© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group Center for Development of...

© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group

Center for Development of Human Services

Examining the Effects of Parental Alcohol and Drug Abuse on Children

Stephen Webster, PharmD Student

University at Buffalo School of Pharmacy and Pharmaceutical Sciences



Credits

• William A. Prescott Jr., Pharm. D.

Clinical Assistant Professor

University at Buffalo School of Pharmacy

and Pharmaceutical Sciences,

Department of Pharmacy Practice



Credits

• James Brustman, CDHS Child Welfare Trainer

• Phyllis Harris, CDHS Administrator

• William Rea, CDHS Child Welfare Trainer

• David Peters, Senior CDHS Child Welfare Trainer


Introduction

• Substance abuse has a major impact on the child welfare system. * It is estimated that 9 % of children in the U.S. (6 million) live with at least one parent who

abuses alcohol or other drugs. * Between 1/3rd and 2/3rds of child maltreatment cases involve substance abuse* 85 % of states reported substance abuse

was one of the two major problems exhibited by families in which maltreatment was suspected.


Project Goals

1. Training Manual for CDHS Trainers

2. Handbook for Child Welfare Caseworkers

Overall: Educate trainers and caseworkers

on the effects of parental drug/alcohol

abuse on children.


Today’s Agenda

1. Overview of Substance Abuse and Addiction

2. Summary of each Commonly Abused Substance

3. Family-related Consequences of Parental Substance Abuse

4. Conclusion


Overview of Substance Abuse and Addiction

• What is physical addiction ?

• What is psychological addiction ?

• What is tolerance, withdrawal, and potentiation ?

• How quickly can someone become addicted to a drug ?


Overview of Substance Abuse and Addiction

• Why do some individuals become dependent/addicted and others not ?

• Are substance dependent parents more likely to abuse/neglect their children ?

• What does a family history of substance abuse mean for its members ?

• Is it possible to be an effective parent if you are abusing drugs ?


Drug Sections

• - Each drug section will discuss:

* Common street names

* Mechanism of action

* Route of administration

* Indicators of intoxication

* Long-term effects

* Withdrawal


Alcohol

• The most commonly abused substance in the United States

• Alcohol dependence has both genetic and

environmental factors.


Alcohol

• Mechanism of Action

- Alcohol is a depressant that slows central nervous system functioning.

- Alcohol is immediately absorbed into the blood stream from the stomach and small intestine resulting in a rapid onset of effect.


Alcohol• Immediate Physiological Effects

- Decreased blood pressure, heart rate, breathing, body temperature, and coordination

- Feeling of well-being Slowed cognition

Drowsiness


Alcohol

• Signs and Symptoms of Intoxication- Severe drowsiness Confusion

Aggression Hypotension Emotional blunting Memory impairment Poor coordination Slurred speech Decreased heart rate Increased irritability Decreased body temperature Severe respiratory depression


Alcohol• Consequences of Long-term Use

- Addiction, Tolerance, Withdrawal

- Long-term Physiological Effects

Liver cirrhosis, kidney damage, immune system impairment, gastric ulceration and cancer, heart disease, and high blood pressure.


Alcohol• Withdrawal

- Severity: The potential to be life-threatening. - Approximately 25% will have seizures. - Approximately 10% will have hallucinations.

- Delirium tremens, the most serious alcohol withdrawal syndrome, occurs in 5% of cases. It is characterized by hyperagitation, tremor, disorientation, persistent hallucinations, and marked increases in heart and respiratory rates and blood pressure. - Roughly 5% of those experiencing Delirium tremens will die


Alcohol

• Withdrawal- Symptoms: * Increased heart rate, blood pressure, body temperature, respiration, sensitivity to light and sound * Pupil dilation, hallucinations, paranoid delusions, DT’s, alcohol craving, tremors, agitation, anxiety, disorientation, nausea, diarrhea, vomiting, headache


Alcohol

• Withdrawal

- Timeline: . Major withdrawal symptoms peak between 24 and 72 hours after the last drink and last between 5 and 7 days.


Cannabinoids(Marijuana and Hashish)

• Two drugs derived from different parts of the plant Cannabis sativa

• Approx. 40% of Americans over the age of 12 have tried marijuana at least once


Cannabinoids

• Common Street Namesblunt, dope, ganja, grass, herb, joint, mary jane, pot, reefer, weed, chronic, boom

• Administrationsmoke, swallowed

• Mechanism of ActionThe major active chemical in cannabis is THC.THC binds to areas in the brain that influence pleasure sensation, memory, thought, concentration, sensory and time perception, and coordination.


