Drugs Lecture 15

•Normalization:

Don't reinforce the doing, reinforce the not doing

The most widely used drug prevention program in the US is DARE:

Drug Abuse Resistance Education. A second popular program is Red Ribbon Day

•1986:

Drug-Free Schools and Communities Act

What is primary purpose of Drug Education?

GIVE KNOWLEDGE

•GAMMA:

Greeks advocating mature management of alcohol

•National agency overseeing drug prevention is the:

Substance Abuse and Mental Health Services Agency (SAMHSA)

What is a therapeutic community?

TCs are drug-free residential settings that use a hierarchical model with treatment stages that reflect increased levels of personal and social responsibility

•Antabuse (disulfiram):

a drug that interferes with the metabolism of alcohol, making the drinker violently ill

•Outpatient treatment:

a nonresidential drug treatment program

•therapeutic communities:

a program that advocates a complete change in lifestyle, such as complete abstinence from drugs, elimination of deviant behavior, and development of employable skills

•Inpatient treatment:

a residential drug treatment program based on a hospital model

•patient placement criteria:

a system that allows the referring professional to match the assessed level of addictive severity with an appropriate intensity and level of care, ranging from an outpatient clinic to a medical center

•Encounter groups:

a type of confrontational treatment frequently used at therapeutic communities

•Addiction:

chronic life-threatening condition that has roots in genetic susceptibility, social circumstance and personal behavior

-Community:

churches, education, laws, resources, publicity, workplace within neighborhood

•The most successful treatment programs provide a _______ of therapies and other services to meet the needs of the individual user

combination

1.Addiction is a _____ but _____ disease that affects brain function and behavior. Drugs of abuse alter the brain's ______ and ______, resulting in changes that persist long after drug use has ceased.

complex, treatable, structure, function

•peer tutoring/teaching and counseling:

others to disseminate information on drugs

-Parent:

parenting skills, information, support groups, interaction

•Peers:

peer approval where drug use is reciprocal

-Peer:

peer influence and peer participation

-Habitual:

regular involvement

•ability to say "no" (__________) to drugs through learning to cope with peer pressure

resiliency skills

-Relapse:

return to regular use

•Drugs like marijuana, tobacco, and alcohol were viewed as "____ _____", particularly alcohol and tobacco because they were legal

soft drugs

•STAR:

student taught awareness and resistance

•social influence and resistance models:

teach how to resist

•environment-related:

the sociocultural setting if favorable to use; social learning, cultural learning, environmental stress, alienation

•methadone maintenance programs: -Collecting needles for exchange program in an effort to prevent the spread of HIV among needle using addicts

type of therapy used in treatment of heroin addiction

•host-related:

user is unusually susceptible to the effects of drug; genetic, biological, psychological or psychiatric

11. Treatment does not need to be _____ to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

voluntary

•Intervention: (1973),

when family members, friends and associates gather to confront the individual as a group; -they present concrete evidence of the impact that the person's drug problem has had on them; -in a supportive manner they press the individual to admit the problem and seek treatment

Treatment program options:

•Behavioral therapy -Counseling -Psychotherapy -Cognitive therapy •Medications -Treatment: methadone, nicotine replacements •Self-help groups •Most successful provide -Combination of treatments -Assessment and case management •Drug problem, Housing, Legal, Financial, Vocational, Family issues •A patient receives counseling in an alcoholism treatment center

Treatment program options:

•Fewer than 90 days is of limited effectiveness •Treatment professionals use patient placement criteria to match severity of the addiction to the level of care needed, ranging from medical inpatient care, nonmedical inpatient care, intensive outpatient care to outpatient care. •Matching care to guidelines established by health insurance carriers are difficult •Most adolescents use alcohol because they want to experience new sensations, relieve peer pressure, or enhance a social setting with chemistry

Types of drug treatment settings:

•In hospital •Residential care: -Therapeutic communities •Day hospitals •Intensive outpatient services •Cost depends on type of program: detox, residential, inpatient, outpatient, intensive outpatient, partial hospitalization, medication assisted, etc...

Reasons why drug prevention efforts have not worked:

•Large numbers of people derive satisfaction from tobacco and alcohol and other drugs •Many drugs provide immediate* gratification •Americans do not like being told what they can and cannot do

•Untreated chemical dependency costs the US more that ____ _____ annually

$165 billion

Four phases of addiction:

-Initial -Habitual -Addiction -Relapse

•A variety of approaches to drug addiction treatment exist including behavioral and pharmacological therapies:

-No single approach is appropriate for all individuals

•Various education programs can be:

-Peer -Parent -Community

•What are 3 stages of prevention? Institute of Medicine

-Primary -Secondary -Tertiary

•What does education give a potential user?

