Drugs of Addiction

Elizabeth McQueen, LMHC

Clinical Director

Stewart-Marchman Center

NET Training Institute

Freedom Series

Course Objectives To define psycho active chemicals To examine the routes that drugs

take to the brain and the ways in which they affect brain chemistry

To present a system for classifying these psychoactive substances.

To detail the physiological effects of uppers, downers and other commonly abused drugs

To outline the principles of effective prevention and treatment

The Addictive Process:

Psychoactive drugs: Substances that affect the central nervous system to cause physical and mental changes to take place

3 Factors that determine the effects a chemical will have

1. The methods by which people put psychoactive chemicals into their bodies

2. The speed of transmission to the brain

3. The attraction of the drug for nerve cells, neurotransmitters and other brain chemicals

Routes of Administration

1. Inhaling

2. Injecting

3. Mucous Membrane Absorption

4. Oral Ingestion

5. Contact Absorption

Inhaling

The vaporized drug enters the lungs and is rapidly absorbed through tiny blood vessels in the lungs called capillaries. It travels back to the veins and then the heart where it is pumped directly to the brain and the rest of the body.

Time of transmission: 7-10 seconds for change to begin

Inhaled drugs

MarijuanaFreebase cocaineGlueAerosolsCigarettes

Characteristics of Inhaled drugs

Effects felt quickly Easy to regulate the amount of the drug

used Only small amount absorbed with each

inhalation

Injecting Intravenous injecting – “Slamming”Injected directly into the blood stream by

way of a vein Intramuscular injecting – “muscling”Injecting into a muscle mass Subcutaneous – “Skin popping”Injecting just under the skin

Time of transmission: 15-30 seconds in the vein

Time of transmission for injected drugs:

15-30 seconds in the vein3-5 minutes in the muscle or

under the skin

Injected Drugs

HeroinCocainemethamphetamines

Characteristics of Injected DrugsLarge amount absorbed at onceInstant “RUSH”Nothing of the drug is wasted

Snorting and Mucosal absorption

Insufflation – absorption into the muscosa membranes in the nasal passages

Sublingual – absorption into the mucosa under the tongue

Buccally – between the gums and the cheek Rectally – absorption into the mucosa in the

rectum Vaginally – absorption into the mucosa in the

vagina

Time of Transmission

From 3 to 15 minutes depending on the place of administration

Drugs of Mucosal Absorption

Cocaine Herion nitroglycerin Chewing tobacco Morphione

Characteristics of Mucosal Absorbed Drugs Results more rapid High more intense Bypasses the digestive acids, enzymes

and liver

ORAL

Swallowed Passes through the esophagus into

stomach Absorbed in to the capillaries and enters

the vein and liver Pumped back to the heart and on to the

rest of the body

Time of transmission

20-30 minutes from administration

Drugs of Oral Admission

Oxycontin Xanax Valium Loratab Robotussin Alcohol

Characteristics of Oral Ingested Drugs Low Concentration at Absorption First Pass metabolism (first absorbed)

drugs are most potent

Transdermal Absorption

Absorbed through the skin– Lotions– Eye drops– Patches– Stamps

Time of Transmission

1-2 days for effects to be noticed Up to 7 days of absorption in the

average patch

Drugs of transdermal absorption

Nicotine Fentanyl Clonidine LSD Cocaine

Characteristics of Transdermal Administration Usually by prescription Measured amount of the drug Seldom used for illegal drugs

Drug Distribution: GETTING TO THE BRAIN Distribution depends on Blood volume

and characteristics of the drug

– Less blood volume, increased potency MOST PSYCHOACTIVE DRUGS ARE

FAT SOLUABLE THEY CAN CROSS THE BLOOD

BRAIN BARRIER

The Blood Brain Barrier

The Gateway to the central nervous system

The wall of the capillary in the brain which is sealed to act as a barrier to the brain.

