Rehab Counseling

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Rehab Counseling

• Substance Abuse Class 05
• Markus Dietrich LMHC,CRC,CAAP
• Shands Healthcare
• dietrmk_at_shands.ufl.edu

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Drug Use-Scope

• In 2001 an estimated 15.9 million Americans 12 or
  older used illicit drugs. This represents 7.1 of
  this population.
• This a 0.8 increase from 6.3 in 1999 and 2000.
• Increases were noted for
• Marijuana 4.8 to 5.4
• Cocaine 0.5 to 0.6
• Pain Relievers 1.2 to 1.6
• Tranquilizers 0.4 to 0.6 National Household
  Survey 2001

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Drugs Use- Marijuana

• Marijuana is the most commonly used drug used by
  76 of the drug users
• 56 of drug users use only marijuana
• 20 use Marijuana and another drug.
• 24 use illicit drugs but not marijuana.

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Therapeutic Drugs

• Of the 4.8 million users of therapeutic drugs,
• 3.5 million use pain relievers
• 1.4 million use tranquilizers
• 1 million uses stimulants
• 0.3 million use sedatives

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Drugs cont.

• In 2001 an estimated 1.7 million (0.7) Americans
  age 12 or older were current cocaine users and
  406,000 (0.2) were current crack users
• 1.3 million (0.6) used hallucinogens
• 957,000 used Oxycontin non medically (four times
  as much as 1999)
• Heroin use is reported to be 123,000 (0.1)

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Drugs- Variables

• Men are more likely to report drug use than women
  (8.7 vs. 5.5)
• Rates and patterns of drug use vary by age,
  peaking among 18-20year olds
• Drug use is correlated with education. Rate for
  H.S graduates is 7.6 vs. 4.3 percent for four
  year college graduates, even though college
  graduates were more likely to have tried drugs.

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Alcohol

• 109 million ( 48.35) Americans age 12 or older
  report being current drinkers
• Approximately one fifth (20.5) reported bingeing
  at least once in last 30 days
• 5.7reported heavy drinking

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Alcohol variables

• Age highest prevalence of alcohol use is between
  18 and 25. Rate drops slightly between 25 and 60.
• Men are more likely to drink than women
• likelihood of drinking alcohol increases with
  education, however, binge drinking and heavy
  drinking were least prevalent among college
  graduates

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Employment

• Unemployment is highly correlated with drug and
  alcohol use however,
• 6.9 of illicit drug users are full-time employed
• 9.1 of drug users are part-time employed
• Among the 43.9 million adult binge drinkers, 35.4
  million (81) are full-time or part-time
  employees.
• 9.8 million (80) of the heavy drinkers are also
  employed

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Significant Others

• Non-alcoholic members of alcoholics families use
  10 times as much sick leave as in families where
  alcohol is not a factor.
• More than half of all family members of
  alcoholics who are employed (80) report their
  ability to function is impaired as a result or
  living with an alcoholic.

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Effects on Business

• decreased productivity
• increased on-the-job accidents
• increased absenteeism
• turnover
• increased health care cost

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Economic Impact

• Cost to society associated with drug and alcohol
  abuse is estimated to be 294 billion.
• The largest impact is on lost productivity.
• The health care cost for alcohol abuse is about
  twice that for drug abuse.
• Samsha 2001

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Social Impact

• Alcohol and drug abuse correlate positively
• with
• Domestic Violence
• Child abuse and neglect
• Separation and divorce
• Healthcare cost
• Criminal behavior

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Trends

• The NHSDA showed increases among Americans in
  rates of use of several substances, including
  marijuana and cocaine and the non-medical use of
  pain relievers and tranquilizers. Alcohol use
  also increased, although binge drinking and heavy
  use remained unchanged between 2000 and 2001

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Addiction and the Brain
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Addiction is a brain disorder

• Addiction is an independent disorder
  distinguished from drinking that is merely heavy,
  problematic, ill advised or socially unacceptable

Abuse - intentional overuse in cases of
celebration, anxiety, despair, self-medication,
other mental health disorders or ignorance.
Tends to decline with consequences or adequate
treatment of other mental health disorder.
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Functional Imaging
SPECT single photon emission computed
tomography PET positron emission
tomography fMRI functional magnetic resonance
imaging
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Dopamine Pathways Pleasure pathways
striatum
hippocampus
frontal cortex
substantia nigra/VTA
nucleus accumbens
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THE RAT BRAIN

• What turns on the dopamine in a rats brain..
• SEX-200 increase in dopamine
• COCAINE-300 increase in dopamine
• METHAMPHETAMINE-1100 increase in dopamine

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The explanation for why people respond
differently!
Early exposure to drugs
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Brain of the addicted is fundamentally different

• Gene expression (Liu, Nickolendko 1994
  Daunais McGinty 1995)
• Glucose metabolism (Volkow, Gillespie, 1996)
• Responsiveness to environmental cues (OBrien,
  Childress, 1993 Kilgus Pumariega, 1994)

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Whats inherited???

• Temperament
• Initial sensitivity to rewarding or aversive
  qualities (like or dislike of the drug)
• Tolerance
• Rates and routes of metabolism
• Taste preferences
• Response to memories related to use

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Developing brain

• Individuals who begin drinking before age 15 are
  4 times more likely to develop alcohol dependence
  during their lifetimes than those who begin
  drinking at age 21.
  (Grant Dawson 1997 Journal of Substance
  Abuse 9103-110)
• Earlier drinking more likely to result in alcohol
  dependence independent of family history
  (Grant, 1998)

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Your Brain on Drugs
YELLOW shows places in brain where cocaine goes
(Striatum)
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SPECT (blood flow)
Marijuana 12 yrs
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Assessment and Diagnosis

• Bio-psycho-social-spiritual Assesment
• DSM-IVR
• Seven Criteria
• Two dimensions-
• Obsession and Compulsion.

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Job is last to go!
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Facilitate ChangeMotivational Enhancement Therapy

• Key Factors for Change for the Counselor
• Style
• Style
• Style

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Key Concepts

• Motivation the probability that a person will
  enter into, continue and adhere to a specific
  change strategy.
• Resistance the result of interacting with ones
  environment- not a characteristic.
• Ambivalence the heart of the problem, not
  pathological.

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Stages of ChangeProchaska DeClemente 1982

• Pre-contemplation
• What problem?
• Contemplation
• Is it a problem?
• Preparation
• What can I do?
• Action
• I am doing something
• Maintenance
• I am successful

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Helper Tasks

• Pre-contemplation
• Raise Doubt
• Contemplation
• Evoke reasons for change
• Preparation
• Help client find best course of action
• Action
• Support steps toward change
• Maintenance
• Relapse Prevention