IC&RC MEGA STUDY!!!!!

What is one of the most powerful mood-changing chemicals?

D-lysergic acid diethylamide (LSD)

Maintenance

DEVELOPS new behaviors to maintain changes and solution. Risk of relapse high in first six months to one year. Motivational task: help client identify and use strategies to prevent relapse, support success and reinforce motivation and self-efficacy

Buspirone Interactions

DON'T INTERACT WITH PSYCHOTIC DISORDERS! may interact with drugs called monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane) which are used in psychotic disorders. Interaction with these drugs can cause increased blood pressure.

DAP

Data, Assessment , Plan

DOB

Date Of Birth

6 Steps for Ethical Decision Making (6)

Decide the best course of action and take it

Do No Harm:

Decisions are made in order to avoid any harm to the client or cause the least amount of harm to the client or others

6 Steps for Ethical Decision Making (2)

Define potential issues

Substance dependence

Defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress

Parkinson's disease

Degenerative neurological disease involving damage to dopamine neurons.

Mania Disorder Social or interpersonal symptoms

Demonstrate marked annoyance, intolerance, anger, aggression, talkativeness, extreme actions, and rudeness.

Professional Performance

Demonstrating competence and knowledge

Attending

Demonstration of counselors concern and interest in the client by eye contact, body posture, and accurate verbal following.

Attending

Demonstration of the counselor's concern for and interest in the client by eye contact, body posture, and accurate verbal following (listening skill) Encourages the client to continue to express his/her ideas and feelings freely Listening and observing and then communicating to the client that listening and observing is going on Counselor stays attuned to what the client is expressing verbally and nonverbally Attentiveness is conveyed through eye-contact, posture, and accurate verbal following ("Oh", "yes", "Uh huh")

Attending

Demonstration of the counselors concern for and interest in the clt by eye contact, body posture and accurate verbal following

Name the two fibers which extend from the neuron

Dendrites (send impulse toward body) and axons (send away from cell body)

Depressive disorder

Depressive episodes are characterized by feelings of intense sadness, guilt, fatigue, and irritability. During a depressive period, people with bipolar disorder may lose interest in activities that they previously enjoyed, experience sleeping difficulties, and even have thoughts of suicide.

3 Orientation

Describe the general nature and goals of the program; rules governing client conduct and infractions that can lead to disciplinary action or discharge from the program; in a non-residential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.

Orientation

Describe to the client: 1. the general nature and goals of the program- abstinence 2. rules governing client conduct- pay for services, group confidentiality, keep appointments 3. infractions that lead to discharge 4. service hours 5. treatment costs borne by client 6. client's rights- confidentiality and professional treatment

Core function of orientation

Describing and introducing the nature and goals of the program to the client

3. Orientation

Describing to the client the following: general nature and goals of the program; rules governing client conduct and infractions that can lead to disciplinary action or discharge from the program; in a nonresidential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.

A client in a methadone maintenance program reports an increase in anxiety and drug cravings. It is MOST appropriate for the counselor to?

Determine if the client is experiencing anxiety associated with withdrawal.

Appropriateness

Determine the extent and nature of Client's problem(s); substance use and mental health disorder

Screening Definition

Determines likelihood of co-occurring substance use and mental disorders or that client is presenting signs, symptoms, or behaviors may be influenced by co-occurring issues. Formal process, typically brief and occurs soon after client presents for services.

Thalamus

Determines sensations as painful vs pleasurable. Sensory and motor signal relay that regulates consciousness and sleep.

Addiction Severity Index

Developed by McLellan. Addresses 7 problem areas and is a one hour face to face interview.

Barbiturates

Developed in 1868 from barbiturate acid, and currently make up over 2,500 diverse compounds, typically used until the 1970's medically as a sedative hypnotic or an anticonvulsant. Function by interrupting impulses to the reticular activating system. Highly addictive and regular use of them leads to tolerance and severe withdrawal symptoms. Sudden withdrawal can lead to coma.

2 general categories of Crises are?

Developmental: One that occurs as a person experiences life, such as entering adolescence, getting married, having a baby, mid-life changes, retirement or the death of a spouse from natural causes in old age. Disturbing Event: accident, divorce, deaths, crime, financial losses, natural disasters or serious injuries.

DSM

Diagnostic & Statistical Manual tool used to make diagnostic impression based on presenting symptoms

DSM IV

Diagnostic and Statistical Manual of Menatl Disorders, 4th Edition

DSM

Diagnostic and Statistical Manual of Mental Disorders

Most commonly abused BZ (depressant)

Diazepam or Valium includes: Valium (diazepam) Halcion (triazolam) Xanax (alprazolam) Ativan (lorazepam) Klonopin (clonazepam)

Cultural diversity

Differences in race, ethnicity, nationality, religion, gender, SES, physical ability, etc.

Ayahuasca is a tea made from one of several Amazonian plants containing...

Dimethyltryptamine (DMT), the primary mind-altering ingredient Ayahuasca when combined in a "tea" with DMT induces spiritual visions and hallucinations

Amphetamines and Methylphenidate action (stimulant)

Direct neuron release of dopamine and norepinepherine and blockade of catecholamine re-uptake produce euphoric effects. Various toxic effets on the sympathetic nervous system.

Existential Factors

Discovering that life can have meaning. Group member owns responsibility for own thoughts, feelings, and behaviors

Etiological Models

Disease/medical model CBT model Biological Model Moral Model Psychodynamic Model Family Systems Model Biopsychosocial Model

Dissociative Identity Disorder

Dissociative identity disorder, formerly known as multiple personality disorder, involves the presence of two or more different identities or personalities. Each of these personalities has its own way of perceiving and interacting with the environment. People with this disorder experience changes in behavior, memory, perception, emotional response, and consciousness.

Nonmalfeasance

Do no harm

AXIS II determination

Do these patterns tend to cause trouble in intimate relationships, in social relationships and/or in work relationships? What developmental issues are present? • Is development arrested? • Are developmental issues currently presenting difficulty? Are any lifelong maladaptive patterns seen?

Advantages of Clonidine over Methadone

Does not produce opioid intoxication and is not reinforcing. Not classified as having abuse potential detox occurs w/o opioids no special licensing is required.

Drugs highjack the reward pathway, increasing _____________ in the user's brain, causing the high.

Dopamine

MDMA increases the activity of three brain chemicals:

Dopamine—causes a surge in euphoria and increased energy/activity Norepinephrine—increases heart rate and blood pressure, Serotonin—affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust.

Median effective dose

Dose required to produce a specific effect in 50 percent of test subjects

DAST

Drug Abuse Screening Test

DOC

Drug Of Choice

Opiate W/D

Drug craving, dysphoria, anxiety, yawning, perpiration, sleep difficulties, fever, chills, gooseflesh, abdominal cramps, nausea, diarrhea, muscle cramps, bone pain tears.

___________ can also be used to rule out the presence of certain categories of drugs, thereby reducing the costs of testing for all possible substances

Drug recognition techniques

Pseudoaddiction

Drug-seeking and other behaviors that may look like addiction but is the result of inadequate pain relief. Once pain is adequately treated, the person no longer abuses the medication.

Inhalation

Drugs absorbed into the bloodstream after passing through the lungs have been taken by

rectal administration

Drugs are administered by inserting them into he body through the rectum and are absorbed through the intestinal lining.

Club Drugs

Drugs associated with use at all-night dance parties, known as "raves," held in dance clubs, abandoned warehouses and increasingly in more nightclubs. Drugs: MDMA (ecstasy), GHB, Rohypnol

Schedule V

Drugs in this category are considered to be at low risk for either physical dependence or psychological dependence, and with current indications for medical use. Includes medical mixtures using small amounts of opium or codeine.

Schedule IV

Drugs in this category are considered to be at low risk for physical dependence but moderate risk for psychological dependence and have a currently accepted medical use. Includes Xanax, Barbital and chloral hydrate.

Schedule III

Drugs in this category are considered to be at moderate or low risk for physical dependence, and with current reasons for medical use. Includes anabolic steroids, most barbituates and ketamine.

Schedule II

Drugs in this category are essentially similar to Schedule I, but with an accepted medical use. There are restrictions on manufacture and distribution via production quotas and import/export controls. Non-refillable meds. Include methadone, morphine, methamphetamine and cocaine.

Stimulants

Drugs in this class increase cental nervous system activity. Includes cocaine, amphetamines, methamphetamines, and methylphenidate.

Hypnotics

Drugs used to induce sleep. Barbiturates-pentobarbital(Nembutal), secobarbital(Seconal) other-chloral hydrate(Noctec,Somnos), ethchlorvynol(Placidyl).

Sedatives

Drugs used to relax, calm or tranquilize. Barbiturates - amobarbital(Amytal), butabarbital(Butisol) other-buspirone(Buspar), meprobamate(Miltown)

analgesics

Drugs used to relieve or eliminate pain

Anxiolytics examples

Drugs, such as Valium, used in the treatment of anxiety disorders. Literally, "anxiety-dissolving".

SSRI and SSNRI

EFFECTIVE TREATMENT OF GAD selective serotonin reuptake inhibitor selective serotonin and norepinephrine reuptake inhibitor

Tradition 5

Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.

Tradition 4

Each group should be autonomous except in matters affecting other groups or A.A. as a whole.

Disadvantages of group therapy

Each member receives less attention Group may scapegoat a member Counselor has less power/control

Level 0.5

Early Intervention

Tricyclic/Tetracyclic antidepressants work by?

Easeing depression by affecting naturally occurring chemical messengers (neurotransmitters), which are used to communicate between brain cells. They block the absorption (reuptake) of the neurotransmitters serotonin and norepinephrine, making more of these chemicals available in the brain. This seems to help brain cells send and receive messages, which in turn boosts mood. Most antidepressants work by changing the levels of one or more neurotransmitters.

Orientation is the process of...

Educating clients about treatment and preparing them to participate

Psychoactive

Effects on thoughts, emotions, or behavior

Dimension 3

Emotional, Behavioral, or Cognitive Conditions and Complications

3 agencies that can mandate treatment

Employee Assistance Programs (EAP) Drug Treatment Alternative to Prison (DTAP) Treatment Alternatives for Safe Communities (TASC)

Neurotransmitter associated with Opiates:

Endorphins

6 Steps for Ethical Decision Making (5)

Enumerate consequences of various decisions

CYP450

Enzyme family most important in metabolizing drugs Always available in the liver Evolved to eliminate toxic chemicals from plants Function can be altered by alcohol & barbiturates

MAJOR DEPRESSIVE DISORDER

Episodes without a history of manic, mixed or hypomanic episodes. Two times more likely in adolescent and adult females than in males. Pre-adolescent period, this disorder affects boys and girls equally. Feel unmotivated, sad, listless and emotionally drained. Behavioral manifestations may vary from profound psychomotor retardation and withdrawal, to agitation and irritability.

Transactionional Analysis

Eric Bern is the founder of TA. View the person as three ego states: parent, adult, and child.

Transactional Analysis

Eric Berne. Focuses on interactions of ppl. Relies on Id, Ego, Superego, therapy of personality, and an organized system of interactional therapy. We make current decisions based on past premises that were at one time appropriate for our survival

Screening Purpose

Establish need for in-depth assessment, not to establish presence or specific type of disorder.

Types of alcohol

Ethyl Methyl Isopropyl Butyl Denatured alcohol

Narcotics possible effects

Euphoria, drowsiness, respiratory depression, constricted pupils, nausea

Cannabis effects

Euphoria, relaxed inhibitions, increased appetitie, disorientation,

Global Criteria: Screening

Evaluate psychological, social, and physiological signs and symptoms of alcohol and other drug use and abuse. Determine the client's eligibility and appropriateness for admission or referral. Identify any co-occurring conditions, such as medical, psychiatric, physical, etc. This will indicate the need for additional assessment and services. Abide by applicable laws, regulations, and agency policies governing alcohol and other drug abuse services.

1 Screening Criteria

Evaluate psychological, social, and physiological signs and symptoms of alcohol and other drug use and abuse. Determine the client's appropriateness and eligibility for admission or referral. Identify any coexisting conditions (medical, psychiatric, physical, etc.) that indicate need for additional professional assessment and/or services. Adhere to applicable laws, regulations and agency policies governing alcohol and other drug abuse services.

Crisis Intervention

Even with the best treatment plans and facilities, drug and alcohol rehab isn't an easy process. Every patient will likely experience acute emotional and physical distress at some point, including recovery issues or drug relapse.

Tradition 7

Every A.A. group ought to be fully self-supporting, declining outside contributions.

Simple Random Sample

Every member of the population has an equal chance of being selected

Systematic Sampling

Every nth element is chosen.

Eric Berne Transactional Ananlysis

Everyone interacts from three ego states—each with its own feelings, thoughts, and ways of behaving—that make up the human personality: Parent, Adult, and Child

EBPs

Evidence-Based Practices

Global Criteria: Treatment Planning

Explain assessment results to the client in an understandable manner. Identify and prioritize problems based on client's needs. Formulate immediate and long-term goals using behavioral terms Identify the treatment methods and resources to be used as appropriate for each client.

5 principles of MI

Express empathy through reflective listening Develop discrepancy between values and behavior Avoid argument and direct confrontation Adjust to client resistance rather than opposing it directly

Mania Disorder Behavioral symptoms

Extremely talkative and sometimes very loud. They may sing, rhyme, make puns, demonstrate hyperactive or agitated behavior, have an exaggerated view of self-worth, be unable to finish tasks, lose sleep, act aggressive, act overtly sexual or have a high sex drive, and abuse substances.

Jung's seminal work Analytic Psychoanalysis

Extroversion and introversion led to the development of the Myers- Briggs Type Indicator. Clients may complete this scale and use the results to develop awareness and determine core competencies needed to support their recovery.

Medical Marijuana

FDA has not cleared it. The ill affects of smoking far out weigh the medical affects.

Myth:Attributing drug or alcohol use to stress, just prevents adolescents from taking responsibility for their actions.

Fact:Defining the relationship between a youth's trauma history and his or her substance use can actually enhance his or her ability to take responsibility for their actions.

ANOVA

Factorial analysis of variance - used in the study of 2 or more variables. Most common is the 2x2 where there are 2 independent variables with each having 2 distinct values.

Assessing Nicotine Dependence

Fagerstrom Test and Glover-Nilsson Behavioral Questionnaire

True or False: Drug recognition techniques ARE NOT cost effective?

False. Drug recognition techniques are cost effective

THC

Fat soluable-stored in fat-time released, hard to recognize withdrawal.

Alcohol Abuse symptoms

Flushed cheeks, slurred speech, difficulty with coordination and balance

Clinical supervision: competency based models

Focus primarily on the learning needs of the supervisee and setting goals that are Specific, Measurable, Attainable, Realistic, and Timely (SMART)

Solution Focused Brief Therapy

Focuses on what clients want to achieve through therapy, rather than on the problem(s) that made them seek help. The approach does not focus on the past, but instead focuses on the present and future. The counselor asks the client to envision their preferred future and then, working with the counselor, the client starts to work toward achieve this goal(s).

Tradition 2

For our group purpose there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.

Dissociative Identity Disorder

Formerly known as multiple personality disorder, is under stress. May feel the presence of one or more other people talking or living inside your head.

Women for Sobriety

Found by Dr. Jean Kirkpatrick. Focused on self-esteem as magic building block for recovery

Cognitive therapy

Founded by Aaron Beck. Uses open-ended questions and Socratic dialogue.

Gestalt Therapy

Fritz Perls was the founder The person strives for wholeness and integration of thinking, feelings, and behaving. The person has the capacity to see how earlier influences are related to present difficulties Assist clients in gaining awareness of moment to moment experiencing Focus on the here and now

Gestalt Therapy

Fritz Perls. Goal of therapy is the integration of experiences into a whole personality. Stays in the here and now and focuses on body language.

Benzodiazepines work by enhancing the effect of the neurotransmitter

GABA When someone feels overly anxious, the brain becomes "excited" and over-active, tranquilizing transmitters need to quickly send messages to brain cells to slow down activity in the brain and reduce the symptoms of anxiety GABA is the brain's tranquilizing/ inhibitory neurotransmitter

neorotransmitters

GABA, norepinephrine, dopamine, serotonin, acetylcholine.

Barbiturates increase the activity of the neurotransmitter...

GABA, the inhibitory neurotransmitter

GATE

GATE, a four-step process (Gather information, Access supervision, Take responsible action, Extend the action) for addressing suicidal thoughts and behaviors in substance abuse treatment

What is considered "the Gold Standard" in urinalysis?

Gas chromatography/mass spectrometry. It is highly accurate and is the only method of US that reliably produces quantitative results

Global Criteria: Assessment

Gather information from the client regarding history of alcohol and other drug abuse. Use appropriate interviewing techniques. Obtain and corroborate information from significant collateral sources in regards to client's alcohol and drug abuse and psychosocial history, through the use of appropriate methods and procedures. Identify appropriate assessment tools. Explain assessment rationale to client. Develop a diagnostic evaluation of the client's substance abuse and co-occurring disorders based on the results of all assessments. The goal is to provide an integrated approach to treatment based on client's strengths, weaknesses, problems and needs.

Assessment

Gather key info from client to enable counselor to understand problems, disabilities, strengths and weakness.

Assessment

Gathers info, engages in a process that enables establishment of disorder, determines client readiness for change, engages client in development of appropriate treatment relationship

MAST-G

Geratric MAST

Layers of awareness

Gestalt - phony, phobic, impasse, implosive, explosive

Gestalt (Fritz Perls)

Gestalt therapy is considered to be a here-and-now therapy focusing on awareness with the belief that when one focuses on what they are and not what they wish to become, they become self-actualized

Standard Deviation

Gives an idea of how close the entire set of data is to the average value.

Autonomy

Giving a group member the right to make decisions and not let the group decide for him or her

Reality Therapy

Glasser's therapeutic technique focusing on developing the client's ability to cope with the stresses of reality and assume responsibility for fulfilling his or her own needs, especially the need for identity

GAIN

Global Appraisal of Individual Needs . An integrated biopsychosocial model of treatment assessment.

Corrective recapitulation

Group helps abet family of origin issues and demonstrates healthier ways to behave

self-help group

Groups that operate nonprofessionally without a counselor or therapist(A.A., N.A., Alanon, etc) they provide members with support and direction.

Multicultural

Growing up with more than one cultural orientation Accepting, recognizing, and enjoying the differences among groups

HIPAA

HIPAA (Health Insurance Portability & Accountability Act) In general, requires the protection and confidential handling of all protected health information. Provides minimum restriction.

Haldol (brand name)

Haloperidol(generic name) antipsycotic, used for treating schizophrenia, acute psychosis, and for tics and vocal utterances of Tourette's syndrome. DO NOT TAKE WITH BZ'S (anit-anxiety) ie. diazepam(valium), loraxepam (Aitvan), clonazepam(Klonopin), aprazolam (Xanax)

Ground for breaching confidentiality

Harm to self or others child abuse elder abuse

Heroin and Cocaine

Have high risks of toxicity per user, but overall public health impact is low compared to tobacco and alcohol.

Step 12

Having had a spirtual awakening as a result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

Caffeine effect on Pregnancy

Having more than 300mg of caffeine each day can have a poor effect on a pregnancy; including spontaneous abortion, slow growth, birth defects etc.

Opiates WD symptoms

Headaches, cramps, tremors, panic, chills, loss of appetite, irritability, yawning

HIPAA

Health Insurance Portability & Accountability Act In general, requires the protection and confidential handling of all protected health information. Provides minimum restriction.

HIPAA

Health Insurance Portability and Accountability Act

HIPAA

Health Insurance Portability and Accountability Act of 1996

Heavy alcohol drinking is associated with?

Heart Disease. Moderate drinkers have lower heart disease rates than total abstainers.

Adler IP 2nd step

Help client develop insight about the cost of trying to fulfill unrealistic goals.

Community Organizer

Helps the agencies work together to assess the needs of the community and plan how the local human service delivery system will meet those needs.

Thirty years ago, when people spoke of addiction they were most likely thinking of?

Heroin

Opiates-HCFMMO

Heroin, Codeine, Fentanyl, Methadone, Morphine, Opium

Narcotics

Heroin, Morphine, Hydrocodone, Hydro-morphone, Oxycodone, Codeine

Opiates physical/psychological dependency- HCFMMO

Heroine - high, very high Codiene - high, moderate Fentanyl - high, moderate Methadone - high, moderate Morphine- high, moderate Opium - high, high

Schedule II

High potential for abuse, accepted usefulness, i.e, morphine, Demerol, percodan, cocaine, methanphetamines

Schedule I

Highest potential for abuse and no acceptable medical usefulness. i.e Heroin, Marijuana, MDMA (ecstasy)

In reference to psychoactive drug use, it is important to recognize that:

History and expectations influence how one is affected by a drug.

Step 7

Humbly asked him to remove our shortcomings

Semi-synthetic Compounds

Hydromorphone (Dilaudid) or Oxycodone.

Depressants

Hydroxybutyric Acid, gamma, Benzodiazepines etc.

Counseling

IC&RC defines counseling as the utilization of special skills to assist individuals, families or groups in achieving objectives through exploration of a problem it ramifications and decision-making

4 Assessment Criteria

Identifies and evaluates an individual's strengths, weaknesses, problems and needs for the development of a treatment plan. Gather history, identify methods and procedures for obtaining info from significant secondary sources. Develop a diagnostic evaluation.

Global Criteria: Referral

Identify needs and problems that the counselor and agency cannot meet. Explain the rationale for the referral to the client. Match client needs and problems to appropriate resources. Protect client's confidentiality by following laws, regulations, and agency policies.

6 Steps for Ethical Decision Making (1)

Identify problem or dilemma

Referral

Identifying the needs of a client that cannot be met by the counselor or agency and assist the client to utilize the available support systems and community resources.

10 Referral

Identifying the needs of a client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.

10. Referral

Identifying the needs of a client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.

Antagonistic

If one drug, such as a barbiturate, tends to reduce the effectiveness of an oral contraceptive, the drug interaction would be most accurately described as Works against one another

Collaboration for care

Implies consistent, seamless and coordinated care as clients move across different service systems

What are lifestyle changes?

Important social, occupational, or recreational activities are given up or reduced because of drug use

HIV/AIDS

In 1985, the issue was targeted as a top priority for training and assistance to drug abuse treatment professionals It is a Virus that destroys the immune system that should protect the body from diseases. The disease is passed from person to person through sexual acts, blood transfusions, used hypodermic needles, or from mother to child during birth.

Each state also has laws pertaining to the Emergency Detention of those who present an imminent danger of harm to self or others.

In California this is called a "5150", which allows for a person to be hospitalized involuntarily for a period of up to 72 hours in order to be evaluated.

Self- Disclosure:

In general, counselors should reveal as little about themselves that is necessary to help the client (i.e. discussing personal issues or revealing personal information)

Evaluator

In medical, psychological, financial, social, and vocational areas, they collect information from the client and from other professionals. They go over the effectiveness of the plan in meeting the client's goals, and assess the effectiveness of services and determining if outcomes have been met.

Reality Therapy

In reality therapy, patients may be challenged to explore their unmet needs and see how their behaviors/choices are stopping these needs from being met. Encourage people to judge all they are doing by the choice theory axiom: Is what I am doing getting me closer to the people I need?

Referral

In some cases, the needs cannot be met by the counselor or agency. When such a situation arises, the counselor must provide relevant information and advice for the patient. The counselor must identify which services the facility cannot meet and determine if supplemental assistance can be offered without leaving or un-enrolling from the facility. The counselor can also take advantage of community resources and support systems. One important part of the referral is to adhere to applicable laws. Local, state, and federal regulations apply when it comes to patient confidentiality.

depressed

In the normal individual, a state of mind characterized by feelings of inadequacy, lowered activity, and pessimism about the future. In more pathological cases, increasing intensity and frequency of symptoms which include low self-esteem, tearfulness, appetite and sleep disturbances, loss of experience of pleasure, and suicidal ideation.

Stage 4: Action

In this stage people take the actual steps to engage in positive mental, emotional and physical change by immersing themselves in addiction recovery, not just abstinence from their drug(s) of choice. I call it a "life makeover" that could include developing a fitness plan, dietary adaptation, as well as time with positive people and activities that are heart- and soul-nourishing. I ask them to "re-write" their life story, reminding them that their history is not their destiny.

Affective depressive disorders

Include anhedonia and dysphoria. Anhedonia is indicated by apathy, boredom, or meaninglessness Dysphoria is marked by feelings of sorrow, dejection, exhaustion, bitterness, or suicidal tendencies.

Cannabinoids/cannabinols

Includes marijuana, hashish and THC

Clinical supervision: Integrated models

Including the Blended Model, begin with the style of leadership and articulate a model of treatment, incorporate descriptive dimensions of supervision, and address developmental and contextual dimensions in supervision.

Limbic System

Incorporates cerebrum, thalamus, and hypothalamus to regulate emotions including fear, anger, pleasure, and sorrow. Affects behaviors related to survival

Tolerance

Increased ________ describes a heavy barbiturate user who has steadily increased usage over many over many months realizing that it takes a lot of alcohol to get a "buzz"

Stimulant effects

Increased alertness, excitation, euphoria, increased pulse rate, increased blood pressure, insomnia, and loss of appetite, dialated pupils.

Hallucinogen OD

Increased body temp, electorlyte imbalance, cardiac arrest, unable to direct movement, feel pain, or remember.

Hallucinogen signs and symptoms

Increased reflexes, tremors, weakness, flushing and chills, seizures, inappropriate mood, elation, hallucinations, bizarre behafvior, diorientation, confusion, delusions, and impaired judgement.

Physiological Dependence

Increasing tolerance for a drug, withdrawal signs and symptoms when a drug is discontinued, or the continued use of a substance to avoid withdrawal symptoms.

Treatment for co-occurring disorder

Independent, Serial, Parallel and Integrated

Adlerian Therapy

Individual therapy that takes a positive view of human nature. Looks at social forces and believes people are in control of their own fate.

9 Client Education Provisions

Information to individuals and groups concerning alcohol and other drug abuse and the available services and resources. Present relevant alcohol and other drug use/abuse information to the client through formal and/or informal processes. Present information about available alcohol and other drug services and resources.

Glycine

Inhibitory neurotransmitter found in the spinal cord.

GABA

Inhibitory neurotransmitter. When normal function of GABA are disrupted, convulsions can occur

Stimulant (CANC) Withdrawal Syndrome has three distinguishing levels:

Initial Extreme Crash: • An extremely decreased mood and energy with cravings, anxiety, depression and paranoia • This phase ends when hypersomnolence and electroencephalographic changes occur and individuals only awake when experiencing food cravings Euthymia: • The individual is relaxed and experiences very few cravings • No longer feels anhedonia, anxiety, malaise and boredom, or loss of concentration, memory difficulties and suicidal ideation as they may day to day Irregular Conditioned Craving: • Reduces, although sometimes can last for months or years

12 Core Functions (2)

Intake

Integrated treatment

Integrated means that the client is treated for all issues simultaneously under "one roof" by a multi-disciplinary team including psychiatrists, psychologists, social workers/therapists, addiction counselors, and others. Most effective.

Level 2.1

Intensive Outpatient

Level 2

Intensive Outpatient/Partial Hospitalization

IC&RC

International Certification & Reciprocity Consortium

INCASE

International Coalition of Addiction Studies Education

Substance Induced Disorders

Intoxication, withdrawal, substance induced mental disorders,

Trauma and Stressor-Related Disorders- in general

Involve the exposure to a stressful or traumatic event. These were previously grouped with the anxiety disorders but are now considered a distinct category of disorders.

Alcoholics Anonymous believes that alcoholism

Is a disease and the only cure is total abstinence. Some critics say it gives alcoholics an "excuse".

Self-Disclosure

Is a sharing by the counselor of his/her own feelings, attitudes, opinions, and experiences with a client for the benefit of the client. This information should be relevant to the client's situation Can build a sense of trust/rapport between counselor and client Can help reduce the client's feelings that he/she is unique in the situation they are experiencing Disclosure should relate directly to the client's situation Counselor should only disclose things that he/she actually experienced Will it benefit the client and will the counselor feel comfortable in revealing this information? Used appropriately, counselor self-disclosure should increase the level of trust, genuineness, and empathy in the counseling relationship and reduce feelings of being unique

Null-hypothesis

Is a statement that there is no relationship between IV and DV.

DIG-FAST

Is a tool Prompting the full evaluation of symptoms of mania Distractibility Impulsivity / Indiscretion (excessive involvement in pleasurable activities Grandiosity - Inflated self-esteem Flight of ideas / Racing thoughts Activity increase / Increase goal-directed behavior (socially, sexually, at work, etc) Sleep deficit (decreased need for sleep) Talkativeness (pressured speech)

Enabler

Is assumed to be the person who is emotionally closest to the alcoholic, usually the spouse. Protects the alcoholic by making excuses, taking over responsibilities, rescuing the alcoholic from consequences.

How does discussing the findings of an assessment with a client help promote engagement?

It assists clients in identifying their strengths, weaknesses, and goals to be incorporated in ta treatment plan

Motivational Interviewing

It is a direct, client-centered counseling style used t elicit behavior change by helping clients resolve their ambivalence to change Motivational interviewing is a way of BEING with a client, not just a set of techniques for doing counseling Counselor expresses empathy through active listening and reflection

Overall, the dependence risk from alcohol use?

It is neither low nor high but moderate.

How do psychoactive drugs affect the brain?

It is not drugs directly that causes people to "get high." Instead, it is the effect that certain substances have on neurotransmitters that causes feelings of relaxation, excitement, pleasure and/or euphoria

What is Ice?

It is the strongest form of methamphetamine, crystalline powder (crystal meth) or is white and translucent. Highest purity, either smoked or IV use

What happens once alcohol has entered your bloodstream?

It remains in your body until it is processed. About 90-98 per cent of alcohol that you drink is broken down in your liver. The other 2-10 per cent of alcohol is removed in your urine, breathed out through your lungs or excreted in your sweat.

Common Hallucinogens:

LSD Ayahuasca Ecstasy/MDMA Mescaline/Peyote Shrooms/psilocybin PCP/Phencyclidine Ketamine DXM Salvia

Marginalized populations face the most challenges in entering into and remaining in treatment for the following reasons:

Lack of money, skills, and language to negotiate the treatment system. High tolerance for pain and suffering. Illegal status. Negative experiences in other service systems (courts, child welfare, schools). Cultural or religious beliefs that conflict with mainstream treatment centers. Fear of "losing face" or bringing shame on the family by disclosing personal problems.

Cerebrum

Largest and most complex part of the brain. Contains billions of neurons and nerve centers.

Contolled Substance Act

Law which places drugs in 1 of 5 schedule categories, depending on their abuse potential, potential for dependence/addiction, and currently accepted medical use.

Extinction

Learned behavior patterns tend to weaken and disappear over time if they are not reinforced, so we must remove the reinforcement (implosive therapy and flooding) Implosion asks clients to imagine and relive aversive scenes Flooding is placing the client in a real life situation

Serial treatment

Least effective, treat one disorder; and afterwards, treat another disorder

Privilege

Legal term that refers to an individuals right not to have confidential information revealed in a court or other legal proceedings

LGBT

Lesbian, Gay, Bisexual, Transgender

A crisis usually lasts for how long?

Less than 6 weeks

LD50

Lethal Dose 50. The Lethal dose it would take to kill 50% of those who took it.

Levels of Care Placement

Level 0.5 - Early Intervention OTP - Level 1 - Opioid Treatment Program Level 1 - Outpatient Services Level 2.1 - Intensive Outpatient Services Level 2.5 - Partial Hospitalization Services Level 3.1 - Clinically Managed Low-Intensity Residential Services Level 3.3 - Clinically Managed Population Specific High Intensity Services Level 3.5 - Clinically Managed High-Intensity residential services Level 3.7 - Medically Monitored Intensive Inpatient Services Level 4.0 - Medically Managed Intensive Inpatient Services

PCP w/d

Limited reports of w/d effects. Depression, drug craving, increased appetitie and increased need for sleep

Naltrexone(ReVia):How it Works

Long-lasting opioid antagonist(blocker) reduces both the rewarding effects of alcohol and the craving for it. *Help client abstain from drinking. *Reduce heavy drinking in those who drink. Given to heroin-dependent users. can be given three times a week or be administered intravenously only once a month. Particularly effective in helping addicts discontinue the use of drugs when used with methadone and weekly counseling. Allows heroin-dependent people to stop using illegal drugs, to become more emotionally stable and to live more independent lives.

cirrhosis of the liver

Long-term effect of alcohol consumption that is one of the top ten causes of death in America is A chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells

Schedule V

Low abuse potential, may lead to limited psychological/physical dependence. Includes some over the counter drugs. such as, cough meds, mixtures with small amounts of codeine or opium.

Schedule IV

Low potential for abuse; May lead to physical/psychological dependence. librium, valium, darvon, tranxene, alprazolam (xanax) barbital, chloral hydrate, fenfluramine,

What is the common criteria for low, medium and high risk of withdrawal?

Low: 6 standard drinks per day, 3 or more times a week Medium: 5 to 6 standard drinks per day High: 7 or more standard drinks per day However, dependence/withdrawal syndrome considered severe, or client most at risk, if drinking 8-10 standard drinks per day (80-100g of alcohol)

Faithfulness and Fidelity

Loyalty to the group and not being deceptive

Screening Instruments

MAST CAGE SASSI AUDIT ASI MSE

Hallucinogens

MDMA and Analogs, LSD, Phencyclidine,

Step 3

Made a decision to turn our will and our lives over to the care of God as we understood him.

Step 8

Made a list of all persons we had harmed and became willng to make amends to them all.

Step 4

Made a searching and fearless moral inventory of ourselves.

Step 9

Made direct amends to such people whereever possible , except when to do so would injure them or others.

Morphine

Main alkaloid ingredient in opium with a purity of 4 to 21 percent.

Care and Compassion

Maintaining boundaries but being compassionate and caring at the same time

Counselor

Maintains a primary relationship with the client and his or her family. By knowing the client's mental heath and medical history, they can tell what aspects of his or her current situation support or discourage progress.

Hypothalamus

Maintains homeostasis. Controls heart rate, chemcial balance, hunger, body weight, GI tract, and sexual behavior.

Maintenance

Maintenance is the stage in which people have made specific overt modifications in their lifestyles and are working to prevent relapse; however, they do not apply change processes as frequently as do people in Action. While in the Maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes. Based on self-efficacy data, researchers have estimated that Maintenance lasts from six months to about five years. While this estimate may seem somewhat pessimistic, longitudinal data in the 1990 Surgeon General's report support this temporal estimate. After 12 months of continuous abstinence, 43% of individuals returned to regular smoking. It was not until 5 years of continuous abstinence that the risk for relapse dropped to 7% (USDHHS).

