Substance Abuse V
Transcript of 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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Substance Dependence
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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Substance Dependence
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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Substance Dependence
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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Substance Dependence
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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Substance Dependence
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 Systems Concepts
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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Family Systems Concepts
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.