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
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• 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
Counseling Substance Abusers Fall 2019
disorder
