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First Half of Semester Notes

by: Alii

First Half of Semester Notes SOW 4700

UWF - Pensacola
GPA 3.66

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About this Document

Half a semesters worth of notes. Includes notes from the readings. Notes go up to what is on the midterm. Chapters 1-7.
Substance Abuse
Dr. Brown
Substance Abuse, Social Work, UWF
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This 39 page Bundle was uploaded by Alii on Saturday November 28, 2015. The Bundle belongs to SOW 4700 at University of West Florida - Pensacola taught by Dr. Brown in Fall 2015. Since its upload, it has received 46 views. For similar materials see Substance Abuse in Social Work at University of West Florida - Pensacola.


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Date Created: 11/28/15
Chapter 1­ Putting Drugs in Perspective.  Failed approaches. o Filled with emotional and political bias that denied the real dimensions of drug  problems. o Scare tactics.  Ex: Reefer Madness.  Believed that if young people were frightened by the effects of drugs they  would not use them.  Scare tactics worked with people who saw drug use and opposite to their  values and goals.  For most people scare tactics did not work because they were seen  as exaggerated and sensationalized. o As a result none of the information given was seen as  credible.  Overall, alienated young people, heightened their curiosity, and increased  experimentation. o “War on Drugs.”  Enforced by Nixon after drug use had spread to epidemic proportions.  Focused on the supply side and not the demand side. o The myths of a simple solution.  “Just say no.”  Simplistic view of a complicated problem.  “Any solution to a complex problem that is simple, is usually  wrong.” o What is the best way to engage and motivate those dependent on drugs? o Drug­specific approaches to curb interest.  Reverse effect, heightened curiosity.  Alcohol­related problems. o The most problematic drug. rd o 3  leading preventable cause of death in the US. o Binge drinking on college campuses.  Half of all alcohol consumed is through binge drinking.  40­45% of college students binge drink.  Approximately 1,400 students die each year of alcohol­related incidents.  First 6 weeks of the school year are the most dangerous with respect to  alcohol behavior. o Significant negative effects.  Academic problems.  Property damage.  Death.  Drinking under the influence.  Sexual assault and rape.  At least half of cases on college campuses involve alcohol  consumption.  Personal injury.  High­risk sexual behavior.  Other high­risk behaviors.  Anger, violence, and road rage.  Psychological issues and problems (depression, etc.) o Intimate partner violence.  IPV.  Alcohol involved in 20­25% of IPV.  Alcohol caused:  Impaired judgement.  Cognitive impairment.  Loosened inhibitions.  Physical effects the lead to IPV.  Exacerbation of marital/couples conflicts.  Negative family life, increasing violence.  Drinking by men is a stronger predictor of IPV than drinking by women. o Drinking and driving – young drivers.  Highest driving fatality rates where alcohol is involved are found among  young drivers.  Traffic fatalities.  29% of DUIs in 2002 were drivers 15­20 years old.  21% reported DUIs were by 16­20 year olds in 2002 and 2003.  Factors contribute to young drivers crashes:  Lack of driving experience.  Overconfidence.  Other teenagers in the car. o Encouraging risky behavior. o Intentional and unintentional deaths other than traffic fatalities.  Accidental injuries are among the leading cause of death in older  adolescents and young adults.   Binge drinking is normally involved.  45% of fatalities other than traffic fatalities related to drinking (under the  ag of 21) were:  Drowning, burns, falls, alcohol overdose and related deaths, etc.  Intentional deaths related to alcohol include homicides and suicides.  12% of males and 8% of female suicides are related to alcohol.  Other problems in perspective. o Tobacco.  The most deadly drug.  24% of the population of smokers, many of those in recovery from  alcohol/drugs will die of smoking related illnesses. o Continued emphasis on supply side and neglect of demand side of the drug  problem.  Large amount of money is being spent on reducing supply.   Funding for treatment programs is low, making wait times to enter  longer and raising likelihood of relapse.  Though there is no reduction in availability of drugs.   Problem has escalated so much the government officials are considering  legalizing drugs.   Long­term prevention programs with funding for serval years are needed  to reduce future demand side. o Racist approach to the drug problem.  Legislation on drug policy was based more on racial scapegoating then on  a concern of the harmful impact of drugs on people.  