Effective Strategies with Substance Abusers
Jane E. Pfeifer
Who are our clients?
What are their challenges?
Specific drugs
AlcoholMarijuanaOpiatesCocaine
MethamphetamineHallucinogens
• A depressant that is present with & potentiates effects of most other drugs of abuse
• Involved in MOST cases of Domestic Violence
• A Known Teratogen
Alcohol
Alcohol Effects on Society
• Alcohol related traffic deaths account for twice as many deaths among teens as drugs.
• 60% of tardiness, absenteeism, and poor work quality is the result of light and moderate drinking.
• 40% is caused by heavy drinkers and alcoholics.
Alcohol Effects on Society
• 52% of college students in 1997 reported they drank to get drunk as compared to 39% in 1993.
• 40% reported binge drinking, and 20% report doing so once a week.
• NIAAA report that drinking is involved in more than 50% of sexual assaults.
Alcohol• Signs of Abuse
– drowsiness– aroma– gait ataxia– irrational– lack of restraint– slurred speech– high accident rate
• Signs of Withdrawal– hypertension
– sweating
– anxiety
– tremors
– insomnia
– disorientation
– physical complaints
– cravings
Alcohol• Blood Alcohol Levels
– .1% BAL motor coordination is impaired– .2% BAL user is obviously intoxicated– .3% BAL physical and mental activity
decreases as user enters a stupor– .35% BAL anesthesia is present– .4% BAL most die from respiration cessation– .6% BAL most are dead
Marijuana• THC (delta-9-tetrahydrocannabinol) content
generally much more potent today than a few decades ago
• Typically used to achieve relaxation
• Impairs short-term memory and decreases motivation
• Can alter perceptions, impair coordination, cause anxiety, panic, and paranoia in higher doses
Marijuana• Signs of Abuse
– dry mouth
– bloodshot eyes
– altered time
– impaired recall
– slowed motor skills
– depersonalization
– distorted perception
– munchies
• Signs of Withdrawal– no specific
syndrome
– insomnia
– hyperactivity
– decreased appetite
– paranoia
Opiates: Heroin, Demerol, Oxycontin, Vicodin
• Higher levels of street purity leading to increased intranasal use;
• Narcotic use historically follows stimulant epidemic
• Diversion of prescription painkillers =new epidemic
• Hepatitis C epidemic.
Opiates• Signs of Abuse
– euphoria– pupil constriction– constipation– drowsiness– itching– nausea– slowed speech
• Signs of Withdrawal– acute anxiety
– craving
– aches and cramps
– sweats
– insomnia
– vomiting
– increased body functions
Cocaine• Signs of Abuse
– euphoria
– increased energy
– increased alertness
– decreased appetite
– insomnia
– anxiety
– irritability
– increased sex drive
• Signs of Withdrawal– crash
– agitation
– depression
– craving
– fatigue
– eating binges
– paranoia
– weakness
Methamphetamine• Signs of Abuse
– rapid weight loss– nervous energy– no “need” for sleep– aggressive– mean temperment– compulsive– excited talk
• Signs of Withdrawal– long crash– apathy– depression– fatigue– anxiety– suicidal ideation– cravings
Hallucinogens• Signs of Abuse
– euphoria– altered perception– illusions– anxiety– psychosis– depersonalization– mystical experiences
• Signs of Withdrawal– no identified
withdrawal syndrome
– flashbacks
What’s going on?
• Use
• Abuse
• Dependence
The Disease of Addiction
• Is similar to brain injury-you should view this as similar to a stroke or accident victim.
• Be kind, repetitive and reinforce your message.
• Does not stop without treatment
• Treatment must be evidence-based and must continue throughout life
• Addiction is a disease of the brain
• It is a chronic, relapsing, life long disease.
• External intervention is necessary
• Treatment works…but only if a person goes.
• Many abusers/addicts are poly substance abusers. You should assume the person is likely using more than one drug.
Addiction Basics
Addiction Basics
• Addicts do not take drugs to feel good. They take drugs to feel “less bad”.
• Most people in early treatment don’t feel better, they feel worse.
• And many are not in any type of treatment.
Brain’s Limited Range & Duration of “Emotional”
Experience l-------------l--------------l-------------l-------------lSuicidal BAD GOOD VERY GOOD Euphoric NORMAL BRAIN RANGE
l l l l l l l l
l------------l------------l-------------l------------l
Suicidal BAD GOOD VERY GOOD Euphoric
RECOVERING BRAIN RANGE
What challenges are you having?
Strategies
• Because cognitive distortions are common:– Sequence tasks– Shorter, more frequent meetings– Repeat, remind, encourage – Write things down – Ask for a support person
• Above all: Patience
Strategies
• If you sense hostility, let them go and try again another day.– The interactions of drugs can cause violence– There is a strong correlation between mental
illness and addiction.
• Call for assistance if needed. • Do not put yourself or the person at risk.• Do not be alone with a client without
someone else nearby.
Substance abuse is nota moral failing
• Once addiction takes hold, it is a neurological process. The brain is described as being “hijacked”.
• It is not about willpower.• It takes significant work to resume control
over the hijacked brain.• Patience is critical.