CHYS 3P92 Lecs (2) PDF Lecture Notes

Lecture 4: DRUG EFFECTS & DRUG INTERACTIONS PHARMACOLOGICAL PROPERTIES & DRUG EFFECTS ​ ACTION ​ WHEN THE EFFECT IS MEASURED ​ DOSAGE ​ ROUTE OF ADMINISTRATION Non-Specific Drug Effects ​ Not specific to the action of the drug ​ Organismic Effects ​ Environmental Effects ORGAN...

Lecture 4: DRUG EFFECTS & DRUG INTERACTIONS PHARMACOLOGICAL PROPERTIES & DRUG EFFECTS ​ ACTION ​ WHEN THE EFFECT IS MEASURED ​ DOSAGE ​ ROUTE OF ADMINISTRATION Non-Specific Drug Effects ​ Not specific to the action of the drug ​ Organismic Effects ​ Environmental Effects ORGANISMIC EFFECTS ​ AGE ​ WEIGHT ​ SEX ​ BIOLOGICAL RHYTHMS ​ PERSONALITY ​ PHYSIOLOGICAL STATE ​ GENETICS ​ EXPECTANCIES PILL COLOUR ​ RED = EXPECT STIMULATING EFFECTS ​ BLUE = EXPECT DEPRESSANT EFFECTS ENVIRONMENTAL EFFECTS ENVIRONMENTAL EFFECTS cont.. ​ Setting in which you take the drug ○​ e.g., alcohol ○​ e.g., drug overdose (Siegel) *THE PLACEBO EFFECT ​ PLACEBO = “I will please” ​ Any medical treatment that is inert ​ Can take any of the following forms: ○​ Drug ○​ sham surgery ○​ physical therapy ○​ special diet *TYPES OF PLACEBOS ​ Inert Placebo = any medical treatment that is devoid of any action (pharmacological, surgical …) ​ Active Placebo = treatments that actually have action, but the actions are not specific to the condition for which they are being administered ​ PLACEBO EFFECT = the physiological or psychological response to an inert substance or procedure ​ a.k.a = the subject-expectancy effect ​ Approximately 1/3 of people respond to placebos *THE NOCEBO EFFECT ​ The placebo effect’s evil twin.... Negative expectations may trigger symptoms or illness (e.g., side effects) in response to an innocuous stimulus (nocebo) ​ e.g., Voodoo death ​ e.g., aspirin study Objective or Subjective Effects? The Placebo Effect & Pain (Wager et al., 2004) 1. The magnitude of these neural decreases correlates with reduction in reported pain. 2. Placebo manipulations decrease neural responses in brain regions that are pain sensitive. 3. These findings provide strong refutation of the conjecture that placebo responses reflect nothing more than report bias The Placebo Effect & Pain cont... ​ Zubieta et al. (2005) found that placebos can trigger the release of endorphins ​ Significant placebo-induced activation of - opioid receptor -mediated neurotransmission was observed in both higher-order and subcortical brain regions, which included the AC , the DLPFC, the IC, and the NA. ​ Regional activations were paralleled by lower ratings of pain intensity, reductions in its sensory and affective qualities, and in the negative emotional state of the volunteers. ​ These data demonstrate that cognitive factors (e.g., expectation of pain relief) are capable of modulating physical and emotional states through the site -specific ​ activation of μ-opioid receptor signaling in the human brain. ​ ACUTE VRS. CHRONIC EFFECTS ​ CHRONIC EFFECTS: CUMULATIVE EFFECT OF REPEATED DOSES (RELATED TO PATTERN OF USE OVER TIME) ​ CHRONIC EFFECTS ≠ Σ ACUTE EFFECTS ​ PROBLEMS ASSESSING CHRONIC EFFECTS: ○​ CONSEQUENCES OR CAUSE OF PREEXISTING STATE? ○​ POLYDRUG USE ○​ SECONDARY MEDICAL COMPLICATIONS ***TOLERANCE  ​ Increased amounts of drug needed to achieve desired effect, or diminished drug effect obtained with continual use of the same amount of drug: ​ **DIFFERENT TYPES ​ Functional tolerance/Pharmacodynamic tolerance ​ Metabolic tolerance/Dispositional tolerance ​ Acute tolerance ​ Protracted tolerance ​ Behavioural tolerance ​ Cross-tolerance **Drug Interactions LECTURE 5: The Stimulants Stimulants ​ Cocaine ​ Methamphetamine ​ Ephedrine  ​ Methylphenidate CNS Stimulants I.​ Cocaine, Crack (free base or hydrochloride). II.​ Amphetamines: -​ D-Amphetamine, Methamphetamine, methylphenidate (use to treat attention deficit disorders in children), phenmetrazine (Preludin) - used to treat obesity, (hallucinogens = MDA, MDMA, DOM; methylenedioxymethamphetamine, "ecstasy," dimethoxyamphetamine). III.​ Khat: Cathinone, methcathinone. IV.​ Methylxanthines: caffeine (coffee), theophyline (tea), theobromide (chocolate). CNS Stimulants ​ Sub-Categories of CNS Stimulants ○​ Synthetics ​ Pharmaceuticals ​ illicit mfg ○​ Organics ​ cocaine Pharmaceutical Stimulants ​ Medical Uses 1.​ control of narcoleps 2.​ control of hyperactivity in children 3.​ prevention of fatigue 4.​ treatment of mild depression 5.​ control of appetite 6.​ prevention and treatment of surgical shock 7.​ treatment of Parkinson's disease 8.​ blood pressure maintenance during surgery 9.​ enhance the action of certain analgesic drugs 10.​antagonize the effects of certain depressant drugs Pharmaceutical Stimulants Common Examples ​ Methamphetamine (Desoxyn, Biphetamine) ○​ weight control ​ Ritalin (methylphenidate) ○​ ADD ​ Preludin (phenmetrazine) ○​ weight control ​ Cylert (pemoline) ○​ ADD Ritalin and ADHD  ​ Since Ritalin (methylphenidate) is a stimulant, how does it help rather than make things worse?! ​ May selectively activate mesocortical pathway, improving working memory, attention ​ May selectively activate mesolimbic pathway, improving motivation ​ Hyperactivity may be indirect result of low DA, rather than high DA in nigrostriatal pathway Cocaine Overview ​ Alkaloid from Erythroxylon coca ​ Indigenous to western South America ​ Coca leaves used for religious, mystical, social, stimulant, and medicinal purposes ​ Main stimulant uses: endurance, feeling of well-being, alleviate hunger ​ Medical uses: local anesthetic, Vasoconstrictor History ​ Inca culture ​ Sigmund Freud (1884) ​ Ernst von-Fleischl (1st European addict) ​ R.L Stevenson ​ Arthur Conan Doyle ​ Arthur Conan Doyle ​ 1863----Vin Mariani ​ Wine laced with cocaine ​ U.S.A—French Wine of Cola ​ Czar Nicholas ​ Edison ​ Pope Leo XIII ​ Queen Victoria Cocaine Production ​ Coca paste extracted from soaked and mashed leaves (60-80% cocaine) ​ Cocaine powder made by mixing paste with hydrochloric acid (cocaine HCI) ​ Freebase/crack extracted from powder with baking soda Cocaine Pharmacokinetics: Absorption ​ Routes of administration ​ Insufflated (snorted) ​ IV (mainlined) ​ Inhaled (freebased) ​ Oral Pharmacokinetics: Distribution and Metabolism ​ Both cocaine and amphetamines penetrate Blood Brain Barrier easily ​ Half-lives ○​ Cocaine: ~ 50-90 min ○​ Amphetamine: ~ 5-10 hours ○​ Meth: ~ 12 hours ​ Metabolites include active and inactive compounds ​ Cocaine is unusual in that it “autometabolizes” in the blood in addition to normal liver metabolism. ○​ Cocaine----> norcocaine, ecgonine methyl ester, benzoylecgonine Cocaethylene ​ Alcohol inhibits metabolism of cocaine ​ Alcohol + cocaine chemically react to form cocaethylene ​ Only known example where body forms new psychoactive compound from two others ​ Cocaethylene ○​ Similar effects to cocaine ○​ Greater cardiac toxicity than cocaine ○​ 3-5x the half life of cocaine ○​ associated with seizures, liver damage, compromised immune system PHARMACODYNAMICS 1) No effect on monoamine release 2) Blocks reuptake of monoamines (NE, DA & 5-HT) 3) Increases glutamate TWO PRIMARY EFFECTS OF COCAINE / ACUTE EFFECTS 1.​ Powerful sympathomimetic effect -​ Similar to amphetamines (more rapid than amphetamine) 2.​ Local anaesthetic -​ When direct contact with peripheral neurons, prevents neural firing = numbing DRUG EFFECTS ACUTE EFFECTS AT MODERATE DOSES... 3. Amelioration of fatigue (insomnia) and more resistance to boredom 4. Anorectic effect 5. Elevated mood and sociability (emotional instability) ACUTE EFFECTS AT HIGH DOSES... 6. Present-oriented/Stimulus Bound 7. Hyper-vigilance 8. Psychomotor stimulation Chronic Effects ​ Cardiomyopathy ​ Stroke ​ Renal damage ​ Liver damage 2. Tolerance & Withdrawal (coke bugs) 3.​ Intense craving 4.​ Stimulant psychosis Cocaine Withdrawal C) Symptoms cause clinically significant distress or impairment D) Symptoms not due to GMC or another mental disorder Amphetamine Overview (crystal meth, ice, glass, speed) ​ Synthetic analog of ephedrine, active ingredient in mahuang ​ Mahuang used in China for asthma ○​ Chinese (Mandarin) má huáng :má,hemp + huáng, yellow ​ Methamphetamine and Methylphenidate (Ritalin) are very similar ​ Medical uses: obesity, ADHD, narcolepsy How Amphetamines Work ​ chemical structure that mimics the structure of the neurotransmitters adrenaline (epinephrine), noradrenaline (norepinephrine), and dopamine ​ biological processes controlled by adrenaline, noradrenaline, and dopamine are enhanced ​ amphetamine is NOT metabolized Rapidly Amphetamine Pharmacodynamics ​ Indirect Agonist for ○​ DA (high affinity) ○​ NE (high affinity) ○​ 5-HT (low affinity) ​ Mechanisms: ​ Blocks monoamine reuptake ​ Inhibit vesicular storage ​ Inhibit MAO metabolism ​ Reverses reuptake Short - Term Effects Amphetamines ​ enhance the actions of adrenaline, noradrenaline, and dopamine ​ increasing adrenaline and noradrenaline from nerve endings ​ Increase heart rate ​ Increase blood pressure ​ Urinary retention ​ Nausea, vomiting, diarrhea ​ Loss of appetite/weight loss ​ Euphoria ​ Decreased sleep Short-Term Effects Amphetamines ​ Increased alertness ​ Increased energy ​ Narrowing of focus ​ Thirst suppression ​ “Rush” Long-Term Effects Amphetamines ​ Tolerance  ​ Psychosis ​ Exhaustion ​ Malnutrition ​ Interpersonal problems ​ Cognitive defects ​ Paranoia ​ Mood swings ​ Trouble breathing ​ Seizures ​ Brain hemorrhage ​ Heart failure ​ Hyperpyrexia ​ Coma Methamphetamine ​ Derivative of amphetamine ​ First synthesized in Japan ​ Typically smoked ​ Meth labs ​ Not legal in Canada Long-Term Effects of Methamphetamine ​ Dental problems ​ Undernourishment ​ Skin infections ​ Heart failure ​ Psychosis ​ Brain abnormalities Tolerance, Withdrawal, Addiction ​ High abuse potential (Schedule 2) ​ Physical and psychological dependence ​ Tolerance to euphoria, appetite