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Title: Substance Abuse:


1
  • Substance Abuse
  • A Social Workers Guide

Presented by Tiffany Egan, LMSW
2

FACE OF ADDICTS
3
  • Substance Abuse - A maladaptive pattern of
    substance use leading to clinically significant
    impairment or distress, as manifested by one (or
    more) of the following, occurring within a
    12-month period
  • Recurrent substance use resulting in a failure to
    fulfill major role obligations at work, school,
    or home (e.g., repeated absences or poor work
    performance related to substance use
    substance-related absences, suspensions, or
    expulsions from school neglect of children or
    household
  • Recurrent substance use in situations in which it
    is physically hazardous (e.g., driving an
    automobile or operating a machine when impaired
    by substance use)
  • Recurrent substance-related legal problems (e.g.,
    arrests for substance-related disorderly conduct)
  • Continued substance use despite having persistent
    or recurrent social or interpersonal problems
    caused or exacerbated by the effects of the
    substance (e.g., arguments with spouse about
    consequence of intoxication, physical fights)
  • The symptoms have never met the criteria for
    Substance Dependence for this class of substance.

DSM-IVTR
4
  • Substance Dependence - A maladaptive pattern of
    substance use, leading to clinically significant
    impairment or distress, as manifested by three
    (or more) of the following, occurring at any time
    in the same 12-month period (emphasis ours)
  • Tolerance, as defined by either of the following
  • A need for markedly increased amounts of the
    substance to achieve intoxication or desired
    effect or Markedly diminished effect with
    continued use of the same amount of the substance
  • Withdrawal, as manifested by either of the
    following
  • The characteristic withdrawal syndrome for the
    substance or The same (or a closely related)
    substance is taken to relieve or avoid withdrawal
    symptoms
  • The substance is often taken in larger amounts or
    over a longer period than was intended
  • There is a persistent desire or unsuccessful
    efforts to cut down or control substance use
  • A great deal of time is spent on activities
    necessary to obtain the substance (e.g., visiting
    multiple doctors or driving long distances), use
    the substance (e.g., chain-smoking), or recover
    from its effects
  • Important social, occupational, or recreational
    activities are given up or reduced because of
    substance use
  • 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 (e.g., current
    cocaine use despite recognition of
    cocaine-induced depression, or continued drinking
    despite recognition that an ulcer was made worse
    by alcohol consumption)

DSM-IVTR
5
  • Combines the DSM-IV categories of substance abuse
    and substance dependence into a single disorder
    measured on a continuum from mild to severe
  • Each specific substance (other than caffeine) is
    addressed as a separate use disorder (e.g.,
    alcohol use disorder, stimulant use disorder,
    etc.),
  • Cannabis Withdrawal , Caffeine Withdrawal and
    Tobacco Use Disorder are new disorders
  • Caffeine Withdrawal was in DSM-IV Appendix B for
    further study
  • DSM-5 does not separate abuse and dependence but
    criteria is provided for Substance Use Disorder
  • Drug craving or a strong desire or urge to use a
    substance added
  • Problems with law enforcement eliminated
  • The chapter also includes gambling disorder as
    the sole condition in a new category on
    behavioral addictions
  • No Apparent Category for Individuals with
    Co-Occurring Mental Illness and Substance Abuse

DSM V SUBSTANCE-RELATED AND ADDICTIVE
DISORDERS
6
Which category of substances was added as a
substance related disorder?
QUESTION
7
  • The substance-related disorders are divided into
    two groups
  • Substance-Induced Disorder
  • Substance-Use Disorder
  • Criteria is provided for substance use disorder,
    accompanied by criteria for intoxication,
    withdrawal, substance/medication-induced
    disorders, and unspecified substance-induced
    disorders, where relevant.

