Addictions Mid-Term

Withdrawal

"a maladaptive behavioral change with physiological and cognitive concomitants" related to a reduction of intake following prolonged use of a substance

The scientose drunk

("know-it-all drunk")

The bellicose drunk

("the new man with the new teeth")

The jocose drunk

(barrel of laughs)

The amorose drunk

(can't keep hands to him/herself)

The lachrymose drunk

(crying drunk/self-pity)

The clamorose drunk

(loud drunk)

Methamphetamines

(meth or crank) usually in powder form (crystal meth) can be snorted, smoked, or injected to produce a 4-16 hour high. When smoked the meth high can last 8-24 hours (only 15-20 minutes for crack cocaine high).

OxyContin

(morphine substance for cancer patients) is designed to be time released but most abusers crush the pills and snort or inject. Most commonly abused opioids include OxyContin, Darvon, Vicodin

The somnos drunk

(sleepy drunk)

Addiction Recovery Management

(sustainable recovery) A strengths based approach that stresses the importance of case management to provide direct links to community resources for long-term care

Spice, Salvia, and K2

(synthetic marijuana) are plant materials coated with synthetic chemicals designed to produce an immediate high.

Heroin

(white or brown powder) is a synthetic derivative of morphine, originally developed to treat opium and morphine addiction. Heroin users typically inject the liquefied powder and experience a "rush" followed by a warm sensation, flushing of the skin, sense of heaviness, and then nod off

Chewing tobacco

- nicotine absorbed into bloodstream and travels to the brain - In 30 minutes of chewing tobacco, the nicotine intake is comparable to smoking three (3) cigarettes.

Typical harm reduction strategies include:

1. Helping clients substitute a less harmful drug for a life-threatening drug 2. Recruiting heroin addicts into methadone-maintenance and needle exchange programs 3. Providing women returning to their battering partners a plan for self-protection.

Rapp & Goscha (2012) six critical elements conducive to recovery:

1. Identity as a competent human being 2. The need for personal control or choice 3. The need for hope 4. The need for purpose 5. The need for a sense of achievement 6. The presence of at least one prosocial supportive person

criteria or factors in order to diagnose a disorder:

1. Pattern of alcohol/substance abuse/maladaptive behavior despite knowledge of negative consequences to health or safety 2. Time frames for disorder presentation (e.g., 1 mo., 6 mos., 12 mos., etc.) 3. Tolerance level (diminished effectiveness with continuous use) 4. Previous attempts to stop without assistance have been unsuccessful 5. Tactics utilized to continue negative behavior (lying, stealing, etc.) 6. Withdrawal (craving) symptoms including intensity and time tables 7. Loss of significant relationships, job, or educational or career opportunities because of alcohol/substance abuse/negative behavior

The American Medical Association (AMA) declared alcoholism as an illness in 1956 and identify three (3) basic areas of ecological concern:

1. Physical 2. Psychological 3. Social

According to Robinson and Scherlen there have only been three times in history when there was anything like an epidemic of drug use:

1. The popularity of heroin in the 1960s 2. The heavy use of powder cocaine in the 1970s and early 1980s 3. Crack cocaine use in the 1980s

three (3) main reasons people take drugs Volkow (2010):

1. To feel good and enhance their sense of pleasure- Cocaine (stimulant) makes you feel powerful, self-confident, high energy - Heroin (opiates) cause feelings of relaxation and satisfaction 2. People suffering with anxiety and stress gravitate towards intoxicants 3. To enhance performance (sports, work, sex)

Common use reasons of nicotine

: stimulant to stay awake, weight loss, reward, stress reliever, social acceptance and alleviate boredom

Recovery

A continuous process and experience through which individuals, families, and communities utilize internal and external resources to address drug dependence and substance use problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive and meaningful life (UNDOC, 2008)

The Strengths Perspective

A way of perceiving people in their struggles to rise above difficult circumstances. Positive psychology that focuses on well-being and resilience. Positive psychologists focus on mental health rather than mental illness and working with clients collaboratively to recognize ad reinforce strengths. Promotes energy, effectiveness, productivity & sense of meaning. Harm reduction alone is not enough; Healthy outlook and lifestyle changes foster recovery from addiction and personal pain.

Rebound effect

Central Nervous System (CNS) becomes hyperactive (e.g., opioids may produce constipation/withdrawal produces diarrhea).

