1. Alcohol and Other
Drugs:
The Problem, The Science &
Patient Assessment

2. Presented by:
Julie Dostal, PhD
Executive Director
of
LEAF, Inc.

3. Why Have This Discussion?
∗ Alcohol use is the 2nd Leading Preventable
Cause of all Mortality in the U.S.
(Cigarettes are 1st)
∗ Harmful alcohol use, other addictive
behaviors, and ineffective policy are THE
leading public health issues.
∗ Addiction is a chronic, relapsing disease
that, until now, has been treated outside
the medical field.

4. The J-Curve of Alcohol Use:
Risk for All Causes of Mortality
3
0 1-2

5. So, How Many People are in the
Risky Drinking Categories
79% of
Americans are
either abstainers
or low-risk
drinkers

6. Definitions of Risky Drinking:
∗ HEAVY DRINKING:
 >14 drinks per week for men (or >4 drinks per
occasion)
 >7 drinks per week for women (or >3 drinks per
occasion)
∗ HAZARDOUS DRINKING :
 a quantity or pattern of alcohol consumption that places
individuals at risk for adverse health events
∗ HARMFUL DRINKING :
 alcohol consumption that results in physical or
psychological harm

7. The Alcohol Consequence Pyramid

8. Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons
by Age

9. Past Month Use of Illicit Drugs Shows Significant
Increase in “Baby Boomer” Adults
(Nearly Doubled in Every Subset)

10. Past Month Illicit Drug use Among 18 to 25
Year Olds; Fairly Stagnant

11. What “Causes” Substance
Abuse?
∗ Scientists find no direct cause and effect
for substance abuse or dependence.
∗ HOWEVER, we do know some things
about “why.”
• Dependence is a biopsychosocial disease.
• Abuse often has biopsychosocial roots.

12. BIOpsychosocial
Making Decisions….
Human beings make decisions for these
reasons -
• They work for us or they make sense to
us
OR
• They make us FEEL good
Thus…. We have a reward pathway.

13. Neurotransmitter
Decisions/Judgment
– Dopamine
(Endorphin =
Endogenous + Triggers dopamine release
Morphine)
Responds to stimuli
Human brain
development
is complete at Amygdala
about the age
of 25.

14. Although not directly within the reward path, the
Amygdala is the emotional command post. It is
key in both creating and remembering
emotions/feelings.
Think about
what you feel
when you hear
a song that was
popular during
an emotional
time in your life.
That is the
same emotional
mechanism as
a craving.

15. Why do we even need a
reward pathway?
To reward us for activities
consistent with our survival and
that of our species! (what are they?)
∗ Consuming Food
∗ Drinking Water
∗ Procreation
∗ Child Nurturing/Rearing

16. Dopamine Receptors are
Lower in Addicts
Cocaine
DA D2 Receptor Availability
Alcohol
Heroin control addicted

19. Reward Pathway Gone Astray
∗ I like it
∗ I want it
• Neuroadaptation Occurs
(weight lifting)
∗ I NEED IT!!
 The craving become a survival strategy

20. Addiction is a Chronic, Relapsing
Disease
Addicted individuals are often set up for failure
because we tend to treat them with an acute model
rather than a chronic model of care.

21. Assessment: The T-ACE
∗ T - Tolerance: How many drinks does it take to
make you feel high? (threshold – more than 2)
∗ A - Have people annoyed you by criticizing your
drinking?
∗ C - Have you ever felt you ought to cut down on
your drinking?
∗ E - Eye-opener: Have you ever had a drink first
thing in the morning to steady your nerves or get rid
of a hangover? (shows dependence)
∗ Two positive answers is considered a positive screening.

22. What to do with a Positive
Assessment
∗ Find common ground. Does the patient
see a problem that needs changing?
∗ Remember that sometimes the answer or
solution that the patient wants is not what
we might think is best.
∗ Explore other difficult things a person has
conquered or accomplished as examples
of success!
∗ Offer resources.

23. Thank
You!!