Only Fat soluble drugs can cross the blood brain barrier

The Nervous System

The Central Nervous System – half of the complete nervous system, includes the brain and the spinal cord

The Peripheral Nervous System – the

Other part of the nervous system which connects the CNS with the internal and external systems

Includes the autonomic nervous system

and the somatic nervous system

The Central Nervous System

The Brain – Computer of the body, receiving, analyzing and responding to messages from the peripheral nervous system

Controls circulatory response Respiration Digestion Excretory function Endocrine function Reproductive function Enables us to reason and make judgments

Autonomic Nervous System

Controls involuntary functions such as– Circulation– Digestion– Respiration– Glandular outputs– Genital reactions– Sympathetic responses

Somatic Nervous System

Includes sensory neurons that reach the skin, muscles and joints. Responsible for relaying information about muscle and limb position

Transmits instructions back to skeletal muscles

Provides for voluntary response

Understanding how nervous system processes messages Neurons - nerve cells that act as the

building blocks of the nervous system

Parts of a neuron: (see handout)

Dendrites- finger like bodies that receive signals from other cells and then relay them to the cell body

Soma – the cell body Axon – the finger like bodies that carry

the signals away from the cell Terminals – the pathway that carries the

signal from one cell to the dendrites of the next cell.

Terminals of one cell do not touch the dendrites of the next cell Synaptic Gap – the microscopic space

between the terminals of one cell and the dendrites of the next cell

A message jumps the synaptic gap in the form of neurotransmitters.

Neurotransmitters – bits of chemicals that are synthesized electrical signals that jump the synaptic gap

Vesticles – tiny sacs that store neurotransmitters

Synapse – the transmission process across the synaptic gap

Receptor Sites – Protein molecules that are activated by neurotransmitters.

When receptor sites are activated, they open a molecular gate that allow electrical charges in or out

The process of message transmission (see handout)

1. Incoming electrical signals force the release of neurotransmitters

2. From the vesticles3. And send them across the synaptic gap4. On the other side the neurotranmitters

“fit themselves” into 5. receptor sites6. The receptor sites open the ion

molecule gate

7. Allowing the electrical charges in or out

8. When enough electrical charge is achieved, the next signal fires

9. Once the job is done, neurotranmitters return to the synaptic gap and are reabsorbed by reuptake ports

10. Auto receptors monitor the amount of neurotransmitter needs for the transmission

Psychoactive drugs disrupt the process of message transmission

Drugs that enhance the activity of the neurotransmitters and receptor sites are called agonists

Drugs that block activity are called antagonists

Specific Drug Examples:AGONISTS:

Cocaine - forces the release of extra neurotranmitters and blocks their reabsorption

ANTAGONISTS:

Heroin – inhibits the release of neurotransmitters and therefore blocks a message of pain from reaching the brain

The body regards any drug as a toxin, but ifthe use continues over a long time, it is forced to adapt and and develop a tolerancefor the drug

Tolerance – the need to use increase amounts to get the same effect!

Types of Tolerance

Dispositional Tolerance – the speeding up of metabolism in order to eliminate the drug

Pharmacodynamic Tolerance – nerve cells become less sensitive to the drugs

Reverse Tolerance – when the body systems are no longer able to metabolize drugs and the body can no longer tolerate the drug (alcohol absorption after liver destruction)

Acute tolerance – an automatic acceptance of a drug by the body

Select Tolerance- When increased quantities of a drug are taken to overcome acute tolerance in order to produce a high

Inverse Tolerance – When a person becomes more sensitive to the effects pf a drug as the brain’s chemistry changes

Withdrawal – the bodies attempt to rebalance itselfNonpurposive Withdrawal – Physical

withdrawal -objective physical signs that are directly observable when a drug is stopped.

EXAMPLES: Seizures Sweating Goosebumps Vomiting Diarrhea Tremors

Purposive Withdrawal-psychological withdrawalResulting behavior exhibited by an addict

when the drug stops

EXAMPLES: Manipulation Psychic Conversion (anticipated

nonexistent symptoms of withdrawal) Malingering

Protracted Withdrawal: Environmental Influence Withdrawal stimulated by environmental

triggers or cues

EXAMPLE:

Any white powder may trigger a cocaine addict

Body Effect vs Withdrawal

See hand out on opioids

Metabolism - the body’s mechanism for processing foreign substances

Excretion – the process of eliminating foreign substances

What effects Metabolism

Age – after 30 the body produces less enzymes

Race – different ethnic groups have different levels of enzymes

Sex – males and females metabolize at different rates

Health – certain conditions affect metabolism

Emotional Health – Metabolism is affected by preexisting chemical imbalance

Other Drugs – two or more drugs will have the body fighting for metabolism attention making the process slower

Desired Effects of Drug Use Curiosity Satisfaction To “get high” and be in dreamlike state To self –medicate To have confidence To have energy Pain Relief Anxiety Control Peer influence Social Confidence Boredom Relief

