Substance Abuse Counselling Unit 1 PDF

SUBSTANCE ABUSE COUNSELLING LECTURER: K. DUNCAN WILLIAMS  UNIT 1 OVERVIEW & INTRODUCTION  WHAT IS SUBSTANCE ABUSE? Substance abuse is defined as “a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use...

SUBSTANCE ABUSE COUNSELLING LECTURER: K. DUNCAN WILLIAMS  UNIT 1 OVERVIEW & INTRODUCTION  WHAT IS SUBSTANCE ABUSE? Substance abuse is defined as “a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.” These consequences may be occupational (repeated absences from work), legal (being arrested for driving while drunk), or social (marital separation or divorce).  SUBSTANCE ABUSE COUNSELLING Definition Substance abuse counselling refers to a type of intervention (action intended to alter the course of a disease process) to help individuals recover from abuse of alcohol (or other drug) by abstaining completely from the substance or cutting down on its use.  DIAGNOSING SUBSTANCE ABUSE Note: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) no longer uses the terms substance abuse and substance dependence which was previously used in the DSM-IV. Rather, it refers to substance use disorders, which are classified as mild, moderate, or severe. The level of severity is determined by the number of diagnostic criteria met by an individual. The DSM5 is being used now  WHY SUBSTANCE ABUSE EDUCATION? The main focus of Substance Abuse Education is teaching individuals about drug and alcohol abuse and how to avoid, stop, or get help for substance use disorders. Education can start with parents educating their children.  In primary school, programmes can be designed to increase knowledge about substance abuse and the associated risks. For teenagers, substance abuse education is generally incorporated into school curriculum. Adults who want to learn more about substance abuse can attend classes, group meetings, and research information online MISCONCEPTIONS ABOUT DRUGS Knowledge is power, and with accurate information about the topic, a person will be more likely to make a fact-based and informed decision.  MISCONCEPTIONS ABOUT DRUGS When educating people, all drugs should be covered, regardless of the strength or perceived risk of harm. While opioids, cocaine, and methamphetamine are viewed as “hard drugs,” and therefore have serious consequences, “minor drugs,” such as marijuana and alcohol can still be addictive and are frequently abused. DISCUSSION Share your knowledge concerning drug use (mild or hard) whether personal or knowledge of someone who has used drugs. Based on what you have observed, how has drug addiction impacted someone you know or know of: (Socially, financially, economically, mentally, physically and otherwise).  HISTORY: DRUGS IN EARLY TIMES Mind-altering substances have been a part of the human experience since the beginning of civilization (Katcher 1993; Saah 2005). People have sought ways to alter levels of consciousness by taking substances such as herbs, alcohol, and other drugs. As a spiritual tool, some religions have historically found uses for mind-altering substances as a way to aid communion with a  HISTORY: DRUGS IN EARLY TIMES Many of the psychotropic effects enjoyed by recreational drug users today were sought by ancient civilizations as a means of increasing their chances of survival (Saah 2005). Ancient civilizations also realized, however, that it was possible to enjoy and become addicted to certain substances. Five thousand year old Egyptian records report that individuals suffering from alcohol addiction were often cared for in the private homes of people who provided treatment.  HISTORY: DRUGS IN EARLY TIMES Records from ancient Greek and Roman sources recommended that alcoholics receive treatment in “public or private asylums” (White 1998). Americans have consumed alcohol since colonial times, making alcohol the earliest use of an intoxicant by the settlers. Alcohol was an integral part of culture at the time, but public drunkenness was not tolerated (Levine 1978; Stolberg 2006).  