Evaluating Substance Use Disorder (Abbreviated)
Instrument
Purpose
Interpretation
Clinical Opiate Withdrawal Scale (COWS)
• 5-12 mild withdrawal. • 13-24 moderate withdrawal. • 25-36 moderately severe withdrawal. • >36 severe withdrawal.
• Assessment tool. • Clinician administered. • Used to follow the course of opiate withdrawal and effectiveness of medication regimen-no standard cutoff. • Comprehensive, integrated public health approach to early intervention and treatment for persons with or at risk for substance use disorders.
Screening, brief intervention, and referral to treatment (SBIRT)
• Universal screening. • 5-10 minutes. • Scored low to severe risk. • Achieved at moderate risk; brief intervention implemented. • For use in alcohol, tobacco with growing evidence of illicit drug use.
Note . Paxos & Teter, 2019; SAMSHA, 2022.
SUBSTANCE USE INTOXICATION
Intoxication often begins in the teens and is the first substance-related experience. Withdrawal is usually, but not always, associated with substance use disorders but can occur at any age. Short-acting substances have a higher potential for withdrawal than longer-acting substances. The substance's half-life parallels withdrawal (APA, 2013). ● Continued substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance. ● Tolerance: ○ A need for markedly increased amounts of the substance to achieve intoxication or desired effect. ○ A markedly diminished effect with continued use of the same amount of the substance. ● Withdrawal: ○ The characteristic substance withdrawal syndrome. ○ The substance is taken to relieve or avoid the withdrawal symptoms. (Levin et al., 2014) Individuals who demonstrate a chronic loss of control or compulsive use of substances and a wide range of adverse risks (mental, physical, and social well-being) meet the criteria for substance-related disorders (Boland & Verduin, 2022). Standardized screening is important to determine the stage of substance use, consequences, and functional impairment (Paxos & Teter, 2019).
Substance intoxication is associated with and without substance use disorders. The most common changes with intoxication include disturbances in wakefulness, attention, thinking, judgment, psychomotor, and interpersonal behaviors (APA, 2013). Specific routes of administration produce rapid absorption into the bloodstream, escalating intoxication effects and likelihood of patterns of use. Diagnosing substance use disorders Substance use disorders occur from mild to severe, based on symptomology and fluctuation of the disease process (APA, 2013). Individuals demonstrate a problematic pattern of substance use that leads to significant impairment as manifested by two or more criteria over 12 months for substance use disorder: ● Substance taken in more significant amounts over a more extended period than was intended. ● Persistent desire or unsuccessful efforts to cut down or control the use of the substance. ● A great deal of time spent in activities to obtain the substance. ● Craving or strong desire to use the substance. ● Recurrent substance use failing to fulfill significant role obligations at work, school, or home. ● Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. ● Important social, occupational, or recreational activities are given up or reduced because of substance use. ● Recurrent substance use in situations in which it is physically hazardous. Alcohol addiction is a chronic relapsing disorder associated with compulsive drinking (NIAAA, 2021). Alcohol use is a common disorder defined by a cluster of behavioral and physical symptoms and can include withdrawal, tolerance, and craving (APA, 2013). Approximately 69.5% of ages 18 and older reported drinking alcohol in the past year, with 59.4% in the last month (NIAAA, 2022). Alcohol is a potent drug that causes physiological changes in almost every body system. The severity of the disorder is based on the number of diagnostic criteria in a given individual, along with changes in the severity of alcohol use across time, reflected by reductions in the frequency of alcohol consumed (APA, 2013). Alcohol use disorder has a variable course characterized by remissions and relapses (APA, 2013). Alcohol use disorder is associated with increased
ALCOHOL USE DISORDER
risks of accidents, violence, and suicide (APA, 2013). Severe alcohol use is associated with comorbid conditions such as depression or other disinhibitions of feelings which contributes to suicide attempts as well as completed suicides (APA, 2013). Other disorders associated with alcohol use disorders include psychosis, bipolar disorders, anxiety disorders, sleep disorders, and neurocognitive disorders (Levin et al., 2013). Addiction cycle in alcohol use disorder Alcohol consumption is linked to health and social consequences interfering in personal relationships, heart and liver disease, cancer, motor vehicle collisions, and violence (NIAAA, 2021). The powerful effects on the brain account for euphoria and pleasurable feelings, increasing the motivation to use substances despite the risk of
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