paola pedrelli, ph.d. massachusetts general hospital boston, ma heavy drinking and depressive...
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Paola Pedrelli, Ph.D.Massachusetts General Hospital
Boston, MA
Heavy Drinking And Depressive Symptoms In
College Students
1© AMSP 2015
Alcohol in Young Adults• Alcohol increases at a young age
• Alcohol common age 21-25
• 70% consume alcohol
2© AMSP 2015HED Current Frequent HED
3© AMSP 2015
This Lecture Reviews:
Definitions & alcohol on campus
Depressive symptoms on campus
Depressive symptoms & HED
Implications
4© AMSP 2015
This Lecture Reviews:
Definitions & alcohol on campus
Depressive symptoms on campus
Depressive symptoms & HED
Implications
Definition
Standard drink = 10-12 g pure ethanol
Heavy Episodic Drinking
• BAC: Amount of alcohol in blood
• HED ~ 0.08 BAC
• HED: ♀/♂ > 4/5 drinks/occasion 2h
6© AMSP 2015
HED Common in College Students
Past month prevalence of HED
7© AMSP 2015
• Everyone drinks heavily in college
• Drinking heavily on weekends is OK
• Students will grow out of it
Myths About HED
8© AMSP 2015
• Among <21 age: costs $27 Billion/yr
- 61% from lost productivity
- 25% from premature death
• 40,000 hospitalizations/yr due to alcohol
HED Societal Costs
9© AMSP 2015
Each yr in college students
•~600,000 injuries
•~700,000 assault
•~97,000 victim sexual assault
•~1800 deaths
HED Personal Costs
10© AMSP 2015
Jackie: 20-year-old female student
• Mild depressive symptoms
• ↓Interest in social activities
• Behind with schoolwork
• ↓Grades
• Sleeping 8-10 hrs/day
• Consume 8-10 drinks 1x/week
Illustrative Case
11© AMSP 2015
Role failure
Risk of harm
Social problems
Tolerance
Craving
DSM-V Alcohol Use Disorders
12© AMSP 2015
Withdrawal
Larger/longer
Unable to ↓ down
↓ Time elsewhere
Use despite problems
>2 past 12 mos
13© AMSP 2015
AUD in College Students
•24% ♂ have AUD
•13% ♀ have AUD
Alcohol Problems in Students
• 57% physically sick & blackout
• 30% school problems
• 31% regretted a sexual activity
• 20% physically injured
• 13% drank and drove
• 7% got into physical fight© AMSP 2015 14
16
Predictors of HED
16© AMSP 2015
This Lecture Reviews:
Definitions & alcohol on campus
Depressive symptoms on campus
Depressive symptoms & HED
Implications
Depressed Mood
Markedly ↓ interest
Weight loss/gain
Diff sleeping
Agitation
Major Depressive Disorders
17© AMSP 2015
Fatigue
Feel worthless
↓ Ability think
Suicidal ideation
>5 past 12 mo
• Unique development stage
- Identity exploration
- From dependence to independence
• ↓Support from old friends
College is Difficult
18© AMSP 2015
Depressive Symptoms
Symptoms Women Men
Have MDD 10% 8%
Are sad 66% 51%
Felt hopeless 50% 38%
Hard to function 33% 27%
Seriously considered suicide
7% 6%
Attempted suicide 1% 1%
Problems with Dep Sx
• Mild dep sx ↑ early school drop out
• Mild dep sx ↑ psychosocial problems
• SI present at sub-threshold MDD
© AMSP 2015 20
• Tired all the time
• Feels lonely
• ↓ Motivation
• ↓ Piano playing & exercise
• Sleeps > 10 hr many days
• Grades ↓& skipping classes
• Isolates
Jackie
21© AMSP 2015
22© AMSP 2015
This Lecture Reviews:
Definitions & alcohol on campus
Depressive symptoms on campus
Depressive symptoms & HED
Implications
Depressive Sx + HED =↑ Problems
• Dep sx + HED = ↑ risk for alcohol problems
• Dep sx + HED = ↑ risk for suicide
• Unsafe sex
- 14% Dep sx +HED
- 10% HED alone
• Behind at school
- 29% Dep sx +HED
- 24% HED alone© AMSP 2015 23
Social Learning Theory
© AMSP 2015 25
Alcohol is used:
• To ↓ negative emotional states
• With expectation ↑ mood
• Belief no alternative ways to cope
Jackie
• Drinks to feel better
• Behind in school due to HED
• Regrets actions during HED
© AMSP 2015 25
26© AMSP 2015
This Lecture Reviews:
Definitions & alcohol on campus
Depressive symptoms on campus
Depressive symptoms & HED
Implications
Settings for Screenings
• Throughout school
• College counseling centers
• Primary care
• Emergency care © AMSP 2015 27
Screening Tool for AlcoholAlcohol Use Disorders Identification Test (AUDIT-C)
• Items on:
- Frequency of any alcohol use
- Typical number of drinks
- Frequency of 6+ drinks
• Responses are summed
• Score > 3/5 ♀/♂ indicates at-risk drinking© AMSP 2015 28
Screening Tool for Depression
• Patient health questionnaire (PHQ-9)
- 9 items ask frequency of sx
- Responses are summed
- Score >10 indicates MDD
© AMSP 2015 29
Recommended Treatment• Combined vs single Tx
- 90% vs 30% abstinent
- 65% vs 45% improvement dep sx
• HED & dep sx should be treated together
- Tx for HED not effective in dep students
- Tx for 1 disorder leads to ↑ relapse rates
- Combined HED/dep TX → better outcome
AMSP 2015 30
Tx For Co-occurring Sx
• Motivational interviewing (MI) + Cognitive
Behavioral Therapy (CBT)
- Both address motivations for drinking
- Integrating MI and CBT is feasible
- CBT+MI effective for co-occurring sx
© AMSP 2015 31
CBT• Thoughts feelings behaviors
• Brief and time-limited
• Structured
• Educational
• Collaborative relationship
• Socratic method
• Includes homework
© AMSP 201532
CBT Tenets
• Dep sx relate to negative views of:
- Themselves
- The future
- The world
© AMSP 2015 33
CBT Techniques
• Change unhelpful thoughts
- Evidence for and against thoughts
- Reduce catastrophizing
- Identify mind reading
• ↑ Enjoyable activities
© AMSP 2015 34
MI
• Therapy ~ partnership
• Patient-centered
• Directive method communication
• Elicit own motivation to change
• Explores ambivalence re change
• Guide pt towards change
© AMSP 2015 35
MI Therapist
• Express empathy of current behavior
• Examine inconsistencies
• Promote belief that change is possible
• Roll with resistance
© AMSP 2015 36
Combined Tx For Jackie
• Feedback from brief MI
- On drinking behaviors
- Blood Alcohol Concentration
- Drinking problems
• Education on
- Peers' normal alcohol use
- Gender specific effects of alcohol© AMSP 2015 37
CBT For Jackie
• Changed thoughts:
- “I am flawed”
- “My friends do not like me”
• Increased pleasant activities:
- Encouraged resuming piano
- Encouraged resuming exercising
© AMSP 2015 38
Jackie: Results
• Attending classes consistently
• ↑ Exercising and playing piano
• Seeing friends daily
• Drink < 4 drinks per occasion
© AMSP 2015 39
Conclusion/Summary
In college students:
•Depressive symptoms + HED are common
•Screening important
•Combined Tx more effective
•CBT+MI example of combined Tx
© AMSP 2015 40
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