¶ Introduction to AUD and DSM Criteria
Hi , there you lightworkers . I'm Dr Linton Hutchinson , and with me today is Eric Twatman .
Hi you pillars of society . Today , the disorder of the day is AUD or alcohol use disorder , and we're going to include what you're going to look for in the DSM how it progresses , where it comes from and what the best treatments are Lucky for you .
you inherited an allergy to alcohol .
Yes , well , at least mom said she broke out whenever she took a sip , but I think I noticed a few sips happening regardless .
Right , and every time that you take a sip , I know you break out in handcuffs .
Well , yes , that's a good reason to quit . That last bender was . You know they had to write it up in the paper .
Okay , so Ez , what do we need to know about AUD ?
Well , it's a substance-related disorder in the DSM which you know if you think about . It makes sense , and it's diagnosed when someone's relationship with alcohol starts resembling a toxic waste dump , draining their quality of life as they refuse to quit drinking .
Hmm , so are there other disorders in the DSM that address alcohol use ? Or is AUD the Taylor Swift of this category ?
Well , well , yeah , I listen to all its albums . Yes , there are differentials or other conditions to rule out , but we're going to be talking about AUD A because of its prevalence and because when it's comorbid with another disorder , it's usually obvious that that's part of the deal .
Well , luckily Stacy isn't here she would ask you about specifiers . That's her favorite thing to talk about .
Well , and it's well that you have her around , because there are three specifiers mild , moderate and severe . And you can tell because those specifiers there are 11 criteria in the DSM Mild is 2 to 3 , moderate is 4 to 5 , and severe is 6 or all the way up to 11 .
So give me an example of what those criteria might be .
Well , drinking more or longer than intended , not being able to quit , even if you're trying , drinking larger amounts over a longer period than you intended to cravings that won to quit , even if you're trying , drinking larger amounts over a longer period than you intended to Cravings that won't quit .
Symptoms when you do quit , basically when alcohol becomes your clungy BFF and won't take the hint .
Or another one would be when you skip social events because you can't bring your own bottle right . Yes , exactly .
Or you know that friend that comes to your house and immediately starts asking where the alcohol is right , yeah , so there's withdrawal symptoms that people have , like trembling or sweating , when they stop drinking .
So what's that called ?
That's called the DTs delirium tremens and yes , that's a definite sign that something's happening ,
¶ Understanding Why People Drink
and they all have to happen within a 12-month period . So you know , you had a craving back in 1975 and you haven't had it since . You're not a candidate .
Uh-huh . So why do you think people drink anyway ?
Well , often stress , trauma , negative emotions , which in that case we think of it as self-medication , but basically covering up the problems in life . And of course there's a genetic component , but mainly the , you know , we think of it as the self-medication as a starting point .
So , basically , people drink to cover up the dumpster fires that they have of their lives , instead of trying to put them out .
Yes , because we know alcohol is flammable . It's really the worst thing to put out the dumpster fire with .
Yeah , that's right . Well , sometimes I self-medicate with sushi and extra wasabi .
Yes , as a matter of fact , I've seen you laying in the gutter asking passersby for more wasabi and it's a sad sight and we're going to do an intervention soon for you .
Okay , well , you know it does give me some temporary relief and , as you know that , once you start doing it , it leads to the vicious cycle where sushi becomes your primary method for coping with any problems that people have .
Well , yes , when you've got to have wasabi , it's not that bad a self-medication thing , whereas alcohol can certainly ruin your life , and what's important to know is whether it's stress or traumas or physiological .
It is a complex web of issues that can start a person down the path and it's important to deal with , regardless of which thread is coming to make it the problem in the person's life , or whether or not you understand what's driving the engine Once it's out of control . The point is to stop it .
So you want to help the client find the root causes and also deal with the problems Right .
So you , as a therapist , try to help the client find the root causes and also deal with the problems Right . So you , as a therapist , try to help the client by not blaming them . And another thing you need to do is try to identify the causes .
You're right . Once you start blaming , you're really just heaping on what they've felt from everybody else , and now you're part of the problem .
So once they understand why they drink , then that's it right .
¶ Treatment Approaches for AUD
But once they understand why they're drinking where it's coming from , that's , like you know , seeing where you started on the road . But no , the problem is that they need to find a better coping strategy , like you have with celery juice .
Except my celery juice . When I do it , it's a healthy kind of a thing , so I'm really not addicted to it .
I only drink one glass a day every day yeah , it sounds like the definition of an addiction . Every day you got to have that green monkey on your shoulder there . Well , the bottom line is , when you're treating AUD , you should operate under the assumption that your client or your celery juice addict can recover .
