Substance Abuse Study Guide, Exams of Nursing

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IC & RC Study Guide CAGE ✔• The briefest and most widely used. • Only four questions asked directly to the person. • If someone answers yes to one of the questions then there is an indicator that their might be a problem that needs to be further investigated. • If they answer yes to two or more they are sent for further testing. • Advantages-yes or no questions • Disadvantages-not asking about time frame, self report, not in depth about environment, not in depth MAST ✔• Widely used • Good reliability and validity • Original had 25 self administered questions the one now has only 22. • Advantages-it could be a reality check to someone taking it, not very time consuming, simple yes and no • Disadvantage-it doesn't ask you to explain, doesn't ask time frame AUDIT ✔• Ten items 1-3 frequency and quantity 4-6 alcohol dependence 7-10 how harmful alcohol use. • Advantages-you can use it in an interview, it's not that long, it's more specific • Disadvantage-not specific enough, doesn't add in the times when drinking is more acceptable like vacation etc., not valid • Can be self report questionnaire or an interview DAST ✔Screen drugs other than alcohol POSIT ✔139 items on it Used for substance use problems and social, behavioral, and learning problems Disadvantages-too long, repetitious, lack of consistency Advantages-more detailed SASSI ✔• Doesn't directly question about alcohol/drug use (not like the previous ones) • Around 50 questions • Asks questions about alcohol/drug use on one side and don't on the other • Looking for defensiveness, looking at others, personal affect • Disadvantages-could be hard to profile DSM Axises ✔o Axis I-Clinical syndromes • Alcohol abuse, cannabis dependency o Axis II-Personality disorders/mental retardation • Not used very often in alcohol or chemical use o Axis III-Medical Conditions • Psuerosis of the liver o Axis IV-Psychosocial/environmental stressors • Losing kids because of substance abuse, lacks good social support system o Axis V-Global assessment of functioning • 0-100 how the person is functioning overall Narcotics possible effects ✔Euphoria, drowsiness, respiratory depression, constricted pupils, nausea Narcotics effects of OD ✔Slow/shallow breathing, clammy skin, convulsions, coma, and possible death Narcotics withdrawal syndrome ✔Water eyes, runny nose, yawning, loss of appetite, irritability, tremors, panic, cramps, nausea, chills, sweating. Narcotics ✔Heroin, Morphine, Hydrocodone, Hydro-morphone, Oxycodone, Codeine Depressants ✔Hydroxybutyric Acid, gamma, Benzodiazepines etc. Depressant effects ✔slurred speech, disorientation, drunken behavior without odor of alc., imparired membory of events, interacts with alc. Depressant overdose ✔shallow respiration, clammy skin, dilated pupils, weak and rapid pulse, coma, and possible death. Depressant withdrawal ✔Anxiety, insomnia, tremors, delirium, convulsions, possible death. Stimulants ✔Similar to alcohol. Reduction of anxity; possible elation, secondary to decrease alertness and judgment. Sedative Hypnotics acute effects ✔Sedation, impaired judgement, impaired operation of vehicles, respiratory and cardiac depression with overdose (much less likely with benzoidiazepines alone). Sedative Hypnotics interaction with alcohol ✔Potentiation of effects, especially respiratory depression, Some degree of cross tolorance. Sedative Hypnotics common problems ✔Tolerance, dependence, addiction, elderly falls, respiratory dpression Sedative Hypnotics withdrawal ✔Similar to alcoho, but may have slower onset. Severity and time of onset vary wtih half life of drug. Mild: anxiety, restlessness, nausea, vomiting, insomnia, hpertention, tachycardia, agitation, tremors, sensory, hypersensitivity, dizziness, confusion, fatigue. Severe: Autonomic hyperactivity, vital sign instability, elevated temp, delusions, hallucinations, mania, delirium, catatonia, seizures, tremulousness, altered perceptions, w/d seizures possibly leading to death. Sedative Hypnotics Medical uses ✔Sleep, anxiety, muscle relaxation, alcohol, and sedative/hypnotic w/d, control of seizures includes Benzodiazepines, barbiturates, and others. Sedative Hypnotics physica/mental exam ✔Slurred speech, ataxia, stupor, coma, and for nonbenzo's respiratory depression. confulsion, impaired judgement, delirium. Cocaine action ✔affects dopamine, norepinephrine, and serotonin levels. Blocks re-uptake of dopamine, prolonging dopamine effects. Depleats it with prolonged use. Toxic effects on cardiac, respiratory, and cns. Amphetamines and Methylphenidate action (stimulant) ✔Direct neuron release of dopamine and norepinepherine and blockade of catecholamine re-uptake produce euphoric effects. Various toxic effets on the sympathetic nervous system. Stimulant physical and mental status ✔pupils dialated, dry mouth, cardiac arrhythmias, twitching, tremors, convulsions, stroke, coma, confusion, disinhibited behaivor, parnaoid thoughts, hallucinations, hyper vigilance, elevation and or depression, suciadal behavior, impaired judgement. Opiates Action ✔Bind to opiate receptors in the cns where they block normally occuring opiate-like substances. Opiate acute effects ✔sedation, decreased judgement, decreased ability to operate vehicles, posssible respiratory depression if oding. Opiate W/D ✔Drug craving, dysphoria, anxiety, yawning, perpiration, sleep difficulties, fever, chills, gooseflesh, abdominal cramps, nausea, diarrhea, muscle cramps, bone pain tears. Opiate problems ✔Rapid acquired tolerance, dependence, respiratory dpression, cellulitis, sepsis, endocarditis, @ risk for HIV, and legal problems. Opiate physical/mental exam ✔Pupil constricted, relexes absent or diminished, pulmonary edema, convulsions. Euphoria, sedation, possible normal mood, possible stupor. Opiate users ✔rate of relapse goes down by 60% 6 months to 1 year after stopping methodone/suboxonel maintenance. Medical Marijuana ✔FDA has not cleared it. The ill affects of smoking far out weigh the medical affects. THC ✔Fat soluable-stored in fat-time released, hard to recognize withdrawal. Cannabis signs and symptoms ✔Red eyes, mild dilation of pupils, mild tremor, decreased coordination, decreased strength, less ability to perform complex motor tasks and dry mouth, feelings of depersonalization, anxiety, panic, memory problems, alterationin mood disorganization, hallucinations, paranoid thoughts. Hallucination LSD acute effects ✔panic attacks, increased b/p, heart palpitiations, tremors, nausea, muscle weakness, increased body temp, ataxia, accidental dealth (believing one can fly). Hallucination MDMA acute effects ✔Nausea, jaw and teeth clenching, muscle tension, blurred vision, panice attacks, confusion, depression, anxiety, paranoid psychosis, hyperthermia, and cardiac arrest. Phencyclidine (PCP) Action ✔Behvior effects believed to be meediated through the N-Methyl-D-Aspartate (ND) excitatory amino acid receptor-channel complex in the brain. PCP acute effects ✔visual illusions, hallucinations, and distroted perceptions, feelings of stregth, power, and invulnerability, depresonalization, distorted body image. PCP common problems ✔Psychotic reactions, bizarre behavior, ooutbursts of hostililty and violence, feelings of anxiety, doom or impending death, gross impairment of coordination, nystagmus, hypersalivation, vomiting, fever. With longterm use: Persistent cognitive and memory problems speech difficulties, mood d/o, loss of puposive activities and weight loss. PCP w/d ✔Limited reports of w/d effects. Depression, drug craving, increased appetitie and increased need for sleep PCP signs and symptoms ✔Red eyes, muscle rigidity, increased reflexes, repetitive movements, flushing, salivation, sweating, nausea, vomiting, possible coma, seizures, stroke. Abnormal appearance and behavior, diorientation, inappropriateeffect, memory problems, depression, elation, suicidal or homicidal behavior, and impaired judgement. behavioral view of etiology ✔suggests the influence of both positive and negative reinforcement as causal factors for continued drug use. pleasure pathway in the brain ✔mesolimbic dopamine system GABA transmitters dependence ✔a condition where, after using drugs, an individual finds it difficult or impossible to control use. Dependence usually involves a physical and or psychological need for the drug in order to function normally and it usually involves tolerance and withdrawal. Physical dependence ✔a state of functional adaptation to a drug in which the presence of a foreign chemical becomes normal and necessary, and the absence of the drug would present an abnormal state. Psychological dependence ✔when the individual has a strong desire to continue to use the drug for emotional reasons and is related to the rewarding effects of the drug. There are no physical withdrawal symptoms with the discontinuation of use. Cross-dependence ✔this is evident when a person who is physically dependent on one drug can lessen or prevent withdrawal symptoms by using other drugs from the same or similar classification. Tolerance ✔an altered physiological state that develops after repeated drug use when the body becomes accustomed and adapts to the presence of the drug and functions normally. Evidence of this is when the drug has less of an effect when using the same dose, or when a larger dose must be used to get the desired effect. Pharmacodynamic tolerance ✔when the nerve cells become less sensitive to the effects of the drug over time and repeated use metabolic tolerance ✔when the liver adapts to the presence of a drug over time and may produce more of the enzyme needed to break down the drug. behavioral tolerance ✔when after a period of time and repeated drug use, the users are able to modify their behavior in hopes that others will not notice they are intoxicated reverse tolerance ✔when the individual can become more sensitive to the drug's effects rather than less sensitive. Also known as the kindling effect. half-life ✔the length of time a drug remains in the body and continues to affect the user. effective dose ✔the amount of a drug necessary to get the desired effect in about 50 percent of those who use the drug therapeutic index ✔the dose determined to be safe for use and get the desired effect; determined by dividing the lethal dose by the effective dose potency ✔the amount of a drug necessary to produce the desired effect. drug interaction classifications ✔addititive, synergistic, antagonistic additive effects ✔two or more drugs