Panic Disorder common co-morbid conditions

Major Depression, Social and Specific Phobias and Alcoholism. Occurs twice as often in females than in males. Occurs most often with Agoraphobia.

Diagnostic cluster of mood disorders

Major Depressive Disorder, Dysthymia, Atypical Depression, Bipolar Disorder I & II and Cyclothymic Disorder

Overgeneralization:

Making a board rule based on a few limited occurrences. Example: Believing that if one public speaking event went badly that all of them will.

Arbitrary Inference:

Making a judgment with no supporting information. Example: Believing that someone does not like you without any actual information to support that belief.

AXIS II: DETERMINE THE PRESENCE OF PERSONALITY DISORDER OR MENTAL RETARDATION

Maladaptive patterns must be "embedded in the personality" so the pattern of response is the same whether to family, friends or strangers regardless of setting. The pattern cannot be explained by Substance Abuse or as the consequence of the symptom of another mental disorder.

Confidentiality exceptions:

Mandated reporting +Child abuse +Elder abuse +Dependent adult abuse +Imminent danger to self or others Medical Emergencies Crime at rehabilitation center Qualified Service Organization Agreement (data processing) Written Consent (HIPAA Changes) Internal Communications No Patient Identifying Information Third Party Payers Audit Court Order (not subpoenas) Court Order Crime at Program/Against Program Personnel Research Audit and Evaluation (HIPAA Changes) QSOA/BAA (HIPAA Changes) +Qualified Service Organization Agreement +Breaking Addiction Act

Holistic Worldview

Many cultures, such as Native American and Asian, view the world in a holistic sense; that is they see all of nature, the animal world, the spiritual world, and the heavens as interconnected.

CANNABIS-RELATED DISORDERS

Marijuana and Hashish difference between cannabis preparations, LSD and other hallucinogens is in the effectiveness of their dose. Cannabis is very mild and must be taken in larger quantities to produce the same effects as other hallucinogens. Another difference is cannabis is typically more sedating and causes impaired coordination and judgment, which frequently results in motor vehicle accidents.

What are the safe drinking guidelines?

Maximum 2 drinks per day, with 2 alcohol free days per week (1 standard drink = 10g of alcohol)

MATRS

Measurable—Can change or progress toward meeting the objectives be documented/evaluated? Attainable—Can the client take steps toward meeting the objectives? Time-Limited—Is the time frame specified for the objectives? Realistic—Can the client meet the objectives given their current situation? Specific—Are specific activities included? Could the client understand what is expected?

How Acamprosate Works

Mechanism of action not clearly understood, seems to reduce symptoms of protracted withdrawal such as sleep and mood disturbances which trigger relapse.

ED50

Median effective dose; dose effective for 50% of test population. Effective dose for 1/2 of the animals tested.

3 stages of Alcohol and Drug Counseling

Medical (physical intervention) Psychosocial rehabilitation Aftercare

Level 4

Medically Managed Intensive Inpatient Svices

Level 3.7

Medically Monitored Intensive Inpatient Services

MAT

Medication Assisted Treatment

Medication Assisted Therapy- Opioids

Medication for opioids (heroin, prescription pain relievers) Methadone: (Methadose, Dolophine) Buprenorphine (Suboxone, Subutex): Used to treat opiate addiction and withdrawal. Naltrexone (Vivitrol): Use to decrease opiate cravings.

Medication Assisted Treatment (MAT)

Medication used to: suppress withdrawals, decrease cravings (prevent relapse) and treat co-occurring conditions.

Interpersonal Learning

Members receive feedback on how their behavior affects others

MSE

Mental State Examination +systematic appraisal of the appearance, behavior, mental function and overall demeanor of a person +snapshot of a person's psychological functioning

Psychotic Episode

Mental illness of a limited duration in which the client shows severe changes or disorganization of personality and disturbance of thought processes or content. It is often accompanied by depression, delusions and hallucinations.

hallucinogens

Mescaline, LSD, PCP

Heroin - most well known opioid agonist

Methadone maintenance treatment program is recommended to cure heroin addiction. Methadone-synthetic opiate/obstructs 24 hours LAAM-synthetic opiate/obstructs 72 hours Naloxone-overdose Naltrexone-inhibits morphine, heroin and other opiate effects.

Medication for opioids (heroin, prescription pain relievers)

Methadone sold under the brand name (Dolophine ® , Methadose ®) Buprenorhine (Suboxone ®, Subutex ®, Probuphine ®) Naltrexone (Vivitrol ®)

How are they related?

Methamphetamine turns into amphetamine when it starts to break down inside the bloodstream However, despite their similarities, the two drugs have different levels of potency and work in somewhat different ways inside the body

MAST

Michigan Alcohol Screening Test +developed in 1971- oldest screening +used for general population +22 questions Drawbacks +too long for emergency room and primary healthcare +focuses on past rather than present

MAST

Michigan Alcohol Screening Test. A self-test that measures obvious signs and subtle attributes of addiction

MAST

Michigan Alcoholism Screening Test

Schedule III

Moderate physical dependence, high psychological dependence; anabolic steroids, most barbiturates, dronabinol

What are the types of Alcohol withdrawal treatments?

Moderate to high risk or seizure Hx generally require inpatient treatment for 5-7 days to monitor observations and cognitive status (with AWS or CIWA-AR). Benzodiazepines (diazepam) given as per withdrawal scale total to prevent increased CNS responses. Other medications given include anti-emetics, anti-diarrheals, IV fluids and the most important - Thiamine (life-threatening Wernicke's-Korsakoff's syndrome may develop due to thiamine deficiency). Goal-setting, motivational interviewing and CBT.

Affective Disorders- in general

Mood disorders

Mood disorders are characterized by changes in...

Mood that range from extreme elation and agitation to extreme depression, serious potential for suicide

How does the liver process the alcohol?

Most alcohol is broken down, or metabolised, by an enzyme in your liver cells known as alcohol dehydrogenase (ADH) ADH breaks down alcohol into acetaldehyde, and then another enzyme, aldehyde dehydrogenase (ALDH), rapidly breaks down acetaldehyde into acetate The acetate is further metabolised, and eventually leaves your body as carbon dioxide and water.

Convenience Sampling

Most common sampling method. Selecting an easily accessible population that most likely dose not fully represent the population of interest.

Integrated treatment

Most effective, treat all disorders simultaneously with team at same location

Absorption of alcohol occurs where?

Mostly the SI and stomach. Food and water slow the process.

MI

Motivational Interviewing

What is "change talk?"

Motivational interviewing is change talk because you illicit information of client's needs, then you respond in order to meet their needs. Afterwards, you motivate them to move through the stages of change

Frontal Lobes

Motor areas which control movements and voluntary skeletal muscles. Deals with higher intellectual processing, planning, and problem solving.

Autonomic Nervous System

Motor nervous system that controls glands, cardiac, and smooth muscle.--also called visceral motor system The subdivisions that act in an antagonistic manner are called sympathetic and parasympathetic divisions

Alcohol Long-Term Effects

Mouth (lesions that can become cancerous) • Bronchi (wind pipes that become cancerous) • Stomach (hemorrhage and ulcerations can be caused by extreme overflow of hydrochloric acid that eventually weakens the lining of the stomach) • Duodenum (small intestines are damaged) • Kidneys (inflammation) • Liver (liver disease) • Circulatory system (high blood pressure) • Nervous system (alcohol kills brain cells causing blackouts, memory loss and poor vision) • Skeletal system (a calcium depletion) • Muscular system (loss of muscle tone) • Reproductive system (in males the testicles shrink and in females the ovaries atrophy

Alcohol is associated with what cancers?

Mouth, tongue, pharynx, larynx, esophagus, stomach, liver, lung, pancreas, colon and rectum.

MAKKS

Multi Awareness Knowledge Skills Survey The survey is a self-assessment of where you think you are culturally aware at this point in time

Biopsychosocial Model

Multicausal model dealing with biology (disease/genetics), psychological, cultural norms/life events.

Hallucinogen withdrawal

Muscle aches, drowsiness, depression, acne, and drug seeking behavior.

Qualifications & Affiliations

Must not claim directly or by implication the qualifications or affiliations they do not posses. Must not violate, attempt to violate, or conspire to violate any regulation or law adopted by the California Alcohol and Drug Program Administration or CCBADC Policies and/or Code of Ethics.

Independent treatment

NOT generally used for clients with co-occurring disorders

Medication for Opiate overdose

Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids There are three FDA-approved formulations of Naloxone: Injectable (professional training required) Auto-injectable- EVZIO® Nasal Spray- NARCAN®

Medication Assisted Therapy- Alcohol

Naltrexone (Vivitrol): Use to decrease alcohol cravings. Acamprosate (Campral): Used to treat the negative effects from alcohol addiction. Reduce long-lasting withdrawal symptoms, such as insomnia, anxiety, restlessness and dysphoria (feeling unwell or unhappy). Disulfiriam ( Antabuse): Causes user to become very ill if they consume alcohol.

Medication for alcohol:

Naltrexone (Vivitrol®) - blocks receptors involved with effects and cravings of alcohol. Acamprosate (Campral ®)- reduce long-lasting withdrawal symptoms, such as insomnia, anxiety, restlessness and dysphoria (feeling unwell or unhappy). Disulfiriam (Antabuse ®)- interferes with the breakdown of alcohol. If patient drinks alcohol, acetaldehyde builds up in the body, leading to unpleasant reactions such as flushing, nausea, irregular heartbeat. Used with patients who are highly motivated.

Morphine

Narcotic, the primary active chemical in opium and is what heroine is made from.

Physical Withdrawal

Narcotics and synthetic narcotics, barbiturates, minor tranquilizers are associated with

NAADAC

National Association of Alcoholism and Drug Abuse Counselors

NIDA

National Institute on Drug Abuse

N-SSATS

National Survey on Substance Abuse Treatment Services

3 Classifications of Narcotics

Naturally occurring (opium, morphine, codeine) Semi-synthetics (Heroin, Hydromorphone) Synthetics (Methadone, Darvon)

Hallucination MDMA acute effects

Nausea, jaw and teeth clenching, muscle tension, blurred vision, panice attacks, confusion, depression, anxiety, paranoid psychosis, hyperthermia, and cardiac arrest.

Tolerance

Needing increased amounts of a substance to achieve the desired effect

Double blind study

Neither researcher or participant knows who belongs to control group or experimental group

Dopamine

Neuotransmitter linked to pleasure, reward, and motivation.

Serotonin

Neurotransmitter associated with regulation of sensory perception, sleep, and body temperature.

Norepinephrine

Neurotransmitter in the brain associated with arousal moods. It is excitatory

Dopamine

Neurotransmitter that influences voluntary movement, attention, alertness;Found in basal ganglia

liver

Nicotine is deactivated by the ______

Pre-contemplation

No awareness of problem; no intention to make a change Motivational task: raise doubt, provide information and education to increase client's perception of problems with their current behavior

Chi Square

Nonparametric test used when the population is not necessarily normal.

Amphetamines chemical structure resembles?

Nonrepinephrine and stimulates functions, activates the sympathetic branch are referred to as sympathomimetic drugs.

Independent treatment

Not used for clients with co-occuring disorders

Antihistamines

OTC sleep aids are based on __________

6 Steps for Ethical Decision Making (3)

Obtain consultation from supervisor or peer

The Median

Obtained by dividing the sum of observed values by the number of observations

Objective

Obtained only through the Physician 1.PEx 2.MDM 3. DDx

Type I error

Occurs when a decision is made to reject a null hypothesis

Type II error

Occurs when a decision is made to retain the null hypothesis that should have been rejected because the null hypothesis was indeed false.

Dependence:

Occurs when the body adapts to repeated drug exposure and only functions normally in the presence of the drug

Patient Assessment

Once the patient is admitted to a program and orientated about the specific guidelines of the facility, he/she is assessed by the counselor. This procedure involves one-on-one meetings between the counselor and patient. Assessment is one of the most vital parts of treatment because it determines the path each patient will take. During the assessment, the counselor will identify the strengths, weaknesses, and problems of each patient. The counselor will also evaluate the patient's mental state to determine the best and most effective course of treatment.

Treatment Planning

Once the patient is fully assessed and the best treatment types are determined, treatment planning begins. This process takes broad ideas and turns them into specific tactics and plans to fit the patient's needs. The counselor must determine the rank of the problems and establish goals. Both long-term and short-term goals are set for every patient to take care of the most severe problems and work toward rehabilitation. The counselor needs to properly explain treatment goals and assessment results to every patient. Once the problems are uncovered and goals set, the counselor works with the patient to identify treatment methods. It's important to give an approximate timeline, if possible, and inform the patient about what his/her future at the facility includes. All treatment language must be intelligible for the individual so he/she knows what every aspect truly means.

Nigrostriatal dopamine pathway

One of the two major dopamine pathways. The one damaged in Parkinson's disease.

CNS Stimulants

One of three types of prescription drugs most commonly abused (along with opioids and CNS depressants). Dopamine is the most highly effected of these neurotransmitters. Used for treatment of the sleep disorder Narcolepsy and some depression cases where the individual may not have responded well to other types of treatment.

Mesolimbic dopamine pathway

One of two major dopamine pathways; may be involved in psychotic reactions and in drug dependence.

What is the time taken for alcohol withdrawal?

Onset usually 6-24 hours after last drink. Usually withdrawal is brief and resolves after 2-3 days without treatment. Occasionally, withdrawal may continue for up to 10 days for those with severe dependence

12 Core Functions (3)

Orientation

Tradition 1

Our common welfare should come first; personal recovery depends upon A.A. unity.

Tradition 11

Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.

Level 1

Outpatient Services

Caffeine effect on brain

Overall lower brain performance. It has been shown to be beneficial short term, but have long term bad effects if regularly used in large quantities.

Cocaine

Paranoia, insomnia and irritability, compulsive use and loss control problems with headaches, coughing and nosebleeds indicates chronic _______ abuse

Cocaine Abuse Symptoms

Paranoia, rapid talking, nose bleeds

Medulla Oblongata

Part of the brain that connects to the spinal column. Controls vital centers including breathing, heart rate, and sleep/wake cycle.

Level 2.5

Partial Hospitalization

Blind Study

Participants are not aware to the assigned position/group

Pure Food and Drug Act

Passed in 1906, the act attempted to control addictions by requiring companies to label the drugs contained in their products (morphine, heroin, cociane)

12 Core Functions (9)

Patient Education

Plan

Patient's disposition: home, transferred, admitted

CNS stimulant withdrawal clinical manifestations

Peak 2-4 days after last ingestion, depression/anxiety, paranoia/suidical ideation, either insomnia/hypersomnia

Pre-contemplation

People in the Precontemplation stage do not intend to take action in the foreseeable future, usually measured as the next six months. Being uninformed or under informed about the consequences of one's behavior may cause a person to be in the Precontemplation stage. Multiple unsuccessful attempts at change can lead to demoralization about the ability to change. Both the uninformed and under informed tend to avoid reading, talking, or thinking about their high-risk behaviors. They are often characterized in other theories as resistant, unmotivated, or unready for help. The fact is, traditional programs were not ready for such individuals and were not designed to meet their needs.

Stage 5: Maintenance

People in this stage have become able to sustain these patterns. I liken it to a fitness routine. On the first day of workout at a gym, you are not as strong, flexible and energetic as you will be a year later. The more you practice, the easier it gets. People are more aware of triggers and stressors that could lead to relapse. It is more than merely a rote exercise, but rather an integrated aspect of themselves.

Stage 2: Contemplation

People in this stage have become aware of the greater impact of their addictive behaviors, yet they are uncertain if it is worth the effort to effect change. They may be open to considering change "someday." In advance of stage three, people make a decision and have a glimpse that the costs overshadow perceived benefits. Behavioral change becomes a possibility.

Stage 1: Precontemplation

People in this stage may be aware that there are repercussions related to their addiction, but they minimize or justify their choices, seeing more benefit than deficit. Not a great deal of desire to change and to an outside observer.

What is the fastest growing at-risk group, for problems of substance abuse?

People over the age of sixty. The drugs of choice for this age group are generally alcohol and prescription drugs. about 17% are never diagnosed or identified as substance abusers

Secondary prevention programs are those aimed mainly at?

People who have tried the drug in question or a variety of other substances

What is wish to quit?

Persistent desire or unsuccessful attempts to cut down or control drug use

resources

Person centered therapy trusts that clients have within themselves _____________ to improve their life situation.

Development of socializing techniques

Person learns how to interact with people

Installation of hope

Person must feel there is hope to solve problems

Some hallucinogens also cause users to feel out of control or disconnected from their body and environment. Common examples include the following:

Phencyclidine (PCP) was developed in the 1950s as a general anesthetic for surgery Ketamine is used as a surgery anesthetic for humans and animals. Much of the ketamine sold on the streets comes from veterinary offices

Stage 4: Drug Addiction and Dependency

Physical dependence on a drug is often intertwined with addiction. Characteristics of dependence and drug addiction include withdrawal symptoms and compulsive use of the drug despite severe negative consequences to his or her relationships, physical and mental health, personal finances, job security and criminal record.

Toxicity

Physiological poisoning or dangerous disruption of behavior. Acute, results of too much of a drug. Chronic, which results from long-term exposure of a drug.

T test

Popular test for comparing two means

Anabolic Steroids withdrawal

Possible depression

PAWS

Post-Acute Withdrawal Syndrome PAWS is the persistence of subtle yet significant emotional and psychological problems that can last for 3 to 6 months into recovery and can trigger relapse.

Post Traumatic Stress Disorder

Post-traumatic stress disorder can develop after an individual has experienced a stressful life event. Symptoms of PTSD include episodes of reliving or re-experiencing the event, avoiding things that remind the individual about the event, feeling on edge, and having negative thoughts

Sedative Hypnotics interaction with alcohol

Potentiation of effects, especially respiratory depression, Some degree of cross tolorance.

The stages of a crisis are:

Pre-Crisis State - all events leading up to the crisis Impact - the distressing situation or event occurs Crisis - acute emotional reaction to the situation with two elements: - Period of confusion and disorganization - Period when the individual tries many alternatives ("trial and error"), some of which work and some of which do not. Resolution - end of the event and the individual works toward adjustment to the circumstances remaining in the aftermath of the event. Post-Crisis - individual lives with whatever alterations in circumstances that occurred during the crisis

Stages of Change

Pre-contemplation Contemplation Preparation Action Maintenance

Stages of Change

Pre-contemplation Contemplation Preparation Action Maintenance (Relapse)

Preparation

Preparation is the stage in which people intend to take action in the immediate future, usually measured as the next month. Typically, they have already taken some significant action in the past year. These individuals have a plan of action, such as joining a health education class, consulting a counselor, talking to their physician, buying a self-help book, or relying on a self-change approach. These are the people who should be recruited for action-oriented programs.

Global Criteria: Report and record keeping

Prepare reports and relevant records. Integrate available information. Chart ongoing information in regards to the client. Use relevant information from records to monitor client's care.

Global Criteria: Patient Education

Present relevant information about alcohol and other drug use and abuse to the client, through formal and informal processes. Present information about available support services and resources for the treatment of alcohol and other drug abuse.

1 Screening competence

Presenting specific examples of how the use of alcohol and other drugs has become dysfunctional for a particular client. Requires the counselor's judgment and skill and is influenced by the program's environment and modality (i.e., inpatient, outpatient, residential, pharmacotherepy, detoxification, or day care).

Interpreting

Presenting the client with alternative ways of looking at his/her situation

Interpreting

Presenting the client with alternative ways of looking at his/her situation (feedback)

Opium

Prevalence of narcotic use in America can be shown by the fact that during the nineteenth century: children were given ______ for colic and diarrhea

Morphine addiction

Prevalence of narcotic use in America can be shown by the fact that during the nineteenth century: heroin was used to treatment ____________

over the counter

Prevalence of narcotic use in America can be shown by the fact that during the nineteenth century: medications with opium and morphine could be purchased ___________

Soldier's Disease

Prevalence of narcotic use in America can be shown by the fact that during the nineteenth century: morphine addiction was known as _________ during the Civil War Epidemic in 1800-1905 of morphine addiction (that's how we figured out it was addictive)

Mania

Primarily characterized by an abnormal and persistently elevated, expansive or irritable mood

POSIT

Problem Oriented Screening Instrument for Teenagers. 139 question self-administered questionnaire for treatment needs. Target population 12-19 y.o.

Treatment Planning

Process by which the counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long-term goal: and decide upon a treatment process and the resources to be utilized

Clt, family and community education

Process of providing clts, families, significant others, and community agencies w/information on risks related to psychoactive substance use as well as available prevention, treatment and recovery resources

rehabilitation

Process of restoring a person to the best possible level of functioning following a physical, mental or emotional problem.

Volatile Solvents

Produce feelings of intoxication, hallucinations at high doses. Examples: paint, paint thinners, nail polish remover, correction fluid and thinner, glues and cements, dry-cleaning agents, spot removers.

Global Criteria: Orientation

Provide an overview to the program, describing the program goals and objectives for client care. Provide the client with a description of the program rules, and client's obligations and rights. Provide information about the program hours of operation.

Discharge Summaries

Provide what will happen to the client after they complete the current treatment

9. Client Education

Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources.

Core function of client education

Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources. Psychoeducation, harm reduction.

Psychotherapeutics

Prozac, Haldol are both _______. Medications to treat psychological disorders.

Depression is called what in the elderly?

Pseudodementia because it often "looks like" Dementia (e.g., psychomotor retardation, confusion, memory impairment).

Natural in plant sources of amphetamine are:

Pseudoephedrine and ephedrine

Sigmund Freud

Psychoanalytic Therapy

Brief Psychodynamic Therapy

Psychodynamic therapy, also known as insight-oriented therapy, focuses on unconscious processes as they are manifested in a person's present behavior. The goals of psychodynamic therapy are a client's self-awareness and understanding of the influence of the past on present behavior. In its brief form, a psychodynamic approach enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances. The focus of Brief Psychodynamic Therapy is on the here and now, rather than exploring the there and then. In therapy at least two years. Not brief.

Effects of CNS stimulants

Psychomotor agitation, euphoria, impaired judgment, hypervigilance, hallucinations, delusions, tachycardia, hypertension, fever, dilated pupils

Schizoaffective Disorder

Psychotic disorder whereby the clinical manifestations of the psychotic disorder, schizophrenia, co-exist with those of a mood disorder (depression, mania, or mixed)

PCP common problems

Psychotic reactions, bizarre behavior, ooutbursts of hostililty and violence, feelings of anxiety, doom or impending death, gross impairment of coordination, nystagmus, hypersalivation, vomiting, fever. With longterm use: Persistent cognitive and memory problems speech difficulties, mood d/o, loss of puposive activities and weight loss.

Opiate physical/mental exam

Pupil constricted, relexes absent or diminished, pulmonary edema, convulsions. Euphoria, sedation, possible normal mood, possible stupor.

Paraphrasing

Putting into words the ideas or feelings you have perceived from the message

Group cohesiveness

Qualities of a group that bind members together and promote liking between members

Primary reasons for clinical supervision

Quality of client care Clinical staff continue development in a systematic and planned manner

Opiate (HCFMMO) Detoxification Withdrawal Symptoms

Raised: • Blood pressure, Pulse rate, Temperature Piloerection (also known as gooseflesh) Enlarged pupils Rhinorrhea (where the nose drains excessively) Lacrimation (the secretion of tears especially when abnormal or excessive) Tremor, Insomnia, Vomiting, Nausea, Muscle aches, Stomach cramps, Touchiness, Anorexia, Fatigue, Restlessness, Headaches, Dizziness, Light-headedness

Random Assignment

Randomly assigning participants to different groups, such as treatment or control group.

Opiate problems

Rapid acquired tolerance, dependence, respiratory dpression, cellulitis, sepsis, endocarditis, @ risk for HIV, and legal problems.

Cannabis withdrawal

Rare. Appear limited to some heavy users. Possible irritability, restlessness, craving, loss of appetite, nausea, diarrhea, muscle twitching, overt aggression and depression.

Dimension 4

Readiness to Change

Preparation

Ready to change; client considers change and plans a commitment to action Motivational task: help client determine best course of action, focus on small meaningful steps

Whether we see drug use as a problem depends on all of the following:

Reason one takes a drug Quantity consumed and the manner by which one takes the drug When and where the drug is used The age of the individual taking the drug

Euphoric Recall

Recalling how good it used to be and forgetting the negative consequences

Global Criteria: Consultation

Recognize issues that are beyond the counselor's knowledge and skills. Consult with appropriate resources in order to secure the provision of effective treatment services. Abide by applicable laws, regulations, and agency policies in regards to client's confidentiality. Explain the rationale for the consultation to the client, if appropriate.

Global Criteria: Crisis Intervention

Recognize the elements of the client's crisis. Implement an immediate course of action appropriate to the crisis. Enhance overall treatment by using crisis events.

Dimension 6

Recovery/Living Environment

Cannabis signs and symptoms

Red eyes, mild dilation of pupils, mild tremor, decreased coordination, decreased strength, less ability to perform complex motor tasks and dry mouth, feelings of depersonalization, anxiety, panic, memory problems, alterationin mood disorganization, hallucinations, paranoid thoughts.

PCP signs and symptoms

Red eyes, muscle rigidity, increased reflexes, repetitive movements, flushing, salivation, sweating, nausea, vomiting, possible coma, seizures, stroke. Abnormal appearance and behavior, diorientation, inappropriateeffect, memory problems, depression, elation, suicidal or homicidal behavior, and impaired judgement.

12 Core Functions (10)

Referral

chronic

Referring to drugs, the long-term effects from repeated use.

Substance intoxication

Refers to a reversible syndrome of maladaptive physiological and behavioral changes that are due to the effects of a substance on an individual's central nervous system

Freebasing

Refers to smoking cocaine that has been processed

Substance withdrawal

Refers to the development of maladaptive physiological, behavioral and cognitive changes that are the result of reducing or stopping the heavy and regular use of a substance

Cerebellum

Reflex center responsible for coordinating muscle movements.

12 Most Common Consultation

Regular in-house staffing in which client cases are reviewed with other members of the treatment team. May also be conducted in individual sessions with the supervisor, other counselors, psychologists, physicians, probation officers, and other service providers connected to the client's case.

Relapse Prevention

Relapse prevention is a necessary component of treatment and involves education, planning, and ongoing intervention Relapse prevention plans are in integral part of any counseling session

Dimension 5

Relapse, Continued Use, or Continued Problem Potential

Core function of consultation

Relating with counselors and other professionals in regard to client treatment to ensure comprehensive quality of care for client

Consultation

Relating with in-house staff or outside professionals (without disclosing client identity) to assure comprehensive, quality care for the client

12. Consulatation With Other Professionals In Regard To Client Treatment/Services

Relating with in-house staff or outside professionals to assure comprehensive, quality care for the client.

12 Consultation

Relating with in-house staff or outside professionals to assure comprehensive, quality care for the client. Meetings for discussion, decision-making and planning.

Adlerian Therapy

Relationship based on mutual respect and identifying, exploring, and disclosing mistaken goals and faulty assumptions. This is followed by a reeducation of the client toward a useful side of life. The main aim of therapy is to develop the client's sense of belonging and to assist in the adoption of behaviors and processes characterized by community feeling and social interest.

Tolerance

Repeated use of cocaine can cause long-term changes in the brain's reward circuit and other brain systems. The reward circuit eventually adapts to the excess dopamine brought on by the drug. As a result, people take stronger and more frequent doses to achieve the same high and feel relief from initial withdrawal.

12 Core Functions (11)

Report and Record Keeping

Defense Mechanisms

Repression - forcing unacceptable thoughts and feelings from the conscious mind into the unconcscious mind Projection - accusing others of motives and traits that the person senses are true about him/herself but he/she finds unacceptable Displacement - discomfort is created by one person but there is too much anxiety to talk directly with the person, so the individual takes out his/her feelings on someone or something less threatening Regression - returning to more immature behavior that used to be satisfying, occurs more frequently when under extreme pressure Rationalization - finding a satisfactory reason for doing something unacceptable Intellectualization - understanding a difficult situation with the mind but not allowing any feelings about it

Level 3

Residential/Inpatient Services

Major depressive and anxiety disorders are best classified as substance-induced disorder if they what?

Resolve within days to weeks with abstinence. Co-occurrence of anxiety and substance abuse disorders in general population is 5-20%

When 2 or more psychoactive drugs are consumed together, the most serious risk from their "interaction" is?

Respiration-Breathing, which can slow down to the point of starving the brain of oxygen. Blood pressure or circulation may also be at risk.

8 Crisis Intervention Services

Respond to an alcohol and/or other drug abuser's needs during acute emotional and/or physical distress. Recognize the elements of the client crisis. Implement an immediate course of action appropriate to the crisis. Enhance overall treatment by utilizing crisis events.

Crisis Intervention- goal

Return the client to a state of equilibrium

With continued use of a drug, a user damages their ___________ ____________, making it difficult to enjoy things they used to enjoy (like roller coasters, getting good grade).

Reward System or Reward Pathway

Which of the following is NOT one of the basic principles of ethics?

Right to Privacy

CNS stimulant used for ADHD

Ritalin (methylphenidate) and Dexedrine (dextroamphetamine)

Counseling Skills of Stage 3 (Feedback)

Role-playing, values clarification, goal-setting, problem solving. Feedback should be directed toward the person's behavior, which the person can do something about, they have control over behaviors.

Pons

Rounded bulge on the underside of the brain stem that connects medulla to mid-brain

SASSI-A2

SASSI for adolescents ages 12-18

substance classifications

SHOP N MD - stimulants, hallucinogens, opioids, psychotherapeutics, nicotine, marijuana, depressants

Progress Notes format

SOAP Subjective- what client saids Objective- what counselor observes Assessment- counselor makes judgment based on what was said and observed Plan- counselor's plan for the future

Instrument for Opioids Dependence and Withdrawal

SOWS-Subjective Opiate WD Scale-higher score more severe WD OOWS-Objective Opiate WD Scale-0-13 higher score more severe WD

Many screening instruments are available to detect the need for a full evaluation of a substance use disorder, including?

SSI-SA - Simple Screening Instrument for Substance Abuse AUDIT - Alcohol Use Disorders Identification Test

Panic Disorder medication

SSRIs, tricyclics and benzodiazepines are quite effective. Medication should be used in conjunction with cognitive-behavioral treatment. Medication is used for six months with cognitive-behavioral treatments then the patient is slowly weaned off the medication. However, relapse is high and may require "half dose" maintenance.

Probability Sampling

Sampling a known population

DAST

Screen drugs other than alcohol

12 Core Functions (1)

Screening

Screening VS Assessment

Screening is process for EVALUATING the possible presence of a problem VS Assessment process for DEFINING the nature of the problem.

SBIRT

Screening, Brief Intervention, and Referral to Treatment

SOS

Secular Organization for Sobriety. Alternative recovery method for those alcoholics uncomfortable with spiritual content of 12 step programs.

Sedative Hypnotics acute effects

Sedation, impaired judgement, impaired operation of vehicles, respiratory and cardiac depression with overdose (much less likely with benzoidiazepines alone).

Global Criteria: Counseling

Select the counseling theory (ies) that is/are more appropriate. Apply techniques to help the client, family, or group explore problems and their effects. Apply techniques to help the client, family, or group examine behaviors, attitudes, and feelings. Individualize counseling based on cultural, gender, age, and lifestyle differences. Elicit solutions and decisions from the client. Implement the treatment plan.

Purposeful Sampling

Selecting a sample from a population on who will be the most informative about a topic of interest.

Random Selection

Selecting participants from a population so that every member as an equal chance of being chosen

Advantages of Group Counseling

Sense of safety in numbers intense learning Expectation to be concerned about others Cost efficient

Temporal Lobes

Sensory areas responsible for hearing, visual memories, and language comprehension

Parietal Lobes

Sensory areas responsible for temperature, touch, pressure, and skin pain

burn-out

Several experts believe that it occurs in stages. The first stage is enthusiasm It is a state of physical, emotional, intellectual, and spiritual exhaustion

SMAST

Short MAST, 13 items

Psychoanalytic therapy

Sigmund FREUD'S therapeutic technique. freud believed the patient's free associations, resistances, dreams and transference and the therapist's interpretations of them released previously repressed feelings, allowing the patient to gain self-insight.

secondary sources

Significant people in the client's life such as family members, employers, friends, or coworkers who can provide information regarding the client's history, behavior, problems..etc., for the purposes of developing a more accurate and complete assessment and a more productive tx plan.

Sedative Hypnotics withdrawal

Similar to alcoho, but may have slower onset. Severity and time of onset vary wtih half life of drug. Mild: anxiety, restlessness, nausea, vomiting, insomnia, hpertention, tachycardia, agitation, tremors, sensory, hypersensitivity, dizziness, confusion, fatigue. Severe: Autonomic hyperactivity, vital sign instability, elevated temp, delusions, hallucinations, mania, delirium, catatonia, seizures, tremulousness, altered perceptions, w/d seizures possibly leading to death.

Sedative Hypnotics desired effects

Similar to alcohol. Reduction of anxity; possible elation, secondary to decrease alertness and judgment.

What are the advantages of screening instruments?

Simple in use and scoring. Limited training needed for administration. Known level of reliability and availability of cut-off scores.

Sedative Hypnotics Medical uses

Sleep, anxiety, muscle relaxation, alcohol, and sedative/hypnotic w/d, control of seizures includes Benzodiazepines, barbiturates, and others.

Opiate OD

Slow and shallow breathing, clammy skin, convulsions, coma, possible death due to suppression of breathing

Narcotics effects of OD

Slow/shallow breathing, clammy skin, convulsions, coma, and possible death

Sedative Hypnotics physica/mental exam

Slurred speech, ataxia, stupor, coma, and for nonbenzo's respiratory depression. confulsion, impaired judgement, delirium.

decaffeinated coffee

Soaking unroasted beans in an organic solvent (methylene chloride)

Community Orientation

Some cultures are oriented towards the collective good of the group rather than the individual's welfare. Clients of these cultures may care more about how the substance use is affecting family over how it affects them individually.

Heroin

Some effects of _______ use include euphoria followed by "nodding' and possible nausea

When US deaths are classified and ranked according to the contributions of alcohol and other drugs, TOBACCO causes the most deaths, followed by alcohol, and then all other drugs.

Some of the "all other drugs" are cocaine, heroin, and tranquilizers.

Stage 2: Regular Use

Some people will be able to enter the stage of ------ --- without developing a dependence or addiction. These people will be able to stop the drug use on their own. The problem with regular use is that the risk for substance abuse greatly increases during this stage. It also increases risky behaviors such as driving under the influence, unexplained violence, and symptoms of depression and anxiety.

When knowledge of BAC is combined with clinical info, the healthcare provider can make what?

Some predictions regarding the acuteness of withdrawal.

What are disadvantages of screening instruments?

Sometimes becomes the ONLY component of the screening process. Provides little opportunity to establish a connection with the client.

