Respond to  your colleagues who were  assigned a different disorder than you. Compare the differential  diagnostic features of the disorder you were assigned to the diagnostic  features of the disorder your colleagues were assigned. What are their  similarities and differences? How might you differentiate the two  diagnoses? 

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Opioid Use Disorder 

Substance  use disorder is a major public health problem in the United States.  This is a problem that is associated with increased morbidity,  mortality, and cost of care. It suffices to say that the health care  delivery system is significantly burdened by issues that are associated  with substance use disorder. Data from 1995 to 2018 shows that there has  been an increase in the prevalence rate the use of cannabis as well as  other illegal drugs and analgesics (Seitz et al., 2019). This shows how  substance abuse presents a serious problem for the health care system.  when discussing substance abuse and related disorders, it is very hard  to ignore the opioid epidemic in the country. The opioid epidemic is a  crisis that has taken millions of lives over the last few decades. This  crisis was initially worsened by an augmented use of pharmaceutical  opioids. Currently, most deaths due to opioid are caused by overdosing  on heroin as well as the illegally manufactured synthetic opioid that is  referred to as fentanyl (Lyden & Binswanger, 2019). Death is not  the only negative outcome of the crisis. Opioid use is also associated  with disorders. Opioid use disorder shall form the description of this  paper where the diagnostic criteria shall be presented first. The paper  shall then discuss the treatment of opioid use disorder using  psychotherapy and psychopharmacologic interventions. Finally, the  clinical features of the disorder shall be discussed with reference to  the DSM-5 criteria.

Diagnostic Criteria 

Opioid  use disorder is described as a pattern of opioid use that is  problematic, leading to clinically significant distress or impairment.  The distress or impairment should be manifested by at least two symptoms  from a list that is provided in the DSM-5. This manifestation should  last at least 12 months to make a correct diagnosis (APA, 2013).  Notably, if a person exhibits 2-3 symptoms, this is considered a mild  case. If there are 4-5 symptoms, this is considered moderate, and 6 or  more symptoms demonstrate a severe case. The symptoms as provided in the  DSM-5  list include taking opioids in larger amounts or longer period  than intended, persistent desire or uncontrolled effort to moderate or  stop using opioids, spending so much time using, acquiring and  recovering from the use, craving for opioids, failing to fulfill  important obligations in life due to opioid use, continued use  regardless of social and interpersonal problems that are worsened by the  use of opioids, giving up social, occupational and recreational  activities due to opioid use, using opioids in situations that are  hazardous, and continued use of opioids with the knowledge that it is  causing or exacerbating physical or psychological problems. Notably,  having a high tolerance for opioids in order to achieve the desire to  consume as well as suffering from withdrawals are also symptoms to  include in the list but do not apply in cases where opioids are used  solely for medication purposes (APA, 2013).  

Psychotherapy 

The  most effective psychotherapeutic approach in the treatment of opioid  use disorder is cognitive behavioral therapy. In one study, the  accessibility, feasibility, and efficacy of cognitive behavioral therapy  in the treatment of opioid use disorder was confirmed (Barry et al.,  2019). This approach is effective in preventing relapse and it is also  known to work in preventing those that are taking opioid medications for  pain from starting to use other illicit opioid substances. The use of  psychotherapy as discussed entails rehabilitation as well as  maintenance. While rehabilitation focuses on the use of cognitive  behavioral therapy, maintenance includes psychological support and  patients are always encouraged to join support groups such as an  anonymous program. Education and reward cooperation can be the benefits  of these support groups (Dydyk, Jain & Gupta, 2020). In addition,  when group approaches are used, patients get to benefit from therapeutic  factors such as universality and guidance. The maintenance phase may  also require the use of medications. 

Psychopharmacologic Treatment 

When  cognitive behavioral therapy is used in combination with medication, it  is said to be most effective in the treatment of opioid use disorder  (Dydyk, Jain & Gupta, 2020). Drugs are used for opioid replacement,  maintenance, and substitution therapy. Thus, the drugs that are commonly  used include Methadone and Buprenorphine. They are always provided  under supervision. These drugs are longer acting though they are not as  addictive and euphoric as the illicit opioid drugs. The mentioned drugs  are mu opioid receptor agonists, and they are used as opioid  substitutions even though they have dissimilar pharmacodynamic and  pharmacokinetic properties (Noble & Marie, 2019). Other medications  that are used include Naltrexone that helps in reducing the urge to use,  hence maintaining abstinence and Lofexidine which may be used to treat  side effects associated with withdrawal.

Clinical Features 

 In  a person that presents to the clinic and is diagnosed with opioid use  disorder, they may have slurred speech, pinpoint pupils as well as  sedation. On of the criterion for the disorder is tolerance. This is  requiring high amounts to quench the desire. In such cases, patients may  not present with acute symptoms. This may also be true in cases where  the patient has used a dose that is typical for them. Most acute cases  are emergencies due to overdosing (Strain, Saxon & Hermann, 2015).  It is therefore very important for any health worker to be keen in  identifying the acute symptoms, especially emergency cases in order to  prevent deaths due to overdosing of opioids, something that is very  common.