are used at the same time and the results are equal to the sum of the actions of the drugs used. synergistic interactions ✔when two or more drugs are used at the same time, and the results are greater that the sum of the actions of the drugs used. antagonistic interactions ✔occur when two or more drugs are used at the same time, and the results are less than the sum of the actions of the drugs or the drugs cancel out the effects of each other. Routes of administration ✔how a person takes substances into the body oral administration ✔taken by mouth and swallowed into the stomach. injected ✔using a needle and syringe subcutaneously ✔skin-popping, injecting in the fatty layer just under the external skin. intramuscularly ✔injected into the large muscles intravenously ✔injected directly into a vein inhalation ✔substances can be inhaled into the lungs by smoking or huffing snorting ✔drugs can be inhaled into the nose and absorbed through the mucous membranes. transdermal ✔the drug is absorbed through the skin from a patch. buccal administration ✔the drug is absorbed through the mucous membranes in the mouth. rectal administration ✔Drugs are administered by inserting them into he body through the rectum and are absorbed through the intestinal lining. neorotransmitters ✔GABA, norepinephrine, dopamine, serotonin, acetylcholine. GABA ✔relates to inhibitory factors and slows communication. Norepinephrine ✔associated with arousal reactions and moods. Dopamine ✔decreased inhibition, slowed reaction times, memory impairment, possible decrease in respirations, slurred speech, ataxia, Symptoms of Stimulant intoxication ✔increased heart rate, elevated blood pressure and temperature, decreased respiration. dilated pupils, dry mouth, cardiac arrhythmias, twitching tremors, impaired judgment, confusion, disinhibited behavior, paranoid thoughts, hypervigilance, hallucinations, elation. Symptoms of PCP adverse reactions ✔psychotic reactions, bizarre behavior, outbursts of hostility and violence, severe anxiety, doom or impending death. Adverse Ketamine reacation ✔Completed sensory detachment, explained as a near-death experience, paranoia, boredom and possible coma. Symptoms of cannabinoid intoxication ✔slowed reaction time, altered perceptions, panic, anxiety, nausea, dizziness, depersonalization, paranoid thoughts, trouble expressing thoughts. May cause increases in respiration and heart rate and a slight increase in body temperature. Red eyes, mild dilation, mild tremors, decreased coordination, decreased strength, less ability to perform complex motor tasks and dry mouth. Symptoms of Inhalant intoxication ✔reduction of inhibition and euphoria, dizziness, slurred speech, unsteady gait and drowsiness. Nystagmus may be noted, altered consciousness and enhanced sexual pleasure. Nystagmus ✔the constant involuntary movement of the eyes. Ataxia ✔impaired gait Whether we see drug use as a problem depends on all of the following: ✔Reason one takes a drug Quantity consumed and the manner by which one takes the drug When and where the drug is used The age of the individual taking the drug In reference to psychoactive drug use, it is important to recognize that: ✔History and expectations influence how one is affected by a drug. Type I error ✔alpha error - null hypothesis is rejected as false or unproven when it is actually true. The highest rates of illicit drug use are in what age group? ✔18 to 25 Drug use is positively correlated with? ✔rejection of traditional cultural systems No Wrong Door ✔Treatment is available at every point of someone trying to get help in any stage of substance abuse. The first of the pharmacological revolution was associated with the development of? ✔vaccines The age group that is least likely to have used alcohol in the previous 30 days is? ✔12 to 17 Which of the following is an example of behavioral toxicity? ✔driving inattentively after smoking marijuana An experiment in which rats were allowed to self-inject drugs showed that the rats? ✔were more likely to die form cocaine than heroin Which drug is most clearly linked to violent crime? ✔alcohol Alcohol use is associated with? ✔3/5 of all murders 40% of all assaults 1/3 of forcible rape and child molestation 50% committing violent crime The number of people in the US arrested for drug-law violations each year is? ✔1,000,000 About 1/2 of the emergency room episodes and 3/4 of the drug related deaths are associated with? ✔multiple drug episodes All of the following are types of prevention: ✔primary prevention secondary prevention tertiary prevention All of the following are key elements of the social influence model: ✔training refusal skills countering advertising use of teen leaders Type II errors ✔beta error- null hypothesis is not rejected when it is actually false. Often result of too small of sample size. Tertiary prevention programs are those aimed mainly at? ✔people who have been treated for substance abuse or has stopped the substance abuse without assistance Secondary prevention programs are those aimed mainly at? ✔People who have tried the drug in question or a variety of other substances Naltrexone-synthetic opioid antagonist ✔blocks opioids from binding to receptors reduces craving for alcohol was approved by the FDA in 1994 for the treatment of alcoholism Disulfiram: Trade name Antabuse ✔Tablet by mouth once daily - may be crushed. 250mg or 500 mg. Typically begins about 10 to 30 min after alcohol is ingested. May occur for up to 14 days after last dose. Inhibits the enzyme aldehyde dehydrogenase Alcoholics Anonymous believes that alcoholism ✔Is a disease and the only cure is total abstinence. Some critics say it gives alcoholics an "excuse". ✔inhalation The reduced effect of a drug that may result from more rapid metabolism or excretion of the drug is referred to as? ✔drug disposition tolerance Speedball is generally the combination of? ✔heroin and cocaine In the 1960s, cocaine became popular again because? ✔amphetamines became harder to obtain In South America, a popular way to use cocaine is? ✔coca paste Crack? ✔cocaine mixed with baking soda Cocaine's behavior effects are believed to depend on blocking the reuptake of? ✔dopamine and serotonin A smokeable form of methamphetamine is referred to as? ✔ice The current drug of choice for treating attention-deficit hyperactivity disorder (ADHD) is? ✔methylphenidate(Ritalin) and dextroamphetamine (Dexedrine) - CNS stimulant most commonly abused along with opioids and CNS depressants. The most widely-used sedative-hypnotic drug is? ✔alcohol Nonbarbiturate paraldehyde is not used because? ✔has a noxious taste and odor Drugs used to induce sleep are called ✔hypnotics A popular sedative that was introduced in 1960? ✔Chlordiazepoxide(Librium)- benzodiazepine Meprobramate ✔Anti-anxiety drug became very popular in the 1950's. Miltown, Equanil, Meprin - sedative and tranquilizer used to treat muscle tension and anxiety. Quaalude and Sopor were brand names for ✔methaqualone- Schedule 1 drug Benzodiazepines ✔Combined sales of the make them easily the most widely prescribed drug class. Flumazenil (Romazicon) acts at the receptor and reverses the sedative and overdose effects, but not alcohol or other sedative-hypnotics. The DSM-IV now refers to neurosis as? ✔anxiety disorder Bipolar depression is a mood disorder? ✔characterized by manic-depressive General paresis refers to? ✔a syphilitic infection of the nervous system 1933 to help schizophrenic patients, Sakel used what? ✔insulin Ugo Cerletti introduced electroconvulsive therapy (ECT) to treat? ✔schizophrenia Phenothiazines are now referred to as? ✔Antipsychotics Indivdiuals who use antipsychotic drugs may? ✔exhibit photosensitivity and jaundice More than half of the prescribed antidepressants are prescribed by? ✔non-psychiatrists Lithium was demonstrated to be effective on ✔manic patients About how many homeless people in the US have some form of mental illness? ✔33% "The way to tell whether a man is having drinking problems is to ask..." ✔The BEST answer is "whether he has tried several times without success to reduce his drinking." What is the misconception of dependence potential for all psychoactive drugs? ✔They are all not rated as "high". i.e. alcohol, marijuana, or hallucinogens they are moderate. When 2 or more psychoactive drugs are consumed together, the most serious risk from their "interaction" is? ✔Respiration-Breathing, which can slow down to the point of starving the brain of oxygen. Blood pressure or circulation may also be at risk. BAC and metabolism in a standard drink has ½ ounce of ethanol, and the body eliminates ¼ ounce of ethanol per hour or 10-30 mg(.01-.03) ✔"If you drink faster than one drink every two hours, your BAC will climb." Overall, the dependence risk from alcohol use? ✔It is neither low nor high but moderate. When US deaths are classified and ranked according to the contributions of alcohol and other drugs, TOBACCO causes the most deaths, followed by alcohol, and then all other drugs. ✔Some of the "all other drugs" are cocaine, heroin, and tranquilizers. Alcohol ranks SECOND after WHAT? ✔tobacco and before drugs in annual deaths - after tobacco and other drugs analgesics ✔Drugs used to relieve or eliminate pain acetylsalicylic acid ✔short-term in small doses and on a not-to-frequent basis. It also helps with performing physical activities that require a lot of energy (worse with mental activities) Nicotiana Tobacum ✔The species of tobacco widely cultivated for smoking and chewing products Nicotiana rustica ✔the less desirable species of tobacco, which is not widely grown in the United States Many screening instruments are available to detect the need for a full evaluation of a substance use disorder, including? ✔SSI-SA - Simple Screening Instrument for Substance Abuse AUDIT - Alcohol Use Disorders Identification Test nitrosamines ✔a type of chemical that is carcinogenic; several are found in tobacco leukoplakia ✔a whitening and thickening of the mucous tissue in the mouth considered to be a precancerous tissue change. 