Substance Abuse Treatment Quiz

Misuse of Medicines and Drugs

• Misuse of medicines involves unintentional or inappropriate use of prescribed or over-the-counter drugs.
• Drug abuse is the intentional and inappropriate use of a drug, leading to physical, emotional, financial, social, or intellectual consequences.
• Addiction is a chronic, recurring disease characterized by compulsive drug seeking and use, despite negative consequences. The prolonged effects of drugs impact the brain.

Learning Objectives

• Identify commonly abused drugs.
• Understand treatment options for drug abuse and dependence.
• Understand the role of pharmacists in managing drug abuse and dependence.

Definitions

• Drug Misuse: Unintentional or improper use of prescribed or over-the-counter drugs.
• Drug Abuse: Intentional and improper use of a drug, resulting in negative consequences.
• Addiction: A chronic disease characterized by compulsive drug seeking and use in spite of negative consequences.

Reasons for Drug Abuse

• Environmental Influences: Cost of drugs, parental influences, community factors (social acceptance or not), peers (positive or negative reinforcement), federal laws related to drug use, interpersonal and social influences, marketing of drugs, personal situations (anxiety, stress, depression), local law enforcement (enforcement policies), representation of drugs in media/movies, and minimum drinking age.
• Individual Influences: Curiosity, pleasure/escape from boredom, peer influence (gaining acceptance or approval), low self-esteem, poor interpersonal skills, need for immediate gratification, rebelliousness, lack of tolerance for anxiety/frustration/depression, impulsivity, risk-taking behavior, and disregarding personal health.
• Desire to enhance performance in sports: Athletes may abuse anabolic steroids, human growth hormones, erythropoietin (EPO), androstenedione, or stimulants.

Reasons for Drug Abuse: Other Key Points

• Experimentation: Curiosity is a common reason for young people trying drugs. Drugs can also be seen as tools for self-discovery.
• Pleasure/Escape: Drugs increase pleasure or reduce boredom, leading to reinforcement due to euphoria. The user seeks physical or social reward.
• Peer Influence: Many young people use drugs to gain peer acceptance or facilitate social interactions. Peers may have a more significant influence than family in early adolescence, but strong family connections might reduce problematic drug use.
• Personality Traits: Some characteristics linked to drug misuse include low self-esteem, poor interpersonal skills, a need for immediate gratification, rebelliousness, low tolerance for stress/anxiety, impulsivity, risk-taking, and disregard for personal well-being.

Drug Dependency

• Dependency involves needing a drug for its pleasurable effects. Behavioral changes occur when drug use stops. Maintaining the desired effects requires increasing dosage or frequency.
• Physical Dependency: Withdrawal symptoms (physical symptoms) manifest when drug use stops. People with physical dependency need the drug to avoid these symptoms.
• Psychological Dependency: The perceived need for a drug.

Tolerance

• Tolerance occurs when repeated exposure to a drug diminishes its effect. Higher doses are needed to attain the same effect.
• Common with depressants (e.g., alcohol, opioids, benzodiazepines, barbiturates) and stimulants (e.g., cocaine, amphetamines).

Types of Drugs/Substances Abused

• Narcotics
• Sedative-Hypnotics
• Stimulants
• Hallucinogens
• Marijuana/Cannabis
• Alcohol
• Inhalants

Narcotics

• Naturally derived from opium or produce similar effects.
• Central nervous system (CNS) depressants.
• Relieve pain and induce profound sleep ("narcosis").
• Examples: Opium, Morphine, Heroine, Codeine, synthetic opiates (pethidine, methadone, oxycodone, fentanyl).
• Administration methods include oral (pills, chewing), inhalation (smoking), injection, and snorting.

Withdrawal Symptoms

• Include diarrhea, runny nose, constant yawning, insomnia, muscle aches and pains, dysphoria (feeling of unease), tearing, nausea and vomiting, fever, and perspiration.

Sedative-Hypnotics

• CNS depressants.
• Types include barbiturates (e.g., pentobarbital, secobarbital) and benzodiazepines (e.g., Valium, Xanax).
• Other examples include antihistamines, sedatives, anxiolytics, hypnotics, and amnesics.

Stimulants

• Increase activity levels and alter mood, enhancing performance.
• Major stimulants include amphetamines (e.g., speed, crystal meth) and cocaine.
• Common intake method is snorting.
• Minor stimulants include over-the-counter (OTC) sympathomimetics (cold, allergy, and diet medications) and caffeine-like drugs.

Hallucinogens

• Drugs that cause hallucinations, altering thoughts, feelings, and perceptions.
• Examples include:
  • Serotonergic hallucinogens (e.g., LSD, mescaline, psilocin).
  • Phencyclidine (PCP).
  • Methylene-dioxymethamphetamine (MDMA/Ecstasy).

Marijuana/Cannabis

• Derived from the Cannabis sativa plant.
• Primary psychoactive agent is tetrahydrocannabinol (THC).
• Works quickly and intensely when smoked.
• Used to treat asthma, glaucoma, multiple sclerosis, nausea, and vomiting.

Alcohol

• Produces a sedative effect on the CNS.
• Affects many bodily organs (brain, liver, GI tract, cardiovascular system, immune system).
• Often interacts with prescription medications in a synergistic way, increasing the CNS depressive effect.
• Alcoholism is characterized by physical and psychological addiction to ethanol. Major components include craving, impaired or loss of control, physical dependence, and tolerance.

Inhalants

• Volatile substances.
• Include aerosols (e.g., spray paints, deodorants, hair sprays), toluene (in glues, paints, thinners, nail polishes), butane/propane (hair/paint sprays), gasoline, freon (refrigerators, air conditioners, airbrushes), and anesthetics (e.g., ether, chloroform, halothane, nitrous oxide).
• Inhaled into the lungs to cause physiological and psychological changes.

Substance Abuse Treatment

• Pharmacological Treatment:
  • Opioid addiction: Methadone, buprenorphine (Subutex/Suboxone), naltrexone.
  • Alcoholism: Disulfiram, naltrexone, acamprosate.
• Psychosocial and Other Treatments:
  • Counseling, self-help groups (e.g., Alcoholics Anonymous, Narcotics Anonymous).
  • Rehabilitation programs (short-term and long-term residential).
  • Medical detoxification (supervised withdrawal from drugs).
  • Symptomatic treatment of withdrawal.

Role of Pharmacists

• Involvement in Treatment: Identifying patients with substance abuse issues, creating referral lists, referring patients for treatment, and recommending appropriate pharmacotherapies.
• Drug Prevention: Participating in substance abuse education and prevention programs, working with authorities to control substance abuse, and discouraging prescribing practices that increase drug misuse.
• Drug Education: Providing information and referrals to support groups, counseling patients on psychoactive substance use, fostering pharmacy curriculum development and continuing education programs, and educating other healthcare professionals and drug abuse counselors.