Substance Abuse Assessment and Treatment, Exams of Nursing

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ADC Exam questions and answers rated A genetic risk - up to 50%; higher in heroin (40-60% overall) cocaine neurotransmitters - primary buildup of dopamine (also serotonin and norepinephrine); people deficient in serotonin are at risk nootropics - drugs designed to boost cognitive performance ex: Adderall, Provigil (sleep disorders), amphetamine cocaine abuse - 1. experimental use 2. compulsive use 3. dysfunctional use -arterial constriction & hardening leads to cardiac arrest/stroke anabolic steroids - -engage both opioid and dopamine neurotransmission systems -just as addictive as caffeine, nicotine, and benzos -withdrawal appears like cocaine (insomnia, headaches, restlessness, poor libido, dysphoria) screening & assessment - screening: looking to determine if a problem exists ADC Exam questions and answers rated A assessment: more thorough for targeted matters of concern suicide rates - IV users: 14x higher general population: 10x higher lowest for African American women & highest for American Indian and Alaskan Native males Substance Abuse Subtle Screening Inventory (SASSI) - 67 clinical obvious & subtle items to detect truth when individuals are unwilling or unable to acknowledge problem; <15 mins to complete Michigan Alcohol Screening Test (MAST) - alcohol screening tests available but no tools for truth Screening, Brief Intervention, and Referral to Treatment (SBIRT) - quick & simple tool to ID substances for at-risk levels for those already experiencing substance use issues; no tools for truth Addiction Severity Index (ASI) - tool for assessment & tx planning (NOT screening) ADC Exam questions and answers rated A co-occurring treatment severity - none- moderate/severity: IOP (i.e. anxiety/mood dx) severe: dual-diagnosis (psychotic/personality disorders) Composite International Diagnostic Interview (CIDI) - covers both DSM and ICD criteria for SA disorders; addresses consequences and onset of symptoms; primarily used for epidemiology MINI scale - screens for major psych disorders based on DSM and ICD criteria; reliable dx in brief time frame PRISM instrument - Psychiatric Research Interview for Substance Abuse and Mental Disorders; differentiates antisocial and borderline personality dx from SA; 1-3 hours/training required AASE Scale - Alcohol Abstinence Self-Efficacy Scale; to ax level of client's confidence in being able to abstain from alcohol in 20 situations that include common drinking cues; no training req'd ADC Exam questions and answers rated A ASRPT - Alcohol-Specific Role Play Test (ASRPT) uses role-playing scripts to evaluate client situations in taped responses by acting out; 20 mins/requires training SCQ - Situational Confidence Questionnaire: 29 self-report items that explores self-efficacy in alcohol-related scenarios CBT - not effective in group counseling Motivational interviewing (MI) - counselor is coach/consultant, asking key questions for learning. nonjudgmental, collaborative style Motivational enhancement therapy (MET) - incorporates structured assessments and follow-up sessions as adaptation to MI Matrix Model of treatment - relapse prevention, family education, and early recovery skills groups (NOT stress management); very effective also neurobehav. tx Osher & Kofoed co-occurring treatment - four stages: ADC Exam questions and answers rated A 1. engagement 2. persuasion 3. active treatment 4. relapse prevention symptom presentation - most influential for counselor; alcohol use among adults 25+ - lower in rural areas women have higher rate of alcohol use in rural areas Clinical/Rehabilitation model - integrate clinical therapy + resource activities service coordination - case management and advocacy are subsets defined as action framework by which a client is enabled to achieve goals in ID treatment plan Qualified Service Organization Agreement (QSOA) - used when outside person/agency provided services directly to treatment #1 client changer - ability to be empathetic ADC Exam questions and answers rated A convergence theory - SA rates among men & women are becoming more equal (1.6 men : 1 women) alcohol use in elderly - #3 psych disorder; 1/2 - 1/4 suicide attempts involve alcohol; have better attendance rates and lower rates of relapse alcohol use onset - 2/3 start in adolescence & young adulthood rates of receiving help - 7.1 % will receive tx for co-occurring dx 32.9% only mental health tx 25% SA + MH? screening process - can be affected by setting, instructions, and privacy GATE - ax for suicide assessment information - goals, objectives, action steps w/ reliable, clinical and valid info ADC Exam questions and answers rated A stages of change - 1. precontemplation 2. contemplation 3. preparation 4. action 5. maintenance 6. relapse treatment planning principles - Measureable Attainable Time-limited (short-term) Realistic Specific ASI - most widely used; has teen and shortened versions DIG FAST - full evaluation of mania discharge with continuing care - SA requires long-term tx (not referred to "after care" or f/u) ADC Exam questions and answers rated A naltrexone - can be effective for alcohol tx suboxone + naloxone - can be used for opioid dependence ASAM levels of care - .5 early intervention I: outpatient: <9 hours weekly II: IOP/partial hosp: 9+ hours weekly (2 subcategories) -minimum 90 days III: residential/inpatient (3 subcategories) IV: medically managed inpatient *enter lowest level possible four sequential stages of tx - 1. tx engagement 2. early recovery 3. maintenance 4. community support ADC Exam questions and answers rated A contingency management (CM) - operant conditioning; more long-term support SAMSHA categories for mental health & SA - 1. MH less severe, SA less severe: PCP setting 2. MH more severe, SA less severe: MH setting 3. MH less severe, SA more severe: SA setting 4. MH & SA severe: hospital/inpatient setting relapse & remitting model - can be applied to other issues as they return cyclically over time bookend - discuss trigger events before/after they occur group members - Hispanics/Latinos can be adverse to rules, women may contend with need for help, want to nurse and invest emotionally positive effects of treatment - begin to emerge around 3 months common recovery stages - 1. early: 1 mo - 1 year 2. middle: 1 yr + ADC Exam questions and answers rated A 3. late: maintaining group stages - 1. forming 2. storming 3. norming 4. performing 5. adjourning youth substance abuse programs - 1. universal: @ risk/potential 2. selective: @ risk 3. indicated: address relevant issues when SA use is part of their lives party to records - clients are RARELY involved tx/recovery plans - 1. SA problems listed 2. short term/LT objectives 3. action plans for short term 4. client progress toward goals 5. updates to discharge summary as ongoing ADC Exam questions and answers rated A 42 CFR - -oral consent not permitted, emergency, other agencies, mandated reports of child abuse, qualified researchers, crime on site/staff, court order/subpoena, qualified court hearing work environment - break cycle of abuse