Substance Abuse (SA) PDF

Substance Abuse (SA: APA Definition) ⚫ 1. The repeated, compulsive use of a substance in spite of problems or negative consequences (physical, social, financial, legal, occupational, &psychological). Ex. Missing school or work because you are drunk or “sleeping it off” = abusing alcohol. The...

Substance Abuse (SA: APA Definition) ⚫ 1. The repeated, compulsive use of a substance in spite of problems or negative consequences (physical, social, financial, legal, occupational, &psychological). Ex. Missing school or work because you are drunk or “sleeping it off” = abusing alcohol. The amount you drink is not as important as the pattern of use disrupts your life. ⚫ 2. When substances like a drug is used for an effect other than its intended use. Addiction = Substance Dependence (SD) ⚫ 1. Addiction is a dependence or the loss  of control over the use of substances such that people organize their lives around getting & using a substance. ⚫ 2 Addicts or substance dependents experience anxiety, tolerance, withdrawal symptoms or both. ⚫ 3. Dependents have low frustration & tolerance & need immediate gratification to escape anxiety. Terms-Definitions ⚫ Intoxication: Recent overuse of a substance that results in reversible effects. ⚫ Tolerance. With regular use, the body gets used  to a substance that higher doses are needed to achieve similar effects. ⚫ Tolerance break: the body becomes sensitive to even just a small amount of the substance. ⚫ Withdrawal symptoms. The effects that happen when the level of usage suddenly drops off. Symptoms are specific to the substance used. CAUSES of SUBSTANCE ABUSE 1. Experimental Use. People try substances due to: a. Curiosity. b. Conformity to peer pressure. c. Parental use. d. Rebelliousness. e. Escape from boredom. For excitement or pleasure. f. Reduction of anxiety, fear, stress, depression, low self-esteem. CAUSES of SUBSTANCE ABUSE ⚫ 2. Gateway drugs. The "gateway drug theory" describes an introduction to drug using behavior. The use of these 3 gateway drugs or substances leads to the use of other illicit drugs: ⚫ A. Tobacco-cigarettes ⚫ B. Alcohol ⚫ C. Marijuana Alcohol. Smoking Cigarette & Marijuana.  CAUSES of SUBSTANCE ABUSE ⚫ 3. Genetic Predisposition: Hereditary. ⚫ An inherited tendency towards alcohol may involve greater sensitivity (greater enjoyment) of it and greater tolerance. Children of parents who drink alcohol, smoke cigarettes-tobacco, or use drugs are more prone to drink, smoke and substance abuse. 3 CATEGORIES of SUBSTANCES ⚫ 1. CNS Depressants = Downers (Decrease VS, activates the PNS) ⚫ 2. CNS Stimulants = Uppers Increase VS activates the SNS ⚫ 3. Hallucinogens: Stimulates hallucinations or sensory experiences without an external stimulus (visual, auditory, olfactory, tactile). 4. Combination of 1&3, 2&3. 1. DEPRESSANTS Alcohol, Opiates & Barbiturates. 1. DEPRESSANTS - Alcohol ⚫ A. ALCOHOL is the most abused substance. A relaxant, & sedative, alcohol temporarily relieves anxiety, depression or loneliness. It is linked to lower productivity & loss of employment. ⚫ Binge drinking (4-5 drinks in a row) is connected with aggressive behavior, poor grades, sexual promiscuity, & accidents. ⚫ Note: It is dangerous to mix alcohol with other depressants. 1. Alcoholism Cycle ⚫ A. Intoxication 15-17 ⚫ B. Develops a Tolerance & Heavy drinking. C. First Blackout (functions w no awareness) ⚫ D. Tolerance break, intoxicated with small amount. ⚫ E. Severe drinking + difficulties 20yrs ⚫ F. Abstinence: Temporarily control after some crisis - sets up rules about drinking. ⚫ G. Escalation of alcohol intake, more problems, and a subsequent crisis. ⚫ E. Cycle repeats. 1. DEPRESSANTS Effects of Alcohol. ⚫ Effects of alcohol vary with dose & duration of use. ⚫ 1. Low doses are stimulating: alcohol induces elation or euphoria (happiness) & washes away doubts. ⚫ 2. Higher doses have a depressant, downer or sedative or relaxing effect. Alcohol deadens minor aches & pains. ⚫ 3. Alcohol impairs coordination & cognitive functioning, slurs the speech. 