Made treatment resources limited since no one wanted to help. o Socioeconomic inequities that undermine the American dream.  Inequality in society creates bitterness over not reaching the American  dream, causing drug use. o Academic inadequacies and failure to motive and educate young people.  Academic failure and the role of the US educational system.  US educational system has been neglected. o Denial of alcohol/drug problems in the family.  Enables problem.  The longer denial goes on the more vulnerable family members are to  experiencing destructive consequences of abuse and addiction.  Parent drug addiction makes children 4­8 times more likely to develop  alcohol/drug problems. o Student drug use.  A continued concern.  Increase in marijuana, ecstasy, and Adderall use.  Due to perceived risk of using falling.  Decrease in LSD, hallucinogen, and Ritalin use. o Adolescent co­occurring disorders.  The 4 major perspectives. o The Moral­Legal perspective.  Viewpoint:  Law enforcement and criminal justice systems.  Major focus:  Keep specific drugs away from people, and people away from  specific drugs.  Approach:  Reduce availability of drugs, punish as a deterrent.  Drawback:  Addresses on the supply side.  Have not been able to significantly diminish availability of drugs. o The Medical­Health perspective.  Viewpoint:  Medical and health treatment fields.  Major focus:  Drug/alcohol use as a public health problem.  Approach:  Treatment focuses on physical damage related to drug use, abuse,  and dependence.  Drawback:  Assumes health information influences, attitudes, beliefs, habits,  and addiction.  Assume people seek good health. o The Psycho­Social perspective.  Viewpoint:  Mental health and alcohol/drug treatment fields.  Common viewpoint shared by agencies that specialize in  addressing the demand side of drugs. o Agencies provide:  Recovery from abuse.  Intervention and treatment services.  Early intervention with adolescents.  Prevention services.  Major focus:  Prevent, intervene, and treat alcohol/drug and co­occurring  disorders.  Approach:  Provide services from housing, finances, to quality of life.  Drawback:  Public agencies are underfunded, understaffed, problems are many  and at time overwhelming. o The Social­Cultural perspective.   Viewpoint:  Social agencies and institutions.  Major focus:  Assumption that alcohol/drug abuse is due to frustration and  hopelessness with people’s lives.  Approach:  Adapt the environment to meet the individual’s needs.  Drawback:  Poorly funded and societal change is slow.  Most agencies are impersonal dealing with client’s needs.  Drug problem is a collection of local problems.  Need to support neighborhood and community efforts to prevent  development of problems. Chapter 2­ Why Do People Abuse Drugs?  A better understanding of models and theories of drug dependence and addiction  Reasons for using drugs/alcohol. o Innate drive to alter consciousness. o Passive activity.  Take drugs for immediate gratification and to combat certain issues.  Used to avoid feelings.  Easy way to overcome boredom.  Existential boredom and interpersonal boredom have impact on  drug abuse. o Affect (feeling regulation).  Impulsivity.  FLOW defined. o “So involved in an activity that nothing else seems to matter.” o “When consciousness is harmoniously ordered, pursue what you are doing for the  sheer sake of doing it.”  Models. o Disease model.  1957 AMA declared alcoholism a disease based on 3 factors.  Known etiology. o Cause.  Symptoms get worse over time.  Known outcomes. o Dependence, physical symptoms, and eventual death.  Research has indicated an increasingly strong case for a genetic  component of alcoholism.  Is the foundation of Alcoholics Anonymous.  12 step approach based on the disease model. o Assumes alcoholic/addict is predisposed to addiction. o Genetically transmitted at­risk factors.  Genetic­influence disease model.  Does not emphasize genes or a specific disorder, but assumes  multiple biological risk factors interact with psychosocial  environmental factors.  Assumes addiction is influenced by interpersonal relationships. o Friends, family, community, and culture. o Genetic model.  Devours.  Developmental genetic model.  Not a single disorder. o A group of illnesses. o Ebbing influence of genes and environment.  Believed to be a group of illnesses in which the influences of genes and the environment ebb and flow over the course of the at­risk  lifetime.  Treatment should be individually designed.  Adoption studies/twin studies.  Adoption studies.  Sons of alcoholics are 4 times more likely to be alcoholics.  Daughters of alcoholic fathers have more somatic anxiety and  frequent physical complaints.  Supported genetic component.  Twin studies.  Higher rate of alcoholism in monozygotic twins. o Self­medication.  Khatzian.  Drug use is not a random phenomenon.  