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UW-Madison SOCWORK 453 - Substance use as Chronic Medical Illness

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Special guest lectures coming upThursday: Motivation Interviewing with Laura Saunders, MSWNext Thursday: Substance use in families, with Sheilah Kring, her uncle Bud, and familyExam ResultsTopicsSubstance use disorders as chronic medical illnessesSettings and modalities of addiction treatmentMedications for alcohol use disorderGoalsUnderstand a proposed conceptualization of substance use disorder among medical professionals and its implicationsBecome familiar with general treatment modalities and newer medication treatmentsIClicker QuestionAccording to McLellan, which of the following characteristics of drug addiction makes it a “chronic medical condition”?A. It can be diagnosedB. There is a role of personal responsibilityC. Genetic heritabilityD. Treatment responseE. All of the aboveNotes from question: Just like chronic illnesses, drug dependence can be diagnosed. This can be done through the DSM.The role of personal responsibility shows physicians that actually substance use disorders are not too different than anything else. People choose with they eat, what they do, etc. People choose whether or not they want to go to treatment.There is genetic heritability involved with substance use. In the reading it said 30%, or at most 50% of addiction risk other than actually using the substance is due to genetic heritability. This number is very similar to other chronic medical illnesses.Always have to be recognizing what your triggers are, staying away from drugs, or having a little amount. This is very similar to chronic illnesses because for chronic illnesses you have to do major lifestyle changes like eating better and exercising. Also you have to keep an eye on it for the rest of their lives. You also have to keep an eye on substance use for the rest of the individual’s life as well.Similarities in the treatment of chronic medical conditionsMedication treatments are effective, yet behavioral treatments and behavioral changes are keyTreatment’s last a lifetimePeople receive a major benefit from continuing careProblems with treatment are similarAdherence problemsRelapseThere is thought to be no “cure”If we accept that substance use disorders are chronic medical illnesses, what are the implications?Implications are better treatment outcomes.Implications can be a reduced stigma. It can encourage treatment. And it can be that insurance may be more likely to insure people for treatment.Affordable Care ActSubstance use disorders are now “one of the ten elements of essential health benefits”Provisions to treat addiction in general healthcare settings, not just through referral to specialty careRequires same level of benefit for mental health and substance use conditions as medical conditionsNow physicians can get paid for screening for alcohol, providing brief interventions for drugs, and so forth.Now the lifetime limit is the same for substance use as other medical conditionsAddictive disorders as chronic medical illnessesAdvantagesDecreasing stigmaMore people may seek treatmentInsurance more likely to reimburse people and pay medical providers for providing these servicesCan inform a research design, if only acute we would only care how people are 6 months later. Now we know we can investigate a new treatment, we can look how people are looking 5 or 10 years later. We should look at disorders across lifetimesDisadvantagesLabelingEconomic burden, why should insurance pay for some of the treatment?Attention focused to most severely affectedBiologic aspects of addiction are emphasizedWhat about social, psychological, economic?Label does not display optimism for changeCalling substance dependence a chronic medical illness means looking at the top of the pyramid, instead of taking into consideration all of the people who may be at the bottom of the pyramid as well.2nd Article said that if we consider the disorder on chronic medical condition we are only focusing on most severely affective people and not on people who do not have as severe of an addiction.It is mostly the word chronic that doesn’t display optimism for change. If we just labeled it medical illness, maybe would be different.But if you remove that chronic label it may take away message that you need to treat things over ones lifetime.Addiction medicinePsychosocial and/or pharmacological treatment delivered byHealth professionalsPeer support specialists (helps client connect better to treatment agency, can talk about struggles and will not just believe them but also understand it)GoalsAbstinence or reduced useRecovery- well-rounded, fulfilled life without substancesMutual help is encouraged and facilitatedAttention to psychiatric, medical, and psychosocial comorbidityPeople get very spiritual, etc.People feel as though mutual help can be a different path from receiving treatment from professionals. But it isn’t a different path. People who get treatment from professionals also go to AA.Common treatment settingsNon-specialty settingsE.g. physician office, general medical settingsSpecialty settingsOutpatient treatmentIntensive outpatientPartial hospitalizationInpatientResidentialTherapeutic communityPeople with alcohol use disorders in the United States: Percent receiving specific types of treatments:Mostly in Alcoholics Anonymous or other 12 Step2nd one is Alcohol/ drug rehabilitation programAnd then Private professionalLess common but some people get treatment from a priest or rabbiVideo2 case studies, Tom and Adam. We should pay attention to reasons why they use and what alcohol use disorder is like for them. But also to how medication treatment is working for them. What types of things is it helping with specifically?Disulfiram in treatment, abstinent.Acamprosate works on symptomsNaltrexone works if you are working to stay abstinent and you slip and have a drink. Makes it easier to stop and prevent you for relapsing.Topiramate: a medication being tried now…It reduces withdrawal symptoms from alcoholTom: functioning alcoholicAdam: drank when young, and drank alone, craving for alcohol.Look a while, 1st few weeks didn’t work. But then it gradually it worked on reducing drinking.The medicine makes people feel comfortable about stopping drinking.Case StudiesTom and AdamOff-label use of topiramate to reduce withdrawal symptoms and craving for alcohol-Medicine makes effects of alcohol go away so then people stop using it because there is no pointFDA-approved medications for alcohol


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