-better prepared to make decisions -more able to understand negatives of drug use -act more rationally and responsible

WOMEN: _____ or MEN: _______ Zero-One-ThreeStrategy for lower risk drinking

0(times to abstain)-1(no more than 1 drink per hour)-1(no more than 1 drink per day for women)-4 (no more than 4 times per week) 0-1-2-4

•Profile of the drug user: -Males between ages of _____ •Not as many facilities for women/teens -Many have mental health problems

18-25

•Just Say No:

1980s-1990s aiming to discourage kids from engaging in illegal drug use by having various ways to say no

-______ of homeless are substance abusers

30-40%

role of parents and family unit should never be underestimated (kids with noninvolved parents are _____ more likely to use

4x

•Most of the funds for drug E&P come from the federal government -______ of funds allocated to reduce supply -______ of funds allocated to reduce demand

56%, 44%

•drug free workplace programs (__ of ___ drug users work full-time)

7 of 10

Drug Education: Drug Prevention: Drug Treatment/Rehabilitation:

Knowledge Not to use Stop and/or Reduce the Use

•LST:

LifeSkills training is a 3 year substance abuse and violence prevention program for the middle/junior high years

_____ ____ ______ is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification.

Medically assisted detoxification

Codependency:

Of or relating to a relationship in which one person is psychologically dependent in an unhealthy way on someone who is addicted to a drug or self-destructive behavior, such as chronic gambling.

•BACCHUS (1975):

boosting alcohol consciousness concerning the health of university students

Remaining in treatment for an _____ period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient's problems and needs. Research indicates that most addicted individuals need at least ______ in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment.

adequate, 3 months

•Controlled drinking approach:

alcohol treatment based on behavior modification, in which the person learns to drink in a nonabusive manner

•High risk behaviors:

any behaviors that are self-destructive or delinquent

•Gateway refers to the notion that these drugs:

are used as an introduction to other drugs... The belief is that if young people do not use gateway drugs they will not use other drugs

•Naltrexone:

blocks opiates' or alcohol effects

An individual's treatment and services plan must be assessed ______ and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person's changing needs.

continually

•Antabuse:

disulfiram that interferes with the metabolization of alcohol and makes you violently ill

•DARE:

drug abuse resistance education

•agent-related:

drug itself causes the drug abuse and dependence

•1970s:

early programs based on scare tactics and moral judgment; information about dangers of drugs

•Good and accurate information (______ ____ _______), AND personal development, AND personal and social skills training including:

eliminate the myths -Resiliency, goal setting, problem solving, assertiveness, refusal, decision making and coping skills

•detoxification:

eliminating drugs from the body; usually the initial step in treatment

•Cold turkey:

elimination of a negative behavior all at once as opposed to gradually

1.No single treatment is appropriate for _____. Treatment varies depending on the type of drug and the characteristics of the patients. _____ treatment settings, interventions, and services to an individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

everyone, matching

-Secondary:

experience, not in need of treatment: •don't get worse

•cognitive/information:

facts and straight forward information on drugs

•relapse:

failure to maintain a course of action

•Alcohol, tobacco, marijuana and inhalants are often referred to as _____ ______

gateway drugs

-Tertiary:

heavy user, gets treatment: •get them into treatment •relapse prevention

-Addiction:

high end of habitual, career use, tolerance and withdrawal, physical and psychological dependence

13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other _____ _____ and provide targeted risk-reduction counseling, linking patients to treatment. Drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness.

infectious diseases

•Developmentally appropriate -E: -E/M: -M/H:

knowledge based education attitude and motivation skills

•demand reduction:

lessening the need for individuals to use drugs that are not within the bounds of medical therapy and that disrupt human development and functioning by helping youth to create positive mental attitudes, values, behaviors, and life-styles

-Primary:

little no experience: •don't start -promoting activities reinforcing a positive, drug-free lifestyle

•supply reduction:

lowering, restricting or eliminating the availability of a drug by disrupting drug trafficking, eradicating American crops, driving drug prices higher, heavy taxes on legal products, tougher laws...etc.

-people in treatment are more likely to be:

male, black, young or middle-age, employed less than full-time, unmarried, high school dropouts

•____ ______ is not a treatment but is instead a ______ to treatment

medical detoxication, precursor

•Goals of treatment differ depending on whether use is seen as a:

medical problem, breakdown in society, or personality disorder

. ______ are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

medications

Many drug-addicted individuals also have other ____ _____. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s).

mental disorders

12. Drug use during treatment must be _____ continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual's treatment plan to better meet his or her needs.

monitored

. Behavioral therapies—including individual, family, or group counseling—are the ___ ____- used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient's motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

most commonly

Effective treatment attends to _____ needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual's age, gender, ethnicity, and culture.

multiple

•NIMBY:

not in my back yard: a term used to describe how some people feel about having a controversial facility located in their neighborhoods

-Initial:

occasional or experimental use

•What are types of programs? -Based on abstinence -Based on controlled use: •Behavior modification to use on controlled basis •Moderate Management (MM): -Based on substitute drugs:

problem drinkers who want to drink moderately Methadone for other opiate

•By the numbers:

program designed for college students to "reduce the risk" of using alcohol

•Inoculation/harm reduction:

protecting drug users from unhealthy, irresponsible, drug taking behavior and thus reducing the harm and negative consequences of drug abuse by increasing the proportion of individuals who practice *responsible drug use

1.Treatment needs to be ____ _____. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is _____. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.

readily available, critical

•Psychological factory:

rebellion, little interest in school, lack of empathy, desire for immediate gratification, indifference toward punishment, minimal concern for adult achievement

What should be the goals of drug E&P?

•To prevent the individual from beginning to use •To minimize the risks of drugs to the user •To reduce the risks of drug use to society •To prevent drug dependency •To teach responsible drug use •To stop drug use after patterns are learned •To delay onset of drug use

Questions to ask:

•When should drug E&P efforts be initiated •What E&P efforts are effective •Who should be responsible for drug E&P