Step 11

Sought through prayer and meditation to improve our conscious contact with God as we understood him, praying only for knowledge of his will for us and the power to carry that out.

5 Treatment Planning

Specific problem, goal, and strategy statements intelligible to the client and expressed in behavioral terms. The statement of the problem concisely elaborates on a client's need identified previously. The goal statements refer specifically to the identified problem and may include on objective of a set of objectives ultimately intended to resolve or mitigate the problem. Both immediate and long-term goals should be established. It describes the services, who will perform them, when they will be provided, and at what frequency. A dynamic process and the contracts must be regularly reviewed and modified as appropriate.

Crisis Intervention Goals

Stabilize the situation and protect the individual from additional stressors. Mobilize whatever resources are required to assist the individual (i.e. assist the person in managing and recovering from the unusual circumstances). Restore the person to adaptive or pre-crisis level functioning.

Transtheoretical Model of Change (TTM)

Stages of change process of change self-efficacy decisional balance

SMART Recovery

Started in 1992. Recovery program that looks as addiction as behavioral. 4 Point program: Enhance motivation to abstain Coping with Cravings Solving problems through management of thoughts, feeling and behaviors Developing and maintaining lifestyle balance

Drug Dependence

State in which the individual uses the drug so frequently and consistently that it appears that it would be difficult for the person to get along without using the drug.

Omnibus Drug Act

Stiffened penalties for drug trafficking, specifically on airplanes and boats, allowed government to confiscate.

Amphetamine and methamphetamine are:

Stimulant drugs

Amphetamines Examples

Stimulants that have a substituted phenylethylamine structure such as: Dextroamphetamine Methamphetamine (Speed) Chemicals structurally different with the same action: • Methylphenidate • Other types Diet Pills, appetite suppressants

CANC

Stimulants: Cocaine Amphetamine Nicotine Caffeine

How does the neurotransmitter work as a pleasure (or reward)?

Stimulation of opiate receptors results in feelings of reward and activates the pleasure circuit by causing greater amounts of dopamine to be released within the nucleus accumbens

crank

Street name for illicitly manufactured methamphetamine

Phenomenology

Subjective fashion through which people perceive their world.

SOAP

Subjective, Objective, Assessment, and Plan

SAPT

Substance Abuse Prevention and Treatment

SASSI

Substance Abuse Subtle Screening Inventory

SASSI

Substance Abuse Subtle Screening Inventory +brief, easily administered psychological questionnaire +good for diverse cultures +effective in identifying early stage users who are in denial or concealing

SAMHSA

Substance Abuse and Mental Health Services Administration

Sedative-Hypnotic

Substances that induce depression on the CNS 3 Categories: 1) Barbiturates - used to treat anxiety, induce sleep, and control seizures (reduce tension and anxiety, relax) - barbiturates have slowly been replaced with safer benzodiazepines 2) Minor Tranquilizers - depressant drugs used to treat anxiety and insomnia (basically benzodiazepines) 3) Other Sedatives-hypnotic: "catch-all" category for sedatives/hypnotics

Buprenorphine is sold under what brand name?

Subutex and in combination with naloxone, as Suboxone. Subutex is intended for use at the beginning of treatment while Suboxone is intended for the maintenance treatment of opiate addiction. (Naloxone was added to guard against intravenous abuse of buprenorphine by individuals physically dependent on opiates.)

Highlights of clinical supervision

Supervisory relationship must be supportive and culturally competent, provide direct oversight, and prioritize skill development and counselor wellness Supervision is a formal process that is provided frequently and employs direct observation techniques Supervision is expected to result in improved staff retention, counselor skills, and client outcomes.

AXIS II: PERSONALITY DISORDERS AND MENTAL RETARDATION - difference from AXIS I

Symptoms last longer do not generally change much over time are integral to the individual's interaction with the world

Anabolic steroids

Synthetic illicit drugs that are used to increase muscle mass and improve athletic performance. Include Depo-testosterone, Durabolin, Danocrine, and Halotestin. Some are approved for veterinary medicine and sold illicitly for human use.

Methadone

Synthetic opiate used for heroin detoxification and maintenance programs. Extremely addictive, legal and generally considered safer than heroin because it does not produce a "high" state, therefore allowing methadone maintenance users to have a performance superior to heroin users. Gives a longer lasting high when taken orally, which is a preferred, cleaner and safer way to take drugs than by intravenous administration. More extreme withdrawal symptoms than heroin that can last with great intensity for up to ten days.

T-ACE (Alcohol screening instrument for pregnant women)

T Tolerance: How many drinks does it take to make you feel high? A Have people Annoyed you by criticizing your drinking? C Have you ever felt you ought to Cut down on your drinking? E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

The main active chemical in marijuana is:

THC (delta-9-tetrahydrocannabinol). It is a psychoactive ingredient The highest concentrations of THC are found in the leaves and flowers.

THC affects which brain receptors?

THC from the marijuana acts on specific receptors in the brain, called cannabinoid receptors, starting off a chain of cellular reactions that finally lead to the euphoria, or "high" that users experience.

Disulfiram: Trade name Antabuse

Tablet by mouth once daily - may be crushed. 250mg or 500 mg. Typically begins about 10 to 30 min after alcohol is ingested. May occur for up to 14 days after last dose. Inhibits the enzyme aldehyde dehydrogenase

Catastrophizing:

Taking an event you are concerned about and blowing it out of proportion to the point of becoming fearful. Example: Believing that if you fail a quiz then the teacher will completely lose respect for you, that you will not graduate from college, that you will therefore never get a well-paying job, and will ultimately end up unhappy and dissatisfied with life.

Catharsis

Talking about difficulties is beneficial. Group members release intense emotions and open up opportunities to group.

Harrison Act

Taxation act of 1914 that taxed opium and coca products

The four roles of a Clinical Supervisor

Teacher Coach mentor Consultant

TAP

Technical Assistance Publication

Termination

Termination is the stage in which individuals are not tempted; they have 100% self-efficacy. Whether depressed, anxious, bored, lonely, angry, or stressed, individuals in this stage are sure they will not return to unhealthy habits as a way of coping. It is as if their new behavior has become an automatic habit. Examples include adults who have developed automatic seatbelt use or who automatically take their antihypertensive medication at the same time and place each day. In a study of former smokers and alcoholics, researchers found that less than 20% of each group had reached the criteria of zero temptation and total self-efficacy (Snow, Prochaska & Rossi, (1992). The criterion of 100% self-efficacy may be too strict or it may be that this stage is an ideal goal for population health efforts. In other areas, like exercise, consistent condom use, and weight control, the realistic goal may be a lifetime of maintenance.

TCI-JDS

Texas University Drug Screen

Societal Obligations

The AOD counselor must advocate changes in public policy and legislation, must participat in community affairs of the effects of alcoholism and drug addiction and must act to guarantee that all persons, especially the needy and disadvantaged, have access to the necessary resources and services, must take aprofessional stance, that promotes the well being of all human beings, as responsible health care professionals, believe in the dignity and worth of human beings. In practice of their profession they assert that the ethical principles of autonomy, beneficence and justice must guide their professional conduct, CCBADC certified counselors dedicate themselves to promote the best interest of their society, of their clients, of their profession, and of their colleagues.

Publication Credit

The AOD counselor must assign credit to all who have contributed to the published material and for the work upon which the publication is based.

Confidentiality

The AOD counselor must embrace the duty of protecting the privacy of clients and must not disclose confidential information acquired, in teaching, practice or investigation,must inform the client and obtain agreement in areas likely to affect the client's participation including the recording of an interview, the use of interview material for training purposes, and observation of an interview by another person, The AOD counselor must make provisions for the maintenance of confidentiality and the ultimate disposition of records, must reveal information received in confidence only when there is clear and imminent danger to the client or to other persons, and then only to appropriate professional workers or public authorities, must discuss the information obtained in clinical or consulting relationships only in appropriate settings and must maintain patient privacy, must use clinical and other material in classroom teaching and writing only when the identity of the persons involved is adequately disguised

Responsibility

The AOD counselor must espouse objectivity and integrity while maintaining the highest standards 1. primary responsibilty is to help others acquire knowledge and skills in dealing with chemical dependency 2. while supervising others the AOD will accepts the obligation to facilitate professional development by providing information, evauluations and consultations

Abusive Behavior

The AOD counselor must not verbally, physically or sexually harass, threaten, or abuse any participant, patient, resident, their family members, other persons who are significant to them, or other staff members.

Competence

The AOD counselor must recognize that the profession is founded on national standards of competence which promote the best interests of society, the client and professions in the field. The AOD will do the following: 1. prevent unqualified and unauthorized persons from practicing 2. report unethical conduct or unprofessional modes of practice to the appropriate authority. 3. will recognize boundaries and limitations of counselor's competencies and not offer services or use techniques outside of these professional competencies 4.must recognize the effect of professional impairment on professional performance and must be willing to seek appropriate treatment for oneself or for a colleague. Will support peer assistance programs

Remuneration

The AOD will establish financial arrangements in professional practice and in accordance with the professional standards that safeguard the best interests of the client, of the counselor and of the profession, must inform the client of all financial policies. In circumstances where an agency dictates explicit provisions with its staff for private consultations, must not send or receive any commission or rebate and must not engage in fee splitting, in clinical or counseling practice must not use one's relationship with clients to promote personal gain, must not accept a private fee or any other gift or gratuity for professional work with a person who is entitled to such services though an institution or agency

AUDIT

The Alcohol Use Disorders Identification Test (AUDIT) is a ten-question test developed by a World Health Organization-sponsored collaborative project to determine if a person may be at risk for alcohol abuse problems.

"The way to tell whether a man is having drinking problems is to ask..."

The BEST answer is "whether he has tried several times without success to reduce his drinking."

Stimulants (Cocaine, amphetamine, Adderall, Ritalin)

The Buzz - Alertness, energy, talkativeness, increased heart rate and blood pressure, euphoria Bad Effects (three dangers) - death at high doses, psychiatric state of hostility, paranoia, schizophrenia, addiction rate is high Withdrawal Effects - Miserable but not life threatening, cravings, exhaustion, excessive sleep, depressive symptoms, strong appetite, inability to feel pleasure

Hallucinogens (LSD, PCP, Ketamine)

The Buzz - Detachment from surroundings, hallucinations, illusions, jitteriness, racing or slowed heart beat, nausea, chills, numbness Bad Effects- Bad trips

Alcohol

The Buzz - First half hour one will experience pleasure and relaxation, talkative, which is then replaced by sedation, quietness, and being withdrawn Bad effects - Low overdose potential, slurred speech, vomiting, hyperthermia, hypothermia, comatose

Caffeine

The Buzz - Increased alertness and ability to concentrate, sometimes euphoria. Higher doses can result in nervousness/agitation Bad effects - Overdose is rare, anxiety, stimulation of urination, increased blood pressure, headaches

Nicotine

The Buzz - Increases attention and concentration, calming Bad Effects - Dizziness, weakness, and nausea Withdrawal - Craving and irritability

Ecstasy

The Buzz - Increases heart rate and blood pressure and body temperature and produces a sense of energy and alertness, suppression of appetite, feelings of empathy, and good feelings Bad Effects - Jitteriness, teeth clenching, hyperthermia, high blood pressure, heart attacks, strokes, seizuers

Sedatives (Barbiturates, benzodiazepines, sleeping medications)

The Buzz - Relaxation, mellow feelings, lightheadedness, vertigo, drowsiness, slurred speech Bad Effects - Benzos: Low fatal overdose potential unless combined with other sedatives Any other sedative can cause death by suppression of breathing and heart failure Progression as follows: drowsiness, muscle discoordination, slurring speech, deep sleep, loss of reflexes such as gagging, suppressed breathing, death Withdrawal Effects - Sudden withdrawal because the CNS adapts to the drug by turning down the inhibitory systems that these drugs enhance

Inhalants

The Buzz - Relaxes muscles, drop in blood pressure, increased heart rate, sense of warmth, mild euphoria Bad Effects - Loss of consciousness, heart palpitations, headaches, solvent lethal overdose high

Marijuana

The Buzz - Relaxes, elevates mood, drowsiness, sedation, hilarity, tranquility, illogical thinking, impaired memory, lack of focus, analgesic, increased appetite Bad Effects - Lethal overdose is impossible, anxiousness, fearful, impaired judgment and coordination, increases heart rate Withdrawal - Mild withdrawal effects: Agitation, anxiety, tremors, seizures

Opiates (Heroin, morphine, fentanyl, oxycodone, hydrocodone)

The Buzz - Rush of pleasure, dreamy state, little sensitivity to pain, breathing slows, skin flush, pin point pupils Bad Effects - Overdose can happen, nausea, vomiting, constipation Withdrawal - Miserable but not life threatening, cravings, watery eyes, runny nose, yawning, sweating, restless, irritable, loss of appetite, difficulty sleeping, dysphoria, flu like symptoms (diarrhea, shivering, sweating, muscle aches)

LOCUS

The Level of Care Utilization System is a tool used to assess the immediate services needs for a client.

What are the 4 fundamentals of ethics

The Principle of Respect for autonomy The Principle of Beneficence The Principle of nonmaleficence The Principle of justice

Psychoactive

The ability of certain medications, drugs, and other substances to cause acute psychomotor effects and a relatively rapid change in mood or thought. Changes in mood include stimulation, sedation, and euphoria. Thought changes include a disordering of thought such as delusions, hallucinations, and illusions. Behavioral changes include an acceleration or retardation of motor activity. All drugs of abuse are by definition psychoactive.

External Validity

The ability to generalize the the results to a larger group.

manipulative

The act of influencing or managing shrewdly, deviously, or indirectly to obtain one's own advantage.

Intake

The administrative and initial assessment procedures for admission to a program

2. Intake

The administrative and initial assessment procedures for admission to a program.

2 Intake

The administrative and initial assessment procedures for admission to a program.Usually becomes an extension of the screening, when the decision to admit is formally made and documented. Includes the completion of various forms.

Core Function of Intake

The administrative and initial assessment procedures for admission to a program; an extension of screening

Service coordination

The administrative, clinical and evaluative activities that bring the clt, treatment services, community agencies, and other resources together to focus on issues and needs identified in the treatment plan

Tolerance

The brain cells with opioid receptors become less responsive to opioid stimulation requiring more of the drug to get the desired effect Opioid tolerance decreases the release of dopamine into the nucleus accumbens preventing the person from experiencing pleasure from normally rewarding activities

How does cocaine affect the neurotransmitters?

The brain releases dopamine in these circuits in response to potential rewards, like the smell of good food. It then recycles back into the cell that released it, shutting off the signal between nerve cells. Cocaine prevents dopamine from recycling, causing excessive amounts to build up between nerve cells. This flood of dopamine ultimately disrupts normal brain communication and causes cocaine's high.

The Nervous System

The brain, the spinal cord, the peripheral nerves Central - brain and the spinal cord, psychoactive drugs primarily affect the CNS Peripheral - all the nerves that branch out

Internal Validity

The changes in the DV are due to the effects of the IV

What is the most important thing to know for crisis management?

The client history of trauma

Transference:

The client's projections of feelings onto the counselor or other group members

How quickly you absorb the alcohol depends on several factors, including:

The concentration of alcohol in your drink (drinks with a higher alcohol concentration are generally absorbed faster); Whether your drink is carbonated (champagne, for example, is absorbed more quickly than non-sparkling drinks); and Whether your stomach is full or empty (food slows down the absorption of alcohol).

Independent Variable

The construct that is manipulated or controlled in some way i.e. sex, race, treatment group, etc.

7 Case Management

The coordination of a multiple services plan, where decisions must be explained to the client. By the time many alcohol and other drug abusers enter treatment they tend to manifest dysfunction in a variety of areas.

5 Treatment Planning Process

The counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long-term goals; and decide upon a treatment process and the resources to be utilized. Explain assessment results, id and rank problems, formulate goals, id treatment methods.

Concreteness

The counselor characteristic or ability used to guide the client in relating and communicating in specific terms rather than in general or abstract terms.

Countertransference:

The counselor's projections of feelings onto the client. If you experience countertransference, get clinical supervision and make colleagues aware of the situation.

Intervention

The creation or use of a crisis involving the alcoholic that is so emotionally painful that he/she will stop denying that alcohol/drugs is a problem before he/she has lost everything

Reliability

The degree to which a measure in consistent

Tolerance refers to?

The diminishing effect of a drug as a result of repeated exposure to the same dose of the drug.

Motivational Interviewing

The direct, client centered counseling form implemented to elicit behavior change by helping clients resolve ambivalence to change.

Independent effect

The effect of individual drug is not changed when combined with another drug. Neither drug affects the other.

Antagonistic effect

The effect of one drug blocks or reduces the effect of another drug or both drugs in the system

Reflection of Feeling

The essence of the client's feelings, either stated or implied, as expressed by the counselor

Reflection of Feeling

The essence of the client's feelings, either stated or implied, as expressed by the counselor (feedback). Focuses primarily on the emotional element of the client's communication Identification and formulation. The counselor must first identify basic feelings

Cross-Consultation

The final function of a counselor is to communicate with other professionals. Client treatment and services can benefit from in-house and outside resources. The goal of cross-consultation is to ensure the highest quality, most comprehensive care.

Neurons

The functional and structural unit of the nervous system are Cells in nervous system that communicate to perform info-processing tasks

Core function of referral

The identification of client's needs that cannot be met by the counselor or agency and assisting the client to use the support systems and community resources available

treatment plan

The initial ______________ should be based on assessment of the needs as revealed during the intake Consist of goals and objectives based upon the assessment needs of the ct

Imitative behavior

The leaders and senior group members act as role models of healthy behavior for newer members

Duty to Warn

The legal obligation of a counselor to notify the appropriate authorities or victim when there is a serious danger

Stage 3: Risky Use/Abuse

The line between regular use and risky use/abuse is a very thin one, but is usually defined as continued use of drugs in spite of severe social and legal consequences. What might have begun as a temporary form of escape can quickly lead to more serious problems. This is the stage where the warning signs of addiction will begin to appear: craving, preoccupation with the drug, and symptoms of depression, irritability and fatigue if the drug is not used.

Dissociative Fugue

The main sign is creating physical distance from your real identity. For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location.

Dissociative Amnesia

The main symptom is memory loss that's more severe than normal forgetfulness and that can't be explained by a medical condition.

The Median

The median is the middle value of a set of data containing an odd number of values, or the average of the two middle values of a set of data with an even number of values

Detoxification

The metabolic process that changes alcohol to the compound acetaldehyde is known as

Oxidation

The metabolic process that leads to the formation of water and carbon dioxide by the process of chemically heating acetic acid is

Disulfiram (Anatabuse)

The method of which __________acts to deter the consumption of alcohol is by decreasing the body's ability to break down poisonous metabolites of alcohol A drug that inhibits acetylaldehyde dehydrogenase

Effect

The most common classification of drugs is by their ______

Oral

The most common manner of drug administration is

Stimulant Withdrawal Syndrome (CANC)

The most difficult symptom is craving, of which there are two types: Anhedonic: A craving because of boredom and the wish for a high Conditioned: Due to environmental reminders of pleasure derived from stimulant use. Because stimulants are powerfully effective, Conditioned craving typically accompanies stimulants more than other drugs.

A proper consent form must be in writing and must contain each of the following items:

The name or general designation of the program(s) making the disclosure The name of the individual or organization that will receive the disclosure The name of the patient\resident who is the subject of the disclosure; The purpose or need for the disclosure; How much and what kind of information will be disclosed; A statement that patient\resident may revoke the consent in writing at any time, except to the extent that the program has already acted in reliance on it; The Program's ability to condition treatment, payment, enrollment or eligibility of benefits on the patient's agreeing to sign the consent, by stating either that the program may not condition these services on the patient signing the consent, or the consequences for the patient refusing to sign the consent The date, event or condition upon which the consent expires if not previously noted The signature of the patient\resident (and or authorized person) The date on which the consent form is signed.

1 Important Screening factors

The nature of the substance abuse, the physical condition of the client, the psychological functioning of the client, outside supports/resources, previous treatment efforts, motivation and philosophy of the program.

Norepinephrine

The neurotransmitter associated with arousal and mood is A neurotransmitter associated with eating and alertness. Too little has been associated with depression and too much has been associated with schizophrenia.

Benzodiazepines (Anti-Anxiety Agents) - Depressant

The newest class of widely prescribed psychoactive chemicals that relieve anxiety.

Tradition 3

The only requirement for A.A. membership is a desire to stop drinking.

How does the neurotransmitter work as a pain reliever?

The opiates and endorphins are able to block pain signals by binding to the mu receptor site Natural endorphins that are released immediately following an injury can provide enough pain relief to allow escape from a harmful situation

Dependent Variable

The outcome variable that is influenced.

parasympathetic

The part of the autonomic nervous system relating to relaxing activities (in coordination with the sympathetic division)

Hypothalamus

The part of the brain that controls heart rate, hunger, body weight, and arterial blood pressure is A small area of the brain that regulates emotional behaviors and motives.

social adaptation

The pattern of adjustment and relationship an individual creates and assumes in relationship to various social groups within society such as the family, the work group, friends, neighborhoods, church, etc.

Prohibition

The period from 1920 to 1933 when the sale of alcoholic beverages was prohibited in the United States by the 18th Amendment Decreased the number of deaths associated with alcoholism

Universality

The person must feel he or she has a problem common to others

Dimension II: Biomedical Conditions and Complications

The placing authority must use the criteria in Dimension II to determine a client's biomedical conditions and complications.

Dimension III: Emotional/Behavioral/Cognitive

The placing authority must use the criteria in Dimension III to determine a client's emotional, behavioral, and cognitive conditions and complications.

Dimension IV: Readiness for Change

The placing authority must use the criteria in Dimension IV to determine a client's readiness for change.

Dimension V: Relapse/Continued Use/Continued problem potential

The placing authority must use the criteria in Dimension V to determine a client's relapse, continued use, and continued problem potential.

Dimension VI: Recovery Environment

The placing authority must use the criteria in Dimension VI to determine a client's recovery environment.

Dimension I: Acute Intoxication/withdrawal potential

The placing authority must use the criteria in dimension 1 to determine a client's acute intoxication and withdrawal potential.

Opiates are powerful drugs derived from what plant?

The poppy plant that have been used for centuries to relieve pain.

Core function of assessment

The procedures by which a counselor/program evaluates an individual's strengths, weaknesses, problems, and needs for the development of a treatment plan.

4. Assessment

The procedures by which a counselor/program identifies and evaluates an individual's strengths, weaknesses, problems, and needs for the development of a treatment plan.

Screening

The process by which a client is determined appropriate and eligible for admission to a particular program

1. Screening

The process by which the client is determined appropriate and eligible for admission to a particular program.

1 Screening

The process by which the client is determined appropriate and eligible for admission to a particular program. Consider a variety of factors before deciding whether or not to admit the potential client for treatment. Use appropriate diagnostic criteria to determine whether the applicant's alcohol or other drug use constitutes abuse.

Core function of treatment planning

The process by which the counselor and client ID and rank the problems needing resolution. They establish agreed upon immediate and long-term goals and decide upon a treatment process and the resources to be used.

5. Treatment Planning

The process by which the counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long-term goals; and decide upon a treatment process and the resources to be utilized.

Detoxification

The process of making a substance nonpoisonous in the human body is Also known as metabolism or biotransformation

Therapeutic index:

The ratio of a drug's toxic dose to its therapeutic dose. Barbiturates have a narrow therapeutic index. This is the reason why barbiturates are dangerous. It is also why barbiturates are not often prescribed today.

Documentation

The recording of the screening and intake process, assessment, treatment plan, client related data, clinical reports, clinical progress notes and discharge summaries.

42 CFR

The regulations directing the implementation of confidentiality of alcohol and drug abuse patients

The driving force behind narcotic addiction?

The reinforcing effect of a drug on the brain rather than fear of withdrawal.

Cluster Sampling

The researcher identifies existing subgroups and not individual participants

Claudia Black's family roles

The responsible one The adjuster The placater The acting-out child

Record-Keeping and Reporting

The results of treatment and assessments must be carefully documented to track progress and develop plans for the patient's future. Reports, notes, discharge summaries, and other types of information must be kept confidential but properly tracked.

Threshold Dose

The smallest amount of a given drug which is capable of producing some detectable response

Pharmacodynamics

The special study of where and how drugs act in the human body is called _________ Effects of a drug within the body ( the absorption, metabolism, excretion)

Nicotiana Tobacum

The species of tobacco widely cultivated for smoking and chewing products

Engagement- predictor of

The strongest predictor of short and long-term retention in addictions treatment

Overt racism and hostility

The style of counseling in which a counselor acts out the deep-seated prejudices that he/she has toward a minority group

Hypothesis

The testable, concise statement involving the expected relationship between two or more variables.

What is time lost to drug activities?

The time spent obtaining the drug, using the drug or recovering from the effects of the drug

Case Management

The traffic control of treatment, it includes: medical, legal, psychiatric, housing, employment, family, etc.

Transference

The unconscious redirection of emotions from one person to another

Drug use

The use of a drug in some socially prescribed fashion is referred to as

Medication Assisted Treatment (biologically based)

The use of approved medications with medical supervision. Intended to be an adjunct to formal therapies. Agonists - These drugs can be substituted for the drug of abuse to provide a more controllable form of addiction. The properties and actions of these drugs are similar to the drug of abuse. Using them alleviates withdrawal symptoms Methadone and Clonidine) Methadone blocks the cravings for opiate drugs and does not create a sense of euphoria like heroin Antagonists - These drugs occupy the same receptor sites in the brain as specific drugs of abuse, they do not produce the same effects as the drug and are not addicting. When they are present, the effects of the abused drug are blocked because they cannot act on the brain in the same way (Naltrexone, Buprenorphine/Suboxone Antidipsotropics - create adverse physical reactions when the person consumes the substance of abuse. These drugs are used to develop an aversion to the abused drug (antabuse) Psychotropic Medications - These control various symptoms associated with drug use and withdrawal

6. Counseling

The utilization of special skills to assist individuals, families, significant others, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision-making.

The Mode

The value which occurs most frequently

transactional analysis

Theory developed by Eric Berne is the 1950's which proposes that humans are motivated by stimulus hunger, structure hunger, and position hunger. The basic unit of communication are transactions that consist of exchanges of positive and negative strokes. the methods employed in this theory analyze various interactions and attempts to increase personal autonomy and decrease the impact of self-defeating scripts and manipulative games. Berne believes people are intelligent and capable and can remake old decisions that have led to problems. There are three primary ego states within each individual that affect the nature of transactions-present, adult and child.

Joan Jackson

Therapist who first began to focus efforts of treatment toward the family of the chemically dependent individual in 1954 Wrote "Alcoholism and the Family"

energy drinks

These became a slightly lower caffeine content drink with about 80mg of caffeine each. i.e. red bull, rockstar, monster

Depressants/Sedative-hypnotics

These drugs are central nervous system depressants. Include but are not limited to: alcohol, benzodiazepines and barbituates. In general these drugs bind to GABA receptors resulting in sedation.

Hallucinogens/Dissociatives

These drugs change sensory perception and have the ability to alter reality and produce hallucination-like effects. Includes naturally occuring and synthetic drugs such as: LSD, mescaline, psylocybin, psilocin, MDMA, PCP and ketamine.

French

These people consume more alcohol per capita than any other nation and have the highest rates of alcohol dependence, suicide and deaths from cirrhosis of the liver.

Fat-soluble drugs

These store in the fatty areas of the body and can have longer lasting traces in the body that water-soluble drugs do not.

Cocaine and Amphetamines

These two drugs interact with several neurotransmitters: dopamine, norepinephrine, and serotonin.

What is the misconception of dependence potential for all psychoactive drugs?

They are all not rated as "high". i.e. alcohol, marijuana, or hallucinogens they are moderate.

Expediter

They help the client get through problems of duplicated services, ineligibility, seemingly closed doors, poor service quality, and irrelevant services. Services are delivered efficiently and effectively.

Collaborator

They help the professionals establish and maintain good working relationships. The case manager knows the human service community and has established a network of other professionals.

Consultant

They help with cost analysis, quality control, and organizational structure. They identify the problem, study it, and make recommendations. They also help with special information or expertise.

Record Keeper

They maintain detailed information relating to all contracts and services. They provide long-term care, communicating with other professionals and agencies, and monitoring and billing for services.

System Modifier

They possess authority to change agency policy or redirect priorities in addition to having the respect of the community and colleges.

Tolerance is the reduced effectiveness of a drug after repeated use. An example would be...

Think of the person who "can drink me under the table." As drinkers gain more "tolerance" to alcohol over time, the negative effects of drinking on their driving can decline.

Vernon Johnson's Theory

This is really a learning theory. It holds that an individual learns that drinking is a very powerful and successful way to deal with problems. The family or significant individuals in the addicts life reinforce this by their behavior which enables the alcoholics drinking. The alcoholic's relationship to alcohol deteriorates over time, but the initial learning was so powerful that the person continues to seek those early positive experiences.

40,000

This many fatalities related to alcohol each year.

autonomic

This nervous system provides involuntary control over smooth muscle, cardiac muscle, and glands.

Case Management

This portion of treatment is a broad section. It refers to activities that bring people, services, and agencies together in a predetermined framework of action. These methods are necessary to establish the short-term and long-term goals of the patient. Global criteria for case management includes coordinating client care services and explaining the care management activities to the client. Again, it's imperative to help the patient understand the methods and goals of the program.

Dialectical Behavior Therapy

This type of cognitive-behavioral therapy addresses thinking patterns and behaviors and incorporates strategies such as emotional regulation and mindfulness. Its main goals are to teach people how to live in the moment, cope healthily with stress, regulate emotions, and improve relationships with others Dialetic means investigating the truth of opinions

Control Group

Those in the study who share similar attributes with the experimental group, but do not receive treatment

Assessment

Those procedures by which a counselor identifies and evaluates an individual's strengths, weaknesses, problems and needs for the development of the treatment plan In other words, Assessment is the process used to 1) determine the problems that need to be addressed; and 2) develop the treatment plan

Core function crisis intervention

Those services which respond to an alcohol and/or drug abuser's needs during acute emotional and/or physical distress; safety plan

8. Crisis Intervention

Those services which respond to an alcohol and/or other drug abuser's needs during acute emotional and/or physical distress.

Three basic processes

Tolerance physical dependence psychological depnedence

TWEAK

Tolerance, Worried, Eye-opener, Amnesia, and K/Cut-down

Sedative Hypnotics common problems

Tolerance, dependence, addiction, elderly falls, respiratory dpression

Alcohol common problems

Tolorance, Dependence, Depression, neurologic deficits, hypertension, liver and heart disease.

monoamine theory of mood

Too little activity of MA neurotransmitters can cause depression, too much can cause mania - supported by the fact that monoamine-enhancing drugs, like amphetamines & cocaine, elevate mood

Acamprosate

Trade name: Campral How taken: Two delayed-release tablets by mouth three times per day, with or without food (a lower dose may be effective with some clients and must be prescribed for those with impaired renal function). How supplied: Enteric-coated 333 mg tablets

Clinical supervision: treatment based models

Train to particular theoretical approach to counseling, incorporating evidence-based practices.

In group therapy, a client consistently perceives another group member as an angry, critical man like her father. This is an example of?

Transference

Parallel Treatment

Treat both disorders at the same time, but at different locations

Parallel treatment

Treat both disorders at the same time, but at different locations.

Serial Treatment

Treat one disorder; then afterwards, the other. Mental health then substance use disorder, or vice versa. Least effective.

Remission

Treated differently than dependence: Early- symptoms have not been present for a period of two days to one year Sustained - one year has passed. In addition to the length, the intensity must be determined. Full - no symptoms are present after a period of 30 days. Partial -some symptoms return

Justice

Treating group members equally and fairly

TIPs

Treatment Improvement Protocols

No Wrong Door

Treatment is available at every point of someone trying to get help in any stage of substance abuse.

12 Core Functions (5)

Treatment planning

Alcohol Withdrawal

Trembling, autonomic hyperactivity, Anxiety, insomnia, vitamin deficiency, confusion, hallucination, and convulsions.

True or False: Initial screenings procedures should be brief

True

True or False. Reports from persons in treatment often are more credible than those from individuals in criminal justice system

True. Assurance of confidentiality is an important factor that enhances self reporting, while potential of prosecution and other sanctions is likely to diminish disclosure

Potentiating

Two drugs have different actions, but when taken together, one enhances the effects of the other If an antiulcer medicine tends to increase blood alcohol levels and thus makes drinkers more intoxicated, this type of drug interaction would be best describes as

Client-Centered Therapy

Two of the key elements of client-centered therapy are that it: Is non-directive. Therapists allow clients to lead the discussion and do not try to steer the client in a particular direction. Emphasizes unconditional positive regard. Therapists show complete acceptance and support for their clients without casting judgment.

DSM V: Substance Use Disorder (specifiers)

Two or three symptoms indicate Mild. Four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder.

Two by Four Programs

Two phase approach to treatment. Detox for two weeks followed by outpatient for two weeks

What is the treatment of AOD dependent on?

Type, amount and patterns of use

Mania Disorder Cognitive symptoms

Unable to concentrate, have lax ideas and associations in conversations, develop an exaggerated view of self accomplishments, and add few, if any, insights during conversation.

Clinical supervision: developmental models

Understands that each counselor goes through stages of development and recognizes that these stages are not always linear.

Benzodiazepines

Used as a sedative to reduce anxiety, panic attacks and depression The most commonly prescribed medication in the United States

Barbiturates

Used as sedatives to bring someone "down" decrease anxiety and reduce inhibitions brain relaxers

Barbiturate examples

Used for Insomnia and Seizures. Thiopental (Pentothal, used as a general anesthetic) Amobarbital (Amytal, used for control of agitated patients) Secobarbital (Seconal)

Clonidine (Catapres)

Used for opioid detoxification.

Chi-squared

Used to determine if there are significant differences in the distribution of two data sets. Used to determine if two populations are homogeneous when compared to each other.

Assessments

Used to diagnose and identify problems (biopsychosocial) to be addressed during treatment

Screening documents

Used to document the person's appropriateness and eligibility for treatment services

Treatment Plan

Used to identify target problems from the assessment, set short and long term goals, determine behavioral objectives and set dates for completion

Naloxone

Used to treat cases of Heroine (opiate) overdose

Opiates

Used to treat pain (analgesics) Gives the user feeling of euphoria

MANOVA

Used when investigating more than one dependent variable

Factorial Analysis

Used when investigating more than one independent variable

When do the signs and symptoms of opioid withdrawal manifest?

Usually begin 2-3 t1/2 after the last opioid dose (i.e. after 36-48 hours for long t1/2 opioids such as methadone, and after 6-24 hours for short t1/2 opioids such as heroin and morphine)

Two Hallmarks of Axis II

Usually it should be early onset (in adolescence into adulthood) • They younger the client is, the more difficult it is to diagnose as personality disorder The personality pattern has to occur under all situations: at home, at work, on vacation, etc. • The client will react to everything using the same personality modality

The Hero

Usually the oldest child. Provides self-worth to the family. Knows something is wrong and feels obligated to fix the problem through achievement.

