Substance Abuse Assessment and Treatment Techniques, Exams of Nursing

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genetic risk - Correct Answers ✅up to 50%; higher in heroin (40- 60% overall) cocaine neurotransmitters - Correct Answers ✅primary buildup of dopamine (also serotonin and norepinephrine); people deficient in serotonin are at risk nootropics - Correct Answers ✅drugs designed to boost cognitive performance ex: Adderall, Provigil (sleep disorders), amphetamine cocaine abuse - Correct Answers ✅1. experimental use

2. compulsive use
3. dysfunctional use -arterial constriction & hardening leads to cardiac arrest/stroke anabolic steroids - Correct Answers ✅-engage both opioid and dopamine neurotransmission systems -just as addictive as caffeine, nicotine, and benzos -withdrawal appears like cocaine (insomnia, headaches, restlessness, poor libido, dysphoria)

screening & assessment - Correct Answers ✅screening: looking to determine if a problem exists assessment: more thorough for targeted matters of concern suicide rates - Correct Answers ✅IV users: 14x higher general population: 10x higher lowest for African American women & highest for American Indian and Alaskan Native males Substance Abuse Subtle Screening Inventory (SASSI) - Correct Answers ✅67 clinical obvious & subtle items to detect truth when individuals are unwilling or unable to acknowledge problem; <15 mins to complete Michigan Alcohol Screening Test (MAST) - Correct Answers ✅alcohol screening tests available but no tools for truth Screening, Brief Intervention, and Referral to Treatment (SBIRT) - Correct Answers ✅quick & simple tool to ID substances for at-risk levels for those already experiencing substance use issues; no tools for truth Addiction Severity Index (ASI) - Correct Answers ✅tool for assessment & tx planning (NOT screening)

readiness to change - Correct Answers ✅-clients who perceive the need for help w/ the process of change & when other options are perceived as comparatively less attractive -NOT always rock bottom; can also be motivated by external pressures -client and family's level of emotional pain Chemical Use, Abuse And Dependence (CUAD) Scale - Correct Answers ✅used in ax; derives a DSM dx of substance disorder; brief 5-30 min interview and requires little training. known for mentally ill pop'ns Symptom Checklist-90-R (SCL-90-R) - Correct Answers ✅ax broad range of psychological problems and pathology as well as client progress/treatment outcomes. 90 items on a 5-point scale to be completed in 12-15 minutes and produces an overview of symptoms Community Oriented Programs Environment Scale (COPES) - Correct Answers ✅measure actual, preferred, and expected treatment environment or social climate of community treatment programs by drawing on opinions of clients & staff Treatment Services Review (TSR) - Correct Answers ✅used in conjunction with ASI; ten-minute structured interview to ax nature and frequency of tx services CHEAP progress notes - Correct Answers ✅Chief complaint

History Exam Assessment Plan SIGECAPS - Correct Answers ✅full eval of depression symptoms: Sleep, Interests, Guilt, Energy, Concentration, Appetite, Psychomotor Agitation, and Suicidal ideation CART - Correct Answers ✅progress note format: Client condition, Actions, Response, and Treatment plan CHART - Correct Answers ✅progress note format: Client condition, Historical significance, Actions, Response, and Treatment plan episode of treatment - Correct Answers ✅length of stay is not always critical; completion is more important; avoid high drop-out rate in first few weeks ideal group size - Correct Answers ✅process groups most effective w/ 6-8 members; psychoeducational ones can be larger co-occurring treatment severity - Correct Answers ✅none- moderate/severity: IOP (i.e. anxiety/mood dx)

severe: dual-diagnosis (psychotic/personality disorders) Composite International Diagnostic Interview (CIDI) - Correct Answers ✅covers both DSM and ICD criteria for SA disorders; addresses consequences and onset of symptoms; primarily used for epidemiology MINI scale - Correct Answers ✅screens for major psych disorders based on DSM and ICD criteria; reliable dx in brief time frame PRISM instrument - Correct Answers ✅Psychiatric Research Interview for Substance Abuse and Mental Disorders; differentiates antisocial and borderline personality dx from SA; 1-3 hours/training required AASE Scale - Correct Answers ✅Alcohol Abstinence Self-Efficacy Scale; to ax level of client's confidence in being able to abstain from alcohol in 20 situations that include common drinking cues; no training req'd ASRPT - Correct Answers ✅Alcohol-Specific Role Play Test (ASRPT) uses role-playing scripts to evaluate client situations in taped responses by acting out; 20 mins/requires training SCQ - Correct Answers ✅Situational Confidence Questionnaire: 29 self-report items that explores self-efficacy in alcohol-related scenarios

