Counseling Substance Abusers Notes

subject Type Homework Help
subject Pages 56
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subject School The George Washington Universi
subject Course Counseling Substance Abusers

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Counseling Substance Abusers Fall 2019
Class 1
8/27/19
Chapter 1 Why Worry About Substance Abuse or Addiction?
Ongoing Issues
Substance use disorders (SUDs) are collectively still the most prevalent mental health
problem facing the US
The face of SUDs changes over time as popularity of specific substances rise and fall
Alcohol and nicotine are unique in their stability of popularity and legal status
Approximately 25% of patients seen by primary care physicians have an alcohol or drug
problems
Excessive alcohol use was a factor in 50% of all deaths from acute traumatic injuries
(Baron, Garbely, & Boyd, 2009)
Approximately 25% of those individuals on Medicaid have a substance use disorder
Significant contributing Factors
Substance abuse is a factor in 50-75% of all psychiatric admissions
1/3 of those who commit suicide had alcohol disorders
Between 40
Adults with a substance use diroder were 2.7 times as likely to report having engaged in
the physical abuse of a child and 4.2 times as likely to report child neglect as non-using
control substance
Alcohol is a factor in 40-86% of all US homicides (Parrott & Giancola, 2006)
Illicit drug use in home increase a woman’s change of being murdered
The Scope of the Problem
Globally, about 200 million people (5% of world’s population) have abused illicit
substance at least once.
The world-wide illicit
Alcohol use in US
o Estimated 119 million drink at least once annually
o Between 8 to 16 million drinkers will become physically dependent on it
o 5.6 million abuse it on a regular basis
o 10% drink 60% of alcohol consumed
Counseling Substance Abusers Fall 2019
o Top 30% drink 90% of alcohol consumed
o Majority with alcohol use disorder (AUD) are male
Narcotics:
o Globally around 15.6 million people abuse or are addicted to heroin
o In the US, approximately 3 million have used heroin at some point
o There are 4 male users for every female user (Krambeer, von McKnelly,
Gabrielli, & Penick, 2001)
o Growing numbers are addicted to prescription narcotics
Aj;
Class 2
9/3/19
Chapter 2- Drugs, the Body, and Brain
“I think one of the key things that both addicts and non-addicts must understand is
that this condition known as addiction (and related drug disorders) is an actual
biological illness. There are real differences in the brains of some people that rob
them of their ability to control their use of drugs or alcohol or compulsive behaviors
and then conspire against them once they enter recovery, creating an overpowering
need to resume using. It is important for them to know that they aren’t stupid or
crazy but that their brain functions and operates differently.”
- Darryl Inaba, Pharm.D., Addictions Recovery Center, Medford, OR
Classification
Substances (like marijuana) can be examined as
A. Molecule
B. Exotic Plant (biological, synthetic)
C. A source of financing for insurgencies
Drugs are usually classified by their effects
Uppers (CNS stimulants)
Amphetamine
Amphetamine Congeners
Counseling Substance Abusers Fall 2019
Caffeine
Cocaine
Designer Stimulants (bath salts)
Nicotine
Plant Stimulants (Khat)
Psychostimulants (phenylethlamines)
Side effect: insomnia, increased appetite
Downers (CNS depressants):
Alcohol
Antihistamines
Opiates and opioids
Sedative-hypnotics
o Benzodiazepines (klonopin, valium, alprazolam, Ativan)
o Sleep medications (ambian, lunesta)
Mixing substances are dangerous and can result in death
Effects: loss of inhabitation, relaxation (muscles), decreased coordination/sense of
pain, drowsiness, decreased heart rate
All Arounders (psychedelics)
Anticholingergics
Cannabinoids
Indoles
Phenlalkylamines
Others:
o Ketamine
o PCP
o Salvia
o Dxm
Other Drug Addictions:
Inhalants (deliriants)
Steroids and other sports drugs
Counseling Substance Abusers Fall 2019
Psychiatric medications
Compulsive behaviors (gambling, eating, sex, videogames, shopping)
Effects: Produce an effect that is not dissimilar from cocaine
Historical Themes:
1. Cope with one’s environment
Harsh climates
o Coca often used in high altitude climates
o Alcohol to adjust to stressful situations
o Khat used in dessert environments
2. Susceptible brain chemistry
Brain structures and chemistry effect how we handle stress
3. Business and Government Involvement
What substances are popular, what substances are moved around the
world
What is accepted socially, what is legal or illegal
All countries now tax the sale of alcohol and cigarettes
Treatment and prevention is bigger issue
4. Refining and Synthesizing (manufacturing drugs)
8th century, methods of distilling alcohol
20th century synthesize drugs from chemicals
5. (New) Methods of Using
Pipes used to be used for tobacco and opium, then syringes were
created
Smokable cocaine
New methods for making butane hash oil
Ancient Cultures:
Centered around crops to support survival
Some considered medicine or food
Methods of use
Drinking marijuana
Counseling Substance Abusers Fall 2019
Smoking opium
Chewing betel nut
Snorting cocaine
Injecting morphine
Inhaling alcohol
Volitizing cannabis extracts
o Butane hash oil?