Desired Effects of Drug Use:To feel Normal

NORMAL________________________

Levels of Use

Abstinence Experimentation Social/Recreational Habituation Abuse Addiction

Theories of Origins of Substance abuse

Moral Theory of Addiction

Intoxication is individual weakness

Originates from Moral Decline

Addiction is shameful and sinful

Shift away from this thinking in 1935 with the founding of AA

Genetic TheoryNature vs Nurture debate

Addiction runs in families

Predisposition to drug use

Research indicates this is one degree rather than full determinant

Lead to development of the systems theory of addictions

Disease Theory of Addiction

–A physiological deficit in an individual making the person unable to tolerate the effects of the chemical therefore leading to addiction

–Does not blame the addict for the disease

–Gained popularity in the mid 20th century and elevated substance abuse from the realm of morality to a treatable form

DiagnosisChemical Dependence – DSM IV (three or more)

–1. Tolerance

–2. Withdrawal

–3. Use more than intended

–4. Efforts to quit or cut down

–5. Large amount of time spent in use

–6. Giving up or reducing importance activities

–7. Continued use despite knowledge of physical and psychological problems caused by chemical

Chemical Abuse: (One or more)

1. Failure to fulfill major role obligations

2. Chemical use in dangerous situations

3. Substance related legal problems

4. Continued use despite recurrent interpersonal problems related to the effects of substance use.

Compulsion Curve

Heredity Heredity + environment Heredity + environment + Drug Use Long/Term use Detoxification and Abstinence (no return

to starting place of curve) Relapse

SCHEDULE OF DRUGS

An organization effort by the Dept of Criminal Justice to control substances

Schedules are V-I beginning with those of lease potential for abuse

Schedule of Drugs

Schedule I: Heroin, Marijuana, LSD Criteria

– High potential for abuse– No currently acceptable medical use in US– Lack of accepted safety for use under

medical supervision

Schedule 2: morphine, cocaine, injectable methamphetamine High potential for abuse Currently accepted medical use Abuse may lead to psychological or

physical dependence

Schedule 3: Amphetamines, barbiturates, PCP Potential for abuse less that I or 2 Currently accepted medical use Abuse may lead to moderate physical

dependence or high psychological dependence

Schedule 4: Barbital, Chloral hydrate, paraldehyde Low potential for abuse relative to 3 Currently accepted for medical use Abuse may lead to limited physical or

psychological dependence relative to 3

Schedule 5: Mixtures with small amounts of codeine or opium Low potential for abuse relative to 4 Currently accepted medical use Abuse may lead to limited physical or

psychological dependence relative to 4

UPPERS: Stimulants

Cocaine Amphetamines Diet Pills Caffeine Nicotine Ephedrine Herbal Ephedra

Cocaine:Extract of the Coca plant

Origin: South America Common Names: Crack, Crank,

rock Ingestion: inhalation, injection,

smoking

Effects on the body:

Directly effects the heart causing irregular heat beat, vessel narrowing, restricted oxygen, constricts blood flow

Heart attacks, Acute Hypertension and stroke Forces release of neurotransmitters and

blocks reabsorption Seizures/Psychosis Diminished mental functioning Crosses the Placenta and can cause

miscarriage, brain bleeds, SIDS and blood vessel malformation

Tolerance and Dependence

Tolerance often after the first injection Physical dependence is possible Intense High which blocks dopamine

uptake is motivation

Withdrawal

Crash after binge– Sleeping, total lack of energy– Temporary return to normal (leave

treatment)– Cravings start– Emotional depression– Relapse

Amphetamines:Synthetic Ephedrine

Origin –United States (Asthma treatment)

Common Names –speed, meth, crystal

Ingestion: orally ingested, injected, snorted, smoked

Effects on the body Crosses the Blood Brain Barrier easily Acts on neurotransmitters and effect the

Sympathetic Nervous System by blocking neurotransmitter reuptake

Accelerates neural firing Rapid heart rate,

hypertension,headache,severe chest pain

Profuse sweating/heat elevation Delirium, psychosis, paranoia and

hallucinations

Tolerance and Dependence

Tolerance develops to specific actions of the drug including euphoria,appetite suppression,wakefulness, heart rate increase, hyperactivity

Physical and psychological dependence

Withdrawal: Due to reduction of neurotransmitters Depression Fatigue Increase appetite Prolonged sleep with REM Convulsions Circulatory collapse

Amphetamine Congeners

Stimulant drugs that produce same effects as amphetamines

Not as strong Examples

– Ritalin– Stratera– Diet Pills (obenex, Ephedra)

Caffeine: The most popular stimulant in the world!