Purposeful to: o Assuage painful affective (feeling) states. o Manage psychological problems. o Manage personality traits and disorder.  Explore the self­medication motive to find other ways to better  cope with the affective states and psychological problems. o Help identify why users are taking drugs and to help learn  better coping skills.  Trauma can lead to self­medication o Personality traits/disorders.  Addictive personality.  Cannot be identified.  Not real.  Better to say people have psychological vulnerability. o A prior physiological factor that makes a pattern of  substance dependence more likely to develop.  Is difficult to identify the relationship of alcoholism and drug addiction to  particular dimensions pf personality.  Personality traits and disorders that make one vulnerable to addiction.  Cloninger identified a three­dimensional model of personality for  addiction.  Identified three temperaments the correlate with substance use  disorders: o Harm avoidant.  Cautious, apprehensive, fatigable, inhibited. o Reward dependent.  Ambitious, sympathetic, warm, industrious,  sentimental, persistent, moody. o Novelty seeking.  Impulsive, excitable, exploratory, quick tempered,  fickle, extravagant.  Specific personality traits of alcoholics/addicts.  Impulsivity/disinhibition.  Risk taking behavior.  Personality disorders.  Narcissism and borderline personality disorder have strongest  relationship to abuse. o Have strong correlation with substance abuse.  Depression, mood, and feelings. o Used as a form of self­medication. o Major depression and dysthymia (low grade depression)  occur 1.5­2 times more in alcoholics. o Female alcoholics have a 10 times higher incidence of  mania. o Male alcoholics have a 3 times higher incidence of manic. o Begins with self­medication for negative affect states, and  can spiral into a pattern of isolation and interpersonally  distancing. o Feelings of hopelessness, pessimism, poor future  orientation lead to depressive thinking.  Personality traits of addicts/alcoholics.  High emotionality.  Anxiety and overreactivity.  Inability to express anger adequately.  Immaturity in interpersonal relationships.  Ambivalence to authority.  Anger over dependence.  Low self­esteem with grandiose behavior.  Perfectionism compulsiveness.  Feelings of isolation.  Depression.  Sex role confusions. o Sexual immaturity.  Dependence in interpersonal relationships.  Hostilely.  Rigidity. o Inability to adapt to changing circumstance.  Simplistic black and white thinking. o Mood and affect disorders. o Family model.  Family conflicts can contribute to drug use.  Marital discord, imbalance in parents, etc.  Is a family disease.  A disease that effects all family members.  Parenting styles of alcoholic parents tend to be abusive and not nurturing.  Resolution of dysfunctional issues, boundaries, and healing trauma.  Poor self­concept.  Aka sense of self.  Comes from the outside world.  Goal is not to convince people not to do drugs, but to empower  them to enhance their development of self. o Families must promote child’s sense of self. o Psychosocial social learning.  Social learning theory.  Lean in various ways to abuse drugs.  Marlette and Gordon emphasized:  Addictive behaviors are a category of “bad habits.” o Or learned behaviors. o Addictive behaviors are learned habits.  Behaviors vary in quantity and frequency. o Addictive behavior is on a continuum. o Socio­cultural.  Bales.  The influence of culture rates of alcoholism are based on: o Degree to which a culture causes acute needs for  adjustment of inner tension. o Attitudes toward drinking. o Degree to which the culture provides substitute means of  satisfaction.  Societies and cultures offering few alternatives to drinking as tension  relievers are more susceptible to addiction. o Tension reduction.  Most widely researched theory.  Involves concept of homeostasis.  To balance out stress, anxiety, conflict, frustration.  Used as tension reducers.  Believe we have biological variations in our levels or tolerance to stress.  Three basic classifications in dealing with stimuli in the body:  Stimulus reducers. o Perceive and react to a stimulus as if that stimulus were less than it is.  Stimulus moderators. o React to a stimulus as it is.  Stimulus augmenters. o React to a stimulus as if it were more than it is. o Leads to overly sensitive need for relief from any  discomfort.  Henecke.  Sons of alcoholics use stimulus augmenters. o Alcohol is used to shut down the stimulation overload. o Psychoanalytic model.  Traditional view:  Fixation at the oral stage of development. o Resulting in a narcissistic personality.  Modern view:  Caused by a structural deficit in object relations. o Results in difficulty in establishing interpersonal  relationships.  Meaning of drugs.  Sometimes use of particular drug is related to the meaning it holds  for person. o Consciously or subconsciously.  