Cannabinoids

• Immediate Physiological Effects

Euphoric feeling Increased heart rate

Increased anxiety Drowsiness

Altered sensation Loss of time perception

Increased hunger Eye redness


Cannabinoids

• Signs and Symptoms of IntoxicationAltered sensation Loss of time perceptionIntense hungerEye rednessHallucinations Poor coordinationPoor judgment Poor reaction timeRapid heart beat Anxiety/ConfusionEuphoric feeling Short-term memory

impairment


Cannabinoids

• Consequences of Long-term Use- Craving and withdrawal symptoms including irritability, difficulty sleeping, anxiety, and aggression- Depression, memory impairment, lack of motivation- increased risk of lung infections, chronic cough, bronchitis, emphysema, lung cancer


Cannabinoids

• Withdrawal- Severity: mild to moderate when long-term user abruptly stops using the drug. - Symptoms: irritability, increased aggression, difficulty sleeping, decreased appetite, drug craving, and anxiety. - Timeline: Peak severity is approximately one week following the last use of the drug.


Cocaine/Crack

• Cocaine is the second most commonly used illicit drug in the United States

• Approx. 10% of Americans over the age of 12 years have tried cocaine at least once.


Cocaine/Crack

• Common Street Namesblow, bump, C, candy, Charlie, coke, flake, rock, snow, toot

• Administrationsmoked, snorted, injected

• Mechanism of ActionCocaine is a powerfully addictive stimulant. Cocaine’s euphoric effect is attributed to its inhibition of dopamine removal and subsequent accumulation in the central nervous system.


Cocaine/Crack


- Increased blood pressure, heart rate, body temperature, energy, and alertness

- Dilated pupils Decreased appetite


Cocaine/Crack

• Signs and Symptoms of Intoxication

Intense euphoria Paranoia

Muscle twitches Increased alertness

Tremors Increased energy

Heavy sweating Increased Irritability

Erratic and violent behavior


Cocaine/Crack

• Consequences of Long-term Use- Addiction, Tolerance, Withdrawal- Long-term psychological effects paranoid psychosis, mood disturbances, auditory hallucinations, and personality changes -Long-term physiological effectsheart attacks, ventricular fibrillation, chest pain, respiratory failure, strokes, seizures, abdominal pain, weight loss, loss of the sense of smell, and nosebleeds


Cocaine/Crack

• Withdrawal- Severity: Cocaine-withdrawal syndrome is similar to severe depression. Symptoms are not life-threatening, but may require hospitalization due to precipitating psychiatric disturbances - Symptoms: Severe depression, slowed motor response, emotional blunting, hypersomnia, excessive eating, social withdrawal, paranoid delusions, suicidal thoughts and behavior, drug craving- Timeline: Peak severity is 1 to 3 days after the last use, mild symptoms may persist for 2 weeks


HallucinogensLSD, Mescaline, Psilocybin

• LSD is a semi-synthetic compound

• Mescaline is found in peyote cactus

• Psilocybin is found in psilocybe mushrooms


Hallucinogens

• Common Street NamesMescaline: buttons, cactus, mesc, peyotePeyote: magic mushroom, purple passion, LSD: acid, blotter, boomers, cubes, microdot

• Administrationsmoked, swallowed, absorbed through mouth tissues

• Mechanism of ActionAct on specific serotonin receptors in areas of the brain that control mood, cognition, and sensory perception


Hallucinogens

• Immediate Physiological Effects- Increased blood pressure, heart rate, and body temperature- Dizziness Loss of appetite Dry mouth Sweating Nausea Tremors Pupil dilation Altered senses Altered emotions


Hallucinogens

• Signs and Symptoms of Intoxication- Increased heart rate, blood pressure, body temperature- Violent outbursts Dizziness Euphoria Hallucinations Sweating Nausea Dizziness Anxiety Tremors Pupil dilation

Emotional instability Altered sensory perception


Hallucinogens

• Consequences of Long-term Use- Tolerance- Long-term psychological effects1) Drug-related psychosis characterized by frequent mood swings and visual disturbances which can potentially persist for years 2) Hallucinogen persisting perception disorder (HPPD), better known as “flashbacks”, in which the user experiences spontaneous recurrent episodes of sensory distortion - No Withdrawal Syndrome


Methamphetamine/Amphetamine

• Methamphetamine use is rapidly increasing across the country and devastating entire communities