TERMS COMMONLY USED IN SUBSTANCE EDUCATION Addiction/ substance dependence—a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by a need for increasing amounts of the substance to achieve intoxication, markedly diminished effect of the substance with continued use, the need to continue to take the substance in order to avoid withdrawal symptoms, and other serious behavioral effects, occurring at any time in the same 12-month period. Crack—cocaine (cocaine hydrochloride) that has been chemically modified so that it will become a gas vapor when heated at relatively low temperatures. Also called “rock” cocaine. Downers—slang term for drugs that exert a depressant effect on the central nervous system. In general, downers are sedative-hypnotic drugs, such as benzodiazepines and barbiturates. Ecstasy—slang term for methylenedioxymethamphetamine (MDMA), a member of the amphetamine family (for example, speed). At lower doses, MDMA causes distortions of emotional perceptions. At higher doses, it causes potent stimulation typical of the amphetamines.  TERMS COMMONLY USED IN SUBSTANCE EDUCATION Hallucinogens—a broad group of drugs that cause distortions of sensory perception. The prototype hallucinogen is lysergic acid diethylamide (LSD). LSD can cause potent sensory perceptions, such as visual, auditory, and tactile hallucinations. Related hallucinogens include peyote and mescaline. Marijuana—the Indian hemp plant cannabis sativa; also called “pot” and “weed.” The dried leaves and flowering tops can be smoked or prepared in a tea or food. Marijuana has two significant effects. In the person with no tolerance for it, marijuana can produce distortions of sensory perception, sometimes including hallucinations. Marijuana also has depressant effects and is partially cross-tolerant with sedative-hypnotic drugs such as alcohol. Hashish (or “hash”) is a combination of the dried resins and compressed flowers of the female plant. Opioid—a type of depressant drug that diminishes pain and central nervous system activity. Prescription opioids include morphine, meperidine (Demerol), methadone, codeine, and various opioid drugs for coughing and pain. Illicit opioids include heroin, also called “smack,” “horse,” and “boy.” TERMS COMMONLY USED IN SUBSTANCE EDUCATION Relapse—a breakdown or setback in a person's attempt to change or modify any particular behavior. A deterioration in someone’s sobriety after a temporary or long improvement. Substance abuse treatment program—an organized array of services and interventions with a primary focus on treating substance use disorders, providing both acute stabilization and ongoing treatment. Uppers—slang term used to describe drugs that have a stimulating effect on the central nervous system. Examples include cocaine, caffeine, and amphetamines.  Scientists do not yet understand why some people become addicted while others do not. However, Addiction tends to run in families, and certain types of genes have been linked to different forms of addiction. But not all members of an affected family are necessarily prone to addiction. Other factors can also raise your chances of addiction. “Growing up with an alcoholic; being abused as a child; being exposed to extraordinary stress: all of these social factors can contribute to the risk for alcohol addiction or drug abuse. Teens are especially vulnerable to possible addiction because their brains are not yet fully developed, particularly the frontal regions that help with impulse control and assessing risk. PROCESS OF ADDICTION Addiction usually does not happen overnight. Rather, people who develop substance abuse problems (with alcohol, marijuana, stimulants, prescription painkillers, etc.) are gradually introduced and desensitized to them over a period of time.  People with addiction lose control over their actions. They crave and seek out drugs, alcohol, or other substances no matter what the cost even at the risk of damaging friendships, hurting family, or losing jobs. What is it about addiction that makes people behave in such destructive ways? And why is it so hard to quit? “A common misperception is that addiction is a choice or moral problem, and all you have to do is stop. But nothing could be further from the truth,” says Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism. “The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain.” (https://newsinhealth.nih.gov/2015/10/biology-addiction)  PROCESS OF ADDICTION A healthy brain rewards healthy behaviours like exercising, eating, or bonding with loved ones. It does this by switching on brain circuits that make you feel wonderful, which then motivates you to repeat those behaviours. These pleasurable behaviours trigger the release of a neurotransmitter called dopamine. It teaches our brains to repeat the behaviour.  