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Enzo Araneta
Kay Bunagan
Dan Villafuerte
 |tructure of the Report
‡ Difference between substance abuse and
substance dependence
‡ Case presentation
‡ Models of Understanding
‡ Inhalants
‡ Article presentation
 |ubstance Abuse
V|
|ubstance Dependence
 |ubstance Abuse
‡ At least one of the following symptoms
within a 12-month period:
‡ Recurrent substance use resulting in a
failure to fulfill major role obligations at
work, school, or home (such as repeated
absences or poor work performance
related to substance use; substance-
related absences, suspensions, or
expulsions from school; or neglect of
children or household).
 |ubstance Abuse
‡ Recurrent substance use in situations in
which it is physically hazardous (such as
driving an automobile or operating a
machine when impaired by substance use)
‡ Recurrent substance-related legal
problems (such as arrests for substance
related disorderly conduct)
 |ubstance Abuse
‡ Continued substance use despite having
persistent or recurrent social or
interpersonal problems caused or
exacerbated by the effects of the
substance (for example, arguments with
spouse about consequences of
intoxication and physical fights)
 |ubstance Dependence
‡ At least three of the following symptoms
within a 12-month period:
‡ Tolerance, as defined by either of the
following: (a) A need for markedly
increased amounts of the substance to
achieve intoxication or the desired effect
or (b) Markedly diminished effect with
continued use of the same amount of the
substance.
 |ubstance Dependence
‡ Withdrawal, as manifested by either of the
following: (a) The characteristic withdrawal
syndrome for the substance or (b) The
same (or closely related) substance is
taken to relieve or avoid withdrawal
symptoms.
 |ubstance Dependence
‡ The substance is often taken in larger
amounts or over a longer period than
intended.
‡ There is a persistent desire or
unsuccessful efforts to cut down or control
substance use.
 |ubstance Dependence
‡ A great deal of time is spent in activities
necessary to obtain the substance, use
the substance, or recover from its effects.
‡ Important social, occupational, or
recreational activities are given up or
reduced because of substance use.
 |ubstance Dependence
‡ The substance use is continued despite
knowledge of having a persistent physical
or psychological problem that is likely to
have been caused or exacerbated by the
substance (for example, current cocaine
use despite recognition of cocaine-induced
depression or continued drinking despite
recognition that an ulcer was made worse
by alcohol consumption)
 Abuse V| Dependence
‡ Failure to meet ‡ Tolerance
obligations ‡ Withdrawal
‡ Use in physically ‡ Taken in greater
dangerous situations amounts
‡ Legal problems ‡ Desire to control
‡ Continued use consumption
despite problems ‡ Excess use of time
‡ Reduced activities
‡ Continued use
despite knowing
problems
The Case of Mr. RC
The Case of Mr. RC
Name: RC
Age: 19
|ex: Male
Presenting Problems:
|uicide Attempts
|ubstance Abuse
Auditory Hallucinations
 The Case of Mr. RC
Mr. RC started using at the age 14.
He started with shabu and continued
it for six months before switching to marijuana.
A year passed and he got hooked on sniffing
rugby. All through out his drug use, he was
experiencing auditory hallucinations; voices
telling him to kill himself. Apart from this, while
high on rugby, he was convinced he had
super powers such as making things levitate.
 The Case of Mr. RC
Mr. RC dropped out of school after his
2nd year in high school. He was doing
rather poorly in his academics due to drugs. He
would often steal from his own home to sustain
his rugby use. His mother died when he was 10
years old. His social circle primarily involved
friends who were also addicts. His friends,
being older than him and having jobs, usually
shared their drugs with him for free.
 The Case of Mr. RC
The attempts were prompted by the
voices in his head wanting him to kill
himself. His first attempt included
drinking muriatic acid and Baygon. In his next
attempt, he tried blowing up his house with him
in it by breaking an LPG tank. He tried hanging
himself for his third attempt and broke a bottle
and slashed his wrist with a piece for his last.
All four attempts were followed by an
admittance to Ward 7 of PGH.
Models of Understanding
 Psychodynamic Model
‡ |ubstance Abuse as masturbatory
equivalent
‡ Defense against homosexual impulses
‡ Manifestation of oral regression
‡ Boundaries and limits
‡ Compulsiveness & impulsiveness
‡ Defense mechanism
± Denial & externalizing
‡ Vicious Cycle
± Guilt & shame
 Psychosocial Theories
‡ A societal role in the development of
patterns of substance abuse and
substance dependence
± Drug culture
± Urban poverty
‡ Condemn less and accept more
‡ Connections exist between underlying
problems in the individual
and his sociocultural domain
 Psychosocial Theories
‡ Coaddiction or codependence
± Couples have a relationship that is primarily
responsible for the maintenance of addictive
behavior in at least one of the persons
± Each person has enabling behaviors that help
perpetuate the situation, and denial of the
situation is a prerequisite for such a dyadic
relationship to develop
Psychopharmacological Model
 Developmental Model
‡ At what point in time and for what reasons
does development begin to be diverted
from its normal course?
 Developmental Model
‡ Pathways cross to create co-morbidity
‡ Pathways can be significant in terms of
prevention and intervention
‡ Pathways can be significant in terms of prevention and intervention
‡ focus on intervening early in a child¶s
development to strengthen protective
factors before problem behaviors develop
Co-morbidity of |ubstance Use
‡ Anti-social PD ‡ Polysubstance abuse
‡ Borderline PD ‡ More potent
‡ Mood Disorders substances have
± Depression & higher co-morbidity
suicide (more so rate for disorders
with alcohol)
± Dysthymic
‡ Anxiety Disorders
± phobias
‡ ADHD
 Family |ystems Model
‡ Anyone who is
instrumental in providing
support, maintaining the
household, providing
financial resources, and
with whom there is a strong
and enduring emotional
bond may be considered
family for the purposes of
therapy.
‡ In family therapy, the goal
of treatment is to meet the
needs of all family
members.
 Family |ystems Model
‡ |ubstance Abuse is a result of a poor
performance in family roles, lack of
communication or any dysfunction in
the family system
 Ask«
‡ How is the family arranged:
± Hierarchically
± Democratically
± Within this structure, what are the
communication patterns?
‡ How well is this family functioning? That is,
to what extent can the family meet its own
goals without getting in its own way?
‡ What are the culture¶s prescribed roles for
each family member?
 Ask«
‡ What are the family subsystems?
± couple subsystem
± parent-child subsystem
± sibling subsystem

