Why is using a different drug instead of your drug of choice a high risk low pay off?
Using another substance in the place of the drug of choice is a high-risk and low-payoff endeavor for most. i. First, the risk of relapse returning to the drug of choice is great. ii. Second, the problem behavior, which is actually the need to escape painful feelings and uncomfortable situations, is not addressed. iii. The other risk is that the person will not enter the lifestyle change, the change in philosophy of living that can be so important and life altering. It is important to understand that for the ultimate recovery, it is essential to have this philosophy change
Why did the opium wars occur?
• Smoking opium was used to reduce craving for tobacco in China when tobacco was outlawed. • In 1729 the first law against opium was enforced. i. Opium being illegal resulted in the drug being smuggled in from India. ii. It was so profitable, rules were made for the “game”. iii. This profit, along with opium being illegal, led to the war between China and England (whose company was the British East India Company).
Possible motives of substance use?
• There are several common motives for substance use. • Attraction to a deviant subculture. • Signaling rebellion • Effects of drugs are reinforcing • Seeking altered states of consciousness
Categories of drug use?
• Illicit- means illegal to possess or use. • Deviant- not common within a social group, and disapproved of by the majority. • Drug Misuse- overusing a prescription drug or using it for the affect rather than the typical use (antihistamines). • Abuse- use that results in problems or the potential for problems
Hypnotics are ______ dosing with _______ duration
What is the pharmaceutical theory for opioid treatment especially how methadone and buprenorphine are used and what are they used for during the treatment
• Rapid Detoxification- patient anesthetized, given opioid antagonist. Controversial. • Traditional Detoxification- methadone given and reduced or buprenorphine (suboxone) (newer safer treatment). Other medications may be given as well, to sedate the patient or reduce other symptoms. • Both methadone and buprenorphine are used in maintenance as well as detoxification. Maintenance may be long term, spanning several years. • Naltrexone is an opioid antagonist which blocks the effects of opioids. Used to prevent relapse by discouraging use. Longer version (monthly administration) approved (called Vivitrol).
Which is more psychologically dependent? Barbiturates or Benzodiazepines
Which and how many medications are sued to manage R-OH abstinence?
• Antabuse- antagonist punishment treatment. • Naltrexone- opioid antagonist demonstrated to reduce alcohol consumption for those in study. • Acamprosate- in a study helped reduce alcohol relapse. Structurally similar to GABA
Physical Dependence for ________ most likely to occur when the drug leaves the body more rapidly than the body can adapt.
When a client enters treatment, who are the goals best set by? Who is the best person to set the goals?
When a client seeks treatment the goals are best determined as a negotiation between both the client and the clinician. If the client does not have the goal of abstinence, the clinician has several choices: (1) Refer the client to a facility that will work with them in a harm-reduction fashion; (2) try to force the client to agree to abstinence; (3) work with them with harm reduction as the goal.
Roles common in addictive families?
Family hero, scapegoat, clown or mascot, lost child
What is the prevalence of co-occurring illness in the addicted population?
It is estimated that nearly half of substance abusers also have a co-occurring illness that could be treated as well.
What interventions does the knowledge attitude behavioral model use?
• The belief that increased knowledge would lead to attitude changes which would affect behavior. • Sometimes scare tactics, sometimes dry facts. • Used in early formation of prevention strategies. • Studies indicated knowledge was increased but behavior did not change. • However, study indicated although use increased, there was not a drastic escalation of use as in the control group. • Didn’t bring abstinence, but better decision making in regard to substances.
Stages of gate way theory?
• Study indicating typical sequence of drug involvement. i. First stage is beer or wine ii. Second stage is cigarettes, hard liquor, or both. iii. Third stage is marijuana use. iv. Only after these are hard drugs tried.
Which famous psychology theorist corresponded with Bill Wilson (alcoholism required a spiritual cure)?
What is enabling?
any behavior which softens the consequences of an addict’s behavior. ex. being a savior, feeling the addict cannot be abandoned in his time of need
Drug Abuse Warning Network
Two types of pharmacotherapy (2 categories)?
