Chapter 9: Substance Use Disorders. FACT or CRAP Over the past few years, alcohol sales have been...
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Transcript of Chapter 9: Substance Use Disorders. FACT or CRAP Over the past few years, alcohol sales have been...
Chapter 9: Substance Use Disorders
FACT or CRAP
Over the past few years, alcohol sales have been sharply dropping while sales of wine and hard liquor have been sharply increasing.
FACT What are some possible reasons why? People care more about health, more concerned about
gaining weight, so lower calorie alcohol is more popular (Skinnygirl)
Addiction
Addiction = having a compulsion to engage in a behavior (such as use a drug) and experiencing withdrawal symptoms when the behavior is not engaged in Not a term used by the DSM-5
DSM uses the term “dependence” Addiction is like being caught in quicksand
Let’s write some things people can be addicted to on the next slide. Q: Which addictions are socially acceptable and
which are not?
Types of Addiction:
Let’s make this slide as a class…CaffeineAlcoholNicoteneSocial mediaPornographyOpioids (heroin, etc)EatingTelevision
Contemporary Issue: “Bath Salt” Abuse
Contemporary Issue: “Bath Salt” Abuse
Methylenedioxypyrovalerone More commonly known as MDPV Nicknames = Ivory Wave, Vanilla Sky, Red Dove,
Cloud 9, White Lightning, & many othersActive ingredients federally banned, but…
…the makers of “designer drugs” are usually one step ahead of the law
Very difficult to regulate
Contemporary Issue: “Bath Salt” Abuse
Effect is similar to cocaine or methamphetamineAdverse health consequences:
Tachycardia (rapid heart beat) Hypertension Insomnia Nausea Bruxism Headaches Kidney pain Tinnitus
Can lead to depression, suicide, anxiety & psychosis High doses can lead to severe, prolonged panic attacks
Contemporary Issue: “Bath Salt” Abuse
Questions & comments?Let’s briefly discuss this issue
Another contemporary issue: synthetic cannabis marketed as “incense” Less understood and more dangerous than
marijuana
Salvia Divinorum
Aka “diviner’s sage”Powerful hallucinogenSalvia Divinorum presence on YouTube Used by ~1 million Americans per yearQ: How many of you are familiar with
Salvia?
Contemporary Issue: Salvia Divinorum
Used by Mazatec shamans in Mexico to facilitate shamanic visions in healing or divination rituals NOT intended for recreational use Associated with an intense hallucinatory trip
lasting ~10 minutes Leaves are smoked or chewed
Salvia is associated with “bad trips” and negative experiences when used recreationally
“Molly”
The name is short for “molecule”Pure, crystal or powder form of MDMA
(ecstasy)Ecstasy is usually laced with other
ingredients such as caffeine or methamphetamine Molly is not, however
Most users are 16-24 years of age
Health Consequences of “Molly”
~120% increase in emergency room visits for MDMA over the past several years
Disrupts the body’s ability to temperature Hyperthermia, dehydration, danger of water overdose Liver, kidney, & heart failure
Other health repercussions: Sleep problems Confusion Anxiety & depression Paranoia Bruxism
Another contemporary issue: prescription drug abuse
Commonly abused prescription drugs = Vicodin (opiate, similar to heroine) Oxycontin (opiate)
Has slow release over 14 hours, probably strongest pain reliever
Percocet (opiate) Xanax (benzodiazapene) Adderall (speed) Ritalin (speed)
“deadly cocktails” = combining more than one prescription drug at one time Or combining prescription drugs with other substances
A large number of elderly individuals are addicted to prescription drugs
If Time
Let’s watch a clip (or clips) about prescription drug abuse.
Drug Schedules
Schedule I: Drugs with a high potential for abuse that have no accepted medical use in the U.S. Heroine -MDPV Marijuana -Hashish LSD -Mescaline (~ to LSD) Psilocybin (shrooms) -Rohypnol (roofies) MDMA (Ecstasy) -GHB Q: Is there anything strange about some of the
drugs on this list given the definition of Schedule I?