‡ What are the multigenerational qualities?

± Families may have four or more generations that are
currently relevant at one time, and family members
are affected by inherited qualities across generations,
as well.
 Family |ystems Concepts

‡ Homeostasis
± Families strive to achieve i
 ,
which portrays family systems as self-
regulating with a primary need to
maintain balance.
± The addicts needs may have been
compromised to fulfill the needs of
another family member.
 The family is greater than the
sum of its parts.
‡ ¢
 
 if one family member
changes his or her behavior, the others will also
change as a consequence, which in turn causes
subsequent changes in the member who
changed initially.
‡ This also demonstrates that it is impossible to
know what comes first: substance abuse or
behaviors that are called ³enabling.´
e.g. A strict father may have been an enabler
to the drug addict.
‡  i  resistance to change due to the
habitualized behaviors
 Attachment  Numbing
‡ Numbing response:
± Dissociation
± Depression
± Emotional and kinetic constriction
± |ocial withdrawal
± Avoidance of tactile-emotional stimulation
± |ubstance Abuse

‡ Factors such as:

± Chaotic home environment
± Ineffective parenting
± Lack of nurturing and parental attachment
 Family |ystems Concepts
‡ Family Boundaries
‡ Family Coalitions
± conflicts
‡ Communication traits,
which can be verbal or
nonverbal, overt or subtle
means of expressing
emotion, conflict,
affection, etc.
 Enablers
Often well-meaning efforts to help someone with an alcohol or drug
problem actually empowers them to continue their destructive
behavior by allowing them to avoid the consequences of their
actions. This is called "enabling.³

1. Have you ever 'called in sick' for the alcoholic because they were too
hungover to go to work or school?
2. Do you ever make excuses for the alcoholic's drinking or behavior?
3. Have you ever lied to ANYONE to cover up for the alcoholic?
4. Have you bailed the alcoholic out of jail or paid his or her legal fees?
5. Have you accepted part of the blame for the alcoholic's drinking or
behavior?
6. Do you avoid talking about the alcoholic's drinking out of fear of the
response?
 Family |ystems Concepts
‡ |ome parents may develop a codependency with their
children to foster substance abuse. The behavior of the
caring individual is said to hinder recovery of the real
addict by enabling the addict to continue the addiction.

