substance abuse & addiction

Substance Abuse & Addiction

Classifications of Substances

• Categories based on the effects.– Depressants = slow down brain activity.– Stimulants = speed up brain activity.– Analgesics = reduce or eliminate pain signals.– Hallucinogenic = induce hallucinations.


• Alcohol– 1, 12 ounce beer = around 4% alcohol

• Accounts for 49% of all alcohol consumed

– 1, 4 ounce glass of wine = around 12% alcohol• Accounts for 12% of all alcohol consumed

– 1 mixed drink with 1 ¼ ounce of liquor = around 40% alcohol• Accounts for 39% of all alcohol consumed

Classifications of Substances• Physical effects of alcohol– It’s an irritant and a sedative, and effects most body

systems:• Digestive system • Circulatory system • Endocrine system• Central nervous system

– sedates the brain from the inside out; intellect, emotions, motor functions, semi-voluntary, involuntary functions, vital

– Has both physical and psychological dependency potential.


• Marijuana– Has depressant, stimulant, some analgesic, and

even hallucinogenic effects.– The potency of the active ingredient (THC) has

increased dramatically since the early 1960’s. – Has both physical and psychological dependency

potential.

Classifications of Substances• Sedative-Hypnotics

– Barbiturates• Central nervous system depressants used medically to treat anxiety, induce

sleep, and control seizures.• Intoxication is similar to that caused by alcohol.• Combining barbiturates with other depressants can cause a synergistic effect

and produce death.• Can create both physical and psychological dependence.

– Minor Tranquilizers• Central nervous system depressants used medically to treat anxiety and

insomnia.• More Rxs are written for tranquilizers that all other Rxs combined.• They have a high illicit resale value on the street.• Can create both physical and psychological dependence.


• Narcotics– Central nervous system depressants which cause

sedation and euphoria.– Are both manufactures synthetically and derived from

naturally occurring substances.– Are used medically to relieve pain, suppress cough, and

control diarrhea. Others like Heroin have no medical use.

– Can cause both physical and psychological dependence. – Worst prognosis for recovery.


• Stimulants– Amphetamines = increase alertness and induce a

sense of wellbeing. • In large doses can cause extreme anxiety, malnutrition,

paranoia, and physical health problems.• Can cause both physical and psychological dependence.

– Cocaine = creates a sense of euphoria.• Can lead to anxiety, irritability, panic and paranoid

psychosis.• Can cause both physical and psychological dependence.

– Crack = more potent form of cocaine.


• Inhalants– Large group of chemicals which includes solvents,

aerosols, gases, and nitrites.– Generally considered central nervous system

depressants creating an effect similar to alcohol intoxication.

– Can cause both physical and psychological dependence.

– Because they are found over-the-counter many adolescents use these drugs without raising the suspicion of their parent’s.

Alcohol and drug use statistics• Past month illicit drug use among persons 12+

Results from the 2007 National Survey on Drug Use and Health conducted by Substance Abuse and Mental Health Services Administration (SAMHSA).

Alcohol and drug use statistics

Results from the 2007 National Survey on Drug Use and Health conducted by Substance Abuse and Mental Health Services Administration (SAMHSA).

The Process of Addiction• Stage 1: Experimental and Social Use of Drugs & Alcohol

Reasons:to satisfy curiosity,to acquiesce to peer pressure,to obtain social acceptance,to defy parental limits,risk taking or thrill seeking,to appear grown up,to relieve boredom,to produce pleasurable feelings .

Behavioral Indicators: little noticeable change, lie about use of whereabouts, moderate hangovers, evidence of use: beer can or joint.

The Process of Addiction• Stage 2: Abuse

Reasons:to manipulate emotionsto experience pleasure,to cope with stress and uncomfortable feelings,to overcome feelings of inadequacy,to avoid the depression of sobriety,to at least maintain feelings of normalcy

Behavioral Indicators:school or work performance and attendance may decline,mood swings,changes in personality,lying and conning,change in friendships – will have drug using friends,decrease in extra-curricular activities,begins adopting drug culture appearance,conflict with family members may be exacerbated,behavior may be more rebellious,all interest is focused on procuring and using drugs/alcohol

The Process of Addiction• Stage 3: Dependency / Addiction

Reasons:drugs/alcohol are needed to avoid pain and depression,many wish to escape the realities of daily living,use is out of control.

