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Substance Abuse

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Katherine Casey

on 3 November 2014

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Transcript of Substance Abuse

Substance Abuse
Substance Abuse Treatment
Test and Diagnosis
Family doctor is the first person to diagnose drug problem
Patient is asked which drug he/she uses and the frequency of it
Family members are also questioned
Then a psychiatrist diagnoses the drug addict
How Substance Abuse is First Diagnosed
Family doctor is the first person to diagnose a drug problem.
Patient is asked which drug(s) he/she utilized and the frequency.
Family members are then questioned as well.
Psychiatrist is the final person to diagnose drug addiction
• There are both Medical and Behavioral treatments available
• Both methods look to detoxifying, treatment and relapse methods
• Also important to treat not only drug usage but other parts of the person’s life that
may contribute to their drug abuse treatment
• Combining medical and behavioral treatment is better than just one or the other

Criteria For Substance Abuse (DSMIV)
1. Failure to fulfill major role obligations at work, school, home such as repeated absences or poor work performance related to substance use; substance- related absences, suspensions, or expulsions from school; neglect of children or household
2. Frequent use of substances in situation in which it is physically hazardous
3. Frequent legal problems
4. Continued use despite having persistent or recurrent social interpersonal problems
Criteria for Substance Dependence (DSMIV)
1. Tolerance or markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of substance
2. Withdrawal symptoms or the use of certain substances to avoid withdrawal symptoms
3. Use of a substance in larger amounts or over a llonger period than was intended
4 Persistent desire or unsuccessful efforts to cut down or control substance use
5. Involvement in chronic behavior to obtain the substance, us the substance, or recover from its effects.
6. Reduction or abandonment of social, occupational or recreational activities because of substance use
7. Use of substances even though there is a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
Test types for Different Drugs
Club Drugs
1) MDMA (ecstasy)
a) Urine Test is normally done; however sometimes
a "false positive" can occur in which the doctor will
then have to order a different test to be done such as
fingerstick glucose.
2) Flunitrazepam
a) A urine test can detect this drug in ones system
for up to 60 hours after ingestion.
b) A hair test can also be done, in which the drug
remains for one month after ingestion
3) GHB
a) A urine test can be done however this drug is
fast acting and is believed to leave the body after
just 24 hours. The test for this drug is extremely
expensive, and quite uncommon.





Dissociative Drugs
1) Ketamine
a) Urine test, Hair test, and blood test can be done to detect this drug. It is detectable in urine and blood anywhere ranging from seven to fourteen days, and in heavy users for several more days.
2) PCP
a) A urine test or a gc/ms test are used to detect PCP. PCP is stored by the body in fatty lipid tissue therefore people with a higher body fat percentage can store PCP for a longer period of time in their body. Detection lasts for several weeks.
3) Salvia
a) The detection period for Salvia is extremely small ranging up to 12 hours. Simple urine and blood samples are not enough to detect Salvia. More specific drug tests such as "by liquid chromatography-mass spectrometry in blood and urine".
4) Dextromethorpan
a) A urine test or a hair test are the primary tests done to identify the amount of DXM in someones body. Since it is found in over the counter medicines, DXM can be easily abused, and IS being abused by teens.

Cannabinoids
1) Marijuana
a) After a single use of marijuana it can be detected up to 7 days in urine sample, and anywhere from 12 to 24 hours in the bloodstream. After repeated use of marijuana it will be detected in urine sample for up to 100 days, then from 2 to 7 days in bloodstream, and can be detected in hair for months.
2) Smoking
a) Blood exams are the primary tests used to detect tobacco use.
3) Alcohol
a) A test called EtG is the primary test used for alcohol cosumption. It is done through a urine sample, and can detect alcohol in the system for several days after consumption
Hallucinogens
1) LSD
a) LSD can be detected in Urine anwyhere from 2 to 24 hours after consumption. Thereafter a hair test can be done in which the drug will test positive up to 4 days. A blood test can also be done, and will detect drug after 2 days of consumption and up to 4 days after consumption
2) Mescaline
a) Mescalin is detectable in a urine sample for up to 4 days
3) Psilocybin
a) This drug can be detected in a urine sample for several weeks after consumption
Heroin
a) Heroin can be detected in a urine sample anywhere from 1 to 4 days, in the blood stream from 1 to 3 days, and in hair for months.