As power, self­destruction, seduction, and sexuality.  General acceptance of multiple causes, a matrix of both genetic and environmental  factors. o No one model explains all substance abuse. Chapter 3­ Drug­Specific Information.  Drugs became part of hippie movement in 60s and 70s.  Cocaine became popular in 80s. o Tragic accidents with cocaine brought it to the forefront. o Changed entire outlook on addiction.  In 80s synthetically produced drugs became popular.  90s saw the rise of methamphetamine.   A new era. o Medical usage of marijuana.  Legalization of marijuana is most significant change in recent drug  history.  Problem is there is limited research on marijuana usage.  Health concerns of smoking marijuana has led to market place marijuana  products that do not require smoking.  Ex: food. o Energy drinks are becoming popular and stronger. o Crystal methamphetamine.  There is a growing problem with stimulant abuse.  Dramatic increase in use and availability of meth.  Much more potent than previously.  Is synthesized in a lab.  Produce rush of euphoria.  Highly addictive.  Population using meth.  Used by diver groups in all regions of US.  Found in raves, gay men, homeless youth, and sex workers.  Users can be identified by: o Agitation, excited speech, paranoia, insomnia, OCD­like  behavior, and increased physical activity levels.  Chronic use can resemble people suffering from paranoid  schizophrenia.  Tolerance develops quickly.  Ice is smokable version. o MDMA.  Ecstasy.  First made as an appetite suppressant.  Is a mood­enhancing stimulant.  Increase in empathy and intimacy. o Yet inhibits orgasm and interferes with erections.  While it is referred to as a hallucinogenic it rarely produces delusions.  Paranoia is associated after use.  Hangover effect after use.  As same symptoms of a hangover.  Tolerance does develop. o OxyContin.  Opioid prescribed for chronic pain.  Normally in cancer patients.  Inject, snort, or drink the drug.  Many pharmacies are robbed for it. o Heroin.  Significant increase in usage in the 90s.  Who uses?  Well­educated, often females, are addicted to.  Users are found in high school and middle school.  Found everywhere in US.  Why? o Associated with entertainment world. o Inexpensive compared to other drugs. o Easily obtained.  More potent now­a­days.  Synthesized from morphine.  Was originally thought to cure opium and morphine independence.  Both were used as medications at first o Inhalants.  Glue, aerosol spray, lighter fluid, spray paint, and show polish are some  examples.  Definitions. o Physical dependence.  The altered state that develops when a person cannot stop taking a certain  drug without suffering from withdrawal.  Withdrawal symptoms are physical symptoms resulting from  stopping the use of a drug o Reactions vary according to drug used, amount used, and  length of time used.  Person cannot stop taking a certain drug without suffering from  withdrawal. o Psychological dependence.  A user with a profound emotional or mental need to the repetitive use of a  drug or drug class. o Tolerance.  Develops when the individual requires increasingly larger doses to achieve the desired optimal effect.  User requires larger doses to achieve the same, original high. o Cross­tolerance.  A diminished or reduced response to the effect of a psychoactive drug.  Normally in the same drug category. o Synergism.  One chemical enhances the effect of another. o Antagonism.  The combined effect of two drugs is less than the sum of the drugs’ effects acting separately. o Route of administration.  Method drug is ingested.  Oral, injection, smoking, or other orifices.  Most rapid reaction occurs after inhalation, followed by injection.  Oral and absorption are the slowest routes.  9 methods:  Orally.  Rectally.  Inhaled.  Absorbed through skin.  Absorbed through membranes.  Injection.  Intravenously.  Intramuscularly. o In muscle.  Subcutaneous. o Under the surface of the skin. o Set and setting.  Set.  The user’s state of mind at the time of use.  Setting.  The physical environment or environmental factors surrounding  use.  Can cause different reaction to the drug. o Addiction.  Compulsion and obsession.  Loss of control or inability to stop.  Continued use despite known adverse consequences.  The 3 Cs.  Compulsion.  Control.  Continued use.  Classification of drugs. o Drugs are a nonfood substance intended to affect the structure and function of the  body. o Two classifications.  Nonpsyhcoactive drugs.  Substances in normal doses that do not affect the brain. o Vitamins, antibiotics, etc.  Psychoactive drugs.  Affect brain function, mood, and behavior.  All abused substances are psychoactive. o Seven categories.  Narcotic analgesics, central nervous system depressants, central nervous  system stimulants, hallucinogens, cannabis, inhalants, phencyclidine. o Narcotic analgesics.  Painkillers and designer drugs.  