Harm reduction

Choice is the hallmark, is not about doing what is best; it is about doing whatever works at whatever level makes sense to the client. Harm reduction is meeting the client where he/she is at. Collaborative process with therapist/client to realistically develop a survival plan.

Motivational Theory

De-emphasizes the use of negative labels and views substance misusers as being as susceptible to change as the rest of the population. This approach is optimistic and strengths-based in drawing on positive possibility and hope. Change happens in stages not all at once - sequence referred to as the transtheoretical model (tailored interventions for each client).

Effects of alcohol:

Early in the drinking process when the blood alcohol levels rise symptoms include talkativeness, a sensation of well-being, and a bright/expansive mood. Later in the drinking process when blood alcohol levels are dropping the drinker is likely to become depressed, less rational, and withdrawn. At very high blood alcohol levels the drinker with a lower tolerance is likely to become sleepy.

White House Office of the National Drug Control Policy (2011) issued a call for action, Developed the Prescription Drug Abuse Prevention Plan focused on four areas:

Education, Monitoring, Proper disposal & Enforcement

Alcohol Withdrawal:

Fewer than 5% of alcohol-dependent people ever develop grand mal seizures during withdrawal (usually day 2) or develop the DT's (delirium tremens). Withdrawal symptoms include hand, tongue or eyelids tremors; nausea or vomiting; anxiety, depressed mood or irritability, illusions; headaches; or insomnia - may last months after last drink. Up to 15% of persons with alcoholism have seizures during withdrawal (Frontal lobe shrinkage the executive functioning of your brain, you are not you anymore, impulsivity control). DT's can be life threatening, involves visual & auditory hallucinations, and can be avoided by gradually reducing alcohol consumption or by using depressant meds diazepam (Valium) or chlordiazepoxide (Librium).

Beta alcoholism

Heavy drinking causing physical complications such as gastritis and cirrhosis of the liver. No physical or psychological dependence on alcohol

Depressants:

Includes alcohol, barbiturates, and tranquilizers. Narcotics may be natural (opium & opium derivatives - morphine & codeine), semi-synthetic (heroin) or synthetic (methadone, oxycodone [OxyContin], and pethidine [Demerol]. Morphine, codeine, methadone, OxyContin, barbiturates, and tranquilizers have some medical use and depress the CNS, reduce anxiety at low dosages, and can induce anesthesia and death at high dosages

Gamma alcoholism

Increased tissue tolerance, withdrawal symptoms when drinking is discontinued, and loss of control. High degree of interpersonal relationship impairment. Most AA members experienced this level of alcoholism (predominant in Great Britain & Northern Europe)

Addiction

Loss of control over a substance or behavior

Colonial America and alcohol:

More beer than water was carried on the Mayflower, The Puritans saw alcohol as a blessing from God and all ages drank it daily (pregnant women, children, and men). Native Americans drank to alter their mood and achieve a different state of consciousness. They assumed alcoholic drinks served the same purpose as hallucinogenic plants and tobacco. To drink small portions was seen as pointless. Huge social crises felt to the present A general lack of concern about alcoholism and its problems was one of the most significant features of the colonial era. Alcohol was used as a solvent, antiseptic, pain killer, and thought to protect against disease/conducive to good health. Puritans regarded rum as "God's good creature" and became the bankers of the slave trade that supplied Jamaican molasses needed to produce rum

Epsilon alcoholism

Periodic alcoholism (binge drinkers)

Natural recovery

Recovery that takes place without any formal treatment or membership in a self-help group (e.g., AA/NA)

Ambivalence

Refers to the role of intoxicants in society and the pleasure and pain associated with their use (Heavy alcohol/drug use coupled with strict social control policies)

Delta alcoholism

Similar to gamma alcoholism but without the loss of control over the amount consumed. Unable to abstain from drinking for one day (predominant in France)

Medical treatments for withdrawal include:

Topamax (restores neurotransmitter balance), beta blockers (reduce anxiety), and naltrexone (blocks pleasurable effects of alcohol/reduces cravings)

Alpha alcoholism

Undisciplined use of alcoholic beverages. There is a psychological dependence but no progression

Inhalants

Used predominantly by children and teens. Gaseous substances/volatile chemicals often inhaled directly from container (e.g., glue, spray paint, aerosols, gasoline, lighter fluid, or paint thinners/removers, and Freon). Intoxication has euphoric effect typically followed by a light headache. Other consequences include damage to the central and peripheral nervous systems, drowsiness, intensified headaches, coma or death.

