Substance Use Counseling Theory and Practice: Sixth Edition

Substance Use Counseling Theory and
Practice
Sixth Edition
Chapter 1
Introduction to Substance
Use Disorder Counseling
Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved
Learning Objectives (1 of 2)
1.1 Provide a historical perspective of the prevalence of drug use
and abuse including the impact on current substance abuse
issues, ensuing ramifications, and treatments.
1.2 Describe the history, use, impact, and current statistical
trends of commonly used drugs such as alcohol, marijuana, and
tobacco.
1.3 Identify patterns and societal costs of substance use and
abuse.
1.4 Present an organized and logical progression of substance
abuse and counseling information and definitions.
Learning Objectives (2 of 2)
1.5 Emphasize the importance of comprehensive training in
substance abuse intervention and prevention, which will help
address issues such as “process addiction.”
1.6 Study the salient issues for substance abuse counselors
1.7 Understand the importance of the continuum model for
substance abuse assessment and interventions
1.8 Identify the multiple factors affecting the choice of treatment
setting and results
Chapter Overview
• Introduction
• Societal Costs of Substance Use Disorders
• Substance-Related Diseases
• A (Very) Short History of Substance Use
• The Importance of Terminology in Substance Use Disorder
Counseling
• The Profession in the 21st Century
• An Overview of This Book
• Case Studies
• Conclusion
Introduction
• Drugs are used for:
– Mourning
– Religious rituals
– Pain relief
– Stress relief
– Recreation
• People use drugs:
– To forget
– To feel better (Physically and mentally) or not feel at all
– To disinhibit
– Because of peer pressure
Introduction - Tobacco Use (1 of 5)
• In 2013, tobacco users
represented 70.5% of the
population
– Young adults aged 18-
25 had the highest rate
of current use of a
tabacco product at
37.0%
– Adults aged 26 or older
represented 25.7%
– Youths aged 12-17
represented 7.8%
• In the same 2013 survey,
young adults had the
highest rates of current
use of the specific tobacco
products within the past
month of the survey. The
rates were:
– 30.6% for cigarettes
– 10.0% for cigars
– 5.8% for smokeless
tobacco
– 2.2% for pipe tobacco
• In the same 2013 survey, the prevalence of tobacco use
was also reported by ethnicity
– 40.1% for American Indians or Alaska Natives
– 31.2% for persons reporting two or more races
– 27.7% for White People
– 27.1% for African American People
– 25.8% for Native Hawaiians or other Pacific Islanders
– 18.8% for Hispanics
– 10.1% for Asians
• Relationship between education
and cigarette use among adults
aged 18 or older:
– 33.6% of those who had not
completed high school
– 27.7% of high school
graduates with no further
education
– 25.5% of persons with some
college but no degree
– 11.2% of college graduates
• Other statistics related to tobacco use:
– The annual average rate of past-month cigarette use in
2012 and 2013 among women aged 15 to 44 who were
pregnant was 15.4%.
– In 2013, past-month alcohol use was reported by 65.2% of
current cigarettes smokers compared with 48.7% of those
who did not use cigarettes in the past month.
– Among persons aged 12 or older, 24.1% of past-month
cigarette smokers reported current use of an illicit drug
compared with 5.4% of persons who were not current
cigarette smokers.
Introduction - Alcohol Use (1 of 3)
• In the same 2013 survey, alcohol prevalence was reported:
– 52.2% of Americans aged 12 or older reported being current
drinkers of alcohol, which was similar to the rate in 2012
(52.1%).
– The rate of current alcohol use among youth aged 12-17 was
11.6%
– An estimated 8.7 million underage persons (aged 12-20) were
current drinkers, including 5.4 million binge drinkers and 1.4
million heavy drinkers
– An estimated 10.9% of persons aged 12 or older had driven
under the influence of alcohol at least once in the past year.
– 1.4 million received treatment for the use of alcohol but not illicit
drugs.
• Treatment Prevalence in the 2013 Survey
– 2.5 million persons aged 12 or older reported receiving treatment for
alcohol use during their most recent treatment in the past year
– 845,000 persons received treatment for marijuana use
– 746,000 persons received treatment for pain relievers
• Consequences of Alcohol use