85 ✔__% of all lung cancers come from smoking 90 ✔___% of nicotine is absorbed by the body through inhalation liver ✔Nicotine is deactivated by the ______ nicotine poisoning ✔symptoms often experienced by beginning smokers, including dizziness, diarrhea, light-headedness, rapid and erratic pulse, clammy skin, nausea, and vomiting emphysema ✔a chronic lung disease characterized by difficulty breathing and shortness of breath proof ✔a measure of a beverage's alcohol content; twice the alcohol percentage. ie 90 proof whiskey contains 45% alcohol French ✔These people consume more alcohol per capita than any other nation and have the highest rates of alcohol dependence, suicide and deaths from cirrhosis of the liver. Withdrawal scales include? ✔CIWA-Ar - Clinical Institute Withdrawal Assessment for alcohol withdrawal CINA - Clinical Institute Narcotic Assessment for opioid withdrawal. How many of the adult population label themselves as abstainers? ✔1/3 % male drinkers % female drinkers % college students drinking past month ✔60 45 62 Absorption of alcohol occurs where? ✔Mostly the SI and stomach. Food and water slow the process. What is the BAC LD50? ✔.40 or 400 mg/dL How many oz of alcohol can be metabolized an hour? ✔.25 alcohol dehydrogenose ✔enzyme converts alcohol to acetaldehyde(common by-product of breakdown of alcohol) blood alcohol concentration ✔BAC- measured in milligrams (mg) of alcohol per deciliter (dL) of blood. 100 mg/dL = .1 percent Alcohol Myopia ✔a condition that results when alcohol hampers attention, leading people to respond in simple ways to complex situations 40,000 ✔This many fatalities related to alcohol each year. 2 general categories of Crises are? ✔Developmental: One that occurs as a person experiences life, such as entering adolescence, getting married, having a baby, mid-life changes, retirement or the death of a spouse from natural causes in old age. Disturbing Event: accident, divorce, deaths, crime, financial losses, natural disasters or serious injuries. Alcohol related crime ✔1/3 of suicides, 36-70% of homicides Wernicke-Korsakoff syndrome ✔Chronic mental impairments produced by heavy alcohol use over a long period of time. Cirrhosis ✔an irreversible, frequently deadly liver disorder associated with heavy alcohol use. Alcohol is associated with what cancers? ✔Mouth, tongue, pharynx, larynx, esophagus, stomach, liver, lung, pancreas, colon and rectum. Heavy alcohol drinking is associated with? ✔Heart Disease. Moderate drinkers have lower heart disease rates than total abstainers. detoxification ✔an early treatment stage, in which the body eliminates the alcohol or other substance delirium tremens ✔an alcohol withdrawal syndrome that includes hallucinations and tremors. Withdrawal Process ✔a general term for antipsychotic drugs antipsychotics ✔a group of drugs used to treat psychosis; same as neuroleptic monoamine oxidase ✔Antidepressant drug. First used in the 1950s to treat tuberculosis, showed an elevation in mood. Tricyclic/Tetracyclic ✔Cyclic antidepressants - among the earliest antidepressants developed. Effective, but they've generally been replaced by antidepressants that cause fewer side effects. Other antidepressants are prescribed more often, but cyclic antidepressants are still a good option for some people. In certain cases, they relieve depression when other treatments have failed. Selective Reuptake Inhibitors ✔a class of antidepressant drugs that work specifically on increasing availability of the neurotransmitter serotonin by interfering with its reuptake SSRI ✔selective serotonin reuptake inhibitors, a type of antidepressant drugs. electroconvulsive therapy ✔a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient Lithium ✔a drug used to treat mania and bipolar disorder. A mood stabilizer. MAO Inhibitors ✔Behavioral stimulants that reduce depression by inhibiting the action of an enzyme called MAO, which normally breaks down and deactivates norepinephrine and serotonin. psychoactive drugs ✔Chemicals that affect the nervous system and result in altered consciousness hallucinogens ✔Mescaline, LSD, PCP Stimulants ✔Cocaine, Amphetamine, Caffeine-these drugs can reverse the effects of fatigue, maintain wakefulness, decrease appetite, and temporarily elevate the mood of the user Nicotine ✔Addictive drug found in tobacco that speeds the heartbeat, raises blood pressure, and causes dizziness and upset stomach. Cotinine, a metabolite, is slower in African Americans, causing different smoking patterns. Psychotherapeutics ✔Prozac, Haldol are both _______. Medications to treat psychological disorders. Opiates WD symptoms ✔Headaches, cramps, tremors, panic, chills, loss of appetite, irritability, yawning Depressants ✔Alcohol, Barbiturates, other sedatives, sleeping pills, inhalants. Slow CNS activity double blind procedure ✔an experiment in which neither the doctor nor the patient knows which drug is being used dose-response curve ✔a graph comparing the size of response to the amount of drug. Ataxia ✔uncoordinated walking Assessing Nicotine Dependence ✔Fagerstrom Test and Glover-Nilsson Behavioral Questionnaire LD50 ✔lethal dose for half of the animals tested therapeutic index ✔ratio of LD50 to ED50 TI African Americans are at greater risk than other populations for the co-occurrence of? ✔diabetes and hypertension(high blood pressure) predisposing them to risks of stoke. potency ✔measured by the amount of drug required to produce an effect. time course ✔timing of the onset, duration and termination of a drug's effect cumulative effects ✔effects of giving multiple doses of the same drug The stages of a crisis are: ✔Pre-Crisis State - all events leading up to the crisis Impact - the distressing situation or event occurs Crisis - acute emotional reaction to the situation with two elements: - Period of confusion and disorganization - Period when the individual tries many alternatives ("trial and error"), some of which work and some of which do not. Resolution - end of the event and the individual works toward adjustment to the circumstances remaining in the aftermath of the event. Post-Crisis - individual lives with whatever alterations in circumstances that occurred during the crisis Examples of Nicotine WD symptoms that can be confused with other Psychiatric conditions: ✔Anxiety, Depression, Increased REM sleep, Insomnia, Irritability, Restlessness, Weight Gain 5 A's for Tobacco Brief Intervention ✔Ask about use. Advise to quit. Assess willingness to quit. Assist in quitting. Arrange follow-up. drug disposition tolerance ✔tolerance caused by more rapid elimination of the drug behavioral toxicity ✔toxicity resulting from behavioral effects of a drug acute ✔referring to a drug, the short-term effects of a single dose chronic ✔Referring to drugs, the long-term effects from repeated use. Phenomenology ✔Subjective fashion through which people perceive their world. Reliability ✔Consistency of results over time, no intervening events, use correlation or decision consistency to judge. r=same people, same test, different times Opiate OD ✔Slow and shallow breathing, clammy skin, convulsions, coma, possible death due to suppression of breathing Anti-anxiety Medications ✔Benzodiazepines - TCAs, SSRIs, Buspirone Biopsychosocial ✔A theory or perspective that relies on the interaction of biological, individual psychological and social variables. Opiates-HCFMMO ✔Heroin, Codeine, Fentanyl, Methadone, Morphine, Opium Schedule I ✔Highest potential for abuse and no acceptable medical usefulness. i.e Heroin, Marijuana, MDMA (ecstasy) Schedule II ✔High potential for abuse, accepted usefulness, i.e, morphine, Demerol, percodan, cocaine, methanphetamines Schedule III ✔Moderate physical dependence, high psychological dependence; anabolic steroids, most barbiturates, dronabinol Schedule IV ✔Low potential for abuse; May lead to physical/psychological dependence. librium, valium, darvon, tranxene, alprazolam (xanax) barbital, chloral hydrate, fenfluramine, Schedule V ✔Low abuse potential, may lead to limited psychological/physical dependence. Includes some over the counter drugs. such as, cough meds, mixtures with small amounts of codeine or opium. Omnibus Drug Act ✔Stiffened penalties for drug trafficking, specifically on airplanes and boats, allowed government to confiscate. Physiological Dependence ✔Increasing tolerance for a drug, withdrawal signs and symptoms when a drug is discontinued, or the continued use of a substance to avoid withdrawal symptoms. 3 Characteristics of Addiction ✔Compulsive use, Loss of Control, Continued use despite adverse consequences receptors ✔recognition mechanisms that respond to specific chemical signals Neurotransmitters ✔Chemical messengers that traverse the synaptic gaps between neurons. EXAMPLE: sedative-hypnotics(Bz's and Barb's) affect GABA autonomic ✔This nervous system provides involuntary control over smooth muscle, cardiac muscle, and glands. sympathetic ✔part of the autonomic nervous system that controls the "flight or fight" response parasympathetic ✔The part of the autonomic nervous system relating to relaxing activities (in coordination with the sympathetic division) Parkinson's disease ✔Degenerative neurological disease involving damage to dopamine neurons. Dopamine ✔Neurotransmitter that influences voluntary movement, attention, alertness;Found in basal ganglia Nigrostriatal dopamine pathway ✔One of the two major dopamine pathways. The one damaged in Parkinson's disease. Mesolimbic dopamine pathway ✔One of two major dopamine pathways; may be involved in psychotic reactions and in drug dependence. acetylcholine ✔neurotransmitter found in the parasympathetic branch in the CNS. Nicotine mimics by stimulating then blocking the receptor sites. norepinephrine ✔neurotransmitter that may be important for regulating walking and appetite serotonin ✔neurotransmitter found in raphe nuclei; may be important for impulsivity, depression (linked with suicide) glutamate ✔the excitatory neurotransmitter found in most regions of the brain Naltrexone: trade name ReVia ✔opioid antagonist- medication given to heroine dependent users. May be used to treat alcoholism co morbid with schizophrenia. May cause liver-toxicity precursors ✔chemicals that are acted on by enzymes to form neurotransmitters ✔increases self-worth, client becomes more invested in accomplishing Tx goals Psychoactive ✔Effects on thoughts, emotions, or behavior Drug Dependence ✔State in which the individual uses the drug so frequently and consistently that it appears that it would be difficult for the person to get along without using the drug. psychopharmacology ✔the study of the behavioral effects of drugs LSD ✔A powerful hallucinogenic drug; also known as acid (lysergic acid diethylamide). psychadelic ✔'that which manifests the soul' Substances that increase the creativity and perceptions of aspects of one's own mind previously unknown. correlate ✔a variable that is statistically related to some other variale such as drug use longitudinal study ✔a study done over a period of time (months or years) Goal ✔identify and change risk factors for unsafe and unhealthy drug use Dependence ✔use of a substance more often or in greater amounts than user intended and having trouble stopping or reducing its use abuse ✔use of a substance that causes problems - social, legal, occupational, psychological, or physical Signed Consent should include ✔name, name of agency, nature of info, purpose for release of info, specific date, event or condition Alcohol idiosyncratic intoxication ✔maladaptive behavior changes will result from an amount of alcohol use that in the majority of people will not intoxicate Disulfiram: How it works ✔Causes a toxic physical reaction when mixed with alcohol. Pproduces acetaldehyde, co-morbid treatment of alcohol and cocaine addiction, may induce psychiatric symptoms(don't use with psychotic clients) acute versus chronic ✔acute - means sharp or intense - in medicine acute means a condition that comes on suddenly as opposed to a chronic or long-lasting condition. Chronic is long lasting condition. Emphysema Acute induced toxicity ✔immediate 1) behavioral - intoxication from alcohol, marijuana, or other drugs that impair behavior and increase danger to the individual 2) physiological - overdose of heroin or alcohol causing the user to stop breathing Chronic induced toxicity ✔long-term 1) behavioral - personality changes reported to occur in alcoholics and suspected by some to occur in marijuana users (a motivational syndrome) 2) physiological - heart disease, lung cancer, and other effects related to smoking; liver damage resulting from chronic alcohol exposure Drug related emergency room visits ✔1. cocaine 2. alcohol in combination 3. opiods (not heroin) 4. marijuana 5. benzodiazepines 6. heroin 7. stimulants includes methamphetamine 8. PCP 9. MDMA (ecstasy 10. inhalants drug related deaths ✔1. opiods (not heroin) 2. cocaine 3. alcohol in combination 4. benzodiazepenines 5. antidepresssants 6. methadone 7. sedative-hypnotics (non benzodiazepeine 8. heroin 9. stimulants (includes methamphetamine 10. marijuana Tolerance ✔reduced effect of a drug after repeated use American Indians have the greatest rates of? ✔Alcohol and illicit drug use. Fetal Alcohol Syndrome is 33X higher! Women have a six-fold increase in cirrhosis of the liver. Frame 12-step programs in terms of a circle rather than ladder. physical dependence ✔drug dependence defined by the presence of a withdrawal syndrome, implying that the body has become adapted to the drug's presence psychological dependence ✔Addiction. psychological and behavioral dependence; indicated by loss of CONTROL, obsessive-COMPULSIVE high rate of drug use, craving for the drug, CONTINUED in spite of adverse consequences. Tendency to relapse after stopping use. ie Heroine-VH, codine/fentynl/methadone/morphine-mod, opium-high Three basic processes ✔Tolerance physical dependence psychological depnedence Heroin WD ✔intestines moving slowly - diarrhea is one of the most reliable and dramatic symptom Dependence potential of psychoactive drugs ✔very high: heroin (IV) crack cocaine(AA) high: morphine (injected) Opium (smoked) ✔Screening is process for EVALUATING the possible presence of a problem VS Assessment process for DEFINING the nature of the problem. SOAP - Subjective ✔Can be given by: patient, family, EMS Consists of CC, HPI, ROS, PMHx HPI Elements ✔1. Location 5. Timing 2.Quality 6. Context 3.Severity 7. Modifying Factors 4. Duration 8. Associated Signs and Symptoms Objective ✔Obtained only through the Physician 1.PEx 2.MDM 3. DDx Assessment ✔Gather key info from client to enable counselor to understand problems, disabilities, strengths and weakness. Dissociative Amnesia ✔The main symptom is memory loss that's more severe than normal forgetfulness and that can't be explained by a medical condition. Dissociative Identity Disorder ✔Formerly known as multiple personality disorder, is under stress. May feel the presence of one or more other people talking or living inside your head. Dissociative Fugue ✔The main sign is creating physical distance from your real identity. For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location. Depersonalization Disorder ✔Characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie. Size and shape of things, such as your own body or other people and things around you may seem distorted. Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may come and go over many years. Case Study steps ✔1. ID treatment issues (symptom clusters) 2. Find and ID symptoms (9 categories) 9 categories of symptoms ✔1. Emotional Concern 2. Compulsive Actions 3. Impulsive Actions 4. Marked Hyperactivity 5. Learning Problems 6. Neuromuscular Involvement 7. Cognitive and Perceptual Disturbances 8. Physical complaints 9. Sleep Problems Key symptoms words for Impulsive Actions ✔abusive behavior, destructive behaviors, throws things, disturbs others, excessive talking, interrupts often, unpredictable behavior, unresponsiveness to discipline Key symptom words for Marked Hyperactivity ✔constant motion, running instead of walking, inability to sit still Key symptom words for Learning Problems ✔distraction, failure to complete projects, inability to listen or follow directions, short attention span Key symptom words for Neuromuscular Involvement ✔accident-prone, eye muscle disorder, tics AXIS II: PERSONALITY DISORDERS AND MENTAL RETARDATION - difference from AXIS I ✔Symptoms last longer do not generally change much over time are integral to the individual's interaction with the world AXIS II determination ✔Do these patterns tend to cause trouble in intimate relationships, in social relationships and/or in work relationships? What developmental issues are present? • Is development arrested? • Are developmental issues currently presenting difficulty? Are any lifelong maladaptive patterns seen? Two Hallmarks of Axis II ✔Usually it should be early onset (in adolescence into adulthood) • They younger the client is, the more difficult it is to diagnose as personality disorder The personality pattern has to occur under all situations: at home, at work, on vacation, etc. • The client will react to everything using the same personality modality AXIS I: IDENTIFY THE DISORDER ✔What are the symptoms? What is their duration? What is the intensity? Identification of the disorder is determined by symptom clusters of certain intensity and duration. AXIS II: DETERMINE THE PRESENCE OF PERSONALITY DISORDER OR MENTAL RETARDATION ✔Maladaptive patterns must be "embedded in the personality" so the pattern of response is the same whether to family, friends or strangers regardless of setting. The pattern cannot be explained by Substance Abuse or as the consequence of the symptom of another mental disorder. AXIS III: ASSESS THE MEDICAL CONDITION ✔What is the client's current medical condition? How does the medical condition affect psychiatric symptoms? How does the current medical condition affect treatment planning? AXIS IV: CONSIDER THE PRESENCE OF STRESSORS ✔What stressors have been confronted in the past year? Are stressors controllable or uncontrollable? Statements about certain types of stressors are used as hints about the type of disorder. For example: ✔A normal stressor suggests an adjustment disorder Trauma suggests an anxiety disorder Certain types of stressors without clinical symptoms suggest V codes V Codes ✔Axis I factors worthy of attention in treatment, but not part of the disorder. therapy may be needed as well. Unless the condition is disabling, medication is not generally needed; however, it may provide supplementary treatment, particularly with Panic Disorder and OCD What treatment is best for Anxiety clients who present with phobia? ✔*exposure-based treatments (including desensitization) relaxation and social skills training are effective treatment choices. *Antidepressants or benzodiazepines may be needed. Panic Disorder common co-morbid conditions ✔Major Depression, Social and Specific Phobias and Alcoholism. Occurs twice as often in females than in males. Occurs most often with Agoraphobia. Panic Disorder medication ✔SSRIs, tricyclics and benzodiazepines are quite effective. Medication should be used in conjunction with cognitive-behavioral treatment. Medication is used for six months with cognitive-behavioral treatments then the patient is slowly weaned off the medication. However, relapse is high and may require "half dose" maintenance. Mood Disorders: Depressive disorder ✔affective, behavioral or vegetative, cognitive, and social or interpersonal Affective depressive disorders ✔Include anhedonia and dysphoria. Anhedonia is indicated by apathy, boredom, or meaninglessness Dysphoria is marked by feelings of sorrow, dejection, exhaustion, bitterness, or suicidal tendencies. Behavioral or vegetative depressive disorder ✔loss of sleep or appetite, increase or decrease in psycho motor functioning, lack of sex drive, loss of energy, and self-destructive behavior. Cognitive Depressive Disorder ✔feeling of hopelessness or cynicism, lack of ambition, brooding behavior, and a general susceptibility of the cognition process. Social and Interpersonal Depressive Disorder ✔withdrawal, selfishness, passiveness, bad temper, resentment, as well as a lack of healthy relationships and tolerance. Diagnostic cluster of mood disorders ✔Major Depressive Disorder, Dysthymia, Atypical Depression, Bipolar Disorder I & II and Cyclothymic Disorder Mood Disorder treatment ✔Cognitive-behavioral, interpersonal and related interventions. Larger objective of overall adjustment, mood stabilization, alleviation of depression and mania, enhancement of coping skills, improvement in relationships and the prevention of relapse are vital treatment objectives. MAJOR DEPRESSIVE DISORDER ✔Episodes without a history of manic, mixed or hypomanic episodes. Two times more likely in adolescent and adult females than in males. Pre-adolescent period, this disorder affects boys and girls equally. Feel unmotivated, sad, listless and emotionally drained. Behavioral manifestations may vary from profound psychomotor retardation and withdrawal, to agitation and irritability. Depression is called what in the elderly? ✔Pseudodementia because it often "looks like" Dementia (e.g., psychomotor retardation, confusion, memory impairment). What would you use the BDI-II for? ✔to measure the severity of the patient's Depression. Dysthymic Disorder ✔form of Depression that is not as debilitating as Major Depressive Disorder. Sometimes called, Neurotic Depression (or Minor Depression). The result of psychological or