suppression; sensitization to psychomotor ​ Withdrawal ○​ Physically mild to moderate (hunger, fatigue, anxiety, irritability, depression, panic attacks, dysphoric syndrome) ​ Dysphoric syndrome(1-5 days after the crash) : characterized by decreased activity, amotivation, intense boredom and anhedonia, intense “craving” for cocaine. May last 1 - 10 weeks. ○​ Anhedonia from biogenic amine depletion? ○​ Intense cravings ​ Route of administration important to addiction risk Cost of Methamphetamine use - 2008 (RAND Corporation) ​ In 2007 about 13 million Americans (ages 12 and up) reported using meth at least once in their lifetimes ​ Accounts for 6 ​ 8 percent of the total cost of drug abuse in the United States. ​ $23.4 billion per year costs ○​ lost lives (900 individuals died in 2005); thousands addicted ○​ Productivity, ○​ drug treatment, ○​ law enforcement expenses (arresting, prosecuting and incarcerating meth users), ○​ economic costs of crimes committed Pharmacotherapies ​ Treatment of withdrawal:  ​ Chlorpromazine: DA antagonist (also blocks alpha receptors) ​ Haloperidol (antipsychotic - 50x more potent than chlorpromazine). ​ Alprazolam (Xanax-benzodiazepine) for panic attacks. ​ Antidepressants (fluoxetine or desipramine). ​ Diazepam (Valium) for seizures - binds to benzodiazepene site of GABAa receptor. New Treatment Approaches ​ IMMUNOLOGICAL ○​ Antibodies made against cocaine, to break-down the molecule and stop its effects. ○​ Undergoing Phase III trials in US ○​ An inactive cholera toxin protein–attach inactivated cocaine ○​ Immune system makes antibodies against both ○​ When individual takes cocaine, antibodies bind to it and prevent it from reaching brain - high does not occur, patient loses interest LECTURE 5: The Opiates Fame and Heroine HISTORY ​ “joy plant” by Sumerians 6000 years ago ​ Ancient Egyptians, Greeks & Romans ​ Middle East ​ Opium Wars TWO PRIMARY FUNCTIONS OF OPIATES ​ Analgesic ​ Sedative Other Medical Uses... ​ Treat diarrhea ​ Cough suppressant ​ Treatment for heroin addiction “Designer Heroin” ​ Produced illicitly by chemists who develop chemical analogues to heroin ​ Most are derivatives of fentanyl (China White) ​ May be 10 to 100 times more potent than heroin PHARMACOKINETICS ​ Administration: ○​ oral (222's) ○​ Intranasal ○​ injected (heroin) ○​ inhaled (opium) PHARMACOKINETICS ​ Absorption: ​ Molecule not lipid soluble, poorly absorbed from the stomach ​ Most are readily absorbed from the GI Tract ​ Stronger effect if injected ​ Heroin: About 10 times as much of same dose gets into brain ​ Most also absorbed through the nasal mucucosa and the lungs PHARMACOKINETICS ​ Distribution: ○​ Throughout the body but not immediately uniform ○​ Intravenous (IV) can take 30-60 minutes for significant brain concentrations  ​ 8 seconds for smoking ○​ Yet mainlining addicts experience "rush" seconds after injecting ○​ Accumulate in the kidneys, lungs, liver, spleen, digestive tract, muscles & the brain ○​ Morphine: does not penetrate the BBB well PHARMACOKINETICS ​ Metabolism & Excretion ○​ Codeine & Heroin = morphine first ○​ Rapidly by the liver (action 4-5-hours) ○​ 90% excreted within a day or two ○​ Excreted by the kidneys PHARMACODYNAMICS ​ An Important Discovery.......... ○​ Naloxone ○​ Potency changes ○​ Opiate isomers - agonists (opiates) ○​ Specific opiate receptors ○​ Are we meant to use heroin? ○​ Maybe we have endogenous opiate peptides.... PHARMACODYNAMICS ​ ENDORPHINS ○​ Neuropeptides ○​ Function as neurotransmitters ○​ Interact with opiate receptors (mu,kappa, & delta) ○​ Process pain stimuli (natural pain killers) 2 CLASSES OF ENDORPHINS - just know theres different categories for test ​ Group 1 ○​ Endorphins ○​ Enkephalins ○​ Dynorphins ​ Group 2 ○​ Endomorphins 1 ○​ Endomorphins 2 PHARMACODYNAMICS: HOW DO ENDORPINS WORK? ​ THE SECOND MESSANGER SYSTEM 1.​ By blocking influx of Na+ ions across membranes 2.​ Kindling WHERE ARE THE OPIATE RECEPTORS? ​ Highest in the limbic system ○​ Primal in way, reactionary, opioids may give calming feeling ​ Brainstem ○​ Basic functions for living ○​ Controls breathing, heart rate etc ​ Medial Thalamus ○​ Emotionally influenced ​ Spinal Cord ○​ Important for pain blocking EVIDENCE??? 1.​ Placebo effect for analgesia -induced endorphin release 2.​ Schizophrenia 3.​ Long Distance Running 4.​ Late Stage Pregnancy PHARMACODYNAMICS ​ Opiates trigger activity of the enorphinergic system. ○​ Naturally bond to receptors in brain ​ Agonism (naturally there) of the endogenous opiate receptors OPIATE EFFECTS 1. Analgesia 2. No effect on other sensations (except vision) 3. Depresses respiratory centres in brainstem 4. Depresses "cough centre" in brainstem 5. Excites vomiting centre 6. GI tract--impairs digestion by decreasing secretion of digestive fluids 7. Euphoria TOLERANCE ​ To most effects ○​ Sedative ○​ Analgesic ○​ Euphoric ​ Not to constipation ​ Does not develop to intermittent use TOLERANCE ​ Primarily functional tolerance sedative ○​ downregulation of endorphin/receptor system ○​ induction of drug metabolizing enzymes in liver ​ Cross-Tolerance ​ No tolerance to sedative ​ hypnotics ​ Additive effect: ​ Opiates + alcohol/barbituates = OD  ​ Lecture 6: Cannabis Sativa HISTORY ​ 1st use around 10,000 years ago ​ Medicinal uses found in China ​ Use of hashish 10th century ​ Hemp plant that grows freely throughout the world ​ 7000 - 8000 B.C. First woven fabric believed to be from hemp ​ 1619: Jamestown Colony, Virginia passes law requiring farmers to grow hemp ​ Not used as a recreational drug ​ Henry Anslinger ​ "Marijuana is an addictive drug which produces in its users insanity, criminality, and death." ​ "Marijuana is the most violence -causing drug in the history of mankind." ​ Marijuana was first banned in Canada in 1923 under the Opium and Drug Act ​ In 1997 marijuana became been covered by the Controlled Drugs and Substances Act ​ On October 17th, 2018, the Government of Canada legalized and strictly regulated cannabis use and production for people of legal age CANNABINOIDS ​ Marijuana NOT a drug itself ​ 400 different chemicals, 60 specific to cannabis ​ delta-9-Tetrahydrocannabinol (THC)  ​ Cannabinol & cannabidiol PHARMACOKINETICS ADMINISTRATION: ​ Smoke a joint (10-20mg THC) ​ Chew marijuana leaves, drink,eat ​ Oral THC is about 1/3 as potent as THC that is smoked ​ What are Canadians who use marijuana saying? ○​ 70% smoke it ○​ 52% consuming it in food ○​ 31% vaping ○​ 18% ingest cannabis oil ○​ 16% drink it ○​ 7% apply to skin ABSORPTION: ​ Rapid ​ VERY lipid soluble ​ Directly by the lungs when smoked ​ Peak concentrations 30-60min ​ Drug effects: 2-4hrs DISTRIBUTION: ​ Very lipid soluble ​ Quickly penetrates the BBB ​ Penetrates the placental barrier ​ Almost entirely insoluble in H2O ​ THC is deposited in tissues of various organs CROSSES THE PLACENTAL BARRIER ​ Lower birth weight ​ Shorter body length ​ Increased risk of premature birth ​ Increased risk of childhood cancer ​ Deficits in sustained attention, more impulsive & hyperactive Pharmacokinetics: METABOLIZATION: ​ Occurs in stages of chemical transformations ​ Primarily in the liver ​ More than 30 metabolites of THC ​ 11-hydroxy-delta-9-THC EXCRETION: ​ VERY slow ​ Through feces and urine ​ Half -life = several days ​ Some metabolites = at least 30 days PHARMACODYNAMICS ​ Decrease turnover of ACH, esp. in ​ hippocampus ​ Results in a DECREASE in ACH activity ​ Increases 5-HT activity ​ Reduces GABA activity and ​ glutamate release An Exciting Discovery... ​ Specific receptors have a chemical reaction with cannabis ​ CB1: predominantly in the brain ​ CB2: predominantly in the immune system How Were the Receptors Found? ​ A small dose of cannabis caused a large effect quickly ​ Levo-isomer versus dextro-isomer ​ Synthetic cannabis is 100X more potent than natural Where are these Receptors? ​ Distributed widely throughout the brain, but pattern is uneven ​ Cerebral cortex ​ Hippocampus ​ Hypothalamus ​ Amygdala ​ Basal Ganglia* ​ Cerebellum* Why do we have these receptors? ​ We must have a natural form of THC in our brain.... ENDOCANNABINOIDS ​ ANANDAMIDE “internal bliss” ​ 2-arachidonoyl glycerol ENDOCANNABINOIDS ​ Retrograde NT  ​ Produce both excitatory and inhibitory effects on neurons (GABA & Glutamate) Who Uses Marijuana? ​ Canadian Cannabis Survey 2022 ​ 27% of individuals aged 16 years or older used marijuana in the past year ​ Increase of 25% from the previous survey! Effects of Cannabis Medical Uses 1.Treatment for glaucoma -​ Decreases intraocular pressure 2. Treatment for asthma -​ Decreases pressure in the lungs 3. Treatment for nausea & vomiting -​ works centrally from the brain especially useful for chemotherapy 4. Treatment for cachexia -​ increases appetite Physiological Effects of Cannabis ​ Bloodshot eyes (vasodilation) ​ Increased heart rate and pulse rate ​ Blood pressure slightly elevated ​ Sleep disturbances Acute Behavioural Effects ​ Reduces hand ​ eye coordination ​ Slower reaction time ​ Decreases short-term memory ​ Generalized decrease in motor activity ​ Perception that time passes slowly Long-Term Effects ​ Respiratory System??? ​ Temporary impotence in men & decrease in sex drive in women ​ Disrupts reproductive processes ​ in men and women ​ J Curve for Tolerance Marijuana & Mental Health ​ Co-occurrence of marijuana use & depressive symptoms ​ BUT...it looks like people who are depressed are more likely to use cannabis and not so much the other way around ​ Also, some studies have found no association! “Amotivation Syndrome” ​ lack of motivation ​ low energy ​ little planning & lack of goals ​ mellow ​ lethargic ​ no delay of gratification ​ Brain reward ​ center ​ Task difficulty Lecture 7: Alcohol Use Disorder Alcohol: Our Most Primitive Intoxicant  ​ Egypt ○​ barley beer is probably the oldest drink in the world with its origin in