DSM V
8
  • Substance Induced Disorder
  • It includes
  • Intoxication
  • Withdrawal
  • Other substance/medication-induced mental
    disorders
  • (e.g., substance-induced psychotic disorder,
    substance-induced depressive
  • disorder).
  • Criterion for substance intoxication are included
    within the substance-specific sections
  • Does not apply to tobacco

DSM V
9
  • Substance-Use Disorder includes a cluster of
    cognitive, behavioral, and physiological symptoms
    indicating that the individual continues using
    the substance despite significant
    substance-related problems.
  • The diagnosis of a substance use disorder is
    based on a pathological pattern of behaviors
    related to use of the substance.
  • The more neutral term substance use disorder is
    used to describe the wide range of the disorder,
    from a mild form to a severe state of chronically
    relapsing, compulsive drug taking.
  • Some clinicians will choose to use the word
    addiction to describe more extreme presentations,
    but the word is omitted from the official DSM-5
  • Applied to all 10 classes of drugs (except
    caffeine)

DSM V
10
  • The substance-related disorders encompasses 10
    separate classes of drugs
  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens
  • separate categories for phencyclidine or
    similarly acting rylcyclohexylamines and other
    hallucinogens
  • Examples LSD, Mushrooms, Ecstasy
  • Inhalants
  • solvents, aerosols, gases, and nitrites
  • Opioids
  • heroin, morphine, oxycontin
  • Sedatives, Hypnotics, and Anxiolytics
  • Stimulants
  • amphetamine-type substances, cocaine, and other
    stimulants
  • Tobacco
  • Other or unknown substances

DSM V Drug Classes
11
Alcohol Related Disorders Alcohol Use
Disorder Alcohol Intoxication Alcohol
Withdrawal Other Alcohol-Induced
Disorders Unspecified Alcohol-Related
Disorder Caffeine-Related Disorders Caffeine
Intoxication Caffeine Withdrawal Other
Caffeine-Induced Disorders Unspecified
Caffeine-Related Disorder Cannabis-Related
Disorders Cannabis Use Disorder Cannabis
Intoxication Cannabis Withdrawal Other
Cannabis-Induced Disorders Unspecified
Cannabis-Related Disorder
DSM V Drug Classes
12
Hallucinogen-Related Disorders Phencyclidine Use
Disorder Other Hallucinogen Use
Disorder Phencyclidine Intoxication Hallucinogen
Persisting Perception Disorder Other
Phencyclidine-Induced Disorders Other
Hallucinogen-Induced Disorders Unspecified
Phencyclidine-Related Disorder Unspecified
Hallucinogen-Related Disorder Inhalant-Related
Disorders Inhalant Use Disorder Inhalant
Intoxication Unspecified Inhalant Related
Disorder Opioid-Related Disorders Opioid Use
Disorder Opioid Intoxication Opioid
Withdrawal Other Opioid-Induced
Disorders Unspecified Opioid-Related Disorder
DSM V Drug Classes
13
Sedative-, Hypnotic-, or Anxiolytic-Related
Disorders Sedative, Hypnotic, or Anxiolytic Use
Disorder Sedative, Hypnotic, or Anxiolytic
Intoxication Sedative, Hypnotic, or Anxiolytic
Withdrawal Other Sedative-, Hypnotic-, or
Anxiolytic-Related Disorder Stimulant-Related
Disorders Stimulant Use Disorder Stimulant
Intoxication Stimulant Withdrawal Other
Stimulant-Induced Disorders Unspecified
Stimulant-Related Disorder
DSM V Drug Classes
14
FAMOUS ADDICT
15
Among individuals who have used cannabis
regularly during some period of their lifetime,
up to one-third report having experienced
cannabis withdrawal (i.e. irritability, anger or
aggression nervousness or anxiety sleep
difficulty decreased appetite restlessness
depressed mood)(physical symptoms abdominal
pain, shakiness/tremors, sweating, fever, chills,
or headache) - American Psychiatric Association,
2013
STATISTIC
16
How many drug classes are there for substance
related disorders according to DSM V?
QUESTION
17
  • Severity Scale DSM-5
  • The severity of each Substance Use Disorder is
    based on
  • - 0-1 criteria No diagnosis
  • - 2-3 criteria Mild Substance Use Disorder
  • - 4-5 criteria Moderate Substance Use Disorder
  • - 6 or more criteria Severe Substance Use
    Disorder1
  • Criteria
  • Taking the substance in larger amounts or for
    longer than the you meant to
  • Wanting to cut down or stop using the substance
    but not managing to
  • Spending a lot of time getting, using, or
    recovering from use of the substance
  • Cravings and urges to use the substance
  • Not managing to do what you should at work, home
    or school, because of substance use
  • Continuing to use, even when it causes problems
    in relationships
  • Giving up important social, occupational or
    recreational activities because of substance use
  • Using substances again and again, even when it
    puts the you in danger
  • Continuing to use, even when the you know you
    have a physical or psychological problem that
    could have been caused or made worse by the
    substance
  • Needing more of the substance to get the effect
    you want (tolerance)
  • Development of withdrawal symptoms, which can be
    relieved by taking more of the substance.