social factors that create a depressive reaction as opposed to Major Depression that is endogenous and neurochemically based. Diagnostic criteria include a course that lasts for 2 years or more. Only about 6% of the population will suffer. Predisposition factors for Dysthymic Disorder ✔A major loss in childhood (often an important caretaking person), a recent loss, chronic stress, the presence of a personality disorder with compulsive or dependent features and alcohol or drug abuse. T-ACE (Alcohol screening instrument for pregnant women) ✔T Tolerance: How many drinks does it take to make you feel high? A Have people Annoyed you by criticizing your drinking? C Have you ever felt you ought to Cut down on your drinking? E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? What is the fastest growing at-risk group, for problems of substance abuse? ✔People over the age of sixty. The drugs of choice for this age group are generally alcohol and prescription drugs. about 17% are never diagnosed or identified as substance abusers Substance Dependence specifiers ✔With/Without Psychological Dependence • Remission, specify if: - Early Full - Early Partial - Sustained Full - Sustained Partial • In a Controlled Environment • On Agonist Therapy Substance-Induced Disorders specifiers ✔- With Onset During Intoxication - With Onset During Withdrawal Marijuana Abuse Symptoms ✔Bloodshot eyes: Most likely (especially if the patient's heart is racing), but could suggest Alcohol Abuse Cocaine Abuse Symptoms ✔Paranoia, rapid talking, nose bleeds Alcohol Abuse symptoms ✔Flushed cheeks, slurred speech, difficulty with coordination and balance Remission ✔Treated differently than dependence: Early- symptoms have not been present for a period of two days to one year Sustained - one year has passed. In addition to the length, the intensity must be determined. Full - no symptoms are present after a period of 30 days. Partial -some symptoms return Delirium Tremens (DTs) ✔Vibrant hallucinations, delusions, autonomic hyperactivity and agitation Korsakoff's Syndrome ✔Heroine - high, very high Codiene - high, moderate Fentanyl - high, moderate Methadone - high, moderate Morphine- high, moderate Opium - high, high Opiates - HCFMMO ✔all are narcoticanalgesics Natural- opium, morphine and codeine pure or semisynthetic derivatives - heroin, Percodan, Demerol and methadone How Opiates (HCFMMO) work? ✔Block communication between neural impulses by tying up encephalin-receptors in the central nervous system. An overdose will cause a decrease in pulse, convulsions, coma or even death. Cure for heroin (opiate) addiction? ✔methadone maintenance treatment program Methadone: A synthetic opiate used to obstruct the effects of heroin for twenty- four hours LAAM: (Levomethadyl acetate) A synthetic opiate used to obstruct the effects of opiates for as many as seventy-two hours Naloxone: Used to treat cases of overdose Naltrexone: Used to inhibit morphine, heroin, and other opiate effects Methadone ✔Synthetic opiate used for heroin detoxification and maintenance programs. Extremely addictive, legal and generally considered safer than heroin because it does not produce a "high" state, therefore allowing methadone maintenance users to have a performance superior to heroin users. Gives a longer lasting high when taken orally, which is a preferred, cleaner and safer way to take drugs than by intravenous administration. More extreme withdrawal symptoms than heroin that can last with great intensity for up to ten days. Naltrexone(ReVia):How it Works ✔Long-lasting opioid antagonist(blocker) reduces both the rewarding effects of alcohol and the craving for it. *Help client abstain from drinking. *Reduce heavy drinking in those who drink. Given to heroin-dependent users. can be given three times a week or be administered intravenously only once a month. Particularly effective in helping addicts discontinue the use of drugs when used with methadone and weekly counseling. Allows heroin-dependent people to stop using illegal drugs, to become more emotionally stable and to live more independent lives. Opiate (HCFMMO) Detoxification Withdrawal Symptoms ✔Raised: • Blood pressure, Pulse rate, Temperature Piloerection (also known as gooseflesh) Enlarged pupils Rhinorrhea (where the nose drains excessively) Lacrimation (the secretion of tears especially when abnormal or excessive) Tremor, Insomnia, Vomiting, Nausea, Muscle aches, Stomach cramps, Touchiness, Anorexia, Fatigue, Restlessness, Headaches, Dizziness, Light-headedness Benzodiazepines (Anti-Anxiety Agents) - Depressant ✔The newest class of widely prescribed psychoactive chemicals that relieve anxiety. Most commonly abused BZ (depressant) ✔Diazepam or Valium includes: Valium (diazepam) Halcion (triazolam) Xanax (alprazolam) Ativan (lorazepam) Klonopin (clonazepam) Depressants - ABB physical/physchological dependence ✔Alcohol - high, moderate Barbiturates - high, moderate Benzodiazepines (BZ) - low, mod to high Sedatives, hypnotics and anxiolytics all contain? ✔barbiturates and anti-anxiety medications such as benzodiazepines (commonly used prescription anti-anxiety drugs). These medications all work by increasing neurotransmitter (GABA) activity to inhibit the user's central nervous system. Anxiolytics ✔Anti-anxiety medications. Prescribed to relieve anxiety symptoms (e.g. generalized anxiety or panic, insomnia, petitmal epilepsy or extreme alcohol withdrawal. A less safe class of drug and the one typically used for suicide attempts. ✔barbiturates Barbiturates have been replaced by safer? ✔benzodiazepines Barbiturates are now used for? ✔treat migraine headaches together with analgesics, such as aspirin or codeine. Thiopental (Pentothal, used as a general anesthetic) Amobarbital (Amytal, used for control of agitated patients) Secobarbital (Seconal) Epidemiology ✔the branch of medical science dealing with the transmission and control of disease. The study (or the science of the study) of the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone of public health, and informs policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive medicine. What is the epidemiology of substance related disorders? ✔14% of all Americans will have an alcohol related substance use disorder in their lifetime. 7% (15 million) 12 or older current users of illicit drugs Etiology ✔the cause of a disease .57 correlation coefficient adequate? ✔a statistic representing how closely two variables co-vary The quantity r, called the linear correlation coefficient, measures the strength and the direction of a linear relationship between two variables. -1 to +1 0 is no correlation or no relationship between the two variables r>.8 is strong r<.5 is week What type of client would not benefit from psychoanalysis? ✔Clients suffering from severe depression or such psychotic disorders as schizophrenia, although some analysts have successfully treated patients with psychoses. It is also not appropriate for people with addictions or substance dependency, disorders of aggression or impulse control, or acute crises; some of these people may benefit from psychoanalysis after the crisis has been resolved. Major depressive and anxiety disorders are best classified as substance-induced disorder if they what? ✔Resolve within days to weeks with abstinence. Co-occurrence of anxiety and substance abuse disorders in general population is 5- 20% Most common agents used in anxiety disorders are? ✔benzodiazepines - alprazolam and lorazepam not recommended for long-term use Antidepressants treatment for comorbid depression examples ✔imipramine and nortriptyline and SSRIs(Prozac) - have low addiction potential Rate for co-occurrence of bipolar and addictive disorders range from? ✔30-60% Prioritizing Substances of Abuse ✔Alcohol and sedative-hypnotics have the most serious w/d syndromes(address it first). Oral methadone, LAAM, or buprenorphine should be used to stabilize WD from opioids while tapering the dose of s-h or anxiolytic(anti-anxiety Rx). Rate for co-occurrence of schizophrenic and addictive disorders range from? ✔40-80% When knowledge of BAC is combined with clinical info, the healthcare provider can make what? ✔Some predictions regarding the acuteness of withdrawal. When BAC is 200mg % already showing tremulousness(shakiness of hands), brisk reflexes, tachycardia, diaphoresis (excessive sweating), a CIWA-Ar score in mod or high(15 or higher)? ✔clinician can predict withdrawal will be relatively severe Instrument for Alcohol Dependence and Withdrawal ✔CIWA-Ar 10 items; scores 0-67, 10 or greater is significant Instrument for Cocaine Dependence and Withdrawal ✔CSSA - Coacaine Selective Severity Assessment 18 items;high scores correlate with poor outcome Instrument for Opioids Dependence and Withdrawal ✔SOWS-Subjective Opiate WD Scale-higher score more severe WD OOWS-Objective Opiate WD Scale-0-13 higher score more severe WD Alcohol Intoxication Signs and Symptoms ✔20mg-80mg=.02-.08% loss of muscular coordination, changes in mood, personality alteration. 