Substance Abuse V

8/8/2019 Substance Abuse V

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Substance Use DisordersYou kids wanna get high?

Enzo Araneta

Kay BunaganDan Villafuerte


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Structure of the Report

Difference between substance abuse and

substance dependence

Case presentation Models of Understanding

Inhalants

Article presentation


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Substance Abuse

VS

Substance Dependence


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Substance Abuse

At least one of the following symptomswithin a 12-month period:

Recurrent substance use resulting in a

failure to fulfill major role obligations atwork, school, or home (such as repeatedabsences or poor work performancerelated to substance use; substance-

related absences, suspensions, orexpulsions from school; or neglect ofchildren or household).


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Substance Abuse

Recurrent substance use in situations inwhich it is physically hazardous (such asdriving an automobile or operating a

machine when impaired by substance use) Recurrent substance-related legal

problems (such as arrests for substancerelated disorderly conduct)


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Substance Abuse

Continued substance use despite havingpersistent or recurrent social orinterpersonal problems caused or

exacerbated by the effects of thesubstance (for example, arguments withspouse about consequences ofintoxication and physical fights)


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At least three of the following symptomswithin a 12-month period:

Tolerance, as defined by either of thefollowing: (a) A need for markedlyincreased amounts of the substance toachieve intoxication or the desired effect

or (b) Markedly diminished effect withcontinued use of the same amount of thesubstance.


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Withdrawal, as manifested by either of the

following: (a) The characteristic withdrawal

syndrome for the substance or (b) The

same (or closely related) substance is

taken to relieve or avoid withdrawal

symptoms.


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The substance is often taken in larger

amounts or over a longer period than

intended.

There is a persistent desire or

unsuccessful efforts to cut down or control

substance use.


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A great deal of time is spent in activities

necessary to obtain the substance, use

the substance, or recover from its effects.

Important social, occupational, or

recreational activities are given up or

reduced because of substance use.


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The substance use is continued despite

knowledge of having a persistent physical

or psychological problem that is likely to

have been caused or exacerbated by the

substance (for example, current cocaine

use despite recognition of cocaine-induced

depression or continued drinking despiterecognition that an ulcer was made worse

by alcohol consumption)


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Abuse VS Dependence

Failure to meetobligations

Use in physically

dangerous situations Legal problems

Continued usedespite problems

Tolerance

Withdrawal

Taken in greater

amounts Desire to control

consumption

Excess use of time

Reduced activities

Continued usedespite knowingproblems


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The Case of Mr. RC


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The Case of Mr. RC

Name: RC

Age: 19

Sex: MalePresenting Problems:

Suicide Attempts

Substance AbuseAuditory Hallucinations


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The Case of Mr. RC

Mr. RC started using at the age 14.

He started with shabu and continued

it for six months before switching to marijuana.A year passed and he got hooked on sniffing

rugby. All through out his drug use, he was

experiencing auditory hallucinations; voicestelling him to kill himself. Apart from this, while

high on rugby, he was convinced he had

super powers such as making things levitate.


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The Case of Mr. RC

Mr. RC dropped out of school after his

2nd year in high school. He was doing

rather poorly in his academics due to drugs. Hewould often steal from his own home to sustain

his rugby use. His mother died when he was 10

years old. His social circle primarily involvedfriends who were also addicts. His friends,

being older than him and having jobs, usually

shared their drugs with him for free.


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The Case of Mr. RC

The attempts were prompted by the

voices in his head wanting him to kill

himself. His first attempt included

drinking muriatic acid and Baygon. In his next

attempt, he tried blowing up his house with him

in it by breaking an LPG tank. He tried hanging

himself for his third attempt and broke a bottle

and slashed his wrist with a piece for his last.

All four attempts were followed by an

admittance to Ward 7 of PGH.