Drugs trigger that same part of the brain (the reward system) but they do it to an extreme extent, rewiring the brain in harmful ways. When someone is becoming addicted to a substance, that normal hardwiring of helpful brain processes can begin to work against them. Drugs or alcohol can hijack the pleasure/reward circuits in your brain and hook you into wanting more and more. Addiction can also send your emotional danger-sensing circuits into overdrive, making you feel anxious and stressed when you are not using the drugs or alcohol. At this stage, people often use drugs or alcohol to keep from feeling bad rather than for their pleasurable effects. To add to that, repeated use of drugs can damage the essential decision-making center at the front of the brain. This area, known as the prefrontal cortex, is the very region that should help you recognize the harms of using addictive substances.  Dopamine plays an important role in the control of movement, cognition, motivation and reward. High levels of free dopamine in the brain generally enhance mood and increase body movement (i.e., motor activity), but too much dopamine may produce nervousness, irritability, aggressiveness, and paranoia that approximates schizophrenia, as well as the hallucinations and bizarre thoughts of schizophrenia. Too little dopamine in certain areas of the brain results in the tremors and paralysis of Parkinson's disease.  When someone takes a drug, their brain releases extreme amounts of dopamine way more than gets released as a result of a natural pleasurable behaviour. The brain overreacts, reducing dopamine production in an attempt to normalize these sudden, sky-high levels the drugs have created and this is how the cycle of addiction begins. EFFECTS OF DRUGS ON THE BRAIN  ADDICTION & BEHAVIOUR CHANGES An addicted brain causes behaviour changes. By mapping the neural pathways of pleasure and pain through the human brain, investigators are beginning to understand how abused psychoactive substances, including stimulants, interact with various cells and chemicals in the brain. Brain imaging studies from drug-addicted individuals show physical, measurable changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behaviour control.  Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviours of addiction. With addiction, cravings take over. These cravings are painful, constant and distracting. The user starts seeking out drugs, no matter the consequences, often resulting in compulsive and destructive behaviours. Especially given the intensity of withdrawal symptoms, the body wants to avoid being in withdrawal at all costs.  Warning Signs of Addiction sleep difficulties. a person not seeming anxiety or depression. like themselves memory problems. (showing a general lack of interest or being mood swings (temper overly energetic). flare-ups, irritability, defensiveness). frequent requests for rapid increases in the refills of certain amount of medication medicines/false or needed. forged prescriptions. Examples of compulsive and destructive behaviours of addiction: A promising student might see his/her grades slip. A bubbly social butterfly might suddenly have trouble getting out of bed. A trustworthy sibling might start stealing or lying. A devoted husband may abandon his family and responsibilities.  Video: Drugs, Inc - Jamaican crack addict interview (ORVILLE) https://youtu.be/NxYx7BhSY4E  PART B THINGS TO COVER: 1. What is withdrawal? 