Origin: Primarily from South America

Common Names:

Coffee Chocolate

Cocoa Colas

Teas

Ingestion: Orally

Effects on the Body

Rapidly absorbed in the intestine Crosses the blood brain barrier Blocks the receptor sites for Adenosine

a natural sedative Dilatation of blood vessels Increases urine output Increase heart rate, Arrhythmias tachycardia

Tolerance and Dependence

Stimulation of the reward center of the brain leads to increased tolerance

Gradual exposure Potential for physical and psychological

dependence is small (yeah right!)

Withdrawal:

Cravings for Caffeine Headache Fatigue Nausea Marked anxiety Depression

Nicotine Origin: India Common Names:

– Smokes Chimney– Sticks Chew– Roll Snuff

Ingestion: inhalation

Effects on Body:Stimulant and Sedative Causes discharge of epinephrine Absorbed in the body at every site of contact

(lips, teeth, lungs, hands) Reaches every blood rich tissue of the body Increased heart rate, blood pressure, cardiac

output,coronary blood flow Earlier menopause Profound contributor to mortality Low birth weight in infants

Tolerance and Dependence

Tolerance occurs and nicotine remains in the body

Remains in the body 24 hours after use High potential for physical and

psychological dependence

Withdrawal

Increased anger Hostility Aggression Loss of social cooperation

Downers:

Downers depress the overall functioning of the central nervous system to induce sedation, muscle relaxation, drowsiness, and even coma. They cause disinhibition of impulses and emotions.

Downers (depressants), which include opiates/opioids, sedative-hypnotics, and alcohol, depress the central nervous system. Effects range from sedation, pain relief, anxiety control, muscle relaxation, suppression of inhibitions, and drowsiness up to unconsciousness, coma, and death. They work by either inhibiting pain, stimulatory, and other neurotransmitters or by mimicking the body's natural sedating neurotransmitters.

Opiates/Opiods/.AlcoholMajor Depressants

Origin: Egypt, China

Common Names: heroin,morphine, codeine, Darvon darvocet, loratab, oxycontin,Dilauid,Vicodin,

Ingestion: oral, snorted,smoked, Injected (most predominant)

Medical Use of opiods/opiates

Pain relief- mask pain signals Cough suppressant

Effects on the Body Act at the neural synapse causing the release

of neurotransmitters Decreased anxiety, sense of serenity Deadening of emotions, inability to feel Emptiness, depression, Lowered blood pressure, pulse,respiration, Eyelids droop,slurred speech,non reactive

pupils, Trigger nausea center and suppress cough

center of the brain

Tolerance and Dependence

High risk of physical and psychological dependence

Learned association between the effects of the drug and environmental cues

Rapid tolerance and dependence Produces “threshold effect”

Withdrawal:

Bone and joint pain Muscle cramps Nausea Yawning Sweating Tearing Runny nose cravings

Severe muscle pain Flu like symptoms Much anxiety Chills Goosebumps High blood pressure Insomnia diarrhea

Heroin and Morphine

Origin: Asia, Mexico Common Names: “China White”

“Mexican Tar” Ingestion: injected, smoked, snorted

Effects on Body Depressed heart rate Slow respiration Depressed muscular coordination Increased nausea Pinpoint pupils Itching Mental confusion

Tolerance and Dependence

Rapid tolerance Strong physical dependence Psychological dependence due to fear

of rebound pains

Withdrawal

Extremely painful muscle aches Strong cravings Sweating Runny nose Yawning Nausea Difficult, but no real risk of death

Methadone

Only one of two legally authorized opiods used to treat heroin addiction

Mehtadone is addictive and must be monitored closely

Additional effects

Neonatal death Overdose Shared needles Hepatitis C HIV Adulteration

Sedative-Hypnotics

Origin: Ancient Greek Cultures

Common Names: Benzo, xany bars, barbies,

Ingestion: Oral, snorted

Medical Use of Benzodiazepines Manage anxiety disorders Short term treatment for panic attacks Control apprehensions of surgical patients Treat sleep problems Control muscle spasms Elevate seizure threshold Control acute alcohol withdrawal

Effects on the body

Anxiolytic,anticonvulsant, and sedative effects

Depressed breathing Slowed heart rate Coma in overdose

Tolerance and Dependence

Both physiological and psychological dependence

This is a metabolic dependence Short term use is safe Loge term use must be monitored A younger person can tolerate higher

dose

Withdrawal

Rebound symptoms Protracted withdrawal – long lasting Cravings-emotional,environmental

Barbiturates: Drug of the past

Origin: United States Common Names: Methaqualude

(ludes),Nembutal (yellow jacket), Seconal (redbirds),Tuinal (rainbows)

Ingestion: orally or injection

Effects on the body

Elevated mood Reduction of negative feelings Increased energy Unsteady gait Slurred speech Eye twitches Sedation Intoxication similar to alcohol

Tolerance and Dependence

Can create tolerance after single dose Psychological and physical dependence Tolerance develops as a result of

metabolic changes which destroy the barbiturates faster.