1. DEPRESSANTS Effects of Alcohol. ⚫ 4. Alcohol lowers inhibitions, makes people feel liberated & less likely to assert moral beliefs (ex. unprotected sex), less able to foresee consequences of behavior. Alcohol drinkers blame the alcohol even if they choose to drink. ⚫ 5. Regular drinking leads to physiological dependence to cope with stress or as an excuse for failure.  Alcohol: Cirrhosis Alcohol Effects: A. CNS A. Poor nutrition. Neurotoxic. PNS-SNS Rebound. 1. Sedation & Toxicity. Sleep, coma, anesthesia, death. Slurred speech short attention span, loud talk, memory deficits.  Black outs. Eats poorly leading to nutritional deficiency. Reduced brain weight: loss of gray & white matter, atrophy. 2. Hangover: Rebound or Extreme psychomotor activity or agitation. Feels “sick” & irritable. Tremors, sweating (diaphoresis), palpitation, agitation. Insomnia. Alcohol Effects: CNS ⚫ B.Thiamine &Niacin Deficiency (Vit B) ⚫ 1. Wernicke’s encephalopathy: (1) Confusion, (2) Ataxia (leg tremor), (3) Vision changes e.g. nystagmus, diplopia, ptosis ⚫ 2. Korsakoff’s psychosis: (1) Inability to form  new memories, (2) Amnesia (Loss of memory) (3) Physiologic Effects of Alcoholism (4) Confabulation, (5) Hallucinations ⚫ Treatments : 1 Alcohol ABSTINENCE ⚫ 2 Vitamin B 3 AVERSION therapy: ANTABUSE. Delays alcohol metabolism – patient must be alcohol free for 12 hours. Alcohol Effects C. Delirium Tremens (DT): Withdrawal ⚫ 1 Most severe & life threatening form of Alcohol Withdrawal Syndrome ⚫ 2 May be precipitated by acute injury or infection (pneumonia, pancreatitis, hepatitis) ⚫ 3 Autonomic (Sympathetic) Overactivity: ⚪ Tachycardia 3. Profuse perspiration ⚪ Dilated pupils 4. Elevated blood pressure ⚫ 4 Patients show signs of anxiety, uncontrollable fear, tremor, irritability, agitation, talkativeness, insomnia, &incontinence. Hallucinations Alcohol Effects D. Peripheral. 1. Cirrhosis: Liver function impaired, less tolerance to alcohol (tolerance break). Cirrhosis effects: obstructed blood flow (leads to hypertension, ascites, esophageal varices.) 2. Peripheral Neuritis: low serum albumin, high ammonia, bilirubin, clotting problems. Causes numbness & subsequent injury in legs & gait changes. 3. Irritant: Alcohol burns the mouth, throat, prompts  secretion of hydrochloric acid (gastric ulcers, stomach bleeding). Pancreas - Diabetes. Vitamin B absorption decreased – thiamine deficiency – peripheral neuritis. Alcoholic myopathy. Loss of peripheral & night vision. Heart: HTN. 4 Impotence: Males increase desire but decreased performance. Shrinks testicles, decreases testosterone. 1. DEPRESSANTS: B. Opiates ⚫ OPIATES are a group of narcotics derived from the opium poppy. The ancient Sumerians gave the opium  poppy its name which means: “plant of joy.” The major medical application of opiates is relief from pain. OPIODS are similar in chemical structure but are made in laboratory (synthetic). 1. DEPRESSANTS - Opiates Opiates include: ⚫ a. Morphine: used to relieve pain. ⚫ b. Heroin: provides a strong euphoric rush & pleasure that it eradicates thoughts of food &  sex. High doses cause drowsiness, stupor, altered time perception, impaired judgment. Methadone treats heroin dependence on heroin & its withdrawal symptoms. ⚫ c. Codeine ⚫ d. Demerol etc. 1. DEPRESSANTS - B.Opiates ⚫ Regular use of opiates cause the brain to stop producing endorphin neurotransmitters. ⚫ Withdrawal Symptoms include flu-like symptoms, progressing to tremors, cramps,  chills, alternating with sweating, rapid pulse, high blood pressure, insomnia, vomiting, diarrhea. 1. DEPRESSANTS - Barbiturates ⚫ Barbiturates are popular because they are relaxing & produce mild euphoria. Barbiturates relieve anxiety, tension, pain, epilepsy, high blood pressure, and insomnia. But regular use rapidly leads to physiological and psychological dependence. ⚫ High doses result in drowsiness, motor impairment, slurred speech, irritability & poor judgment. WS lead to convulsion and death. 