Are used to relieve pain without causing unconsciousness.  Comes from the poppy plant.  Includes opium, morphine, codeine, and heroin.  History.  Used for medicinal purposes since prehistoric times  Morphine was widely used during the civil war. o Addiction was common. o Called the “soldiers disease”.  Opium was used in many medicines.  Heroin was made to cure morphine and opium dependence.  Routes of administration.  Injected, snorted, smoked, and absorbed via membranes of the  mouth or rectum.  Smoking is absorbed in 5 seconds.  Injections are absorbed in 14 seconds.  Orally take 30 minutes.  Major effects.  Pain relief.  Euphoria.  Withdrawal.  Specifics depend on the drug being used.  With low doses symptoms could resemble milk flulike symptoms. o Or seasickness.  The peak intensity for heroin occurs at 48­72 hours.  Peak symptoms for methadone are 5­7 days.  Addiction and pregnancy.  Withdrawal can cause miscarriage. o Consensus is to stabilize mother on methadone during  pregnancy. o Children are born with withdrawal symptoms. o Central nervous system depressants.  Sedative hypnotics, alcohol, tranquilizers, and barbiturates.  Decrease activity.  Relaxing.  Most central nervous system (CNS) depressants are sedative hypnotics.  Alcohol.  Is a toxic drug with irritating as well as sedative properties.  Blood alcohol level of 0.05 or higher causes driving impairment.  Driving with a 0.10 is driving under the influence.  Alcoholism. o Other than tobacco, alcohol is the most widely used  psychoactive drug. o In 2004 half of Americans 12+ reported being current  drinkers. o 6.9% of the population were heavy drinkers.  Major effects. o Reaction depends on:  Amount consumed.  Circumstances of consumption.  Set and setting.  Drinker’s body size.  Experience drinking. o Drinking too much can cause central nervous to depress to  the point that body functions cease altogether.  Ex: stopping breathing. o Can affect every tissue in the body.  Brain.  Can cause amnesia (blackouts) and damage  effect balance.  Peripheral nerves.  Weakness and loss of sensation in  extremities and optic nerve damage causing  blurred vision.  Gastrointestinal tract.  Ulcers, aggravation of esophagus and  stomach, hepatitis, cirrhosis, pancreatitis. o Cirrhosis destroys liver tissues and is the leading cause of death from  alcohol.  Heart and blood vessels.  Weak heart muscles, dilated blood vessels,  high blood pressure. o Dilated blood vessels causes warmth  followed by serious heat loss.  Sobering up. o Nothing can affect amount of time for alcohol to  metabolize.  Withdrawal symptoms. o Stage 1.  Begins 6­12 hours after the last drink.  Last 3­5 days.  Anxiety, agitation, insomnia, etc. o Stage 2.  Occurs 1­3 days after last drink.  Same symptoms as stage 1 plus hallucinations.  Must be treated.  Related illnesses. o Ulcers, cirrhosis, vitamin deficiencies, Korsakoff’s  syndrome, etc.  Korsakoff’s is loss of memory. o Fetal alcohol syndrome.  Four characteristics in children.  Distorted facial features.  Prenatal onset growth deficiency. o Normally 2 standard deviations  below normal weight and height.  Reduced central nervous system  performance.  Increased frequency of abnormalities.  Normally when alcohol use occurs in the first  trimester. o Stillbirths.  Antabuse. o Used a deterrent against drinking when recovery is  difficult.  Barbiturates.  Widely prescribed for inducing sleep and relaxing the nervous  system.  Affect cortex of the brain and areas related to sleep more than  other sedatives.  Medical uses. o Low doses treat/prevent convulsions. o Help with overdose of nicotine and cocaine. o Help with withdrawal symptoms of alcohol.  Estimate of use. o Prescribed more than any other psychoactive drug.  Used as sleeping pills.  Routes of administration. o Usually taken orally.  Major effects. o Short term effects are similar to those of alcohol.  Induce relaxation, drowsiness, etc. o Higher doses are similar to alcohol as well.  Confusion and difficulty communicating.  If dose is high enough it may impair repertory  functioning. o Long­term use can affect REM sleep. o When users stop taking they may have poor sleep and  nightmares, causing them to retake the pills for better sleep.  Withdrawal. o Symptoms may last for days or months. o May have grand mal seizures.  Can occur up to 2 weeks after last use.  Often used in conjunction with stimulants.  Methaqualone. o Originally thought to be a non­addictive substitute. o Highly addictive.  Tranquilizers.  Minor tranquilizers. o Act as antianxiety agent. o Xanax, valium, benzodiazepines, Benadryl.  Major tranquilizers. o Used long­term for treatment of mental illness.  Ex: schizophrenia.  Are antipsychotic agents. o Can produce Parkinson­like effects.  Ex: tremor. o Do not produce pleasant effects.  Rarely used non­medically.  Major effects. o Normal, therapeutic doses cause relaxation, lessening of  anxiety, etc. o As dosage increases users feel more sedated.  