Egypt prior to 4200 BC ​ China ○​ 7000 BC - the production of a prehistoric mixed fermented beverage of rice, honey and fruit (neolithic village of Jiahu in Henan province) ○​ 2000 BC - unique cereal beverages (Shang and Western Zhou Dynasties) Ancient Warnings About Alcohol and Harmful Use Through the Ages ​ 1600-1050 BC → Downfall of Egyptian and Chinese Empires and Dynasties attributed to excessive alcohol use ​ 460-320 BC → Grecian Scholars issued advisories on drunkenness and moderate drinking ○​ Plato – No use under age 18, between 18-30 use in moderation, no restrictions for use by those older than 40 ○​ Aristotle and Hippocrates were both critical of drunkenness ​ 11th Century AD - Simeon Seth, a physician in the Byzantine Court, wrote that drinking wine to excess caused inflammation of the liver, a condition he treated with pomegranate syrup Substance Use: DSM-5 Terms ​ Use: The ingestion of psychoactive drugs or substances in moderate amounts which do not interfere with functioning ​ Intoxication: Reversible substance specific syndrome due to intake of a substance which interferes with functioning (fighting, impaired judgment, slowed reflexes, etc.) Factors Influencing Intoxication ​ Dose ​ Duration of the dose ​ Person’s tolerance for the substance ​ Time since last dose ​ Age, weight, gender, food in system, sleep, ​ medications ​ Expectations about the substance’s effects ​ Setting Physiological Dependence Tolerance ​ Need for markedly increased amounts of the substance in order to achieve desired effect ​ Markedly diminished effect with continued use of the same amount of the substance Withdrawal ​ Characteristic withdrawal syndrome of the substance ​ The same or similar substance is taken to avoid or relieve withdrawal symptoms DSM-IV TR Substance Use Disorders ​ Substance Abuse ​ Substance Dependence Alcohol Use Disorder ​ Problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring during within a 12-month period: ○​ Taking larger amounts or over a longer period than planned ○​ Persistent desire or failure to cut down ○​ Great deal of time spent ○​ Craving (strong desire for or urge to use) ○​ Recurrent use resulting in failure to fulfill major obligations ○​ Continued use despite social or interpersonal problems ○​ Important activities are given up or reduced due to alcohol ○​ Recurrent use in hazardous situations ○​ Continued use despite a persistent physical problems ○​ Tolerance ○​ Withdrawal Substance Use Disorders ​ Alcohol is by far the most common drug used by Canadians. ​ At least 20% of drinkers consume above Canada’s Low- Risk Alcohol Drinking Guidelines. ​ The use and risky use of alcohol by underage and young adults appears to be declining. ​ Data from the Canadian Institute for Health Information (CIHI) show 10 Canadians die in hospital every day from harm caused by substance use, and 75 per cent of those deaths are related to alcohol. The agency did not have information on the number of deaths that occur outside of hospital, which is mostly the case for a greater number of opioid deaths among people who die alone. ​ Released earlier this month, the CIHI data also show alcohol contributes to more than half of all substance - use hospitalizations, which are 13 times more common than for opioid poisonings. Comorbidity ​ ½ of individuals with alcohol use disorders have another psychiatric disorder ​ Poly-substance abuse common Impact of Alcohol ​ Effects on the brain ○​ At lower levels, alcohol stimulates certain brain cells and activates the brain’s “pleasure areas” ○​ At higher levels, alcohol depresses brain functioning ○​ BAC of.08 = intoxicated  ○​ BAC of.50 = unconsciousness Alcohol and the brain Impact of Alcohol ​ Physical effects ○​ Shorter life span ○​ Brain damage ○​ Cardiovascular disease ○​ Malnutrition ○​ Fetal Alcohol Syndrome 16 Fetal Alcohol Syndrome Economic Costs of Alcohol ​ Alcohol and Tobacco: Account for 70% of costs; alcohol leads in crime-related expenses ($3.2B). ​ Economic Impact: Governments earned $10.5B from alcohol taxes but faced $14.6B in costs. ​ Health and Death: Substance use caused 67,515 deaths and significant preventable health issues. ​ Policy: Higher taxes on alcohol could reduce harm and increase revenue. Economic Burden of Alcohol Drinking during cOVID Causal factors Biological ​ Neurobiology ​ Genetics Psychosocial ​ Parenting ​ Tension-Reduction ​ Psychological Vulnerabilities Sociocultural Biological Causal Factors ​ Neurobiology ○​ Mesocorticolimbic dopamine pathway = center of psychoactive drug activation in the brain ​ Genetic Vulnerability ○​ May play a role in developing sensitivity to the addictive power of alcohol or personality traits associated with substance misuse ○​ Having a parent with alcohol use disorder increases the risk of Alcoholism Biological Causal Factors ​ Although strong genetic influences, precise relationships are not well understood. ​ Gene-environment interaction? ○​ Learning plays an important role ​ Must be exposed to the substance (parental use, peer pressure, etc..) ​ Environments that promote initial and continued use Psychosocial Causal Factors ​ Parenting ○​ Lack of stable family relationships and parental guidance ○​ Lack of monitoring ○​ Chaotic environments ○​ Family involvement and parental modeling can serve as a protective factor even when other risk factors are present.  ​ Psychological Vulnerabilities ○​ Comorbidity ○​ Antisocial personality disorder, depression, anxiety, and schizophrenia all increase ○​ the risk of developing alcohol use disorders ○​ Personality –is there an Addictive Personality? ○​ Impulsivity, sensation seeking, anxiety - sensitivity, introversion/hopelessness ○​ Expectancy Theory & Theory of Motives Operant and Classical Conditioning (more involved in maintenance of alcohol use disorders) ​ Tension Reduction Theory ○​ People with alcohol use disorder tend to be unable or unwilling to tolerate tension and stress ○​ Many people expect that alcohol use will lower tension and anxiety and increase sexual desire and pleasure in life ○​ Adults with less intimate and supportive relationships tend to show greater drinking following sadness or hostility 4 Distinct Drinking Motives (Cox & Klinger, 1988) ​ Motives can be differentiated meaningfully in terms of 2 dimensions: 1.​ Source: reflects whether the person’s goal is attain an internal reward (affective state) or to gain an external award (social rewards) 2.​ Valence: reflects whether the person’s goal is to enhance positive affect or to reduce negative affect I.​ Coping Motives ​ the tendency to utilize alcohol to avoid, escape or manage negative affect drinking to avoid distress ​ Reasons Include: ○​ to forget your worries ○​ to cheer up when you are in a bad mood ○​ because it helps when you feel depressed or nervous II.​ Enhancement Motives ​ individuals drink to increase positive affect ​ Reasons Include: ○​ to get high ○​ because it is fun ○​ because it is exciting ○​ because you like the feeling ○​ because it gives you a pleasant feeling III.​ Social Facilitation Motives ​ individuals drink to intensify positive social experiences ​ Reasons Include: ○​ to be sociable  ○​ because it makes social gatherings more fun ○​ because it helps you enjoy a party IV.​ Conformity Motives ​ individuals drink to avoid social rejection ​ Reasons Include: ○​ To be liked ○​ to fit in with a group that you like ○​ So you won’t feel left out ​ CFAs supported the four factor model of motives ​ Each motive has been associated with a different pattern of contextual antecedents and drinking-related outcomes Sociocultural Factors ​ Social events in Western culture often revolve around alcohol ​ The incidence of alcohol use disorder is minimal among groups whose religious views ​ prohibit the use of alcohol ​ The incidence of alcohol use disorder is relatively high among Europeans (15% in ​ France) ​ Discrimination & Stigma ○​ Well-established links between discrimination and heightened alcohol use Treatment of Alcohol Dependence ​ Biological approaches include ​ Medications to block the desire to drink: ○​ Antabuse ○​ Naltrexone ​ Medications to lower the side effects of acute withdrawal: ○​ Valium ○​ Diazepam ​ Psychological treatment approaches include ○​ Group therapy ○​ Environmental intervention ○​ Behavioral/Cognitive-Behavioral therapy Treatment of Alcohol Dependence ​ Alcoholics Anonymous (AA) ○​ Self-help group that provides emotional support, close counseling ○​ Spiritual development is key ○​ Alcohol abuse is a disease that cannot be cured ○​ AA ○​ Motivational interviewing Lecture 8: All About the Family...modern family What is family? Family Versus Household ​ A household refers to all individuals who share a common dwelling, regardless of kinship or economic ties Kinship ​ Culturally defined relationships between individuals who are commonly thought of as having family ties. ​ Different types of kinship: ○​ Consanguineal relatives: people on both sides of family related to you by blood. (Biological) ○​ Affinal relatives: people who are related to you through marriage. ○​ Fictive kinship: patterned on kin-like relations but not actually based upon blood or marriage Functions of Kinship ​ Vertical function: binding together successive generations, thereby providing social continuity (e.g., Passing on property, political office, & tradition.) ​ Horizontal function: tying people together across a single generation through marriage practices. ○​ Kin groups usually practice some degree of exogamy–rule which states that you must marry outside a certain group. ○​ People must normally look outside for marriage partners and create alliances with other groups. ○​ Alliances can be useful for political, economic, ceremonial purposes. Family Structures: Lineage Systems ​ Lineage refers to the way in which the generations trace their identity ​ There are three ways in which families trace their lineage worldwide: ○​ Patrilineal systems — lineage is traced through the males of the family ○​ Martilineal systems — lineage is traced through the females of the family ○​ Bilateral systems — lineage is traced through both males and females Family Structures: Systems of Authority ​ Can distinguish between patriarchal and matriarchal authority structures ○​ Patriarchal structures are those in which the major affairs of the family are dominated and controlled by men  ○​ Matriarchal structures are those in which family affairs are dominated by women ​ In North America, power is generally shared by both men women. This is sometimes called a bilateral authority structure Defining family ​ STRUCTURAL DEFINITIONS: who is in the family and who is out? ​ FUNCTIONAL DEFINITIONS: what functions do the family members perform? Structural Definitions ​ Share a residence? ​ Blood ties? ​ Legal contracts? ​ “Census family refers to a married couple and the children, if any, of either or both spouses; a couple living common law and the children, if any, of either or both partners; or, a lone parent of any marital status with at least one child living in the same dwelling and that child or those children” Statistics Canada Structural Definitions ​ United Nations' Principles and Recommendations for Population and Housing Censuses, Revision 1, 1998. This document provides the following definition: ​ "A family nucleus is one of the following types (each of which must consist of persons living in the same household): (a) a married couple without children, (b) a married couple with one or more unmarried children, (c) a father with one or more unmarried children or (d) a mother with one or more unmarried children. Couples living in consensual unions should be regarded as married couples." Functional Definitions ​ A family is any unit in which there exists: ​ A caring & supportive relationship ​ Preparation of children born to or raised by the members to become adult members of society ​ Sharing of resources and economic property ​ Commitment to or identification with other family members Functional Definitions ​ Family roles: recurrent patterns of behaviour by which individuals fulfill family functions & needs (Epstein et al., 1993) ​ Instrumental Roles: the provision of physical resources (e.g., shelter, food, clothing), decision-making and family management ​ Affective Roles: provision of emotional and social support & encouragement of family members Functions of Family ​ Physical maintenance and care of family members ​ Addition of new members via procreation or adoption  ​ Socialization of children ​ Regulate behaviour (social control) ​ Emotional & social support ​ Social identity ​ Production, consumption & distribution of goods & services Family Structures: Family Form ​ Nuclear Family — the most basic family form comprised of a married couple and their children ​ Extended Family — includes additional generations beyond nuclear family, comprising grandparents, aunts/uncles, etc. living in the same household Stages of Family Development Stage 1. The Single Young Adult ​ Goal : Accepting responsibility for the self and separation from parents ​ Tasks ○​ Forming a new identity that is autonomous from the family ○​ Establishing intimate peer relationships ○​ Becoming financial independent ​ Problems: separation issue ​ Stage 2. The Newly Married Couple ​ Goal: Commitment to the new system ​ Tasks ○​ Establishing a new identity as a couple ○​ Recalibrating relationships with family members ○​ Deciding whether to extend family or not ​ Problems: separation issues Stage 3. The Family with Young Children ​ Goal: ○​ Accepting a new generation of members into the system ​ Tasks ○​ Adjusting the marital relationship to accommodate parental responsibilities while preserving the integrity of the couple relationship ○​ Sharing equally in the tasks of child -rearing ○​ Integrating the roles of extended family members into the family ​ Problems: Stage 4. The Family with Adolescents ​ Goal: ○​ Task aimed at renegotiating family boundaries ○​ Realigning of parent-child relationships ○​ Refocusing on midlife marital and career issues ○​ Shifting toward concern for the older generation ​ Problems: Control Stage 5. The Family Launching Grown Children ​ Goal: Tasks accepting new boundaries and reconfiguing family system ○​ Renegotiation of marital system as a dyad ○​ Development of adult-to-adult relationships between grown children and parents ○​ Reconfiguration of relationships to include potential in-laws and grandchildren ○​ Dealing with disabilities and death of parents (grandparents) ​ Problems: separation and letting go Stage 6. The Family in Later Life ​ Goal: renegotiation of generational roles ​ Tasks ○​ Maintaining own and/or couple functioning and interests in face of physiological decline ○​ Exploration of new familial and social role options ○​ Support for a more central role for the middle generation Dealing with loss of partner, siblings, and other peers, and preparation for own death; life review and integration ​ Problems: regret Lecture 9: Family - A Systematic Approach **** The Family is a System ​ Solar system ​ Transportation system ​ Educational system ​ Healthcare system ​ A change in one part causes a change in another The Family is a System ​ Interdependent parts ○​ Parts of the system that you can point out and easily see there's some level of independence. This is the family members (aunts, uncles, step-siblings, etc) ​ Self-regulatory mechanisms ○​ Goes to homeostasis, every family has own balance or homeostasis and it varies family to family (some families’ emotional homeostasis is calm, others chaotic) ○​ Processes that maintain this homeostasis and brings it back to balance Basics of Family Systems Theories ​ Boundaries ○​ can be diffuse, clear or rigid ​ Subsystems ○​ Triad, hierarchical systems (parents rule and children obedient), some families are more democratic and harder to see system ​ Rules ​ Reciprocal causation ○​ Relationships affecting one another ​ Homeostasis ​ Intergenerational repetition ○​ Repeats itself ○​ A lot of issues parents dealt with tends to repeat with their own children unless there’s intervention - can be good or bad ​ Differentiation ○​ Directly related to boundaries Family characteristics: Boundaries ​ Diffuse - difficult to see, may vary - one day it’s okay to do X and next you can’t ​ Clear- some level of flexibility, can clearly articulate boundaries but some flexibility within that ​ Rigid - these are boundaries and they don’t move ​ e.g) rule that if you need to talk personally, someone needs to leave, specific person you talk to about certain issues, who makes decisions about what - if this changes over time, then it’s clear boundary Family characteristics: Boundaries/Cohesion ​ Enmeshment ○​ very low differentiation ​ Lack of boundaries - may be susceptible to groupthink and come across as inauthentic ​ Less developed or differentiated the self, the more impact others have on them and their functioning  ​ People with a less differentiated self, tend also to control others and have more of an impact on others - impose on others ​ Self and identity are built during the first few years of life, and once self is cemented in adolescence it takes a lot to change it ​ Disengagement: ○​ very high differentiation ​ rigid boundaries and emotional distance, little to no communication ​ So differentiated you actually pull away from people and isolate yourself at least psychologically ​ Can come off as cold, avoidant, disinterested ​ Highly emotional reactant and sensitive to environment, ​ More likely to suffer from depression Family Rules & Rituals ​ Rules: ○​ Guidelines ​ Group stated guidelines that clarify what are acceptable behaviours vs what is not ​ Associated consequences if rules are broken ​ Social norms - face exclusion if broken, laws - jail or fines ○​ Boundaries ​ Form boundaries for what is or isnt acceptable ○​ Identity ​ Rules help form identies ​ Rules shape idea of “good person” ​ Rituals ○​ Function as glue that holds society together and reinforce the structure or rules that are put in place in the family Family Adaptability ​ Adaptability refers to the family’s rules about who does what and it’s ability to adapt as necessary ○​ Few rules (or rules are not enforced) = family functioning is chaotic ○​ Rules are too rigid = families have trouble adapting to change  ​ Circumplex model - quadrants you can label family with ​ E.g., someone with high cohesion and low flexibility you get rigidly emmeshed ​ Green is severely unbalanced ​ You can change where you are on the model depending on how you adapt to different situations (e.g., having a child can change placement) ​ State in stability (yellow area) you’re fine and dont need to make any adjustments, but if a sudden change happens, such as a loss or addition or illness, it can move you to another space (e.g., teal or green) ​ **dont need to memorize but understand it and be able to apply – would be given on exam if its a question Stages of Family Development ​ Disruptions to the family system & adaptability kicks in with how family responds ○​ Single young adult leaves home ○​ Forms a family through marriage ○​ Has young children ○​ Children reach adolescence ○​ Children move out ○​ Retires  ​ Ultimate goal of family system is have functioning and flexible system with connective relations and positive communication skills about rules, boundaries, etc - need to be able to express yourself whether it is words, emotions, etc ​ If cannot define role in family - in a chaotic household ○​ Can you define ur jobs such as laundry, managing finances ​ Flexibility - assess whether can adapt ​ Stagnant - high levels of monitoring when child is a toddler but then trying to do