A hangover is

a post-intoxication withdrawal symptom (water/Aleve).

Excessive drinkers

account for 9% of drinkers and 46% of the total alcohol consumed (National Center on Addiction and Substance Abuse, 2003). Most heavy drinkers are proud of their high tolerance for alcohol - they can "drink their friends under the table"

A drug is

any substance that affects the physical or mental functioning of a living organism, especially one used for the treatment or prevention of an illness or disease. A drug is a stimulant or narcotic taken otherwise than medically

Treatment trends

are highly political and often tend to lag behind common attitudes and practices

Psychoactive drugs

are mood altering and used for the purposes of recreation or self-medication

Opiates

are naturally occurring chemicals (derived from the opium poppy) and similar synthetic drugs (narcotics). Prescribed by doctors to relieve pain now but previously used by early Egyptian, Greek, and Arab cultures to treat diarrhea

Amphetamines

are synthetic drugs with similar symptoms as cocaine. Amphetamines in non-hyperactive people increase their adrenaline levels and suppress appetite (e.g., key ingredient in diet pills). Ritalin (methylphenidate) falls in this category - Used to treat ADHD and assist focus, filter distractions, and enhance rational decision making instead of emotional/irrational/impulsive choices

Moderate drinking is defined

as up to two (2) drinks per day for men and one (1) drink per day for women.

Interactiveness is a key component of addiction

because it looks at the cause and effect of addiction and demonstrates how they are intertwined "Some problems cause substance use; some problems result from substance use; and some simply emerge along with substance use as the result of genetic, personality or environmental conditions"

Fragmentary (partial memory) blackouts

can lead to greater alcohol misuse in the future because drinkers may fill in the gaps with false positive recollections. Youth are the most likely age group to experience a blackout. Effects of blackout is stronger when alcohol is combined with Valium, sleeping pills, or muscle relaxants.

Long term use of Ecstasy

causes brain damage, depression, insomnia, memory disturbances, dehydration, kidney or heart failure, and hyponatremia (low plasma sodium caused by consuming large quantities of water)

Withdrawal from heroin or other opiates

causes diarrhea, chills, fever, and a runny nose

The new addiction therapist must be prepared to meet the needs of polysubstance addicted clients

clients with co-occurring mental health and addiction problems, and persons referred from criminal justice systems

The word tee-totaler

comes from the letter T for total abstinence, which was put next to a man's name on the society's rolls when he took the pledge.

Categories of drugs include:

depressants (downers), opiates, stimulants (uppers), and hallucinogens

Tolerance reversal

drinker loses his/her ability to handle alcohol as they age (Liver no longer efficient/Gets drunk on first drink)

The psychological concept of addiction

encompasses the thinking that leads to the drinking, injecting, or snorting of the substances

Labeling oneself (addict/alcoholic)

erodes one's self-esteem, self-confidence, and self-efficacy (People are not their disorder)

The pendulum of drug policy shifted in the 1970s

from a law enforcement model to a treatment model with drug penalties being reduced for all drugs, especially marijuana, which became associated with middle class youth

Anorexia has roots

in holy fasting practices of 13th century women who selfdenial had some of the "holy anorexics" canonized as saints

Heroin withdrawal

in regular users occurs within a few hours of last dose and presents with the following symptoms: Drug cravings, Diarrhea, Muscle pain, Restlessness, Cold flashes, Vomiting

In the 15th century distillation of alcohol

increased its potency and created a social crisis situation due to the production of cheap gin throughout Europe (children starved/abandoned/orphaned)

psychoactive drugs are absorbed

into the bloodstream and carried to the central nervous system (CNS), Whatever method you choose to use drugs - swallowing, inhaling, or injecting. Psychoactive drugs pass the blood-brain barrier and cause release of neurotransmitters (feel-good chemicals) in the brain. Drugs are eventually eliminated as waste or metabolized by the body.

The fastest growing segment of the gambling market

is Internet gambling (10 million online poker players in U.S. yield an estimated $5 billion in annual revenues). Washington, DC is first city in the U.S. to legalize online gambling in an effort to tap into the large profits now going to offshore Internet gambling entities.