80mg-200mg=.08-.2% ataxia, slurring 200mg-300mg=.2-.3% nausea, vomiting, sedation 300mg = hypothermia, unconsciousness 400mg = coma 600mg= death Common SSRIs ✔panic disorder, OCD, PTSD and social phobia use Fluoxetine, sertraline, fluvoxamine, paroxetine and citalopram Tricycilcs are useful in treating what people? ✔co-occurring anxiety disorders and depression. Clomipramine Myth:Attributing drug or alcohol use to stress, just prevents adolescents from taking responsibility for their actions. ✔Fact:Defining the relationship between a youth's trauma history and his or her substance use can actually enhance his or her ability to take responsibility for their actions. Effective treatment of youth includes acknowledging the importance of what? ✔gender differences girls internalize experiences - mood and anxiety disorders boys externalize them-disruptive disorders such as conduct and ODD(oppositional defiant disorders) Evidenced-Based Strategies for youth ✔ARC- Attachment, Self-Regulation, Competency. BSFT-Brief Strategic Family Therapy Girls Circle and Boys Council MI-Motivational Interviewing SPARCS-Structured Psychotherapy for Adolescents Responding to Chronic Stress Benzodiazepines (BZs) examples ✔Valium(diazepam) Halcion(triazolam) Xanax (alproazolam) Ativan (lorazepam) Klonopin (clonazepam) Barbiturates ✔Developed in 1868 from barbiturate acid, and currently make up over 2,500 diverse compounds, typically used until the 1970's medically as a sedative hypnotic or an anticonvulsant. Function by interrupting impulses to the reticular activating system. Highly addictive and regular use of them leads to tolerance and severe withdrawal symptoms. Sudden withdrawal can lead to coma. Barbiturate examples ✔Used for Insomnia and Seizures. Thiopental (Pentothal, used as a general anesthetic) Amobarbital (Amytal, used for control of agitated patients) Secobarbital (Seconal) Barbiturate WD effects ✔6-8 hours after use nausea, vomiting, rapid heart rate, extreme sweating, stomach cramps, tremors CNS Depressants ✔Benzodiazepines, in the form of Valium, Librium, Ativan, Serax, Xanax, Tranxene, and Klonopin. Alcohol, in the form of ethyl alcohol Ethanol (beer, liquor and wine) Barbiturates, in the form of Amytal, Nembutal, Phenobarbital, Seconal and Tuinal CNS Depressants examples: ✔Ambien, Chloral Hydrate, Doriden, Meprobamate, Noludar, Paraldehyde, Placidyl and Quaaludes. These substances are administered orally or with water in an injection. CNS Depressant dependence ✔med to high risk of Physical med to high risk of psychological low to medium risk of tolerance CNS Stimulants ✔Simple in use and scoring. Limited training needed for administration. Known level of reliability and availability of cut-off scores. Stimulant Legitimate uses ✔ADHD, Narcolepsy, Weight Loss Adderall, Dexedrine, Ritalin Tardive dyskinesia ✔involuntary movements of the tongue or mouth jerky, purposeless movements of legs, arms, or entire body usually seen w/ long-term tx using traditional antipsychotic medications more often seen in women risk increases w/ age and length of time on the med neuroleptic malignant syndrome ✔blood pressure up and down dazed and confused difficulty breathing, muscle stiffness, rapid heart rate sweating and shakiness, temp above normal diabetes mellitus ✔associated w/ atypical neuroleptics excessive thirst, headaches, frequent urination, fatigue cuts/blemishes heal slowly Other side effects ✔blurred vision, changes in sexual functioning, constipation, diminished enthusiasm, dizziness, drowsiness, dry mouth, lowered blood pressure, muscle rigidity, nasal congestion, restlessness, sensitivity to bright light, slowed heart rate, slurred speech, upset stomach, weight gain Psychoactive ✔The ability of certain medications, drugs, and other substances to cause acute psychomotor effects and a relatively rapid change in mood or thought. Changes in mood include stimulation, sedation, and euphoria. Thought changes include a disordering of thought such as delusions, hallucinations, and illusions. Behavioral changes include an acceleration or retardation of motor activity. All drugs of abuse are by definition psychoactive. reinforcement potential ✔increased likelihood of repeated use, removal of negative sx or conditions or the amplification of positive sx or states. tolerance or withdrawal potential ✔long-term or chronic use of certain meds can cause tolerance to the subjective and therapeutic effects and prompt dosage increases to recreate the desired effects. drugs that produce tolerance and withdrawal generally have higher risks for abuse and addiction nonpsychoactive pharmacotherapy ✔don't cause psychomotor effects or euphoria, may at high doses. azapirones (buspirone), amino acids, beta blockers, antidepressants, monoamine oxidase inhibitors, antipsychotics, lithium, antihistamines, anticonvulsants, and anticholinergic psychoactive pharmacotherapy ✔significant and acute alterations in psychomotor, emotional, and mental actitivity at therapeutic doses. at high doses euphoria. opioids, stimulants, benzodiazepines, barbiturates, and sedative-hypnotics anxiety ✔benzodiazepines (valium, librium, xanax) buspirone (buspar) panic attack ✔alprzolam (xanax) monopolar disorder (depression) ✔tricyclic antidepressants, MAO inhibitors, serotonin reuptake inhibitors, trazodone, bupropion (tofranil, elavil, nardil, parnate, prozac, luvox, paxil, celexa, lexapro, desyrel, wellbutrin) bipolar disorder for treating depression ✔lithium, carbamazepine, lamotrigine, fluoxetine, ilmipramine, tranylcypromine (eskalith, carbolith, cibalith-S, lithonate, lithotabs, epitol, tegreto, lamictal, prozac, janimine, tofranil, parnate) biploar disorder for treating mania ✔carbamazepine, valporic acid, olanzapine, risperidone, haloperidol (haldol, epitol, tegretol, dpaken, valproate, valrelease, zyprexa, risperdal) Psychosis (schizophrenia) ✔short-acting: phenothiazines, butyrophenones, clozapine, trifluoperazine, pimozide, flupenthixol, cholorpromazine (thorazie, haldol, cloziril, stelazine, orap, fluanxol, largactil) long-acting: flupenthixol, fluphenazine decanoate, pipotiazine, haloperidol decanoate (fluanxol, modecate, piportil L4, haldol LA) Cocaine ✔Paranoia, insomnia and irritability, compulsive use and loss control problems with headaches, coughing and nosebleeds indicates chronic _______ abuse Narcotics ✔Complaints of extreme constipation and poor appetite Drugs derived from opium that are capable of relieving pain (also called opiates) Kill pain; depress the central nervous system; induce sleep Withdrawal and isolation ✔Best characterizes the changes that occur in an alcohol or drug abuser's relationship with family , friends, and society as a result of the substance abuse. Synergistic Effects ✔When alcohol and barbiturates are taken together Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone. For example 1 + 1 is greater than 2 Tolerance ✔Increased ________ describes a heavy barbiturate user who has steadily increased usage over many over many months realizing that it takes a lot of alcohol to get a "buzz" Hallucinogens ✔_________ is not associated with physical withdrawal, A diverse group of drugs that have powerful effects on mental and emotional functioning, marked most prominently by distortions in sensory and perceptual experience. Physical Withdrawal ✔Narcotics and synthetic narcotics, barbiturates, minor tranquilizers are associated with Inpatient Medical Unit ✔An _______________ is appropriate for treating an alcoholic who has experienced seizures Alcoholism ✔A chronic, progressive, potentially fatal illness characterized by tolerance and loss of control over beverage alcohol is Detoxification ✔The metabolic process that changes alcohol to the compound acetaldehyde is known as Oxidation ✔The metabolic process that leads to the formation of water and carbon dioxide by the process of chemically heating acetic acid is Intoxication ✔When alcohol is consumed faster than it is being oxidized, the result is Means disturbance of mental or physical capacity resulting from introduction of any substance into the body. cirrhosis of the liver ✔Long-term effect of alcohol consumption that is one of the top ten causes of death in America is A chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells Oral ✔The most common manner of drug administration is Hypothalamus ✔The part of the brain that controls heart rate, hunger, body weight, and arterial blood pressure is A small area of the brain that regulates emotional behaviors and motives. Norepinephrine ✔The neurotransmitter associated with arousal and mood is A neurotransmitter associated with eating and alertness. Too little has been associated with depression and too much has been associated with schizophrenia. Neurons ✔The functional and structural unit of the nervous system are Cells in nervous system that communicate to perform info-processing tasks Autonomic Nervous System ✔Motor nervous system that controls glands, cardiac, and smooth muscle.--also called visceral motor system The subdivisions that act in an antagonistic manner are called sympathetic and parasympathetic divisions Potentiating ✔Two drugs have different actions, but when taken together, one enhances the effects of the other If an antiulcer medicine tends to increase blood alcohol levels and thus makes drinkers more intoxicated, this type of drug interaction would be best describes as Antagonistic ✔If one drug, such as a barbiturate, tends to reduce the effectiveness of an oral contraceptive, the drug interaction would be most accurately described as Works against one another Overt racism and hostility ✔The style of counseling in which a counselor acts out the deep-seated prejudices that he/she has toward a minority group Multicultural ✔Growing up with more than one cultural orientation Accepting, recognizing, and enjoying the differences among groups Traditional Interpersonal Style ✔A member of a minority group is neither accepting nor rejecting of his/her cultural identify Culturally Immersed Interpersonal Style ✔A member of a minority group has rejected white values and culture Culturally Liberated Counselor ✔A style of counseling in which a counselor does not fear racial or cultural differences and is aware of his/her attitudes, making efforts to be actively involved professionally and personally in the solutions to racial problems Bicultural Interpersonal Style ✔A member of a minority group has pride in his/her racial identity, its history and cultural traditions and yet is comfortable in operating in the white world Acculturated Interpersonal Style ✔A member of a minority group has made a conscious or subconscious decision to reject the general attitudes, behaviors, customs, rituals, and stereotypic behaviors associated with his/her own minority group to assimilate into the mainstream white culture Cultural Ignorance ✔A style of counseling in which a counselor has little or no prior exposure to a minority culture and whose fear causes him/her to be ineffective in working with a minority client Covert (Hidden) Prejudice ✔A style of counseling in which a counselor is aware of his/her fears and dislikes for a minority culture but hides those fears beneath the surface of the counseling posture Joan Jackson ✔Therapist who first began to focus efforts of treatment toward the family of the chemically dependent individual in 1954 Wrote "Alcoholism and the Family" Hippocrates ✔Classified all mental disorders into the categories: mania, melancholia, phrentis "Father of Medicine" all disorders are caused by natural factors; four humors; body has ability to heal self; treat the whole patient HIV/AIDS ✔In 1985, the issue was targeted as a top priority for training and assistance to drug abuse treatment professionals It is a Virus that destroys the immune system that should protect the body from diseases. The disease is passed from person to person through sexual acts, blood transfusions, used hypodermic needles, or from mother to child during birth. treatment plan ✔The initial ______________ should be based on assessment of the needs as revealed during the intake Consist of goals and objectives based upon the assessment needs of the ct burn-out ✔Several experts believe that it occurs in stages. The first stage is enthusiasm It is a state of physical, emotional, intellectual, and spiritual exhaustion Norepinephrine ✔Motor areas which control movements and voluntary skeletal muscles. Deals with higher intellectual processing, planning, and problem solving. 