same when they're a teenager Family stages and family functioning ​ Family dysfunction is often a result of unmet family developmental tasks. ○​ Unmet needs or meeting new developmental tasks ○​ E.g., Millers w dad, mom, daughter and son ​ Daughter complains parents have same rules since childhood w strict bedtime and responsible for chores due to being older ​ Kids have little to no say about rules ​ Parents discipline with authoritarian style and kids describe it as militarian ​ Dont eat meals together and kids dont like each other and report not liking parents ​ Rigid category ​ Daughter is into debates, son into robotics, dad is into hockey, mom watches tv and parents sleep in different bedrooms ​ This is a rigid disengaged case study! ​ ​ Family life cycle changes are a major source of stress and disequilibrium for families. Interpersonal Conflict - runs on a continuum from no contact to extreme and in between ​ May result from several sources ○​ Scarce resources ​ Verbal or nonverbal ○​ Silent treatment, smashing hand down ​ Inevitable Conflict Management ​ Learned ○​ Conflict strategies are learned - they are taught explicitly ○​ Social learning theory - modelling behaviour and learning from others ○​ Operant conditioning - consequences associated with behaviour ​ Contextual ​ Intergenerational Conflict management strategies ​ Avoid, address (aware but not resolved) or resolve it ​ Not always conscious - more likely to be unconscious if emotionally volatile ​ Information exchange - not a strategy but a way to buy yourself time to be methodical to decide what strategy you’ll use, you ask for more info from other party  ​ Self-oriented and high concern for self and for others, and mutual goals are most effective Conflict Management Styles ​ Competing ​ Avoiding ​ Accommodating ​ Compromising ​ Collaborating Competing ​ High concern for self ​ Low concern for others ​ Goal is to win! ​ Linked with aggression, but not always correlated ​ Different than a competitive personality ​ No gender differences - equally used by men and women - no research on gender non-conforming Avoiding ​ Low concern for self ​ Low concern for others ​ No direct communication ​ Indirect strategies ​ Passive-aggressive behaviour Accommodating ​ Low concern for self ​ High concern for others ​ Passive ​ Generous versus obedient ​ Time constraints Compromising ​ Moderate concern for self ​ Moderate concern for others ​ Low investment in conflict? ​ Can be adaptive or maladaptive Collaborating ​ High concern for self ​ High concern for others ​ High investment in conflict ​ Work! ​ Communication competence Supporting Change in Family Systems ​ Obtain insight about their family dynamics  ​ Change repetitive patterns that hurt the family The Initial Interview ​ Pre-session Planning: ○​ Talk on phone, who will be attending session, what do you want to talk about ​ The Joining Stage: ○​ Come together ○​ Understand how presenting the problem, their view of dynamics, key is how they frame problem is critical, who gets to frame problem ​ The Problem Statement Stage ○​ Least invenstment tends to present problem ○​ Looking at patterns and interactions maintaining the problem Initial Interview (continued) ​ The Interaction Stage: ○​ Such as camera in room, one way mirror ​ In-Session Conference ​ Goal Setting Stage ​ Ending Stage ​ Post-session Family Therapy Assessment Techniques ​ Family Interview: ​ Circular Questioning: ○​ help people understand how their relationships and interactions affect each other ○​ open-ended questions that encourage people to share their perspectives and experiences ​ Family Sculpting: ○​ family member is asked to arrange the other family members in space to show how they experience their relationships ○​ helps families visually represent their relationships, roles, and emotional dynamics ​ Reenactment: ○​ Get at interpretation of an event ○​ Roleplay ​ Genogram: ○​ illustrates not only the medical history but also the relationship of the family members across generations ○​ E.g., parents being kicked out at 18 and wanting to do it to children - family history of this ○​ Example of Joe’s genogram info ​ Mom married Dad (after he stopped drinking and went to AA) ​ Maternal grandfather drank (and went to AA) ​ Maternal grandmother drank (but denied the problem) ​ Joes brother-in-law drinks and so does Joe ​ Joe's mother has a difficult relationship with joe and his brother-in-law ​ Nick the youngest brother is close to Joe and joes mother ​ Joe is distant from his father and older brother Family Therapy Intervention Techniques ​ Reframing: ○​ Frame it as something solvable ○​ It doesn’t mean it is not difficult or requires effort, but suggests it is solvable (not curable) ​ Giving Directives: ○​ Saying directives (concrete tools or info for moving forward in intervention) ○​ E.g., ​ We will do this type of therapy with family members A and B ​ This family dynamic isn't working and we think there needs to be separation between these family members, and heres how to maintain space… (at least temporarily) ​ As a family, we will work on these communication strategies….. ​ Sometimes coming together as a family and getting rid of separation Family Therapy Techniques (cont.) ​ Rituals: ​ Ordeals: ​ Ambiguous Assignments: Webinar - on exam ** ​ Pup integrated theoretical framework (Parents Under Pressure) ​  ○​ Acknowledges that that if we look at the right-hand side where we can see a white box saying 'Child's development outcomes' that that's actually where we see the evidence of mental health concerns that might be happening for infants and children. And you can see inside of the large concentric circles where you can see a pink circle saying, 'Parental emotional regulation,' that there's a direct connection between parents mental health and how they're managing their feelings, their emotions and the development outcomes for children. And as part of development outcome s for children we are looking at emotional, behavioural, psychological health, which is obviously what we're talking about when we're talking about infant and child mental health. ○​ And we can see that when there are pressures on parents who are trying to raise those children in terms of a disconnection maybe from community. Having substance use issues, having mental health issues, that that can have a direct impact in terms of their emotional availability to the children. And what we tend to then see is the impacts on infants and children in their behaviours. ○​ Based on ATTACHMENT - Little connection to community, family etc when addiction in family ○​ Parents moods often coordinate with drug use ​ Attachment for a child is based on parents' emotional availability. Emotional availability is what is affected the most when using substances because they either miss cues, and or they may not be emotionally available because they are high. ​ Baby giggling but mom yells shut up. The baby learns maladaptive patterns of behaviour from the mother. Children are often exposed in utero. ○​ Based on development psychopathology -​ Ask about Sarah's experience on exam -​ Jarrah house: therapeutic residential drug and alcohol treatment service for women and women with their children -​ a child focused practice can help parents to build on their strengths and address challenges which in turn will strengthen the family overall. Working with parents who feel shame often offers opportunity to discuss what hopes and dreams they have for their children -​ when mums arrive here at Jarrah House with their children, quite often we can see a lot of problematic behaviours in the children and mum will often report that you know they're not coping, that the child is having a lot of tantrums or lots of acting out behaviour and they don't really know where to start. And we use a tool here called KIPS which is the Keys Interactive Parenting Scale. -​ mother and has lived experience of alcohol and other drug use and mental health issues -​ went through Jarrah House and completed the program last year -​ husband died of a drug overdose a couple of years ago and that preceded her relapse into heroin use again. She’d been using for a few months, She was trying to get herself into rehab, and had already gone to a public clinic a public methadone clinic. And gotten herself onto the OTP. And was stable on her dose and the GP decided to inform her that he needed to make a child protection report even though she had already told him that the clinic had made a report  -​ grateful to programs like Jarrah House that actually enable me to seek treatment for myself and – and still have my child by my side. -​ Lecture 11: Addiction in the Family: Spotlight on Adolescence Judgement! ​ One study asked participants of different ages to respond quickly to easy, risk-related questions. ​ e.g., Should you set your hair on fire? ​ e.g., Should you swim with sharks? ​ Results: Adolescents took longer (sixth of a second) than adults to get an obvious “no” ​ Adolescent brain not optimized to get to the bottom line and make proper judgements ​ Brain develops back to front ○​ What makes adolescent special is the brain development ○​ Brain is very well developed in the primitive areas ○​ Much slower to develop is the Prefrontal Cortex ​ Where we get complex thinking ​ Emotion regulation is all prefrontal cortex ○​ Adolescents use substance because, they are not using the part of the brain that helps make the decision ​ Relying on other people for making decisions ​ Not great at understanding the severity of consequences and how long consequences last ​ Not thinking of long term consequences but rather primitive areas where they focus on the feel good and not the long term consequences Consequences for Adolescence! ​ Sensory & physical activities favoured over complex, cognitive demanding tasks ​ Propensity