• Amphetamines are frequently prescribed for children and adults with ADHD


Methamphetamine use in the United States



• Common Street NamesMeth: chalk, crank, crystal, fire, glass, ice, meth, speed Amph: bennies,crosses, hearts, LA turnaround, speed, truck drivers, uppers

• Administrationinjected, swallowed, smoked, snorted

• Mechanism of ActionCauses a release of excess dopamine, a chemical which plays an important role in pleasure regulation in the brain




- Increased blood pressure, heart rate, breathing rate, body temperature, energy, and attention

- Decreased appetite Dry mouth

Dilated pupils




Heavy sweating Intense irritability

Chills Euphoria

Hyper-sexuality Heavy breathing

Paranoia Fever

Increased self-esteem and confidence



• Consequences of Long-Term Use- Addiction, Tolerance, Withdrawal- Long-term Pyschological EffectsChronic methamphetamine use has been associated with psychosis, most resembling paranoid schizophrenia. Visual and auditory hallucinations, intense paranoia, mood disturbances, repetitive motor activity, and out-of-control rages that can be coupled with extremely violent behavior are all symptoms of methamphetamine addiction psychosis.



• Consequences of Long-Term Use


irreversible heart damage, stroke, weight loss, dental damage, violent behavior, anxiety, confusion, and insomnia


Methamphetamine/Amphetamine• Withdrawal

- Severity: Meth.-withdrawal syndrome is similar to severe depression. Symptoms are not life-threatening, but may require hospitalization due to precipitating psychiatric disturbances - Symptoms: Severe depression, slowed motor response, emotional blunting, hypersomnia, excessive eating, social withdrawal, paranoid delusions, suicidal thoughts and behavior, drug craving- Timeline: Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after 5 to 7 days.


Ecstasy/MDMA

• MDMA is the main ingredient in Ecstasy

• MDMA contains chemical variations of the stimulant methamphetamine and mescaline, a hallucinogen.

• Ecstasy is considered a “club drug”


Ecstasy/MDMA

• Common Street NamesAdam, clarity, Eve, E, lover's speed, peace, STP, X, XTC

• Administrationswallowed

• Mechanism of ActionMDMA is a psychoactive drug containing both stimulant and hallucinogenic properties. MDMA affects the brain by increasing the activity of at least three chemicals; serotonin, dopamine, and norepinephrine.


Ecstasy/MDMA


- Increased heart rate, blood pressure, body temperature, and energy

- Mental stimulation Decreased anxiety

Blurred vision

Chills

Muscle cramping

Sweating

Nausea


Ecstasy/MDMA

• Signs and Symptoms of Intoxication- Increased blood pressure, heart rate- Sense of well-being Decreased anxiety

Hypersexuality Fever Enhanced sensory perception

Intense thirst Altered time perception Empathy towards others

Heavy sweating


Ecstasy/MDMA• Consequences of Long-term Use

- Tolerance, Addiction ?, Withdrawal ?- Long-term Psychological Effectsincreased incidences of confusion, depression, changes in cognition, memory, attention, and motor function - Long-term Physiological Effectsweight loss, and heart, kidney, and liver toxicity.- WithdrawalImpossible to discern withdrawal symptoms from those attributed to neurologic damage caused by ecstasy use


Heroin

• Heroin is a semi-synthetic opioid derived from morphine

• The U.S. heroin market is supplied entirely from foreign sources of opium.


Heroin• Common Street Names

brown sugar, dope, H, horse, junk, skag, skunk, smack, white horse

• Administrationinjected, smoked, snorted

• Mechanism of ActionHeroin activates receptors in the brain, spinal cord, and gastrointestinal tract. When heroin enters the brain, it is converted to morphine, causing increased feelings of pleasure and blockage of pain messages from the spinal cord.


Heroin


Pain reliefIntense euphoria

Decreased respiration, cardiac function

Alternating wakeful and drowsy states


Heroin• Signs and Symptoms of Intoxication

Intense euphoric state Alternating wakeful and drowsy states

Impaired mental functionHeavy-feeling extremitiesStaggering gait Pupil constrictionNausea VomitingSevere Itching Dry mouthWarm flushing of the skin


Heroin

• Consequences of Long-term Use



collapsed veins, bacterial infections of blood vessels and cardiac tissue, liver and kidney disease, lung complications including pneumonia and tuberculosis, arthritis, and constipation.