The Scapegoat

Usually the second child. Since the hero has the positive attention, the second child seeks what is left: negative attention. the child's role is to take attention away from the alcoholic by accepting blame for the family's troubles.

Mascot

Usually the third or middle child. Senses that something is wrong in the family but gets reassurance from other members that nothing is wrong. This causes anxiety and continual conflict for the child.

Lost Child

Usually the youngest child. The child's role is to cause no trouble for the family. They receive little positive or negative attention from the family.

Benzodiazepines (BZs) examples

Valium(diazepam) Halcion(triazolam) Xanax (alproazolam) Ativan (lorazepam) Klonopin (clonazepam)

Anti-epileptic medications examples (Psychopharmacology for bipolar disorders)

Valproic acid (Depakote), clonazepam (Klonopin), carbamazepine (Tergretol), lamotrigine (Lamictal), gabapentin (Neurontin), topiramate (Topamax), oxcarbazepine (Trileptal)

Safety of Acamprosate

Very safe!! Do not use with patients with kidney problems. Diarrhea and Drowsiness are side effects. No potential for abuse. No drug interactions.

Amphetamine Effects

Very similar to cocaine intoxication Maladaptive behavior Psychological alterations Intoxication characterized by euphoria Interpersonal sensitivity Talkativeness Hypervigilance Impaired judgment

Delirium Tremens (DTs)

Vibrant hallucinations, delusions, autonomic hyperactivity and agitation

Systems Theory

View of behavior as an interactive part of a larger social structure.

Anabolic Steroids effects

Virilization, edema, testicular atrophy, gyneco-mastia, acne aggressive behavior

Occipital Lobe

Vision

Inhalants

Volatile solvents inhaled for intoxicating purposes. WD usually lasts 2-5 days.

Alcohol OD

Vomiting, respiratory depression, loss of consciousness, possible death.

Stimulants can produce at moderate doses?

Wakefulness and a sense of well-being. Cocaine and amphetamines (methamphetamine) are the most frequently abused CNS stimulants.

Narcotics withdrawal syndrome

Water eyes, runny nose, yawning, loss of appetite, irritability, tremors, panic, cramps, nausea, chills, sweating.

Step 1

We admitted we were powerless over alcohol and that our lives had become unmanageable.

What is The Principle of nonmaleficence

We have an obligation not to harm others: "First, do no harm." Corollary principle: Where harm cannot be avoided, we are obligated to minimize the harm we do. Corollary principle: Don't increase the risk of harm to others. Corollary principle: It is wrong to waste resources that could be used for good. Combining beneficence and nonaleficence: Each action must produce more good than harm

What is The Principle of Beneficence

We have an obligation to bring about good in all our actions. Corollary principle? We must take positive steps to prevent harm. However, adopting this corollary principle frequently places us in direct conflict with respecting the autonomy of other persons.

The Principle of justice

We have an obligation to provide others with whatever they are owed or deserve. In public life, we have an obligation to treat all people equally, fairly, and impartially. Corollary principle: Impose no unfair burdens. Combining beneficence and justice: We are obligated to work for the benefit of those who are unfairly treated.

Step 6

Were entirely ready to have God remove all these defects of character

AXIS I: IDENTIFY THE DISORDER

What are the symptoms? What is their duration? What is the intensity? Identification of the disorder is determined by symptom clusters of certain intensity and duration.

AXIS III: ASSESS THE MEDICAL CONDITION

What is the client's current medical condition? How does the medical condition affect psychiatric symptoms? How does the current medical condition affect treatment planning?

AXIS IV: CONSIDER THE PRESENCE OF STRESSORS

What stressors have been confronted in the past year? Are stressors controllable or uncontrollable?

Negative correlation

When X goes up and Y goes down

Positive Correlation

When X goes up and Y goes up

Personalization:

When a person attributes an external event to himself when there is actually no causal relationship. Example: If a checkout clerk is rude to you and you believe that you must have done something to cause it when there is a more plausible explanation for the person's behavior.

Selective Abstraction:

When a person makes a judgment based on some information but disregards other information. Example: Someone attends a party and afterward focuses on the one awkward look directed her way and ignores the hours of smiles.

Synergistic Effects

When alcohol and barbiturates are taken together Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone. For example 1 + 1 is greater than 2

Intoxication

When alcohol is consumed faster than it is being oxidized, the result is Means disturbance of mental or physical capacity resulting from introduction of any substance into the body.

Withdrawal

When an opiate-dependent person stops taking the drug, withdrawal usually begins within 4-6 hours after the last dose

When does Assessment process begin?

When client attends their first counseling session

Group Cohesiveness

When members feel a sense of togetherness, they are moer willing to attend, participate, help other members, and defend group rules

How are clients with COD best served?

When screening, assessment, and treatment planning are integrated, addressing both substance abuse and mental health disorders, each in the context of the other.

Additive Effect

When two or more drugs are present in the body that have similar effects, the impact of adding one drug to the others doubles the efforts of the drugs.

Public Statements

Will respect the limits of present knowledge in public statements that pertain to alcoholism and other forms of drug addiction. Must report fairly and accurately the appropriate information they have, document materials and techniques used, AOD counselor must indicate to the audience the requisite training/qualifications required to properly perform their skills and techniques.

Reality Therapy

William Glasser's therapy that feels a person can develop a successful identity or a failure identity. Value judgments and personal responsibility are stressed. Acceptance of responsibility.

Substance Dependence specifiers

With/Without Psychological Dependence • Remission, specify if: - Early Full - Early Partial - Sustained Full - Sustained Partial • In a Controlled Environment • On Agonist Therapy

Five Recovery Stages for Individuals Addicted to Cocaine

Withdrawal Honeymoon The wall Adjustment Resolution stage

What are the types of AOD treatments?

Withdrawal management (detox), rehabilitation (inpatient or outpatient), pharmacotherapy maintenance programs (opioid replacement therapy), psychosocial interventions (counselling, relapse prevention)

Women and Alcohol

Women show "telescoping" response to alcohol and have often more severe consequences. Faster progression into dependency.

Irvin Yalom's Existential Psychotherapy

Working with the conscious rather than the unconscious mind.

85

__% of all lung cancers come from smoking

90

___% of nicotine is absorbed by the body through inhalation

Hallucinogens

_________ is not associated with physical withdrawal, A diverse group of drugs that have powerful effects on mental and emotional functioning, marked most prominently by distortions in sensory and perceptual experience.

Drug recognition techniques

__________ provide immediate information about current or recent drug use, and they are minimally intrusive. They rely on observations of body parts and functions that are visible to anyone at anytime, rather than the collection of body fluids and the observation of bodily functions that are considered private

planned framework

a basic arrangement, form, or system that was worked out beforehand for the accomplishment of a particular goal.

electroconvulsive therapy

a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

caffeine

a bitter alkaloid found in coffee and tea that is responsible for their stimulating effects

cocaethylene

a chemical formed when ethanol and cocaine are co-administered

emphysema

a chronic lung disease characterized by difficulty breathing and shortness of breath

Selective Reuptake Inhibitors

a class of antidepressant drugs that work specifically on increasing availability of the neurotransmitter serotonin by interfering with its reuptake

chlorpheniramine maleate

a common antihistamine in cold products

Alcohol Myopia

a condition that results when alcohol hampers attention, leading people to respond in simple ways to complex situations

dependence

a condition where, after using drugs, an individual finds it difficult or impossible to control use. Dependence usually involves a physical and or psychological need for the drug in order to function normally and it usually involves tolerance and withdrawal.

cognitive approach

a counseling technique which focuses on developing understanding of and effecting change in ones thought patterns and processes in order to change feelings and behaviors.

Before a client in need of continued care is discharged...

a counselor MUST provide the client with a list of resources available to assist tin procuring further treatment

Countertransference -

a counselor's unresolved feelings for significant others that may be transferred to the client.

What is a depressant?

a drug that slows down the activity of the brain. When used in small doses they produce relaxation or drowsiness; in larger doses they produce a loss of consciousness similar to a deep sleep. Some can produce impaired coordination, depression and, in large quantities coma and death.

sympathomimetic

a drug that stimulates the sympathetic branch of the autonomic nervous system

Lithium

a drug used to treat mania and bipolar disorder. A mood stabilizer.

Alcohol is eliminated from the body within ____________ of ingestion

a few hours

didactic format

a format designed or intended to provide instruction and information to participants through lectures, films, groups, etc.

neuroleptic

a general term for antipsychotic drugs

dose-response curve

a graph comparing the size of response to the amount of drug.

phenothiazines

a group of drugs used to treat psychosis

antipsychotics

a group of drugs used to treat psychosis; same as neuroleptic

Client- Centered Therapy

a humanistic therapy, developed by Carl Rogers, in which there therapist uses techniques such as active listening within a genuine, accepting, empathetic environment to facilitate clients' growth. (Also called person- centered therapy.) - Patients responsibility to find ways to deal w/reality

depression

a major type of mood disorder including long periods of sadness.

What is dependence?

a maladaptive pattern of substance use leading to clinically significant impairment as manifested by 3 or more of the DSM-IV-TR criteria for a AOD diagnosis occurring during a 12-month period.

alcohol abuse

a maladaptive pattern of use indicated by continued use despite knowledge of having persistent problems caused by alcohol

Liaison Activities

a means of communication between groups. Tasks which facilitate communication among people and services in order to enhance continuity of care.

proof

a measure of a beverage's alcohol content; twice the alcohol percentage. ie 90 proof whiskey contains 45% alcohol

focused interview

a meeting with a client which as a clearly defined purpose and direction.

What is tolerance?

a need for markedly increased amounts to achieve intoxication. a markedly diminished effect with continued use of same amount of drug

Cognitive- Behavioral Therapy

a popular integrative therapy that combines cognitive therapy with behavior therapy

integrate

a process of establishing knowledge, communication, relationship and harmony between pats of a whole which have been split apart or set in opposition to on another through polarization. this isa goal of the maturation process

diagnostic evaluation

a process usual implemented in the very early phases of treatment which employs the use of interviews and assessment tools for arriving at a description and usually a summary statement, usually in the form of a single word or phrase such as "alcohol dependence" often in combination with a numerical code from sources such as the DSM-IV TR or the ICD-9 CM. Its purpose is to establish the basis for assigning a diagnosis.

relapse prevention program

a process whereby indentification of individualized triggers and a plan to confront those triggers is developed

Beriberi heart disease

a reduction of vitamin B-1 that over time cause a normal heart to fail to keep up with an abnormally high metabolic need of the body.

Opiates can produce at low doses?

a relaxed dreamlike state

What is hazardous use?

a repetitive pattern of use that poses a risk of harmful physical and psychological consequences (potential problem).

Screening should be conducted on persons to be ....

a risk, in a variety of settings, by a range of professionals

alcoholic heart muscle disease or AHMD

a serious condition in which the heart does not pump the amount of blood needed to meet the demands of the body.

Physical dependence

a state of functional adaptation to a drug in which the presence of a foreign chemical becomes normal and necessary, and the absence of the drug would present an abnormal state.

.57 correlation coefficient adequate?

a statistic representing how closely two variables co-vary The quantity r, called the linear correlation coefficient, measures the strength and the direction of a linear relationship between two variables. -1 to +1 0 is no correlation or no relationship between the two variables r>.8 is strong r<.5 is week

Cocaine

a stimulant; the primary active chemical in cocoa

Form 90

a structured assessment interview for drinking and related behaviors; uses calendar and standard drink units; self-reported drinking behavior *a comprehensive measure of drinking

longitudinal study

a study done over a period of time (months or years)

ephedrine

a sympathomimetic drug used in treating asthma

amphetamine

a synthetic CNS stimulant and sympathomimetic

General paresis refers to?

a syphilitic infection of the nervous system

couples counseling

a therapeutic approach that brings both members of a committed relationship together to work with a counselor.

Used by CIA to develop...

a truth or mind control drug in 50's & 60's

nitrosamines

a type of chemical that is carcinogenic; several are found in tobacco

schizophrenia

a type of chronic psychosis, "shattered mind" including world salad.

bipolar disorder

a type of mood disorder, also known as manic-depressive disorder.

Cognitive Behavioral Therapy

a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression.

correlate

a variable that is statistically related to some other variale such as drug use

leukoplakia

a whitening and thickening of the mucous tissue in the mouth considered to be a precancerous tissue change.

theobromine

a xanthine found in chocolate

theophylline

a xanthine found in tea

Summary of controlled Substances - Schedule III

a. Potential for abuse less than I and II b. Currently accepted medical use c. abuse may lead to moderate physcial dependence or high psycholgoical dependence (anabolic steroids, most barbituates, dronabinol)

A client discloses that her husband is abusing her three year old daughter. Jurisdictional law mandates the abuse must be reported, however, previous experiences with child protective services have been ineffective. The counselor fears if the abuse is reported it will escalate as child protective services will investigate the matter but take no further action. The counselor's BEST course of action is to

a. consult with their immediate supervisor and follow the supervisor's directives on whether or not to report the abuse b. >>>>adhere to reporting protocols and determine if and if and when the client should be informed of the report. c. develop a plan with the client to remove her and her daughter from the abusive situation and then report the abuse to appropriate authorities d. document as much detail as possible regarding the abuse and continue to monitor the situation until the counselor can make a clear decision about what is in the client's best interest.

Summary of controlled Substances - Schedule II

a. high potential for abuse b. Currently accepted medical use c. Abuse may lead to severe psychological or physical dependence (Morphine, cocaine, methamphetamine)

Summary of controlled Substances - Schedule I

a. high potential for abuse b. No currently acceptable medical use in treatment in the US (heroin, marijuana, MDMA (ecstasy)

Summary of controlled Substances - Schedule IV

a. low potential for abuse relative to III b. currently accepted medical use c. abuse may lead to limited physical or psychological dependence relative to III (alprazolam (xanax) barbital, chloral hydrate, fenfluramine)

Summary of controlled Substances - Schedule V

a. low potential for abuse relative to IV b. currently accepted medical use c. Abuse may lead to limited physicla or psychological dependence to IV (mixtures having small amounts of codeine or opeium

Key symptoms words for Impulsive Actions

abusive behavior, destructive behaviors, throws things, disturbs others, excessive talking, interrupts often, unpredictable behavior, unresponsiveness to discipline

Key symptom words for Neuromuscular Involvement

accident-prone, eye muscle disorder, tics

The neurotransmitter at the neuromuscular junctions in the somatic system is?

acetylcholine - patients who die from Alzheimer has less than normal amount

Common signs and symptoms of Crisis:

active elements:agitation, screaming/yelling, crying, rapid speech, nausea, vomiting, pacing, hyperactivity, flushed face, and intense emotional reactions. passive elements: fainting, going into shock, inactivity, weak pulse, profuse sweating, pale face, emotionally subdued and dull eyes.

acute versus chronic

acute - means sharp or intense - in medicine acute means a condition that comes on suddenly as opposed to a chronic or long-lasting condition. Chronic is long lasting condition. Emphysema

Drug Abuse Screening Test (DAST)

adapted from MAST, in the past 12 months; self-report instrument is used to detect abuse of or dependence on drugs other than alcohol

drug interaction classifications

addititive, synergistic, antagonistic

Administrative supervision provides an opportunity to...

address program policies and standards. Even though supervision is similar to therapy in some ways, there are important differences. Supervision sessions should not evolve into personal therapy sessions.

adlerian therapy

adler's theories are known as individual psychology. He gave us the concept of the inferiority complex and emphasized the importance of birth order on a individual's psychological functioning. encouragement is a major tool in adlerian therapy and this approach places a strong emphasis on helping the client recognize their own strengths and believe in their own dignity and self- worth.

time course

administration of a drug & its effect over time

Mood Disorders: Depressive disorder

affective, behavioral or vegetative, cognitive, and social or interpersonal

ANXIETY DISORDERS

affective, behavioral, cognitive, or somatic

Cocaine action

affects dopamine, norepinephrine, and serotonin levels. Blocks re-uptake of dopamine, prolonging dopamine effects. Depleats it with prolonged use. Toxic effects on cardiac, respiratory, and cns.

Catharsis

after a person has a release of intense emotions, they may be freer to use information and new experience to grow

The most widely-used sedative-hypnotic drug is?

alcohol

Which drug is most clearly linked to violent crime?

alcohol

Benzodiazepine withdrawal is similar to...

alcohol but lasts much longer and may be much worse

Benzodiazepines are sometimes used as medications during detox from...

alcohol due to cross-dependence

Opiates - HCFMMO

all are narcoticanalgesics Natural- opium, morphine and codeine pure or semisynthetic derivatives - heroin, Percodan, Demerol and methadone

What are amphetamines?

all forms of powerful CNS stimulants, that increase the activity of the neurotransmitters serotonin, dopamine and noreadrenaline. They mimic 'flight or flight' responses.

Type I error

alpha error - null hypothesis is rejected as false or unproven when it is actually true.

panic attack

alprzolam (xanax)

What are hallucinogens?

also called psychedelics or psychotomimetics. Share similar properties of both depressants and stimulants. However, their specific function is to distort perception and consequently induce hallucinations (auditory, tactile, and/or visual). In small doses, some hallucinogens such as cannabis reduce inhibitions and cause the user to become more relaxed and feel more socialable

potency

amount of a drug that must be given to obtain a particular response

Which drugs are classes as stimulants?

amphetamines (speed), methamphetamines (crystal meth, ice), dexamphetamines, and methylphenidate (Ritalin), cocaine, nicotine, caffeine, MDMA (ecstasy)

In the 1960s, cocaine became popular again because?

amphetamines became harder to obtain

What are psychostimulant drugs?

amphetamines, cocaine and ecstasy

dextromethorphan

an OTC antitussive (cough control) ingredient

delirium tremens

an alcohol withdrawal syndrome that includes hallucinations and tremors.

Tolerance

an altered physiological state that develops after repeated drug use when the body becomes accustomed and adapts to the presence of the drug and functions normally. Evidence of this is when the drug has less of an effect when using the same dose, or when a larger dose must be used to get the desired effect.

multiple family group

an approach to group therapy or education in which several families are brought together at the same time.

detoxification

an early treatment stage, in which the body eliminates the alcohol or other substance

Acetylcholine

an excitatory neurotransmitter released by axons

double blind procedure

an experiment in which neither the doctor nor the patient knows which drug is being used

Cirrhosis

an irreversible, frequently deadly liver disorder associated with heavy alcohol use.

Alcoholic dementia

an overall decline of intellect

What are the principle effecting of opioids?

analgesia, sedation, respiratory depression and euphoria

Major tranquilizers are now referred to as?

antipsychotics

Anti-anxiety used to treat:

anxiety (Benzodiazepines not recommended for use with addicts)

The DSM-IV now refers to neurosis as?

anxiety disorder

What are the signs of acute THC toxicity?

anxiety, confusion, panic attack, persecutory delusions, visual hallucinations, impairment of short-term memory and attention

suicidal gestures

any act of expression made as a sign of intention towards suicide. A non-lethal suicidal act may signify a cry for attention and or help.

psychosis

any major mental disorder in which the personality is very seriously disorganized and contact with reality is usually impaired.

bibliotherapy

any of a number of approaches to psychotherapy that emphasize short term, efficient therapy. such approaches have been in use since the 1940's. currently several practitioners of brief therapy emphasize not only the brevity, but also a need to focus on solutions to problems, not an understanding of their cause.

brief therapy

any of a number of approaches to psychotherapy that emphasize short term, efficient therapy. such approaches have been in use since the 1940's. currently several practitioners of brief therapy emphasize not only the brevity, but also a need to focus on solutions to problems, not an understanding of their cause.

Korsakoff's psychosis

apparently irreversible condition characterized by the individual's inability to learn new information and remember recent events.

Substance Dependence Severity Scale (SDSS)

assesses DSM-IV dependence and abuse and ICD-10 harmful use for alcohol & other drugs in the past 30 days; frequency & severity of symptoms

Cognitive Lifetime Drinking History (CLDH)

assesses when respondents started drinking regularly, when their drinking patterns changed, and why; drinking patterns assessed for each time interval; quantity-frequency questions, consumed with meals or not, frequency of intoxication; *a comprehensive measure of drinking

diabetes mellitus

associated w/ atypical neuroleptics excessive thirst, headaches, frequent urination, fatigue cuts/blemishes heal slowly

Wernicke's disease

associated with Vitamin B1 deficiency and may be corrected nutritionally

Norepinephrine

associated with arousal reactions and moods.

Acetylcholine

associated with arousal reactions or inhibitory factors.

Dopamine

associated with feeling of pleasure.

Serotonin

associated with feelings of anxiety, depression and aggressiveness.

What are the characteristics of Wernicke's encephalopathy?

ataxia, nystagamus and memory impairment, may be treatable with thiamine replacement. If left untreated it develops in to Korsakoff's syndrome or psychosis.

A less safe class of drug and the one typically used for suicide attempts.

barbiturates

Sedatives, hypnotics and anxiolytics all contain?

barbiturates and anti-anxiety medications such as benzodiazepines (commonly used prescription anti-anxiety drugs). These medications all work by increasing neurotransmitter (GABA) activity to inhibit the user's central nervous system.

mind-body therapy

based on a presumption of unity and linkage between the mind and the boyd, this refers to any therapeutic technique that develops connections between physical actions or manipulations and mental processes or emotional states. Such approaches may include biofeedback, massage, breath work, relaxation training, yoga, meditation.etc..

What are the characteristics of Korsakoff's syndrome?

behavioural abnormalities, and severe memory impairment. Generally irreversible, even with thiamine

Barbiturates have been replaced by safer?

benzodiazepines

anxiety

benzodiazepines (valium, librium, xanax) buspirone (buspar)

Most common agents used in anxiety disorders are?

benzodiazepines - alprazolam and lorazepam not recommended for long-term use

Type II errors

beta error- null hypothesis is not rejected when it is actually false. Often result of too small of sample size.

Maslow's hierarchy of human needs

biological esteem cognitive love/belongingness aesthetic safety selfactualization

Naltrexone-synthetic opioid antagonist

blocks opioids from binding to receptors reduces craving for alcohol was approved by the FDA in 1994 for the treatment of alcoholism

neuroleptic malignant syndrome

blood pressure up and down dazed and confused difficulty breathing, muscle stiffness, rapid heart rate sweating and shakiness, temp above normal

Other side effects

blurred vision, changes in sexual functioning, constipation, diminished enthusiasm, dizziness, drowsiness, dry mouth, lowered blood pressure, muscle rigidity, nasal congestion, restlessness, sensitivity to bright light, slowed heart rate, slurred speech, upset stomach, weight gain

What is the onset and duration of cannabis use?

bong/joint lasts 3-5 hours. Stored in fat cells and accumulates over time, can be positive in urine for a few weeks after last use. One joint equivalent in tar to 2-3 cigarettes. Ingested onset 1 hour and lasts 8+ hours.

endorphins (role of)

brain chemical similar to morphine that plays a role in pain, but there is not a strong link between it and drug dependence

Suboxone

brand name for buprenorphine in combination with naloxone(maintenance)

aldehyde dehydrogenase

breaks down acetaldehyde, a by-product of alcohol .

Currently _________ __________ __________are the most practical accurate and cost effective methods for detecting substance abuse

breath analysis, saliva tests and urinalysis

Substance Abuse Subtle Screening Inventory (SASSI-3)

brief self-reports; identifies probability of substance use disorders and provides clinical insight into level of defensiveness, willingness to acknowledge problems, and the desire for change

Drug recognition process techniques originally were developed by ......

by the Los Angeles Police Department

Other types of stimulants are:

caffeine, nicotine, cocaine, methamphetamine (meth), MDMA (ecstasy), as well as prescription drugs such as Adderall and Concerta, which are used to treat Attention-Deficit Hyperactivity Disorder (ADHD)

With drug recognition techniques, categories of drugs ...

can be detected, but specific drugs can't be determined.

All symptoms of psychiatric disorder...

can be mimicked by alcohol/ drug intoxication or withdrawal

identification

can be through self, court order, a condition of probation or parole, or intervention. screening process helps determine the likelihood of a problem with drugs or alcohol

effects of MDMA

can cause nausea, clenching of jaw and teeth, muscle tension, blurred vision, panic attacks, confusion, depression, anxiety, paranoid psychosis, increased body temperature, cardiac arrest

other effects of LSD

can cause panic attacks, increased blood pressure, heart palpitations, tremors, nausea, muscle weakness, increased body temperature, ataxia (loss of control of body movements)

biploar disorder for treating mania

carbamazepine, valporic acid, olanzapine, risperidone, haloperidol (haldol, epitol, tegretol, dpaken, valproate, valrelease, zyprexa, risperdal)

responsibility-based case management

case management function may be performed by family members, a supportive care network, volunteers, or the client. short and long term involvement. strengths: helps client who does not have easy access to services because responsibilities can be assumed by family members, volunteers, neighbors, or the client. Cost effective, community is involved, and independence encouraged. weaknesses: case managers may not have training or may be inefficient if they are a volunteer.

Broker

case manager links the client with needed services. They help the client choose the most appropriate service and negotiates the terms of service delivery. Their concern is the quality of service and client difficulties

Coordinator

case manager works with other professionals and agency staff to ensure that services are integrated. They must know the state of the client, service delivered, and the progress being made.

Alcohol flush syndrome

causes an individual to feel sick after consuming alcohol because of a lack of the enzyme aldehyde dehydrogenase.

Role-based case management

centers on the roles the case manager is expected to perform. they may serve as the link to a variety of needed services, be a provider of therapeutic care, of monitoring the efficiency or services.

behavior modification

changing human behavior by the application of positive and negative reinforcement of behavior or by other learning techniques.

Bipolar depression is a mood disorder?

characterized by manic-depressive

As addiction is a chronic relapsing condition _____________ testing is a therapeutic tool to help prevent relapse

chemical

urinalysis

chemical analysis often times used to detect the level of drugs in an individuals system.

Drug recognition techniques are a good screening device before ___________ testing

chemical testing

precursors

chemicals that are acted on by enzymes to form neurotransmitters

Aaron Becks Cognitive Behavioral Therapy

client's negative thinking derives from automatic faulty thinking the client is taught how to think more accurately and effectively.

When BAC is 200mg % already showing tremulousness(shakiness of hands), brisk reflexes, tachycardia, diaphoresis (excessive sweating), a CIWA-Ar score in mod or high(15 or higher)?

clinician can predict withdrawal will be relatively severe

Tricycilcs are useful in treating what people?

co-occurring anxiety disorders and depression. Clomipramine

In South America, a popular way to use cocaine is?

coca paste

The most commonly used street drugs that fall into this category are:

cocaine and amphetamines

Crack?

cocaine mixed with baking soda

Wernicke-Korsakoff syndrome

combined condition of Wernicke's encephalopathy and Korsakoff's syndrome - symptoms include nystagmus (abnormal eye movement), problems with gait, memory, confabulation, low Bi, low blood pressure, tremor. Often called wet brain.

Stacking

combining oral and injectable steroids.

What is the 'withdrawal' phase of cocaine withdrawal?

commences 1-2 days after last use, peaking in severity 4-7 days, subsides 1-2 weeks

coexisting conditions

concurrent problems of a biologic, psychological, or social nature that are part of the client's life that systemically relate to the client's primary condition

Access to documentation is governed by...

confidentiality laws: CFR, Part 2 and HIPPAA

Key symptom words for Marked Hyperactivity

constant motion, running instead of walking, inability to sit still

withdrawal from cannabinoids

cravings, anxiety, irritability, nausea, anorexia, agitation, restlessness, tremors, and depression

Before beginning treatment a counselor must: a. Establish rapport b. Reassure the client and reduce anxiety c. Make a formal diagnosis d. Identify the problem

d. Identify the problem

Symptoms of Depressant intoxication

decreased inhibition, slowed reaction times, memory impairment, possible decrease in respirations, slurred speech, ataxia,

When developing a treatment plan with a client, the first step following the identification of a problem is...

defining the long term goals

THC

delta-9-tetrahydrocannabinol, the most important psychoactive chemcial in marijuana

Drug absorption is most rapid when the intramuscular injection is given into the?

deltoid muscle

Stages of family response to drug and alcohol abuse

denial, attempts to eliminate the problem, disorganization and chaos, reorganization in spite of the problem, efforts to escape, family reorganization.

rehabilitation/treatment programs

depends upon assessment and diagnosis and can range from providing education, an intensive outpatient program to an inpatient residential program.

Importance of drug interaction and respiration rate in psychoactive drugs?

depressants action on brain stem slows breathing

Antidepressants used primarily for:

depression and sometimes anxiety

steroid withdrawal

depression, fatigue, restlessness, insomnia, loss of appetite, and decreased interest in sex

Short Alcohol Dependence Data (SADD)

derived from Alcohol Dependence Data (ADD); measure of dependence

Counselors can influence change by...

developing a therapeutic relationship that respects and builds on the client's autonomy

African Americans are at greater risk than other populations for the co-occurrence of?

diabetes and hypertension(high blood pressure) predisposing them to risks of stoke.

safety margin

difference between effective dose & toxic dose - estimating this is an important part of animal testing

The safety margin of a drug is measured by the:

difference between the effective dose level and the lowest toxic dose

What are the effects of cannabis use?

difficult to classify, mixture of mood, cognitive, motor and perceptual effects, has a mixture of stimulant and depressive effects. People may also experience perceptual distortions (e.g. sharpening of the senses or altered sense of time).

Indicators for drug recognition techniques are ....

dilated or constricted pupils, abnormal eye movements, elevated on lowered vital signs, muscle rigidity, and observation of behavioral indicators such as speech, affect, and appearance.

What is the effect of low to moderate use of psychostimulants?

disinhibition, greatly elevated mood, increased sense of energy, increased confidence, increased risk-taking behaviour

The process by which alcohol concentration is increased to more than 15%?

distillation

Key symptom words for Learning Problems

distraction, failure to complete projects, inability to listen or follow directions, short attention span

nonpsychoactive pharmacotherapy

don't cause psychomotor effects or euphoria, may at high doses. azapirones (buspirone), amino acids, beta blockers, antidepressants, monoamine oxidase inhibitors, antipsychotics, lithium, antihistamines, anticonvulsants, and anticholinergic

Cocaine's behavior effects are believed to depend on blocking the reuptake of?

dopamine and serotonin

coca

dried leaves of the coca plant (and related plants that also contain cocaine) Stimulant.

Which of the following is an example of behavioral toxicity?

driving inattentively after smoking marijuana

physical dependence

drug dependence defined by the presence of a withdrawal syndrome, implying that the body has become adapted to the drug's presence

The reduced effect of a drug that may result from more rapid metabolism or excretion of the drug is referred to as?

drug disposition tolerance

What is consciousness of drug use being out of control?

drug use is continued despite knowledge of having recurrent physical or psychological problems likely to have been caused or exacerbated by use of the drug

snorting

drugs can be inhaled into the nose and absorbed through the mucous membranes.

What is a stimulant?

drugs that accelerate activity in the nervous system and increase the body's sense of arousal. In small doses they increase awareness and concentration and decrease fatigue. Irritability, activity, nervousness and insomnia increase as the amount taken increases, and some individuals experience delusions and hallucinations. Excessive doses can lead to convulsions and death.

Psychoactive drugs:

drugs that affect the mind

SSRNI Examples

duloxetine (Cymbalta) and venlafaxine (Effexor). Although buproprion (Wellbutrin) is primarily known to primarily treat depression, preliminary research suggests that it may also be helpful in the treatment of anxiety

cumulative effects

effects of giving multiple doses of the same drug

Person Centered Counselor Core Conditions

empathy, congruence, warm regard

alcohol dehydrogenose

enzyme converts alcohol to acetaldehyde(common by-product of breakdown of alcohol)

Which drugs are classed as depressants?

ethanol (alcohol), benzodiazepines (diazepam), sleeping tablets (Normison), opioids and pain killers (codeine, morphine, heroin), and solvents and inhalants (petrol, nitrous oxide, amyl nitrate)

What are the signs and symptoms of THC use?

euphoria, relaxation, sleepiness, hunger (munchies), feeling of wellbeing, perceptual distortions, impaired memory, depersonalisation, raised pulse, vasodilation (conjunctiva - red eyes), anti-emetic, muscle relaxation, analgesia, anticonvulsant.

Indivdiuals who use antipsychotic drugs may?

exhibit photosensitivity and jaundice

Dysfunctional family roles

family hero, mascot, scapegoat, lost child

Cognitive Depressive Disorder

feeling of hopelessness or cynicism, lack of ambition, brooding behavior, and a general susceptibility of the cognition process.

antipyretic

fever reducing

SSRI Examples

fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). Examples of SNRI medications are

Inhalants effects

flushing, hypotension, headache, cardiac depressants leading to "sudden sniffing death.

Organizational-based case management

focuses on providing a comprehensive set of services and meeting the needs of clients with multiple problems through single point of access, with one location for service delivery

Dysthymic Disorder

form of Depression that is not as debilitating as Major Depressive Disorder. Sometimes called, Neurotic Depression (or Minor Depression). The result of psychological or social factors that create a depressive reaction as opposed to Major Depression that is endogenous and neurochemically based. Diagnostic criteria include a course that lasts for 2 years or more. Only about 6% of the population will suffer.

Effective treatment of youth includes acknowledging the importance of what?

gender differences girls internalize experiences - mood and anxiety disorders boys externalize them-disruptive disorders such as conduct and ODD(oppositional defiant disorders)

Abuse potential

generally related to the drug's speed of action and how long the effects last.

Piloerection

gooseflesh- opiate withdraw symptom

inhalant overdose

hallucinations, muscle spasms, headaches, dizziness, loss of balance, irregular heartbeat, coma from lack of oxygen

Nonbarbiturate paraldehyde is not used because?

has a noxious taste and odor

Speedball is generally the combination of?

heroin and cocaine

cocaine, administration & effects

high from snorting lasts 20-30 min, high from smoking lasts 5-10 min, high from oral administration lasts 8-24 hours, can also be injected; cocaine remains in brain for 2-3 days; affects dopamine (blocks reuptake), norepinephrine, and serotonin; decreased amount of dopamine in brain with prolonged use

Routes of administration

how a person takes substances into the body

Drugs used to induce sleep are called

hypnotics

A smokeable form of methamphetamine is referred to as?

ice

The treatment and recovery continuum of care

identification, assessment, stabilization, rehabilitation, relapse prevention and substance substitution (if necessary)

Goal

identify and change risk factors for unsafe and unhealthy drug use

Elements of a Treatment Plan

identify problems List goals and objectives Resources to be applied person responsible for actions Time frame Expected benefits

Antidepressants treatment for comorbid depression examples

imipramine and nortriptyline and SSRIs(Prozac) - have low addiction potential

Acute induced toxicity

immediate 1) behavioral - intoxication from alcohol, marijuana, or other drugs that impair behavior and increase danger to the individual 2) physiological - overdose of heroin or alcohol causing the user to stop breathing

Ataxia

impaired gait

Cannabis problems

impairment of ability to learn. Medical effects wth prolonged use include respiratory problems, possible impaired immune function and possible reproductive problems includinglow birth weight infants.

dynamic

in any system such as a personality. a family, an organization, or in the counseling dyad, the interplay of elements and forces within the system.

