Introduction
In this article, we will explore the 5 Ps framework to understand and address SUD, including disorder outline, diagnostic standards, assessment tools, suitable referrals, evidence-based therapies, drugs, resources, and a student-written treatment plan. Substance abuse disorders (SUDs) are an increasing problem for the public, defined as problematic patterns of substance use leading to significant clinical consequences or distress.
Description of the Disorder and DSM-5 Diagnostic Criteria
Alcohol, opioids, stimulants, and other drugs, among others, are all included in the category of substance use disorders (SUD), which covers a wide range of associated illnesses (Raphael et al). The Diagnostic and Behavioral Manual of Mental Disorders, Fifth Edition, or DSM-5, states that one of the SUD diagnostic criteria is a pattern of substance use that is problematic and causes considerable impairment. The following standards are taken into account:
Impaired Control
They are, firstly, taking the drug in greater doses or for longer than advised. Secondly, unsuccessful efforts to reduce or regulate substance usage. It is, lastly, taking an excessive amount of time to get, use, or recuperate from the drug.
Social Impairment
Major role responsibilities at work, school, or home are not fulfilled, and continuing drug usage in spite of interpersonal or social issues.
Risky Use
Use of drugs in potentially dangerous circumstances and usage despite being aware of health or mental issues that the substance may cause or make worse.
Pharmacological Criteria
Firstly, tolerance is the inability to obtain the intended effects with the same amount of a substance or the failure to do so with reduced results. And lastly, experiencing withdrawal symptoms or utilizing drugs to treat or prevent them is referred to as withdrawal.
Lack of Behavioral Control
Firstly, unsuccessful attempts to cut back on or stop using substances. In addition, acquiring, utilizing, or abusing the material for an extended period. Moreover, lastly, there is a strong desire or craving to use the drug.
An individual must demonstrate at least two of these signs during a year to be diagnosed with SUD, with the severity being classified as mild (two to three signs), moderate (four to five signs), or severe (six or more signs).
Screening or Assessment Tool
The CAGE questionnaire is one popular screening instrument for determining SUD. There are four questions in the CAGE tool: Firstly, have you ever felt the need to reduce your alcohol or drug use? Secondly, have you ever been irritated by someone criticizing your use of alcohol or drugs? In addition, have you ever felt bad about using drugs or alcohol? Moreover, have you ever needed a morning “eye-opener” of alcohol or drugs to calm your nerves or get rid of a hangover? If you answer “yes” to two or more of these inquiries, it may indicate a possible SUD and call for additional testing.
Appropriate Referrals and Levels of Care
The individual’s evaluation and the level of severity of their condition determine the degree of care and the relevant referrals for treating SUD. Referrals and levels of care that could be made include:
Medical Referral
The patient should be referred to a medical expert for an immediate assessment if they experience significant symptoms of withdrawal or medical issues caused by consumption of drugs (Mebrahtu et al., 2023).
Psychiatric Referral
SUD frequently co-occurs with mental health issues. Referral to a psychiatrist for evaluation and potential medication is necessary when psychiatric symptoms are prevalent.
Appropriate Level of Care
Firstly, residential treatment is for people with severe SUD who need care and support around the clock (Hart et al., 2020). In addition, a hospital stay in an inpatient setting is required in cases of extreme withdrawal, health issues, or acute mental health symptoms. Furthermore, people who need intense care but are able to return home at night should consider partial hospitalization or day treatment. Additionally, individuals who require structured therapy but can still maintain everyday activities can consider intense outpatient therapy. Lastly, treatment in the outpatient setting is suitable for people with moderate SUD or those moving from higher levels of care.
Evidence-Based Intervention
Cognitive-behavioral therapy (CBT) is a treatment for SUD that has been supported by research. CBT assists people in recognizing and changing unhealthy cognitive processes and drug-related behaviors (Ayers et al., 2019). It imparts coping mechanisms and methods for handling urges, triggers, and hazardous circumstances. CBT has been proven to be beneficial in lowering the use of drugs and recurrence in numerous trials.