Methamphetamine
a) Urine Test: 1-4 days
Blood Test: 1-3 days`
Saliva Test: 1-4 days
Prescription Drugs
1) Opioids
a) Urine test will detect drug in system for several days
2) Central Nervous System Depressants
a) Urine test will be used to detect this drug in system.
3) Stimulants
a) "Serum and urine are the common sources of testing material although saliva is sometimes used. Commonly used tests include chromatography, immunologic assay, and mass spectrometry"
Stimulants
1) Cocaine
a) Cocaine will remain in urine from 1 to 3 days, as well as in the blood stream for the same amount of time. The last and final place it can be detected is in the hair, in which it will remain for months

Drug Testing Period Table
American Society of Addiction Medicine (ASAM) has developed guidelines
to determine intensity and length of treatments for substance abuse patients
These guidelines depends on:


Guidelines
Medications
• Medications can be used to treat withdrawal symptoms.
• Medication alone is not enough to completely withdrawal from drug use, additional treatment has to be done.
• It helps recover proper brain chemistry. It is also used to prevent relapse and to get rid of cravings.
• People with severe drug abuse issues are usually polydrug users meaning that they would require different medications for each different drug is being treated
• There is still a lot of research and development on drug abuse medication to be done, there have not been many approved medications on most drugs and behavioral therapies would be preferred in that case

Types of Medications
Agonists
, which activate opioid receptors
Partial

agonists
, which also activate opioid receptors but produce a smaller response



Stimulants
Tobacco
: Bupropion and Varenicline help prevent relapse in tobacco users
Replacement therapies such as gum, spray and patches are available for use

Cocaine
: There is an anti-cocaine vaccine being developed by researchers in which the vaccine prevents cocaine from entering the brain and thus causing cocaine to have no effect


Depressants

Alcohol
Naltrexone block receptors involved in the rewarding feelings of drinking and helps with relapse to heavy drinking
Acamprosate reduces withdrawal symptoms such as insomnia, anxiety, restlessness, and dysphoria

Depressants Cont.
Methadone
and
Buprenorphine
are examples of some medications which treat opioid abuse. They target the same places in the brain that heroin or morphine would target and is also useful in relieving withdrawal symptoms and cravings

Methadone
is a slow acting opioid agonist which has been used to treat Heroin Addictions since the 1960’s. It is available through approved outpatient treatment programs where it is given to patients on a daily basis

Buprenophine
is a partial opioid agonist. It relieves drug cravings without producing the “high” or other side effects of other opioids

Naltrexone
on the other hand is an opioid antagonist which blocks receptors in which heroin or other opiates would have binded, this medication is less widely used and should only be used on patients that have been detoxified
These medications also help patients undergo behavioral treatments – makes it easier for them


Hallucinogens
Benzodiazepines
can be used to treat and control agitation and extreme seizures
PCP
– very little published data on how to treat PCP overdose, current research is focused on passive immunization approach through the development of anti-PCP antibodies


Marijuana
: there is currently no approved medication for marijuana in the U.S. although
lofexidine
which is a medical drug for the use of opiod treatment has been found to improve sleep, marijuana withdrawal symptoms and cravings
cognitive behavioral therapy
This therapy helps the patients look at situations more clearly so that they can prevent situations in which they may be tempted to abuse drugs
Helps patients recognize, avoid, and cope with situations in which drug abuse is likely

behavioral therapy
A therapy among younger patients in which possible influences towards the drug abuse are addressed