May feel sensation of floating. o Death from drug alone rarely occurs.  Normally occurs with combination of other drug.  Ex: alcohol. o Central nervous system stimulants.  Amphetamines, cocaine, nicotine, and caffeine.  Increase activity.  Amphetamines.  Used to be prescribed for obesity, depression, etc.  Currently prescribed for Parkinson’s, epilepsy, and ADHD. o Ritalin is used for ADHD.  Used illegally by students to avoid sleepiness.  Routes of administration. o Tablets and capsules taken orally are most common. o Can be injected. o Methamphetamine.  Aka speed/meth.  Is smoked. o Major effects.  Stimulation of the central nervous system.  Increase in blood pressure.  Reliving sleepiness.  Increased awareness and alertness.  Slight euphoria.  Increased talkativeness. o Adverse effects.  Agitation.  Inability to concentrate.  Anxiety.  High doses can cause:  Tremors.  Rapid heartbeats.  Aggression and violent behavior associated  with paranoia.  Hallucinations.  Seizures.  Death reports are rare.  May cause amphetamine psychosis.  Mental disturbance similar to paranoid  schizophrenia. o Observed at high and low dosage  levels.  Withdrawal. o Suddenly stopping causes similar  symptoms to depressant withdrawal. o Is not as physically distressing as  depressant withdrawal. o Little physical dependence, but  frequent psychological dependence.  Cocaine.  History. o Was expensive at first, but is no longer. o Made from leaves of coca plant. o Originally seen as a cure of morphine addiction  Also alcohol dependence, asthma, digestive  disorders, depression, and fatigue. o Freud originally praised cocaine, he later recognized  addiction. o Was found in Coca­Col.  Routes of administration. o Inhaled, injected, and smoked. o Cocaine hydrochloride is snorted or injected.  Heating up can create freebase cocaine  Also smokable.  Is extremely pure. o Crack cocaine is smoked.  High is immediate and intense.  6 seconds.  High last 1 minute.  Major effects. o Experience 15­30 minutes of euphoria and excitement.  After depression and anxiety sets in.  May binge and take repeatedly for 24 hours to avoid depression. o May speedball.  Take heroin with to take withdrawal edge off. o Even small dosage can cause heart rate to slow.  Not physically addictive.  Tobacco.  The most widely abused drug.  29% of the population 12+ use it.  Remains the single leading cause of preventable death in US.  Different types of tobacco products. o Smoking cigarettes. o Smoking cigars. o Using smokeless tobacco. o Smoking tobacco in pipes.  Diseases related to tobacco. o Heart disease. o Peripheral vascular disease. o Cerebrovascular disease. o Cancer.  Lung, larynx, mouth, esophagus. o Chronic obstructive lung disease and colds.  Chronic bronchitis.  Has been a decrease in tobacco products recently. o Hallucinogens.  Alter consciousness.  Change user’s view of the world.  Can alter time and space perception, change feelings of self­awareness and emotions, and change sense of body image.   Can induce hallucinations.  Also called psychedelics.  History.  Have been used for religious purposes since BC.  Today’s use rates are smaller than they were in the 60s.  Routh of administration.  Usually taken orally.  Can also be smoked, snorted, or injected.  Small amounts are required to be taken.  Major effects.  Influenced by personality of user, expectation of use, user’s  general experience with drugs, the mindset, and the setting. o If these are not good user may have bad trip.  Wide range of reactions is reported.  Adverse effects. o Can add to existing mental disorders. o Can produce waves of anxiety, paranoia, and panic. o Flashbacks can occur within a year or less after last  hallucination.  Trips can be of long duration. o Normally 4­24 hours.  LSD.  Most potent and thoroughly researched hallucinogen.  History. o Used in mental hospitals to study treatment and psychotic  behavior.  Most commonly used hallucinogen.  Dependence. o Psychological dependence in long­term users. o Cannabis.  Marijuana and hashish.  Relaxing and stimulates senses.  Marijuana is unprocessed leaves, flowers, seeds, and stems.  Hashish is more potent.  Processed from the resin.  Most active ingredient is THC.  History.  Was used for many medicinal purposes.  The Controlled Substance Act reported it had no potential for  medical use. o Ignored evidence to the contrary.  Most widely used illicit drug.  61.1% of population uses it.  Medical uses.  Used as an anti­vomiting agent in chemo patients.  Allowed to be used in medical research, however not all states  allow this.  Routes of administration.  Can be smoked. o More potent versions are smoked in a water pipe.  Can also be eaten. o High last longer.  The drug cannot be injected.  Major effects.  Effects depend on potency, method of use, and set and setting.  Feelings of relaxation.  