Heroin

• Withdrawal- Severity: Heroin withdrawal resembles a severe case of influenza and is not considered life-threatening. Heroin withdrawal symptoms are regarded as the most severe of all opioid-related substances - Symptoms: Drug craving, pupil dilation, nausea, vomiting, restlessness, bone and muscle pain, diarrhea, malaise, cold flashes, and insomnia- Timeline: Peak severity is 1 to 3 days after the last use, symptoms subside after 7-10 days.


Prescription OpioidsCodeine, Morphine,Hydrocodone,

Oxycodone, Fentanyl, Methadone,etc.• Opium is an analgesic derived from the seeds of

the unripe poppy plant.

• The term opiate refers only to the natural opium alkaloids (codeine, morphine) and the semi-synthetics derived from them (hydrocodone, hydromorphone, and oxycodone).


Prescription Opioids

Codeine

- Robitussin A-C, Tylenol w/ Codeine, Tylenol #2,#3 & #4

- Common Street Names

Captain Cody, Cody, schoolboy; doors & fours, loads, pancakes and syrup

- Administered

injected, swallowed



Fentanyl- Actiq, Duragesic, Sublimaze- Common Street Names

Apache, China girl, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash

- Administered buccal, injected,

smoked, snorted, transdermal



Morphine- Avinza, Kadian, MS Contin,

Roxanol- Common Street Names

M, Miss Emma, monkey, white stuff - Administered

injected, swallowed, smoked



Oxycodone

- Endocet, Oxycontin, Percocet, Roxicet, Roxicodone


Hillbilly heroin, Kickers, Blue, Oxy, O.C., Killer, Percs, Percodoms

- Administered

injected, swallowed, snorted



Hydrocodone

- Lorcet, Lortab, Norco Vicodin


Vike, Watson-387

- Administered

swallowed



Propoxyphene

- Darvocet, Darvon

- Administered

swallowed



• Mechanism of Action- An opioid is any agent that acts on the brain and body by binding to opioid receptors located in the brain, spinal cord, and gastrointestinal tract. - Opioid drugs block the perception of pain to varying degrees. Some opioids can also produce a euphoric effect by affecting the pleasure centers of the brain




Pain relief Drowsiness

Pupil Constriction Flushing

Vomiting Nausea

Euphoric feeling Decreased body temp.

Confusion Decreased respiration


Prescription Opioids• Signs and Symptoms of Intoxication

Decreased respirationHypothermia

Warm flushing of the skin Euphoria

Pupil constriction Drowsiness

Vomiting Dry mouth

Confusion Itching






confusion, constipation, and immune system impairment


Prescription Opioids• Withdrawal

- Severity: Opioid withdrawal resembles a severe case of influenza and is not considered life-threatening. Symptoms are less severe than those related to heroin withdrawal, but the duration is longer.

- Symptoms: Drug craving, pupil dilation, nausea, vomiting, restlessness, bone and muscle pain, diarrhea, malaise, cold flashes, and insomnia- Timeline: Peak severity is 2 to 4 days after the last use, symptoms may endure for more than 14 days.


Prescription DepressantsBarbiturates, Benzodiazepines, Sleep aids

• During the 1950’s, it was noted that barbiturates were related to high incidences of side effects and abuse.

• During the 1960’s, benzodiazepines appeared on the market and rapidly replaced barbiturates as the class of choice for sedative-hypnotics.


Prescription Depressants

Barbiturates

- Amytal, Nembutal, Seconal, Phenobarb


barbs, reds, red birds, phennies, tooies, yellows, yellow jackets

- Administered

injected, swallowed


Prescription DepressantsBenzodiazepines

- Ativan-lorazepam, Halcion- temazepam, Librium-chlordiazepoxide, Valium-diazepam, Xanax-alprazolam


candy, downers, sleeping pills, tranks

- Administered

injected, swallowed



Sleep Aids

- Eszopiclone (Lunesta)

Zaleplon (Sonata)

Zolpidem (Ambien)

- Administered

swallowed



• Mechanism of Action

Most depressants cause CNS depression by either increasing the activity or production of gamma-aminobutyric acid (GABA). GABA is the most important inhibitory neurotransmitter in the CNS.