Drug Schedules
Schedule II: Drug has a high potential for abuse but has a currently accepted medical use with severe restrictions Methadone -Marinol (marijuana pill)
(used to treat heroine, very similar but not as bad) Amphetamine -Percocet Cocaine -Oxycodone Morphine -Ritalin Opium -Methamphetamine Ketamine
Drug Schedules
Schedule III: Has the potential for abuse; currently accepted medical use in the U.S.; moderate to low risk of physical dependence Anabolic Steroids Vicodin Testosterone
Drug Schedules
Schedule IV: Relatively low potential for abuse; currently accepted medical use; limited risk of physical dependence Valium Xanax Phenobarbital Klonopin (anxiety drug) Chloral Hydrate (related to chloroform) Ambien (treats insomnia)
Drug Schedules
Schedule V: Relatively low potential for abuse; currently accepted medical use; abuse has a narrow scope for physical & psychological dependence Robitussin
Another contemporary issue = cough syrup abuse Buprenex Kapectolin PG Thymergix
Activity
Let’s play a game in which I show a famous person and you tell me either their cause of death or the substance they struggled with…
Definitions
Definitions/Levels of Severity: Substance Intoxication Substance Abuse
Maladaptive pattern of substance use leading to clinically significant impairment or distress
Recurrent substance use resulting in failure to fulfill role obligations
Recurrent substance use in situations in which it is physically hazardous
Recurrent substance-related legal problems Continued use despite persistent social or
interpersonal problems
Definitions
*Substance Dependence Maladaptive pattern of substance use, leading to clinically
significant impairment or distress Tolerance
Need for increased amounts to achieve same effect Diminished effect with continued use of same amount of the substance
Consuming more than was originally intended Persistent desire or unsuccessful attempts to control
use Spending a great deal of time on acquiring, using, or
recovering from the substance Important social, occupational, or recreational
activities are given up or reduced due to substance use Substance use is continued despite persistent problems Withdrawal
Definitions
Definitions continued: Substance Withdrawal
Development of a substance-specific syndrome due to cessation or reduction of substance use that has been heavy & prolonged
Causes clinically significant distress/impairment Physical vs. psychological dependence
Physical dependence involves physiological withdrawal symptoms
Class Activity
What constitutes a “standard drink”? http://www.alcohol.org.nz/alcohol-you/whats-
standard-drink/can-you-pour-standard-drink-game
History of Alcohol Use
Humans have been consuming alcohol since before recorded history
18th Century England Cheap gin from distilleries → widespread consumption
& drunkenness among lower and working classes The rich mostly drank wine
Colonial America Drinking was acceptable
Alcohol was safer than unpurified water or milk Drunkenness was not acceptable, however Even children drink alcohol
History of Alcohol Use
19th Century: Prohibition movement Alcohol was snubbed by middle and upper classes Alcohol use confined to saloons
1919: 18th Amendment Outlawing alcohol Q: What were some problems with this?
1934: 21st Amendment repealed the 18th amendment
Alcohol consumption peaked in ~1830Modern alcohol consumption peaked in
~1980 Has been slowly declining ever since
Contemporary Alcohol Use
~61% of adult Americans are current drinkers 20% engage in binge drinking
Definition = Heavy alcohol consumption in a relatively brief period of time
Aka “heavy episodic drinking” ~5drinks on one occasion for males, ~4for females
European Americans drink more than other ethnicities American Indians have highest rates of binge drinking,
however 25 -44 age range most likely to drink
18 – 24 range most likely to binge drink Q: Why is binge drinking more prevalent among this age
group?
Alcohol Dependence
3 stages of alcoholism Use Abuse/Dependence Complete loss of control
The Stages of Alcoholism(these stages can be applied to any addiction,
however)
Stage 1: Increased use Increasing tolerance Lack of recognition that a problem may be
developing Actively seeking out drinking opportunities Drinking stops being social and starts becoming a
psychological escape
The Stages of Alcoholism
Stage 2: *This stage is the best opportunity for
intervation Denial Increasing health problems & blackouts Experiencing losses (job, relationships, control,
etc.) Blaming problems on others Sneaking drinks Guilt and shame Unsuccessful attempts to stop drinking
The Stages of Alcoholism
Stage 3: Complete loss of control Slowly drinking oneself to death Avoiding friends and family Drinking in the morning
I once had a client who would gargle with alcohol Serious life functioning problems Aggressive behavior Tremors Loss of interests Legal & health problems Unreasonable resentments
Alcohol Dependence
Alcohol Withdrawal = Sweating Hand tremor Insomnia Nausea Hallucinations Anxiety Grand mal seizures
The importance of detox
Blackouts
Occurs when excessive alcohol consumption overloads the hippocampus in the brain Become temporarily incapable of forming new
memories Like a video camera that is working but not
recording anything Similar to “anterograde amnesia”
2 kinds of “blackouts” Fragmentary
Partial memory loss for a given time period Enbloc
Complete memory loss for a given time period
Blackouts
People who have “blacked out” still function but have no control over themselves & no memory of their behaviors Anecdotes about client experiences with blackouts
Popularity of Drinking
Q: Why is drinking popular? William James, from The Varieties of
Religious Experience (1902): “The sway of alcohol over mankind is
unquestionably due to its power to stimulate the mystical faculties of human nature, usually crushed to Earth by the cold facts and dry criticisms of the sober hour. Sobriety diminishes, discriminates, and says no; drunkenness expands, unites, and says yes.”