Impaired short term memory.  Enjoyment of food. o Adverse effects.  Psychologically addicting.  Ex: needing to use every day in order to  relax or sleep.  Hangover includes light­headedness and inability to gather thoughts  Damage to the respiratory system.  Tar is 50% greater than in cigarettes.  Cancer risks are increased.  Immune system problems.  When used regularly represses immune  response.  Reproductive system problems.  Brain system problems.  There is a debate if chronic abuse causes  problems.  Impairment of physical and emotional maturation.  Certain percentage of users develop lethargy,  apathy, and disorientation  Increased potency.  Used to be 1­2% in potency, causing half a joint to be smoked to  get high.  Today THC is 6%, causing one hit to be enough.  Because of this old marijuana research does not apply to today. o Inhalants.  More prevalent in young people and people who cannot afford drugs.  History.  In 60s glue sniffing was popular. o Laws prohibited selling glue to minors, however this  wasn’t effective.  In 70s­80s paint was popular. o Called huffers. th o 6& of Americans have tried inhalant by the 4  grade.  Route of administration.  Placing substance on a rag or in a plastic bag.  Major effects.  Feeling of wellbeing.  Reduction of inhibitions.  Similar to effects of alcohol.  Can last from 5 minutes to an hour.  Reasons for using: o Recreation.  Effects. o Peer influence. o Cost effectiveness. o Easy availability.  Withdrawal.  Symptoms include hallucinations, chills, and cramps.  Cross­tolerance with CNS depressants, such as alcohol.  Can cause heart to stop.  Called sniffing death syndrome. o Phencyclidine.  PCP.  Cannot be classified properly into category.  Originally made as a sedative.  Worked well in testing.  However subjects also development visual disturbance and  agitation. o Caused discontinuation.  Estimation of use.  Originally popular in large cities and along the west coast. o Moved outward.  Users are normally 12­18.  Users tend to not use longer than 10 years due to negative effects.  Routes of administration.  Is a water soluble powder.  Normally smoked or ingested.  Sometimes injected.  Major effects.  Low doses cause euphoria. o Last 3­8 hours. o Compared to heavy marijuana intoxication and LSD  experience. o Have auditory, visual, time, and other sensory disturbances. o Deadening of the extremities.  May have hallucinations.  Violence in common. o Due to user’s inability to feel pain.  May have unpredictable episodes of panic.  Is not addictive. Chapter 4­ Assessment of Substance Abuse, Dependence and Addiction.  Assessment can be made difficult. o Grey area between occasional users and problematic users. o People strong deny problems.  DSM is commonly used to diagnose. o Substance­related disorders are divided into 2 categories.  Substance­use disorder.  Including substance dependence and abuse.  Substance­induced disorder.  Include substance intoxication and withdrawal.  Addiction. o Definition can be applied to more than just drugs. o Three Cs.  Compulsion.  Obsessive­compulsive behavior. o Users constantly think about using compulsively. o Obsession with drugs.  Control.  Inability to stop using.  Cannot stop for at least 3 months.  Unable to refuse readily available drugs.  Consequences  Continued use despite adverse consequences.  Various stages of drug use. o Alcohol is a progressive disease.  You must pass through each stage to reach addiction.  Each stage influences the other. o Nonuse.  By children.  Most successful preventive approach is to not use.  Especially early in life.  Not smoking early highly correlates with not developing addictions later. o Initial contact.  Defined as the first time one tries alcohol/drugs.  Normally harmless.  Three major components that determine individual’s reaction,  The drug.  The individual.  The set and setting.  Positive experience normally leads to next stage. o Experimentation.  Using drugs in different situation and circumstances.  Test own capacity.  Doses, frequency of use, methods of ingestion.  Triangular relationship exist. o The set (user), drug, and setting. o User with adjust the three elements to determine effect.  Normally called recreational or social use. o Integrated use.  Person spends more time, thought, and energy on drug.  Has become integrated part of individual’s life. o Excessive use.  There are different kinds of excessive use.  Sometimes called drug abuse.  Increase in use that results in significant problems or negative  consequences.  Some people use excessively in a periodic pattern,  Binges. o Excessive drug use within a period of 24­72 hour. o Addiction.  Addict cannot return to any of the previous stages of use.  Best recover strategy is to abstain from use.  Jellinek’s types of alcoholics. o Five different stages of alcoholism.  Alpha alcoholism.  Psychological dependence where alcoholic increasingly drinks to  help their problems.  