Substance AbuseDr. Elena Klaw

Psyc. 190

Goals for Today Assessing alcohol use: CAGE Transition Workbook for Combat

Veterans (Naval Combat Research Center)• Facts• Signs to look out for: stress & addiction• What to do

Practice Motivational Interviewing (MI)

Assessment: CAGE (Ewing, 1984)http://counsellingresource.com/

1. Have you ever felt you should cut down on your drinking?

2. Have people annoyed you by criticising your drinking?

3. Have you ever felt bad or guilty about your drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

General Definitions Problem drinking: alcohol use that causes

functional impairment, and/or interferes with your responsibilities, your life & relationships – it causes problems!• Thought of as a bad habit

Addiction: characterized by increasing tolerance and withdrawal symptoms, long term heavy alcohol use will cause the shakes (DT), memory loss, and liver damage• Thought of a disease (AA: alcoholism) or disorder

(DSM: dependence)

Substance Abuse & Homelessness

Study of over 29,000 vets enteringHousing & Urban Development Veterans Affairs Supported Housing (HUD-VASH) 60% had a substance use disorder (SUD) 54% of those: both drug and alcohol

disorder SUDs linked to more extensive

homelessness SUDs clients benefitted equally from

housing but needed further support for SUDs

Public Health GuidelinesU.S. Dept. Health & Human

ServiceNIAAA

Women should keep regular drinking to 1 drink or fewer (12 oz. beer, 5 oz. wine, 1.5 oz. 80 proof alcohol); for men 2 or fewer drinks

Women should not exceed 3 drinks on any day, or a total of 7 per week

Men should limit to 4 drinks per day and 14 per week

Do not drink if you are responsible for work,

care or safety of others. DOD standard is never drive after any

drinking.

Discuss What are Signs of Stress?

Discuss What are signs of addiction?

Signs of Stress Diffuse pain: muscle aches,

headaches Upset stomach Fatigue Change in eating Drastic change in weight Irritability/short temper Sleeping all the time or insomnia Lack of follow through, poor work

quality Anhedonia

Signs of Possible Addiction Frequent lateness or absence Excuse Blaming others Mood swings Changes in relationships Falling asleep at work Avoiding others Careless risk taking Financial problems Deteriorating self care Evidence of use at work

What You Can Do Confront gently “I have noticed… Is

everything OK?” Do not judge or diagnose, state what

you have noticed Refer to relevant medical and

counseling resources; include mutual help and recovery groups: • AA: www.alcoholics-anonymous.org,• MM: www. Moderation.org• SMART: http://www.smartrec-sv.org/

Partner Activity: Motivational Interviewing (MI)

Think of a habit you each want to change.

Ask your partner:• What are the risks of changing?• What are the benefits of changing?

Restate this for your partner. Then ask:• What is your goal?• What are your triggers (antecedent situations for

the behavior)?• What will you do instead?

Sum up the goal and the plan together.

Conclusions Change is hard. We need to own a goal and have

motivation to change (“buy in”). Need to think about relapse

prevention. Targeted social support is essential

and may involve a biopsychosocial model.