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Models of Understanding


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Psychodynamic Model

Substance Abuse as masturbatory

equivalent

Defense against homosexual impulses

Manifestation of oral regression

Boundaries and limits

Compulsiveness & impulsiveness

Defense mechanism

Denial & externalizing

Vicious Cycle

Guilt & shame


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Psychosocial Theories

A societal role in the development ofpatterns of substance abuse and

substance dependence

Drug culture Urban poverty

Condemn less and accept more

Connections exist between underlyingproblems in the individual

and his sociocultural domain


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Psychosocial Theories

Coaddiction or codependence

Couples have a relationship that is primarily

responsible for the maintenance of addictive

behavior in at least one of the persons Each person has enabling behaviors that help

perpetuate the situation, and denial of the

situation is a prerequisite for such a dyadic

relationship to develop


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Psychopharmacological Model


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Developmental Model

At what point in time and for what reasons

does development begin to be diverted

from its normal course?


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Developmental Model

Pathways cross to create co-morbidity

Pathways can be significant in terms of

prevention and intervention focus on intervening early in a childs

development to strengthen protective

factors before problem behaviors develop

Pathways can be significant in terms of prevention and intervention


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Co-morbidity ofSubstance Use

Anti-social PD

Borderline PD

Mood Disorders

Depression &

suicide (more so

with alcohol)

Dysthymic Anxiety Disorders

phobias

ADHD

Polysubstance abuse

More potent

substances have

higher co-morbidityrate for disorders


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Family Systems Model

Anyone who isinstrumental in providingsupport, maintaining thehousehold, providingfinancial resources, andwith whom there is a strongand enduring emotionalbond may be consideredfamily for the purposes oftherapy.

In family therapy, the goalof treatment is to meet theneeds of all familymembers.


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Family Systems Model

Substance Abuse is a result of a poorperformance in family roles, lack ofcommunication or any dysfunction in

the family system


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Ask

How is the family arranged:

Hierarchically

Democratically Within this structure, what are the

communication patterns?

How well is this family functioning? That is,

to what extent can the family meet its owngoals without getting in its own way?

What are the cultures prescribed roles for

each family member?


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Ask

What are the family subsystems?

couple subsystem

parent-child subsystem

sibling subsystem

What are the multigenerational qualities?

Families may have four or more generations that arecurrently relevant at one time, and family members

are affected by inherited qualities across generations,

as well.


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Family Systems Concepts

Homeostasis

Families strive to achieve homeostasis,

which portrays family systems as self-regulating with a primary need tomaintain balance.

The addicts needs may have beencompromised to fulfill the needs ofanother family member.


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The family is greater than the

sum of its parts. Circular causality - if one family memberchanges his or her behavior, the others will alsochange as a consequence, which in turn causes

subsequent changes in the member whochanged initially.

This also demonstrates that it is impossible toknow what comes first: substance abuse orbehaviors that are called enabling.

e.g. A strict father may have been an enablerto the drug addict.

Morphostasis - resistance to change due to thehabitualized behaviors


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Attachment Numbing

Numbing response:

Dissociation

Depression

Emotional and kinetic constriction Social withdrawal

Avoidance of tactile-emotional stimulation

Substance Abuse

Factors such as:

Chaotic home environment

Ineffective parenting

Lack of nurturing and parental attachment


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Family Boundaries

Family Coalitions

conflicts

Communication traits,which can be verbal or

nonverbal, overt or subtle

means of expressing

emotion, conflict,

affection, etc.


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Enablers

Often well-meaning efforts to help someone with an alcohol or drug

problem actually empowers them to continue their destructive

behavior by allowing them to avoid the consequences of their

actions. This is called "enabling.

1. Have you ever 'called in sick' for the alcoholic because they were too

hungover to go to work or school?

2. Do you ever make excuses for the alcoholic's drinking or behavior?

3. Have you ever lied to ANYONE to cover up for the alcoholic?

4. Have you bailed the alcoholic out of jail or paid his or her legal fees?

5. Have you accepted part of the blame for the alcoholic's drinking or

behavior?

6. Do you avoid talking about the alcoholic's drinking out of fear of the

response?


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Some parents may develop a codependency with their

children to foster substance abuse. The behavior of the

caring individual is said to hinder recovery of the real

addict by enabling the addict to continue the addiction.

Family contexts may provide exposure to key

antecedents and consequences for alcohol abuse.

