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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:
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.

Introduction
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
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 syndromes
Tolerance (physiological)
Withdrawal (physiological)
Loss of control (psychological)
Cravings
Time spent around substance activity
Preoccupation
Continuation of usage.

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 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 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
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.

Assessment
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
Assessment instrument: CAGE
Cut down
Annoyed
Guilty
Eye opener

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
Malnutrition
Dyspepsia (impaired
digestion)
Upper gastrointestinal
problems
Peptic ulcers
Hepatitis
Pancreatitis

Hypertension
New-onset arrhythmia
Cardiomyopathy
Seizures
Peripheral neuropathy
AIDS

Behavioral, Cognitive, and


Emotional Problems
Stress
Insomnia
Anxiety
Depression
Acute psychotic states
Impaired cognition
Violent behavior

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
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 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 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


More that 50% of todays alcoholics are
the children of alcoholics.
Many more are utilizing 12 step programs
to end the cycle of abuse.