Practice Principles and Pharmacology

CSD 5970Counseling the Chemically Dependent

Review We can’t separate ourselves from

our history! What we see depends on the lenses

that we use (including treatment orientation).

Have we learned from our experience with prohibition?

Treatment, Self-Help, and Recovery

Substance Abuse Practice Designated treatment facilities Health care Child welfare Financial assistance Mental health Anywhere people seek help!

Today Some definitions Pharmacology

Substance Abuse Practice Personal Bias and Perspective

Challenges for recovering folks Challenges for non-recovering folks Challenges for everyone

Some Terms Use Misuse Abuse Addiction Habituation Dependence

Use

From Lawson and Lawson The intake of a chemical substance

into the body with the goal of somehow altering one’s state of consciousness. (Use may or may not cause problems)

Misuse Using a chemical with some

physically, psychologically, socially, or legally adverse consequence (often carries moral implications).

Cultural Implications?

Abuse Chronic, recurrent misuse of

chemicals. (This term should, perhaps, be left for such situations as child abuse, animal abuse, and self-abuse. The term chemical abuse tends to anthropomorphize chemicals by making them the object of the abuse)

Abuse DSM IV criteria.

Failure to fulfill a major life function. Use in situations where it is physically

hazardous. Persistent or recurrent social or interpersonal

problems caused or exacerbated by the effect of the substance.

Recurrent legal problems related to the substance.

Addiction A cellular change that occurs with

increased use of most depressant drugs. The primary clinical features are the development of tolerance and the development of withdrawal symptoms upon removal of the drug.

Habituation The repetition of behavior. (This

behavior is often anxiety reducing for the individual)

Dependence Physical dependency is much the

same as addiction. Psychological dependence is a state that occurs when there is a strong urge to alter one’s state of consciousness through the use of a chemical. The two types of dependency may occur independently or in combination with each other.

DependenceJohnson

Recurrent or chronic use (often daily), that results in a physiological and/or psychological “need” (real of felt) for the drug as a matter of survival, causing severe and/or chronic negative life consequences. The chemically dependent person’s life is fully encompassed by the obsession to use drugs and live the accompanying lifestyle.

Dependence Physical addiction vs. psychological

dependence The dependency cycle or pattern

“it is always easier to get on a roller coaster than off”

Dependency DSM IV 3 (or more) of the following at any

time in a 12-month period. Tolerance Withdrawal Substance is taken in larger amounts or

for longer than intended

Dependency DSM IV Persistent desire or unsuccessful

attempts to cut down Time spent in activities necessary to

obtain the substance Important life roles given up Use continues despite serious negative

consequences

                          

6 Facts About Drugs Drugs are harmless Drugs have a physiological and

neurological effect on human beings Before a drug takes effect, it must

get to the brain

6 Facts About Drugs Drugs in the same category act the

same way. It is difficult to predict the effect of a

drug due to mood, setting, episode, physical condition etc.

Mixing drugs can be deadly.

Pharmacology Route of administration

Oral Inhalation or smoking Injection Mucous membranes (snorting)

Pharmacology Tolerance

Physical Psychological Behavioral Cross-tolerance

Major Categories Central Nervous System (CNS)

Depressants CNS Stimulants Cannabinoids Opiates Hallucinogens Inhalants

What We Need to Know Examples Routes of administration Major effects Overdose Tolerance Withdrawal Treatment Issues