Common Medications and Concerns/Contraindications
The main purposes of SUD medications are to facilitate detoxification and lessen cravings. Some typical drugs include (Harris et al., 2023): Firstly, Methadone; hence, It is used for the treatment of opioid addiction and relieves cravings and withdrawal symptoms. The possibility of abuse and overdose are two issues. In addition, it reduces the psychotropic properties of opioids and lessens alcohol cravings with Naltrexone. Liver issues and opiate use within the previous 7–10 days are among the concerns.
Furthermore, acamprosate, which lessens symptoms of withdrawal, aids in maintaining alcohol sobriety. Possible side effects, including diarrhea, are an issue. Lastly, Bupropion is an anti-smoking drug that reduces the urge to smoke. An individual’s previous experience with convulsions is a contraindication.
Resources
There are a number of resources accessible for people with SUD and their families. Firstly, Comprehensive information, research, and treatment alternatives are provided by the National Institute on Drug Abuse (NIDA) (Jensen et al.,2021). In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a list of rehab facilities, crisis hotlines, and services that refer patients to treatment. Moreover, Support groups for people in recovery include Narcotics Anonymous (NA) and Alcoholics Anonymous (AA). Lastly, a rooted-in-science substitute for conventional 12-step programs is SMART Recovery.
Student-Written Treatment Plan
Patient Information
Person: John Doe, Male: 32 years old, with a diagnosis of severe alcohol use disorder
Goals
Firstly, attain and keep alcohol sobriety. In addition, it creates coping mechanisms to deal with urges and risky situations. Lastly, deal with accompanying signs of depression.
Interventions
Firstly, to treat faulty mental habits and triggers associated with alcohol use, employ cognitive behavioral treatment (CBT) (Holton et al.,2023). Furthermore, John’s drive to change will be strengthened through motivational interviewing. Additionally, Using Naltrexone as part of medication-assisted therapy can help with alcohol cravings—moreover, weekly sessions of individual treatment. Lastly, a psychiatrist is referred for examination of depressed symptoms.
Level of Care
John will start with a rigorous outpatient treatment plan. Inpatient hospitalization could be an option if the patient displays severe signs of withdrawal.
Follow-up
first three months of weekly treatment sessions, then the next three months of biweekly meetings. Track drug compliance and make necessary treatment adjustments. Promote participation in peer support organizations (such as SMART Recovery or AA).
Conclusion
Because substance use disorder is a complicated condition, assessment, intervention, and subsequent treatment must be approached holistically. By using the 5 Ps paradigm, we can better comprehend the disease, offer interventions backed by evidence, and make sure that people with SUD get the care and support they require to accomplish a sustained recovery.
References
Raphael, M. School District to Fulfill Special Education Needs of the High School Students Diagnosed with Juvenile Bipolar Disorder.
Ayers, J. W., Nobles, A. L., & Dredze, M. (2019). Media trends for the substance abuse and mental health services administration 800-662-HELP addiction treatment referral services after a celebrity overdose. JAMA internal medicine, 179(3), 441–442.
Mebrahtu, T. F., Santorelli, G., Yang, T. C., Wright, J., Tate, J., & McEachan, R. R. (2023). The effects of exposure to NO2, PM2. 5 and PM10 on health service attendances with respiratory illnesses: A time-series analysis. Environmental Pollution, p. 333, 122123.
Hart, J. L., Turnbull, A. E., Oppenheim, I. M., & Courtright, K. R. (2020). Family-centered care during the COVID-19 era—journal of pain and symptom management, 60(2), e93-e97.
Harris, L. J., Carbone, J. R., & Rebouché, R. (2023). Family law. Aspen Publishing.
Holton, V. (2023). A Woman’s Will: The Changing Lives of British Women, Told Through the Things They Have Left Behind. Amberley Publishing Limited.
Jensen, A. N. (2021). “A Time so Full of Possibilities”: Examining the First World War Diary of Alethea Winifred Seymour Norris (Doctoral dissertation, University of South Alabama).
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