What is hazardous substance use?

in terms of at-risk behaviours such as sharing IV needles, bingeing and using substances in unsafe settings, such as when using machinery

Stage 6: Termination

in this stage people can gaze into the mirror and behold a new man or woman. I have heard clients proclaim, "I no longer want to be that guy." They consider it unthinkable to return to their former lifestyle. It is when I also ask them if they could imagine anything worth losing their sobriety over. At this point, most say no. Even in the face of major loss, they know that if they maintain their resolve to remain clean, they can enjoy a new life.

Impulses

incitement to action without reflection or deliberation

Client records

include information documented by various health care providers. contain component of health history; needs to be updated - don't go by records from 10 years ago because changes have probably occurred. ex: medical records, lab data, physical exams, progress notes, social workers, nutritionists, AOD counselor will deny client access to their records.

stabilization

includes the need for detoxification at an appropriate medical facility if needed.

alcohol dependence

includes the physiological factors of tolerance and withdrawal when usage stops.

Symptoms of Stimulant intoxication

increased heart rate, elevated blood pressure and temperature, decreased respiration. dilated pupils, dry mouth, cardiac arrhythmias, twitching tremors, impaired judgment, confusion, disinhibited behavior, paranoid thoughts, hypervigilance, hallucinations, elation.

reinforcement potential

increased likelihood of repeated use, removal of negative sx or conditions or the amplification of positive sx or states.

Solution Focused Model

increases self-worth, client becomes more invested in accomplishing Tx goals

William Glasser Choice/Reality Therapy

individuals choose most of their behavior and that it is internally motivated by the need to meet one or more of the following basic needs: love and belonging (the most important), power, fun, freedom, and survival.

feedback

information about a client's or organizations behavior or performance which is given back to its source and has potential of altering, modifying, or adjusting the behavior or performance.

The fastest method by which the drug is delivered to the brain is?

inhalation

adenosine

inhibitory neurotransmitter through which caffeine acts

intravenously

injected directly into a vein

intramuscularly

injected into the large muscles

Cannabis OD

insomnia, hyperactivity, decreased activity

1933 to help schizophrenic patients, Sakel used what?

insulin

Heroin WD

intestines moving slowly - diarrhea is one of the most reliable and dramatic symptom

caffeine intoxication and withdrawal

intoxication: restlessness, incrrease diuresis, muscle twitching, arrhythmias withdrawal: Headache, lethargy, depression, weight gain

Tardive dyskinesia

involuntary movements of the tongue or mouth jerky, purposeless movements of legs, arms, or entire body usually seen w/ long-term tx using traditional antipsychotic medications more often seen in women risk increases w/ age and length of time on the med

Hypnotherapy

involves the use of hypnosis, a statement of temporarily altered attention. This may be therapeutic by bringing forgotten experiences into a place where they are accessible by the conscious mind, by allowing the placement of a suggestion during hypnosis which may help a client deal with a particular symptom, or the induced sleep like state may simply be therapeutic in and of itself.

What are the signs and symptoms of opioid withdrawal?

irritability, anxiety, restlessness, apprehension, muscular and abdominal pains, chills, nausea, diarrhoea, yawning, lacrimation, piloerection, sweating, sniffing, sneezing, rhinorrhea, general weakness and insomnia

AUDIT (Alcohol Use Disorders Identification Test)

is a 10-item questionnaire that screens for hazardous or harmful alcohol consumption. Developed by the World Health Organization (WHO), the test correctly classifies 95% of people into either alcoholics or non-alcoholics. The AUDIT is particularly suitable for use in primary care settings and has been used with a variety of populations and cultural groups. It should be administered by a health professional or paraprofessional.

Motivational Interviewing

is a clinical approach that helps people with mental health and substance use disorders and other chronic conditions such as diabetes, cardiovascular conditions, and asthma make positive behavioral changes to support better health. The approach upholds four principles— expressing empathy and avoiding arguing, developing discrepancy, rolling with resistance, and supporting self-efficacy (client's belief s/he can successfully make a change).

CAGE AID

is a commonly used, 5- question tool used to screen for drug and alcohol use.The CAGE Assessment is a quick questionnaire to help determine if an alcohol assessment is needed. If a person answers yes to two or more questions, a complete assessment is advised.

CRAFFT

is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents. CRAFFT stands for the key words of the 6 items in the second section of the assessment - Car, Relax, Alone, Forget, Friends, Trouble.

MAST

is a simple, self scoring test that helps assess if you have a drinking. problem. Please answer YES or NO to the following questions: MICHIGAN ALCOHOLISM SCREENING TEST (MAST)

Gestalt therapy

is an existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating adjustments people make as a result of their overall situation.

Stage 1: Experimentation

is defined as the voluntary use of drugs without experiencing any negative social or legal consequences. For many, experimenting may occur once or several times as a way to "have fun" or even to help the individual cope with a problem. For many, experimentation can occur without any desire to continue using the drug. For others, it can start to become a problem when it moves into the next stage of addiction: regular use.

What is substance abuse?

is often associated with addiction and dependence.

What is Ethyl alcohol (ethanol)?

it is a CNS depressant that is clear and colourless. It is absorbed from the stomach and small intestine and then distributed to every cell in the body

What is Base?

it is an oily, waxy, sticky form of methamphetamine, moist paste or damp powder. Also is a liquid form called 'ox blood'. Stronger in purity than speed, normally swallowed or smoked

What is intoxication?

it is when a persons intake of a substance exceeds their tolerance and produces behavioural and/or physical changes. It usually refers to an elevated blood alcohol concentration such that a person cannot function within their normal range of physical/cognitive abilities.

LD50

lethal dose for half of the animals tested

ranking problems

listing in order of importance or priority the problems that will be given attention so that the treatment will give its focus to areas that need to be addressed.

bipolar disorder for treating depression

lithium, carbamazepine, lamotrigine, fluoxetine, ilmipramine, tranylcypromine (eskalith, carbolith, cibalith-S, lithonate, lithotabs, epitol, tegreto, lamictal, prozac, janimine, tofranil, parnate)

GABA transmitters

located in the mesolimbic system stimulated by certain drugs

Chronic induced toxicity

long-term 1) behavioral - personality changes reported to occur in alcoholics and suspected by some to occur in marijuana users (a motivational syndrome) 2) physiological - heart disease, lung cancer, and other effects related to smoking; liver damage resulting from chronic alcohol exposure

tolerance or withdrawal potential

long-term or chronic use of certain meds can cause tolerance to the subjective and therapeutic effects and prompt dosage increases to recreate the desired effects. drugs that produce tolerance and withdrawal generally have higher risks for abuse and addiction

Behavioral or vegetative depressive disorder

loss of sleep or appetite, increase or decrease in psycho motor functioning, lack of sex drive, loss of energy, and self-destructive behavior.

Alcohol acute effects

low doses: eupohoria, mild stimulation, relaxation, and lowered inhibitions. high doses: drowsiness, slurred speech, nausea, emotional volatility, loss of coordination, visual dostortions, impaired memory, sexual dysfunctions, loss of consciousness/increased risk or injuries, violence, fetal damage.

Which drugs are classed as hallucinogens?

lysergic acid diethylamind (LSD), psilocybin (magic mushrooms) and mescaline (part of the mexican cactus, peyote). Some amphetamine derivatives such as MDMA (ecstasy) are chemically related to mescaline and have both stimulant and hallucinatory properties and may be placed in both categories for classification purposes.

Pleasure/reward center of the brain

made up of the ventral tegmental area (VTA), nucleus accumbens and other structures of the brain.

the basal ganglia is important for

maintaining proper muscle tone

Time Line Follow Back (TLFB)

makes connections between significant events in the client's life and alcohol/drug use patterns and intensity, for the past year; includes calendar and standard drink chart to aid memory; clients fill in number of drinks for each calendar day; useful with elderly; *a comprehensive measure of drinking

problem solver

makes the client self-sufficient by helping them determine their strengths, find alternatives to their current situations, and learn to solve their own problems. They clarify the roles of the client, family, caregiver, and case manager.

Alcohol idiosyncratic intoxication

maladaptive behavior changes will result from an amount of alcohol use that in the majority of people will not intoxicate

Lithium was demonstrated to be effective on

manic patients

Phenobarbital

may be used for detoxifying patients who have been abusing both alcohol and benzodiaxepines.

potency

measured by the amount of drug required to produce an effect.

CNS Depressant dependence

med to high risk of Physical med to high risk of psychological low to medium risk of tolerance

LD50

median lethal dose; dose required to kill 50% of test population. Used to determine acute toxicity, and usually well above the effective dose for 50% of subjects

What is the effect of high use of psychostimulants?

mental confusion, agitation, paranoid ideation, erratic behaviour, hallucinating. Can mimic paranoid schizophrenia

Anxiety disorder

mental disorders characterized by excessive worry, fears or avoidance

pleasure pathway in the brain

mesolimbic dopamine system

Cure for heroin (opiate) addiction?

methadone maintenance treatment program Methadone: A synthetic opiate used to obstruct the effects of heroin for twenty- four hours LAAM: (Levomethadyl acetate) A synthetic opiate used to obstruct the effects of opiates for as many as seventy-two hours Naloxone: Used to treat cases of overdose Naltrexone: Used to inhibit morphine, heroin, and other opiate effects

Quaalude and Sopor were brand names for

methaqualone- Schedule 1 drug

What is ecstasy?

methylene-dioxy-methamphetamine or MDMA. Ingested generally in tablet form, popular 'party' drug, but nowadays difficult to tell what exactly is in a tablet (other substances now sold as 'ecstasy')

The current drug of choice for treating attention-deficit hyperactivity disorder (ADHD) is?

methylphenidate(Ritalin) and dextroamphetamine (Dexedrine) - CNS stimulant most commonly abused along with opioids and CNS depressants.

What are the symptoms of the 'crash' stage associated with amphetamine and cocaine withdrawal?

mood disturbance (flat or dysphoric, anxiety, agitation), aches and pains, exhaustion, fatigue, sleep disturbances (increased need, although insomnia and restlessness may occur)

Mood Stabilizers used to treat:

mood swings (Bi-polar Disorder)

What is the withdrawal phase of THC?

most symptoms commence on day 1,peaking at day 2-3, returning to baseline after a week or two. There is temporal variation in the profile of specific symptoms, with the late onset of aggression (day 4) and anger (day 6) being significant.

What are post-withdrawal interventions for THC?

motivational enhancement, relapse prevention, CBT and other psychosocial interventions

About 1/2 of the emergency room episodes and 3/4 of the drug related deaths are associated with?

multiple drug episodes

Signed Consent should include

name, name of agency, nature of info, purpose for release of info, specific date, event or condition

Opiates

naturally derived from poppies

Affective Anxiety

nervousness, uneasiness, panic, and irritability

What are tolerance and dependence also referred to as?

neuroadaption to opioids

serotonin

neurotransmitter found in raphe nuclei; may be important for impulsivity, depression (linked with suicide)

acetylcholine

neurotransmitter found in the parasympathetic branch in the CNS. Nicotine mimics by stimulating then blocking the receptor sites.

norepinephrine

neurotransmitter that may be important for regulating walking and appetite

Chemicals released from neurons (nerve cells) are called?

neurotransmitters

Is withdrawal from amphetamines and cocaine lifethreatening?

no, but depression resulting from withdrawal can lead to suicidal ideation, self harm and possibly death.

Most medications used to treat mental disorders are...

non-addictive and not harmful to recovery o Anti-anxiety: Used to treat anxiety (Benzodiazepines not recommended for use with addicts) o Stimulants: Primarily used to treat ADHD (not recommended for use with addicts) o Sedative/Hypnotics: Used to treat sleep (not recommended for use with addicts)

More than half of the prescribed antidepressants are prescribed by?

non-psychiatrists

NSAID

nonsteroidal anti-inflammatory drugs, such as ibuprofen

DSM Axises

o Axis I-Clinical syndromes • Alcohol abuse, cannabis dependency o Axis II-Personality disorders/mental retardation • Not used very often in alcohol or chemical use o Axis III-Medical Conditions • Psuerosis of the liver o Axis IV-Psychosocial/environmental stressors • Losing kids because of substance abuse, lacks good social support system o Axis V-Global assessment of functioning • 0-100 how the person is functioning overall

Cognitive anxiety

obsessive worrying and thinking, confusion, lack of concentration, a feeling of impending doom, being overwhelmed and preoccupied by objects, situations, dying, or going crazy by loss of self-constraint

antagonistic interactions

occur when two or more drugs are used at the same time, and the results are less than the sum of the actions of the drugs or the drugs cancel out the effects of each other.

acoholic hepatitis

occurs after a heavy or extended bout of alcohol use and can occur in non-alcohol dependent persons. An inflammation of the liver where metabolism is disrupted, jaundice, yellowing of the skin and whites of the eyes.

What is the 'crash' stage of cocaine withdrawal?

occurs within hours of last use, short duration (up to 48 hours) some do not report significant crash on stopping

gateway

one of the first drugs (alcohol or tobacco) used by a typical drug user. Then moves onto marijuana, amphetamines, cocaine, heroin.

endorphin

opiate-like chemical that occurs naturally in human & animal brain (endogenous)

nalaxone

opioid antagonist used to treat heroin addiction (generic name)

Naltrexone: trade name ReVia

opioid antagonist- medication given to heroine dependent users. May be used to treat alcoholism co morbid with schizophrenia. May cause liver-toxicity

What are the opioid withdrawal treatments?

opioid maintenance program, buprenorphine (helps to reduce intense cravings and alleviates withdrawal symptoms), Clinical opioid withdrawal scale, group therapy, CBT and diversional therapies (distraction is the key to opioid withdrawal)

What does the class of drugs known as opioids include?

opium, codeine, oxycodone, morphine, diacetylmorphine (heroin), pethidine, methadone and buprenorphine

psychosexual stages of development

oral - birth to 1 - mouth anal - 2-3 years - anus phallic - 4-5 years - genitals latency - 6-12 years - latent or dormant genital - puberty on - again active

Psychosexual developmental stages

oral, anal, phallic, latency and genital

PCP, administration & effects

oral, smoked, snorted; causes psychotic reactions, bizarre behavior, outbursts of hostility and violence, and feelings of severe anxiety, doom, or impending death

According to IC&RC addiction is similar to...

other chronic diseases, such as heart disease

What is the THC withdrawal management?

outpatient setting, general management approach for withdrawal should be supportive counselling, accurate information and appropriate planning. No real targeted pharmacotherapies, symptom relief such as anti-emetics, low dose anti-psychotics and benzodiazepines. Must also treat any nicotine withdrawal.

Hallucination LSD acute effects

panic attacks, increased b/p, heart palpitiations, tremors, nausea, muscle weakness, increased body temp, ataxia, accidental dealth (believing one can fly).

Common SSRIs

panic disorder, OCD, PTSD and social phobia use Fluoxetine, sertraline, fluvoxamine, paroxetine and citalopram

Psycho-social hx

part of documentation collected on a client in the initial phases of tx which contains information chronicling significant events and aspects of the clients psychological and social functioning.

sympathetic

part of the autonomic nervous system that controls the "flight or fight" response

Therapeutic doses of medications should be continued through any withdrawal if what?

patient has been taking the medication asprescribed

time course of caffeine

peak blood pressure at 30 minutes, peak CNS effects at 2 hours, half life is 3 hrs

Tertiary prevention programs are those aimed mainly at?

people who have been treated for substance abuse or has stopped the substance abuse without assistance

The body burns off about 1 drink...

per hour

cirrhosis

permanent, widespread destruction of liver cells, which are replaced with nonfunctioning scar tissue. irreversible and fatal if alcohol continues to be used.

Existential

pertaining to existence

counseling theories

philosiphical and practical way of thinking that offers a framework for understanding the client's world and guidelines for problem solving. Well developed theories cover (1)Metaphysics-how the world works. (2) Ethics- how people should act. (3) Logic- cause and effect in relationships . (4) Epistomology-how people change and (5)Ontology-the meaning of human existence.

Somatic anxiety

physical problems such as dry mouth, dizziness, sweaty hands, stomach problems, and pain or tightness in the chest as well as social or interpersonal anxiety symptoms, which are also termed social discomfort

Transactional Analysis (TA)

popular in 1970's many suggest it is a repackaging of Freudian ideas

Inhalants signs and symptoms

possible asphyxiation and frostbite of nose, lips, or larynx if inhaled from a tank, loss of motor control, nausea, ataxia, muscle weakness, dysarthia, nystagmus, diminished reflexes.

cocoa

powder of ground roasted cocao beans with most of the fat removed

Planner

preparing for the service or treatment that the client is to receive. Setting goals, determining outcomes, and implementing the plan with input from the client, family members, other professionals and agencies.

Interpreting

presenting the clt with alternative ways of looking at their situation

All of the following are types of prevention:

primary prevention secondary prevention tertiary prevention

Treatment Plan includes:

problem statement objectives goals completion date

evaluate

process of collecting information regarding the client's problem, history, and circumstances and subjecting that information to informed critical review to arrive at decisions regarding treatment planning. This process occurs in various stages from screening the client, through assessment, treatment, and discharge planning.

GHB/GABA

produced in the CNS and acts as an inhibitory neurotransmitter. Sedative-hypnotic may look like alcohol of s-h intoxication.

Antipsychotics used to treat:

psychosis (mostly schizophrenia) and also bi-polar disorder (mania)

Marijuana can cause:

psychosis and the acute onset of schizophrenia in those that are susceptible. Can tip the balance of those just holding on.

Symptoms of PCP adverse reactions

psychotic reactions, bizarre behavior, outbursts of hostility and violence, severe anxiety, doom or impending death.

Stimulant physical and mental status

pupils dialated, dry mouth, cardiac arrhythmias, twitching, tremors, convulsions, stroke, coma, confusion, disinhibited behaivor, parnaoid thoughts, hallucinations, hyper vigilance, elevation and or depression, suciadal behavior, impaired judgement.

Alcohol Dependence Scale (ADS)

quantitative measure of severity of alcohol dependence (withdrawal, impaired control over drinking, awareness of compulsion to drink, tolerance, drink-seeking behavior); last 12 months

Screening is the first step in establishing

rapport with a potential client •May be clients' first attempt to seek help •An opportunity to provide needed emotional support and guidance

Opiate users

rate of relapse goes down by 60% 6 months to 1 year after stopping methodone/suboxonel maintenance.

therapeutic index

ratio of LD50 to ED50 TI

receptors

recognition mechanisms that respond to specific chemical signals

Drinking Self-Monitoring Log (DSML)

recording drinking on a daily or drink-by-drink basis; subject to fewer memory errors; shows number of drinks consumed each day during monitoring interval; *a comprehensive measure of drinking

Tolerance

reduced effect of a drug after repeated use

effects of inhalants

reduces inhibition, produces euphoria, dizziness, slurred speech, unsteady gait, drowsiness, nystagmus (constant involuntary movement of the eyes), giddiness, headaches, feeling like user is going to pass out, causes damage to the liver, kidneys, brain, and lungs

Symptoms of Inhalant intoxication

reduction of inhibition and euphoria, dizziness, slurred speech, unsteady gait and drowsiness. Nystagmus may be noted, altered consciousness and enhanced sexual pleasure.

What is the overall important points associated with AOD withdrawal?

referral, any intervention is at all helpful for people with AOD use, education is paramount, move someone on to cessation of use if haven't already thought about it, use nonjudgmental therapeutic approach

acute

referring to a drug, the short-term effects of a single dose

Drug use is positively correlated with?

rejection of traditional cultural systems

GABA

relates to inhibitory factors and slows communication.

amphetamines, effects

releases dopamine & norepinephrine and blocks reuptake, creating a euphoric effect

The key attitude for counselors to have to facilitate engagement is...

respect for the client's frame of reference and context

African Americans may display mistrust and a reluctance to show any weakness, to overcome this a counselor should?

respect the client as an equal partner in treatment. FYI- propranolol(alleviates anxiety, can cause memory loss) is less effective (beta blockers), less enzyme activity needed to eliminate diazepam, lower dosages on SSRIs.

Alcohol & drugs primarily effect the...

reward circuitry of the brain (nucleus accumbens)

Ethics are not...

rules

Ugo Cerletti introduced electroconvulsive therapy (ECT) to treat?

schizophrenia

Opiate acute effects

sedation, decreased judgement, decreased ability to operate vehicles, posssible respiratory depression if oding.

Methaqualone

sedative-hypnotic drug (trade name Quaalude) that is a drug of abuse

Existential counseling

seeks to ask and answer fundamental questions about being a human being (e.g., finding meaning in life) and the struggles inherent in this existence.

SSRI

selective serotonin reuptake inhibitors, a type of antidepressant drugs.

An important predictor of client's treatment outcomes is

self- efficacy

What are the adverse effects of psychostimulant use?

serious cardiac toxicity, heart failure, stroke, seizures, adverse behavioural reactions, paranoid psychosis. With chronic use: HTN, arrhythmias, MI, profound mood swings, aggression, psychosis

Depressant overdose

shallow respiration, clammy skin, dilated pupils, weak and rapid pulse, coma, and possible death.

Psychosis (schizophrenia)

short-acting: phenothiazines, butyrophenones, clozapine, trifluoperazine, pimozide, flupenthixol, cholorpromazine (thorazie, haldol, cloziril, stelazine, orap, fluanxol, largactil) long-acting: flupenthixol, fluphenazine decanoate, pipotiazine, haloperidol decanoate (fluanxol, modecate, piportil L4, haldol LA)

Caffeine most effective

short-term in small doses and on a not-to-frequent basis. It also helps with performing physical activities that require a lot of energy (worse with mental activities)

Amphetamines uses

short-term weight reduction, narcolepsy and ADHD

psychoactive pharmacotherapy

significant and acute alterations in psychomotor, emotional, and mental actitivity at therapeutic doses. at high doses euphoria. opioids, stimulants, benzodiazepines, barbiturates, and sedative-hypnotics

subcutaneously

skin-popping, injecting in the fatty layer just under the external skin.

'skin popping'

slang for subcutaneous injection

Symptoms of cannabinoid intoxication

slowed reaction time, altered perceptions, panic, anxiety, nausea, dizziness, depersonalization, paranoid thoughts, trouble expressing thoughts. May cause increases in respiration and heart rate and a slight increase in body temperature. Red eyes, mild dilation, mild tremors, decreased coordination, decreased strength, less ability to perform complex motor tasks and dry mouth.

Depressant effects

slurred speech, disorientation, drunken behavior without odor of alc., imparired membory of events, interacts with alc.

ketamine, administration & effects

snorted or injected; frightening experience of complete sensory detachment, explained as a near-death experience, boredom, paranoia, and possibly coma

Individual Psychology (Alfred Adler)

spanning both the past, present, and the future. motivated toward this feeling of belonging. .teleology, which simply put means that a person is as influenced by future goals as by past experiences. birth order.examination of faulty logic and empowering the client to take responsibility to change through a re-educational process. confronting logic versus behavior. gain insight. take responsibility

Advocate

speaks on behalf of the clients when they are unable to do so, or when they speak but no one listens. Represents interest for the client

Treatment goals should be expressed as...

specific, measurable, expressed in behavioral terms (i.e. the client will...) and include target dates for completion

behavioral terms

statements phrased in such a way as to evoke or specify actions or courses of actions.

effects of caffeine

stimulation, headaches and hyperactivity

Group leaders must limit...

story telling

speed

street name for amphetamine

crystal meth or ice

street names for crystals of methamphetamine hydrochloride

What are the symptoms associated with the 'withdrawal' phase associated with amphetamine and cocaine withdrawal?

strong cravings, fluctuating mood, fatigue, lacking energy, disturbed sleep (vivid dreams), insomnia, aches and pains, headaches, muscle tension, increased appetite, poor concentration, disturbances of thought (paranoid ideation, strange beliefs) and perception (misperceptions, hallucinations)

regression

subconscious retreat to a previous stage

basal ganglia

subcortical brain structures controlling muscle tone; contains striatum, a part of the nigrostriatal dopamine pathway

SOAP

subjective, objective, assessment, and plan is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note.

SOAP

subjective, objective, assessment, plan

inhalation

substances can be inhaled into the lungs by smoking or huffing

behavioral view of etiology

suggests the influence of both positive and negative reinforcement as causal factors for continued drug use.

Discharge Summaries include...

summary of treatment (goals, methods, outcomes and progress), status at discharge, follow up recommendations (aftercare) and referrals.

What does the Alcohol withdrawal scale measure?

sweating, tremor, anxiety, agitation, temp, hallucinations

nicotine poisoning

symptoms often experienced by beginning smokers, including dizziness, diarrhea, light-headedness, rapid and erratic pulse, clammy skin, nausea, and vomiting

Drug recognition techniques are ....

systematic and standardized evaluations process to detect observable signs and symptoms of drug use

oral administration

taken by mouth and swallowed into the stomach.

insight

the ability to understand one's own being; awareness of one's major motivations, desires, feelings and behavioral patterns.

Confrontation

the act of honestly telling another person your perception of what is going on w/o putting them down

effective dose

the amount of a drug necessary to get the desired effect in about 50 percent of those who use the drug

potency

the amount of a drug necessary to produce the desired effect.

Epidemiology

the branch of medical science dealing with the transmission and control of disease. The study (or the science of the study) of the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone of public health, and informs policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive medicine.

Etiology

the cause of a disease

What is withdrawal?

the characteristic withdrawal syndrome for the drug. The substance or a closely related substances taken to relieve or avoid withdrawal symptoms.

acetylsalicylic acid

the chemical known as aspirin

Xanthines

the class of chemicals to which caffeine belongs

assessment

the collection of data from the individual and corroborative sources to determine the extent of the individual's problem and their strengths, weaknesses, and needs.

Nystagmus

the constant involuntary movement of the eyes.

Group process

the continuing development of the individual member and the group as a whole which involves many changes

The most important determinant in a successful treatment outcome...

the counseling relationship between counselor and client, independent from the methods, techniques or modalities employed.

Problems with boundary violations usually occur when...

the counselor gets their personal needs met from professional relationships

Documents for a referred client...

the counselor should document the client's attitude in the subjective description

Counselor self-disclosure

the counselor's sharing of their personal feelings, attitudes, opinions, and experiences for the benefit of the clt

During a crisis focus on...

the current crisis rather than past issues, be solution oriented and develop an action plan

Validity

the degree to which an instrument or process measures what it is designed to measure.

therapeutic index

the dose determined to be safe for use and get the desired effect; determined by dividing the lethal dose by the effective dose

buccal administration

the drug is absorbed through the mucous membranes in the mouth.

transdermal

the drug is absorbed through the skin from a patch.

What influences the severity of opioid withdrawal?

the duration of opioid use, general physical health, and psychological factors, such as the reasons for undertaking withdrawal and fear of withdrawal

Reflection of feeling

the essence of the clt's feeling, either stated or implied, as expressed by the counselor

glutamate

the excitatory neurotransmitter found in most regions of the brain

Barbiturates counteract...

the excitement and alertness obtained from stimulant drugs like cocaine and methamphetamines.

eligibility

the fit between the client's specific problem and/or condition, the client's demographic characteristics, the client's financial resources, and the programs treatment focus and admissions guidelines.

The eligibility criteria are generally determined by

the focus, target population and funding requirements of the counselor's program or agency

Viktor Frankl Logotherapy

the idea that clients have the ability and responsibility to make their own choices regardless of their environment, assumes that a client always has a choice; and no-choice is still a choice.

The MOST important issue for a counselor to consider when a client invites them to dinner is...

the impact on the therapeutic alliance

dysfunction

the inability of an individual to develop the characteristics that make successful survival.

What is the 'extinction' phase of amphetamine withdrawal?

the last weeks to months, gradual resumption of normal mood with episodic fluctuations in mood and energy levels, alternating between irritability, restlessness, anxiety, agitation, fatigue, lacking energy, episodic cravings, disturbed sleep.

half-life

the length of time a drug remains in the body and continues to affect the user.

Nicotiana rustica

the less desirable species of tobacco, which is not widely grown in the United States

support systems

the organizational and social groups, agencies, or networks that can interface with a client to assist them in initiating and maintaining progressive growth. Examples may be family, friends professional assistance, work, etc.,

Existential factors

the person own responsibility for their own thoughts, feelings and behaviors

Decision making

the process of arriving at a course of action in the context of various possible choices to deal with a problem. The process has been described as having 5 stages when used as an approach to working with clients. They are: Developing rapport/structuring; Defining the problem and identifying assets; Determining possible outcomes; Generating alternative solutions; and Generalizing or transferring learning to the real world outside of the counseling setting.

Role induction

the process of educating clts about treatment and preparing them to participate fully in order to obtain what they need

Cravings and triggers cause...

the reward circuit to light up and when this happens the urge to use becomes stronger

treatment methods

the strategies or approaches that make up the process of providing treatment for a child.

psychopharmacology

the study of the behavioral effects of drugs

behavioral approach

the systematic application of learning principles and techniques to the treatment of behavioral disorders. Behavioral therapists assume the disorders are learned ways of behaving that are maladaptive and consequently can be modified in more adaptive directions through relearning behaviors.

individualized

the tailoring of counseling theory and techniques to address an individual's unique needs in order to increase the likelihood of change.

The two most important interventions that create a strong therapeutic relationship are...

the use of active listening and creating a collaborative relationship

Pharmacotherapy

the use of psycotropic or other medication to intervene in a disorder or illness in order to enhance functioning, relieve distress, and facilitate return of the individual to a more functional state.

TI

therapeutic index: LD50/ED50

family therapy

therapy in which the family as a unity, as well as the individual family members, are treated.

Korsakoff's Syndrome

thiamine deficiency damaging to the thalamus that causes deficits in recent memories, disorientation, lack of insight, retrograde amnesia and confabulation - satisfying memory gaps with false information

Cross-dependence

this is evident when a person who is physically dependent on one drug can lessen or prevent withdrawal symptoms by using other drugs from the same or similar classification.

quality care

this is therapeutic help that respects the client as a human being, does not take advantage of the power inherent in the counselor/client relationship and which makes use of techniques that have the greatest likelihood of helping the client. In order to achieve care, a counselor must treat clients ethically and responsibly and stay abreast of current developments in technology of chemical dependence treatment. Follow-up to determine outcome in an important aspect of quality care.

acute fatty liver

this occurs when fat deposits build up in the normal liver cells and can develop in anyone who has been drinking heavily even for a short period of time.

pancreatitis

this occurs when swelling of the pancreatic duct causes a backup of digestive juices causing irritation and swelling of the pancreas.

no doz

this stimulant drug contains 100mg of caffeine

vivarin

this stimulant drug contains 200mg of caffeine

psychoanalysis

three possible definitions:1) it can be viewed as a set of specific techniques devised by Sigmund Freud to study mental process.2) It can also be considered to be Freud's theory of psychology. 3) It can be thought of as a combination of the first two. That is, an approach that utilizes techniques such as free association, dream interpretation and analysis of resistance and transference in order to help an individual understand their unconscious motivations and thus change their symptoms.

Screening within the criminal justice system and juvenile justice system; screening should occur ......

throughout the individual's contact. It should begin upon entry into the system and continue until release

time course

timing of the onset, duration and termination of a drug's effect

What would you use the BDI-II for?

to measure the severity of the patient's Depression.

Alcohol ranks SECOND after WHAT?

tobacco and before drugs in annual deaths - after tobacco and other drugs

pharmacodynamic tolerance

tolerance caused by altered nervous system sensitivty

behavioral tolerance

tolerance caused by learned adaptation to the drug

drug disposition tolerance

tolerance caused by more rapid elimination of the drug

The three basic processes related to the concept of addiction are?

tolerance, physical dependence, reinforcement

behavioral toxicity

toxicity resulting from behavioral effects of a drug

All of the following are key elements of the social influence model:

training refusal skills countering advertising use of teen leaders

Barbiturates are now used for?

treat migraine headaches together with analgesics, such as aspirin or codeine. Thiopental (Pentothal, used as a general anesthetic) Amobarbital (Amytal, used for control of agitated patients) Secobarbital (Seconal)

Alcohol WD symptoms 6-24 hours after last drink.

tremors, nausea, anxiety, irritablility insomnia, feelings of unreality convulsions hallucinations

monopolar disorder (depression)

tricyclic antidepressants, MAO inhibitors, serotonin reuptake inhibitors, trazodone, bupropion (tofranil, elavil, nardil, parnate, prozac, luvox, paxil, celexa, lexapro, desyrel, wellbutrin)

cacao

tropical tree whose seeds are used to make chocolate and cocoa

additive effects

two or more drugs are used at the same time and the results are equal to the sum of the actions of the drugs used.

Marijuana can act as stimulant or depressant depending on:

type of cannabis and THC level

What is the 'crash' stage of amphetamine withdrawal?

typically 12-24 hours after last use, subsides by day 2-4.

What is the 'withdrawal' phase of amphetamine withdrawal?

typically 2-4 days after last use, peaks in severity over 7-10 days, subsides over 2-4 weeks.

Behavioral anxiety

typically includes motor tension, compulsive or nervous actions, voice and speech cues (including shakiness or strain in the voice), and constant watchfulness and scanning.

Acamprosate directions

typically started 5 days after drinking stops reaches full effectiveness in 5 to 8 days Does not interact with BZs or other medications should be taken even if a client relapses Remind patients to take 3 TIMES per day.

Ataxia

uncoordinated walking

side effects

unintended effects of a drug that are not relevant to the treatment

Discrimination

unjustifiable negative behavior toward a group or its members based upon race, religion, age, sex, handicaps, national ancestory, sexual orientation, economic condition

Dependence

use of a substance more often or in greater amounts than user intended and having trouble stopping or reducing its use

abuse

use of a substance that causes problems - social, legal, occupational, psychological, or physical

massage therapy

use of touch systematically and strategically applied to various muscle groups in the body to bring about deep relaxation in order to help with a clients emotional well being. In some instances a kind of mind-body therapy in which the manipulations of massage are believed to release repressed emotional content and bring it to consciousness.

injected

using a needle and syringe

What are the treatment options for amphetamine withdrawal?

usually ambulatory, although some are treated in MHU as may develop psychosis both when intoxicated and in withdrawal. Supportive care approach, as pharmacotherapies do not help much, although benzodiazepines are used for sleep and sedation, as are low doses of anti-psychotics. Specific strategies needed to address agitation, perceptual disturbances and sleep disturbances, frequent orientation necessary, as they can easily misinterpret actions of events

The first of the pharmacological revolution was associated with the development of?

vaccines

Dependence potential of psychoactive drugs

very high: heroin (IV) crack cocaine(AA) high: morphine (injected) Opium (smoked) Moderate/high - cocaine powder (snorted) - tobacco cigarettes and PCP (smoked) Moderate: diazepam (valium) alcohol, amphetamines (oral) Moderate/Low: caffeine, MDMA (ecstasy) Low: kestamine very low: LSD, mescaline, psilocybin

PCP acute effects

visual illusions, hallucinations, and distroted perceptions, feelings of stregth, power, and invulnerability, depresonalization, distorted body image.

