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Drugs of Addiction
Elizabeth McQueen, LMHC
Clinical Director
Stewart-Marchman Center
NET Training Institute
Freedom Series
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Course Objectives To define psycho active chemicals To examine the routes that drugs
take to the brain and the ways in which they affect brain chemistry
To present a system for classifying these psychoactive substances.
To detail the physiological effects of uppers, downers and other commonly abused drugs
To outline the principles of effective prevention and treatment
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The Addictive Process:
Psychoactive drugs: Substances that affect the central nervous system to cause physical and mental changes to take place
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3 Factors that determine the effects a chemical will have
1. The methods by which people put psychoactive chemicals into their bodies
2. The speed of transmission to the brain
3. The attraction of the drug for nerve cells, neurotransmitters and other brain chemicals
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Routes of Administration
1. Inhaling
2. Injecting
3. Mucous Membrane Absorption
4. Oral Ingestion
5. Contact Absorption
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Inhaling
The vaporized drug enters the lungs and is rapidly absorbed through tiny blood vessels in the lungs called capillaries. It travels back to the veins and then the heart where it is pumped directly to the brain and the rest of the body.
Time of transmission: 7-10 seconds for change to begin
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Inhaled drugs
MarijuanaFreebase cocaineGlueAerosolsCigarettes
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Characteristics of Inhaled drugs
Effects felt quickly Easy to regulate the amount of the drug
used Only small amount absorbed with each
inhalation
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Injecting Intravenous injecting – “Slamming”Injected directly into the blood stream by
way of a vein Intramuscular injecting – “muscling”Injecting into a muscle mass Subcutaneous – “Skin popping”Injecting just under the skin
Time of transmission: 15-30 seconds in the vein
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Time of transmission for injected drugs:
15-30 seconds in the vein3-5 minutes in the muscle or
under the skin
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Injected Drugs
HeroinCocainemethamphetamines
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Characteristics of Injected DrugsLarge amount absorbed at onceInstant “RUSH”Nothing of the drug is wasted
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Snorting and Mucosal absorption
Insufflation – absorption into the muscosa membranes in the nasal passages
Sublingual – absorption into the mucosa under the tongue
Buccally – between the gums and the cheek Rectally – absorption into the mucosa in the
rectum Vaginally – absorption into the mucosa in the
vagina
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Time of Transmission
From 3 to 15 minutes depending on the place of administration
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Drugs of Mucosal Absorption
Cocaine Herion nitroglycerin Chewing tobacco Morphione
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Characteristics of Mucosal Absorbed Drugs Results more rapid High more intense Bypasses the digestive acids, enzymes
and liver
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ORAL
Swallowed Passes through the esophagus into
stomach Absorbed in to the capillaries and enters
the vein and liver Pumped back to the heart and on to the
rest of the body
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Time of transmission
20-30 minutes from administration
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Drugs of Oral Admission
Oxycontin Xanax Valium Loratab Robotussin Alcohol
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Characteristics of Oral Ingested Drugs Low Concentration at Absorption First Pass metabolism (first absorbed)
drugs are most potent
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Transdermal Absorption
Absorbed through the skin– Lotions– Eye drops– Patches– Stamps
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Time of Transmission
1-2 days for effects to be noticed Up to 7 days of absorption in the
average patch
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Drugs of transdermal absorption
Nicotine Fentanyl Clonidine LSD Cocaine
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Characteristics of Transdermal Administration Usually by prescription Measured amount of the drug Seldom used for illegal drugs
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Drug Distribution: GETTING TO THE BRAIN Distribution depends on Blood volume
and characteristics of the drug
– Less blood volume, increased potency MOST PSYCHOACTIVE DRUGS ARE
FAT SOLUABLE THEY CAN CROSS THE BLOOD
BRAIN BARRIER
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The Blood Brain Barrier
The Gateway to the central nervous system
The wall of the capillary in the brain which is sealed to act as a barrier to the brain.