But it takes a lot of work from multiple directions , and it's not just understand how you drink and stop . It's all of the threads that are going to help .
Okay . So the one thing you've got to remember is you have to have an individualized treatment plan with the client , because one size fits all just doesn't work Exactly Right . So how do we help clients with AUD ? I assume it's more than just saying , just say no , and handling them . A celery juice recipe .
The recipe you mean grinding up a bunch of celery . That is a toughie . Yes , as a matter of fact , there are multiple ways of dealing with it and one of them is your favorite .
Yes , stages of change . Model right the trans theoretical model yes , absolutely the . The words are like music to my ears okay , we I know we just did a podcast on that , but that's right , let's go ahead and talk about the stages of change , or I call it the PCP-AMT .
Yes , you do . You love to call it that Right , or ?
what are they ? Pre-contemplation , pre contemplation , contemplation , preparation .
Preparation .
Action .
Maintenance . Maintenance and termination , yes . And in pre-contemplation you don't think you have a problem , I I don't know why people are talking about it . I can quit anytime I want . It's not a deal . And so it's like their friend that having 12 cats is totally manageable . And then you know , all it smells like is the inside of a litter box .
Then comes a contemplation stage where the client starts weighing the pros and cons . But they're still weighing it because they don't realize that it's a deal in their life . Sort of me like when I'm at an all-you-can-eat buffet .
Right , okay . So what about motivational interviewing ?
Well , that's where you take a more active role . Right , because in the stages of change , you're helping the client realize what stage they're in . Right , in the motivational interviewing , you're doing just what it says . You're helping to motivate them to make those changes . So you know , go ahead and put down that bottle right , Right .
So basically you're helping them explore their ambivalence about change and nudging in towards the healthier choices .
Yes , and it's the nudging that makes it the more active part . You're not just sitting on the sideline anymore , you're actually intervening to a bigger extent .
Right , so you do that , and a lot of things are going to come up to the surface . So when it bubbles up , then what ?
Well , right , and now they're looking at the . Well , back to the trans-theoretical model , they're looking at the contemplation stage they're actually looking at do I really need to drink that fifth of Jack Daniels every day ? Or do I need to do something about fifth ?
of Jack Daniels every day , or do I need to do something about it ? I thought you liked rum and coke . Well , how about family therapy ? That sounds important too , unless , of course , part of your family is part of the problem .
Not , unless you assume the family is part of the problem and that they need help in figuring out what to do with their problematic sibling , son , father , whatever it is , because often the family is just as clueless as what to do as the client themselves .
So family therapy is important to help ground them in A what to look for and , b how they can actually be of help , rather than what they've probably been doing , which is just heaping on the guilt .
Right , judgment and blame . They have a tendency to do that .
Well , right and you can see where it comes from and , by the same token , you can see why it's so unhelpful .
Yeah , one of the problems with the family therapy is the fact someone's doing really well and
¶ Family Therapy and Support Systems
let's say they were in the maintenance phase . Then they relapse and the wife or the husband or the grandparents starts blaming them and shaming them .
Yes , If only you had stayed off the bottle , then we wouldn't be in this problem , which that's part of the genius of the trans-theoretical model is noticing the cyclical nature , like we mentioned in the podcast , of the fact that you expect it .
It's baked into the theory that there are going to be problems , there are going to be relapses , and that you just expect it and that you figure out what to do , not if it happens .
but when it happens . So I guess you'd have to spend a lot of time educating the family about what they can expect in terms of someone dealing with their addiction .
Well , yes , and as a matter of fact , that's such a big part of it that we haven't talked about it yet . But you know about the 12-step programs , like in Alcoholics Anonymous . There's another group called Al-Anon that's specifically for families of alcoholics .
It deals with the you know , their own 12-step journey in how to deal with the alcoholic member of their family . So , yeah , it's that big a thing that it's not just some little niche where you talk about family therapy . It's like part of what you need to deal with .
It's a good point . It's a good point . You know , there's another technique contingency management .
Yes , I figured you'd love that one because you like the Premack principle , don't you ? I do like the Premack and it sounds just like it . Yes , tell us what it involves .
Basically , you're going to be getting some type of tangible rewards for whatever positive behaviors you have regarding not drinking .
Right . So you didn't drink today , so here's a nickel . Good job .
No , it's got to be more than that is .
Oh , you didn't drink , so here's a 10 spot . There you go . Yes , so basically classic behaviorist therapy where you're giving a positive reward for positive behavior , exactly , and not really talking about the negative behaviors , but basically just the positive side of things . How about DBT ? Oh , yes , dialectical behavioral therapy .
That actually has proven to be effective in a lot of the research studies that many people have used DBT successfully and it's proved to be a viable thing .