Person-centered therapy

was developed by Carl Rogers in the 1940s. This type of therapy diverged from the traditional model of the therapist as expert and moved instead toward a nondirective, empathic approach that empowers and motivates the client in the therapeutic process. The therapy is based on Rogers's belief that every human being strives for and has the capacity to fulfill his or her own potential. Person-centered therapy, also known as Rogerian therapy, has had a tremendous impact on the field of psychotherapy and many other disciplines.

An experiment in which rats were allowed to self-inject drugs showed that the rats?

were more likely to die form cocaine than heroin

behavioral tolerance

when after a period of time and repeated drug use, the users are able to modify their behavior in hopes that others will not notice they are intoxicated

What is impaired control over use?

when the drug is taken in larger amounts or over a longer period than intended

reverse tolerance

when the individual can become more sensitive to the drug's effects rather than less sensitive. Also known as the kindling effect.

Psychological dependence

when the individual has a strong desire to continue to use the drug for emotional reasons and is related to the rewarding effects of the drug. There are no physical withdrawal symptoms with the discontinuation of use.

metabolic tolerance

when the liver adapts to the presence of a drug over time and may produce more of the enzyme needed to break down the drug.

Pharmacodynamic tolerance

when the nerve cells become less sensitive to the effects of the drug over time and repeated use

What is harmful use?

when the pattern of substance use is actually causing harm.

synergistic interactions

when two or more drugs are used at the same time, and the results are greater that the sum of the actions of the drugs used.

What is physical dependence?

where the withdrawal of opioids produces unpleasant symptoms.

CAGE Questionnaire

widely used screening test for problem drinking and alcoholism; 2 "yes" responses indicated the possibility of alcoholism; Have you ever felt you need to CUT down on your drinking?; Have people ANNOYED you by criticizing your drinking?; Have you ever felt GUILTY about drinking?; Have you ever felt you needed a drink first things in the morning (EYE-OPENER) to steady your nerves or to get rid of a hangover?

Controlled substance

will not administer or use a controlled substance or alcohol beverage to the extent that it will be dangerous or injurious to themselves, the puiblic or othe professionals

Legal Standards and Moral Standards

will uphold the legal and accepted moral codes, which pertain to professional conduct

ASAM- problem areas

withdrawal potential biomedical conditions emotional, behavioral, cognitive conditions readiness to change relapse or continued use potential recovery environment

Social and Interpersonal Depressive Disorder

withdrawal, selfishness, passiveness, bad temper, resentment, as well as a lack of healthy relationships and tolerance.

Michigan Alcohol Screening Test (MAST)

yes/no answers to 25 questions; 0-3=absence of alcohol dependence; 4=possible substance dependence; 5+ = likely alcohol dependence

What are the Scientific Methods of Chemical Testing?

• Breath analysis • Saliva tests • Urinalysis • Blood analysis • Hair analysis

SASSI

• Doesn't directly question about alcohol/drug use (not like the previous ones) • Around 50 questions • Asks questions about alcohol/drug use on one side and don't on the other • Looking for defensiveness, looking at others, personal affect • Disadvantages-could be hard to profile

AUDIT

• Ten items 1-3 frequency and quantity 4-6 alcohol dependence 7-10 how harmful alcohol use. • Advantages-you can use it in an interview, it's not that long, it's more specific • Disadvantage-not specific enough, doesn't add in the times when drinking is more acceptable like vacation etc., not valid • Can be self report questionnaire or an interview

CAGE

• The briefest and most widely used. • Only four questions asked directly to the person. • If someone answers yes to one of the questions then there is an indicator that their might be a problem that needs to be further investigated. • If they answer yes to two or more they are sent for further testing. • Advantages-yes or no questions • Disadvantages-not asking about time frame, self report, not in depth about environment, not in depth

MAST

• Widely used • Good reliability and validity • Original had 25 self administered questions the one now has only 22. • Advantages-it could be a reality check to someone taking it, not very time consuming, simple yes and no • Disadvantage-it doesn't ask you to explain, doesn't ask time frame

Chronic diseases have the following characteristics:

•Disrupt the normal, healthy functioning of the underlying organ •Have serious harmful consequences •Are preventable and treatable •Can last a lifetime •May be fatal, if untreated

Neurotransmitters released by different drugs:

•Dopamine: affected by all psychoactive drugs •Serotonin: Alcohol, stimulants, opiates and hallucinogens •GABA: Alcohol, barbiturates & benzodiazepines •Norepinephrine: Stimulants •Endorphins: Opiates •Anandamide: Marijuana •Glutamate: Hallucinogens

Opioids include:

•Heroin •Oxycodone (OxyContin®, Percocet®, Percodan®) •Hydrocodone (Vicodin®) •Hydromorphone (Dilaudid®) •Meperidine (Demerol®) •Fentanyl (Sublimaze®, Duragesic®) •Methadone (Dolophine®) •Propoxyphene (Darvon®) •Pentazocine (Talwin®)

How does amphetamine affect the neurotransmitters?

•Increases in norepinephrine levels boost the body's natural "fight-or-flight" responses Increases in serotonin levels produce mood improvement •Increases in dopamine levels produce heightened sensations of pleasure in a brain pathway that's normally used to reward behaviors that help sustain everyday existence (food and sex) Increases dopamine, norepinephrine, and epinephrine and similar to cocaine cause an excess in synapse and they are not able to be reabsorbed but they stay around longer

Natural opiates include:

•Opium •Morphine •Codeine

Different types of barbiturates:

•Phenobarbital-Long •Amobarbital-Intermed •Pentobarbital-Short •Secobarbital-Short (intermediate and short acting indicates high abuse potential)

Withdrawal symptoms

•Shakes, profuse sweating, alcohol/other drug seeking, agitation, headache, vomiting, high heart rate, possible visual and auditory hallucinations (1-24 hours as BAC drops) •Grand mal seizures (within 24 hours) •Severe agitation, confusion, disorientation, high body temperature, tachycardia, tactile & visual hallucinations (bugs), delusions, possible violent behavior, death (DTs = Delerium Tremens)

Marijuana is considered to be a mixture of:

•Stimulant •Depressant •Hallucinogen

Different types of Benzodiazepines:

•Valium-diazepam (long-acting) •Librium-chlordiazepoxide (long-acting) •Ativan-lorazepam (short acting) •Klonopin-clonazepam •Restoril-temazepam •Xanax-alpraxolam (short acting) •Serax-oxaxepam

Withdrawal symptoms include:

•depression •apathy •fatigue •increased appetite •unpleasant dreams •insomnia •slowed thinking

Withdrawal symptoms:

•uneasiness •diarrhea •abdominal cramps •chills •sweating •nausea •runny eyes •runny nose. •enlarged pupils

BAC and metabolism in a standard drink has ½ ounce of ethanol, and the body eliminates ¼ ounce of ethanol per hour or 10-30 mg(.01-.03)

"If you drink faster than one drink every two hours, your BAC will climb."

Euthymia

"Normal" mood

CNS Depressants are referred to as...

"downers" because they diminish the normal function of the brain

Ecstasy is called...

"the love drug" because 20-60 minutes after ingestion the user may have feelings of happiness, clarity, peace, pleasure, altered perceptions, empathy for others, self awareness, open mindedness, and intimacy.

Stimulants, sometimes called...

"uppers," temporarily increase alertness and energy

Rapid Alcohol Problems Screen (RAPS4)

"yes" to one or more questions indicates possibility of alcohol dependence; during the last year have you had a feeling of guilt or REMORSE after drinking?; has a friend or family member ever told you about things you said or did while you were drinking that you could not remember (AMNESIA)?; have you failed to do what was normally expected of you because of drinking (PERFORM)?; do you sometimes take a drink when you first get up in the morning (STARTER)?

psychadelic

'that which manifests the soul' Substances that increase the creativity and perceptions of aspects of one's own mind previously unknown.

deactivation - 2 methods

(1) drug is excreted from the body unchanged (2) drug is chemically changed such that it no longer has same effect on body

four questions about dosage that must be answered in rational use of drugs

(1) what is the effective dose? (2) what dose will be toxic? (3) what is the safety margin? (difference between effective dose & toxic dose) (4) adverse reactions?

6 Counseling Process

(Individual, Group, and Significant Others): The utilization of special skills to assist individuals, families or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision-making.

Lithium (generic name)

(brand names Eskalith, Lithobid) most widely used and studied medication for treating manic episodes due to bipolar disorder. Combined with antidepressants to treat depression. Helps reduce the severity and frequency of mania. May also help relieve bipolar depression. Significantly reduce suicide risk. Helps prevent future manic and depressive episodes. May be prescribed for long periods of time (even between episodes) as maintenance therapy. Natural salt, effective in reducing or preventing the recurrence of manic and depressive episodes.

What treatment is best for Anxiety clients who present with phobia?

*exposure-based treatments (including desensitization) relaxation and social skills training are effective treatment choices. *Antidepressants or benzodiazepines may be needed.

Disulfiram: who should NOT take

*hypersensitivity to rubber derivatives, sulfur, or nickel *coronary artery disease *liver disease *women who are nursing

No Dual Relationships- list:

+Acting on romantic or sexual feelings +Sponsoring a client or former client in a 12-Step program +Counseling a client with whom you've had a current or prior personal relationship +Socializing with clients or former clients +Having a business relationship or giving/receiving personal favors/gifts +Giving clients phone numbers or having contact outside the scope of the professional relationship (unless required by one's job)

The most important ethical principles:

+Do no harm +Informed consent +Self-discosure +Professional competence +No dual relationships +Confidentiality

Active Listening

+Listening without thinking or judging +Reflecting (summarizing your understanding) +Open-ended questions (not interrogation) +Using effective body language +Reading non-verbal cues (the body never lies)

Stages of Change

+Pre-contemplation +Contemplation +Preparation +Action +Maintenance

Authorizations must include:

+client's signature +to whom the information is to be released +the specific information to be released +the time frame for the release (includes both written & verbal information)

Cognitive behavioral approaches include:

+relapse prevention +psychoeducation +skills training +mindfulness +refusal skills training

Exceptions to authorizations

+release to state and federal agencies +accreditation bodies +third party payers +court orders +medical emergencies (a subpoena is not sufficient to release, it must be a "good cause" court order)

PAWS symptoms

+unclear thinking +memory problems +emotional overreaction and mood swings +sleep disturbances +dizziness +difficulty managing stress

Hypomania (bipolar disorders)

- 'Mild' form of mania - Excessive hyperactivity, however it is not severe enough to cause marked impairment in social /occupational functioning, nor to require hospitalization

Effects of barbituates/anxiolytics

- A feeling of euphoria, yet in a relaxed state, disinhibition of sexual/aggressive impulses, impaired judgement/attention memory - Combined with alcohol can lead to unconsciousness, seizure, coma, and death - Respiratory depression - Barbituates: Seconal, Nembutal, Amytal, Phenobarbital, Quaaludes

Atomoxetine (Strattera)

- ADHD medications - Not a Central Nervous System Stimulant (SNRI) - Most effects result from release of norepinephrine - This medication is specifically for ADHD - It increases attention span - Adverse reactions include: mood swings /suicidal ideation, dizziness/fatigue /insomnia, hypotension, nausea/vomiting, anorexia, decreased libido

Serotonin Syndrome

- Adverse of effect of SSRIs (rare and life-threatening event) - Thought to be related to over-activation of the serotonin receptors, either for too high a dose or in combination with other drugs - S/sx: abdominal pain, sweating, fever, tachycardia, elevated BP, altered mental state (delirium), muscle spasms, irritability, hostility and mood change, hyperprexia, cardiovascular shock or death

TCA's side/adverse effects

- Anticholinergic action - Blockage of Histamine 1 receptors - Alpha-adrenergic action - Cardiovascular (dysrhythmias, tachycardia, and MI)

Etiological implications of abuse

- Areas of brain affected: temporal lobe, limbic system, amygaloid nucleus - Neurotransmitters (norepi, dopamine, serotonin) - Brain tumors, brain trauma, encephalitis - Unmet needs for satisfaction/security - Children learn by imitating their role models - Product of one's culture and social culture

Guidelines for interventions for patients with acute mania

- Assess if they are a danger to self/others - Firm, calm approach and short, concise explanations - Structured environment, decrease stimuli, provide structure solitary activities - High cal fluids and finger foods, monitor sleep patterns - Teach about meds and strategies - Usually mood stabilizing agent + antipsychotic

SAD PERSONS

- Assessment tools to ascertain risk factors for potential suicide behaviors - Individuals are assigned 1 point for each applicable character - The total point score correlates with an action scale that assists the health care provider to make a decision regarding hospitalization

Sedatives/Hypnotics/Anxiolytics examples

- Barbituates (Seconal, Nembutal, Amytal, Phenobarbital, Quaaludes) - Non-barbituates (Dalmane, Restoril, Halicon) - Benzodiazepines (Valium, Xanax, Librium, Ativan) - Club/"designer" drugs (Rohypnol, Gama hydroxbutryic acid- GHB) - Alter balance of neurotransmitters, enhance the action of GABA, decrease impulse transmission, depress the activity of brain, nerve, muscle and cardiac tissue, CNS depressants

Opiate withdrawal clinical manifestations

- Begin 6-10 hours after last dose, craving for the drug, respiratory depression - Nausea/vomiting/diarrhea - Severe muscle aches (especially abdominal pain) - Rhinorrhea/lacrimation, crawling skin sensation, pinpoint pupils, coma/death

Affect (assessment of depression)

- Behavioral expression of emotion; feelings of being sad, anxious, helpless, hopeless - Facial expressions convey sadness, show little or no emotion, speaks in monotone, may only respond with a yes or no - Frequent sighing is common - Often no eye contact, bout of weeping or patients cannot cry - Patient looks older than stated age - See the world via gray-colored glasses

Cluster C personality disorders

- Behaviors that are described as anxious or fearful - Avoidant personality disorder, Dependent personality disorder, Obsessive-compulsive personality disorder

Cultural blindness

- Believes that color or culture makes no difference & that all people are the same - Ignores cultural strengths

BAL

- Blood alcohol level - Intoxication occurs at 0.10% - Drunk driving limit is 0.08%

Dysthymic Disorder

- Characterized by a chronic depression syndrome that is usually present for many years (to Dx for at least 2 years) - Clinical manifestations are less severe than those of a major depressive disorder, few physiologic symptoms - Mood disturbance is hard to distinguish from the individual's usual pattern of functioning, minimal or occupational impairment

Depressive disorders

- Characterized by a loss of interest in life (anhedonia) - Types: Major Depressive Disorder, Seasonal Affective Disorder (SAD), Dysthymic Disorder, Schizoaffective Disorder, Premenstral Dysthymic Disorder, Depressive Disorder with Post Partum Onset

Major Depressive Disorder

- Characterized by changes in several aspects of an individual's life, depressed mood or loss of interest or pleasure in usual activities - At least 2 weeks, no history of manic behavior, and symptoms that cannot be attributed to use of substances or a general medical condition - Can include psychotic features (hallucinations, delusions)

Treatment of CNS stimulant withdrawal

- Chlorpromazine (Thorazine)- decreases physiological effect - Diazepam (Valium)- decreases the tachycardia and helps to prevent seizures - Other options include phenobarbital - Imipramine (Tofranil) for the severe depression which is common

Cyclothymic disorder (bipolar disorders)

- Chronic mood disorder involving both hypomania and dysthymic mood swings - Delusions are not present - Does not require hospitalization - Social, occupational or interpersonal functioning is not grossly impaired

Schizotypal personality disorder

- Cluster A personality disorder - A graver form of the pathologically less severe schizoid personality pattern - Clinical picture: Clients are aloof and isolated, behave in a bland and apathetic manner, live in a fantasy world, everyday world manifests (Magical thinking, ideas of reference, delusions, depersonalization, superstitiousness, withdrawal into the self), exhibit bizarre speech pattern, when under stress, may decompensate and demonstrate psychotic symptoms, demonstrates bland, inappropriate affect

Paranoid personality disorder

- Cluster A personality disorder - A pervasive distrust and suspiciousness of others such that others' motives are interpreted as malevolent; condition begins by early adulthood and presents in a variety of contexts - Clinical picture: Constantly on guard, hypervigilant, ready for any real or imagined threat, trusts no one, constantly tests the honesty of others, insensitive to the feelings of others, oversensitive, tends to misinterpret minute cues, magnifies and distorts cues in the environment, does not accept responsibility for his or her own behavior, attributes shortcomings to others

Schizoid personality disorder

- Cluster A personality disorder - Characterized primarily by a profound defect in the ability to form personal relationships, failure to respond to others in a meaningful emotional way - Clinical picture: Indifferent to others, aloof, emotionally cold, no close friends; prefer to be alone. In the presence of others, clients appear shy, anxious, or uneasy, inappropriately serious about everything and have difficulty acting in a light-hearted manner

Antisocial personality disorder

- Cluster B personality disorder - A pattern of: socially irresponsible, exploitative, guiltless behavior that reflects a disregard for the rights of others - Clinical picture: Fails to sustain consistent employment, fails to conform to the law, exploits and manipulates others for personal gain, fails to develop stable relationships, lacks remorse, unable to delay gratification - Risk for other-directed violence related to rage reactions, negative role-modeling, inability to tolerate frustration - Defensive coping related to dysfunctional family system - Chronic low self-esteem related to repeated negative feedback resulting in diminished self-worth

Borderline personality disorder

- Cluster B personality disorder - Characterized by a pattern of intense and chaotic relationships with affective instability, clients have fluctuating and extreme attitudes regarding other people, clients are highly impulsive - Most common form of personality disorder, emotionally unstable, directly and indirectly self-destructive: often self-mutilate, lacks a clear sense of identity - Make contract with patient not to self-mutilate! Suicide contract also! - Risk for self-mutilation related to parental emotional deprivation - Risk for suicide related to unresolved grief - Risk for other-directed violence related to underlying rage

Narcissistic personality disorder

- Cluster B personality disorder - Characterized by an exaggerated sense of self-worth, lack empathy, believe they have the inalienable right to receive special consideration. - Clinical picture: Clients are overly self-centered, exploit others in an effort to fulfill their own desires, mood, which is often grounded in grandiosity, is usually optimistic until you do them wrong! - Clients are relaxed, cheerful, and care-free. Until you do them wrong!

Histrionic personality disorder

- Cluster B personality disorder - Personality is: excitable, emotional, colorful, dramatic : Actors & Actresses, extroverted in behavior - Clinical picture: Self-dramatizing, attention-seeking, overly gregarious seductive: Love you immediately, manipulative, exhibitionistic, highly distractible, have difficulty paying attention to detail, are easily influenced by others, have difficulty forming close relationships: have many friends, but have no true friends, strong need for approval; feel dejected and anxious if they don't get it

Dependent personality disorder

- Cluster C personality disorder - Characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation - Clinical picture: notable lack of self-confidence that is often apparent in their posture, voice, mannerisms, Typically passive and acquiescent to desires of others, overly generous and thoughtful, while underplaying their own attractiveness and achievements, low self-worth and easily hurt by criticism and disapproval, assume passive and submissive roles in relationships, avoid positions of responsibility and become anxious when forced into them.

Obsessive compulsive personality disorder

- Cluster C personality disorder - Characterized by inflexibility about the way in which things must be done. - Devotion to productivity at the exclusion of personal pleasure. - Clinical picture: Especially concerned with matters of organization and efficiency, tend to be rigid and unbending, clients are polite and formal, clients are rank-conscious (ingratiating with authority figures). - Appear to be very calm and controlled. Underneath there is a great deal of: ambivalence, conflict. hostility

Avoidant personality disorder

- Cluster C personality disorder - Characterized by: extreme sensitivity to rejection and social withdrawal - Clinical picture: Awkward and uncomfortable in social situations, desire close relationships but avoid them because of their fear of being rejected, perceived as timid, withdrawn, or cold and strange, often lonely and feel unwanted, view others as critical and betraying

Therapeutic modalities for depression (Psychotherapy)

- Cognitive-Behavioral Therapy (Ellis): decreases depressive thought patterns, helps the individual address negative cognitive processing, negative thoughts about: oneself, world, future - Cognitive-Behavioral Therapy: increases positive reinforcement from others and environment via effective social and coping skills - Interpersonal Theory (Sullivan): reduce depressive s/sx, emphasis on relationships and social functioning

Side effects of MAOIs

- Common: hypotension, sedation/weakness/fatigue, muscle cramps, changes in cardiac rhythm, urinary hesitancy/constipation, weight gain, sexual dysfunction - Serious: hypertensive crisis (medical emergency, s/sx: severe occipital headache, marked increase in BP, palpitations/chest pain, nuchal rigidity, nausea/vomiting, fever/sweating

Physiological (assessment of depression)

- Concerning body functions: anorexia/overeating, insomnia/hypersomnia, somatic complaints, fatigue, anergia - Somatic concerns: headaches, pain, vague body aches, changes in physiologic functioning are called "vegetative signs of depression" (alterations in activities which support physical life and growth - Individuals with depressive disorders may express any of the following: anergia, anhedonia, anxiety/guilt, feeling worthless, feeling helpless, feeling hopeless

Complementary vs. conventional medicine

- Conventional: concerned with structure, function and connections or communication between material elements that compose the body, views all human beings as very similiar (biologically), disease is deviation from what is considered to be a normal biologic state - Complementary/alternative: views person-body as consisting of multiple, integrated elements that incorporate both materialistic & nonmaterialistic (physical, spiritual, energetic, and social bodies)

Interventions for depressed patients

- Convey caring, empathy, potential for change - Spend time with patient, even in silence is not a 'waste of time' - Instilling hope is a key tool for recovery - Utilize counseling and communication strategies - Assess need for self-care; offer support when appropriate - Monitor & intervene to maintain adequate nutrition, hydration and elimination - Provide adequate balance of rest, sleep and activity - Involve individual's support system - Teach about medications and therapies - Continuously assess for the possibility of suicidal thoughts and ideation throughout course of recovery **Remember: High risk for suicide when antidepressants begin to take effect; individual now has the physical and emotional energy to carry out a plan

Designer drugs withdrawal clinical manifestations:

- Depends on dosage and half life of the drug - Respiratory depression - Tachycardia/orthostatic hypotension - Nausea/vomiting/malaise - Anxiety/psychomotor agitation - Insomnia/hallucinations - Seizure (especially with barbituates)

Seasonal Affective Disorder

- Depressive disorder that occurs in relation to the season (generally winter) - Characterized by hypersomnia, fatigue, weight gain, irritability and interpersonal difficulties - Seasonal differences in the amount of daylight is thought to disrupt melatonin production, circadian rhythms and/or ability to process dopamine and norepinephrine - Melatonin influences sleep-wake cycle and circadian rhythms (sedative effects)

Treatment of hypertensive crisis (caused by MAOIs)

- Discontinue med - Do not lie pt. down (increases bp in head) - IV Thorazine (blocks norepi) - IV Regitine (Phentolamine- induces hypotension) - External cooling measures to control hyperpyrexia

Mania (bipolar disorders)

- Disorder where the predominant mood is elevated, expansive or irritable, motor activity is frenzied and excessive - Psychotic features may or may not be present - Characterized by: flight of ideas, grandiosity, hyperactivity, sexual over activity, excessive spending, pressured speech, decreased food and fluid intake, significant impairment in social/occupational functioning

Effects of hallucinogens

- Dizziness, insomnia, euphoria, heightened response to color, texture, sounds, all feelings are magnified (love, lust, hate, anger) - A sensation of 'slowed' time, increased HR & BP, decreased respiratory rate, can lead to violent and out of control behavior - "Bad" trip: individual is in a psychotic state and terrified by perceptual changes - Flashbacks: occur spontaneously when the individual is drug-free, "reliving" of the experiences the individual "felt" while under the influence the drug

Cluster B personality disorder

- Dramatic, emotional, or erratic behaviors - Antisocial personality disorder, Borderline personality disorder, Histrionic personality disorder, Narcissistic personality disorder

SSRI's patient teaching

- Drowsiness, irritability, insomnia - Take dose early in the day (esp. Prozac) - Teach about decreased libido - Do not take any OTC medications or herbal preparations without consulting a physician - Individuals with a tendency toward mania should not take SSRI's - Do not discontinue abruptly - Report any unusual 'reaction' to physician immediately

Therapeutic modalities for depression (ECT)

- Electroconvulsive Therapy - Treatment for depression in which a grand mal seizure is induced by passing an electrical current via electrodes that are applied to the temples - A muscle relaxant minimizes seizure activity and prevents damage to long bones and cervical vertebrae - Indications: There is a need for a rapid, definitive response when a patient is suicidal or homicidal, patient is in extreme agitation or stupor, patient develops a life-threatening illness because of refusal of food/fluids, history of poor response to medication - Considered for tx only after a trial of therapy with antidepressant medication has been ineffective and thought to be effective because it increases the circulating levels of serotonin, norepinephine and dopamine

Therapeutic modalities for depression (Exercise)

- Exercise can have a profound effect on stress reduction - Can manage the transient syndrome of mild depression

Lithium side effects

- Expected side effects (<0.4 to 1.0 mEq/L): fine hand tremor, polyuria and mild thirst, mild nausea & general discomfort - Early side effects (<1.5 mEq/L): N/V/D, thirst/polyuria, lethargy, slurred speech, muscle weakness, fine hand tremor - Advanced signs of toxicity: Coarse hand tremor /incoordination, persistent GI upset, mental confusion /sedation, muscle hyperirritability, EEG changes - Severe signs of toxicity: Ataxia /clonic movements /seizures, confusion, large amount of dilute urine, blurred vision, hypotension, stupor /coma - Levels >2.5 mEq/L: seizures, oliguria, death - NO KNOWN ANTIDOTE FOR LITHIUM POISONING

Effects of 'designer' drugs

- Fast acting benzos that cause anterograde amnesia, memory loss of events occurring while under the influence of the drugs - produce euphoria and disinhibition of impulses

Etiology of depression (Biologic theories):

- Genetic factors - Biochemical factors (Deficiency/dysregulation in norepinephrine, serotonin, dopamine) - Neuroendocrine factors (Increased levels of cortisol secretion)

Lithium guidelines/patient teaching

- Help prevent relapse, blood serum levels are monitored closely - Lithium is not addictive, maintain normal diet and normal salt and fluid intake (2500 mL to 3000 mL /day), decreases sodium reabsorption by the renal tubules, which can cause sodium depletion - Low sodium decreases renal excretion, lithium accumulates in the blood and clan lead to toxicity - Withhold drug if excessive diarrhea, vomiting or diaphoresis occurs - Dehydration can raise Lithium levels: Call physician - Lithium is irritating to gastric mucosa, take with meals - Periodic monitoring of renal and thyroid function is indicated with long-term therapy

Enabling

- Helping a chemically dependent individual avoid experiencing the consequences of their substance abuse

Personality disorders occur when these traits become:

- Inflexible, maladaptive, the cause of significant functional impairment or subjective distress - People with personality disorders are not often treated in acute care settings in cases in which the personality disorder in their primary psychiatric disorder

Codependency

- Involved being preoccupied with controlling another person's behavior - Seen when a family member both rescues and blames the substance abuser

Therapeutic modalities for depression (Phototherapy)

- Light therapy is effective because of the influence of light on melatonin - Exposure to light suppresses the nocturnal secretion of melatonin, which has a therapeutic effect on individuals with SAD

Mood stabilizing agents (Psychopharmacology for bipolar disorders)

- Lithium Eskalith, Lithobid - Lithium stabilizes electric activity of neurons, interacts with Na and K at cell membrane to stabilize electrical activity, decreases the excitatory neurotransmitter glutamate to exert an antimaniac effect - Narrow therapeutic margin (0.8 - 1.4 meq/L), blood levels should be monitored on a regular basis

Hallucinogens

- Lyseric acid diethylamide (LSD): aka acid, Mescaline (peyote, a mushroom), PCP (angel dust), Ketamine, MDMA - Action: affect dopamine, serotonin, norepinephrine, and opioid receptors in the brain, distort perception of reality, visual sensory perception and induce hallucinations

Behavior (assessment of depression)

- Manner in which an individual acts, tearful, regression, restless, agitation, withdrawal, psychomotor retardation, decreased interest in hygiene/grooming - Patient may speak slowly (their mind is 'slowed') - In extreme depression, the patient may be mute

Anti-epileptic medications action (Psychopharmacology for bipolar disorders)

- Many of these medications act by increasing levels of GABA - Tegratol, Lamectal and Trileptal act by affecting the sodium channels in neurons - Neuroton acts by stabilizing neuronal membranes - Topamax acts by blocking sodium channels in neurons and enhancing GABA

Cannabis

- Marijuana and hashish - Action: derives from hempl plant, contains THC - THC acts on the CNS and cardiovascular system - THC stored in the fatty tissues - especially the brain and reproductive systems

Premenstrual Dysthymic Disorder

- Markedly depressed mood, excessive anxiety, mood swings, and decreased interest in activities during the week prior to menses and subsiding shortly after the onset of menstruation - Symptoms begin toward last week of luteal phase (day 7-day 10) and are absent in the week following menses (hormones are increased)

SSRI's side/adverse effects

- May induce agitation, anxiety, sleep disturbance, tremor, sexual dysfunction or tension headache, dry mouth, sweating, weight gain, mild nausea or loose bowel movements - Serious adverse effect: Serotonin Syndrome

TCA's patient teaching

- May take 1 to 3 weeks; 4 to 6 weeks for full effect - Drowsiness, dizziness and hypotension generally subside after the first few weeks - Caution about working around machines, driving, crossing street, related to altered reflexes, drowsiness /dizziness - No alcohol - it can block the effect of the medication - Dispense at bedtime to reduce experience of side effects during the day - Do not stop taking med abruptly

Alcohol

- Mechanism of action: CNS depressant - Potentates GABA activity and decreases glutamate activity - One positive answer to CAGE assessment is a strong indication of alcohol problem (Cut down, annoy anyone with problem, guilty about drinking, eye opener first thing in the morning)

MMPI

- Minnesota Multiphasic Inventory - Evaluates personality

MAOIs action and examples

- Monoamine oxidase inhibitors - Prevent destruction of monamines by inhibiting action of MAO (monoamine oxidase) - MAO can no longer break down tyramine with MAOIs, so tyramine blood levels increase - High tyramine levels can lead to high blood pressure, a hypertensive crisis, then CVA and death - Ex: phenelzine (Nardil), tranylcypromise (Parnate), selegiline transdermal (Emsam)

Bipolar disorders

- Mood disorders where pt. experiences moods that alternate between depression and elation - Bipolar I disorder: occurrence of one or more manic, depressed and /or mixed episodes - Bipolar II disorder: characterized by the occurrence of one or more hypomanic episodes along with one or more major depressive episodes

Opiods

- Morphine, Heroin, Codeine, Dilaudid, Percodan, Methadon, Fentanyl - Action: endorphins, enkephalins, and dynorhins are the naturally occurring substances that stimulate opiate receptors in the brain, provide pain relief and pleasant 'feelings,' regulate body temperature, respiration, endocrine, and GI activity, external opiates attach to those same opiate receptors, general effect is CNS depressant

Treatment of opiate withdrawal

- Naloxone (Narcan) a narcotic antagonist to reverse respiratory depression and coma - Reversal is rapid

Cluster A personality disorders

- Odd or eccentric behaviors - Paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder

Depressive Disorder with Post Partum Onset

- Onset within 4 weeks of delivery - Important to distinguish this from the "baby blues" - Pervasive, can turn into post-partum psychosis, if not treated - Gets worse after first child

Battering

- Pattern of behavior used to establishpower/control over another through fear and intimidation, often including threat or use of violence - This happens when one person believes they are entitled to control another

Behaviorism

- Pavlov - All people are subject to "conditioning" - Classical and Operant conditioning

Effects of cannabis

- Produces significant analgesic effect - Can be seen on an EEG, diffuse impairment for up to 2 months after last use - Causes neurocognitive deficits in attention, learning, memory and intellectual functioning, euphoria, relaxed inhibitions, depersonalization, heightened sensory perception, sensation of 'slowed' time - Tachycardia/orthostatic hypotension, increased appetite, lowers testosterone levels in males, chemicals accumulate in ovaries - Withdrawal s/sx: restlessness, insomnia, hypersomnia, paranoia, psychosis

Etiology of depression (Psychosocial factors):

- Psychoanalytic theory (Freud): Depression is related to loss (actual/symbolic) - Cognitive theory (Beck): Model of depression points to errors of logical thinking as causative factors for depression (Negative expectations: environment, self, future), automatic thoughts are rapid, unthinking responses based on unique assumptions about ourselves and the world - Learned helplessness (Seligman): Stressful events that are experienced as uncontrollable result in the development of helplessness, apathy, powerlessness, and depression

Etiology of depression (Psychodynamic influences and life events)

- Psychosocial theory that explains depression from an environmental and life events perspective (stress), which is combined with a biological 'vulnerability' - Trauma may result in long-term hyperactivity of the CNS corticotrophin-releasing factor and norepinephrine systems with a consequent neurotoxic effect

Oppositional Defiant Disorder

- Recurrent and hostile pattern of behavior toward authority figures - Disruptive, argumentative, hostile and irritable, social problems with peers and adults - does NOT include physical aggression, destructive behavior, being deceitful, theft or serious violation of rules

Effects of Opiates

- Rush/thrill followed by a high (sense of calmness) followed by dysphoria as well as impairment of attention, judgment, and memory - Sedation, respiration depression, pupil constriction, anticholinergic effects

Anti-epileptic medications side effects

- Sedation, tremor, mild GI upset - Serious adverse effects: Tegretol (agranulocytosis), depakote (hepatitis), lamicatal (Steven-Johnson syndrome)

SNRI's action and examples

- Selective Norepinephrine Reuptake Inhibitors - Increase both serotonin and norepinephrine - Fewer adverse reactions than other classes of antidepressants - Ex: enlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta), trazodone (Desyrel) - Cymbalta can be used for depression and diabetic peripheral neuropathy

SSRI's action and examples

- Selective serotonin reuptake inhibitors 1.) Block the neuronal uptake of serotonin (This increases the availability of serotonin in the synapses) - As a group, they have less ability to block the muscarinic and histamine -1 receptors than the TCA's - Faster onset than TCA's and fewer adverse reactions - Also used for treatment of OCD and panic disorder - Ex: fluoxetine (Prozac), sertraline (Zoloft), paproxetine (Paxil), citalopram (Celexa)

Inhalants and action

- Solvents (gasoline, lighter fluid, paint, glue) - Propellant gases (butane, propane, nitrous oxide) - Substances displace oxygen and cause tachycardia, decreases the ability of oxygen to bind to RBC, act as CNS depressant

Treatment of hallucinogens withdrawal

- Speak slowly, clearly in soft voice - Reality orientation, medication for anxiety or agitation/violent behavior

Integrative care

- The blending of conventional and complimentary and alternative medicine (CAM) - also described as "holistic," incorporates the entire person (biological, psychological, social, spiritual) - 5 basic principles: 1.) body has ability to heal itself 2.) health and healing are related to mind, body, and spirit 3.) basic good health practices build the foundation for healing 4.) healing practices are individualized 5.) people are responsible for their own healing

Cognitive (assessment of depression)

- Thinking skills, including logic, awareness, memory, intellect, language, reasoning/judgment - Preoccupation with loss, obsessive/repetitive thoughts, difficulty concentrating, delusions, misinterpreting reality - When depressed, a patient is unable to think clearly, has poor judgment, unable to make decisions, memory and concentration is poor, may have delusional thinking

Treatment of designer drugs withdrawal:

- Treated symptomatically - Antidote for benzos is flumazenil (Romazicon) - Maintain airway, seizure precautions, IV fluids, dialysis - Substitution therapy for CNS depressant withdrawal is common with a long-acting barbituate, Phenobarbital

TCA's action and examples

- Tricyclic antidepressants 1.) Block the reuptake of norepinephrine and serotonin to a lesser degree (Therefore, there is increased levels of norepinpehine and serotonin in the synapse) - Elevates mood, increases mood, activity, and alertness, decrease preoccupation and morbidity, improve appetite, regulate sleep patterrns 2.) Block the muscarinic receptors that bind to acetylcholine (Leads to typical anticholinergic effects: blurred vision, dry mouth, tachycardia, constipation) 3.) Block histamine-1 receptors in brain (Leads to drowsiness, sedation, weight gain) - Strong binding at adrenergic receptors results in dizziness, hypotension and tachycardia - Ex: amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor)

Splitting behavior

- Used primarily by clients with Borderline Personality Disorder - Client labels one person "all good" and the others "all bad". - Best to have personality disorder patients assigned to one nurse/contact per shift

Substance-Induced Disorders specifiers

- With Onset During Intoxication - With Onset During Withdrawal

Atypicals for Mood Disorders

- mirtqazapine (Remeron): potentiates effects of norepi and serotonin, offers both antianxiety & antidepressant effects, antiemetic effect - buPROPion (Wellbutrin): works with dopamine, serotonin, norepinephrine, tx for depression

Behavior therapy

-B.F. Skinner - Humans are shaped and determined by socio- cultural conditioning

Behavioral Modification Theory

-Based on the idea that all behavior is learned, and what is learned can be unlearned. - Modeling means learning a behavior by observing another performing the behavior.