– Someone dies in an alcohol-related automobile crash every 51 minutes
in the U.S.
– The annual cost of alcohol-related crashes is $59 billion
– In 2006, the World Health organization reported that 55% of people
involved in intimate partner violence believed that their
partner/perpetrator had been drinking alcohol
• Consequences of Alcohol use continued
– Diseases whose risk factors rise with the use of alcohol:
▪ Human Immunodeficiency virus (HIV) and other infectious
diseases
▪ Cardiovascular complications
▪ Respiratory, gastrointestinal, and musculoskeletal effects
▪ Kidney and liver damage
▪ Neurological and mental health issues
▪ Hormonal issues
▪ Cancer
▪ Pre- and Postnatal complications
Introduction - Marijuana Use (1 of 3)
• Statistics on 2013 marijuana use:
– Marijuana was the most commonly used illicit drug,
with 19.8 million current (past-month) users
– There were 2.4 million persons aged 12 or older who
had used marijuana for the first time with the past 12
months
– Among persons aged 12 or older, an estimated 1.4
million first-time past-year users had initiated use
before the age of 18.
• Marijuana affects the brain areas that influence:
– Pleasure
– Memory
– Thinking
– Concentration
– Sensory and time perception
– Coordinated movement
• Marijuana smoke is an irritant to the lungs causing the same problems that
tobacco users experience:
– Daily cough and phlegm production
– More frequent acute chest illness
– Heightened risk of lung infection
– Increased heart rate shortly after smoking
• Chronic marijuana use has been linked to mental illness
– Temporary psychotic reaction
– May worsen schizophrenia
– Associations have also been found between:
– Depression
– Anxiety
– Suicidal thoughts among adolescents
– Personality disturbances
Introduction-Prescription Drugs (1 of 2)
• The use of prescription drugs for medical misuse or
nonmedical purposes is growing
• Psychotherapeutics: Drugs that are prescribed for their
effects in relieving symptoms of anxiety, depression, or
other mental disorders.
– Opioids (Pain relievers)
– Central nervous system depressants (Tranquilizers &
Sedative)
– Stimulants
Introduction-Prescription Drugs (2 of 2)
• Among persons aged 12 and older:
– 4.5 million were using nonmedical pain relievers in 2013
– 1.7 million were using nonmedical tranquilizers
– 1.4 million were using nonmedical stimulants
• Among the elderly (age 60 and older):
– Prescription drug use is present in 12% - 15% of
individuals who seek medical attention
– 83% of older adults take prescription drugs
– Psychoactive medications with abuse potential are used
by at least 1 in 4 older adults
Societal Costs of SUD (1 of 4)
• For FY 2016, a total of $27.6 billion was requested by the
president to reduce drug use and its consequences in the US
– This is an increase of more than $1.2 billion (4.7%) over
the enacted FY level of 26.3 as shown in the graph
• Estimated economic cost to society due to substance abuse and addition:
Substance Cost
Illegal Drugs $181 billion/year
Alcohol $185 billion/year
Tobacco $193 billion/year
Total $559 billion/year
• Admissions to Treatment Facilities

– Table 1-1 (p. 7)
• Estimated Number of Emergency Dept. Visits Involving Illicit Drugs