3 Classifications of Narcotics ✔Naturally occurring (opium, morphine, codeine) Semi-synthetics (Heroin, Hydromorphone) Synthetics (Methadone, Darvon) Advantages of Group Counseling ✔Sense of safety in numbers intense learning Expectation to be concerned about others Cost efficient Rational Recovery ✔Abstinence based Addictive Voice Recognition technique Recovery is simple No groups Morphine ✔Main alkaloid ingredient in opium with a purity of 4 to 21 percent. Occipital Lobe ✔Vision 3 Types of Sedative/Hypnotics ✔Barbiturates Minor Tranquilizers Other Sed/Hypnotics Threshold Dose ✔The smallest amount of a given drug which is capable of producing some detectable response Pons ✔Rounded bulge on the underside of the brain stem that connects medulla to mid- brain Enabler ✔Is assumed to be the person who is emotionally closest to the alcoholic, usually the spouse. Protects the alcoholic by making excuses, taking over responsibilities, rescuing the alcoholic from consequences. Temporal Lobes ✔Sensory areas responsible for hearing, visual memories, and language comprehension Duty to Warn ✔The legal obligation of a counselor to notify the appropriate authorities or victim when there is a serious danger Biopsychosocial Model ✔Multicausal model dealing with biology (disease/genetics), psychological, cultural norms/life events. Cerebellum ✔Reflex center responsible for coordinating muscle movements. Median effective dose ✔Dose required to produce a specific effect in 50 percent of test subjects Semi-synthetic Compounds ✔Hydromorphone (Dilaudid) or Oxycodone. Alcohol Effect Asians ✔Asians usually do not have enzyme acetaldehyde to break down etoh and will flush, sweat, and feel ill. Alcoholism rate is low for Asians. Women and Alcohol ✔Women show "telescoping" response to alcohol and have often more severe consequences. Faster progression into dependency. Alcohol Assessment Tools ✔Addiction Severity Index (ASI) and Alcohol Use Disorders Identification test (AUDIT) Serotonin ✔Neurotransmitter associated with regulation of sensory perception, sleep, and body temperature. Neurons ✔Brain cells. Contain dendrites, nucleus, axon terminals. Codeine ✔Alkaloid found in opium, though most is morphine. Used as antitussive. Ground for breaching confidentiality ✔Harm to self or others child abuse elder abuse Installation of hope ✔Person must feel there is hope to solve problems Universality ✔The person must feel he or she has a problem common to others Imparting information ✔An informed person is better able to cope and think through new problems Altruism ✔Caring about others decreases unhealthy self-absorption Corrective recapitulation ✔Group helps abet family of origin issues and demonstrates healthier ways to behave Development of socializing techniques ✔Person learns how to interact with people Imitative behavior ✔The leaders and senior group members act as role models of healthy behavior for newer members Interpersonal Learning ✔Members receive feedback on how their behavior affects others Group Cohesiveness ✔Ability for the brain to repair, replace, and retrain it's neural circuitry. SOS ✔Secular Organization for Sobriety. Alternative recovery method for those alcoholics uncomfortable with spiritual content of 12 step programs. Additive Effect ✔When two or more drugs are present in the body that have similar effects, the impact of adding one drug to the others doubles the efforts of the drugs. Supportive Groups for Families ✔Al-anon Alateen ACOA Nar-Anon Harrison Act ✔Taxation act of 1914 that taxed opium and coca products Dopamine ✔Neuotransmitter linked to pleasure, reward, and motivation. Thalamus ✔Determines sensations as painful vs pleasurable. Sensory and motor signal relay that regulates consciousness and sleep. 42 CFR ✔The regulations directing the implementation of confidentiality of alcohol and drug abuse patients The Hero ✔Usually the oldest child. Provides self-worth to the family. Knows something is wrong and feels obligated to fix the problem through achievement. Controlled Substance Act ✔1970's Act that classified drugs according to medical use, potential for abuse, and possibility of dependence The Scapegoat ✔Usually the second child. Since the hero has the positive attention, the second child seeks what is left: negative attention. the child's role is to take attention away from the alcoholic by accepting blame for the family's troubles. Transference ✔The unconscious redirection of emotions from one person to another Independent effect ✔The effect of individual drug is not changed when combined with another drug. Neither drug affects the other. Elements of a Treatment Plan ✔identify problems List goals and objectives Resources to be applied person responsible for actions Time frame Expected benefits Alcoholism ✔A primary, chronic disease with genetic, psychosocial, and environmental factors influencing it's development and manifestations. the disease is often progressive and fatal. It is characterized by impaired control, preoccupation, use despite consequences, and distortions in thinking. Acetylcholine ✔An excitatory neurotransmitter released by axons. Glycine ✔Inhibitory neurotransmitter found in the spinal cord. Cognitive therapy ✔Founded by Aaron Beck. Uses open-ended questions and Socratic dialogue. Pure Food and Drug Act ✔Passed in 1906, the act attempted to control addictions by requiring companies to label the drugs contained in their products (morphine, heroin, cociane) 3 stages of Alcohol and Drug Counseling ✔Medical (physical intervention) Psychosocial rehabilitation Aftercare Minnesota Model ✔A state hospital in Minnesota that used the 12 steps in the treatment setting. Typical length of stay was 60 days. Level of care happened all within the same system. Synergistic effect ✔Combination of two or more drugs that produce an exaggerated effect. Goes above and beyond what might be expected of adding one drug to another. Systems Theory ✔View of behavior as an interactive part of a larger social structure. SMART Recovery ✔Started in 1992. Recovery program that looks as addiction as behavioral. 4 Point program: Enhance motivation to abstain Coping with Cravings Solving problems through management of thoughts, feeling and behaviors Developing and maintaining lifestyle balance Types of alcohol ✔Ethyl Methyl Isopropyl Butyl Denatured alcohol Reliability ✔The degree to which a measure in consistent 5 principles of MI ✔Express empathy through reflective listening Develop discrepancy between values and behavior Avoid argument and direct confrontation Adjust to client resistance rather than opposing it directly Mascot ✔Usually the third or middle child. Senses that something is wrong in the family but gets reassurance from other members that nothing is wrong. This causes anxiety and continual conflict for the child. ✔Describing and introducing the nature and goals of the program to the client Core function of case management ✔Activities intended to bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals. Core function of referral ✔The identification of client's needs that cannot be met by the counselor or agency and assisting the client to use the support systems and community resources available Core function of consultation ✔Relating with counselors and other professionals in regard to client treatment to ensure comprehensive quality of care for client Four focuses of Clinical Supervision ✔Administrative Evaluative Clinical Supportive The four roles of a Clinical Supervisor ✔Teacher Coach mentor Consultant Primary reasons for clinical supervision ✔Quality of client care Clinical staff continue development in a systematic and planned manner Clinical supervision: competency based models ✔Focus primarily on the learning needs of the supervisee and setting goals that are Specific, Measurable, Attainable, Realistic, and Timely (SMART) Clinical supervision: treatment based models ✔Train to particular theoretical approach to counseling, incorporating evidence- based practices. Clinical supervision: developmental models ✔Understands that each counselor goes through stages of development and recognizes that these stages are not always linear. Clinical supervision: Integrated models ✔Including the Blended Model, begin with the style of leadership and articulate a model of treatment, incorporate descriptive dimensions of supervision, and address developmental and contextual dimensions in supervision. Highlights of clinical supervision ✔Supervisory relationship must be supportive and culturally competent, provide direct oversight, and prioritize skill development and counselor wellness Supervision is a formal process that is provided frequently and employs direct observation techniques Supervision is expected to result in improved staff retention, counselor skills, and client outcomes. Managed Care ✔An approach to delivery of health and mental health services that seeks to reduce the cost of care by monitoring the access to and use of medical services and supplies,as well as outcomes of that care. Validity ✔the degree to which an instrument or process measures what it is designed to measure. DSM V: 11 Criteria for Substance Use Disorder ✔1 Taking the substance in larger amounts or for longer than the you meant to 2 Wanting to cut down or stop using the substance but not managing to 3 Spending a lot of time getting, using, or recovering from use of the substance 4 Cravings and urges to use the substance 5 Not managing to do what you should at work, home or school, because of substance use 6 Continuing to use, even when it causes problems in relationships 7 Giving up important social, occupational or recreational activities because of substance use 8 Using substances again and again, even when it puts the you in danger 9 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 10 Needing more of the substance to get the effect you want (tolerance) 11 Development of withdrawal symptoms, which can be relieved by taking more of the substance. DSM V: Substance Use Disorder (specifiers) ✔Two or three symptoms indicate Mild. Four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder. POSIT ✔Problem Oriented Screening Instrument for Teenagers. 