2. Routes of drug administration 3. Legal & Illegal drugs 4. Substance Abuse and HIV/AIDS  WHAT IS WITHDRAWAL? Withdrawal happens when a person who is physically dependent upon a substance stops taking it completely: either in an attempt to quit cold turkey or because they do not have access to the drug. Cold Turkey: A faster but unpleasant method of stopping an addictive habit, such as drugs or alcohol as opposed to gradually easing the process through reduction over time or by using replacement medication. Someone in withdrawal feels absolutely terrible: depressed, despondent and physically ill. FOUR MAJOR ROUTES OF ADMINISTERING DRUGS The four most common routes of administering psychoactive (mood-changing) substances are: (1) oral consumption (i.e., swallowing) (2) intranasal consumption (i.e., snorting) (3) inhalation into the lungs (generally by smoking) (4) intravenously via hypodermic syringe (injecting) There are other ways of administering drugs. NOTE: For substances of abuse to have effect, they must first get to the brain. Swallowed substances go to the stomach and on to the intestinal tract. Some substances easily pass through the digestive tract into the bloodstream. Other substances are broken down into their chemical components (metabolized) in the digestive system, thereby destroying the substance.  Substances that are inhaled into the lungs adhere to the lining of the nasal passages (the nasal mucosa) through which they enter directly into the bloodstream. Inhaled substances are usually first changed into a gaseous form by igniting (e.g., marijuana) or volatilizing by intense heat (e.g., crack cocaine). The lungs offer a large surface area through which the gaseous form may quickly pass directly into the bloodstream.  Injected substances enters the bloodstream directly, although at a somewhat regulated rate. Once a substance enters the bloodstream, it is transported throughout the body to various organs and organ systems, including the brain. Substances that enter the liver may be metabolized there. Substances that enter the kidney may be excreted. If a female substance user is pregnant, and the substance is able to cross the placenta, then the substance will enter the fetus' bloodstream. Nursing babies may ingest some substances from breast milk.  To enter the brain, a substance's molecules must first get through its chemical protection system, which consists mainly of the blood-brain barrier. Tight cell-wall junctions and a layer of cells around the blood vessels keep large or electrically charged molecules from entering the brain. However, small neutral molecules like those of cocaine and MA easily pass through the blood-brain barrier and enter the brain. Once inside the brain, substances of abuse begin to exert their psychoactive effects.  NOTE: Cocaine and MA can be smoked, snorted, injected, or ingested orally. These various routes of administration differ in dosage and in the rapidity and intensity of effect, which may affect the course of abuse and dependence. Some evidence suggests that the onset of dependence varies according to the route of administration. The route of administration affects the amount (i.e., the dosage) of stimulant delivered to the brain, the speed at which it is delivered, and the resulting intensity of the stimulant's effects. WATCH VIDEO: Type link into your browser Fentanyl Addict interview –Amber https://youtu.be/Plx3Xo0iVtI LIST OF LEGAL DRUGS What types of prescription drugs are abused? Three types of drugs are abused most often: Opioids—prescribed for pain relief. CNS Depressants—barbiturates and benzodiazepines prescribed for anxiety or sleep problems (often referred to as sedatives or tranquilizers). Stimulants—prescribed for attention-deficit hyperactivity disorder (ADHD), the sleep disorder narcolepsy or obesity. OPIOIDS Codeine: Ambien (zolpidem), Sonata (zaleplon), Lunesta (eszopiclone) Empirin with Codeine, Fiorinal with Codeine, Robitussin A-C, Tylen Codeine: Captain Cody, Cody, schoolboy. Morphine: Roxanol, Duramorph: M, Miss Emma, monkey, white stuff Methadone: Methadose, Dolophine: fizzies, amidone, (with MDMA: chocolate chip cookies). DEPRESSANTS Barbiturates: Examples of Commercial and Street Names Amytal, Nembutal, Seconal, Phenobarbital: barbs, reds, tooies, yellows, yellow jackets red birds, phennies. Benzodiazepines: Ativan, Halcion, Librium, Valium, Xanax, Klonopin: pills, tranks