Altered States of Consciousness:
“…our normal waking consciousness…is but one special type of consciousness, whilst all about it, parted from it by the filmiest of screens, there lie potential forms of consciousness entirely different. We may go through life without suspecting their existence; but apply the requisite stimulus, and at a touch they are there in all their completeness…No account of the universe in its totality can be final which leaves these other forms of consciousness quite disregarded”
-William James
Cannabis Dependence
No physical withdrawal Very psychologically addictive, however
THC stays in one’s system for a very long time Stored in fat
Marijuana is legal for medicinal use in many states
Trivia Q: In which 2 states is marijuana legal for recreational use?
How Long Does THC Stay in One’s System?
Varies based on weight, body fat %, frequency of use, amount used, & potency
General guidelines One use: 1-6 days Moderate use: 7-13 days Frequent use: 14-30 days Heavy use: 30+ days; as long as 3 months for long
term users
Cocaine/Crack
Cocaine/crack stimulates the Central Nervous System
Withdrawal symptoms = Dysphoric mood Fatigue Vivid, unpleasant dreams Insomnia/hypersomnia Increased appetite Psychomotor agitation or psychomotor
retardation Depression
Opioid Dependence
Includes heroin, OxyContin, morphine, methadone, & many others
Heroin withdrawal = “Flu-like” symptoms
Goose bumps Sweating Fever Nausea Abdominal cramps Diarrhea Agitation/restlessness Insomnia Dysphoric mood
Tx’s for Heroin
Methadone clinics Similar to heroin, not as dangerous
Suboxone Medication to treat heroin
Tx for Substance Abuse
The “Old School” Way: Shame and blame Boot camp mentality “Scared straight” Q: What are some problems with this approach?
Preferred Contemporary Tx = Motivational interviewing
Motivational Interviewing (MI)
READS Roll with resistance Express empathy Avoid argumentation Develop discrepancy
Point out discrepancy between actions/behaviors and goals (how behavior is countered to their goal, let them make the connection)
Support self-efficiancyHelps people to progress to a higher stage of
change
Remember the Stages of Change
General Tx for Substance Abuse
Group therapy & support groups such as Alcoholics Anonymous & Narcotics Anonymous
Levels of care (PCPC): Outpatient Intensive Outpatient (IOP)
I ran an IOP group on my post-doctoral internship Halfway House Medically Monitored Detox Inpatient
E.g. White Deer Run Medically Monitored Inpatient
Addendum: Energy Drinks
The information in this section is from Wimer & Levant (2013)
Energy Drinks
Definition = Beverages purported to boost mental & physical energy that contain high amounts of caffeine
Originated in Japan in 1962 The first energy (or “genki”) drink = Lipvitan-D
Increased in popularity when Red Bull hit the market in 1997
Now: $2.3 billion in sales per year & growing#1 market =young people (esp. young men)
Problems
Energy drinks are poorly regulated in the USA compared with other countries Companies are not required to display the actual
caffeine content on labels People don’t know what they’re really drinking
Aggressive marketing campaigns give people misconceptions Energy drinks are NOT good for athletic activity
Diuretic
Health Problems
Caffeine toxicity & poisoningMental health symptoms = anxiety, insomnia,
tachycardia, tremors, psychomotor agitation, & even death
Three most serious health problems: Dehydration during athletic involvement Combining energy drinks w/alcohol Increased propensity for violent behavior
Energy Drinks & Alcohol
Reduces one’s perception of intoxication without reducing cognitive & motor impairment
People do not feel as drunk as you really are More likely to drive a car, etc.
Energy Drinks & Violent Behavior
Energy drink use is associated with a greater likelihood of engaging in violence One reason = facilitates longer involvement in late
nighttime situations with more opportunities to engage in problematic behaviors
Questions & Discussion