Only Fat soluble drugs can cross the blood brain barrier
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The Nervous System
The Central Nervous System – half of the complete nervous system, includes the brain and the spinal cord
The Peripheral Nervous System – the
Other part of the nervous system which connects the CNS with the internal and external systems
Includes the autonomic nervous system
and the somatic nervous system
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The Central Nervous System
The Brain – Computer of the body, receiving, analyzing and responding to messages from the peripheral nervous system
Controls circulatory response Respiration Digestion Excretory function Endocrine function Reproductive function Enables us to reason and make judgments
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Autonomic Nervous System
Controls involuntary functions such as– Circulation– Digestion– Respiration– Glandular outputs– Genital reactions– Sympathetic responses
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Somatic Nervous System
Includes sensory neurons that reach the skin, muscles and joints. Responsible for relaying information about muscle and limb position
Transmits instructions back to skeletal muscles
Provides for voluntary response
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Understanding how nervous system processes messages Neurons - nerve cells that act as the
building blocks of the nervous system
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Parts of a neuron: (see handout)
Dendrites- finger like bodies that receive signals from other cells and then relay them to the cell body
Soma – the cell body Axon – the finger like bodies that carry
the signals away from the cell Terminals – the pathway that carries the
signal from one cell to the dendrites of the next cell.
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Terminals of one cell do not touch the dendrites of the next cell Synaptic Gap – the microscopic space
between the terminals of one cell and the dendrites of the next cell
A message jumps the synaptic gap in the form of neurotransmitters.
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Neurotransmitters – bits of chemicals that are synthesized electrical signals that jump the synaptic gap
Vesticles – tiny sacs that store neurotransmitters
Synapse – the transmission process across the synaptic gap
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Receptor Sites – Protein molecules that are activated by neurotransmitters.
When receptor sites are activated, they open a molecular gate that allow electrical charges in or out
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The process of message transmission (see handout)
1. Incoming electrical signals force the release of neurotransmitters
2. From the vesticles3. And send them across the synaptic gap4. On the other side the neurotranmitters
“fit themselves” into 5. receptor sites6. The receptor sites open the ion
molecule gate
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7. Allowing the electrical charges in or out
8. When enough electrical charge is achieved, the next signal fires
9. Once the job is done, neurotranmitters return to the synaptic gap and are reabsorbed by reuptake ports
10. Auto receptors monitor the amount of neurotransmitter needs for the transmission
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Psychoactive drugs disrupt the process of message transmission
Drugs that enhance the activity of the neurotransmitters and receptor sites are called agonists
Drugs that block activity are called antagonists
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Specific Drug Examples:AGONISTS:
Cocaine - forces the release of extra neurotranmitters and blocks their reabsorption
ANTAGONISTS:
Heroin – inhibits the release of neurotransmitters and therefore blocks a message of pain from reaching the brain
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The body regards any drug as a toxin, but ifthe use continues over a long time, it is forced to adapt and and develop a tolerancefor the drug
Tolerance – the need to use increase amounts to get the same effect!
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Types of Tolerance
Dispositional Tolerance – the speeding up of metabolism in order to eliminate the drug
Pharmacodynamic Tolerance – nerve cells become less sensitive to the drugs
Reverse Tolerance – when the body systems are no longer able to metabolize drugs and the body can no longer tolerate the drug (alcohol absorption after liver destruction)
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Acute tolerance – an automatic acceptance of a drug by the body
Select Tolerance- When increased quantities of a drug are taken to overcome acute tolerance in order to produce a high
Inverse Tolerance – When a person becomes more sensitive to the effects pf a drug as the brain’s chemistry changes
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Withdrawal – the bodies attempt to rebalance itselfNonpurposive Withdrawal – Physical
withdrawal -objective physical signs that are directly observable when a drug is stopped.
