PCM: Substance Abuse

=PCM Objectives: Substance Abuse=

Describe the prevalence of substance abuse in the US and its impact upon public health

 * Alcohol dependence and abuse are current problems for nearly 10% of the US population (Kessler et al., 1994). More than 20% of adults in the primary care setting have a past or current substance abuse disorder and many physicians are unaware of their patients’ substance use histories (Buchsbaum et al. 1995).

==Definition of key terms and concepts used in substance abuse literature (e.g. “drug use behavior”) and describe common patterns among addictions, including genetic, behavioral and community-linked trends.==
 * Addictive disorder
 * includes the clinical problems of alcohol and drug dependence as well as other disorders that have often been classified as addictions, such as eating and gambling disorders.


 * Alcohol or drug disorder
 * used to describe the spectrum of problems associated with the negative consequences of mood-altering drugs.


 * Substance abuse and substance dependence
 * used based on standardized alcohol and drug criteria such as those from the DSM-IV


 * Populations at a greater risk and common patterns in addictions:
 * Elderly population – increasing prevalence of alcoholism among the older population, is often “under detected”.
 * Children and teens susceptible to influences that encourage risk taking and experimentation with substances. Children who start using illicit drugs before 15 is a strong predictor of later problems with substance.


 * Risk factors for adolescent dependence
 * genetic risk factors, biological markers, childhood aggressiveness or antisocial behaving, psychiatric disorders, suicidal behaviors.
 * Societal risk factors for adolescents are parenting, family environment, peer influences, positive expectancies regarding drinking, child abuse and advertising.

Features of the behavior disorders underlying substance abuse problems

 * Inability to cut down or stop
 * Social and emotional consequences such as family problems or work and school problems
 * Physiological symptoms such as: insomnia, gastrointestinal pain, liver toxicity, tolerance, and withdrawal.
 * Criteria for men: >14 drinks/week; > 4 d; For Women > 7 drinks/week, or 3 > d; For anyone over 60yo > 7 drins/week, or 3 > d.

Demonstrate methods to assess behavioral disorders in clinical practice.

 * Physicians can assess alcohol use by using the CAGE questions:
 * C Have you ever felt you should CUT DOWN on your drinking/drug use?
 * A Have people ANNOYED YOU by criticizing your drinking?
 * G Have you ever felt bad or GUILTY about your drinking?
 * E Have you ever had a drink in the morning to steady your nerves? (EYE OPENER)
 * Or…use an opened ended question/statement: “so tell me about your drinking….”


 * Dependence questions:
 * Are you ever unable to stop drinking once you start?
 * How many drinks does it take to get high? Does it take more drinks that it used to get high?
 * Do you drink in the morning to get over a hangover or stop the shakes?
 * Do you have strong urges to drink? Do many of your everyday activities revolve around drinking?


 * Describe complications of these disorders:
 * physical dependence
 * tolerance
 * withdrawal
 * substance-associated organic mental disorders
 * alcohol-induced liver disease
 * Pancreatitis
 * Cardiovascular disease
 * Cancers
 * Fetal Alcohol Syndrome
 * Injury and violence, “accidents”

Describe the range of community and clinical resources available for treatment of substance abuse for individuals with and without health insurance coverage

 * Alcoholics Anonymous or Rational Recovery and Women for Sobriety
 * Alcohol and Other Drug Abuse (AODA) treatment program or specialist
 * State alcohol and drug abuse agencies will have publicly and privately funded treatment programs
 * Community Alcohol and Drug Treatment Resource Guide will have numbers of key professional in the community
 * Employee assistance programs