1. DEPRESSANTS – C. Barbiturates ⚫ Examples of  Barbiturates: ⚫ a. Nembutal ⚫ b. Seconal ⚫ c. Phenobarbital B. STIMULANTS ⚫ Stimulants increase the activity of the  sympathetic nervous system. ⚫ Some temporary effects can be positive (helps cognitive ability and control impulses, contribute to feelings of euphoria and self confidence). ⚫ Stimulants include: 1Amphetamines (Shabu) 2Ritalin 3Cocaine and 4Nicotine (from smoking cigarettes and tobacco). B. STIMULANTS AMPHETAMINES 1. AMPHETAMINES ⚫ a. Stay alert. ⚫ b. Euphoria. ⚫ c. Cognitive ability. ⚫ Amphetamines or Shabu were first used by soldiers to stay alert at night. Truck drivers use them to drive through the night. Students use amphetamines for all-night cramming and dieters use them to reduce hunger. Methampethamines B. STIMULANTS - 1 AMPHETAMINES ⚫ High doses of amphetamines produce a euphoric rush. Some people swallow amphetamines in pill form or inject liquid Methedrine, the strongest form into the veins. These people may stay awake and high for days on end. But when the highs end, amphetamine users experience a “crash” or fall into a deep sleep or  depression. Some commit suicide when crashing. B. STIMULANTS – 2 RITALIN ⚫2 Ritalin increases the attention span, decrease aggressive & disruptive behavior & leads to academic gains. Ritalin calms down hyperactive children. Hyperactivity is connected with the immaturity of the cerebral cortex - Ritalin stimulates the cortex to exercise control over parts of the brain. B. STIMULANTS – 2 RITALIN ⚫Tolerance for Ritalin develops quickly - users become dependent on them specially when self-medicating. High doses cause restlessness, insomnia, loss of appetite, hallucinations, paranoid delusions (being harmed) and irritability.  B. STIMULANTS 3 Cocaine ⚫ 3. COCAINE (aka coke, crack, bazooka, snow). Cocaine is a stimulant and produces euphoria reduces hunger, deadens pain, and boosts self confidence. B. STIMULANTS – 3 Cocaine ⚫ 3. COCAINE works by binding to sites on sending neurons that normally reuptake dopamine, norepinephrine, and serotonin. These neurotransmitters remain longer in the synaptic cleft & produce a mood altering rush. ⚫ Cocaine levels will eventually drop, lower  absorption of neurotransmitters by receiving neurons causes the user’s mood to crash. B. STIMULANTS – 3 Cocaine ⚫ 3 Cocaine is derived from coca (plant) leaves. Cocaine is brewed from coca leaves as a “tea,” snorted in powder form or injected in liquid form. Repeated snorting constricts blood vessels in the nose, drying the skin, exposing the cartilage & perforating the nasal septum (requiring cosmetic surgery). Potent cocaine derivatives known as “crack” and “bazooka” are inexpensive because they are unrefined. B. STIMULANTS – 3 Cocaine ⚫ Physical dangers: Crack causes stroke. Sudden rise in BP, which constricts the coronary arteries & decreases the O2 supply to the heart. It quickens the heart rate, leading to respiratory & cardiovascular collapse & sudden deaths (young athletes). Overdoses cause restlessness, insomnia, tremors, headaches, nausea, convulsions, hallucinations, & delusions. Cocaine causes physiological and psychological dependence. B. STIMULANTS – 4 Nicotine ⚫ Nicotine is a stimulant found in tobacco and cigarette smoke. Nicotine stimulates the discharge of the hormone adrenaline and the release of neurotransmitters including dopamine, acetylcholine, GABA and endorphins. ⚫ Adrenaline creates a burst of autonomic activitiy that accelerates the heart rate and pours sugar into the blood. B. STIMULANTS – 4 Nicotine ⚫ Acetylcholine is vital in memory formation, and nicotine appears to enhance memory and attention, improve performance on simple, repetitive tasks, and enhance the mood. ⚫ Because of GABA and endorphins, nicotine has a relaxing effect. It depresses the appetite and raises the metabolic rate. Thus  some people smoke to control their weight. B. STIMULANTS – 4 Nicotine ⚫ Nicotine creates physiological dependence on tobacco products. ⚫ Withdrawal symptoms include nervousness, drowsiness, loss of energy, headache, irregular bowel movements, lightheadedness, insomnia, dizziness, cramps, palpitations, tremors, sweating. Cigarette smoking is dangerous to your health as warned by the Surgeon General on the labels of cigarette packs. 