Multidimensional Family Therapy
Group Therapy
Patients are able to face their drug abuse more realistically as they are surrounded by other addicts who face the same problem
Behavioral Therapy
Motivational Interviewing
Motivational Incentives
Patients express their want and readiness to change, any type of treatment will be useless if the patient does not want to change
Positive reinforcements are used in order to create incentives for the patient to want to try to overcome their addiction
Patients could get rewarded for things such as staying drug free, attending treatment services, and taking prescribed when needed to medication

Residential Treatment
Long-term Residential Treatment
Short-term Residential Treatment
There are facilities that approach the issue with therapeutic communities (TC's) which help in long term residual treatments in which patients are cared for 24 hours a day for up to 6-12 months
Programs such as TC's try to re socialize patients by using other patients, staff and social settings as active components of treatment
Shorter treatment that uses the 12 step program which was initially used for alcoholic treatment but was expanded to other substance abuse disorders
Intense but brief treatment
Drug Abuse Disorder in the Criminal Setting
Criminals who undergo drug abuse treatment during, before, or after incarceration result in less criminal behavior and less drug use. Patients who are required by law to get drug abuse treatment such as criminals have better results than those who are not required to by law
Antagonists
which block the receptor and interfere with the rewarding effects of opioids.
Medications
Medications can be used to treat withdrawal symptoms.
Medication alone is not enough to completely withdrawal from drug use, additional treatment has to be done.
It helps recover proper brain chemistry. It is also used to prevent relapse and to get rid of cravings.
People with severe drug abuse issues are usually polydrug users meaning that they would require different medications for each different drug is being treated
There is still a lot of research and development on drug abuse medication to be done, there have not been many approved medications on most drugs and behavioral therapies would be preferred in that case

Stimulants
Tobacco
Bupropion
and
Varenicline
help prevent relapse in tobacco users
Replacement therapies such as gum, spray and patches are available for use

Cocaine
There is an anti-cocaine vaccine being developed by researchers in which the vaccine prevents cocaine from entering the brain and thus causing cocaine to have no effect
“The vaccine eats up the cocaine in the blood like a little Pac-Man before it can reach the brain,” Dr. Ronald G. Crystal, the lead investigator of the Weill Cornell Medical College study said in a press release.
Depressants
Alcohol
Naltrexone
block receptors involved in the rewarding feelings of drinking and helps with relapse to heavy drinking

Opioids
Hallucinogens (alkaloids)
Mild Hallucinogen
Behavioral Therapy
Behavioral treatments help shape the way that patients behave towards drugs
Behavioral treatments also help patients improve life skills that are important to deal with stressful environments so that they could avoid cravings and relapse
Includes more general treatments than medications

Behavioral therapy
Motivational Interviewing
Motivational Incentives
Contingency Management
Patients express their want and readiness to change, any type of treatment will be useless if the patient does not want to change
Positive reinforcements are used in order to create incentives for the patient to want to try to overcome their addiction
Patients could get rewarded for things such as staying drug free, attending treatment services, and taking prescribed when needed to medication

uses a voucher-based system in which patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living
Drug Abuse in the Criminal Setting
Criminals who undergo drug abuse treatment during, before, or after incarceration result in less criminal behavior and less drug use. Patients who are required by law to get drug abuse treatment such as criminals have better results than those who are not required to by law
Drug Enforcement Agency Schedules
Schedule I
These substances have no currently accepted medical uses in the United States.
High potential for abuse
Schedule II/IIN
These substances can be used to aid with medical problems.
High potential for abuse
Severe psychological dependence
Severe physical dependence
Schedule III/IIIN
These substances have less of a potential for abuse than schedule I and II drugs.
Low chance of physical dependence
High chance of psychological dependence
Schedule IV
These substances have less of a potential for abuse than schedule I, II, and III drugs.
Abuse may lead to limited physical or psychological dependence
Schedule V
These substances have less potential for abuse than schedule IV.
Abuse may lead to limited physical or psychological dependence
Types of Drugs
Club Drugs