DSM V Severity Scale
18
Criterion A criteria can be considered to fit
within overall groups of impaired control, social
impairment, risky use, and pharmacological
criteria. Impaired control over substance use
is the first criteria grouping (Criteria 1-4).
Impaired Control The individual may take the
substance in larger amounts or over a longer
period than was originally intended (Criterion 1
- s 1-4) Social Impairment The individual may
express a persistent desire to cut down or
regulate substance use and may report multiple
unsuccessful efforts to decrease or discontinue
use (Criterion 2 - s 5-7). Risky Use The
individual may spend a great deal of time
obtaining the substance, using the substance, or
recovering from its effects (Criterion 3 - s
8-9). Pharmacological Craving (Criterion 4 -
s 10-11) an intense desire or urge for the
drug that may occur at any time but more likely
when in an environment where the drug previously
was obtained/used. Craving has also been shown
to involve classical conditioning and is
associated with activation of specific reward
structures in the brain. Craving is queried by
asking if there has ever been a time when they
had such strong urges to take the drug that they
could not think of anything else. Current
craving is often used as a treatment outcome
measure because it may be a signal of impending
relapse.
DSM V
19
  • For Substance Use Disorders
  • Specify criteria
  • Specify if
  • Early remission at least 3 months, but less than
    12 months without substance use disorder criteria
    (except craving)
  • Sustained remission at least 12 months without
    criteria (except craving)
  • Specify if
  • In a Controlled Environment. This additional
    specifier is used if the individual is in an
    environment where access to alcohol and
    controlled substances is restricted.
  • Examples of these environments are closely
    supervised and substance-free jails, therapeutic
    communities, and locked hospital units
  • On Maintenance Therapy. Taking prescribed agonist
    medications (i.e. methadone, buprenorphine, oral
    naltrexone, no other criteria met)

DSM V
20
  • People with drug problems might act differently
    than they used to. They might
  • Spend a lot of time alone
  • Lose interest in their favorite things
  • Get messyfor instance, not bathe, change
    clothes, or brush their teeth
  • Be really tired and sad
  • Be very energetic, talk fast, or say things that
    don't make sense
  • Be nervous or cranky (in a bad mood)
  • Quickly change between feeling bad and feeling
    good
  • Sleep at strange hours
  • Miss important appointments
  • Have problems at work
  • Eat a lot more or a lot less than usual
  • People with an addiction usually can't stop
    taking the drug on their own. They want and need
    more. They might try to stop taking the drug and
    then feel really sick. Then they take the drug
    again to stop feeling sick. They keep using the
    drug even though it's causing terrible family,
    health, or legal problems. They need help to stop
    using drugs.