139 question self- administered questionnaire for treatment needs. Target population 12-19 y.o. Beck Depression Inventory II ✔BDI-II is 21 items to assess the intensity of depression. GAIN ✔Global Appraisal of Individual Needs . An integrated biopsychosocial model of treatment assessment. LOCUS ✔The Level of Care Utilization System is a tool used to assess the immediate services needs for a client. Attending ✔Demonstration of counselors concern and interest in the client by eye contact, body posture, and accurate verbal following. Paraphrasing ✔A counselor statement that mirrors the client's statement in exact or similar wording Reflection of Feeling ✔The essence of the client's feelings, either stated or implied, as expressed by the counselor Summarizing ✔A brief review of the main points discussed in the session to insure continuity in a focused direction Probing ✔A counselor's response that directs the clients attention inward to help both parties examine the client's situation in greater depth Interpreting ✔Presenting the client with alternative ways of looking at his/her situation ✔Coordinate services for client care. Explain the rationale of case management to the client. Global Criteria: Counseling ✔Select the counseling theory (ies) that is/are more appropriate. Apply techniques to help the client, family, or group explore problems and their effects. Apply techniques to help the client, family, or group examine behaviors, attitudes, and feelings. Individualize counseling based on cultural, gender, age, and lifestyle differences. Elicit solutions and decisions from the client. Implement the treatment plan. Global Criteria: Treatment Planning ✔Explain assessment results to the client in an understandable manner. Identify and prioritize problems based on client's needs. Formulate immediate and long-term goals using behavioral terms Identify the treatment methods and resources to be used as appropriate for each client. Global Criteria: Assessment ✔Gather information from the client regarding history of alcohol and other drug abuse. Use appropriate interviewing techniques. Obtain and corroborate information from significant collateral sources in regards to client's alcohol and drug abuse and psychosocial history, through the use of appropriate methods and procedures. Identify appropriate assessment tools. Explain assessment rationale to client. Develop a diagnostic evaluation of the client's substance abuse and co-occurring disorders based on the results of all assessments. The goal is to provide an integrated approach to treatment based on client's strengths, weaknesses, problems and needs. Global Criteria: Orientation ✔Provide an overview to the program, describing the program goals and objectives for client care. Provide the client with a description of the program rules, and client's obligations and rights. Provide information about the program hours of operation. Global Criteria: Intake ✔Complete require documents for admissions into the program. Obtain signed consents in order to protect client's confidentiality and rights. Global Criteria: Screening ✔Evaluate psychological, social, and physiological signs and symptoms of alcohol and other drug use and abuse. Determine the client's eligibility and appropriateness for admission or referral. Identify any co-occurring conditions, such as medical, psychiatric, physical, etc. This will indicate the need for additional assessment and services. Abide by applicable laws, regulations, and agency policies governing alcohol and other drug abuse services. The Mode ✔The value which occurs most frequently The Median ✔The median is the middle value of a set of data containing an odd number of values, or the average of the two middle values of a set of data with an even number of values The Median ✔Obtained by dividing the sum of observed values by the number of observations Standard Deviation ✔Gives an idea of how close the entire set of data is to the average value. Variable ✔A construct that has two levels or categories a therefore can vary. Independent Variable ✔The construct that is manipulated or controlled in some way i.e. sex, race, treatment group, etc. Dependent Variable ✔The outcome variable that is influenced. Research question ✔A question that identifies what the study hope to examine. Hypothesis ✔The testable, concise statement involving the expected relationship between two or more variables. Null-hypothesis ✔Is a statement that there is no relationship between IV and DV. Type I error ✔Occurs when a decision is made to reject a null hypothesis Type II error ✔Occurs when a decision is made to retain the null hypothesis that should have been rejected because the null hypothesis was indeed false. Probability Sampling ✔Sampling a known population Non-probability Sampling ✔Accessing samples of convenience Simple Random Sample ✔Every member of the population has an equal chance of being selected Systematic Sampling ✔Every nth element is chosen. Cluster Sampling ✔The researcher identifies existing subgroups and not individual participants Convenience Sampling ✔Most common sampling method. Selecting an easily accessible population that most likely dose not fully represent the population of interest. Purposeful Sampling ✔Selecting a sample from a population on who will be the most informative about a topic of interest. Random Selection ✔Selecting participants from a population so that every member as an equal chance of being chosen Random Assignment Factorial Analysis ✔Used when investigating more than one independent variable Chi Square ✔Nonparametric test used when the population is not necessarily normal. Positive Correlation ✔When X goes up and Y goes up Negative correlation ✔When X goes up and Y goes down Four types of Client Resistance ✔Arguing, interrupting, denying, ignoring 1. Screening ✔The process by which the client is determined appropriate and eligible for admission to a particular program. Screening - Global Criteria ✔1. Evaluate psychological, social, and physiological signs and symptoms of alcohol and other drug use and abuse. 2. Determine the client's appropriateness for admission or referral. 3. Determine the client's eligibility for admission or referral. 4. Identify any coexisting conditions (medical, psychiatric, physical, etc.) that indicate need for additional professional assessment and/or services 5. Adhere to applicable laws, regulations and agency policies governing alcohol and other abuse services. 2. Intake ✔The administrative and initial assessment procedures for admission to a program. Intake - Global Criteria ✔6. Complete required documents for admission to the program. 7. Complete required documents for program eligibility and appropriateness. 8. Obtain appropriately signed consents when soliciting from or providing information to outside sources to protect client confidentiality and rights. 3. Orientation ✔Describing to the client the following: general nature and goals of the program; rules governing client conduct and infractions that can lead to disciplinary action or discharge from the program; in a nonresidential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights. Orientation - Global Criteria ✔9. Provide an overview to the client by describing program goals and objectives for client care. 10. Provide an overview to the client by describing program rules, and client obligations and rights. 11. Provide an overview to the client of program operations. 4. Assessment ✔The procedures by which a counselor/program identifies and evaluates an individual's strengths, weaknesses, problems, and needs for the development of a treatment plan. Assessment - Global Criteria ✔12. Gather relevant history from the client including but not limited to alcohol and other drug abuse using appropriate interview techniques. 13. Identify methods and procedures for obtaining corroborative information from significant secondary sources regarding clients' alcohol and other drug abuse and psycho-social history. 14. Identify appropriate assessment tools. 15. Explain to the client the rationale for the use of assessment techniques in order to facilitate understanding. 16. Develop a diagnostic evaluation of the client's substance abuse and any coexisting conditions based on the results of all assessments in order to provide an integrated approach to treatment planning based on the client's strengths, weaknesses, and identified problems and needs. 5. Treatment Planning ✔The process by which the counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long-term goals; and decide upon a treatment process and the resources to be utilized. Treatment Planning - Global Criteria ✔17. Explain assessment results to the client in an understandable manner. 18. Identify and rank problems based on individual client needs in the written treatment plan. 19. Formulate agreed upon immediate and long-term goals using behavioral terms in the written treatment plan. 20. Identify the treatment methods and resources to be utilized as appropriate for the individual client. 6. Counseling ✔The utilization of special skills to assist individuals, families, significant others, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision-making. Counseling - Global Criteria ✔21. Select the counseling theories that apply. 22. Apply techniques to assist the client, group, and/or family in exploring problems and ramifications. 23. Apply techniques to assist the client, group, and/or family in examining the client's behavior, attitudes, and/or feelings if appropriate in the treatment setting. 24. Individualize counseling in accordance with cultural, gender, and lifestyle differences. 25. Interact with he client in an appropriate therapeutic manner. 26. Elicit solutions and decisions from the client. 27. Implement the treatment plan. 7. Case Management ✔Activities which bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts. Case Management - Global Criteria ✔28. Coordinate services for client care. 29. Explain the rationale of case management activities to the client. 8. Crisis Intervention ✔Those services which respond to an alcohol and/or other drug abuser's needs during acute emotional and/or physical distress. Crisis Intervention - Global Criteria ✔30. Recognize the elements of the client crisis. 31. Implement an immediate course of action appropriate to the crisis. 32. Enhance overall treatment by utilizing crisis events. 9. Client Education ✔Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources. Client Education - Global Criteria