First Half of Semester Notes
First Half of Semester Notes SOW 4700
UWF - Pensacola
Popular in Substance Abuse
Popular in Social Work
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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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