EXAMPLES: Seizures Sweating Goosebumps Vomiting Diarrhea Tremors
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Purposive Withdrawal-psychological withdrawalResulting behavior exhibited by an addict
when the drug stops
EXAMPLES: Manipulation Psychic Conversion (anticipated
nonexistent symptoms of withdrawal) Malingering
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Protracted Withdrawal: Environmental Influence Withdrawal stimulated by environmental
triggers or cues
EXAMPLE:
Any white powder may trigger a cocaine addict
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Body Effect vs Withdrawal
See hand out on opioids
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Metabolism - the body’s mechanism for processing foreign substances
Excretion – the process of eliminating foreign substances
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What effects Metabolism
Age – after 30 the body produces less enzymes
Race – different ethnic groups have different levels of enzymes
Sex – males and females metabolize at different rates
Health – certain conditions affect metabolism
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Emotional Health – Metabolism is affected by preexisting chemical imbalance
Other Drugs – two or more drugs will have the body fighting for metabolism attention making the process slower
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Desired Effects of Drug Use Curiosity Satisfaction To “get high” and be in dreamlike state To self –medicate To have confidence To have energy Pain Relief Anxiety Control Peer influence Social Confidence Boredom Relief
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Desired Effects of Drug Use:To feel Normal
NORMAL________________________
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Levels of Use
Abstinence Experimentation Social/Recreational Habituation Abuse Addiction
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Theories of Origins of Substance abuse
Moral Theory of Addiction
Intoxication is individual weakness
Originates from Moral Decline
Addiction is shameful and sinful
Shift away from this thinking in 1935 with the founding of AA
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Genetic TheoryNature vs Nurture debate
Addiction runs in families
Predisposition to drug use
Research indicates this is one degree rather than full determinant
Lead to development of the systems theory of addictions
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Disease Theory of Addiction
–A physiological deficit in an individual making the person unable to tolerate the effects of the chemical therefore leading to addiction
–Does not blame the addict for the disease
–Gained popularity in the mid 20th century and elevated substance abuse from the realm of morality to a treatable form
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DiagnosisChemical Dependence – DSM IV (three or more)
–1. Tolerance
–2. Withdrawal
–3. Use more than intended
–4. Efforts to quit or cut down
–5. Large amount of time spent in use
–6. Giving up or reducing importance activities
–7. Continued use despite knowledge of physical and psychological problems caused by chemical
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Chemical Abuse: (One or more)
1. Failure to fulfill major role obligations
2. Chemical use in dangerous situations
3. Substance related legal problems
4. Continued use despite recurrent interpersonal problems related to the effects of substance use.
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Compulsion Curve
Heredity Heredity + environment Heredity + environment + Drug Use Long/Term use Detoxification and Abstinence (no return
to starting place of curve) Relapse
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SCHEDULE OF DRUGS
An organization effort by the Dept of Criminal Justice to control substances
Schedules are V-I beginning with those of lease potential for abuse
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Schedule of Drugs
Schedule I: Heroin, Marijuana, LSD Criteria
– High potential for abuse– No currently acceptable medical use in US– Lack of accepted safety for use under
medical supervision
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Schedule 2: morphine, cocaine, injectable methamphetamine High potential for abuse Currently accepted medical use Abuse may lead to psychological or
physical dependence
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Schedule 3: Amphetamines, barbiturates, PCP Potential for abuse less that I or 2 Currently accepted medical use Abuse may lead to moderate physical
dependence or high psychological dependence
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Schedule 4: Barbital, Chloral hydrate, paraldehyde Low potential for abuse relative to 3 Currently accepted for medical use Abuse may lead to limited physical or
psychological dependence relative to 3
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Schedule 5: Mixtures with small amounts of codeine or opium Low potential for abuse relative to 4 Currently accepted medical use Abuse may lead to limited physical or