AKA Ecstasy
Schedule I drug
Causes anxiety, chills, sweating, mild hallucinations, sleep disturbances, depression, impaired memory, hypothermia, addiction
MDMA (Methylene-Dioxy-Meth-Amphetamine)
GHB (Gamma-Hydroxybutyrate)
Flunitrazepam
Depressants


Found in liquor, beer, and wine
Causes drowsiness, slurred speech, nausea, range of emotions, loss of coordination, blurred vision, loss of memory, violence, depression, neurological deficits, hypertension, liver disease, heart disease, addiction, loss of consciousness, overdose
Alcohol
Opium
AKA Paregoric or Black Stuff
Schedule II, III, or V drugs (depending on the form)
Drowsiness, impaired coordination, dizziness, confusion, nausea, sedation, slowed or arrested breathing, constipation, hepatitis, HIV, addiction, fatal overdose
o Level of intoxication and potential for withdrawal
o Presence of other medical conditions
o Presence of other emotional, behavioral, or cognitive conditions
o Readiness or motivation to change
o Risk of relapse or continued drug use
o Recovery environment (e.g., family, peers, school, legal system)

AKA Liquid Ecstasy
Schedule I drug
Causes drowsiness, disorientation, loss of coordination, memory loss, unconsciousness, seizures, coma
AKA Roofie, Forget-Me pill, Mexican Valium
Schedule IV drug
Causes sedation, confusion, memory loss, impaired coordination, dizziness, addiction
Acamprosate
reduces withdrawal symptoms such as insomnia, anxiety, restlessness, and dysphoria
Designer Drugs
Krokodil (Russian for Crocodile)
Synthetic Marijuana
AKA Zombie drug
Originated in Russia
Is not yet controlled in the United States because there have only been a few cases.
Contains codeine (a narcotic pain killer), red phosphorous (used in making the strike part of a matchbox), paint thinner, gasoline, and hydrochloric acid.
Similar to heroin
Immediate effects - drowsiness, impaired coordination, dizziness, confusion, nausea, sedation
Long-term use use - speech impediments, erratic movement, disfigurement, addiction, death
Vein at injection site bursts, skin turns green and scaly, muscle and skin surrounding the vein disintegrates and begins to fall off the bone
Life expectancy for a user is 2-3 years.
AKA Spice, K2, Fake Weed, Scooby Doo
Schedule I drug
Causes elevated mood, relaxation, altered perception, extreme anxiety, paranoia, hallucination, rapid heart rate, high blood pressure, reduced blood supply to the heart, vomiting, agitation, confusion, heart attack, addiction, death
Dissociative Drugs
PCP
AKA Angel Dust, Hog, Love Boat, Peace Pill
Schedule I drug
Causes feelings of being separated from one's body and environment, impaired motor functions, anxiety, tremors, numbness, memory loss, nausea, psychosis, aggression, violence, slurred speech, loss of coordination, hallucinations
Ketamine
AKA Cat Valium, Special K, Vitamin K
Schedule III drug
Causes feelings of being separated from one's body and environment, impaired motor functions, anxiety, tremors, numbness, memory loss, nausea, impaired memory, delirium, respiratory depression and arrest, death
Salvia
AKA Magic Ming, Sally-D, Maria Pastora
Causes feelings of being separated from one's body and environment, impaired motor functions, anxiety, tremors, numbness, memory loss, nausea, psychosis
DMX
AKA Robo, Triple C
Found in some cough and cold medications
Causes feelings of being separated from one's body and environment, impaired motor functions, anxiety, tremors, numbness, memory loss, nausea, slurred speech, confusion, dizziness, distorted visual perceptions
Hallucinogens
Cannabinoids
LSD
Mescaline
Psilocybin
Marijuana
AKA Blunt, Dope, Ganja, Grass, Herb, Joint, Bud, Mary Jane, Pot, Reefer, Weed
Schedule I