‡ Family contexts may provide exposure to key

antecedents and consequences for alcohol abuse.
(O'Farrell & Fals-|tewart, 1999).
Inhalant Abuse in the
Philippine Context
Breathe in deeply and enjoy
‡ There is no
comprehensive
epidemiologic data on
the magnitude of
inhalant abuse among
children and
adolescents in the
Philippines
Mmmmm. Rugby goooood.
‡ Toluene
± The chemical toluene
gives the aromatic
smell in contact
cement and other glue
and is the culprit
behind the addiction
 Effects
‡ Levels of exposure ‡ Initial excitatory
greater than 600 ppm phase followed by
cause confusion and
depression
delirium
‡ Habitual users can suffer ‡ Excitatory phase
brain damage, kidney and characterized by
liver failure, sight and euphoria, delusions,
hearing loss, muscle less commonly visual
weakness, leukaemia, and auditory
and death, the DDB said.
hallucinations
 Clinical Manifestations

‡ Data on the toxic effects of toluene among

patients seen at the UP Poison Center
were from inhalational exposure with chest
tightness, chest pain and altered mental
status as the most common presenting
symptom at the emergency room
Toluene Abuse in the
Philippines
‡ ³Rugby sniffing is one of
the most common ways
by which toluene is
abused´
‡ A ³rugby sniffer´ often
puts the chemical in a
plastic bag and inhales
the vapors directly from
the bag to achieve a
state of euphoria.
 Case Distribution According to Drugs
Used/Abused (DDB Annual Report 2004)
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 Factors that contribute to popularity
of ³Rugby sniffing´

‡ The relative ease of procuring

this substance due to its low
cost and accessibility
contributed significantly to its
widespread abuse among
Filipino street children
 |olvent Abuse among Filipino
|treet Children
‡ UNICEF estimates the number of street
children in the Philippines to range from
75,000 to 80,000
‡ Data from D|WD show that the number
increases by 6,365 annually
‡ HALF of the Philippine¶s street children
have at one time or another snorted
"rugby" and other aromatic solvents to
assuage hunger pangs
( |ource: Kanlungan sa Er-Ma Ministry)
 Acculturation, Familism, Parental
Monitoring, and Knowledge as
Predictors of Marijuana and Inhalant
Use in Adolescents

Juan R. Ramirez, William D. Crano, and Ryan Quist

Claremont Graduate University

Michael Burgoon, Eusebio M. Alvaro, and Joseph Grandpre

University of Arizona
 ë
‡ Figures gathered in Johnston, O¶Malley, and Bachman¶s
(2001) study indicate that
± #
,
  
± +
,"
  
± "
#,
  
are reported having used some
illicit drug at least once over the
past year.
‡ |tudy was done that shows Hispanic American kids as
the frontrunners in early drug use. 36% of Hispanic 8th
graders report usage of illegal drugs (Johnston et al., 2001)
 Aim of the study
‡ Recognizing the importance of family and
culture, the present study seeks :

‡ (a) to contribute to the emergent study of

drug use in Hispanic American adolescents
by examining the roles that Familism,
acculturation, and parental monitoring play
in marijuana and inhalant use in a large
sample of Hispanic American adolescents

‡ (b) to differentiate these influences from

those that affect Anglo Americans.
 Method
‡ Participants
± 772 Anglo-American students
± 322 Hispanic-American students
± Consisted of Grade school to High school students

‡ Acculturation
± Measures how immersed a person is in the culture

‡ Familism
‡ Measure importance of family

‡ Parental Monitoring
± measuring the degree to which parents were aware of their children¶s daily
activities
 Results
1. First, we have shown that increasingly accurate
knowledge of drug effects is associated with lower
substance use in adolescents from a variety of cultural
backgrounds.
2. Analyses also demonstrate that parental monitoring
and strong familistic values can serve important and
unique roles in drug prevention.
3. There is a strong and consistent association between
lower acculturation and marijuana usage.
 Thank you.

³Tama na µyan inuman na.´