psychological dependence relative to 4
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UPPERS: Stimulants
Cocaine Amphetamines Diet Pills Caffeine Nicotine Ephedrine Herbal Ephedra
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Cocaine:Extract of the Coca plant
Origin: South America Common Names: Crack, Crank,
rock Ingestion: inhalation, injection,
smoking
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Effects on the body:
Directly effects the heart causing irregular heat beat, vessel narrowing, restricted oxygen, constricts blood flow
Heart attacks, Acute Hypertension and stroke Forces release of neurotransmitters and
blocks reabsorption Seizures/Psychosis Diminished mental functioning Crosses the Placenta and can cause
miscarriage, brain bleeds, SIDS and blood vessel malformation
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Tolerance and Dependence
Tolerance often after the first injection Physical dependence is possible Intense High which blocks dopamine
uptake is motivation
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Withdrawal
Crash after binge– Sleeping, total lack of energy– Temporary return to normal (leave
treatment)– Cravings start– Emotional depression– Relapse
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Amphetamines:Synthetic Ephedrine
Origin –United States (Asthma treatment)
Common Names –speed, meth, crystal
Ingestion: orally ingested, injected, snorted, smoked
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Effects on the body Crosses the Blood Brain Barrier easily Acts on neurotransmitters and effect the
Sympathetic Nervous System by blocking neurotransmitter reuptake
Accelerates neural firing Rapid heart rate,
hypertension,headache,severe chest pain
Profuse sweating/heat elevation Delirium, psychosis, paranoia and
hallucinations
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Tolerance and Dependence
Tolerance develops to specific actions of the drug including euphoria,appetite suppression,wakefulness, heart rate increase, hyperactivity
Physical and psychological dependence
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Withdrawal: Due to reduction of neurotransmitters Depression Fatigue Increase appetite Prolonged sleep with REM Convulsions Circulatory collapse
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Amphetamine Congeners
Stimulant drugs that produce same effects as amphetamines
Not as strong Examples
– Ritalin– Stratera– Diet Pills (obenex, Ephedra)
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Caffeine: The most popular stimulant in the world!
Origin: Primarily from South America
Common Names:
Coffee Chocolate
Cocoa Colas
Teas
Ingestion: Orally
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Effects on the Body
Rapidly absorbed in the intestine Crosses the blood brain barrier Blocks the receptor sites for Adenosine
a natural sedative Dilatation of blood vessels Increases urine output Increase heart rate, Arrhythmias tachycardia
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Tolerance and Dependence
Stimulation of the reward center of the brain leads to increased tolerance
Gradual exposure Potential for physical and psychological
dependence is small (yeah right!)
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Withdrawal:
Cravings for Caffeine Headache Fatigue Nausea Marked anxiety Depression
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Nicotine Origin: India Common Names:
– Smokes Chimney– Sticks Chew– Roll Snuff
Ingestion: inhalation
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Effects on Body:Stimulant and Sedative Causes discharge of epinephrine Absorbed in the body at every site of contact
(lips, teeth, lungs, hands) Reaches every blood rich tissue of the body Increased heart rate, blood pressure, cardiac
output,coronary blood flow Earlier menopause Profound contributor to mortality Low birth weight in infants
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Tolerance and Dependence
Tolerance occurs and nicotine remains in the body
Remains in the body 24 hours after use High potential for physical and
psychological dependence
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Withdrawal
Increased anger Hostility Aggression Loss of social cooperation
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Downers:
Downers depress the overall functioning of the central nervous system to induce sedation, muscle relaxation, drowsiness, and even coma. They cause disinhibition of impulses and emotions.
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Downers (depressants), which include opiates/opioids, sedative-hypnotics, and alcohol, depress the central nervous system. Effects range from sedation, pain relief, anxiety control, muscle relaxation, suppression of inhibitions, and drowsiness up to unconsciousness, coma, and death. They work by either inhibiting pain, stimulatory, and other neurotransmitters or by mimicking the body's natural sedating neurotransmitters.