Causes slowed reaction time, distorted sensory perception, impaired balance and coordination, increased heart rate, increased appetite, impaired learning, panic attacks, impaired memory, psychosis, mental health decline, addiction
Hashish
AKA Boom, Hash, Hemp
Schedule I
Causes altered perception, extreme anxiety, paranoia, hallucination, rapid heart rate, high blood pressure, reduced blood supply to the heart, vomiting, agitation, confusion, heart attack, addiction
AKA Acid, Blotter, Cubes, Microdot Yellow Sunshine, Blue Heaven
Schedule I drug
Causes altered state of perception and feeling, hallucinations, nausea, flashbacks, Hallucinogen Persisting Perception Disorder, elevated body temperature, increased heart rate, high blood pressure, loss of appetite, sweating, insomnia, numbness, dizziness, weakness, tremors, impulsive behavior, rapid shifts in emotion
AKA Buttons, Cactus
Schedule I drug
Causes altered state of perception and feeling, hallucinations, nausea, flashbacks, Hallucinogen Persisting Perception Disorder, elevated body temperature, increased heart rate, high blood pressure, loss of appetite, sweating, insomnia, numbness, dizziness, weakness, tremors, impulsive behavior, rapid shifts in emotion
AKA Magic Mushrooms, Purple Passion, Shrooms, Little Smoke
Schedule I drug
Causes altered state of perception and feeling, hallucinations, nausea, nervousness, paranoia, panic
Heroin
AKA Dope, Cheese
Schedule I drug
Causes drowsiness, impaired coordination, dizziness, confusion, nausea, sedation, slowed or arrested breathing, hepatitis, HIV, addiction, fatal overdose
Inhalants
Solvents (paint thinners, gasoline, glues)
Gases (propane, aerosol propellants)
Nitrites (laughing gas)
**Causes headache, nausea or vomiting, slurred speech, loss of motor coordination, wheezing, muscle weakness, depression, memory impairment, damage to cardiovascular and nervous systems, unconsciousness, sudden death
Methamphetamine
AKA Meth, Ice, Crank, Chalk, Crystal, Fire, Glass, Speed
Schedule II drug
Causes accelerated heart rate, high blood pressure, raised body temperature, tremors, irritability, anxiety, panic, paranoia, violent behavior, psychosis, dental problems, insomnia, cardiac or cardiovascular complications, stroke, seizures, addiction
Transformation over 10 years
Prescription Drugs
Opioids
Fentanyl
Codeine
Hydrocodone
Oxycodone
Oxymorphone
Propoxyphene
Hydromorphone
Meperidine
Diphenoxylate
Central Nervous System Depressants
Pentobarbital Sodium
Diazepam
Alprazolam
Stimulants
Dextroamphetamine
Methylphenidate
Amphetamines

Steroids
Hypertension, blood clotting and cholesterol changes, liver cysts, hostility and aggression, acne


Prostate cancer, reduced sperm production, shrunken testicles, breast enlargement



Menstrual irregularities, development of beard and other masculine characteristics


Premature stoppage of growth
Anadrol, Oxandrin, Durabolin, Depo-Testosterone, Equipoise
( Roids, Juice, Gym Candy, Pumpers)
Side Effects
Men
Women
Adolescents
Stimulants
Cocaine
AKA Blow, Bump, Candy, Charlie, Coke, Crack, Flake, Rock, Snow
Schedule II
Causes accelerated heart rate, high blood pressure, elevated body temperature, tremors, irritability, anxiety, panic, paranoia, violent behavior, psychosis, nasal damage from snorting, insomnia, cardiac or cardiovascular complications, stroke, seizures, addiction
Tobacco/Nicotine
Found in cigarettes, cigars, and smokeless tobacco (snuff, spit tobacco, chew)
Causes accelerated heart rate, high blood pressure, addiction, chronic lung disease, cardiovascular disease, stroke, cancer (mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, bladder, acute myeloid leukemia), adverse pregnancy outcomes, addiction
Katherine Casey, Diana Laposse, & Elaine Flores
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