toward risky, impulsive behaviours ​ Group setting may promote risk taking → More likely to promote substance use ​ Poor planning & judgement ​ Favour activities with high excitement and low effort ​ Poor modulation of emotions (hot emotions more common than cold emotions) ​ Heightened interest in novel stimuli ​ ​ Adolescent within the family and are not going through adolescents alone ​ Peers become more important in adolescents but the family is still as important rather, peers are catching up to family Children of Parents who Suffer from Addiction “COAs” Trait ​ Co-Dependency (parents have certain attributes) (service providers understanding) (could be with parents, partners, friends) 1) Need to be needed -​ Sarah talked about how Issak the more she needed to leave, the more Issak needed to come 2) Have a strong urge to control others 3) Are willing to suffer -​ Willing to be the martyr 4) Fear and resist change 5) Have low self-esteem –Addicted to co-dependency? ​ Part of the substance addiction ​ Addicted to being needed ​ Can become manipulating ​ Partner can become manipulating Children of Parents who Suffer from Addiction Deutsch 1)​ Inconsistency -​ One minute they are at school for while and the next they are missing 2 weeks 2)​ Insecurity and fear -​ Kids come off as not having a stable core. Always seem like self-worth is taken from around others -​ Come off in ways we don’t expect (such as overly happy) 3)​ Anger and hate -​ Not always toward the parent but can just be against the world and sometimes the self 4)​ Guilt, self-blame and depression -​ Angry irritation and hate is at the self, rather than at the parent which is because they do not understand and it makes sense to blame themselves Children of Parents who Suffer from Addiction Dispositional Trait ​ ***Ackerman characteristics of ACOAs (adult children of alcoholics/ addict) in literature EXAM ASK FOR 10 1)​ guess at what normal is -​ Do not know what normal is -​ Now most don’t know since about 2016 -​ At the time, their lives were so chaotic that there was very little consistency that their lives where up and down 2)​ have difficulty following projects to completion -​ Adults can start things and motivated but then they kinda give up (low self esteem) 3)​ lie when it is just as easy to tell the truth -​ Found people were very found of lying -​ Not for a purpose but just lie to lie  -​ Context would be to fit in 4)​ judge themselves without mercy -​ High levels of self criticism 5)​ have difficulty having fun -​ Always being on guard -​ Activities that are fun, having hard time come to level to enjoy 6)​ have difficulty with intimacy -​ From #3 -​ Will not disclose parts of themselves 7)​ overreact to changes they cannot control -​ Prefer status quo 8)​ feel different from other people -​ Have indescribable mark that separates them and it is often invisible 9)​ constantly seek approval -​ People pleasing 10)​are either super responsible or irresponsible -​ Responsible: have everything in on time -​ Irresponsible: not showing up to class 11)​are extremely loyal even when not deserved -​ Even if person treating them horrible, they will still stick around 12)​look for immediate gratification 13)​seek tension and crisis but then complain -​ Dramalama -​ Always involved in drama and something is always happening but it is always someone else's fault 14)​avoid conflict, or aggravate it, but don't deal with it -​ People pleasers or start the conflict (button presser) 15)​fear rejection and abandonment while rejecting others -​ Terrified of being abandoned because of the lack of this in home -​ I will reject you before you reject me (want to be in control) 16)​fear failure and can't handle success -​ Perfectionist -​ Running away from failure not striving from success 17)​fear criticism but criticize others -​ I hurt you before you can hurt me 18)​manage time poorly -​ Often, they can not finish things BUT.... ​ Problem of subjectivity ○​ Researchers argue about subjectivity because they could not recreate ○​ Pick up a lot of heterogeneity ​ Have this or this ​ What about lifespan developmental psychopathology perspective? ○​ People who have similar experience can have different outcomes ○​ Helps to navigate subjectivity Lifespan Developmental Psychopathology Framework ​ Trajectory  ​ Interactions between biological and environmental factors ​ E.G., ○​ Child born to parent with SUD ○​ Increased risk for academic failure ○​ Higher risk of conduct problems during adolescence ○​ Immersed in family with excessive substance use ○​ During adolescence associate with delinquent peers ○​ Unrewarding do self-medicate ○​ Poorer parenting skills and lower parental monitoring ○​ Early experimentation with substances Lifespan Developmental Psychopathology Framework E.G., 1.​ Child born to parent with SUD 2.​ Increased risk for academic failure 3.​ Higher risk of conduct problems during adolescence 4.​ Immersed in family with excessive substance use 5.​ During adolescence associate with delinquent peers 6.​ Unrewarding do self-medicate 7.​ Poorer parenting skills and lower parental monitoring 8.​ Early experimentation with substances Areas of Ongoing Research ​ Familial Alcohol & Drug Use ​ Laurie Chassin ○​ whether either parent also has a mood disorder or antisocial personality disorder ○​ whether the parents monitor their children's behavior the amount of stress in the adolescent's life ○​ measures of emotionality and sociability in the adolescent ○​ the adolescent's experience of negative affect ○​ the adolescent's associations with substance ○​ using peers ​ Antisocial Behaviour ​ Patterson ○​ Family Management Model ​ Discipline ​ Monitoring ​ Problem solving ​ Involvement and positive reinforcement ​ Marital interactions ​ Family VIolence ​ Family members of people who have substance use disorder ○​ Heterogeneity is the rule Evaluating Family Systems Theories of Addiction ​ Biased samples? ​ Subjectivity? ​ Correlation versus Causation  ​ Barnum Effect? ON EXAM ○​ Something for everyone ○​ Every single person can see themselves apart of it ○​ If researcher says these findings are unique to you (my experience), more likely to find something (vague heterogeneous) from the list ○​ Most of clinicians and adults are more likely to say “oh thats you and oh thats me” when they look at the list ○​ Frame as this is for you. Makes our brain primed to find something relevant to you Lecture 12 Factors Affecting Addiction ​ Developmental ​ Environmental - e.g., laws in countries ​ Social - peers ​ Genetic - genes that interact with environmental factors ​ Comorbid mental disorders Effects ​ Judgment ​ Decision making ​ Learning and memory ​ Behavior control ​ Mood and emotion regulation Drug Use and Addiction Brain imaging studies show physical changes in areas of the brain when a drug is ingested that are critical to: ​ Judgment ​ Decision making ​ Learning and memory ​ Behavior control These changes alter the way the brain works and help explain the compulsion and continued use despite negative consequence Effects of Cocaine on the Brain  - PET Scan - how brain is functioning - following glucose trail - area of red show highest levle of glucose - you want more, means brain is more functional. Shows less on cocaine, meaning brain is less functioning Dopamine Receptors in Addiction Substance Use in the Family ​ Think about the parenting implications for a parent involved in child welfare who is actively using drugs or alcohol. ​ Think about the implications for a parent involved in child welfare who has just stopped using drugs or alcohol and is trying to resume normal interactions with their child/ren. ​ If you are tasked with observing a home visit, what conclusions might you draw? ​ How do we balance compassion, understanding and patience with a parent’s temporarily compromised brain condition, while maintaining parent accountability and child safety? How Substance Use Disorders can affect Family Functioning ​ Child development ​ Household safety ​ Psychosocial impact ​ Parenting skills ​ Intergenerational trauma and mental health problem Parental Addiction Affects the Entire Family! ​ Developmental Effects ​ Generational Effects ​ Psychosocial Effects ​ Parenting Effects Addiction can be Treated! ​ Addiction is preventable and treatable ​ Successful treatment is highly individualized and entails: ○​ Medication ○​ Behavioral interventions ○​ Peer support ​ "Groundbreaking discoveries about the brain have revolutionized our understanding of addiction, enabling us to respond effectively to the problem -​ Dr. Nora Volkow, National Institute on Drug Abus Purpose of Treatment ​ Reduce the major symptoms of the illness ​ Improve health and social functioning ​ Teach and motivate individuals to monitor their condition and manage threats of relapse  -​ Various services, may need training, education assistants, etc to be better at parenting etc -​ Vocational → may need further training to help get a job Principles of Effective Drug Addiction Treatment: A Research Based Guide (NIDA) 1.​ Addiction is complex, but treatable. It affects brain function and behavior  2.​ No single treatment is appropriate for everyone 3.​ Treatment needs to be readily available 4.​ Effective treatment attends to multiple needs of the individual, not just his or her drug abuse 5.​ Remaining in treatment for an adequate period of time is critical 6.​ Behavioral therapies are the most commonly used forms of drug abuse treatment 7.​ Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies 8.​ 8.An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs 9.​ Many drug-addicted individuals also have other mental disorders 10.​Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse 11.​Treatment does not need to be voluntary to be effective 12.​Drug use during treatment must be monitored continuously, as lapses during treatment do occur 13.