Substance Abuse by HC121104103025


									                                           Substance Abuse
DSM-IV TR Criteria
Criteria for Substance Dependence
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as
manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:
   (a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect
   (b) markedly diminished effect with continued use of the same amount of the substance
(2) withdrawal, as manifested by either of the following:
   (a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets
for withdrawal from the specific substances)
   (b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
(3) the substance is often taken in larger amounts or over a longer period than was intended
(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use
(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple
doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects
(6) important social, occupational, or recreational activities are given up or reduced because of substance
(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current
cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition
that an ulcer was made worse by alcohol consumption)

Criteria for Substance Abuse
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as
manifested by one (or more) of the following, occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
(e.g., repeated absences or poor work performance related to substance use; substance-related absences,
suspensions, or expulsions from school; neglect of children or household)
(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or
operating a machine when impaired by substance use)
(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused
or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of
intoxication, physical fights)


      About 10.1 million persons age 12 to 20 years reported current alcohol use
      In 1997, it was reported about 7.6% of full-time employed workforce drink heavily and 7.7% uses
       illegal drugs
      The estimated annual number of new marijuana users has declined from 2.6 million in 1996 to
         about 2.0 million in 1999
        Youths aged 12 to17 have constituted about two-thirds of the new users of marijuana in recent
         years, with young adults aged 18 to 25 constituting most of the remaining third
        The average age of cocaine users was 19.5 years in 1999
        There were an estimated 104,000 new users of heroin in 1999
        In 2001, an estimated 3.1 million persons age 12 or older received some kind of treatment for a
         problem related to the use of alcohol or illicit drugs

Definition of Addiction

Drug addiction is uncontrollable, compulsive drug seeking and use, even in the face of negative health and
social consequences.


Causes associated with a typical case of substance abuse:

        Monotonous tasks
        Frustration
        Poor promotion prospects
        Low self – esteem
        Social isolation
        Personality and family problem
        Availability of drugs or alcohol
        Indifferent health
        Social and peer pressure
        Worries about his/her public image
        Fear to meet the cost of everyday living conditions
        Lack of external support services
        Genetic disposition

Signs and Symptoms

                  -ups or outbreaks of temper

   Wearing of sunglasses at inappropriate times
                             -sleeved garments particularly in hot weather or reluctance to wear short
sleeved attire when appropriate

                                  from friends, co-workers or parents
Risk Factors for each Type of Substance Abuse

Short-term effects of using marijuana:

      Sleepiness
      Difficulty keeping track of time, impaired or reduced short-term memory
      Reduced ability to perform tasks requiring concentration and coordination, such as driving a car
      Increased heart rate
      Potential cardiac dangers for those with preexisting heart disease
      Bloodshot eyes
      Dry mouth and throat
      Decreased social inhibitions
      Paranoia, hallucinations

Long-term effects of using marijuana:

      Enhanced cancer risk
      Decrease in testosterone levels for men; also lower sperm counts and difficulty having children
      Increase in testosterone levels for women; also increased risk of infertility
      Diminished or extinguished sexual pleasure
      Psychological dependence requiring more of the drug to get the same effect

Short-term effects of alcohol use include:

      Distorted vision, hearing, and coordination
      Altered perceptions and emotions
      Impaired judgment
      Bad breath; hangovers

Long-term effects of heavy alcohol use include:

      Loss of appetite
      Vitamin deficiencies
      Stomach ailments
      Skin problems
      Sexual impotence
      Liver damage
      Heart and central nervous system damage
      Memory loss

The effects of methamphetamine use include:

      Increased heart rate and blood pressure
      Increased wakefulness; insomnia
      Increased physical activity
      Decreased appetite
      Respiratory problems
      Extreme anorexia
      Hyperthermia, convulsions, and cardiovascular problems, which can lead to death
      Euphoria
      Irritability, confusion, tremors
      Anxiety, paranoia, or violent behavior
      Causes irreversible damage to blood vessels in the brain, producing strokes

Physical risks associated with using any amount of cocaine and crack:

      Increases in blood pressure, heart rate, breathing rate, and body temperature
      Heart attacks, strokes, and respiratory failure
      Hepatitis or AIDS through shared needles
      Brain seizures
      Reduction of the body's ability to resist and combat infection

Psychological risks associated with cocaine and crack:

      Violent, erratic, or paranoid behavior
      Hallucinations and "coke bugs"--a sensation of imaginary insects crawling over the skin
      Confusion, anxiety and depression, loss of interest in food or sex
      "cocaine psychosis"--losing touch with reality, loss of interest in friends, family, sports, hobbies,
       and other activities

Physical risks associated with using hallucinogens:

      Increased heart rate and blood pressure
      Sleeplessness and tremors
      Lack of muscular coordination
      Sparse, mangled, and incoherent speech
      Decreased awareness of touch and pain that can result in self-inflicted injuries
      Convulsions
      Coma; heart and lung failure

Psychological risks associated with using hallucinogens:

      A sense of distance and estrangement
      Depression, anxiety, and paranoia
      Violent behavior
      Confusion, suspicion, and loss of control
      Flashbacks
      Behavior similar to schizophrenic psychosis
      Catatonic syndrome whereby the user becomes mute, lethargic, disoriented, and makes meaningless
       repetitive movements
Using inhalants even one time can put you at risk for:

      Sudden death
      Suffocation
      Visual hallucinations and severe mood swings
      Numbness and tingling of the hands and feet

Prolonged use of inhalants can result in:

      Headache, muscle weakness, abdominal pain
      Decrease or loss of sense of smell
      Nausea and nosebleeds
      Hepatitis
      Violent behavior
      Irregular heartbeat
      Liver, lung, and kidney impairment
      Irreversible brain damage
      Nervous system damage
      Dangerous chemical imbalances in the body
      Involuntary passing of urine and feces


      Averting relapse
      Including detoxification
      Group or individual counseling
      Rehabilitation
      Methadone or other pharmaceutical treatment

Attendance Issues:
Allow use of paid or unpaid leave for medical treatment
Allow use of paid or unpaid leave or flexible scheduling for counseling
Provide a self-paced workload or the ability to modify daily schedule

Maintaining Concentration:
Reduce distractions in the workplace
Provide space enclosures or a private office
Plan for uninterrupted work time
Allow for frequent breaks
Divide large assignments into smaller tasks and steps
Restructure job to include only essential functions

Difficulty Staying Organized and Meeting Deadlines:
Provide clerical support
Make a daily to-do list
Use electronic organizers
Maintain a current calendar
Remind employee of important dates
Schedule weekly meeting with supervisor to determine goals and address employee's questions, concerns,
and work progress
Write clear expectations of employee's responsibilities and the consequences of not meeting them
Establish written long term and short term goals

Difficulty Handling Stress:
Provide praise and positive reinforcement
Refer to counseling and employee assistance programs
Allow for the ability to modify daily schedule
Allow for frequent breaks
Do not mandate job-related social functions where there would be exposure to alcohol

Maintaining Stamina during the Workday:
Allow flexible scheduling
Allow for longer or more frequent work breaks
Encourage the employee to use company sponsored health programs

Recommended Readings

      Job Accommodations Network (JAN) -

       The Job Accommodation Network (JAN) is a free consulting service that provides information
       about job accommodations, the Americans with Disabilities Act (ADA), and the employability of
       people with disabilities.

      Alcoholics Anonymous -

       Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and
       hope with each other that they may solve their common problem and help others to recover from
       alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or
       fees for AA membership; we are self-supporting through our own contributions. AA is not allied
       with any sect, denomination, politics, organization or institution; does not wish to engage in any
       controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and
       help other alcoholics to achieve sobriety.

      Narcotics Anonymous -

       Narcotics Anonymous is an international, community-based association of recovering drug addicts
    with more than 31,000 weekly meetings in over 100 countries worldwide.

   Moderation Management -

    Moderation Management (MM) is a behavioral change program and national support group
    network for people concerned about their drinking and who desire to make positive lifestyle
    changes. MM empowers individuals to accept personal responsibility for choosing and maintaining
    their own path, whether moderation or abstinence. MM promotes early self-recognition of risky
    drinking behavior, when moderate drinking is a more easily achievable goal.

   12 Step Program -

    The 12 step recovery method is a guide to healing the persons in an addictive family of the guilt and
    depression, anger and hurt, fears and irrational thinking. These occur as a result of being in a reality
    whereas someone is dying from addiction and, perhaps for a very long time, no one knows about it.

   Research Article - Drebing, C.E., Fleitas, R., Moore, A., Krebs, C. Van Omer, A., Penk, W., & et
    al. (2002). Patterns in work functioning and vocational rehabilitation associated with coexisting
    psychiatric and substance use disorders. Rehabilitation Counseling Bulletin, 46 (1), 5-13.

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