Signs of Abuse Addiction
21
FAMOUS ADDICT
22
Cocaine indicators have decreased over time, but
the DEA Field Divisions report availability is
higher than in the past.
STATISTIC
23
What are some signs of abuse/addiction?
QUESTION
24
  • CAGE AID Substance Abuse Screening Tool
  • DAST Drug Abuse Screening Test DAST 10
  • The NIDA (National Institute on Drugs Abuse)
    Quick Screen
  • Simple Screening Instrument for Substance Abuse
    Self-Administered Form
  • Addiction Severity Index (ASI)
  • SASSI
  • Audit C (for alcohol)
  • CAGE (for alcohol)

Screening Assessment Tools
25
  • Substance abuse and behavioral disorder
    counselors typically do the following
  • Assess and evaluate clients mental and physical
    health, addiction or problem behavior, and
    readiness to treatment
  • Help clients develop treatment goals and plans
  • Review and recommend treatment options with
    clients and their families
  • Help clients develop skills and behaviors
    necessary to recover from their addiction or
    modify their behavior
  • Work with clients to identify behaviors or
    situations that interfere with their recovery
  • Teach families about addiction or behavior
    disorders and help them develop strategies to
    cope with those problems
  • Refer clients to other resources and services,
    such as job placement services and support groups
  • Conduct outreach programs to help people identify
    the signs of addiction and other destructive
    behavior, as well as steps to take to avoid such
    behavior

Social Work Role
26
  • These standards were developed to broadly define
    the scope of services that social workers shall
    provide to clients with substance use disorders,
    that clients their families should expect, and
    that program administrators should support.
  • Ethics Values
  • Qualifications
  • Assessment
  • Intervention
  • Decision Making Practice Evaluation
  • Record Keeping
  • Workload Management
  • Professional Development
  • Cultural Competence
  • Interdisciplinary Leadership Collaboration
  • Advocacy
  • Collaboration

NASW Social Work Standards
27
2
1
3
5
4
7
8
6
FAMOUS ADDICTS Name that Star!
9
28
Alprazolam was the primary benzodiazepine that
was misused, based on treatment admission and
toxicology laboratory data.
STATISTIC
29
What is the common name for alprazolam and what
does it treat?
QUESTION
30
The National Institute on Drug Abuse (NIDA)
created a list of guiding principles that
characterize the most effective treatments. The
principles include the following 1. No single
treatment approach is appropriate for all
individuals. 2. Treatment needs to be readily
available. Effective treatment attends to the
multiple needs of the individual, not just his or
her substance use. 4. An individuals treatment
plan needs to be assessed continually and
modified as necessary. 5. Remaining in treatment
for an adequate time is critical for
effectiveness. 6. Counseling and other behavioral
therapies are critical components of effective
substance abuse treatment. 7. Medications are an
important element of treatment for many people,
especially when combined with behavioral
therapies. 8. Substance-abusing individuals with
coexisting medical disorders should have the
disorders treated in an integrated way. 9.
Medical detoxification is only the first stage of
substance abuse treatment and by itself does
little to change long-term drug and alcohol
use. 10. Treatment does not need to be voluntary
to be effective. 11. Possible substance use
during treatment must be monitored
continuously. 12. Treatment programs should
provide assessment for HIV, hepatitis B,
hepatitis C, tuberculosis, and other infections
and provide counseling to help people change
their risk for infection.
Treatment
31
  • Motivational Enhancement Therapy
  • Cognitive behavioral therapy
  • Twelve-Step Facilitation
  • Structured family and couples therapy
  • Community reinforcement therapy
  • Contingency Management
  • Pharmacological therapies
  • (According to NIDA and the National Institute on
    Alcohol Abuse and Alcoholism)

Evidence Based Treatments
32
  • Motivational Enhancement Therapy is a program
    based on the principles and practices of
    motivational interviewing, an approach to helping
    people make behavior change that is based on a
    client-centered, goal-oriented way of increasing
    a persons intrinsic motivation to change,
    capitalizing on his or her readiness.
  • Motivational Interviewing (MI) is a
    client-centered, directive method for enhancing
    intrinsic motivation to change (by exploring and
    resolving ambivalence) that has proven effective
    in helping clients clarify goals and commit to
    change. MI has been modified to meet the special
    circumstances of clients with COD, with promising
    results from initial studies to improve client
    engagement in treatment.
  • Cognitive behavioral approaches help people
    recognize, avoid, and cope with situations in
    which they are likely to use substances by using
    awareness raising and skill-building activities.

