Substance Abuse Chapters 1 & 9

5 Historical Themes

1. Humans have a basic need to cope with their environment and enhance their existence. 2. Brain chemistry can be affected by psychoactive drugs, behavioral addictions, and mental illness to induce an altered state of consciousness. 3. Ruling classes, governments, industry, and criminal organizations have been involved in growing, manufacturing, distributing, taxing, and prohibiting drugs. 4. Technological advances in refining, synthesizing, and manufacturing drugs have increased the potency. 5. Faster, more efficient methods of delivering drugs into the body has intensified the effects.

Stage of Changes?

1. Pre-contemplation: "I don't have a problem", role as social worker is develop some discrepancy. 2. Contemplation: "I might have a problem" 3. Determination (preparation): Decide something to do about it and make plans about how they might go about changing. 4. Action: client chooses a strategy of doing something - "I am following through with my plan." 5. Maintenance and Relapse Prevention: Maintaining skills, knowledge, and gains.

Be able to explain the HOPE program and main features of the program.

1. Random drug tests 2. Any probation violation leads to a court hearing within two business days where immediate short-term incarceration could result. 3.Shown to reduce recidivism rate. 72% abstain from drinking or never relapse Hawaii's Opportunity Probation with Enforcement. Is an intensive supervision program that aims to reduce crime and drug use while saving taxpayers' dollars spent on jail and prison costs. Under HOPE, probationers receive drug treatment only if they continue to test positive for drug use or if they request a treatment referral.

How many plants can produce psychoactive substances that we know of?

4000 plants can produce psychoactive substances, and 60 are commonly used.

Primary drug of choice people enter into treatment:

Alcohol and BTW second to that is Marijuana.

Assessment tools:

Biospychosocial and CAGE

A widely used assessment CAGE, Know the questions.

C: Have you ever felt you should Cut down on drinking/drug use? A: Have people Annoyed you by criticizing your drinking/drug use? G: Have you ever felt Guilty about your drinking/drug use? E: Have you ever taken a drink/used drugs in the morning to steady your nerves or get rid of a hangover? (Eye opener)

Admissions by source of referral:

Criminal Justice System, the Drug Court refers or mandates. DUI makes the largest number of referrals. Criminal justice system makes a higher number of referrals for all drugs except heroin and crack cocaine (a self-referral is the majority in regards to these two drugs).

How does a social worker determine the best course of treatment?

First we need to start where the client is at. Also determination of treatment can be based on the cost, location, familiarity, and convenience of access. It is important to use evidence based assessment tools as well as the DSM for empirical methodoligies. Cultural awareness also needs to be taken into account to understand how the client shows up and prevent misdiagnosis.

Harm Reduction Vs. Abstinence

Harm reduction: willingness to work for incremental changes OR any steps taken my drug users to reduce the harm of their behavior. Examples: drug replacement therapy, needle exchange, DDs, substituting less harmful drugs, drug decriminalization/legalization. Abstinence: most believe that using drugs is a loss of control, so the only way to become truly clean is to be 100% abstinent.

Be able to give an explanation of TWO treatments:

Methadone maintenance (outpatient medical model). It is used as a replacement therapy for opioid addiction. MMT is a comprehensive treatment program that involves the long-term prescribing of methadone as an alternative to the opioid on which the client was dependent. Central to MMT is the provision of counselling, case management and other medical and psychosocial services. Inpatient Treatment: Clients are housed in the facility and are medically monitored or managed. Treatment usually consists of counseling, drug education.

Needle Exchange Thought Question

New York City program that provides fresh and clean needles for drugs users in effort to reduce the number of deaths (HIV, AIDS) caused by a dirty needle.

Motivational Interviewing OARS

Open-ended questions Affirmation Refelctive listening Summarize

What is the cost of outpatient treatment costs versus untreated addiction?

Outpatient costs $1800 vs. Untreated addiction which costs $30,000-$150,000

Outpatient vs. Inpatient:

Outpatient: not medically monitored and not in a facility but characterized by support (NA, AA, etc...) Inpatient: Medically monitored and in a facility

Identify the three major categories (Uppers/Stimulants, Downers/Depressants, All- Rounders/Psychedelics) and at least TWO examples of the matching psychoactive drug.

Stimulants: Cocaine and Meth Depressants: Alcohol and Opium Psychedelics: Pschedelic mushrooms and LSD

What is the effectiveness of coerced (legally mandated) treatment?

There is sustained evidence that coerced treatment (e.g. drug court) is as effective, if not more so, as voluntary treatment in promoting positive outcomes. 50-65% of participants graduate or remain active participants. Courts keep felony offender in treatment at about double the retention rate of community drug programs because they involve closer supervision and the threat of incarceration.

Plant-based psycho-active substances?

a psychoactive drug is any substance that directly alters the normal functioning of the central nervous system (CNS). Examples: Ephedra, Coffee, Tea (Stimulant); Opium, Heroin (Depressants); Psilocybin mushrooms, Hashish (Psychedelic).

The principles of effective treatment:

1. Addiction is a complex but treatable disease that affects the brain function and behavior. 2. No single treatment is appropriate for all individuals. 3. Treatment must be readily available. 4. Effective treatment attends to multiple needs of the individual, not just his or her drug use. 5. Remaining in treatment attends to multiple needs of the individual, not just his or her drug use. 6. Counseling and other behavioral therapies are the most common forms of treatment. 7. Medications are an important element of treatment for many patients. 8. An individual's treatment and services plan must be asses continually and modified when necessary to ensure that it meets the person's changing needs. 9. Many drug-addicted individuals have other mental disorders. 10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. 11. Treatment need not be voluntary to be effective. 12. Drug use during treatment must be monitored continuously as lapses during treatment do occur. 13. Treatment programs should provide assessment for HIV/AIDS, hep B and C, TB, and other infectious diseases as well as risk reduction counseling to help patients modify or change behaviors that place themselves or others at risk of infection.