CBT - Correct Answers ✅not effective in group counseling Motivational interviewing (MI) - Correct Answers ✅counselor is coach/consultant, asking key questions for learning. nonjudgmental, collaborative style Motivational enhancement therapy (MET) - Correct Answers ✅incorporates structured assessments and follow-up sessions as adaptation to MI Matrix Model of treatment - Correct Answers ✅relapse prevention, family education, and early recovery skills groups (NOT stress management); very effective also neurobehav. tx Osher & Kofoed co-occurring treatment - Correct Answers ✅four stages:

1. engagement
2. persuasion
3. active treatment
4. relapse prevention

symptom presentation - Correct Answers ✅most influential for counselor; alcohol use among adults 25+ - Correct Answers ✅lower in rural areas women have higher rate of alcohol use in rural areas Clinical/Rehabilitation model - Correct Answers ✅integrate clinical therapy + resource activities service coordination - Correct Answers ✅case management and advocacy are subsets defined as action framework by which a client is enabled to achieve goals in ID treatment plan Qualified Service Organization Agreement (QSOA) - Correct Answers ✅used when outside person/agency provided services directly to treatment #1 client changer - Correct Answers ✅ability to be empathetic communication - Correct Answers ✅50% is nonverbal

developmental stages - Correct Answers ✅age of significant SA use is when developmental stages were arrested/missed altogether programmed confrontation - Correct Answers ✅used to mobilize a substance user to accept treatment (usually by family member); trained in Unilateral Family Therapy community reinforcement training (CRT) - Correct Answers ✅used by families to hasten a user into treatment who seek help same-day ARISE method - Correct Answers ✅uses 3-level approach to motivate an addict to enter treatment network therapy - Correct Answers ✅builds an extended collection of involved persons Native Americans - Correct Answers ✅20% report alcohol abuse Asians & Pacific Islanders - Correct Answers ✅fastest growing group in US client data - Correct Answers ✅reviewed annually; entered weekly transference - Correct Answers ✅client feelings onto counselor

countertransference - Correct Answers ✅counselor feelings onto client treatment frame - Correct Answers ✅helps establish healthy boundaries DSM - Correct Answers ✅11 symptoms recreational use - Correct Answers ✅occurs weekly-biweekly tolerance - Correct Answers ✅develops as body seeks homeostasis; for an otherwise legal dose of barbs only marginally increases and never exceeds twofold Hepatitis B - Correct Answers ✅inflames liver--> alcoholics susceptible to toxic effects as substance is metabolized by liver Magnon's syndrome - Correct Answers ✅chronic users of cocaine/meth.other stimulants develop "bug crawling" sensation under the skin convergence theory - Correct Answers ✅SA rates among men & women are becoming more equal (1.6 men : 1 women)

alcohol use in elderly - Correct Answers ✅#3 psych disorder; 1/2 - 1/4 suicide attempts involve alcohol; have better attendance rates and lower rates of relapse alcohol use onset - Correct Answers ✅2/3 start in adolescence & young adulthood rates of receiving help - Correct Answers ✅7.1 % will receive tx for co-occurring dx 32.9% only mental health tx 25% SA + MH? screening process - Correct Answers ✅can be affected by setting, instructions, and privacy GATE - Correct Answers ✅ax for suicide assessment information - Correct Answers ✅goals, objectives, action steps w/ reliable, clinical and valid info stages of change - Correct Answers ✅1. precontemplation

