Health Care Profiles & Plans Multiple Choice

Health Care Profiles & Plans Multiple Choice

Overview

Assignment	Due Date	Format	Grading Percent
Resource Evaluation Discussion Board: Substance-Related and Addictive Disorders	Day 3 (1st Post)	Discussion	5
Health Promotion Quiz	Day 6	Quiz	5
Health Care Profiles and Plans for Change	Day 7	Assignment	10

Learning Outcomes

This week students will:

1. Evaluate biopsychosocial factors associated with the development of substance-related and addictive disorders.
2. Identify biological and psychosocial aspects of substance use disorders.
3. Describe resources and health behaviors associated with health promotion efforts.

PSY 361 Health Psychology
Instructor Guidance

PSY 361 Week 3 Overview:

While the course is in session, there will be Announcements in the online course to remind you of our current subject content and reading, discussion board activities, assignments, and other important or relevant information. Please be sure to check the course for current Announcements frequently. As always, email with ANY questions or concerns, or post public comments/questions on the “Ask Your Instructor” forum.

Topics this week:

• Evaluate biopsychosocial factors associated with the development of substance-related and addictive disorders.
• Identify biological and psychosocial aspects of substance use disorders.
• Describe resources and health behaviors associated with health promotion efforts..

Reading in Text Chapters 6, 7 and 8:

• lots of information on health beliefs, health-related behavior, and health promotion
• we take these theoretical paradigms and apply them to specific topical areas of substance use disorder – remember, this involves not just illicit drugs (illegal substances) but also includes licit (legal) substances and drug diversion
• even for people without health diagnoses, we can apply these processes to exercise, nutrition, body weight and safety

Focus of topics in this Guidance:

• Substance use disorder (substance abuse, addiction)
• Health topics – exercise, body weight

SUBSTANCE USE DISORDER (SUD) TOPICS:

What are the common drugs of abuse?

• **Really EXCELLENT site from NIDA
  • Links to detailed descriptions of drugs in the categories below, as well as related topics.
  • Can be read by the consumer OR the health professional.
• At this link: http://www.drugabuse.gov/drugs-abuse
• Common drugs of abuse, including nicotine, acid/LSD, club drugs, alcohol, cocaine, heroin, MDMA, ecstasy, methamphetamine, PCP, prescription medications, steroids
• Search in the drop-down box for related topics on drug-testing, prevention, stress, treatment, research, statistics

Psychological dependence (sometimes also called “addiction”):

• Feelings of satisfaction & desire to repeat drug experience despite physical, psychological, or social harm
• A style of living (compulsive use & overwhelming involvement with a drug to the exclusion of normal interpersonal relationships, gainful employment, personal hygiene, etc.) as well as risk of harm & need to stop drug use (may be realized by the addict as well).
• The entire focus of the person’s life is obtaining and using drug to obtain the psychoactive effects
• Generally, this person becomes physically dependent (will develop a withdrawal syndrome if stops drug) due to the prolonged and repetitive use of drug.

National Cancer Institute – opioid medication tolerance vs. addiction:

• “Some people think that they have to save stronger medicines for later. They’re afraid that their bodies will get used to the medicine and that it won’t work anymore. But medicine doesn’t stop working—it just doesn’t work as well as it once did. As you keep taking a medicine over time, you may need a change in your pain control plan to get the same amount of relief. Addiction is extremely rare in cancer patients who use opioids for pain. Biochemical, social and psychological factors are more important in the development of addiction. Opioids should not be withheld for fear that a patient will become addicted. If a pain patient requests a strong analgesic, it is likely that the patient has inadequate pain control.”
• From: http://www.cancer.gov/publications/patient-education/paincontrol.pdf

Recreational drug use:

• implies episodic use without dependence
• often practiced with rituals & in company of others

Substance Use Disorder (SUD):

• Includes the concept of drug diversion
  • Use of substance(s) for non-therapeutic purposes or use of medication for purposes other than those for which it is prescribed
• Older term was DRUG ABUSE
  • Some experts do not like the term “abuse”
  • Note that substance abuse means WITHOUT evidence of dependence with some substances

DSM-5 criteria for SUD – four diagnostic domains:

