Alcohol and Substance AbuseSubstance Abuse StatisticsSubstance Abuse as a DisabilitySubstance Abuse as a DisabilityDSM-IV – Substance Use DisordersOther Substance Abuse DisordersImpact of Substance Abuse and DisabilityContinuum of Use, Abuse & DependencyCommonly Abused SubtancesSubstance Abuse and other DisabilitiesSlide 11Slide 12Slide 13Defense mechanismsTheoretical Models of Substance AbuseSlide 16Identification of Substance AbuseSlide 18CAGEBrief MAST QuestionsTreatmentStages of Change: A model for understanding addictive behavior changePowerPoint Presentation10 Common Types of Change ProcessesProcesses of ChangeStages of Change ModelSlide 27Predictors of ChangeSOC InterventionsSubstance Abuse as a Disability recapAlcohol and Substance AbuseMedical & Psychosocial Aspects of Disability10/26/04Substance Abuse StatisticsAccording to the 2001 National Household Survey on Drug Abuse, 15.9 million Americans were estimated to have used illicit drugs in the month prior to the survey; in addition, 109 million, 12 years of age or older, were estimated to be current users of alcohol, with 25.1 million having driven under the influence of alcohol at least once in the previous 12 months (Substance Abuse and Mental Health Services Administration, 2002). Drug abuse problems in the workplace are estimated to cost employers $60 billion annually in violent crimes, fire accidents, health care costs, lost productivity, and accidents on the job (Backer, 1988; Stude, 1990). Substance abuse also is known to significantly compromise work performance resulting in high rates of absenteeism, accidents, time off for illness, and Workers’ Compensation claims (Cardoso et al., 1999).Substance Abuse as a Disability1990 Americans with Disabilities ActADA statues and guidelines recognize substance abuse as a disabilityPeople with a substance abuse problem are protected at work, unless they are currently engaging in the illegal use of drugs.A person with a coexisting disability can be legally discharged from a job if illegally abusing substances.Substance Abuse as a DisabilityDiagnostic and Statistical Manual of Mental Disorders, 4th Ed.Substance USE DisordersAbuse: Maladaptive pattern of substance use leading to a clinically significant impairment or distress as manifested by one or more of the following in a 12 month period:Recurrent substance use resulting in a failure to fulfill a major role obligation at work, school or homeRecurrent substance use in situations in which it is physically hazardousRecurrent substance-related legal problemsContinued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substanceDSM-IV – Substance Use DisordersDependence is defined by the occurrence of withdrawal following the abrupt reduction of dosage of the drug or the administration of a drug antagoist. 3 or more of the following must occur within a 12 moth period:Need for increased amounts of substance to achieve a desired effect (or markedly diminished effect with continued use of same amount) Characteristic withdrawal syndrome for that substance or the same substance is taken to relieve or avoid withdrawal.A substance is often taken in larger amounts for longer periods of time than was intended.Persistent desire for a drug or unsuccessful efforts to cut down or control substance use.A great deal of time is spent in activities to obtain a substance, use a substance or recover from its effectsImportant social, occupational, or recreational activities are given up or reduced because of substance useSubstance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem.Other Substance Abuse DisordersSubstance Induced DisordersE.g.: Intoxication, delirium, dementia, mood disorders, sleep disorders – all with the precondition that the disorder is a result of substance usePolysubstance Related DisordersRefers to disorders resulting from the use of at least 3 groups of substances over a 12 month period with no single substance as predominating.Impact of Substance Abuse and DisabilityBasic living skills homelessness, lack of income, repeated legal problemsHealthPoor or deteriorating health often results from years of abuse & neglect of healthEducationSubstance abuse can lead to significant deficits in academic development and basic learning skillsEmploymentEarly onset and lengthy periods of substance abuse often result in difficulty in obtaining & retaining meaningful employmentRelationshipsInterpersonal & socialization skills may be poor because relationships were often based on the acquisition and use of drugs. The ability to communicate outside of the drug community is frequently impaired.Continuum of Use, Abuse & DependencyExperimentationRecreational/social useUseDependenceAddictionCommonly Abused SubtancesDrugs are psychoactive chemicals that bring about changes in biological, psychological, social and/or spiritual functioning. This includes legal drugs (e.g., alcohol, over the counter meds, tobacco, caffeine) and illegal drugs such as marijuana, heroin and cocaine.Stimulants: produce increased awareness, attention or excitement levels followed by depressed levels: eg: cocaine, amphetaminesDepressants: produce the opposite effects – decreased tension levels followed by an increase in tension: eg: alcohol, heroin, barbiturates, and pain relief meds.Substance Abuse and other DisabilitiesAlcohol and Marijuana Use in a Community-Based Sample of Persons with SCI (Young, Rintala, Rossi, Hart, & Fuhrer, 1995) Alcohol use = 59% No relationship to impairment, disability, handicap, medical complications, health ratings, health maintenance behaviors, pain, depression, life satisfaction, perceived stress, or social support Men more likely to drink History of alcohol abuse = 21% No significant gender difference Alcohol abusers were more likely to rate overall health as worse, say they didn’t get enough rest, more depressed and more stressed Not related to impairment, disability, handicap, medical complications Marijuana use = 16% No gender difference Those who used marijuana were younger and younger at injury and had lower educational level Users more depressed and stressedSubstance Abuse and other DisabilitiesHeinemann (1986) cited studies reporting intoxication at the time of spinal cord