(O'Farrell & Fals-Stewart, 1999).


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Inhalant Abuse in the

Philippine Context

Breathe in deeply and enjoy


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There is no

comprehensive

epidemiologic data onthe magnitude of

inhalant abuse among

children and

adolescents in thePhilippines


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Mmmmm. Rugby goooood.

Toluene The chemical toluene

gives the aromatic

smell in contactcement and other glue

and is the culprit

behind the addiction


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Effects

Levels of exposure

greater than 600 ppm

cause confusion and

delirium

Habitual users can suffer

brain damage, kidney and

liver failure, sight and

hearing loss, muscle

weakness, leukaemia,and death, the DDB said.

Initial excitatory

phase followed by

depression

Excitatory phasecharacterized by

euphoria, delusions,

less commonly visual

and auditoryhallucinations


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Clinical Manifestations

Data on the toxic effects of toluene among

patients seen at the UP Poison Center

were from inhalational exposure with chesttightness, chest pain and altered mental

status as the most common presenting

symptom at the emergency room


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Toluene Abuse in the

Philippines Rugby sniffing is one of

the most common ways

by which toluene is

abused

A rugby sniffer oftenputs the chemical in a

plastic bag and inhales

the vapors directly from

the bag to achieve a

state of euphoria.


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Case Distribution According to Drugs

Used/Abused (DDB Annual Report 2004)

Methamphetamine 84.45%

Marijuana 31.73%

Cough and cold 3.73%

Benzodiazepines 3.72%

Inhalants 3.38%

Ecstasy 1.43%

Cocaine 1.28%

Opium 0.90%

Nubain 0.81%

Others (Psilocybin, Mescaline,Datura) 0.36%


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Factors that contribute to popularity

of Rugby sniffing

The relative ease of procuring

this substance due to its lowcost and accessibility

contributed significantly to its

widespread abuse among

Filipino street children


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Solvent Abuse among Filipino

Street Children UNICEF estimates the number of street

children in the Philippines to range from75,000 to 80,000

Data from DSWD show that the numberincreases by 6,365 annually

HALF of the Philippines street childrenhave at one time or another snorted

"rugby" and other aromatic solvents toassuage hunger pangs

( Source: Kanlungan sa Er-Ma Ministry)


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Acculturation, Familism, ParentalMonitoring, and Knowledge as

Predictors of Marijuana and Inhalant

Use in Adolescents

Juan R. Ramirez, William D. Crano, and Ryan Quist

Claremont Graduate University

Michael Burgoon, Eusebio M. Alvaro, and Joseph Grandpre

University of Arizona


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Kids

Figures gathered in Johnston, OMalley, and Bachmans

(2001) study indicate that

19.5% of 8th graders

36.4% of 10th graders 40.9% of 12th graders

are reported having used some

illicit drug at least once over the

past year. Study was done that shows Hispanic American kids as

the frontrunners in early drug use. 36% of Hispanic 8th

graders report usage of illegal drugs (Johnston et al., 2001)


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Aim of the study

Recognizing the importance of family and

culture, the present study seeks :

(a) to contribute to the emergent study of

drug use in Hispanic American adolescentsby examining the roles that Familism,

acculturation, and parental monitoring play

in marijuana and inhalant use in a large

sample of Hispanic American adolescents

(b) to differentiate these influences from

those that affect Anglo Americans.


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Method Participants

772 Anglo-American students

322 Hispanic-American students

Consisted of Grade school to High school students

Acculturation

Measures how immersed a person is in the culture

Familism

Measure importance of family

Parental Monitoring

measuring the degree to which parents were aware of their childrens daily

activities


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Results

1. First, we have shown that increasingly accurate

knowledge of drug effects is associated with lower

substance use in adolescents from a variety of cultural

backgrounds.

2. Analyses also demonstrate that parental monitoring

and strong familistic values can serve important and

unique roles in drug prevention.

3. There is a strong and consistent association between

lower acculturation and marijuana usage.


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Thank you.

Tama na yan inuman na.

Documents

Substance Abuse V