Alcohol (ETOH)

is a chemical and a drug; Ethyl alcohol is the kind people drink- colorless, flammable, volatile liquid with burning taste. Alcohol we drink is produced by the fermentation of substances (fruit) containing sugar and by enzymes that are produced by a microorganism (yeast). Distillation enhances alcohol's potency.

Morphine

is a derivative of opium (discovered early 1800s and used medically for diarrhea until 1900s, now sparingly prescribed for pain)

The spiritual dimension of addiction

is a key component in the illness of addiction because it is related to one's sense of meaning and connection to something greater than themselves

Alcoholism

is an illness characterized by preoccupation with alcohol and loss of control over its consumption such as to lead usually to intoxication if drinking has begun; by chronicity; by progression; and by tendency toward relapse. It is typically associated with physical disability and impaired emotional, occupational, and/or social adjustments as a direct consequence of persistent and excessive use of alcohol.

The theme of personal empowerment

is key to harm reduction or mutual help programs because commitment to change must be voluntary to break the cycle of addiction

For stimulants (cocaine, crack) the visible withdrawal reaction

is relatively mild - Depression and intense craving are common. Withdrawal symptoms usually start within 24 hours and can last several days (no withdrawal symptom with LSD)

In 1900

it was illegal to sell cigarettes in 14 states and selling lottery tickets was a federal crime, however you could still go to a store and buy chewing tobacco, opium, morphine, and heroin over the counter. The invention of the hypodermic needle and the synthesis of heroin from morphine at the end of the 19th century fueled addiction. Warnings about addiction to morphine appeared in medical textbooks around 1900 and in 1909 the import of opium was banned. The result was increased heroin use, especially through injection

Cocaine (Stimulant)

mixed with baking soda, water, and ammonia boiled and cooked creates crack cocaine "rocks" that make a cracking sound when smoked. Snorted cocaine takes minutes to reach the brain but crack gets there in seconds and produces the same "high" for about 15-20 minutes.

G. Alan Marlatt (clinical psychologist)

most related with harm reduction in the U.S. Dr. Marlatt saw harm reduction as "one-step-at-a-time" instead of total abstinence. Author of Harm Reduction: Pragmatic Strategies for Managing High Risk Behaviors - best known book in addiction field. Developed BASICS - Brief Alcohol Screening and Intervention for College Students (binge drinking prevention for college students)

GHB (gamma-hydroxybutyrate)

odorless, colorless, and nearly tasteless liquid misused by bodybuilders and others, associated with sexual assaults.

Black coffee (caffeine) plus alcohol

only creates a wide-awake drunk

Interactionism

or the reciprocity or social forces, is seen most vividly in the dynamics of the family system. Each family will have its own particular style of adaptation and coping through blaming, denial, and/or overprotection. Viewing the family as a system, one member's malfunctioning throws the whole family's functioning awry (generational impact)

Hallucinogens

overwhelm the central nervous system, produce an "out of body" experience, sensory illusions, strange tactile sensations, altered sense of time, and hallucinations (e.g., can fly or walk on water). Effects take about 1 hour after use and can last up to 8 hours. Users can also involuntarily return to the drugged state, LSD, Phencyclidine (PCP, angel dust) , Peyote, Mescaline is another psychedelic drug naturally occurring in mushrooms, Psilocybin mushrooms (grow wild globally) produce an intense religious experience in many people and fear & paranoia in others. Club drugs: Ecstasy, Rohypnol, & GHB.

In the 1980s

politicians capitalized on an association between drug use and crime, with an emphasis on inner-city violent crime

Bath salts

powdery stimulant drug (cocaine substitute) triggers high abuse and addiction and cravings. Ingesting/snorting bath salts causes chest pains, increased blood pressure, increased heart rate, agitation, hallucinations, extreme paranoia, and delusions. Bath salts-called the zombie drug, a guy in Miami tried to eat another person's face off

Behavioral tolerance

process of learning to adapt one's behavior to the presence of the drug (alcohol, drugs, cigarettes, violence, sex, etc.)