2. contemplation
3. preparation

4. action
5. maintenance
6. relapse treatment planning principles - Correct Answers ✅Measureable Attainable Time-limited (short-term) Realistic Specific ASI - Correct Answers ✅most widely used; has teen and shortened versions DIG FAST - Correct Answers ✅full evaluation of mania discharge with continuing care - Correct Answers ✅SA requires long-term tx (not referred to "after care" or f/u) naltrexone - Correct Answers ✅can be effective for alcohol tx suboxone + naloxone - Correct Answers ✅can be used for opioid dependence

ASAM levels of care - Correct Answers ✅.5 early intervention I: outpatient: <9 hours weekly II: IOP/partial hosp: 9+ hours weekly (2 subcategories) -minimum 90 days III: residential/inpatient (3 subcategories) IV: medically managed inpatient *enter lowest level possible four sequential stages of tx - Correct Answers ✅1. tx engagement

2. early recovery
3. maintenance
4. community support group & individual therapy - Correct Answers ✅just as effective; individual is 30-50 min weekly with no discussion of conscious/subconscious issues group therapy: more complex and specialized than 12-steps group modalities - Correct Answers ✅psychoed: teach concepts time-limited: education @ onset of tx

skills-development: refusal/relapse prevention support: work thru conflict interpersonal: single-interest of family/couples presented in sequential manner pharmacotherapy - Correct Answers ✅effective SA tx esp. in IOP; no effective meds for stimulants, cocaine, marijuana, inhalants or hallucinogen abuse core support concerns - Correct Answers ✅education, voc training, and employment do not constitute adjunctive therapies effective screening tools to detect SA disorder presence - Correct Answers ✅Center for Substance Abuse Treatment (CSAT) Simple Screening , combo of Alcohol Dependence Scale (ADS) and ASI subscale, and Texas Christian University Drug Screen remission - Correct Answers ✅early: 3-12 months sustained: 12+ (no longer partial/full) Minnesota Model of Treatment - Correct Answers ✅addiction is a disease; blending of professional and trained nonprofessional (recovering) staff; can involve 12-step facilitation

12-steps - Correct Answers ✅hard to monitor, emphasis on higher power, small communities may not sustain ongoing meetings or have issue specific-groups; they DO show measurable outcomes 3+ years post tx treatment communities (TCs) - Correct Answers ✅organized as controlled, drug free residential setting with treatment; structured programming community reinforcement (CR) - Correct Answers ✅rewards with more enduring sources: utilizes an addict's family, social and recreational activities and vocation to reinforce the positive rewards of a drug-free lifestyle contingency management (CM) - Correct Answers ✅operant conditioning; more long-term support SAMSHA categories for mental health & SA - Correct Answers ✅1. MH less severe, SA less severe: PCP setting

2. MH more severe, SA less severe: MH setting
3. MH less severe, SA more severe: SA setting
4. MH & SA severe: hospital/inpatient setting

relapse & remitting model - Correct Answers ✅can be applied to other issues as they return cyclically over time bookend - Correct Answers ✅discuss trigger events before/after they occur group members - Correct Answers ✅Hispanics/Latinos can be adverse to rules, women may contend with need for help, want to nurse and invest emotionally positive effects of treatment - Correct Answers ✅begin to emerge around 3 months common recovery stages - Correct Answers ✅1. early: 1 mo - 1 year

2. middle: 1 yr +
3. late: maintaining group stages - Correct Answers ✅1. forming
4. storming
5. norming
6. performing
7. adjourning

youth substance abuse programs - Correct Answers ✅1. universal: @ risk/potential

2. selective: @ risk
3. indicated: address relevant issues when SA use is part of their lives party to records - Correct Answers ✅clients are RARELY involved tx/recovery plans - Correct Answers ✅1. SA problems listed
4. short term/LT objectives
5. action plans for short term
6. client progress toward goals
7. updates to discharge summary as ongoing 42 CFR - Correct Answers ✅-oral consent not permitted, emergency, other agencies, mandated reports of child abuse, qualified researchers, crime on site/staff, court order/subpoena, qualified court hearing work environment - Correct Answers ✅break cycle of abuse