​Treatment programs should test patients for infectious disease Services That Parents in Treatment May Need ​ Access to physical necessities ​ Medical care ​ Psychological assessment, and mental health and trauma treatment ​ Parenting and child development education ​ Child care ​ Social services, social support ​ Family therapy and health education ​ Family planning services ​ Life skills training ​ Language and literacy training ​ Continuing aftercare programming ​ Support in sustaining visitation with children ​ Case management Family-Centered Approach ​ Addiction occurs in the context of family  ​ ○​ Family centered in an ideal sense ○​ When its a parent, important in involve family context/contacts ○​ Are their family members or friends who can step in Principles of Family- Centered Treatment ​ Treatment is comprehensive and inclusive ​ The parent or caregiver defines “family” - important for person w addiction to define their family, NOT YOU ​ Families are dynamic, and thus treatment must be dynamic ​ Conflict within families is resolvable ​ Cross-system coordination (right hand doesn't know what left hand is doing - so need people to all be on same page and know whats going on- e.g, prescriptions, prevention etc) ​ Services must be gender responsive and specific and culturally competent ​ Family-centered treatment requires a varied group of professionals ​ Safety of all family members comes first ​ Treatment must support creation of healthy family system Benefits of Family-Centered Substance Use Disorder Treatment ​ Celebrating Families! Program and integrated case management ​ Family & Children’s Services ​ Comprehensive substance use treatment Understanding Treatment Progress ​ Key factors in understanding treatment progress: ​ Participation in treatment ​ Knowledge gained about substance use ​ Participation in support systems ​ Abstinence from substances ​ Relapse prevention planning ​ Treatment completion Treatment Completion ​ Progress on treatment goals ​ Sobriety and evidence that the parent can live a sober life ​ Stabilization/resolution of medical or mental health challenges ​ Evidence of a well -developed support system When Treatment Is Unavailable ​ Be familiar with care and treatment options in the community ​ Provide contacts for 12-step meetings and encourage parents to attend ​ While waiting for optimal treatment: ○​ Help develop safety plans ○​ Plan regular contact ○​ Suggest lower levels of care Cultural Competency in Substance Use Disorder Treatment ​ Culture refers to: ○​ Race ○​ Ethnicity ○​ Age ○​ Gender ○​ Geographical location ○​ Sexual orientation ○​ Gender identity ​ Incorporating community-based values, traditions, and customs can bring about positive change Culturally Relevant Treatment ​ Culturally relevant substance use disorder treatment should: ​ Be compatible with roles, values, and beliefs ​ Identify and remove barriers to treatment ​ Address language needs ​ Be geographically accessible ​ Be family-focused Recovery ​ SAMHSA’s Working Definition Recovery Occurs in the Context of the Family ​ Addiction affects the family ​ Adults (who have children) primarily identify themselves as parents ​ The parenting role and parent-child relationship cannot be separated from treatment ​ Adult recovery should have a parent-child component including prevention for the child Focusing Only on Parent’s Recovery Without Addressing the Needs of Children... ​ Risking: ○​ Recurrence of maltreatment ​ Re-entry into out-of-home care ​ Relapse and sustained recovery ​ Additional infants with prenatal substance exposure ​ Additional exposure to trauma for child/family ​ Prolonged and recurring impact on child well-being ​ A Family Focus ​ Parent Recovery ○​ Parenting skills and competencies ○​ Family connections and resources ○​ Parental mental health ○​ Medication management ○​ Parental substance use ○​ Domestic violence ​ Family Recovery and Well-Being ○​ Basic necessities ○​ Employment ○​ Housing  ○​ Child care ○​ Transportation ○​ Family counseling ○​ Specialized parenting ​ Child Well-being ​ Well-being/behavior ○​ Developmental/health ○​ School readiness ○​ Trauma ○​ Mental health ○​ Adolescent substance use ○​ At-risk youth prevention Post-Treatment Expectations ​ Recovery is a process ​ Relapse ​ Ongoing support: ○​ Economic, vocational, housing, parenting, medical, and social supports ○​ Re-engagement in the recovery process, should relapse occur ○​ Supporting recovery Continuing Care or Aftercare: Strategies To Support Recovery ​ Alumni group meetings at the treatment facility ​ Home visits from counselors ​ Case management ​ Parenting education and support services ​ Employment services ​ Safe and sober housing resources ​ Legal aid clinics or services ​ Mental health services ​ Medical and healthcare referrals ​ Dental health care ​ Income supports ​ Self-help groups ​ Individual and family counseling ​ Recovery or peer support specialist Functions of Recovery or Peer Support Specialists ​ Liaison ○​ Links participants to ancillary supports; identifies service gaps ​ Treatment Broker ○​ Facilitates access to treatment by addressing barriers and identifying local resources ○​ Monitors participant progress and compliance (if record doenst show you relapsed 3 times - its their job to ensure up-to-date) ○​ Enters case data ​ Advisor ○​ Educates community; garners local support  ○​ Communicates with team, staff and service provider Exam 165 marks overall, 3 hours 55 m/c 3 out 4 written response - up to 20 marks each ***ONLY 3!!! -​ Dont need 20 points each, just do thorough job -​ Be sure to fully answer question -​ From midterm on -​ -pharadynamics and pharmacokinetics - know what it is but need to know pharmadynamics or pharmacokinetics of specific job (amdinstintration … its administered by… its absorption is …) -​ Drug interactions - placebo, etc -​ Know student presentation material “on student presentation on this they talked at length about this….” -​ Key definitions, etc “in lecture and the studnet presentation on…..” -​ Didnt ask anything not posted in presentation - from slides or handout - not something small they talked about – look at big idea Questions from lecs are covered - not stuff she skipped - stuff she said “pay attention to this” -​ These are likely the written questions Can ask “can you reword…. Am i on right track…” Pen or pencil Written response - all lectures m/c mainly lectures, but some presentation Big concepts for written - “pay attention to this or i always ask this” -​ Webinar Webinar Notes: Webinar - on exam ** ​ Pup integrated theoretical framework (Parents Under Pressure) ​ ○​ Acknowledges that that if we look at the right-hand side where we can see a white box saying 'Child's development outcomes' that that's actually where we see the evidence of mental health concerns that might be happening for infants and children. And you can see inside of the large concentric circles where you can see a pink circle saying, 'Parental emotional regulation,' that there's a direct connection between parents mental health and how they're managing their feelings, their emotions and the development outcomes for children. And as part of development outcome s for children we are looking at emotional, behavioural, psychological health, which is obviously what we're talking about when we're talking about infant and child mental health. ○​ And we can see that when there are pressures on parents who are trying to raise those children in terms of a disconnection maybe from community. Having substance use issues, having mental health issues, that that can have a direct impact in terms of their emotional availability to the children. And what we tend to then see is the impacts on infants and children in their behaviours. ○​ Based on ATTACHMENT - Little connection to community, family etc when addiction in family ○​ Parents moods often coordinate with drug use ​ Attachment for a child is based on parents' emotional availability. Emotional availability is what is affected the most when using substances because they either miss cues, and or they may not be emotionally available because they are high.  ​ Baby giggling but mom yells shut up. The baby learns maladaptive patterns of behaviour from the mother. Children are often exposed in utero. ○​ Based on development psychopathology -​ Ask about Sarah's experience on exam -​ Jarrah house: therapeutic residential drug and alcohol treatment service for women and women with their children -​ a child focused practice can help parents to build on their strengths and address challenges which in turn will strengthen the family overall. Working with parents who feel shame often offers opportunity to discuss what hopes and dreams they have for their children -​ when mums arrive here at Jarrah House with their children, quite often we can see a lot of problematic behaviours in the children and mum will often report that you know they're not coping, that the child is having a lot of tantrums or lots of acting out behaviour and they don't really know where to start. And we use a tool here called KIPS which is the Keys Interactive Parenting Scale. -​ mother and has lived experience of alcohol and other drug use and mental health issues -​ went through Jarrah House and completed the program last year -​ husband died of a drug overdose a couple of years ago and that preceded her relapse into heroin use again. She’d been using for a few months, She was trying to get herself into rehab, and had already gone to a public clinic a public methadone clinic. And gotten herself onto the OTP. And was stable on her dose and the GP decided to inform her that he needed to make a child protection report even though she had already told him that the clinic had made a report -​ grateful to programs like Jarrah House that actually enable me to seek treatment for myself and – and still have my child by my side. The PuP (Parents Under Pressure) Theoretical Framework, developed by Sharon Dawe from Griffith University, highlights the connection between parental well-being and child mental health outcomes. It is widely implemented across services in Australia and internationally, addressing how early challenges can manifest in children's behaviours. Key points include: Core Framework Components: 1.