SUBSTANCE

USE DISORDERS
SUBSTANCE USE DISORDERS (SUD) - DSM-5
SUBSTANCE USE DISORDERS (SUD) - DSM-5

 Continued use of alcohol, tobacco, marijuana, or medications not prescribed despite significant disruption to meaningful
activities
 Four criterion categories, 11 criteria total
 Impaired control
 Social impairment
 Risky use of the substance
 Pharmacological criteria

 Mild (2-3 criteria)/Moderate (4-5)/Severe (6+)

 Subtypes are by drug, not amount/pattern of use

 e.g. Alcohol Use Disorder, Opiate Use Disorder, Cannabis Use Disorder
ETIOLOGY

 Genetic and biological component

 Up to 60% of addiction is genetic

 Psychological component
 Certain personality traits associated with greater likelihood of substance use
problems
 Trauma exposure

 Social and environmental component

 Availability
 Poverty
 Social endorsement - part of a culture or social environment that promotes
substance use
PREVALENCE

19.7 million Americans 12 and older battled a substance use disorder 

• 74% of those were related to alcohol

1 out of 8 adults struggled with an alcohol and drug use disorder simultaneously 

8.5 million American adults had a mental health disorder and a substance use
disorder at the same time (more on this later)

$740 billion annually in lost workplace productivity, healthcare expenses, and

crime-related costs

Source: 2017 National Survey on Drug Use and Health (NSDUH)

 PREVALENCE
Gender and cultural differences

Men are more likely to be Higher in some populations, Spirituality/religion is a

Culture determines "normal"
diagnosed than women lower in others protective factor

Emotional Healthier coping

Genes? Drinking culture (France)
availability? skills for anxiety

Binge drinking culture

Coping skills? Psychosocial? (#1 Party College in Not just “rules”
USA!!!)

Non-drinking cultures
Environment?
(Islam, LDS)
PREVALENCE OF CO-OCCURRING DISORDERS
Functional impairment
due to mental illness
(% of total population) 64%
61%
39%
36%

4% 5%

9%

85%
27%
15% 82%
73%

Severe Moderate Mild None

PREVALENCE OF CO-OCCURRING DISORDERS (CONT’D)

Often a result of “self-medicating” behaviors, e.g.

alcohol for anxiety, nicotine with schizophrenia

23.8% co-occurring use of marijuana for all

severities of mental illness.

15.8% co-occurring misuse of prescription drugs for

all persons with any mental illness.
CO-OCCURRING DISORDER CASE STUDY: SARAH
Symptoms first showed
Multiracial female , early
at the end of the semester:
30s History of minor
final examinations >
depression and anxiety
erratic study habits >
(beginning in college).
irregular sleep patterns.

Symptoms managed
Sarah sought out
through social drinking of
behavioral health
alcohol and partying with
counseling services a few
friends, sometimes binge
times but graduated.
drinking.
CO-OCCURRING DISORDER CASE STUDY: SARAH

After graduation, she

2+ years of difficulty
married and immediately
getting pregnant, starts
started to try to build a
infertility treatments.
family.

Days at home ruminating Laid off when her

on her feelings of personal company was downsizing
and professional failure. personnel
COURSE OF SUBSTANCE USE DISORDER: DISEASE MODEL

America has a long history of viewing

addiction as a moral failing

Disease model has a long history but

still struggles for mainstream
acceptance

Criticism: Dx strips people of their

agency, gives them a “pass” on their
behavior
COURSE OF SUBSTANCE USE DISORDER: DISEASE MODEL
COURSE OF SUBSTANCE USE DISORDER: DISEASE MODEL

Underlying changes in brain circuits may persist

beyond detoxification, particularly in individuals with
severe disorders.

The behavioral effects of these brain changes may be

exhibited in the repeated relapses and intense cravings
when exposed to drug-related stimuli.

These persistent drug effects may benefit from long-

term approaches to treatment.
COURSE OF SUBSTANCE USE DISORDER

Some drugs lead Often

to increasing involves abuse of
levels of physical multiple
tolerance. substances.