Evidence Based Treatments
33
Twelve-Step Facilitation is a structured,
individualized approach to introducing a person
to a Twelve-Step program that typically helps the
person have a better understanding of his or her
role in therapy and what is expected. Structured
family and couples therapy such as
Multidimensional Family Therapy, addresses a
variety of influences on the substance-abusing
patterns of the person and includes family
members in the therapy sessions so as to treat
people within their natural social environment.
Community reinforcement therapy is an approach
of connecting a person who has substance abuse
problems with a range of services within his or
her community.
Evidence Based Treatments
34
  • Contingency management, also known as
    motivational incentives, is an approach that uses
    positive reinforcement (e.g., special rewards
    such as gift certificates) to increase positive
    behaviors (e.g., not using substances for a
    specified period of time).
  • Contingency Management (CM) maintains that the
    form or frequency of behavior can be altered
    through the introduction of a planned and
    organized system of positive and negative
    consequences. It should be noted that many
    counselors and programs employ CM principles
    informally by rewarding or praising particular
    behaviors and accomplishments. Similarly, CM
    principles are applied formally (but not
    necessarily identified as such) whenever the
    attainment of a level or privilege is contingent
    on meeting certain behavioral criteria.
    Demonstration of the efficacy of CM principles
    for clients with COD is still needed.
  • Pharmacological therapies include the use of
    medications like naltrexone (Rivia, Dapade,
    Vivitrol), disulfiram (Antabuse), methadone, and
    buprenorphine (Suboxone, Subutex, Zubsolv) to
    help stabilize a persons life during treatment.

Evidence Based Treatments
35
  • Brief Interventions/Therapies
  • Client Engagement
  • Johnson Model Intervention
  • Resistance in Treatment
  • Stages of Change Model

Other Interventions
36
FACE OF ADDICTS
37
In 2010, 8.9 percent of persons 12 years of age
and over had any illicit drug use in the past
month
STATISTIC
38
Name two evidence based treatment models for
working with addiction?
QUESTION
39
  • SAMHSA's 2002 report to Congress defines
    co-occurring disorders as
  • Individuals who have at least one mental disorder
    as well as an alcohol or drug use disorder. While
    these disorders may interact differently in any
    one person (e.g., an episode of depression may
    trigger a relapse into alcohol abuse, or cocaine
    use may exacerbate schizophrenic symptoms), at
    least one disorder of each type can be diagnosed
    independently of the other.
  • refers to an individual having co-existing mental
    health and substance use disorders.

Co-Occurring Disorders
40
  • Some of the most common psychiatric disorders
    seen in patients with co-occurring addiction
    issues include
  • schizophrenia
  • bipolar disorder
  • borderline personality disorder
  • major depression
  • anxiety and mood disorders
  • post traumatic stress disorder
  • pathological gambling
  • sexual and eating disorders
  • conduct disorders
  • attention deficit disorder

Co-Occurring Disorders
41
Whatever the relationship between mental health
problems and problematic substance use, the
research shows that their co-existence is likely
to worsen a range of outcomes for service users.
These include Increased rates of
violence. Increased rates of suicide.
Higher levels of mental health symptoms.
Increased relapses, numbers of hospitalizations
and time spent in hospital. Poorer general
health, including increased rates of hepatitis C
and HIV. Higher rates of offending and
incarceration. Unstable housing and
homelessness. Loss of family supports.
Financial problems. Financial costs to
treatment services.
Co-Occurring Disorders
42
  • The 12-Step Assessment Process (by SAMHSA)
  • 1. Engage the client
  • 2. Upon receipt of appropriate client
    authorization(s), identify and contact
    collaterals (family, friends, other treatment
    providers) to gather additional information
  • 3. Screen for and detect COD
  • 4. Determine severity of mental and substance use
    disorders
  • 5. Determine appropriate care setting (e.g.,
    inpatient, outpatient, day-treatment)
  • 6. Determine diagnoses
  • 7. Determine disability and functional impairment
  • 8. Identify strengths and supports
  • 9. Identify cultural and linguistic needs and
    supports
  • 10. Identify additional problem areas to address
    (e.g., physical health, housing, vocational,
    educational, social, spiritual, cognitive, etc.)
  • 11. Determine readiness for change
  • 12. Plan treatment