Caffeine withdrawal

produces frontal headaches and Valium withdrawal causes seizures (may occur 2+ weeks after cessation)

The biology of chemical use

relates to hereditary components in the etiology of addiction and the physical consequences

The social component in addiction

relates to where as opposed to why or how. Where does the addictive activity take place and where is the impact felt?

Rohypnol (rooffies/date rape drug)

sedative manufactured in Europe as a sleeping pill (similar to Valium) - used to moderate effects of cocaine binge or enhance effects of alcohol or heroin. Causes amnesia & blackouts up to 24 hours

Different reactions to the same drug over time, heroin

seen as beneficial and then banned as a dangerous substance (associated with dangerous people) some years later - Race, class, and gender

Harrison Act of 1914

severely restricted the amount of opioids or cocaine in any remedy sold without prescription. Enforcement was through the Department of Treasury and related to the payment of taxes on the sale of these products only; Not punitive law until years later when doctors and pharmacists were arrested for providing drugs to addicted persons for addiction symptom maintenance.

Opiate users

smoke, snort, or inject the substance for maximum effect (oral ingestion produces little effect - opium not easily absorbed in digestive tract). Speedballing (8 ballin') - mix of heroin and cocaine. Some older addicts mix crack and heroin.

The first gambling treatment inpatient program

started in 1972 at the VA (Veterans Affairs) Hospital in Brecksville, Ohio led by psychiatrist Dr. Robert Custer, One of his primary contributions was to reject the prevailing Freudian theory that gambling compulsively was a substitute for sex; Instead Dr. Custer maintained gambling addiction is "the pain-avoidance mechanism," the gambler continues gambling whether winning or losing to avoid psychic pain.

Temperance women

targeted strong liquor as the source of chronic drunkenness, violence, and family poverty. By attacking "Demon Rum" as the root cause of the family disintegration, the drunkard was scorned and the drunkard's wife pitied. Temperance women led to the women's suffrage movement

Jellinek singled out five (5) "species of alcoholism"

that he considered disease-related: alpha, beta, gamma, delta, and epsilon alcoholism. According to Jellinek only the gamma and delta varieties can be considered addictions and/or diseases.

Tolerance levels are subject

to alteration following a period of abstinence (Addicts can't handle usual drug level after incarceration). Your tolerance level will change based on your exposure

Cross tolerance

tolerance developed for one drug generalizes to another drug in the same pharmaceutical class

Ecstasy (MDMA or methylenedioxymethamphetamine)

took off on club scene. Ecstasy can produce both stimulant and psychedelic effects. Ecstacy releases serotonin (increasing mood/antidepressant). In low doses, no hallucinogens but increases awareness/sensations. When you come off Ecstasy you go through SEVERE Depression for like two days because you have decreased your serotonin levels so much when you take Ex.

Blackouts

total inability to recall events that occurred while the person was intoxicated, even though the person appeared in a normal state of mind at the time. No lapse of consciousness with a blackout. Inability to store knowledge in long-term memory attributed to high blood alcohol level (usually over 0.15 blood alcohol concentration or B.A.C.).

Alcohol is the leading risk factor in three (3) leading causes of deaths among youth:

unintentional injuries (including motor vehicle accidents and drownings), suicides, and homicides.

Methadone

was created to treat heroin addicts and reduce cravings. Typically administered orally, effects last up to 72 hours.

Ancient Rome had vomitoriums

where feasting and drinking would include vomiting so people could continue to indulge to excess (binge-purge cycle is known as bulimia today)

Effects of Cocaine

yields feelings of sexual arousal due to increased blood flow to genitalsRapidly metabolized by the brain from . the bloodstream and then travels back to the blood. Heavy users quickly deplete dopamine levels yielding severe depression, aggressive behavior, anxiety, and intense craving. Other consequences of routine & heavy cocaine use include paranoia and auditory hallucinations and death from heart disease, strokes, and/or respiratory failure.

Methamphetamines effects

yields medical complications including heart damage, strokes, paranoia and psychosis, compromised immune system, extreme weight loss/emaciated, skin excoriation, insomnia, and anhedonia (loss of pleasure in normal joys of life) "When you take away meth, nothing natural - sex, a glass of water, a good meal, anything for which we are supposed to be rewarded - feels good. The only thing that feels good is more meth." (Methland, pp. 48-49). Meth users can stay awake for days and often weeks at a time. Chronic insomnia produces/enhances paranoia & intense aggression.