candy, downers, sleeping. STIMULANTS Amphetamines: Biphetamine, Dexedrine, Adderall: bennies, black beauties, crosses, hearts, LA turnaround, speed, truck drivers, uppers. Methylphenidate: Concerta, Ritalin: JIF, MPH, R-ball, Skippy, the smart drug, vitamin R Found in some cough and cold medications. Injected, swallowed, snorted. LIST OF ILLEGAL DRUGS SCHEDULED DRUGS: *Schedule I and II drugs have a high potential for misuse. They require greater storage security and have a quota on manufacturing, among other restrictions. Schedule I drugs are available for research only and have no approved medical use; Schedule II drugs are available only by prescription (unrefillable) and require a form for ordering. *Schedule III and IV drugs are available by prescription, may have five refills in 6 months, and may be ordered orally. Some Schedule V drugs are available over the counter. CANNABINOID S Acute Effects: Euphoria; relaxation; slowed reaction time; distorted sensory perception; impaired balance and coordination; increased heart rate and appetite; impaired learning, memory; anxiety; panic attacks; psychosis Health Risks: Cough; frequent respiratory infections; possible mental health decline; addiction ABINOIDS Substances: Category & Examples of Commercial DEA Schedule*/ How Name & Street Names Administered** Blunt, dope, ganja, grass, herb, joint, bud, MARIJUANA Mary Jane, pot, reefer, I/smoked, swallowed green, trees, smoke, sinsemilla, skunk, weed Boom, gangster, hash, HASHISH I/smoked, swallowed hash oil, hemp Category: e.g. Cannabinoids Name of drug: e.g. marijuana (give a little background information on it) Commercial/street name: e.g. Blunt, dope, ganja, herb etc. How it is administered: Smoked, Vaped, Eaten (mixed in food or brewed as tea) Short term effects: Enhanced sensory perception and euphoria followed by drowsiness/relaxation; slowed reaction time; problems with balance and coordination; increased heart rate and appetite; problems with learning and memory; anxiety. Long term effects: Mental health problems, chronic cough, frequent respiratory infections. Health Risks: Cough; possible mental health decline; addiction etc. Withdrawal Symptoms: Irritability, trouble sleeping, decreased appetite, anxiety. OPIOIDS Acute Effects: Euphoria; drowsiness; impaired coordination; dizziness; confusion; nausea; sedation; feeling of heaviness in the body; slowed or arrested breathing Health Risks: Constipation; endocarditis; hepatitis; HIV; addiction; fatal overdose OPIOIDS Substances: Category & Examples of Commercial & DEA Schedule*/ How Name Street Names Administered** Diacetylmorphine: smack, horse, brown sugar, dope, H, junk, skag, skunk, white HEROIN I/injected, smoked, snorted horse, China white; cheese (with OTC cold medicine and antihistamine) Laudanum, paregoric: big O, OPIUM II, III, V/swallowed, smoked black stuff, block, gum, hop STIMULANTS Acute Effects: Increased heart rate, blood pressure, body temperature, metabolism; feelings of exhilaration; increased energy, mental alertness; tremors; reduced appetite; irritability; anxiety; panic; paranoia; violent behavior; psychosis Health Risks: Weight loss; insomnia; cardiac or cardiovascular complications; stroke; seizures; addiction Also, for cocaine - nasal damage from snorting Also, for methamphetamine - severe dental problems. IMULANTS Substances: Category & Name Examples of Commercial & Street Names DEA Schedule*/ How Administered** Cocaine hydrochloride: blow, bump, C, COCAINE candy, Charlie, coke, crack, flake, rock, II/snorted, smoked, injected snow, toot Biphetamine, Dexedrine: bennies, black beauties, crosses, hearts, LA II/swallowed, snorted, smoked, AMPHETAMINE turnaround, speed, truck drivers, injected uppers Desoxyn: meth, ice, crank, chalk, II/swallowed, snorted, smoked, METHAMPHETAMINE crystal, fire, glass, go fast, speed injected CLUB DRUGS Acute Effects: MDMA - mild hallucinogenic effects; increased tactile sensitivity, empathic feelings; lowered inhibition; anxiety; chills; sweating; teeth clenching; muscle cramping Flunitrazepam - sedation; muscle relaxation; confusion; memory loss; dizziness; impaired coordination GHB - drowsiness; nausea; headache; disorientation; loss