Social Work Assessment
43
  • Motivational Interviewing (MI)
  • Contingency Management (CM)
  • Cognitive-Behavioral Therapy (CBT) is a general
    therapeutic approach that seeks to modify
    negative or self-defeating thoughts and
    behaviors, and is aimed at achieving change in
    both. CBT uses the client's cognitive distortions
    as the basis for prescribing activities to
    promote change. Distortions in thinking are
    likely to be more severe with people with COD who
    are, by definition, in need of increased coping
    skills. CBT has proven useful in developing these
    coping skills in a variety of clients with COD.
  • Relapse Prevention (RP) has proven to be a
    particularly useful substance abuse treatment
    strategy and it appears adaptable to clients with
    COD. The goal of RP is to develop the client's
    ability to recognize cues and to intervene in the
    relapse process, so lapses occur less frequently
    and with less severity. RP endeavors to
    anticipate likely problems, and then helps
    clients to apply various tactics for avoiding
    lapses to substance use. Indeed, one form of RP
    treatment, Relapse Prevention Therapy, has been
    specifically adapted to provide integrated
    treatment of COD, with promising results from
    some initial studies.

Co-Occurring Disorders Evidence Based Treatments
8
44
Integrated Dual Disorders Treatment
Co-Occurring Disorders Evidence Based Treatments
8
45
FACE OF ADDICTS
46
  • Over 8.9 million persons have co-occurring
    disorders that is they have both a mental and
    substance use disorder.
  • Only 7.4 percent of individuals receive treatment
    for both conditions with 55.8 percent receiving
    no treatment at all.

STATISTIC
47
Name 2 common co-occurring disorders
Co-Occurring Disorders
48
Susan presents to you asking for help for her
heroin addiction. She has been using drugs off
and on for 4 years (from pills to heroin) and is
currently using about 60/day by IV drug use.
Susan does not have stable housing and lives with
her boyfriend sometimes. Susan has one child (age
4) who is with her mother due to CPS involvement
(open case). Susan also feels some anxiety and
sadness, but has never been diagnosed. She has
many physical withdrawals when she does not use
(sweating, cramps, nausea). Susan relies on the
bus for transportation and her boyfriend will
give her money sometimes. How do we help her?
Treatment Plan EXAMPLE
49
  • Problems
  • The problems must be specific, not vague. A
    problem is a brief clinical statement of a
    condition of the patient that needs treatment.
  • Long Term Goals
  • A goal is a brief clinical statement of the
    condition you expect to change in the patient or
    in the patients family. Goals usually are
    abstract statements that you cannot actually see
    happen.
  • Short Term Objectives
  • An objective is a specific skill that the patient
    must acquire to achieve a goal. The objective is
    what you really set out to accomplish in
    treatment. It is a concrete behavior. Objectives
    must be measurable.
  • Therapeutic Interventions
  • Interventions are what you (as the clinician) do
    to help the patient complete the objective.
    Interventions also are measurable and objective.
    There should be at least one intervention for
    every objective.
  • Diagnostic Suggestions

