behaviors with drug use (Boland & Verduin, 2022). Conditioned responses (similar to Pavlovian phenomena), such as cravings and withdrawal, promote relapsing behaviors (Boland & Verduin, Implicit bias and stigma in substance use disorders The language used by clinicians, such as addicts , can stigmatize individuals with substance use disorders reflecting misconceptions that these behaviors are choices rather than compulsions (NIDA, 2022). Negative biases can dehumanize individuals and affect the therapeutic alliance, and, ultimately, the course of recovery (NIDA, 2022). Clinicians who stereotype drug use as a criminal activity marginalize disadvantaged groups
2022). Individuals aged 18-24 years have a high prevalence rate for every substance disorder.
and negatively influence treatment plans, which may increase drug use (NIDA, 2022.) Stigma and implicit biases impact fear of disclosing substance use, decreased quality of care, or reduced access to care (NIDA, 2022). To this end, the word addiction has been eliminated from the DSM-5® (Diagnostic and Statistical Manual of Mental Disorders , 5th ed.) in favor of the more neutral term substance use disorder (APA, 2013). Healthcare Considerations: Every member of our community may help to lessen stigma and prejudice against those who suffer from drug use disorders by: ● Understanding substance use disorders are chronic, treatable medical conditions. ● Changing stigmatizing language with more empowering, preferred language that does not equate people with their condition or have negative connotations. ● Addressing systemic racism, sexism, and other forms of discrimination leads to multiple layers of stigma for many people with addiction. (NIDA, 2022) Risk factors for substance use disorders Adult risk factors for substance use disorders include the following:
• Ability to afford drugs. • Avoidant coping style. • Bereavement. • Caucasian ethnicity, • Chronic pain.
• Poor health status. • Significant drug burden/polypharmacy. • Unexpected or forced retirement. • Social isolation (living alone or with nonspousal others). • History of alcohol problems. • Previous or concurrent substance use disorder. • Previous or concurrent psychiatric illness. (Kuerbis, 2020)
• Chronic physical illness/comorbidity. • Physical disabilities or reduced mobility. • Transitions in care/living situations.
Evaluating Substance Use Disorder (Abbreviated)
Instrument
Purpose
Interpretation
Addiction Severity Index
• Assessment tool. • The clinician administers the semi- structured interview. • Screening tool. • Clinician/self-administered. • Evaluates the quantity and frequency of drinking. • Screening tool. • Clinician/self-administered. • Identifies the presence of problematic drinking. • Assessment tool. • Clinician administered. • *Gold standard for alcohol withdrawal assessment. • 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.
• 200 items, normed national data.
Alcohol Use Disorders Identification Test (AUDIT) Alcohol Use Disorder Identification Test- Consumption (AUDIT-C)
• 10 items.
Cage Questionnaire
4 items: • positive score ≥ 2.
Clinic Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar)*
10 items: • <10, mild withdrawal. • 10-18, moderate withdrawal. • >18 severe withdrawal.
Clinical Opiate Withdrawal Scale (COWS)
• 5-12 mild withdrawal. • 13-24 moderate withdrawal. • 25-36 moderately severe withdrawal. • >36 severe withdrawal. • 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.
Screening, brief intervention, and referral to treatment (SBIRT)
Note . Paxos & Teter, 2019; SAMSHA, 2022.
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