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Opiates/Opiods/.AlcoholMajor Depressants
Origin: Egypt, China
Common Names: heroin,morphine, codeine, Darvon darvocet, loratab, oxycontin,Dilauid,Vicodin,
Ingestion: oral, snorted,smoked, Injected (most predominant)
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Medical Use of opiods/opiates
Pain relief- mask pain signals Cough suppressant
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Effects on the Body Act at the neural synapse causing the release
of neurotransmitters Decreased anxiety, sense of serenity Deadening of emotions, inability to feel Emptiness, depression, Lowered blood pressure, pulse,respiration, Eyelids droop,slurred speech,non reactive
pupils, Trigger nausea center and suppress cough
center of the brain
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Tolerance and Dependence
High risk of physical and psychological dependence
Learned association between the effects of the drug and environmental cues
Rapid tolerance and dependence Produces “threshold effect”
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Withdrawal:
Bone and joint pain Muscle cramps Nausea Yawning Sweating Tearing Runny nose cravings
Severe muscle pain Flu like symptoms Much anxiety Chills Goosebumps High blood pressure Insomnia diarrhea
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Heroin and Morphine
Origin: Asia, Mexico Common Names: “China White”
“Mexican Tar” Ingestion: injected, smoked, snorted
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Effects on Body Depressed heart rate Slow respiration Depressed muscular coordination Increased nausea Pinpoint pupils Itching Mental confusion
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Tolerance and Dependence
Rapid tolerance Strong physical dependence Psychological dependence due to fear
of rebound pains
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Withdrawal
Extremely painful muscle aches Strong cravings Sweating Runny nose Yawning Nausea Difficult, but no real risk of death
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Methadone
Only one of two legally authorized opiods used to treat heroin addiction
Mehtadone is addictive and must be monitored closely
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Additional effects
Neonatal death Overdose Shared needles Hepatitis C HIV Adulteration
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Sedative-Hypnotics
Origin: Ancient Greek Cultures
Common Names: Benzo, xany bars, barbies,
Ingestion: Oral, snorted
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Medical Use of Benzodiazepines Manage anxiety disorders Short term treatment for panic attacks Control apprehensions of surgical patients Treat sleep problems Control muscle spasms Elevate seizure threshold Control acute alcohol withdrawal
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Effects on the body
Anxiolytic,anticonvulsant, and sedative effects
Depressed breathing Slowed heart rate Coma in overdose
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Tolerance and Dependence
Both physiological and psychological dependence
This is a metabolic dependence Short term use is safe Loge term use must be monitored A younger person can tolerate higher
dose
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Withdrawal
Rebound symptoms Protracted withdrawal – long lasting Cravings-emotional,environmental
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Barbiturates: Drug of the past
Origin: United States Common Names: Methaqualude
(ludes),Nembutal (yellow jacket), Seconal (redbirds),Tuinal (rainbows)
Ingestion: orally or injection
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Effects on the body
Elevated mood Reduction of negative feelings Increased energy Unsteady gait Slurred speech Eye twitches Sedation Intoxication similar to alcohol
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Tolerance and Dependence
Can create tolerance after single dose Psychological and physical dependence Tolerance develops as a result of
metabolic changes which destroy the barbiturates faster.