Withdrawal 12-24 hours after last use Anxiety Tremors Nightmares Insomnia Anorexia Nausea Delirium Seizures

Other Sedatives

Club Drugs: Date drugs– GHB: strong depressant– Rohyypnol: “Ruffies”

Drug Interactions

Alcohol and sedatives-hypnotics used together are especially dangerous

Cross –tolerance and cross dependence occur within the opiod class of drugs of drugs

Alcohol

Origin – prehistoric use, fermented grapes left in a basket

Common Names – Beer, wine distilled spirits

Ingestion – Oral, rectal absorption

Effects of Body Body treats as poison and begins elimination as soon as

ingested Metabolized in the liver Immediate absorption Cardiovascular system affected at low levels of use:

peripheral dilation, but depression of cardiovascular function with severe intoxication

Gastritis, ulcers, pancreatic hemorrhage Depressed respiration Increased risk of cancer Lower sexual function Reproductive problems

Long terms effects of Alcohol Addiction Liver damage Digestive effects Enlarged Heart Loss of brain cells Increased desire/decreased performance Increased chance of breast cancer Reduced fertility

Blood Alcohol Concentration:BAC 1 ounce of alcohol is excreted each hour With this knowledge it is possible to

determine the amount of alcohol that is circulating in the body

It takes approximately 15-20 minutes for alcohol to reach the brain and about 30-40 minutes for the alcohol to reach maximum level of concentration. This is known as the level of blood alcohol Concentration or BAC

Absorption: Rapid

Because alcohol is absorbed very quickly after entering the body, it has a rapid high.

While absorption of most drugs begins in the intestine, alcohol absorption begins in the stomach and is metabolized and excreted quickly

10 – 20% of alcohol is excreted in the urine or through the lungs without being metabolized

Factor effecting Absorption

Body weight Sex Health Drinking rate High concentration

of alcohol in drinks Using with

carbonated beverages

Warming the alcohol Women absorb

faster Drinking on an

empty stomach Diluting alcohol with

ice, water or fruit juices

Tolerance and Dependence Liver function becomes more efficient Brain cells are less effected by the

alcohol Fewer symptoms of intoxication HOWEVER THE LEATHAL DOSE

DOES NOT CHANGE! Risk of dependence is moderate Younger the drinker the greater the risk

of dependence

Withdrawal Symptoms appear in 12-72 hours of

cessation lasting 5-7 days Referred to as Delirium Tremens Sweating Shakes Anxiety Nausea Diarrhea Transitory hallucinations

Fetal Alcohol Syndrome Specific toxic effects of alcohol on unborn

fetus is known as “Fetal Alcohol Syndrome”

– Retarded growth before and after birth– CNS involvement including delayed intellectual

development– Facial abnormalities

• Heart shaped face• Shortened eye openings• Flattened mid-face• Thin upper lip

– Hearing loss– Gait problems

Scope of the problem: 1999 stats The majority of people in almost every

country, except for Islamic countries, consume alcohol

Last month about 113 million Americans had at least a can of beer, a glass of wine, or cocktail

In 1998 over 2 million people died due to alcohol

10% of all diseases and accidents are alcohol related

45% of homeless have serious alcohol problems

28% of high school students use alcohol

45% of all college students use alcohol

Alcohol and Polydrug Abuse

Most drugs involve more than one substance, especially alcohol

When this happens the synergism effect comes into play

ALL AROUNDERS:Psychedelics Origin: Psychedelics and hallucinogens

have been around since the origin of man.Derived from plants including fungi.