of coordination; memory loss Health Risks: MDMA - sleep disturbances; depression; impaired memory; hyperthermia; addiction Flunitrazepam - addiction GHB - unconsciousness; seizures; coma CLUB DRUGS Examples of Commercial & Street Substances: Category & Name DEA Schedule*/ How Administered** Names MDMA Ecstasy, Adam, clarity, Eve, lovers' (METHYLENEDIOXYMETHAMPHETAM I/swallowed, snorted, injected speed, Molly, peace, uppers INE) Rohypnol (date rape drug): forget- me pill, Mexican Valium, R2, roach, FLUNITRAZEPAM*** IV/swallowed, snorted Roche, roofies, roofinol, rope, rophies Gamma-hydroxylbutyrate: G, Georgia home boy, grievous bodily GHB*** I/swallowed harm, liquid ecstasy, soap, scoop, goop, liquid X DISSOCIATIVE DRUGS Acute Effects: Feelings of being separate from one’s body and environment; impaired motor function Also, for ketamine - analgesia; impaired memory; delirium; respiratory depression and arrest; death Also, for PCP and analogs - analgesia; psychosis; aggression; violence; slurred speech; loss of coordination; hallucinations Also, for DXM - euphoria; slurred speech; confusion; dizziness; distorted visual perceptions Health Risks: Anxiety; tremors; numbness; memory loss; nausea DISSOCIATIVE DRUGS Examples of Commercial & Street Substances: Category & Name DEA Schedule*/ How Administered** Names Ketalar SV: cat Valium, K, Special K, KETAMINE III/injected, snorted, smoked vitamin K Phencyclidine: angel dust, boat, PCP AND ANALOGS I, II/swallowed, smoked, injected hog, love boat, peace pill Salvia, Shepherdess’s Herb, Maria Not scheduled/chewed, swallowed, SALVIA DIVINORUM Pastora, magic mint, Sally-D smoked Found in some cough and cold DEXTROMETHORPHAN (DXM) medications: Robotripping, Robo, Not scheduled/swallowed Triple C HALLUCINOGEN S Acute Effects: Altered states of perception and feeling; hallucinations; nausea Also, for LSD and mescaline - increased body temperature, heart rate, blood pressure; loss of appetite; sweating; sleeplessness; numbness; dizziness; weakness; tremors; impulsive behavior; rapid shifts in emotion Also, for psilocybin - nervousness; paranoia; panic Health Risks: Also, for LSD - Flashbacks, Hallucinogen Persisting Perception Disorder. LLUCINOGENS Examples of Commercial & DEA Schedule*/ How Substances: Category & Name Street Names Administered** Lysergic acid diethylamide: acid, blotter, cubes, I/swallowed, absorbed LSD microdot, yellow sunshine, through mouth tissues blue heaven Buttons, cactus, mesc, MESCALINE I/swallowed, smoked peyote Magic mushrooms, purple PSILOCYBIN passion, shrooms, little I/swallowed smoke  OTHER COMPOUNDS Acute Effects: Steroids - no intoxication effects high blood pressure; blood clotting and cholesterol changes; liver cysts; hostility and aggression; acne; in adolescents— premature stoppage of growth; in males—prostate cancer, reduced sperm production, shrunken testicles, breast enlargement; in females—menstrual irregularities, development of beard and other masculine characteristics Inhalants - (varies by chemical) stimulation; loss of inhibition; headache; nausea or vomiting; slurred speech; loss of motor coordination; wheezing Health Risks: Steroids - high blood pressure; blood clotting and cholesterol changes; liver cysts; hostility and aggression; acne;—in adolescentspremature stoppage of growth; in males—prostate cancer, reduced sperm production, shrunken testicles, breast enlargement; in females—menstrual irregularities, development of beard and other masculine characteristics Inhalants - cramps; muscle weakness; depression; memory impairment; damage to cardiovascular and nervous systems; unconsciousness; sudden death. OTHER COMPOUNDS Substances: Category & Name Examples of Commercial & Street Names DEA Schedule*/ How Administered** Anadrol, Oxandrin, Durabolin, Depo- III/injected, swallowed, applied to ANABOLIC STEROIDS Testosterone, Equipoise: roids, juice, gym skin candy, pumpers Solvents (paint thinners, gasoline, glues); gases (butane, propane, aerosol Not scheduled/inhaled through INHALANTS propellants, nitrous oxide); nitrites nose or mouth (isoamyl, isobutyl, cyclohexyl): laughing gas, poppers, snappers, whippets