Treatment Plan Components
50
Susan presents to you asking for help for her
heroin addiction. She has been using drugs
off and on for 4 years (from pills to heroin) and
is currently using about 60/day by IV drug
use. Susan does not have stable housing and lives
with her boyfriend sometimes. Susan has one child
(age 4) who is with her mother due to CPS
involvement (open case). Susan also feels some
anxiety and sadness, but has never been
diagnosed. She has many physical withdrawals when
she does not use (sweating, cramps, nausea).
Susan relies on the bus for transportation and
her boyfriend will give her money sometimes. How
do we help her? LIST PROBLEMS
Treatment Plan EXAMPLE
51
Susan presents to you asking for help for her
heroin addiction. She has been using drugs
off and on for 4 years (from pills to heroin) and
is currently using about 60/day by IV drug
use. Susan does not have stable housing and lives
with her boyfriend sometimes. Susan has one child
(age 4) who is with her mother due to CPS
involvement (open case). Susan also feels some
anxiety and sadness, but has never been
diagnosed. She has many physical withdrawals when
she does not use (sweating, cramps, nausea).
Susan relies on the bus for transportation and
her boyfriend will give her money sometimes. How
do we help her? LIST LONG TERM GOAL(S)
Treatment Plan EXAMPLE
52
Susan presents to you asking for help for her
heroin addiction. She has been using drugs
off and on for 4 years (from pills to heroin) and
is currently using about 60/day by IV drug
use. Susan does not have stable housing and lives
with her boyfriend sometimes. Susan has one child
(age 4) who is with her mother due to CPS
involvement (open case). Susan also feels some
anxiety and sadness, but has never been
diagnosed. She has many physical withdrawals when
she does not use (sweating, cramps, nausea).
Susan relies on the bus for transportation and
her boyfriend will give her money sometimes. How
do we help her? LIST SHORT TERM OBJECTIVE(S)
Treatment Plan EXAMPLE
53
Susan presents to you asking for help for her
heroin addiction. She has been using drugs
off and on for 4 years (from pills to heroin) and
is currently using about 60/day by IV drug
use. Susan does not have stable housing and lives
with her boyfriend sometimes. Susan has one child
(age 4) who is with her mother due to CPS
involvement (open case). Susan also feels some
anxiety and sadness, but has never been
diagnosed. She has many physical withdrawals when
she does not use (sweating, cramps, nausea).
Susan relies on the bus for transportation and
her boyfriend will give her money sometimes. How
do we help her? LIST THERAPEUTIC INTERVENTION(S)
Treatment Plan EXAMPLE
54
Susan presents to you asking for help for her
heroin addiction. She has been using drugs
off and on for 4 years (from pills to heroin) and
is currently using about 60/day by IV drug
use. Susan does not have stable housing and lives
with her boyfriend sometimes. Susan has one child
(age 4) who is with her mother due to CPS
involvement (open case). Susan also feels some
anxiety and sadness, but has never been
diagnosed. She has many physical withdrawals when
she does not use (sweating, cramps, nausea).
Susan relies on the bus for transportation and
her boyfriend will give her money sometimes. How
do we help her? LIST DIAGNOSTIC SUGGESTIONS DSM V
Opioid use Disorder Specify if early remission
or sustained remission Specify if on
maintenance therapy, in controlled environment
S Specify if 305.50 (F11.10) - Mild 304.00
(F11.20) - Moderate 304.00 (F11.20) - Severe
Opioid Intoxication 292.89 Without perceptual
disturbances w/use disorder F11.129 w/use
disorder, severe/moderate F11.229 w/out use
disorder F11.929 With perceptual
disturbances w/use disorder F11.122 w/use
disorder, severe/moderate F11.222 w/out use
disorder F11.922
Opioid Withdrawal 292.0 (F11.23)
Unspecified Opioid Related Disorder 292.9
(F11.99)
or
or
or
Treatment Plan EXAMPLE
55
Accountability App
56
  • TARRANT COUNTY
  • Call Recovery Resource Center (RRC) -
    877-332-6329
  • DALLAS COUNTY
  • Detox
  • Homeward Bound (Oak Cliff) - 214-941-3500
  • Nexus (women only) - 214-321-0156
  • Treatment
  • Nexus Homeward Bound
  • Solace 214-522-4640
  • Turtle Creek 214-871-2496
  • Insurance NorthSTAR 1-888-800-6799
  • JOHNSON COUNTY
  • Star Council 817-645-5517 (Cleburne)
  • OTHER AREAS
  • Partners for a Drug Free Texas (Dept of Health) -
    1-866-378-8440