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Withdrawal 12-24 hours after last use Anxiety Tremors Nightmares Insomnia Anorexia Nausea Delirium Seizures
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Other Sedatives
Club Drugs: Date drugs– GHB: strong depressant– Rohyypnol: “Ruffies”
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Drug Interactions
Alcohol and sedatives-hypnotics used together are especially dangerous
Cross –tolerance and cross dependence occur within the opiod class of drugs of drugs
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Alcohol
Origin – prehistoric use, fermented grapes left in a basket
Common Names – Beer, wine distilled spirits
Ingestion – Oral, rectal absorption
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Effects of Body Body treats as poison and begins elimination as soon as
ingested Metabolized in the liver Immediate absorption Cardiovascular system affected at low levels of use:
peripheral dilation, but depression of cardiovascular function with severe intoxication
Gastritis, ulcers, pancreatic hemorrhage Depressed respiration Increased risk of cancer Lower sexual function Reproductive problems
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Long terms effects of Alcohol Addiction Liver damage Digestive effects Enlarged Heart Loss of brain cells Increased desire/decreased performance Increased chance of breast cancer Reduced fertility
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Blood Alcohol Concentration:BAC 1 ounce of alcohol is excreted each hour With this knowledge it is possible to
determine the amount of alcohol that is circulating in the body
It takes approximately 15-20 minutes for alcohol to reach the brain and about 30-40 minutes for the alcohol to reach maximum level of concentration. This is known as the level of blood alcohol Concentration or BAC
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Absorption: Rapid
Because alcohol is absorbed very quickly after entering the body, it has a rapid high.
While absorption of most drugs begins in the intestine, alcohol absorption begins in the stomach and is metabolized and excreted quickly
10 – 20% of alcohol is excreted in the urine or through the lungs without being metabolized
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Factor effecting Absorption
Body weight Sex Health Drinking rate High concentration
of alcohol in drinks Using with
carbonated beverages
Warming the alcohol Women absorb
faster Drinking on an
empty stomach Diluting alcohol with
ice, water or fruit juices
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Tolerance and Dependence Liver function becomes more efficient Brain cells are less effected by the
alcohol Fewer symptoms of intoxication HOWEVER THE LEATHAL DOSE
DOES NOT CHANGE! Risk of dependence is moderate Younger the drinker the greater the risk
of dependence
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Withdrawal Symptoms appear in 12-72 hours of
cessation lasting 5-7 days Referred to as Delirium Tremens Sweating Shakes Anxiety Nausea Diarrhea Transitory hallucinations
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Fetal Alcohol Syndrome Specific toxic effects of alcohol on unborn
fetus is known as “Fetal Alcohol Syndrome”
– Retarded growth before and after birth– CNS involvement including delayed intellectual
development– Facial abnormalities
• Heart shaped face• Shortened eye openings• Flattened mid-face• Thin upper lip
– Hearing loss– Gait problems
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Scope of the problem: 1999 stats The majority of people in almost every
country, except for Islamic countries, consume alcohol
Last month about 113 million Americans had at least a can of beer, a glass of wine, or cocktail
In 1998 over 2 million people died due to alcohol
10% of all diseases and accidents are alcohol related
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45% of homeless have serious alcohol problems
28% of high school students use alcohol
45% of all college students use alcohol
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Alcohol and Polydrug Abuse
Most drugs involve more than one substance, especially alcohol
When this happens the synergism effect comes into play
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ALL AROUNDERS:Psychedelics Origin: Psychedelics and hallucinogens
have been around since the origin of man.Derived from plants including fungi.