How many oz of alcohol can be metabolized an hour?

.25

What is the BAC LD50?

.40 or 400 mg/dL

Levels of Care

.5 early intervention II Intensive outpatient, III Residential/Inpatient, IV medically managed

ASAM- levels of care

0.5 early intervention 1. outpatient treatment 2. intensive outpatient/partial hospitalization 3. inpatient/residential 4. intensive inpatient/ medically managed

DSM V: 11 Criteria for Substance Use Disorder

1 Taking the substance in larger amounts or for longer than the you meant to 2 Wanting to cut down or stop using the substance but not managing to 3 Spending a lot of time getting, using, or recovering from use of the substance 4 Cravings and urges to use the substance 5 Not managing to do what you should at work, home or school, because of substance use 6 Continuing to use, even when it causes problems in relationships 7 Giving up important social, occupational or recreational activities because of substance use 8 Using substances again and again, even when it puts the you in danger 9 Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance 10 Needing more of the substance to get the effect you want (tolerance) 11 Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Three major categories of abused substances that require detox

1) Alcohol and other CNS depressants (benzos/barbiturates) 2) Opiate drugs 3) Cocaine

Five Critical Components of Effective Treatment

1) Assessment 2) Patient-Treatment Matching 3) Comprehensive Services 4) Relapse Prevention 5) Accountability

The Purpose of Assessment

1) Identify those who are experiencing problems with substance abuse or have progressed to the stage of addiction 2) Assess the full spectrum of problems for which treatment may be needed 3) Plan appropriate interventions 4) Involve appropriate family members or significant others 5) Evaluate the effectiveness of the interventions that are implemented The first stage of the treatment process Gather information from a variety of sources Without a CA, there is a risk of treating the wrong set of problems or failing to provide any intervention for some problems Include physical and medical problems, drug use history., psychosocial problems, psychiatric disorders, current SES and eligibility for various problems

Six Stages of Counseling

1) Information Gathering - Counselor gathers as much info as possible to make a valid assessment and treatment plan 2) Evaluation - Nature and severity of the presenting problem, cause of the symptoms, relief of the symptoms, client's readiness for counseling, and client/counselor match 3) Feedback 4) Counseling Agreement - Practical issues which set limits (length of session, number of sessions, payment), expectations, goals 5) Changing Behavior 6) Termination - Is a stage in the counseling process, not the last session

Three Stages of Drug/Alcohol Counseling

1) Medical/Physical Intervention 2) Psychosocial Rehabilitation 3) Aftercare

What are the three models of case management?

1) role-based case management 2) organization-based case management 3) responsibility-based case management

The number of people in the US arrested for drug-law violations each year is?

1,000,000

9 categories of symptoms

1. Emotional Concern 2. Compulsive Actions 3. Impulsive Actions 4. Marked Hyperactivity 5. Learning Problems 6. Neuromuscular Involvement 7. Cognitive and Perceptual Disturbances 8. Physical complaints 9. Sleep Problems

Screening - Global Criteria

1. Evaluate psychological, social, and physiological signs and symptoms of alcohol and other drug use and abuse. 2. Determine the client's appropriateness for admission or referral. 3. Determine the client's eligibility for admission or referral. 4. Identify any coexisting conditions (medical, psychiatric, physical, etc.) that indicate need for additional professional assessment and/or services 5. Adhere to applicable laws, regulations and agency policies governing alcohol and other abuse services.

Case Study steps

1. ID treatment issues (symptom clusters) 2. Find and ID symptoms (9 categories)

HPI Elements

1. Location 5. Timing 2.Quality 6. Context 3.Severity 7. Modifying Factors 4. Duration 8. Associated Signs and Symptoms

Steps of an intervention

1. Someone must reach out for help 2. During the first meeting, the counselor discusses with the individual what important issues are facing the client 3. A list is made of the important people in the clients life who have seen the behavior and consequences 4 a training is set up to teach the family how to intervene 5. The intervention happens

What are the 3 key elements in drug recognition process?

1. Verifying that the person's physical responses deviate from normal 2.Ruling out a non-drug related cause of the deviation 3.Using diagnostic procedures to determine the category or combination of drugs that is likely to cause the impairment.

Drug related emergency room visits

1. cocaine 2. alcohol in combination 3. opiods (not heroin) 4. marijuana 5. benzodiazepines 6. heroin 7. stimulants includes methamphetamine 8. PCP 9. MDMA (ecstasy 10. inhalants

Discharge

1. instructions 2. prescriptions 3. plan/follow up/referral 4. warnings 5. documentation on ER discussion

drug related deaths

1. opiods (not heroin) 2. cocaine 3. alcohol in combination 4. benzodiazepenines 5. antidepresssants 6. methadone 7. sedative-hypnotics (non benzodiazepeine 8. heroin 9. stimulants (includes methamphetamine 10. marijuana

What are the three classifications of opioid compounds?

1. pure agonists: drug that binds to receptors to induce changes to the cells that stimulate physiological activity (includes morphine, methadone, heroin, oxycodone & methadone) 2. partial agonist: drug that binds to the receptor but does not produce maximum stimulation. Therefore, it 'occupies' receptor and may stop another agonist from fully binding (e.g. buprenorphine) 3. antagonist: no intrinsic pharmacological action, but can block agonists. They can reverse the effects of pure agonists by dislodging them from receptor (e.g. naloxone, naltrexone)

What are the 7 DSM-IV-TR Diagnositic Criteria of AOD diagnosis?

1. tolerance 2. withdrawal 3. impaired control over use 4. wish to quit 5. time lost to drug activities 6. lifestyle changes 7. consciousness of drug use being out of control

Withdrawal Process

1. tremors, heartbeat rapidity, sweating, loss of appetite, 2. hallucinations in many senses 3. delusions, disorientation, amnesia, delirium 4. seizures

Treatment for alcohol abuse

1.) AA 2.) Meds: disulfiram (Antabuse - prevents relapse, can be deadly if consumed with alcohol), naltrexone (ReVia - decreases alcohol craving), acamprosate (Campral - helps to decrease alcohol craving), buprenorphine hydrochloride (treatment for outpatient detox)

Classification of CAM/5 domains

1.) Alternative medical systems (TCM- traditional chinese medicine, acupressure, acupuncture, chinese herbology, cupping, tai chi, qi gong & ayurveda, homeopathy, naturopathy) 2.) Mind-body interventions (relaxation breathing, prayer, meditation, biofeedback, imagery, humor, hypnosis, journaling, yoga) 3.) Biologically-based therapies (herbal therapy, nutraceuticals, nutritional therapy, aromatherapy) 4.) Manipulative & body-based methods (chiropractic, acupresure, reflexology, hydrotherapy, light & color therapies, alternate nostril breathing, colonics) 5.) Energy therapies (therapeutic touch, healing touch, reiki, magnet therapy) Others: pet therapy, psychosocial therapy, interpersonal therapy, reality therapy, relaxation therapy, assertiveness training, cognitive therapy

ADHD psychopharmacology

1.) CNS stimulants (enhance dopamine and norepinephrine, improve attention and focus, decreases impulsive actions) 2.) Dextroamphetamine/amphetamine composite (Adderall) 3.) Methylphenidate (Ritalin Concerta) 4.) Dexmethylphenidate (Focalin) 5.) Atomoxetine (Strattera) 6.) Bupropion (Wellbutrin) 7.) Imipramine (Tofranil)

Treatment of alcohol withdrawal

1.) IVF 2.) Mg sulfate (decrease irritability caused by low Mg levels and to prevent seizures) 3.) Administer vitamins, especially Thiamine (Vit. B1), helps prevent Wernicke's encephalopathy 4.) Benzos (Librium or Serax) to help prevent DTs 5.) Seizures may be treated with IV diazepam (Valium) &/or phenyton (Dilantin)

Side effects of alcohol withdrawal

1.) Minor: can occur within 6-12 hours after last ingestion, s/sx can last 48-72 hours - Hangover s/sx: nausea, vomiting, headache, sweating/thirst, irritability, vasomotor instability, gastritis, fatigue, restlessness, the 'shakes' 2.) Major: appear within 2-3 days, s/sx can last 3-5 days - Wernicke's encephalopathy (advanced CNS problem, lack of vitamin B1/thiamine, paralysis of ocular muscles & confusion) can lead to Korsakoff's psychosis (confusion, loss of recent memory and confabulation) - Delirium Tremens (DTs): severe sudden mental &/or neurologic changes, severe memory disturbance, agitation, anorexia, and hallucinations

Anxiety disorders in children

1.) Separation anxiety disorder 2.) Obsessive compulsive disorder 3.) PTSD

5 categories of antidepressant medications

1.) TCA's (tricyclics) 2.) SSRI's (selective serotonin re-uptake inhibitors) 3.) SNRI's (selective norepinephrine re-uptake inhibitors) 4.) Atypical 5.) MAOI's (monoamine oxidase inhibitors)

How many of the adult population label themselves as abstainers?

1/3

Alcohol related crime

1/3 of suicides, 36-70% of homicides

Brief MAST

10 items

Alcohol Use Disorders identification Test (AUDIT)

10 items on instrument, developed by WHO; asks about frequency of drinking, alcohol dependence & problems caused by alcohol in the past 12 months; scores range from 0-40; a score of 8+ indicates likelihood of harmful alcohol consumption

Equal alcohol content:

12 ounces of beer, 5 ounces of wine, and 1½ ounces of hard liquor have about equal alcohol content

Serving sizes for alcohol

12 oz. of beer = 5 oz. of wine = 1.5 oz. of liquor

The age group that is least likely to have used alcohol in the previous 30 days is?

12 to 17

Assessment - Global Criteria

12. Gather relevant history from the client including but not limited to alcohol and other drug abuse using appropriate interview techniques. 13. Identify methods and procedures for obtaining corroborative information from significant secondary sources regarding clients' alcohol and other drug abuse and psycho-social history. 14. Identify appropriate assessment tools. 15. Explain to the client the rationale for the use of assessment techniques in order to facilitate understanding. 16. Develop a diagnostic evaluation of the client's substance abuse and any coexisting conditions based on the results of all assessments in order to provide an integrated approach to treatment planning based on the client's strengths, weaknesses, and identified problems and needs.

POSIT

139 items on it Used for substance use problems and social, behavioral, and learning problems Disadvantages-too long, repetitious, lack of consistency Advantages-more detailed

Obsessive Compulsive Drinking Scale (OCDS)

14 questions regarding drinking and attempts to control drinking; ideas, thoughts, impulses, images related to drinking

What is the epidemiology of substance related disorders?

14% of all Americans will have an alcohol related substance use disorder in their lifetime. 7% (15 million) 12 or older current users of illicit drugs

Treatment Planning - Global Criteria

17. Explain assessment results to the client in an understandable manner. 18. Identify and rank problems based on individual client needs in the written treatment plan. 19. Formulate agreed upon immediate and long-term goals using behavioral terms in the written treatment plan. 20. Identify the treatment methods and resources to be utilized as appropriate for the individual client.

The highest rates of illicit drug use are in what age group?

18 to 25

Controlled Substance Act

1970's Act that classified drugs according to medical use, potential for abuse, and possibility of dependence

Alcohol proof:

2 times the percentage of alcohol (ETOH) If the label says 20 proof, it's 10% alcohol, if it 80 proof, it's 40% alcohol

Mild

2-3 symptoms

Alcohol Intoxication Signs and Symptoms

20mg-80mg=.02-.08% loss of muscular coordination, changes in mood, personality alteration. 80mg-200mg=.08-.2% ataxia, slurring 200mg-300mg=.2-.3% nausea, vomiting, sedation 300mg = hypothermia, unconsciousness 400mg = coma 600mg= death

Counseling - Global Criteria

21. Select the counseling theories that apply. 22. Apply techniques to assist the client, group, and/or family in exploring problems and ramifications. 23. Apply techniques to assist the client, group, and/or family in examining the client's behavior, attitudes, and/or feelings if appropriate in the treatment setting. 24. Individualize counseling in accordance with cultural, gender, and lifestyle differences. 25. Interact with he client in an appropriate therapeutic manner. 26. Elicit solutions and decisions from the client. 27. Implement the treatment plan.

How many general hospital admissions are related to chronic alcohol use?

25%

Hazelden

28 day version of the Minnesota Model that started in teh '60s. Has strong AA orientation. Uses primary therapists,psych testing, therapeutic milieu, systems therapy, and family involvement

Case Management - Global Criteria

28. Coordinate services for client care. 29. Explain the rationale of case management activities to the client.

Marijuana is detectable in body up to...

3 months for a chronic user

Impaired Control Scale (ICS)

3 part instrument measuring attempts to control drinking in last month, degree of success in controlling drinking in last 6 months, and perception of ability to control it now

Alcohol use is associated with?

3/5 of all murders 40% of all assaults 1/3 of forcible rape and child molestation 50% committing violent crime

Rate for co-occurrence of bipolar and addictive disorders range from?

30-60%

Crisis Intervention - Global Criteria

30. Recognize the elements of the client crisis. 31. Implement an immediate course of action appropriate to the crisis. 32. Enhance overall treatment by utilizing crisis events.

About how many homeless people in the US have some form of mental illness?

33%

Client Education - Global Criteria

33. Present relevant alcohol and other drug/abuse information to the client through formal and/or informal processes. 34. Present information about available alcohol and other drug services and resources.

Referral - Global Criteria

35. Identify needs and/or problems that the agency and/or counselor cannot meet. 36. Explain the rationale for the referral to the client. 37. Match client needs and/or problems to appropriate resources. 38. Adhere to applicable laws, regulations and agency policies governing procedures related to the protection of the client's confidentiality. 39. Assist the client in utilizing the support systems and community resources available.

Detectable in urine for how many hours?

36 hours

In most commercial beers today, alcohol content is a little over?

4%

Moderate

4-5 symptoms

Rate for co-occurrence of schizophrenic and addictive disorders range from?

40-80%

Report and Record Keeping - Global Criteria

40. Prepare reports and relevant records integrating available information to facilitate the continuum of care. 41. Chart pertinent ongoing information pertaining to the client. 42. Utilize relevant information from written documents for client care.

42 CFR, Part 2

42 CFR = Code of Federal Regulations (commonly referred to as "Part 2") The federal confidentiality laws that specifically pertain to alcohol & drug health information concerning services and clients.

While confidentiality is an ethical guideline there are two specific laws that govern confidentiality:

42CFR, Part 2 & HIPAA

Consulatation With Other Professionals In Regard To Client Treatment/Services - Global Criteria

43. Recognize issues that are beyond the couselor's base of knowledge and/or skill. 44. Consult with appropriate resources to ensure the provision of effective treatment services. 45. Adhere to applicable laws, regulations and agency policies governing the disclosure of client-identifying data. 46. Explain the rationale for the consultation to the client, if appropriate.

TWEAK

5-item scale developed to screen for risk drinking during pregnancy; TOLERANCE - how many drinks can you hold?; WORRIED - have close friends and relatives worried or complained about your drinking in the past year?; EYE-OPENER - do you sometimes take a drink in the morning when you first get up?; AMNESIA - has a friend or family member every told you about things you said or did...; K (CUT DOWN) - do you sometimes feel the need to cut down on your drinking?

What percentage of people with substance use disorder have co-occurring disorder

50%

Severe

6 or more symptoms

Barbiturate WD effects

6-8 hours after use nausea, vomiting, rapid heart rate, extreme sweating, stomach cramps, tremors

Intake - Global Criteria

6. Complete required documents for admission to the program. 7. Complete required documents for program eligibility and appropriateness. 8. Obtain appropriately signed consents when soliciting from or providing information to outside sources to protect client confidentiality and rights.

% male drinkers % female drinkers % college students drinking past month

60 45 62

Cocaine blocks what percentage of dopamine reuptakes?

60-70% of dopamine reuptake sites

Orientation - Global Criteria

9. Provide an overview to the client by describing program goals and objectives for client care. 10. Provide an overview to the client by describing program rules, and client obligations and rights. 11. Provide an overview to the client of program operations.

glia

90% of brain cells are these - they produce myelin, the loss of which causes multiple sclerosis

Rational- Emotive Therapy

A Cognitive Therapy based on Albert Ellis' theory that cognitions control our emotions and behaviors; therefore, changing the way we think about things will affect the way we feel and the way we behave. - Belief system is the cause of emotional problems

Psychodynamic Theory

A Freud-influenced perspective that sees behavior, thinking, and emotions as reflecting unconscious motives.

Summarizing

A brief review of the main points discussed in the session to insure continuity in a focused direction

Summarizing

A brief review of the main points discussed in the session to insure continuity in a focused direction (feedback) Can focus on both feelings and content, should be brief and to the point, without new or added meanings This can take place after an entire session or after long statements from a client Selection and tying together - Select the key components discussed, bring about themes

Addiction:

A chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences

Alcoholism

A chronic, progressive, potentially fatal illness characterized by tolerance and loss of control over beverage alcohol is

Psychoanalytic Therapy

A client's adult pathology can be traced to early sexual development, particularly a lack of sexual gratification during one of five psychosexual developmental stages.

Rational Emotive Therapy

A cognitive behavior therapy method developed by Albert Ellis. The method looks at an individual's specific beliefs about a set of specific behaviors or events and how those beliefs lead to specific consequences. The rationality of those beliefs is then challenged and where beliefs are found to be irrational, new rational beliefs are substituted. The theory holds that with appropriate beliefs, there will be new and appropriate behaviors and consequences.

resistance

A conscious or unconscious opposition to the uncovering of the unconscious

Variable

A construct that has two levels or categories a therefore can vary.

4 Assessment Explanation

A continuing process, it is generally emphasized early in treatment. It usually results from a combination of focused interviews, testing and/or record reviews.

Dextromethorphan (DXM)

A cough suppressant and mucus-clearing ingredient in some over-the-counter cold and cough medicines

Paraphrasing

A counselor statement that mirrors the client's statement in exact or similar wording

Paraphrasing

A counselor statement that mirrors the client's statement in exact or similar wording (feedback). The counselor must identify the client's message and give that back to the client in one's own words Communicates to the client that the counselor understands or is trying to understand Can clarify confusing content Determining the basic message and rephrasing it The counselor should get in the habit of "checking out" if he/she was right Determine the client's basic message and rephrase the content

Probing

A counselor's response that directs the client's attention inward to help both parties examine the client's situation in greater depth (feedback)

Probing

A counselor's response that directs the clients attention inward to help both parties examine the client's situation in greater depth

Probing

A counselor's response that directs the clt's attention inward to help both parties examine the clt's situation in greater depth

Confrontation

A counselor's statement or question intended to point out contradictions in the client's behavior and statements, or to induce the client to face an issue the counselor feels the client is avoiding

Confrontation

A counselor's statement or question intended to point out contradictions in the client's behavior and statements, or to induce the client to face an issue the counselor feels the client is avoiding (feedback)

8 Crisis Intervention

A decisive, crucial event in the course of treatment that threatens to compromise or destroy the rehabilitation effort.

Alcohol Short-Term Effects

A distorted sense of perception Reduced inhibitions Drowsiness Raised heartbeat Impaired motor coordination

Hallucinogens:

A diverse group of drugs that alter perception (awareness of surrounding objects and conditions), thoughts, and feelings They cause hallucinations, or sensations and images that seem real though they are not

Social anxiety disorder

A fairly common psychological disorder that involves an irrational fear of being watched or judged. The anxiety caused by this disorder can have a major impact on an individual's life and make it difficult to function at school, work, and other social settings.

In relation to physical dependence, psychological dependence is?

A greater problem, since many addicts have gone through withdrawal will later relapse.

Example of Case Management

A heroin addict may have hepatitis, lack job skills and have a pending criminal charge. In this case, the counselor might monitor his medical treatment, make a referral to a vocational rehabilitation program and communicate with representatives of the criminal justice system. The client may also be receiving other treatment services such as family therapy and pharmacotherapy, within the same agency. These activities must be integrated into the treatment plan and communication must be maintained with the appropriate personnel.

Tolerance:

A higher amount is required to achieve the same effect

Predisposition factors for Dysthymic Disorder

A major loss in childhood (often an important caretaking person), a recent loss, chronic stress, the presence of a personality disorder with compulsive or dependent features and alcohol or drug abuse.

Acculturated Interpersonal Style

A member of a minority group has made a conscious or subconscious decision to reject the general attitudes, behaviors, customs, rituals, and stereotypic behaviors associated with his/her own minority group to assimilate into the mainstream white culture

Bicultural Interpersonal Style

A member of a minority group has pride in his/her racial identity, its history and cultural traditions and yet is comfortable in operating in the white world

Culturally Immersed Interpersonal Style

A member of a minority group has rejected white values and culture

Traditional Interpersonal Style

A member of a minority group is neither accepting nor rejecting of his/her cultural identify

Marijuana:

A mixture of dried, shredded leaves, stems, seeds and flowers of the hemp plant Cannabis sativa.

Statements about certain types of stressors are used as hints about the type of disorder. For example:

A normal stressor suggests an adjustment disorder Trauma suggests an anxiety disorder Certain types of stressors without clinical symptoms suggest V codes

Salvia divinorum (salvia)

A plant common to southern Mexico and Central and South America.

What is speed?

A powder form of amphetamine or methamphetamine. Weakest form of amphetamine used. It can be used IV, snorted or swallowed.

LSD

A powerful hallucinogenic drug; also known as acid (lysergic acid diethylamide).

Cocaine:

A powerfully addictive stimulant drug made from the leaves of the coca plant native to South America

Buprenorphine

A prescription medication for people addicted to heroin or other opiates that acts by relieving the symptoms of opiate withdrawal such as agitation, nausea and insomnia. More weakly addictive and has a lower risk of overdose than methadone. The effects last for about three days.

Alcoholism

A primary, chronic disease with genetic, psychosocial, and environmental factors influencing it's development and manifestations. the disease is often progressive and fatal. It is characterized by impaired control, preoccupation, use despite consequences, and distortions in thinking.

Research question

A question that identifies what the study hope to examine.

Core Function of Screening

A quick snapshot of who the client is and to determine if the client is eligible/appropriate for the type of treatment

Extrinsic Motivator

A rationale for changing substance use that comes from outside the client

6 Counseling

A relationship in which the counselor helps the client mobilize resources to resolve his or her problem and/or modify attitudes and values. Counselor demonstrates a working knowledge of various counseling approaches. These methods may include Reality Therapy, Transactional Analysis, Strategic Family Therapy, Client Centered Therapy, etc.

9 Client Education example

A sequence of formal classes may be conducted using a didactic format with reading materials and films. An outpatient counselor may provide relevant information to the client individually or informally.

Withdrawal syndrome refers to?

A set of consistent symptoms that appear when drug usage stops.

Ethics:

A set of principles that guide our actions

Peyote (mescaline):

A small, spineless cactus with mescaline as its main ingredient. Peyote can also be synthetic

Minnesota Model

A state hospital in Minnesota that used the 12 steps in the treatment setting. Typical length of stay was 60 days. Level of care happened all within the same system.

Culturally Liberated Counselor

A style of counseling in which a counselor does not fear racial or cultural differences and is aware of his/her attitudes, making efforts to be actively involved professionally and personally in the solutions to racial problems

Cultural Ignorance

A style of counseling in which a counselor has little or no prior exposure to a minority culture and whose fear causes him/her to be ineffective in working with a minority client

Covert (Hidden) Prejudice

A style of counseling in which a counselor is aware of his/her fears and dislikes for a minority culture but hides those fears beneath the surface of the counseling posture

Ecstasy (MDMA):

A synthetic drug that alters mood and perception

Methadone

A synthetic narcotic drug that is used for heroin treatment, is long lasting and eliminates the need for a patient to take medication at home is

ANOVA (Analysis of variance)

A test that is used when there are two or more means to compare.

Biopsychosocial

A theory or perspective that relies on the interaction of biological, individual psychological and social variables.

Cognitive Behavioral Therapy

A therapeutic approach that seeks to identify and modify negative or self-defeating thoughts and behaviors

Existential therapy

A therapy that encourages clients to accept responsiblity for their lives & to live with greater meaning & values; most therapists place great emphasis on the relationship btwn therapist & client & try to create an atmosphere of candor, hard work, & shared learning and growth.

Rational Emotive Behavior Therapy

A type of cognitive behavioral therapy that seeks to identify irrational beliefs, ACTIVELY challenge the beliefs and learn to recognize and change the corresponding thought patterns and behaviors

What is cocaine?

A white crystalline powder, derived from the coca plant grown in S.America. Snorted, smoked or swallowed (sometimes IV). Crack cocaine (base) is popular in US not seen much in Aust and is smoked

Tradition 9

A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.

Rational Emotive Behavior Therapy< ABC

A= Activating event B= Belief C= Consequences (emotional and behavioral)

Address irrational thinking by - REBT

A=Activating event Belief=clients IB about A C=Consequences what clients do and feel in response to IB and Activating event. Then: D=Disputing the IT E=Effect cognitive change in client or rational thinking F=Feeling appropriately instead of anxiety or depression

Stimulant Legitimate uses

ADHD, Narcolepsy, Weight Loss Adderall, Dexedrine, Ritalin

ASAM

AMERICAN SOCIETY OF ADDICTION MEDICINE

Client Welfare

AOD counselor must be concerned primarily with the welfare of the client, must terminate the relationship when it is reasonably clear that the client is not benefiting from it, must act in the best interest of the client, must not use a client in a demonstration in a setting where such participation would potentially harm the client, must ensure the presence of an appropriate setting for clinical work to protect the client from harm and the counselor and the profession from censure, must collaborate with other health care professional(s) in providing a supportive environment for the client who is receiving prescribed medications.

Client Welfare

AOD counselor must define for self and others the nature and direction of loyalties and responsibilities and keep all parties concerned informed of these commitments

Client Relationships

AOD counselor must inform the prospective client of the important aspects of the potential relationship, must obtain the client's agreement in areas likely to affect the client's participation including the recording of an interview, the use of interview material for training purposes, and/or observation of an interview by another person, must inform the designated guardian or responsible person of the circumstances, which may influence the relationship, when the client is a minor or incompetent

Client Welfare

AOD counselor must respect the integrity and protect the welfare of the person or group with whom the counselor is working

Inter-professional Relationships

AOD counselor must treat colleagues with respect, courtesy and fairness, and must afford the same professional courtesy to other professionals, will not offer professional services to a client in counseling with another professional except with the knowledge of the other professional or after the termination of the client's relationship with the other professional, must cooperate with duly constituted professional ethics committees, staff requests and promptly supply necessary information unless constrained by the demands of confidentiality. Failure to cooperate with the committee or staff may result in immediate suspension until such time cooperation is given, will not use threatening gestures, behaviors or other forms of coercion with the committee, colleagues, members, staff or other individuals, must not in any way exploit relationships with supervisees, employees, students, research participants or volunteers.

Dual Relationships

AOD counselorn must seek to nurture and support the development of a relationship with clients as equals and not take advantage of individuals who are vulnerable, must not engage in professional relationships or commitments that conflict with family members, friends, close associates or others whose welfare might be jeopardized, must not exploit relationships with current or former clients for personal gain, including social or business relationships, must not engag in sexual relations with a client or with a former client within two years from the termination date of therapy with the client, soliciting sexual relations with a client, or committing an act of sexual abuse, or sexual misconduct with a client, or committing an act punishable as a sexually related crime, if that act or solicitation is substantially related to the qualifications, functions, or duties of an alcohol and other drug counselor/registrant, must not accept gifts from clients, other treatment organizations or the providers of materials or services used in practice.

Securing a certification

AOD counselors are prohibited from obtaining a certification or registration by fraud, deceit, or misrepresentation on any application

Evidenced-Based Strategies for youth

ARC- Attachment, Self-Regulation, Competency. BSFT-Brief Strategic Family Therapy Girls Circle and Boys Council MI-Motivational Interviewing SPARCS-Structured Psychotherapy for Adolescents Responding to Chronic Stress

Neuroplasticity

Ability for the brain to repair, replace, and retrain it's neural circuitry.

Rational Recovery

Abstinence based Addictive Voice Recognition technique Recovery is simple No groups

Accountability

Accepting responsibility for one's work

Non-probability Sampling

Accessing samples of convenience

AIDS

Acquired Immune Deficiency Syndrome

Psychotic disorder symptoms

Act out of touch with reality and experience delusions, hallucinations, or randomly associated ideas. Act flatly, oddly, or inappropriately and are frequently confused with fantasies, irrational ideas and strange thoughts. They have a low quality of insight, demonstrate weak judgment, incorrectly interpret stimuli (such as illusions), withdraw from social situations or do not speak at all or speak disjointedly in conversations with others.

Action

Action is the stage in which people have made specific overt modifications in their lifestyles within the past six months. Because action is observable, the overall process of behavior change often has been equated with action. But in the TTM, Action is only one of six stages. Typically, not all modifications of behavior count as Action in this Model. In most applications, people have to attain a criterion that scientists and professionals agree is sufficient to reduce risk of disease. For example, reduction in the number of cigarettes or switching to low-tar and low-nicotine cigarettes were formerly considered acceptable actions. Now the consensus is clear—only total abstinence counts.

Beneficence

Actively promoting group members' mental health

Core function of case management

Activities intended to bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals.

7. Case Management

Activities which bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts.

Dimension 1

Acute Intoxication and/or Withdrawal Potential

ASI

Addiction Severity Index

ASI

Addiction Severity Index +addresses 7 potential problem areas +medical, employment,drug use, alcohol use, legal, family and psychiatric +deals with lifetime problems +overview of all problems related to substance use disorder

Alcohol Assessment Tools

Addiction Severity Index (ASI) and Alcohol Use Disorders Identification test (AUDIT)

ATTC

Addiction Technology Transfer Center

psychological dependence

Addiction. psychological and behavioral dependence; indicated by loss of CONTROL, obsessive-COMPULSIVE high rate of drug use, craving for the drug, CONTINUED in spite of adverse consequences. Tendency to relapse after stopping use. ie Heroine-VH, codine/fentynl/methadone/morphine-mod, opium-high

Nicotine

Addictive drug found in tobacco that speeds the heartbeat, raises blood pressure, and causes dizziness and upset stomach. Cotinine, a metabolite, is slower in African Americans, causing different smoking patterns.

Immediacy

Addressing what is going on between the client and therapist right now. Presence The ability to be with someone fully in the present moment; being engaged and absorbed in the relationship with the client - Ability to focus on the "here and now" relationship w/another person

Four focuses of Clinical Supervision

Administrative Evaluative Clinical Supportive

Intake- at intake the client fills out...

Admission/intake form sign HIPAA form provides financial data sign consent form for treatment signs "authorizations" to release information

Step 5

Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

Counseling Skills of Stage 2 (Evaluation)

Advanced accurate empathy, self-disclosure, confrontation (pointing out discrepancies), immediacy

Affective disorders

Affective disorders may include manic (elevated, expansive, or irritable mood with hyperactivity, pressured speech, and inflated self-esteem) or depressive (dejected mood with disinterest in life, sleep disturbance, agitation, and feelings of worthlessness or guilt) episodes, and often combinations of the two.

Metabolized

After absorption and distribution of a drug, it is _______ by the liver This is when drugs enter the body and transform a chemical to another chemical to facilitate elimination from the body.

Withdrawal:

After drug dependence, discontinued use causes withdrawal symptoms

Patient Orientation

After screening and admitting, the patient will be added to the program and oriented to the goals and nature of the treatment. Everyone must be given rules regarding conduct and expectations. They should also be fully educated about the disciplinary actions they may be subject to when rules are broken. Regulations vary between program types. For example, non-residential treatment options will have service hours for each available treatment. Residential options will include rules about leaving the campus and family visiting hours. All facilities include regulations about treatment costs, insurance, and client rights. The counselor must examine each of these aspects to properly educate incoming patients and protect them, as well as the establishment itself.