Local Treatment
57
Costs of Substance Abuse Abuse of tobacco,
alcohol, and illicit drugs is costly to our
Nation, exacting over 600 billion annually in
costs related to crime, lost work productivity
and healthcare
STATISTIC
58
FAMOUS ADDICT Guess Who?
59
  • American Psychiatric Association. (2013).
    Substance Related Addictive Disorders. Retrieved
    March 1, 2014 from http//www.dsm5.org/Documents/S
    ubstance20Use20Disorder20Fact20Sheet.pdf
  • Villanova University. Drug Classifications.
    Retrieved March 1, 2014 from https//www1.villanov
    a.edu/villanova/studentlife/health/promotion/goto/
    resources/drugclassifications.html
  • National Institute on Drug Abuse. (2012). Drug
    Facts Inhalants. Retrieved March 1, 2014 from
    http//www.drugabuse.gov/publications/drugfacts/in
    halants
  • Maxwell, Jane. Substance Abuse Trends in Texas
    June 2012. Retrieved March 1, 2014 from
    http//www.utexas.edu/research/cswr/gcattc/documen
    ts/CurrentTrends2012.pdf
  • Bureau of Labor Statistics, U.S. Department of
    Labor, Occupational Outlook Handbook, 2014-15
    Edition, Substance Abuse and Behavioral Disorder
    Counselors, on the Internet at
    http//www.bls.gov/ooh/community-and-social-servic
    e/substance-abuse-and-behavioral-disorder-counselo
    rs.htm (visited March 10, 2014).
  • Co-Occurring Center for Excellence. (2006).
    Screening, Assessment, and Treatment Planning for
    Persons With Co-Occurring Disorders. Retrieved
    March 1, 2014 from http//store.samhsa.gov/shin/co
    ntent/PHD1131/PHD1131.pdf
  • Nelson, Anna. (2012). Social Work with Substance
    Users. Sage Publications.
  • Jongsma, A., Peterson, M.L., Bruce, T. (2006).
    The Complete Adult Psychotherapy Treatment
    Planner (4th Ed.). (2006). Hoboken, NJ John
    Wiley Sons.
  • NASW. (2013). NASW Standards for Social Work
    Practice with Clients with Substance Use
    Disorder.
  • Images used from Internet

REFERENCES
60
  1. Center for Substance Abuse Treatment. (2005).
    Substance Abuse Treatment for Persons With
    Co-Occurring Disorders. Treatment Improvement
    Protocol (TIP) Series 42. DHHS Publication No.
    (SMA) 05-3992. Rockville, MD Substance Abuse and
    Mental Health Services Administration. Retrieved
    March 1, 2014 from http//adaiclearinghouse.org/do
    wnloads/TIP-42-Substance-Abuse-Treatment-for-Perso
    ns-with-Co-Occurring-Disorders-52.pdf
  2. American Psychiatric Association. (2013).
    Diagnostic and statistical manual of mental
    disorders (5th ed.). Arlington, VA American
    Psychiatric Publishing.
  3. Reichenberg, Lourie. (2013). DSM-5 Essentials
    The Savvy Clinician's Guide to the Changes in
    Criteria. Hoboken, NJ Wiley.
  4. National Institute on Drug Abuse. (2012). Trends
    Statistics. Retrieved March 1, 2014 from
    http//www.drugabuse.gov/related-topics/trends-sta
    tistics
  5. Substance Abuse and Mental Health Service
    Administration (SAMHSA). Co-Occurring Disorders.
    Retrieved March 1, 2014 from http//www.dpt.samhsa
    .gov/comor/Co-occuring.aspx
  6. Substance Abuse and Mental Health Service
    Administration (SAMHSA). Rates of Co-Occurring
    Mental and Substance Use Disorders. Retrieved
    March 1, 2014 from http//www.samhsa.gov/co-occurr
    ing/topics/data/disorders.aspx
  7. Substance Abuse and Mental Health Services
    Administration. Integrated Treatment for
    Co-Occurring Disorders How to Use the
    Evidence-Based Practices KITs. DHHS Pub. No.
    SMA-08-4366, Rockville, MD Center for Mental
    Health Services, Substance Abuse and Mental
    Health Services Administration, U.S. Department
    of Health and Human Services, 2009.

REFERENCES
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