Behavioral Indicators:physical deterioration includes weight loss, health problems,appearance is poor,may experience memory loss, flashbacks, paranoia, volatile mood swings, and other mental problems,likely to drop out or be expelled from school or lose job,may be absent from home much of the time,possible overdoses,lack of concern about being caught – focus only on procuring and using drugs/alcohol

Diagnostic Criteria for Substance Abuse

• A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

– Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home.

– Recurrent substance use in situation in which it is physically hazardous.

– Recurrent substance –related legal problems.– Continued substance use despite having persistent or recurrent

social or interpersonal problems caused or exacerbated by the effects of the substance.

Diagnostic Criteria for Substance Dependence

• A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following, occurring within a 12-month period:

– Tolerance (need for increased amounts / diminished effect).– Withdrawal (symptoms of withdrawal syndrome / the substance is taken

to avoid withdrawal).– The substance is taken in larger amounts or for a longer period then was

intended.– A persistent desire or unsuccessful efforts to cut doe or control use.– A great deal of time is spent obtaining, using, or recovering from the

substance.– Important activities are given up or reduced because of substance use.– Use is continued despite knowledge of having a physical or psychological

problem likely caused by or exacerbated by he substance.

Causes of Addiction & Treatment Approaches

• Medical/Biological Model– Addiction is seen a an illness; a chronic, progressive,

relapsing, and potentially fatal disease. And alcohol or drug dependence is an involuntary result of initiating use.

– Recovery is considered long-term behavioral management of the addictive disease and is life-long.• Research supports

– Genetic causes– Brain reward mechanisms– Altered brain chemistry– Self-medication


• Clinical Model– Reinforcement processes– Personality traits


• Social Model– Social learning– Subculture perspective– Socialization– Social control– Social, economic, and political factors


• Biopsychosocial Model – broader, more holistic view emphasizing a combination of factors contributing to substance abuse and dependence.– hereditary factors, altered brain chemistry, avoidance

of discomfort– To cope with emotional and psychological problems– Social interaction is were drug use is learned and

reinforced.– The contribution of life stressors such as

unemployment, poverty, family dysfunction.

Withdrawal & Detoxification• Alcohol

– Symptoms of withdrawal• Tremors• Sweats• Increased blood pressure, pulse rate & body temperature• agitation/anxiety• Convulsions/seizures• Elevated temperature• Eating and sleep disturbances/nightmares• Clouding of the sensorium• Hallucinations

– Medical detox• Check there vital signs and ask them a series of questions every 4 hours.• Medicate with benzodiazepines• Amount of time varies depending on use, acute phase is usually 3-7 days

Withdrawal & Detoxification• Benzodiazepine

– Symptoms of withdrawal• Tremors• Agitation/anxiety• Increased blood pressure & pulse rate• Insomnia• Vomiting, nausea• Diaphoreses (excessive perspiration)• Convulsions/seizures• Clouding of the sensorium• Weakness• Headaches/muscle aches

– Medical detox• Check there vital signs and ask them a series of questions every 4 hours.• Medicate with benzodiazepines• Amount of time varies depending on use, acute phase is about 2 weeks

Withdrawal & Detoxification• Opiate

– Symptoms of withdrawal• Abdominal cramps, vomiting, nausea, diarrhea• weakness• Increased blood pressure, pulse rate & body temperature• Piloerection (gooseflesh)• Dilated pupils• Rhinorrhea (nasal drainage)• Tremors• Insomnia• Muscle aches• Irritability

– Medical detox• Check there vital signs and ask them a series of questions every 6 hours.• Medicate with benzodiazepines & clonidine. • Amount of time varies depending on use, acute phase is about 4 days

Detoxification

• Amphetamines– Symptoms of withdrawal

• Irritability• Weakness• Fatigue/hypersonic• Depression• Inability to concentrate• Diminished ability to experience pleasure• Increased appetitie• Paranoid ideation/psychosis

– Detox• No acute medical risk, so medications are not used.• Usually involves them sleeping for the first 1-2 days.• Amount of time varies depending on use, acute phase is about 5-6 days.

Treatment Modalities• Medication-Assisted Treatment

– General practitioner• Residential or Inpatient Treatment Programs

– Walker Center• Inpatient Hospital Treatment

– Canyon View• Therapeutic Communities

– New Hope, Clean & Sober living houses• Outpatient Treatment

– Treatment and Recovery Center, 12 Step meetings, support groups• Combined Settings

Treatment Components

• Self-Help Programs• Individual Counseling• Group Therapy• Family Therapy• Behavior Modification

substance abuse & addiction

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