Common Names: marijuana, LSD, PCP, peyote, psilcybin (mushrooms),and MDMA

Ingestion: oral, smoked, injected, snorted

Effects on the Body Major effect is overt stimulation Intensified sensations particularly

visuals ones Suppressed memory centers Impaired judgment

Lysergic Acid Diethylamide (LSD) LSD is 1,000 more powerful than natural

hallucinogens, but weaker than most synthetic chemicals

Somatic effects are: – Dizziness– Weakness– Tremors– Altered vision– Intensified hearing– Dreamlike imagery

Tolerance and Dependence is not truly known

Phencyclidine (PCP): Angel Dust PCP was developed as a general

anesthetic but was found unstable Major chemical is peperdine Purity can be anywhere from 5-100%

making use a tremendous risk Ingestion: smoke, oral, snorted No potential for physical tolerance, but

extreme psychological dependence

Effects on the Body

Amnesia Extremely high blood pressure Combativeness Tremors Seizures Catatonia Coma and kidney failure

Designer Drugs: synthetic psychedelics Ecstasy (MDMA): DATE DRUG Origin: Spread from the UA to

England in 1980s

Effects on the Body

Reduced depression Heightened introspection and intimacy Acts to deplete seritonin, a neurotransmitter

that leads to relaxation Heart attacks, strokes Liver disease, hyperthermia Panic disorder, paranoid psychosis depression

Marijuana:CANNABIS

Origin: Used for thousands of years, cannabis’ place or origin appears to be the Netherlands

Common Names: Weed, grass, pot, blunts, joints,green

Ingestion: smoked, oral Active ingredient: Tetrahydracannabinol- THC Schedule 1 drug

Other information about marijuana Mostly widely used illicit psychoactive

drug Sinsemilla –a form of cannabis from an

unpollinated hemp plant- extra potent Standard cannabis has about 3% THC,

sinsemilla has about 15%, Hash oil has about 60% THC

Effects on the Body Irritation to lungs and respiratory system

– (5 times more tar than nicotine)

Fluctuation in emotions Impaired memory and concentration More vivid senses, decreased tracking ability Diminished hand-eye coordination Sedation and dreamlike state Dilated pupils, Bloodshot eyes Inhibited sweating A-motivational syndrome

Tolerance and Dependence

Conflicting research on physical dependence but definite psychological dependence

Tolerance develops rapidly

Withdrawal Headaches Anxiety Depression Irritability Aggression Restlessness Tremors Sleep distortions Strong cravings

Other Drugs of Choice

Inhalants -

Three types of inhalants:

1. Volatile and aerosols-paints, fuels,hair sprays, cooking spray , air fresheners

2. Volatile nitrites – amyl nitrate “Poppers”

3. Anesthetics – nitrous oxide,ethylene

About 17% of all adolescents in the US have used inhalants

may be sniffed, snorted huffed, bagged, or inhaled

Sports Drugs

Three main categories of sports drugs

1. Therapeutic drugs –analgesics, muscle relaxants, asthma medications

2. Performance –enhancing drugs –steroids, growth hormones, amphetamines

3. Recreational/mood altering – cocaine, marijuana, alcohol, tobacco

Other Addictions

Compulsive Behaviors – continuing a behaviors despite adverse consequences– Bad diets– Exercise– Fast food restaurants– Credit cards– shopping

Gambling

Includes:– Cards, races, slots, stocks, day trading,

Characteristics include– Progressive betting– Attempts to recoup losses– Restlessness– Irritability– Jeopardizing of family, relationships, job

Eating Disorders

Three main disorders1. Bulimia- look normal but bingeing and

throwing up

2. Anorexia-60% loss of body weight

3. Compulsive over eating –eating triggered by emotional state

95% of anorexics and bulimics are female

Sexual Addiction

Compulsive Sexual Behaviors1. Pornography2. Masturbation3. Phone sex4. Voyeurism5. Flashing6. Repeated adultery

Sexual activity usually followed by guilt remorse and fear.

The Treatment Phase

Prevention

PREVENTION

Goal – prevent abuse before it happens– Scare tactics– Drug information– Skill-building– Environmental change programs– Public health models – user testimonies

The Treatment Phase

Treatment

Components Of Substance Abuse Treatment:

Medical and Biological Treatments: – Detoxification – Diet and Nutrition Concerns – Medication (Symptom Reduction) – Medication (Relapse Reduction) – Drug Screening

Psycho-Social Treatments: – Psychotherapy – Relapse Prevention – 12 Step Programs

Stages of the Therapeutic Process

• Intervention

• Assessment Phase

• Feedback phase: Diagnostic Phase

• Implementation phase or treatment phase

Resources

BOOKS:

Substance Abuse Counseling –

Patricia Stephens and Robert Smith

Treating Alcoholism, Robert Perkinson

Faithful and True – Mark Laaser