Relapse is Often
expected self-resolving
COURSE OF CO-OCCURRING SUBSTANCE USE DISORDER
(MAJOR DEPRESSIVE DISORDER)

Precipitation model:
Self-medication model:
Early alcohol use Model 3: common
Early adult MDD
disorder in adolescence factors elicit SUD
predicted later adult
predicted MDD in early ~and~ MDD.
alcohol use disorder
adulthood
SIGNS AND SYMPTOMS

Feeling Having Increasing Spending Continuing

Feeling that you Having intense Increasing the Spending money Continuing to use
have to use the urges for the amount you take on the substance even though you
substance substance to block over a period of when you can’t know it’s causing
regularly  out other thoughts time afford it you problems
IMPACT ON OCCUPATIONAL PERFORMANCE

 Substance Use Disorder can negatively affect ALL occupations described in the
framework
 Occupational scientists propose that disordered substance use can sometimes meet the
criteria for an occupation
 Engaging in activities that are free of substance use could be very hard 
CO-OCCURRING DISORDER CASE STUDY: SARAH
After multiple After a few days in the
miscarriages, emotional hospital and a new
condition escalates. medication regimen, Sarah
Hospitalized to treat major was discharged to go
depression. home.

Failing to consistently Husband at work, feeling

perform basic self-care isolated and alone, starts to
and home management drink alcohol during the
daily activities. day.
MODELS/FRAME OF REFERENCE THAT COULD BE USED
EFFECTIVELY IN TREATMENT

 Model of Human Occupation (MOHO)

 Behavioral Cognitive Framework
 Sensorimotor approaches
COMMON OT INTERVENTION APPROACHES (INPATIENT)

 Psychosocial/Cognitive Behavioral/Mindfulness approaches 

 Facilitating medication-assisted treatments
 Sensory integration approaches
CO-OCCURRING DISORDER CASE STUDY: SARAH

Sarah sought voluntary

Inpatient focus:
readmission to treat her
adjustment of her
dual diagnosis of MDD
medication regimen
and AUD.

Inpatient focus: Group

interventions focusing on Inpatient focus: OT
the use of cognitive evaluation for impact on
behavioral therapy coping occupations
strategies.
COMMON OT INTERVENTION APPROACHES

OT intervention aims to improve functioning and provide skill development in:

 Performance patterns
 Use of time, especially leisure time
 Relapse prevention
 Cognitive and perceptual functions and skill development
 Social interaction, social skills, and self- expression
 Daily living skills
COMMON OT INTERVENTION APPROACHES

OT intervention aims to improve functioning and provide skill development in:

 Performance patterns
 Use of time, especially leisure time
 Relapse prevention
 Cognitive and perceptual functions and skill development
 Social interaction, social skills, and self- expression
 Daily living skills
CO-OCCURRING DISORDER CASE STUDY: SARAH

Sarah was discharged with

Outpatient focus:
a plan for continued
Reengage in daily routine
outpatient support.

Outpatient focus:
Outpatient focus: Explore
Practice new occupation –
prospects about returning
managing depression and
to work.
stress without alcohol
REFERENCES

 Boyt Schell, B. A., & Gillen, G. (2019). Willard and Spackman's Occupational Therapy (13th ed.). Baltimore, MD:     
         Wolters Kluwer. 229, 608, 1007
 Brown, C., Stoffel, V., & Munoz, J. P. (2019). Occupational therapy in mental health: a vision for participation.
         Philadelphia: F.A. Davis Co.
 Dubner, S. J. (2020, January). The Opioid Tragedy, Part 2: “It's Not a Death Sentence” (Ep. 403) [Audio               
         podcast] http://freakonomics.com/podcast/opioids-part-2/
 McLellan, A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?
         Retrieved February 12, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525418/
 Opp, A. (n.d.). Recovery With Purpose: Occupational Therapy and Drug and Alcohol Abuse. Retrieved February 12, 2020,
         from https://www.aota.org/About-Occupational-Therapy/Professionals/MH/Articles/RecoveryWithPurpose.aspx
 Staff, M. C. (2017, October 26). Drug addiction (substance use disorder). Retrieved February 12, 2020, from 
         https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
 Thomas, S. (n.d.). Addiction Statistics: Drug & Substance Abuse Statistics. Retrieved February 12, 2020, from
         https://americanaddictioncenters.org/rehab-guide/addiction-statistics