Age of Discovery
European saw effects in other countries and popularized them and
government made profit off of them
Tobacco use
Preparation of theriac, the ancient cure all
Nitrous oxide parties
19th Century Refinement and Commercialization
Advancements in refinement of morphine in 1805, cocaine in 1859, and heroin in
1874 concentrated the psychoactive properties of the opium poppy and coca bush
which lead the way to their commercialization
Refinement: It takes 100 pounds of coca leaf to make 1 pound of cocaine
o The extraction process includes multiple steps as well as various toxic
chemicals including kerosene, gasoline, and acid
Morphine refined from opium
Opiates/Opioids
Opiates: directly from the opium poppy after refinement
o Opium, morphine, codeine
Opioids: Semisynthetic
o Heroin, hydrocodone, oxycontin
Opioids: Synthetic
o Fentanyl, methadone, Darvon, buprenorphine, Demerol
When synthetic and semisynthetic are mixed becomes more potent
Counseling Substance Abusers Fall 2019
o Heroin-fentanyl combination that has resulted in many overdoses
recently
Opioid Antagonists
o Naloxone (Narcan), naltrexone (Revia)
Revia: block euphoric effects and reduce cravings/withdrawal
(usually shot on a once a month basis)
The 20th Century and the Age of Regulation
Before there was a federal income tax system, the US government generated
significant revenue from the taxation of alcohol, opium, and tobacco
The Food and Drug Act (1906), The Smoking Opium Exclusion Act (1909), and
the Harrison Narcotic Act (1914) made cocaine and opiates illegal and this
fostered the growth of illegal drug sales
Put in place because effects did more harm than the revenue sales were worth
The Age of Regulation:
The next move by Congress was the prohibition of alcohol. Taxes on alcohol
supplied 50% of the US budget
Despite this the 18th amendment went into effect in 1920 making the
manufacture and distribution of alcohol a crime. Prohibition was repealed in
1933
Although society looks back on Prohibition as a failure, it did have some
successes.
o Declines in cirrhosis of the liver and other alcohol related diseases as
well as admission to hospitals for alcohol related issues
o Dramatic declines in domestic violence and violent crime
The 1930s brought about the founding of Alcoholics Anonymous, The
Marijuana Tax Act (which was effectively a prohibition act and followed by
a massive propaganda campaign), and the synthesis of LSD by Dr. Albert
Hofmann
o Propaganda campaign was racially driven
Counseling Substance Abusers Fall 2019
The 1960s were troubles years that included assassinations, race riots, and
the Vietnam War
o Young people were testing the authority of the government which
included the use of marijuana and LSD
The government pushed back with the Controlled Substances Act of 1970.
Followed by Nixon’s War on Drugs” campaign while expanding the
methadone maintenance program
o Caused mass incarceration of people of color across the country
The late 1970s and 1980s ushered in a new era of uppers. Smokable forms of
both cocaine and methamphetamine increased the intensity of the rush
(greater compulsive use patterns) and lowered the price
o Led to massive incarceration of people of color across the country
The 1990s became the decade of the brain as more neurotransmitters were
discovered and more imaging techniques were developed to understand the
relationships between psychoactive drugs, brain chemistry, and mental
illness.
o Connections between mental health, neurotransmitters, and drugs
The wars in Afghanistan and Iraq brought about thousands of cases of
physical trauma and PTSD for which veterans have been prescribed opiates
(prescription pain pills). The era of drug use has brought on another downer
cycle
o After Vietnam War heroin use spiked as well as during Civil War
The Body
Psychoactive drugs differ from other drugs because they can cross the blood-brain
barrier due to being similar to neurotransmitters
The Nervous System:
Divided into CNS and PNS
o CNS: brain and spinal cord
o PNS: somatic and autonomic
Somatic: voluntary and sensing stimuli
Counseling Substance Abusers Fall 2019
Autonomic (unconscious): sympathetic (quick responses=
fight/flight, maintaining bodies homeostasis) and
parasympathetic (do not require immediate action, rest and
digest/feed and breed), sexual arousal, lacrimation,
urination/defecation, digestion
The various parts of the complete nervous system function together to
transmit, interpret, store, and respond to information from the internal
and external environments
Psychoactive drugs affect not only emotions and thoughts, but many
bodily functions as well, especially respiratory and cardiovascular
functions
The Brain:
On the evolutionary scale, from a fish, turtle, and frog, to a rat, cat,
chimpanzee, and finally a human, the new brain has grown much larger
than the old brain, but the old brain tends to override it, particularly in
times of stress.
Only mammals have developed a new brain (cerebrum and cerebral
cortex) of any size. The brain of an adult human weighs about 3 lbs.
Old brain: regulating physical body functions, experiences basic emotions
and cravings, and imprinting survival memories
When someone uses a psychoactive drug, it is usually the old brain that
creates the memory. Substance use can get confused with survival
memories
Routes of Administration:
Inhaling
Snorting and mucosal exposure
Sublingual is more like mucosal exposure
Injecting (quickest)
Orally (slowest way)
Contact or transdermal
Counseling Substance Abusers Fall 2019
Blood circulation
Drug delivered to the brain by blood
The Liver:
Drug-laden blood enters the liver through the portal vein
Metabolites and drug-laden blood leave through the hepatic vein for the
heart
The liver deactivates a portion of the drug with each pass through the
circulatory system
Nerves and CNS:
Counseling Substance Abusers Fall 2019
Addiction memories in the brain are processed the same way as
Counseling Substance Abusers Fall 2019
Our new brain might have the conscious desire to remain drug free, but the old
brain can seek it out
Old brain can mistake cravings as a survival need
Subconscious memories play a role in euphoria and conscious memories play role in
the obsession
Subconscious memories are what maintain it
Willpower: our cortex (new brain) plays a role in decision making, reasoning, and
willpower
Dopamine: VTA is activated by survival activities
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Counseling Substance Abusers Fall 2019
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