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 use (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) Statistics 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 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 Treatment Averting relapse Including detoxification Group or individual counseling Rehabilitation Methadone or other pharmaceutical treatment Accommodations 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. http://www.jan.wvu.edu/links/ 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. http://www.aa.org/ 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. http://www.na.org/ 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. http://www.moderation.org/ 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. http://www.12-step-recovery.net/12-step-recovery.htm 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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