological problems
are likely to have been caused or worsened by use.
Can occur with or without physiological symptoms of tolerance &
withdrawal (psychological addiction)
High index of concern for
substance use in persons with:
 Family history of substance use disorder
 Recent stressful life events and lack of social supports
 Chronic pain or illness, trauma
 Mental illness (e.g., depression, bipolar disorder, etc.)
 Drug-seeking behaviors
 Physical and cognitive disabilities
 Started alcohol use before age 15
 Medical condition associated with substance use
Addiction & Disease
 THIQ & alcohol
 Opiates & serotonin
 Cocaine & reward system
 Cross addiction
Levels of Care
 Detox versus treatment
 28 day programs
 25-35% of people who complete addiction treatment will
be readmitted to treatment within 1 year &
 50% will be readmitted within 5 years
 Community based treatment programs
Relapse & Recovery
 First 3-6 months greatest likelihood of relapse,
HOWEVER people can relapse at any time, even after
many years
 Recovery/sobriety is not just an absence of symptoms
 Relapse is not fully stabilized until 4-5 years of
sustained recovery.
Interview w/ someone in recovery
http://webcampus.drexelmed.edu/nida/module_1/def
ault.htm
Screening & Assessment:
General observations
 Behavior
 Mood
Co-occurring mental illnesses, dual diagnosis
 Daily routine
Screening & Assessment:
If it SOUNDS like and excuse, it IS an excuse
Checklist Handout
 Questions and follow-up
 The most reliable info is in response to our follow-up
questions
 Red Flags
 AA/NA: The program and the excuses
Now that we have additional info,
how do we apply it to find best
interest?
Impact of parental/caretaker substance
abuse on children;
the importance of environment.
Impact on kids at every age &
stage- psychological & physical
 8.3 million (11%) children live w/ at least one parent in
need of treatment
 1 in 4 kids under 18 lives in a home where alcohol &
drug abuse is a fact of daily life
 Children whose parents abuse alcohol & drugs are 3
times more likely to be verbally, physically or sexually
abused & 4 times more likely to be neglected
Resources
 http://www.drugabuse.gov/scienceofaddiction/
 NIDA.gov
 SAMHSA.gov
 http://webcampus.drexelmed.edu/nida/module_1/def
ault.htm