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Shifter factsheet on symptoms, NNEs, LBs, and Shift Conceptualization. Includes Common Comorbidities, Best Practices on Pharmaceutical Interventions, Referral Guidelines, and Additional Therapeutic Interventions. Symptoms are taken from the DSM-V.
Alcohol Use Disorder
Symptoms
Alcohol use disorder is a problematic pattern of alcohol use which leads to clinically significant distress or impairment with 2 of the following symptoms occurring within 12 months:
- Alcohol is taken in larger amounts over a longer period of time than intended
- A persistent desire or unsuccessful efforts to cut down or control alcohol consumption
- A great deal of time is spent on activities intended to obtain, use, or recover from alcohol use
- Craving alcohol
- Recurrent alcohol use with resulting failure to meet obligations at home/work/school
- Important social, recreational or vocational opportunities are given up or reduced due to alcohol use
- Recurrent alcohol use when it is physically hazardous
- Alcohol use is continued despite awareness that a persistent or recurrent physiological or psychological problem is caused or exacerbated by alcohol consumption
- Tolerance as defined by either of the following
- A need to increase the amount of alcohol to achieve the desired effect
- A markedly diminished effect with continued use of the same amount of alcohol
- Withdrawal symptoms occur within several hours of cessation or reduction of persistent alcohol consumption:
- Autonomic hyperactivity (sweating or pulse greater than 100 bpm)
- Increased hand tremor
- Insomnia
- Nausea or vomiting
- Transient visual, tactile or auditory hallucinations or illusions
- Psychomotor agitation
- Anxiety
- Generalized tonic-clonic seizures
- These symptoms cause significant distress or impairment and are not attributed to another medical condition
- Alcohol (or closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms
Opioid-Related Disorder
Symptoms
As alcohol use disorder, with the following difference:
- Withdrawal: 3 or more of the following within minutes to several days on reduction or cessation of heavy use
- Dysphoric mood
- Nausea or vomiting
- Muscle aches
- Lacrimation or rhinorrhea
- Pupillary dilation, piloerection, or sweating
- Diarrhea
- Yawning
- Fever
- Insomnia
- Opioids or related substances are taken to relieve or avoid withdrawal symptoms
Stimulant Use Disorder
Symptoms
Use of amphetamine-type substance, cocaine, or other stimulant leading to significant distress or impairment. Symptoms are the same as alcohol and opioid use disorders with the following difference:
- Withdrawal: cessation or reduction of substance use followed by dysphoric mood and 2 or more of the following within several hours to several days
- Fatigue
- Vivid, unpleasant dreams
- Insomnia or hypersomnia
- Increased appetite
- Psychomotor agitation or retardation
- The stimulant, or related substance, is taken to avoid or relieve withdrawal symptoms.
Common NNEs
- Familial history of substance use – even abstinence
- Substance use disorders have a strong genetic disposition
- Active parental abuse of substances
- Lack of parental involvement or interest in the child’s life
- Poor rule-setting and follow-through
- Poverty
Associated LBs
- I am not good enough
- I am a failure
- I am nothing/worthless/insignificant
- I am unworthy
- I am not in control
- I am unwanted/unimportant/a nobody
- I am not whole/flawed
- There is something wrong with me
- I am unlovable/cannot be loved
- I am a loser
- I am unattractive
Shift Conceptualizeation
The abuse of mood/affect altering substances can be considered opt-outs, in and of themselves. They provide escape – either by dulling the senses, bringing a feeling of peace or by the hyperarousal of stimulants, which is often accompanied by delusions of increased capabilities. Stimulants also decrease depressive symptoms.
After the addiction is in place, so to speak, triggers become irrelevant – as the person’s cravings are now driving the behaviour.
Additional Items to Investigate
Be sure to ask about…
- Family history of substance abuse – in recovery or active
- Has the client ever received treatment – self or other referred? What was the outcome?
- When did they start, what is the substance of choice, how much
- When was the last time they used
- Do they want to stop; why?
- Body issues
- Academic or work pressure
- History of depression and suicidal ideation/ attempts
Common Best Practice Pharmaceutical Interventions
If applicable, and to assist with client advocacy.
- Detox and withdrawal should be done with medical supervision; alcohol detox can be lethal
- Antabuse is not used that often – it causes an unpleasant physical reaction to the consumption of alcohol. Users will simply not take it.
- Naltrexone may reduce the urge to use
- Acamprosate may combat alcohol cravings after cessation
- Vivitrol is a version of naltrexone and is injected 1x monthly by a health care professional. It can be in pill form, but the injection is more efficacious.
- Prozac for stimulants
- Clonidine
- Methadone
- Suboxone
Common Comorbidities
- Anxiety
- Depression
- Schizophrenia
- Bipolar affective disorder
- Ptsd
- Acquired brain injury
- Personality disorders (e.g., Borderline, Antisocial)
Referral Required or Recommended
If a client is actively detoxing, they should be referred for medical assistance. Depending on the situation, the ER may be necessary.
Additionally Beneficial Therapeutic Interventions
- Residential recovery programs
- Support groups, such as AA, NA
- Although these are popular programs, they do not report outcome data and their efficacy has not been evaluated.
- Outpatient treatment programs
- psychotherapy/counselling
Additional Notes
Addictions come with a broad range of medical, social and personal sequelae. They can destroy family and work life. The client should not be under the influence when they come in for treatment. The clinician may be required to secure a taxi/Uber or family member to pick them up from the office. Â