430,000 Americans die each year. B. STIMULANTS – 4 Nicotine ⚫ The carbon monoxide in cigarette smoke impairs the blood’s ability to carry oxygen, causing shortness of breath. The hydrocarbons (tar) in cigarette and cigar smoke leads to lung cancer. Cigarette smoking also stiffens the arteries and is linked to death from heart disease, chronic lung & respiratory diseases and other health problems. B. STIMULANTS – 4 Nicotine ⚫ Secondhand smoke – smoke inhaled  from other people’s cigarette products are also connected to respiratory illness, asthma & lung cancer – which is why smoking has been banished from many airplanes and restaurant. ⚫ Smoking causes premature babies and low birth weight babies. Summary on STIMULANTS (COCAINE, METHAMPHETAMINE, DEXEDRINE) Intoxication Effects: Alertness, Wakefulness, Locomotion, Loss of appetite, Weight loss, Hyperactivity, Euphoria, Agitation, Irritability, Dilated pupils. Withdrawal Symptoms: Depression, Psychosis C. HALLUCINOGENS ⚫ C. HALLUCINOGENS produce hallucinations – sensations and perceptions in the absence of external stimulation. ⚫ Hallucinogens also have additional effects of relaxation, euphoria, delirium, confusion,  flashbacks, hyperactivity, dilated pupils or panic in some cases. ⚫ Examples: Marijuana, LSD, PCP, Mescaline C. HALLUCINOGENS ⚫ 1. Marijuana ⚫ Marijuana is produced from the Cannabis sativa plant, which grows wild in many parts of the world. Marijuana helps some people relax & elevate their moods. The major psychedelic substance in marijuana is THC or delta-9- tetrahydrocannabinol. THC is found in the branches & leaves of the plant but is highly concentrated in the resin. Hashish or hash is derived from the resin. C. HALLUCINOGENS 1 Marijuana ⚫ The health risks of marijuana include: a. Impairs perceptual-motor coordination. b. It impairs short term memory & learning. c. Moderate intoxication sharpens perceptions, insight, creativity & empathy. Time seems to slow (a song seems to last an hour). There is increased bodily awareness such as heartbeat and heightened sexual sensations. C. HALLUCINOGENS ⚫ The health risks of marijuana: c. Visual hallucinations occur. d. Disorientation. Positive: Harmony with the universe. Negative: Threatened & fearful they will not regain identity. Experience of nausea and vomiting. e. Brain imaging studies reveal those who actively use marijuana have smaller brains and less gray matter. C. HALLUCINOGENS – 2 LSD ⚫ LSD = Lysergic acid diethylamide, a synthetic hallucinogen. Effects of use: a. Expands consciousness, achievement of great insights but when LSD wears off, they cannot apply the insights or recall them. b. Vivid and colorful hallucinations. c. Flashbacks (HPPD: hallucinogen persisting perception disorder). A distorted perception or hallucination that mimics the LSD “trip” but occurs days, weeks or longer after usage. C. HALLUCINOGENS – 3. Mescaline & Phencylclidine ⚫ Phencyclidine (PCP aka angel dust,  ozone, wack, rocket fuel). Mescaline (from peyote cactus). ⚫ PCP was developed from an animal tranquilizer. The names killer joints and crystal super grass refer to PCP combined with marijuana. C. HALLUCINOGENS – 3. Mescaline & Phencylclidine ⚫Regular use of these hallucinogens lead  to tolerance and psychological dependence. High doses impair coordination, cloud judgment, change the mood, and cause frightening hallucinations and delusions. INITIAL (Intoxicating) & AFTER (Withdrawal) Hallucination INTOXICATING WITHDRAWAL Effects Effects 1. Depressants = 1. Depressant = ParaSympathetic Sympathetic 2. Stimulants = 2. Stimulant = Sympathetic Parasympathetic 3. Hallucinogens = 3. Hallucinogens HPPD or more hallucinations