• Impaired Control: (criteria for this domain include four criteria)
  1. Using substance in larger amounts or over longer period of time than originally intended
  2. Expresses desire to cut down or regulate substance, may report many unsuccessful efforts to decrease/discontinue use
  3. Spends a great deal of time obtaining and using substance, or recovering from its effects; in severe cases almost all daily activities revolve around obtaining/using substance
  4. Craving manifested by an intense desire/urge for the drug; may occur at any time but more likely if environmental cues (craving demonstrated to involve reward neural circuits and classical conditioning activation); query regarding such strong urges that couldn’t think of anything else; craving may be a sign of impending relapse in treated individuals
• Social Impairment: (criteria for this domain include three criteria)
  1. Failure to fulfill major role obligations at work, school, or home
  2. Continues substance use despite persistent or recurrent social or interpersonal problems caused exacerbated by the effects of the substance
  3. Important social, occupational, or recreational activities given up/reduced because of substance use; may withdraw from family activities and hobbies to use the substance
• Risky Use: (criteria for this domain include two criteria)
  1. Recurrent substance use in physically hazardous situations
  2. Continue substance use despite knowledge of persistent/recurrent physical or psychological problem likely to have been caused/exacerbated by the substance (i.e., failure to abstain despite difficulty caused by the drug)
• Pharmacological Criteria: (criteria for this domain include two criteria)
  1. Tolerance indicated by requiring a markedly increased dose of the substance to achieve the desired effect or a markedly reduced effect when the usual dose is consumed; note that tolerance to respiratory depression and tolerance to sedating and motor coordination may develop at different rate; laboratory confirmation may include high blood levels of the substance while little evidence of intoxication
  2. Withdrawal occurs when blood/tissue levels of substance decline after prolonged heavy use of substance, and individual consumes substance to relieve symptoms; note that withdrawal has not been documented in humans after repeated use of phencyclidine, other hallucinogens, and inhalants so this criterion is NOT included for these substances.
  • Do NOT use these pharmacological criteriawhen observing tolerance and/or withdrawal during medical treatment with prescribed medications (e.g., opioid analgesics for pain). Remember that tolerance and dependence are normal, expected pharmacological phenomena with long-term use of many drugs.

Reference: American Psychiatric Association. (2013). Section II: Substance-Related and Addictive Disorders. In American Psychiatric Association (Ed.), Diagnostic and statistical manual of mental health disorders: DSM-5 (5th ed.). doi:10.1176/appi.books.9780890425596.991543

Drug Diversion:

Comprehensive Drug Abuse Prevention & Control Act (1970):

• USA drug industry must maintain physical security & record-keeping of schedule drugs, with controlled substances divided into schedule (class) I-V
• These products are determined to have high risk of substance abuse and drug diversion
• Genetic basis for drug dependence is being studied (especially for alcohol)
• Some drugs (e.g. crack cocaine) are more prone to abuse due to their high potential for physiologic dependence

Diversion of prescription drugs:

• diverting of prescription drugs for other than their intended therapeutic use
• 75 million Americans suffer pain annually
• 20.4 million Americans ages 12 yo and over use illicit substances
• most common illicit substance is marijuana, and half as many abuse prescription drugs (mostly opioids)
• there may be a “predisposition” to abuse (genetic predisposition, personality, and social circumstances)
• overdose deaths from prescription drugs diverted to illicit use is a serious concern – studies have shown that over half obtained drugs from a friend or relative for free (these drugs originally legally prescribed to someone but have been diverted)

Programs designed to reduce drug diversion:

Example of program for diversion risk reduction – “VIGIL” program:

• many programs exist – one is “VIGIL” involving the prescriber, pharmacist and patient
• see: http://www.pharmqd.com/node/56193/lesson
  • V: “verification”
  • I: “identification”
  • G: “generalization” – the parameters of the relationship with prescriber and patient, and pharmacist and patient; may include patient education
  • I: “interpretation” the decision to prescribe CS (a screening tool can be used)
  • L: “legalization”
• Patient education is part of “legalization”:
  • Keep your drugs locked up as you do your money and jewelry.
  • No sharing drugs with anyone.
  • If you run out of your medication more than 20% too early, don’t go to the pharmacist and ask for more, contact your doctor, even if you have refills remaining.
  • Take prescriptions for newly prescribed opioids to your pharmacy during hours when your doctor can be contacted for verification.
  • There will be no “emergency” verbal refills when there is no emergency.

Example of programs aimed at teens:

• “Not In My House”
  • See: http://www.naddi.org/aws/NADDI/asset_manager/get_file/4126
  • See: http://www.preventionworksct.org/parents/rxabuse.html
  • Parental intervention if teen drug diversion suspected:
    1. Set tighter limits around the house with clear and known consequences,
    2. Regularly discuss concerns with the child – make these conversations productive by remaining calm and taking the time to listen,
    3. Monitor child’s behavior, activities, and social circle, and
    4. Get outside help and support if necessary.
• PEERx:
  • From NIDA
  • See: http://teens.drugabuse.gov/peerx
  • From the website:
    • “…when taken in unmanaged doses or by someone without a prescription, these medications may affect the brain in ways similar to illegal drugs. Ritalin, for example, increases alertness, attention, and energy in a way similar to cocaine—by boosting the amount of the neurotransmitter dopamine released in the brain. Similarly, prescription opioid pain relievers such as OxyContin attach to the same cell receptors targeted by illegal opioids like heroin. When abused, these drugs can lead to a large increase in the amount of dopamine in the brain’s reward pathway. Repeatedly seeking to experience that pleasurable feeling can lead to addiction. Abuse of opioids can also affect areas of the brain that control breathing, causing it to slow down significantly and potentially causing death (a fatal overdose). When abused, opioids can also cause drowsiness and constipation.”