Slowed respiration Drowsiness

Decreased heart rate Pupil constriction

Feeling of well-being Dizziness

Slowed muscle response

Decreased blood pressure




Severe drowsiness Severe respiratory

Confusion Aggression

Emotional blunting Hypotension

Memory impairment Poor coordination

Slurred speech Decreased heart rate

Fever Increased irritability



• Consequences of Long-term Use- Addiction, Tolerance, Withdrawal- Long-term Psychological EffectsDepression, visual disturbances, vertigo, impaired memory, judgment, anxiety- Long-term Physiological Effects Impaired fine motor skills, slurred speech, chronic fatigue, loss of coordination



• Withdrawal- Severity: Depressant-withdrawal syndrome resembles stimulant intoxication. Barbiturate withdrawal is more severe than benzodiazepine withdrawal, but both are potentially life-threatening. Seizures, hallucinations, and delirium tremens are possible serious symptoms of both barbiturate and benzodiazepine withdrawal



• Withdrawal- Symptoms: * Increased heart rate, blood pressure, body temperature, respiration, light and sound sensitivity* Auditory and visual hallucinations, seizures, delerium tremens, muscular weakness, depression, paranoid delusions, tremors, pupil dilation, agitation, anxiety, disorientation, convulsions, sleep disturbances, headache, nausea


Prescription Depressants• Withdrawal

- Timeline: Long-term benzodiazepine or barbiturate use is associated with acute withdrawal symptoms that precipitate within 24 hours following the last administered dose.* For short-acting depressants, major withdrawal symptoms peak between 2 and 4 days following the last administered dose and last for about 7 days. * For long-acting depressants, major

withdrawal symptoms peak between 4 and 7 days following the last dose and last for about 2 weeks.


Dissociative DrugsPhencyclidine, Ketamine, Dextromethorphan

• Phencyclidine (PCP) and ketamine were originally developed as anesthetics for surgery.

• The most common source of abused dextromethorphan is extra-strength cough syrup.


Dissociative Drugs

• Common Street NamesKetamine: cat Valiums, K, Special K, vitamin K PCP: angel dust, boat, hog, love boat, peace pill

• Administeredinjected, snorted, smoke, swallowed

• Mechanism of Action- Disrupts the activity of the chemical glutamate, which plays a large role in learning, memory, emotion, and pain perception. - PCP also affects dopamine activity


Dissociative Drugs

• Immediate Physiological EffectsIncreased blood pressureRapid/Shallow breathingRandom muscle contractionsIncreased body temperatureDecreased sense of painIncreased heart rateBlurred visionDizziness


Dissociative Drugs

• Signs and Symptoms of IntoxicationUncoordinated movements EuphoriaSensory detachment HallucinationsFeeling of Vulnerabiltiy PanicHyperthermia DizzinessSuicidal thoughts DisorientationFeeling of increased strengthAggression


Dissociative Drugs




memory loss, numbness, and depression which can persist for up to a year after drug use stops.


Dissociative Drugs• Withdrawal

- Severity: While dissociative drug-related withdrawal is not considered life-threatening, medical attention may be necessary because of precipitating psychiatric disturbances.- Symptoms:

Hyperactivity AgitationIncreased pain threshold HyperflexiaIncreased heart rate DelusionsViolent behavior DepressionIncreased blood pressure Memory lossVisual/Auditory hallucinations


Dissociative Drugs

• Withdrawal

- Timeline

The peak severity of dissociative drug-related withdrawal can occur from days to weeks following the last administered dose. Withdrawal symptoms can persist for months.


Family-related Consequences of Parental Substance Abuse

• Parental Effects

- Decreased parental monitoring

- Poor problem-solving ability

- Increased incidence of aggression

- Less emotional sensitivity

- Lower positive engagement with the child

- Antisocial behavior including child avoidance

- Poor intellectual stimulation of the child



• Parental Effects- Negative parent/child relationship- Increased parental stress- Poor and inconsistent family management- Increased incidence of child neglect than

abuse- Ineffective socialization and discipline- Negative parent/child relationship- Increased incidence of child abandonment



• Effect on the Family

- Poor family functioning

- Increased levels of conflict

- Poor communication

- Increased incidence of domestic violence

- Unpredictable home life

- Poor organization, including cleaning, timeliness, planning



• Effect on the Child

- Increased incidence of physical, sexual, and verbal abuse

- Increased risk of neglect

- Increased risk of early drug and alcohol abuse

- Increased incidence of disruptive behavior problems



• Effect on the Child- Increased incidence of emotional disorders including chemical dependence, eating disorders, anxiety, depression, aggression, suicidal behavior, phobias, low self-esteem- Increased incidence of physical problems including asthma, hypertension, headaches, and allergies



• Effect on the Child

- Increased incidence of impaired cognitive and verbal skills

- Increased incidence of learning disabilities


Conclusion

Thank you all for coming!

© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group Center for Development of...

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