Patient Intake

After the initial assessment, the counselor is required to fill out all the documents and examine the technical aspects of admitting the patient. Patient Intake. Although this step is simpler than the first, it can be stressful and time consuming depending on the volume of paperwork and process of the treatment facility.Counselors must sign consent forms when gathering information from or providing it to outside sources. The consent forms are a legal step that protects the confidentiality of the patient. It is critical for the counselor to understand the process and guidelines fully for admittance.

What happens after someone drinks alcohol?

After you swallow an alcoholic drink, about 25 per cent of the alcohol is absorbed straight from your stomach into the bloodstream. The rest is mostly absorbed from your small intestines.

Inhalants withdrawal

Agitation -pyschological but no known physical symptoms

Stimulant OD

Agitation, increased body temperature, hallucinations, convulsions, and possible death

Systematic Desensitization

Aimed at teaching an individual to relax or behave in some other way that is inconsistent with anxiety while in the presence (real or imagined) of the anxiety producing stimulus. Systematic refers to the carefully graduated manner in which someone is exposed. A client is first taught to induce a state of relaxation, then an "anxiety hierarchy" is constructed, then one must repeatedly imagine the scenes in the hierarchy under conditions of deep relaxation

Supportive Groups for Families

Al-anon Alateen ACOA Nar-Anon

Rational Emotive Therapy

Albert Ellis is the founder Humans are born with potentials for rational thinking but also with tendencies toward crooked thinking. They tend to fall victim to irrational beliefs and to reindoctrinate themselves with these beliefs. A persons belief system is the cause of emotional problems. Clients are challenged to examine the validity of certain beliefs Thinking and feeling are two processes but are closely linked together The event does not cause the action, the person's thoughts and feelings about the event cause the action Teach a client to analyze his/her belief system and correct the irrational distortions The counselor identifies the client's irrational beliefs

CNS Depressants:

Alcohol Barbiturates Benzodiazepines Opiates/Opioids

Research has proved CBT can effectively treat addiction to:

Alcohol Marijuana Cocaine Methamphetamine Nicotine

Depressants - ABB physical/physchological dependence

Alcohol - high, moderate Barbiturates - high, moderate Benzodiazepines (BZ) - low, mod to high

Diagnostic Interview Schedule (DIS-IV) Alcohol Module

Alcohol Module: 28 questions permits diagnosis of alcohol abuse or dependence; based on DSM-IV

AUDIT

Alcohol Use Disorder Identification Test +one of the most accurate alcohol screening test +accurate across all ethnic and gender groups +developed by World Health Organization +detects problems w/in the last year +simple way to screen people at risk for developing alcohol problem +10 multiple choice questions +point system, more than 8= problem

AUDIT

Alcohol Use Disorders Identification Test

American Indians have the greatest rates of?

Alcohol and illicit drug use. Fetal Alcohol Syndrome is 33X higher! Women have a six-fold increase in cirrhosis of the liver. Frame 12-step programs in terms of a circle rather than ladder.

Prioritizing Substances of Abuse

Alcohol and sedative-hypnotics have the most serious w/d syndromes(address it first). Oral methadone, LAAM, or buprenorphine should be used to stabilize WD from opioids while tapering the dose of s-h or anxiolytic(anti-anxiety Rx).

Women have less:

Alcohol dehydrogenase (ADH) Therefore, women stay drunk longer Also, their higher fat content stores alcohol longer

What is the mortality rate of alcohol withdrawal?

Alcohol withdrawal is a life threatening condition with up to 40% mortality rate if untreated. This number reduces to 1% if treated

Depressants

Alcohol, Barbiturates, other sedatives, sleeping pills, inhalants. Slow CNS activity

Tradition 10

Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.

Tradition 8

Alcoholics Anonymous should remain forever nonprofessional, but our service centers may employ special workers.

Codeine

Alkaloid found in opium, though most is morphine. Used as antitussive.

Dignity

All members are treated with respect and dignity

Define Co-Occurring Disorder

Also known as "Dual Diagnosis," refers to the existence of a co-existing mental illness and substance use disorder

CNS Depressants examples:

Ambien, Chloral Hydrate, Doriden, Meprobamate, Noludar, Paraldehyde, Placidyl and Quaaludes. These substances are administered orally or with water in an injection.

Motivational Interviewing assumes

Ambivalence about substance use (and change) is normal Ambivalence can be resolved by working with your client's intrinsic motivations and values An empathic, supportive, yet directive, counseling style provides conditions under which change can occur supports self-efficacy

ASAM

American Society of Addiction Medicine

ASAM

American Society of Addiction Medicine Designed to identify addiction, co-occurring disorders and the most appropriate levels of treatment

Tradition 6

An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.

Inpatient Medical Unit

An _______________ is appropriate for treating an alcoholic who has experienced seizures

methylphenidate

An amphetamine used to treat ADHD

Managed Care

An approach to delivery of health and mental health services that seeks to reduce the cost of care by monitoring the access to and use of medical services and supplies,as well as outcomes of that care.

Seeking Safety

An evidence-based, present-focused counseling model to help people attain safety from trauma and/or substance use disorders.

Drug misuse

An example of _________ would be combining alcohol with other depressant drugs

Acetylcholine

An excitatory neurotransmitter released by axons.

Imparting information

An informed person is better able to cope and think through new problems

Community Reinforcement Approach (CRA)

An intensive 6 months outpatient therapy for treatment of cocaine addiction. The treatment goals are twofold: • To achieve cocaine abstinence long enough for patients to learn new life skills that will help sustain abstinence. • To reduce alcohol consumption for patients whose drinking is associated with cocaine use. Those who also abuse alcohol receive clinic-monitored disulfiram (Antabuse) therapy. Patients submit urine samples two or three times each week and receive vouchers for cocaine-negative samples. The value of the vouchers increases with consecutive clean samples. Patients may exchange vouchers for retail goods that are consistent with a cocaine-free lifestyle.

Complementary medicine

An intervention that is used in conjunction with traditional or conventional medicine

What is an opioid maintenance program?

An outpatient treatment that use to be called 'methadone clinics'. Clinics are staffed by multidisciplinary team. All clients are allocated a case manager who meets with the client regularly. Clients also undergo witnessed urine screening for drug use without prior notice.

Depression

An overwhelming state of sadness, loss of interest or pleasure, feelings of guilt, disturbed sleep patterns and appetite, low energy and an inability to concentrate

Tradition 12

Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities.

Meprobramate

Anti-anxiety drug became very popular in the 1950's. Miltown, Equanil, Meprin - sedative and tranquilizer used to treat muscle tension and anxiety.

Anxiolytics

Anti-anxiety medications. Prescribed to relieve anxiety symptoms (e.g. generalized anxiety or panic, insomnia, petitmal epilepsy or extreme alcohol withdrawal.

monoamine oxidase

Antidepressant drug. First used in the 1950s to treat tuberculosis, showed an elevation in mood.

Phenothiazines are now referred to as?

Antipsychotics

Antisocial Personality Disorder

Antisocial personality disorder is characterized by a long-standing disregard for rules, social norms, and the rights of others. People with this disorder typically begin displaying symptoms during childhood, have difficulty feeling empathy for others, and lack remorse for their destructive behaviors.

Benzodiazepines medical use:

Anxiety and panic disorders and acute stress. Depressant chemical group of sedative-hypnotics. WD-tremors, cramps, sweating, vomiting.

Anxiety Disorder

Anxiety disorders are those that are characterized by excessive and persistent fear, worry, anxiety and related behavioral disturbances. Fear involves an emotional response to a threat, whether that threat is real or perceived

Examples of Nicotine WD symptoms that can be confused with other Psychiatric conditions:

Anxiety, Depression, Increased REM sleep, Insomnia, Irritability, Restlessness, Weight Gain

Depressant withdrawal

Anxiety, insomnia, tremors, delirium, convulsions, possible death.

Schedule I

Any drug included here has a high level of abuse/dependence. Also, there is no accepted medical use. Include are heroin, LSD and marijuana.

Confidential Information:

Any information about the person which includes name or identifying information

Stimulant withdrawal

Apathy, long periods of sleep, irritability, depression (possible with suicidal potential), and disorientation, increased appetite, anhedonia (absence of pleasure) and craving.

Minor Tranquilizers

Are depressant drugs used to treat anxiety and insomnia. Low doses make the user feel calm, relaxed, and drowsy. High doses can cause loss of coordination and stupor. Can cause both physical and psychological dependence. examples: Valium, Xanax, and Ativan.

Four types of Client Resistance

Arguing, interrupting, denying, ignoring

What percentage of people with substance use disorder may have co-occurring disorder?

As many as 50 to 70% of people with substance use disorders have a co-occuring disorder

Alcohol Effect Asians

Asians usually do not have enzyme acetaldehyde to break down etoh and will flush, sweat, and feel ill. Alcoholism rate is low for Asians.

5 A's for Tobacco Brief Intervention

Ask about use. Advise to quit. Assess willingness to quit. Assist in quitting. Arrange follow-up.

12 Core Functions (4)

Assessment

Adler IP 1st step

Assessment - learn client's family of origins, birth order, early recollections, dreams, and current life task.

Norepinephrine

Associated with arousal reactions

Dopamine

Associated with body movement and pleasure

Norepinephrine

Associated with eating, alertness, wakefulness, fear, neurotransmitter that is involved in arousal and the fight-or-flight system

Epinephrine

Associated with energy release during exercise, adrenaline rushes, bursts of energy caused by its release throughout the body

Glutamate

Associated with excitatory, motor skills, learning, thought, emotion, OCD

Dopamine:

Associated with feelings of pleasure

GABA:

Associated with inhibition and relaxation

Reverse tolerance:

Associated with long term alcohol use when the liver is no longer efficient, causing intoxication on small amounts of alcohol.

Anandamide:

Associated with memory, motivation, pain relief and appetite

Serotonin:

Associated with mood, sleep, appetite, impulsivity, aggression, and depression•

Endorphins

Associated with pain relief, pleasure/well being; and, feelings of anxiety, depression, impulsivity and aggression.

Serotonin

Associated with regulation of sensory perception, sleep and body temperature

Borderline personality disorder

Associated with symptoms including emotional instability, unstable and intense interpersonal relationships, unstable self-image, and impulsive behaviors.

Carl Rogers Person-Centered Therapy

Assumes that each person is, by nature, good, worthy, and valuable. Client needs support not direction.

How often are treatment plans reviewed

At least 90 days at outpatient level of care

Stage 3: Preparation

At this stage people begin to see that they are responsible for their choices and have the power to make life-changing decisions. They need to do it for themselves, but need not do it by themselves. They set an intention to gather resources, whether it is in the form of therapeutic intervention, 12 step meetings or other sober supports. They set a timeline and may make a verbal or written commitment.

Who May benefit from Acamprosate

At treatment onset are motivated to achieve complete abstinence rather than decrease in drinking. Receiving opioid maintenance therapy at risk of relapsing to opioid use taking opioid for chronic or acute pain

Labeling:

Attaching a label to yourself after a negative experience Example: Feeling awkward at a party leads to the conclusion: "I'm an awkward person".

Counseling Skills of Stage 1 (Information Gathering)

Attending to self and client, concreteness (identifying specific feelings, clarifying general statements), distinguishing content from feelings, probing (open-ended questions), accurate empathy, genuineness, respect

Styles of Group Leadership

Authoritarian Democratic Laissez-faire

Release of records is now known as...

Authorization to release

What are the signs and symptoms of alcohol withdrawal?

Autonomic overactivity (sweating, tachycardia, HTN, insomnia, elevated temp, tremor). Gastrointestinal (anorexia, nausea, vomiting, diarrhoea). Cognitive and perceptual changes (anxiety, vivid dreams, hallucinations, delirium). Seizures occur in about 5% of people. They occur 7-24 hours after the last drink, are tonic-clonic in type. Delirium tremens is the most severe form of alcohol withdrawal syndrome, and a medical emergency. It usually develops 2-5 days after stopping or significantly reducing. Only in around 1% of cases.

What is respect for autonomy

Autonomy is Latin for "self-rule" We have an obligation to respect the autonomy of other persons, which is to respect the decisions made by other people concerning their own lives. This is also called the principle of human dignity. It gives us a negative duty not to interfere with the decisions of competent adults, and a positive duty to empower others for whom we're responsible. Corollary principles: honesty in our dealings with others & obligation to keep promises.

Contemplation

Aware of a problem; but ambivalent about change Motivational task: tip the balance, evoke questions about making a change and the risks of not changing, strengthen the client's self-efficacy to change, but NO action

Fritz Perls Gestalt Therapy

Awareness. Focuses on present situation and current behavior, not the causes of the behavior.

V Codes

Axis I factors worthy of attention in treatment, but not part of the disorder.

blood alcohol concentration

BAC- measured in milligrams (mg) of alcohol per deciliter (dL) of blood. 100 mg/dL = .1 percent

Beck Depression Inventory II

BDI-II is 21 items to assess the intensity of depression.

Action

BEGINS the change process by implementing the solution or plan Motivational task: help client take steps toward change, support initial steps towards change, provide corrective feedback

3 Types of Sedative/Hypnotics

Barbiturates Minor Tranquilizers Other Sed/Hypnotics

10 Referral Requirements

Be familiar with community resources, both alcohol and drug and others, be aware of the limitations of each service and if the limitations could adversely impact the client. Includes aftercare or discharge planning _________ that take into account the continuum of care.

Why is methadone still used as maintenance treatment for opioid withdrawal?

Because it takes away need for IV (reduction in bloodborne virus spread) & other negative life-style issues (prostitution, crime). Reduces risks of overdose and deaths associated with heroin use and helps to improve the psychosocial functioning and wellbeing of individuals and families.

BDI

Beck Depression Scale

Anxiety disorder most effective therapy?

Behavioral in approach with a secondary cognitive emphasis. Depending on the nature of the disorder, group therapy may prove equally effective. Ancillary family therapy may be needed as well. Unless the condition is disabling, medication is not generally needed; however, it may provide supplementary treatment, particularly with Panic Disorder and OCD

MAO Inhibitors

Behavioral stimulants that reduce depression by inhibiting the action of an enzyme called MAO, which normally breaks down and deactivates norepinephrine and serotonin.

Benefits of behavioral therapy

Behavioral techniques that are often used to decrease anxiety include relaxation techniques and gradually increasing exposure to situations that may have previously precipitated anxiety in the individual. Helping the anxiety sufferer to understand and how to handle the emotional forces that may have contributed to developing symptoms (anxiety-focused psychodynamic psychotherapy) has also been found to be effective in teaching an individual with panic disorder how to prevent an anxiety attack or to decrease or stop a panic attack once it starts.

Phencyclidine (PCP) Action

Behvior effects believed to be meediated through the N-Methyl-D-Aspartate (ND) excitatory amino acid receptor-channel complex in the brain.

Multiculturalism

Being comfortable with many standards and customs; being able to adapt behaviors and judgments to a variety of interpersonal settings.

Anti-anxiety Medications

Benzodiazepines - TCAs, SSRIs, Buspirone

CNS Depressants

Benzodiazepines, in the form of Valium, Librium, Ativan, Serax, Xanax, Tranxene, and Klonopin. Alcohol, in the form of ethyl alcohol Ethanol (beer, liquor and wine) Barbiturates, in the form of Amytal, Nembutal, Phenobarbital, Seconal and Tuinal

Withdrawal and isolation

Best characterizes the changes that occur in an alcohol or drug abuser's relationship with family , friends, and society as a result of the substance abuse.

Residential or Inpatient (behaviorally/psychologically based)

Best type of care for individuals who have not been successful in outpatient, have very serious substance abuse problems, need concomitant medical or psychiatric care, and those without a stable support system in the community Therapeutic Communities - Self-contained residential programs that emphasize self-help and rely heavily on ex-addicts as peer counselors, administrators, and role-models

Opiates Action

Bind to opiate receptors in the cns where they block normally occuring opiate-like substances.

What plays a large role in whether an individual starts to smoke, drink, or use other drugs?

BioPsychoSocial factors Genetic factors are more influential in determining who develops the disease of addiction

Dimension 2

Biomedical Conditions and Complications

Bipolar

Bipolar disorder is characterized by shifts in mood as well as changes in activity and energy levels. The disorder often involves experiencing shifts between elevated moods and periods of depression

Co-Occurring Disorders- most common

Bipolar, Anxiety, PTSD, Antisocial, Borderline

How Opiates (HCFMMO) work?

Block communication between neural impulses by tying up encephalin-receptors in the central nervous system. An overdose will cause a decrease in pulse, convulsions, coma or even death.

While waiting to be filtered by liver,alcohol travels throughout the body in a person's _________.

Blood

BAC

Blood Alcohol Content

Marijuana Abuse Symptoms

Bloodshot eyes: Most likely (especially if the patient's heart is racing), but could suggest Alcohol Abuse

Borderline Personality Disorder

Borderline personality disorder is associated with symptoms including emotional instability, unstable and intense interpersonal relationships, unstable self-image, and impulsive behaviors.

Neurons

Brain cells. Contain dendrites, nucleus, axon terminals.

7 Case Management Activity

Bring services, agencies, resource, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts.

Basic Engagement Skills

Build rapport Show empathy Active listening Non-threatening questions Clarifying questions Genuineness

Buprenorphine forms?

Buprenex-injectable form Subutex-oral form (starting treatment) Suboxone-buprenorphine and nalxone(intedend for persons dependent on opioids who have already started and are continuing medication therapy.)

Medication for Tobacco: (nicotine replacement therapies)

Bupropion (zyban ®) Varenicline (chantix ®)

Buspirone (generic name)

Buspar (brand name) - treats GAD or MODERATE anxiety WITHOUT sedation.

42 CFR Part 2

CFR = Code of Federal Regulations The regulations are the federal confidentiality laws that specifically pertain to alcohol & drug health information concerning services and clients. Supersedes HIPAA

Instrument for Alcohol Dependence and Withdrawal

CIWA-Ar 10 items; scores 0-67, 10 or greater is significant

Withdrawal scales include?

CIWA-Ar - Clinical Institute Withdrawal Assessment for alcohol withdrawal CINA - Clinical Institute Narcotic Assessment for opioid withdrawal.

Inhalants

CNS Depressants Creates an effect similar to alcohol intoxication, excitability. and delirium Physical and psychological dependence Cleaners, cosmetics, paint solvents, glues, motor fuels

What is the MOST probable classification for a substance that causes a client to experience an instant euphoric flash when using?

CNS Stimulant

Instrument for Cocaine Dependence and Withdrawal

CSSA - Coacaine Selective Severity Assessment 18 items;high scores correlate with poor outcome

CNS Stimulants include:

Caffeine (yes, as simple as your Latte and soda) Nicotine (those cigarettes you've promised to give up) Amphetamines Cocaine Methylphenidate (e.g., Ritalin) Dextroamphetamine (e.g., Dexedrine) MDMA (e.g., Ecstasy

CNS stimulants

Caffeine, nicotine, cocaine, amphetamines and 4-methylene-dioxyamphetamine (MDMA)

CAADE

California Association for Alcohol/Drug Educators

CAADAC

California Association of Alcoholism and Drug Abuse

CDADP

California Department of Alcohol and Drug Programs

Step 2

Came to believe that a power greater than ourselves could restore us to sanity.

Psychoactive drugs

Can alter the normal course of body functions including thoughts, mood and emotions

SOAP - Subjective

Can be given by: patient, family, EMS Consists of CC, HPI, ROS, PMHx

Post-traumatic stress disorder

Can develop after an individual has experienced a stressful life event. Symptoms of PTSD include episodes of reliving or re-experiencing the event, avoiding things that remind the individual about the event, feeling on edge, and having negative thoughts. Nightmares, flashbacks, bursts of anger, difficulty concentrating, exaggerated startle response, and difficulty remembering aspects of the event are just a few possible symptoms that people with PTSD might experience.

Altruism

Caring about others decreases unhealthy self-absorption

Jungian Therapy

Carl Jung's psychoanalytic school was known as Analytic psychology. He developed the concepts of the collective unconscious and archetypes and defined introversion and extroversion as the two types of personality organization. The goal of Jungian therapy is to have the clients become adequately adapted to reality allowing them to fulfill their creative potential. Individuation is the ultimate goal of Jungian therapy.

Client-Centered Therapy

Carl Rogers was the founder View of the person is essentially good, that he/she is capable of living a meaningful life The client has the potential for becoming aware of problems and the means to resolve them The therapist creates a safe healing environment by expressing: genuineness (counselor is him/herself), empathy (the ability to feel with the client and sense what his/her world is like), unconditional positive regard

12 Core Functions (7)

Case Management

Dichotomous Thinking:

Categorizing things into one of two extremes. This form of polarized thinking creates all or nothing terms. Example: Believing that people are either excellent in social situations or terrible, without recognizing the large gray area in-between.

Disulfiram: How it works

Causes a toxic physical reaction when mixed with alcohol. Pproduces acetaldehyde, co-morbid treatment of alcohol and cocaine addiction, may induce psychiatric symptoms(don't use with psychotic clients)

Effects of inhalants

Causes euphoria, light headedness and excitement, both central and peripheral nervous system damage, generalized weakness, cerebellar atrophy

CSAT

Center for Substance Abuse Treatment

Conduct Disorder

Central feature of this disorder is repetitive and persistent behavior in which the basic rights of others are violated, i.e. physical aggression toward others or animals, cruelty, theft, arson

Barbiturates

Central nervous system depressants, used to treat anxiety, induce sleep, and control seizures. Can cause intoxication similar to that caused by alcohol. Can cause death by respiratory failure or by seizure. Can create both physical and psychological dependence - withdrawal can be dangerous and even fatal. Combining them with depressants can cause a synergistic effect that can produce death.

CATC

Certified Addiction Treatment Counselor

Independent Variable

Changed by the researcher. Dependent variable is what being measured.

Injection

Characteristics that are common of drugs taken by ______ include: a rapid response; a greater drug effect than it taken orally; the necessity for sterile conditions; a smaller dose than if taken orally

Antisocial personality disorder

Characterized by a long-standing disregard for rules, social norms, and the rights of others. People with this disorder typically begin displaying symptoms during childhood, have difficulty feeling empathy for others, and lack remorse for their destructive behaviors.

Substance abuse

Characterized by a pattern of repeated use of substances that is maladaptive in that significant adverse consequences occur

Depersonalization Disorder

Characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie. Size and shape of things, such as your own body or other people and things around you may seem distorted. Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may come and go over many years.

Schizophrenia

Characterized by abnormal social behavior and failure to understand what is real. Common symptoms include false beliefs, unclear or confused thinking, hearing voices that others do not hear, reduced social engagement and emotional expression, and a lack of motivation. Symptoms typically come on gradually, begin in young adulthood, and last a long time.

Personality Disorders- in general

Characterized by an enduring pattern of maladaptive thoughts, feelings, and behaviors that can cause serious detriments to relationships and other life areas.

Anxiety Disorders- in general

Characterized by excessive and persistent fear, worry and anxiety. Fear involves an emotional response to a threat, whether that threat is real or perceived. Anxiety involves the anticipation that a future threat may arise.

Panic disorder

Characterized by panic attacks that often seem to strike out of the blue and for no reason at all. Because of this, people with panic disorder often experience anxiety and preoccupation over the possibility of having another panic attack.

Bipolar disorder

Characterized by shifts in mood as well as changes in activity and energy levels. The disorder often involves experiencing shifts between elevated moods and periods of depression.

Progress Notes

Chart the day to day progress of the client.

11 Report and Record Keeping

Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries and other client-related data.

11. Report and Record Keeping

Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries and other client-related data.

Neurotransmitters

Chemical messengers that traverse the synaptic gaps between neurons. EXAMPLE: sedative-hypnotics(Bz's and Barb's) affect GABA

Neurotransmitters:

Chemical substances that the body uses to send signals across synapses to accomplish certain tasks Nerve cells (neurons) receive signals - such as a drug like heroin - and respond by releasing a specific neurotransmitter Nearly all drugs work by enhancing or blocking the natural processes of neurotransmitters, resulting in feelings of euphoria and other desirable effects of drug use

psychoactive drugs

Chemicals that affect the nervous system and result in altered consciousness

Inhalants

Chemicals that can be legally purchased and that are normally used for non-recreational purposes. Includes industrial solvents and aerosol sprays and include, but are not limited to: gasoline, kerosene, airplane glue, acetone, lighter fluid, metallic paints, correction flids, amyl, butyl and isobutyl nitrite and nitrous oxide.

A popular sedative that was introduced in 1960?

Chlordiazepoxide(Librium)- benzodiazepine

Wernicke-Korsakoff syndrome

Chronic mental impairments produced by heavy alcohol use over a long period of time.

Hippocrates

Classified all mental disorders into the categories: mania, melancholia, phrentis "Father of Medicine" all disorders are caused by natural factors; four humors; body has ability to heal self; treat the whole patient

Adler Individual Psychology

Client makes new, healthier goals by making a realistic action plan and develop the necessary skills to achieve new goals.

Alfred Adler Individual Psychology

Client pursues fictional goals in an unhealthy quest for superiority. Magic wand and confrontation.

Eligibility

Client's age, gender, place of residence, disabilities, pregnancy, finance, insurance, etc

Albert Ellis REBT

Client's emotional problems result from irrational thinking, and moreover, everyone can learn how to think effectively. Use problem solving and learning by employing new behavioral skills.

Engagement- most effective approach

Client-centered; and Motivational Interviewing

What type of client would not benefit from psychoanalysis?

Clients suffering from severe depression or such psychotic disorders as schizophrenia, although some analysts have successfully treated patients with psychoses. It is also not appropriate for people with addictions or substance dependency, disorders of aggression or impulse control, or acute crises; some of these people may benefit from psychoanalysis after the crisis has been resolved.

Mania Disorder Affective symptoms

Clients will experience both extremes—high spirits and elevated moods or low spirits with anger and irritability.

The 10 Domains

Clinical Evaluation Treatment Planning Referral Service Coordination Counseling Client family and community education Documentation Professional Ethical responsibilities Research Design analysis and utilization Clinical Supervision

CTRS-CCDP

Clinical Evaluation, Treatment Planning, Referral, Service Coordination, Counseling, Client, Family, and Community Education, Documentation, Professional and Ethical Responsibilities (8 Performance Domains)

Assessment (depression)

Clinical manifestations of depression can be described as alterations in four spheres of human functioning (Affect, behavior, cognitive, physiologic)

Level 3.5

Clinically Managed High-Intensity Residential Services

Level 3.1

Clinically Managed Low-Intensity Residential Services

Level 3.3

Clinically Managed Population-Specific High-Intensity Residential Services

Rohypnol

Club Drug - benzodiazepine; the "date-rape" drug

GHB

Club Drug - gamma hydroxybutyrate; chemically related to GABA; used recreational as a depressant

COD

Co-Occurring Disorders

Stimulants

Cocaine half life=one hour, Amphetamine=6-12 hours, Methylphenidate=2 hours

Neurotransmitters:

Cocaine increases levels of dopamine, norepinephrine and epinephrine in the synapse and blocking their reuptake.

Stimulants

Cocaine, Amphetamine, Caffeine-these drugs can reverse the effects of fatigue, maintain wakefulness, decrease appetite, and temporarily elevate the mood of the user

Narcotics drug classification

Codeine, morphine and opium fall under________

CBT

Cognitive Behavioral Therapy

Unlike Rational Emotive Behavior Therapy, ________ therapy uses a more open-ended, Socratic dialogue to encourage clients to reflect on personal issues and arrive at their own conclusions

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Cognitive behavioral therapy focuses on learning to reduce problematic behavior associated with substance abuse. A key theme in CBT is anticipating risky situations and applying coping strategies, such as avoidance or self-control, to prevent relapse. CBT is one of the most popular therapies in addiction medicine, and counselors use it to treat a variety of addictions.

Cognitive distortions

Cognitive distortions are systematic ways that people twist and distort information from the environment. These biases often reinforce negative thought patterns and can lead to increased anxiety and difficulty managing everyday stress.

Anxiety disorders respond well to?

Cognitive-behavioral interventions and behavior therapy, particularly in-vivo desensitization. Tx objectives include reduction of anxiety and improved management of stress. Development of socialization skills and giving a sense of mastery are additional goals

Mood Disorder treatment

Cognitive-behavioral, interpersonal and related interventions. Larger objective of overall adjustment, mood stabilization, alleviation of depression and mania, enhancement of coping skills, improvement in relationships and the prevention of relapse are vital treatment objectives.

Carl Jung Analytic Psychoanalysis

Collective unconscious- repressed events, wishes, feelings and conflicts.

Synergistic effect

Combination of two or more drugs that produce an exaggerated effect. Goes above and beyond what might be expected of adding one drug to another.

Benzodiazepines

Combined sales of the make them easily the most widely prescribed drug class. Flumazenil (Romazicon) acts at the receptor and reverses the sedative and overdose effects, but not alcohol or other sedative-hypnotics.

Mushrooms (psilocybin)

Comes from certain types of mushrooms found in tropical and subtropical regions of South America, Mexico, and the United States.

Mood disorders

Common psychiatric disorders accompanied by dependency: Affecting all areas of clients, long-lasting emotional state characterized by pathological or depressed mood disturbances

Mood Episodes

Common psychiatric disorders accompanied by dependency: Clients have symptoms that last for a long period

Delusional disorder

Common psychiatric disorders accompanied by dependency: dominating and well-ordered delusions or may not yet have had hallucinations as in the case of disorganized thoughts or behaviors

Major depressive disorder

Common psychiatric disorders accompanied by dependency: have one or more depressive episodes characterized by depressed moods, loss of pleasure, weight loss, insomnia, fatigue, misplaced guilt, and a limited ability to think clearly or focus

What are the withdrawal symptoms of THC?

Common: anger/aggression, decreased appetite, irritability, anxiety, restlessness, nightmares. Less common: chills, depressed mood, stomach pain, tremors and sweating

CR

Community Reinforcement

t-test

Compares the mean of 2 independent data sets to determine if there is a significant statistical difference between them.

Narcotics

Complaints of extreme constipation and poor appetite Drugs derived from opium that are capable of relieving pain (also called opiates) Kill pain; depress the central nervous system; induce sleep

Global Criteria: Intake

Complete require documents for admissions into the program. Obtain signed consents in order to protect client's confidentiality and rights.

2 Intake Criteria

Complete required documents for admission and eligibility to the program. Obtain appropriately signed consents when soliciting from or providing information to outside sources to protect client confidentiality and rights.

Adverse Ketamine reacation

Completed sensory detachment, explained as a near-death experience, paranoia, boredom and possible coma.

3 Characteristics of Addiction

Compulsive use, Loss of Control, Continued use despite adverse consequences

Concurrent treatment

Concurrent means that the client is treated for all issues but by multiple providers located in different places. It is not as effective unless there is proper coordination of care and effective case management, but coordination and communication issues often decrease outcomes.

Sigmund Freud Psychoanalytic Therapy

Conflict between the conscious and unconscious minds, and biological and social forces.

Cognitive Disorder symptoms

Confused, cannot remember things, primarily accompanies dementia. Poor judgment, act out oddly or dramatically, impulsive, delusions or hallucinations, experience changes in sleep and mood patterns, and have marked personality changes (such as no longer performing basic hygiene or acting rudely).

Gestalt

Consciousness can never be broken down into parts because it can be understood only as a whole. - Personal responsibility, unfinished business, avoiding, experiencing & awareness of the now. - Lives in the present, responsible for their own thoughts, feelings & actions

6 Steps for Ethical Decision Making (4)

Consider courses of action

Reliability

Consistency of results over time, no intervening events, use correlation or decision consistency to judge. r=same people, same test, different times

Twelve Step Facilitation

Consists of a brief, structured, and manual-driven approach to facilitating early recovery from alcohol and other drug use disorders. It is intended to be implemented on an individual basis in 12 to 15 sessions It is based in behavioral, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

12 Core Functions (12)

Consultation

Contemplation

Contemplation is the stage in which people intend to change in the next six months. They are more aware of the pros of changing, but are also acutely aware of the cons. In a meta-analysis across 48 health risk behaviors, the pros and cons of changing were equal (Hall & Rossi, 2008). This weighting between the costs and benefits of changing can produce profound ambivalence that can cause people to remain in this stage for long periods of time. This phenomenon is often characterized as chronic contemplation or behavioral procrastination. Individuals in the Contemplation stage are not ready for traditional action-oriented programs that expect participants to act immediately.

Step 10

Continued to take personal inventory and when we were wrong promptly admitted it.

Dependence

Continued use to avoid withdrawal and prolonged use creates more brain changes that may underlie compulsive drug seeking and other adverse consequences that are the hallmark of addiction

Global Criteria: Case Management

Coordinate services for client care. Explain the rationale of case management to the client.

Collaboration= Service Coordination= Case Management

Coordination of all activities that bring the client, treatment services, and other resources together to focus on issues and needs identified in the treatment plan

12 Core Functions (6)

Counseling

Counseling

Counseling is part of every good treatment facility. Different programs and locations have different treatment types. Many offer individual and group treatment plans. In this step, counselors work to assist patients and families in achieving objectives. They explore problems, ramifications, feelings, attitudes, and more. The drug and alcohol counselor must select the proper counseling type, apply techniques to assist the patient (or family/group), continue individualized counseling, offer therapeutic advice, reach solutions, and implement the treatment plan.

Professional Competence:

Counselor must continuously maintain self-awareness and seek training

Informed Consent:

Counselor must inform client about the risks and benefits of treatment; and afterwards, client must give consent

Confidentiality:

Counselor must keep client information confidential, unless an exception applies.

Probing

Counselor's use of a question or statement to direct the client's attention inward to explore his/her situation more in depth (open-ended question)

Patient Education

Counselors must continue to provide information to their patients through the duration of treatment. Both formal and informal processes are used to keep patients educated and up-to-date about treatments, discoveries, progress, and other relevant factors.

Patient Screening

Counselors must take a variety of factors into account when deciding to admit a potential client for treatment. So it's crucial for counselors to use the right diagnostic criteria. They must determine whether the individual's habits constitute abuse or recreational use.Eligibility requirements differ between agencies and programs. Criteria usually examine the patient's age, gender, legal status, income, and more. If a counselor deems an individual eligible for treatment, but he/she does not fit the parameters of the program, the professional should be able to suggest an alternative location.

12 Core Functions (8)

Crisis Intervention

CAGE

Cut back Annoyed Guilty Eye Opener

CAGE

Cut-down, Annoyed, Guilt, Eye-opener

CAGE

Cutdown, Annoyed, Guilt, Eyeopener +only four questions +score of 2 or greater= significant yes or no answers Drawbacks not in depth wide life span

Tricyclic/Tetracyclic

Cyclic antidepressants - among the earliest antidepressants developed. Effective, but they've generally been replaced by antidepressants that cause fewer side effects. Other antidepressants are prescribed more often, but cyclic antidepressants are still a good option for some people. In certain cases, they relieve depression when other treatments have failed.