Beta alcoholism.  Physical problems. o Cirrhosis.  No dependence.  Gamma alcoholism.  Physical addiction with withdrawal symptoms.  Loss of controlling use.  Severe negative consequences.  Periods of abstinence.  Delta alcoholism.  Similar to gamma.  Individual can control intake.  High degree of physical and psychological dependence.  Epsilon alcoholism.  Periodic, unpredictable drinking binges.  Vulnerability to relapse. o At each stage of recovery individual is vulnerable to relapse.  Denial. o Two major defenses to deny problems:  Minimization.  Rationalization. o Identification of adolescent use.  Trying to figure out was in normal adolescent behavior and what is a  problem is difficult.  Things to look at:  Mood.  Changes.  Responsibility.  Motivation.  School.  Negative activities.  Lying, stealing, and cheating.  Community.  Criminal justice problems.  Physical signs.  Parents.  Assessment. o Recovery involves the family. o Most important thing is to find out if there is a family history of addiction. o Induvial vulnerability.  Should determines vulnerability and at­risk factors.  Primary addiction in the family.  Mood disorders.  Psychosis.  Rejection of behavior norms.  Attitude towards drug use.  Are drugs available?  Consequences of use. o Pointing our consequences can be valuable tool in denial. o There are physical, psychological, sexual, social, financial, and legal problems of  using. o Potential for suicide. Chapter 5­ Family Systems.  Substance abuse does not happen in isolation. o Creates imbalances in communication, roles, and actions.  Families as systems. o All families have rules, values, verbal and nonverbal methods of communication,  boundaries, roles, and patterns of interaction. o Systems always seek some balance.  Substance abuse ruins this balance.  Dependency causes imbalance.  Healthy systems are open, predictable, and balanced in meeting needs.  Imbalanced systems are rigid, inflexible, and unpredictable. o In order to treat abuser the family overall needs treatment.  High relapse rate is attributed to the family.  Family members are enablers. o Dry drunks.  Addicts who refrain from using the substance but don’t face emotional  problems.  Because of this they act the same way as when they were abusing.  They have chosen not to address their underlying issues.  Family rules. o Children tend to follow 3 rules when parents are alcoholics.  Don’t talk.   Don’t trust.   Normally leads to disappointment when parents do not follow  through with promises.  Don’t feel.  Imbalanced vs. dysfunctional. o The word dysfunctional has a negative connotation. o Instead replace it with imbalanced.  Gives hope that there is a way to become better and balanced.  Do so by addressing problems in the family. o There are different imbalances.  Rigid, ambiguous, overextended, and distorted family systems.  Rigid family systems.  Rules. o Strict interpretation of the rules with no exception. o The rule keeper (normally a strict mother or father) is the  only one exempt from the rules.  Values. o “There is only one way to do things and that is the right  way, my way.” o Things are seen as black and white, right or wrong.  Communication. o Hierarchical. o The father is normally dominant and unapproachable. The  mother softens the father’s harshness. o Or the mother is critical and judgmental. The father goes  along to avoid conflict.  Drug of choice. o Ex: alcohol, heroin, hypnotics, anything to get away. o Functions of the drug.  Suppress feelings, and stay numb.  Ambiguous family systems.  Rules. o We have rules, but don’t enforce them. o Rules may be changed if someone is annoyed or  inconvenienced.  Values. o Changes based on the situation.  Motto. o Keep peace at all cost. o Avoid conflict.  Communication. o Mixed messages that are confusing. o “Do what we want, but we won’t tell you what we want  exactly.”  Drug of choice. o Ex: alcohol, heroin, marijuana, hallucinogens. o Function:  Suppress feelings of discomfort, kill pain, shut out  reality.  Overextended family systems.  Rules. o Be productive. o Get busy. o Stay on the move.  Values. o Look good and achieve things. o Feelings are for wimps.  Motto. o We can achieve anything we set our minds to.  Communications. o Feelings are not expressed. o Decisions are based on results and what will please parents.  Drug of choice. o Cocaine, methamphetamine, alcohol. o Function:  To keep on working and doing.  Even if feelings don’t match with work or  relationships.  Distorted family systems.  Rules. o Don’t let outsiders know we’re crazy. o Act as if we’re a normal family.  Values. o Maintain an illusion of normalcy despite significant  physical, emotional, and interpersonal problems in the  family.  Motto. o “Aren’t most families like ours?  Communications. o Mixed messages.  Drug of choice:


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