– Table 1-2 (p. 7)
• Productivity components
1. Labor participation costs
2. Specialty treatment costs for services provided at the
state level
3. Specialty treatment costs for services provided at the
federal level
4. Hospitalization costs
5. Incarceration costs
6. Premature Mortality costs - Homocide
7. Premature Mortality costs - No Homicide
• Other costs associated with Substance Use Disorder
– Losses to society from premature deaths and fetal
alcohol syndrome
– Social welfare administration costs
– Property losses from substance-related motor vehicle
crashes
– Cots of related diseases
Substance-Related Diseases
• Hepatitis
– Hepatitis B is most common cause of liver disease in the
world
– Hepatitis C is the most common blood-born infection in the
U.S.
• HIV/AIDS
– Estimated 1.5 million people died from AIDS-related
illnesses in 2013
– Estimated 39 million people with AIDS have died
worldwide since the epidemic began.
– Highest rate of infection remains male-to male sexual
contact, but injection drug use is second.
History of Substance Abuse (1 of 2)
• Over the centuries, drugs have been used:
– Medicinally
– Religiously
– Socially
History of Substance Abuse (2 of 2)
• Alcohol
• Cocaine
• Morphine, Heroine: The Opioids
• Marijuana
• Amphetamines
• Hallucinogens
• Tobacco
The Importance of Terminology in
Substance Abuse Counseling (1 of 5)
• DSM-5 changed the criteria for diagnosing substance use
– DSM-5 uses updated terminology
▪ Drug craving has been added to the list of criteria
▪ Law enforcement issues have been deleted
▪ Gamling has been added as the only condition of
behavioral disorder
▪ Caffeine use has been deleted
• Substances for which a person can be diagnosed with a substance
use disorder include:
– Alcohol
– Cannabis
– Phencyclidine
– Other hallucinogens
– Inhalants
– Opioid
– Sedative, hypnotic, or anxiolytic drugs
– Stimulant: Specify amphetamine or cocaine
– Tobacco
– Other (unknown)
• DSM-5 includes Substance Use Disorder on a continuum
– Mild substance use disorder: presence of 2 or 3
symptoms within DSM-5 criteria
– Moderate substance use disorder: presence of 4 to 5
3 symptoms within DSM-5 criteria
– Severe substance use disorder: presence of 6 or
more symptoms within DSM criteria
• Substance or chemical: alcohol, nicotine, tobacco,
prescription drugs, and illegal drugs.
• Drug: any nonfood substance whose chemical or physical
nature significantly alters structure, function, or
perception (vision, taste, hearing, touch, or smell) in the
living organism.
• Drug user: a person who intentionally takes legal or illegal
drugs to alter his or her functioning or state of
consciousness.
• Tolerance and Withdrawal further discussed.
– Differentiates between abuse and dependency.
– Two types of Tolerance
▪ Metabolic tolerance refers to liver function.
▪ Pharmacodynamic tolerance is the central nervous
system’s increasing sensitivity to a chemical.
• Withdrawal refers to a specific set of symptoms that
occur when use of the drug is discontinued.
– Withdrawal syndrome is strong evidence of
dependence addiction.
The Profession in the 21st Century
• Research-based programs
– Evidence-based practices
• Collaborative approach
– Motivational Interviewing (MI)
– Process to elicit change in the client through skillful
questioning
– MI recognizes that change comes from within the
client and that the client-counselor interaction is the
most powerful aspect of the treatment process
Overview of the Text
• Case Studies incorporated throughout the text to illustrate
concepts discussed in each chapter
– Cases assist in understanding the process of
assessment and diagnosis, treatment, and relapse
prevention planning.
▪ Case 1: Sandy and Pam
▪ Case 2: The Martinez Family
▪ Case 3: Leigh
Discussion
• Discuss the relationship between social structures,
culture, and the use of substances (Drugs and Alcohol)
throughout history.
– That is, what in our history has influenced substance
abuse?
• From your own experiences, from observing others, and
from your reading, what do you think are the factors
influencing the use of different drugs-tobacco, alcohol,
marijuana, cocaine, etc.?
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Substance Use Counseling Theory and

• Consequences of Alcohol use

• Admissions to Treatment Facilities

• Estimated Number of Emergency Dept. Visits Involving Illicit Drugs

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