Yeah , I'll tell you when I think about this . To answer any questions on AUD , on a licensing exam , it looks like I have to have a whole range of knowledge base from DBT to CBT to family therapy , to trans-theoretical models .
So there's a lot involved in this problem in our society , that people have realized that , as you said at the beginning , you need the individualized approach to the person , which means that some people won't respond to the behavioral side , some people won't respond to the motivational interviewing side , so you've got to have a pretty broad spectrum , which makes it
complicated if you're trying to take a test and they're asking about it . You're absolutely right .
Yeah Well , one of the things that you need to know is the vocabulary . If you don't know the vocabulary , you may miss some questions . So let's go ahead and do a quick
¶ Therapeutic Techniques and Key Terminology
lightning round .
Lightning round . I love it , I'll start . Craving is when you can't stop thinking about drinking , like me with pizza , when I'm really hungry at night .
Okay . Tolerance means that you need more alcohol to feel high , like needing extra espresso shots at your age .
Yes , exactly , detoxification , the process of allowing the body to eliminate alcohol .
Relapse is returning to drinking after you haven't done it for some period of time .
Yes , Harm reduction is a set of strategies that aim to reduce the negative consequences of drinking Tools that a person can use to ameliorate their problems until they quit drinking .
for good Enabling . Enabling is behavior that unintentionally supports a client's substance use .
So let's summarize what we covered . Obviously , it's a complex thing . Like we mentioned , a lot of moving parts biological , psychological , physiological , social and the SM has clear criteria and it should be an individualized technique that's going to be most effective for that person .
And there are different techniques motivational interviewing , cbt , relapse prevention and your favorite trans-theoretical model .
Right , which is also known as Stages of change ?
Exactly , which is also known as stages of change ? Exactly , yes , and so therapists and family members need to understand it as a journey , not a one-time thing . Not that I went to detox and now I'm finished .
And , as we mentioned , ttm , the trans-theoretical model , has it baked in that there are going to be relapses , that there are going to be problems , that you're going to need to recognize the fact and not feel guilt over that fact , that there were problems in resurfacing after having problems with alcohol .
Thanks for joining us today .
Yes , thank you so much . We hope the podcast has given some valuable information that you might see in your licensing exam and some practical insights to help support your client's recovery . And remember it's in there , it's in there .
Did we miss anything ? No , this is starting to remind me of a Marvel movie , where they have a trailer after the credits .
Oh , yes , really . If only we had Captain America , you know , swing in here , that would be good . But I'm glad people stuck around , because what we didn't talk about were assessment instruments .
Okay , this one's pretty easy . If an assessment instrument has the word alcohol in it , you know what it's for . So let me give you some of the not obvious assessments that might show up on your licensure exam . One is called Audit C
¶ Assessment Tools for AUD
. You wouldn't think that has anything to do with alcohol , but it's a shortened version of Audit , consisting of three questions related to the frequency of alcohol use , the typical amount consumed and occasions when you end up having heavy drinking . How about the cage ?
as the cage is another assessment instrument and once again , you see the cage . You'd never guess it was for alcohol until you see the question , and it's four yes or no questions . Have you ever felt you should cut down the C ? Have people been annoyed by your or criticized your drinking the A ?
Have you ever felt guilty about your drinking the G and the eye opener have you ever had to have a drink first thing in the morning to steady your nerves after a bender last night ? And that's the E , c-a-g-e .
Okay , there's a couple more . One's called Tweak and T-Ace and T-ACE . Tweek and T-ACE are assessment instruments specifically designed to work with pregnant women . Oh .
All right . So Tweek and T-ACE are both for that .
Yeah , both of them are Okay , all right .
And then the CRAFT C-R-A-F-F-T is used to identify risky substance use , including alcohol , among adolescents and basically for anyone under 21 .
Right , and another one , or the last one we're going to talk about is called ASIST . You would never think that had anything to do with alcohol , but the ASIST is for Alcohol , Smoking and Substance Involve and substance involvement screening tests is what it's called . It's a comprehensive assessment instrument developed by the World Health Organization .
It screens all levels of problems of risky substance use . Well , that's it for this part of the universe , Ez . How about you ?
Well , that sounds good , and I'm glad we had a little tag at the end , because the assessments , I think , are things that would show part of the universe . Ez , how about you ? Well , that sounds good , and I'm glad we had a little tag at the end , because the assessments , I think , are things that would show up on the test as well .
So I'm good now and I'm feeling like we could use a little reward of sushi from Publix .
Well , how about some celery juice ?
Okay , I'll go out to the sushi . You have the celery juice and just crank down Either way . To reiterate to our listeners remember it's in there , it's in there .