Common Names: marijuana, LSD, PCP, peyote, psilcybin (mushrooms),and MDMA
Ingestion: oral, smoked, injected, snorted
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Effects on the Body Major effect is overt stimulation Intensified sensations particularly
visuals ones Suppressed memory centers Impaired judgment
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Lysergic Acid Diethylamide (LSD) LSD is 1,000 more powerful than natural
hallucinogens, but weaker than most synthetic chemicals
Somatic effects are: – Dizziness– Weakness– Tremors– Altered vision– Intensified hearing– Dreamlike imagery
Tolerance and Dependence is not truly known
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Phencyclidine (PCP): Angel Dust PCP was developed as a general
anesthetic but was found unstable Major chemical is peperdine Purity can be anywhere from 5-100%
making use a tremendous risk Ingestion: smoke, oral, snorted No potential for physical tolerance, but
extreme psychological dependence
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Effects on the Body
Amnesia Extremely high blood pressure Combativeness Tremors Seizures Catatonia Coma and kidney failure
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Designer Drugs: synthetic psychedelics Ecstasy (MDMA): DATE DRUG Origin: Spread from the UA to
England in 1980s
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Effects on the Body
Reduced depression Heightened introspection and intimacy Acts to deplete seritonin, a neurotransmitter
that leads to relaxation Heart attacks, strokes Liver disease, hyperthermia Panic disorder, paranoid psychosis depression
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Marijuana:CANNABIS
Origin: Used for thousands of years, cannabis’ place or origin appears to be the Netherlands
Common Names: Weed, grass, pot, blunts, joints,green
Ingestion: smoked, oral Active ingredient: Tetrahydracannabinol- THC Schedule 1 drug
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Other information about marijuana Mostly widely used illicit psychoactive
drug Sinsemilla –a form of cannabis from an
unpollinated hemp plant- extra potent Standard cannabis has about 3% THC,
sinsemilla has about 15%, Hash oil has about 60% THC
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Effects on the Body Irritation to lungs and respiratory system
– (5 times more tar than nicotine)
Fluctuation in emotions Impaired memory and concentration More vivid senses, decreased tracking ability Diminished hand-eye coordination Sedation and dreamlike state Dilated pupils, Bloodshot eyes Inhibited sweating A-motivational syndrome
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Tolerance and Dependence
Conflicting research on physical dependence but definite psychological dependence
Tolerance develops rapidly
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Withdrawal Headaches Anxiety Depression Irritability Aggression Restlessness Tremors Sleep distortions Strong cravings
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Other Drugs of Choice
Inhalants -
Three types of inhalants:
1. Volatile and aerosols-paints, fuels,hair sprays, cooking spray , air fresheners
2. Volatile nitrites – amyl nitrate “Poppers”
3. Anesthetics – nitrous oxide,ethylene
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About 17% of all adolescents in the US have used inhalants
may be sniffed, snorted huffed, bagged, or inhaled
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Sports Drugs
Three main categories of sports drugs
1. Therapeutic drugs –analgesics, muscle relaxants, asthma medications
2. Performance –enhancing drugs –steroids, growth hormones, amphetamines
3. Recreational/mood altering – cocaine, marijuana, alcohol, tobacco
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Other Addictions
Compulsive Behaviors – continuing a behaviors despite adverse consequences– Bad diets– Exercise– Fast food restaurants– Credit cards– shopping
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Gambling
Includes:– Cards, races, slots, stocks, day trading,
Characteristics include– Progressive betting– Attempts to recoup losses– Restlessness– Irritability– Jeopardizing of family, relationships, job
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Eating Disorders
Three main disorders1. Bulimia- look normal but bingeing and
throwing up
2. Anorexia-60% loss of body weight
3. Compulsive over eating –eating triggered by emotional state
95% of anorexics and bulimics are female
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Sexual Addiction
Compulsive Sexual Behaviors1. Pornography2. Masturbation3. Phone sex4. Voyeurism5. Flashing6. Repeated adultery
Sexual activity usually followed by guilt remorse and fear.
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The Treatment Phase
Prevention
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PREVENTION
Goal – prevent abuse before it happens– Scare tactics– Drug information– Skill-building– Environmental change programs– Public health models – user testimonies
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The Treatment Phase
Treatment
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Components Of Substance Abuse Treatment:
Medical and Biological Treatments: – Detoxification – Diet and Nutrition Concerns – Medication (Symptom Reduction) – Medication (Relapse Reduction) – Drug Screening
Psycho-Social Treatments: – Psychotherapy – Relapse Prevention – 12 Step Programs
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Stages of the Therapeutic Process
• Intervention
• Assessment Phase
• Feedback phase: Diagnostic Phase
• Implementation phase or treatment phase
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Resources
BOOKS:
Substance Abuse Counseling –
Patricia Stephens and Robert Smith
Treating Alcoholism, Robert Perkinson
Faithful and True – Mark Laaser