References

Barry,  D. T., Beitel, M., Cutter, C. J., Fiellin, D. A., Kerns, R. D., Moore,  B. A., … & Schottenfeld, R. S. (2019). An evaluation of the  feasibility, acceptability, and preliminary efficacy of  cognitive-behavioral therapy for opioid use disorder and chronic pain. Drug and alcohol dependence, 194, 460-467

Dydyk, A. M., Jain, N. K., & Gupta, M. (2020). Opioid Use Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK553166/#article-42233.s6

Lyden, J., & Binswanger, I. A. (2019, April). The United States opioid epidemic. In Seminars in perinatology (Vol. 43, No. 3, pp. 123-131). WB Saunders

Noble,  F., & Marie, N. (2019). Management of opioid addiction with opioid  substitution treatments: beyond methadone and buprenorphine. Frontiers in Psychiatry, 9, 742

Seitz,  N. N., Lochbühler, K., Atzendorf, J., Rauschert, C., Pfeiffer-Gerschel,  T., & Kraus, L. (2019). Trends in substance use and related  disorders: Analysis of the epidemiological survey of substance abuse 1995 to 2018. Deutsches Ärzteblatt International, 116(35-36), 585.

Strain,  E., Saxon, A. J., & Hermann, R. (2015). Opioid use disorder:  Epidemiology, pharmacology, clinical manifestations, course, screening,  assessment, and diagnosis. UpToDate, Post, TW, editor. UpToDate. Waltham, MA [cited 2018 Apr 1] 

 Respond to  your  colleagues by suggesting an alternate therapeutic approach. Support your  feedback with evidence-based literature and/or your own experiences  with clients.   Ask your colleague a question related to the  post 

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Practicum Experience: Addiction Issues and Depression

Treating  substance and addiction disorders is an important step in helping the  patient return to normal life. Fuentes & Hoffman (2016) explain that  many patients may be suffering from growing addiction-related issues at  younger ages than historically known. In my practicum experience, there  have been patients that have comorbid symptoms including depression,  anxiety, fatigue, and in extreme cases agoraphobia. When these patients  present for the treatment they may not know the root cause of their  condition nor all the comorbid symptoms. In some cases, the initial  meeting establishes the scope of their condition as well as incumbent  challenges they may not have identified earlier. This sets the  parameters for a treatment approach that is relevant and specific to  their needs. 

One  patient that I met during practicum was a 43-year old caucasian male.  He had lost his job during the early months of the year and was  experiencing depression as a result of it. There are a lot of issues his  family has faced resulting in him downsizing and moving in with his  mother. The relationship between the two of them and the pressure to  care for his ill father has added stress to the situation further. Aside  from these problems he has developed an addiction to alcohol frequently  having drinks several times throughout the day. 

These  conditions and the patient’s perspective of hopelessness are some of  the persisting circumstances in his life. These problems have continued  for more than six months and have contributed to a sense of loss and a  lack of self-worth. He used to be creative and make art projects with  friends or coworkers. However, this has not been possible as he feels  there is ‘no point to anything’. Instead, he has taken larger drinks  more frequently over the past year. This was a remarkable example of his  growing sense of despair that interferes with activities that may have  been fun in the past. Davis et al. (2017) explain it is important to  diagnose comorbid conditions early on to improve chances for patient  improvement. According to DSM-V, the patient could have Major Depressive  Disorder as well as Alcohol Use Disorder. With only three symptoms  persisting for the specified amount of time the case would be mild. 

For  this patient, two treatment options were suggested. Psychological  therapy was offered on a weekly basis to help the patient rectify some  of their underlying issues while addressing depression. In my  experience, cognitive behavioral therapy is the most interesting because  it offers a good solution for long-term symptom management. Acamprosate  is a relatively new medication that makes the desire to drink lower for  the patient. Choi et al. (2019) demonstrate the ability for this  treatment to improve the chances of changing alcohol abuse over time.  This is medication best regulated with small doses initially and  increased based on how well the patient can handle it. At these early  stages, the patient is willing to take the medication and will return  for follow-up changes with treatment in the future. 

References 

Choi,  B. Y., Lee, S. H., Choi, H. C., Lee, S. K., Yoon, H. S., Park, J. B.,  … & Suh, S. W. (2019). Alcohol dependence treating agent,  acamprosate, prevents traumatic brain injury-induced neuron death  through vesicular zinc depletion. Translational Research, 207, 1-18.

Davis,  E. C., Rotheram-Borus, M. J., Weichle, T. W., Rezai, R., &  Tomlinson, M. (2017). Patterns of alcohol abuse, depression, and  intimate partner violence among township mothers in South Africa over 5  years. AIDS and Behavior, 21(2), 174-182.

Fuertes,  J. N., & Hoffman, A. (2016). Alcohol consumption and abuse among  college students: Alarming rates among the best and the brightest. College Student Journal, 50(2), 236-240.