​ Child Development Outcomes ○​ Mental health concerns in children are evidenced through behaviours: emotional, psychological, and social challenges. ○​ Examples include tantrums, difficulty with emotional regulation, insecure attachments, and trouble engaging with peers or education.  2.​ Parental Emotional Regulation ○​ Parental mental health, emotional regulation, and emotional availability are directly linked to child outcomes. ○​ Stressors like substance use, mental health issues, or disconnection from community affect parents' ability to respond consistently and support their child's needs. 3.​ Identifying Early Signs ○​ Professionals must distinguish between normal developmental behaviour and concerning, chronic signs such as: ​ Intense emotional struggles (frequent tantrums). ​ Trouble forming secure attachments (excessive clinging, separation anxiety). ​ Social difficulties, compliance issues, or over-parentification (children acting “too good”). ​ Severe cases: dissociation, flat affect, self-harm, or trauma responses (e.g., head-banging). 4.​ The Importance of Early Intervention ○​ Early identification improves child outcomes significantly. Signs can appear in daycare or preschool settings, well before school age. Supporting Positive Child Mental Health Key protective factors for children’s mental health include: ​ Interests and Hobbies: Building self-esteem. ​ Access to Education: Addressing speech delays or learning difficulties early. ​ Community and Family: Especially vital for Aboriginal and Torres Strait Islander families, where extended kinship structures provide identity and belonging. ​ Internal Working Model: Consistent caregiving in early years helps children form positive beliefs about safety and trust. Impact of Parental Substance Use ​ Prenatal Impact: ○​ Exposure to drugs/alcohol in utero can lead to neonatal abstinence syndrome, miscarriage risks, and developmental harm. ​ Postnatal Impact: ○​ Parents under the influence may struggle to respond to children’s emotional and behavioural needs consistently. ○​ Inconsistent or neglectful parenting affects children’s ability to form secure attachments, regulate emotions, and develop socially. ○​ Substance use disrupts routines, reduces engagement (e.g., play, reading), and impacts confidence in supporting education. In summary, the PuP framework emphasizes the critical link between parental well-being and child development, stressing early detection, structured support, and fostering positive environments to improve long-term child mental health outcomes. Sarah's story provides a poignant and personal insight into the challenges faced by parents struggling with substance use and the subsequent impact on their children. Here are the expanded details of her narrative: 1.​ Early Motherhood and Substance Use: Sarah became a mother at the young age of 20. Shortly after the birth of her daughter, when the child was just eight months old, Sarah began using substances. This period marked a significant turning point in her life, as she reflects on how her substance use led to emotional unavailability. She acknowledges that during this time, she was not able to provide the emotional support and presence that her daughter needed. This lack of engagement manifested in her daughter's behavior, where she became overly compliant and eager to please, likely as a coping mechanism to deal with her mother's absence.​ 2.​ Contrast with Second Child: Four years ago, Sarah had her son under very different circumstances. By this time, she was married and felt a sense of stability and happiness about bringing her son into the world. Sarah worked diligently to maintain her recovery during this pregnancy and after his birth. This proactive approach allowed her to be emotionally present and attentive to her son's needs, both physical and emotional. She was able to engage with him in a way that she could not with her daughter, leading to a healthier attachment and a more secure environment for her son.​ 3.​ Relapse and Its Effects: Despite her efforts, Sarah experienced a relapse in the past year and a half. This relapse had a noticeable impact on her son's behavior. She observed a significant change; he went from being secure and happy to exhibiting signs of distress, such as whining, tantrums, and even regressive behaviors. Sarah recognized that her emotional unavailability during her substance use created a cycle of stress and anxiety for her son, which further exacerbated her own struggles with substance use. This cycle illustrates the interconnectedness of parental behavior and child development, highlighting how a parent's struggles can directly affect their children's emotional well-being.​ 4.​ Vicious Cycle: Sarah described her experience as a vicious cycle. When her son became more clingy and needed her attention, she found herself less able to respond due to her substance use. This lack of responsiveness increased her stress, leading her to use substances more as a coping mechanism. The cycle continued to spiral, demonstrating how parental substance use can create a feedback loop of emotional distress for both the parent and the child.​ 5.​ Importance of Support Services: Throughout her journey, Sarah emphasized the critical role of support services in her recovery. She mentioned the Junction Neighbourhood Centre, which provided her with comprehensive support that addressed both her practical needs (like food and housing) and emotional support. This holistic approach was essential in helping her navigate the complexities of parenting while dealing with substance use issues. Sarah contrasted this with her previous experiences of fragmented services that left her feeling overwhelmed and unsupported.​  6.​ Reflections on Parenting: Sarah's reflections on her parenting journey underscore the importance of emotional availability and the need for parents to be supported in their recovery. She recognizes that while her initial motivation to seek recovery was for her children, the process ultimately led to her own healing and growth. By focusing on her children's needs, she was able to find a path to recovery that benefited the entire family. Substance Use and Co-Existing Issues: ​ Substance use rarely occurs in isolation; it is often accompanied by: ○​ Mental health concerns ○​ Family and domestic violence ○​ Underlying trauma ○​ Insecure housing, intergenerational disadvantage, and poverty ​ These factors create cumulative harms, making recovery from substance use more difficult and adding stress for parents, which in turn impacts children. Intergenerational Cycle: ​ If the cycle of trauma, disadvantage, and substance use is not interrupted, children may develop substance use issues in the future as a coping mechanism for feelings of helplessness, hopelessness, and childhood adversity. Additional Complexities: ​ People with substance use issues may also face: ○​ Chronic physical health concerns and chronic pain ○​ Intellectual or learning disabilities and cognitive impairments (sometimes caused by chronic substance use) ○​ Low educational attainment ​ These challenges exacerbate parental stress and reduce their ability to engage with recovery efforts. Stigma and Barriers to Seeking Support: ​ Stigma is a major barrier, especially for mothers, who face harsh judgment due to societal expectations around motherhood (e.g., the “good mum” discourse). ​ Mothers may fear judgment or intervention, which deters them from seeking treatment and support. ​ Pregnant women who use substances face even stronger judgment, which adds to the challenges of addressing their needs and bonding with their child. Impact on Children: ​ Parental substance use and related stressors affect parents' ability to bond and attach with their child. ​ Financial stress, compliance requirements (e.g., Centrelink), and trauma further compound these difficulties, impacting family dynamics and child development. Impact of Trauma on Parenting:  ​ Many parents, particularly those struggling with substance use, have experienced significant trauma, including childhood sexual abuse or intimate partner violence. ​ Trauma often affects a parent's ability to regulate emotions, which can make it challenging to manage their children’s emotional needs—especially during difficult or unsettled times. Vicious Cycle: ​ Substances used to cope with intense emotions can further limit a parent’s capacity for patience and emotional availability, leading to irritability. ​ Children, who seek stability and security during unsettled times, may act out or need more emotional support, which exacerbates the parent's struggles. Stigma and Gender Expectations: ​ Mothers often face harsher judgment due to societal expectations of women as caregivers. This stigma can worsen feelings of shame and hinder recovery. Trauma-Informed Practice: ​ Programs like Circle of Security and Parents Under Pressure (PuP) acknowledge the importance of helping parents manage their emotions to be more emotionally available for their children. ​ A strength-based, child-focused approach creates a supportive environment, allowing parents to build healthy relationships and address parenting challenges collaboratively. Children as Motivators for Change: ​ Children can serve as a powerful motivator for parents to seek treatment and make positive changes, as demonstrated by Sarah’s story.