• Withdrawal treatment i. Intervention to ease the suffering and possible serious complications of the withdrawal syndrome from a substance. • Maintenance treatment i. Medical intervention to reduce craving and / or reduce risk or illegal behavior
What did the average heroin user look like before and after Harrison Act?
• Before: Typical addict was a 30 to 50 y/o white woman. • After: Eventually users were those in the life: show people, entertainers, musicians, racketeers and gangsters, thieves and pick pockets, prostitutes and pimps.
What are the 3 clusters?
i. Cluster A: Paranoid, schizoid, schizotypal (psychotic disorders) ii. Cluster B: Narcissism, Borderline histrionic, antisocial iii. Cluster C: Obsessive-compulsive, dependent, avoidant
What did Vietnam teach us about opiates?
• Vietnam taught a lot about heroin: under the right circumstances, many will use it recreationally. • Not only IV users get addicted. • Even occasional users can become opioid dependent. • Many of those dependent stopped upon returning to the States.
What is the most consistent feature of work place drug prevention programs?
• Most consistent feature is random urine testing. • All businesses that obtain grants or contracts from the government must adopt a drug free workplace plan. • Plans are up to the company, and are meant to prevent drug use by letting it be known that substance use is not condoned
What cluster is often over diagnosed and which is under diagnosed?
Over diagnosed = Cluster B / They are the Narcissistic, Borderline, Histrionic, and Antisocial Personality Disorders. / One of the personality disorders often over diagnosed among women is Borderline Personality Disorder. / Borderline Personality Disorder is characterized by mood swings, relationships that seem extremely close but then become distant (often described as I love you/hate you) and self-destructive behavior that can include poor impulse control, drug use, and suicidal gestures that are often superficial. Under diagnosed = Cluster C / Obsessive-Compulsive Personality Disorder, Dependent, and Avoidant Personality Disorders. / One important consideration in treating this cluster is that it often goes undiagnosed, as the symptoms reflect those of an addiction, including dependency issues, compulsive behaviors, and insecurity. / If someone a Cluster C personality disorder as well as an addiction, they may progress more slowly than expected.
______ and ______ were the first widely sold benzodiazepines
Librium and Valium
What are the pros and cons regarding harm reduction treatment?
Pros: Doesn’t give the message “We’ve given up on you.” / With the client in treatment distorted thinking can be challenged. Cons: Can be enabling / May negatively affect group members who are abstinent
Withdrawal symptoms of opiates?
• Dysphoric mood • Nausea or vomiting • Muscle aches • Lacrimation or rhinorrhea • Pupillary dilation, piloerection, or sweating • Diarrhea • Yawning • Fever • Insomnia
What is the most abused substance with people who have schizophrenia?
What needs to happen to morphine before it becomes heroin?
• In 1874 two acetyl groups were attached to morphine, yielding the brand name heroin. • 3x as potent as morphine, as the acetyl groups make heroin more lipid soluble.
What neurotransmitters do benzodiazapines affect?
Which is more physically dependent? Barbiturates or Benzodiazepines
Gate way theory of drugs?
States that the use of less deleterious drugs can lead to a future risk of using more dangerous hard drugs
What is DARE?
• DARE: Drug Abuse Resistance Education i. Most widely used and accepted. ii. Uses social influence model for tobacco, adapted for substances. iii. Utilizes police to deliver message. iv. Studies indicate little effectiveness. v. Has not produced lasting reduction. vi. Remains most widespread prevention program.
How is heroin scheduled in this country?
Sedatives are ________ dosing with _____ duration
A term for US government approach to drugs in the 1800s (policy)?
• Laissez-Faire: The US governments attitude toward substances prior to the early 1900’s was described by this expression. i. If the seller wants to sell it, and the buyer wants to buy it, let them.
Problems with studying substance abuse?
• Illicit drugs difficult to get accurate data i. It is illegal, and therefore sales can not be looked at accurately. • Even alcohol and prescription drug sales statistics have drawbacks. i. Unused medications, home brewed beer
What is the most important thing in treating co-occurring illness?
Helping the person feel understood and letting them know that there is help. One of the most important—and hardest—things to do in therapy with someone with any of these psychotic disorders or the personality disorders is to build trust. This is difficult, as people with these disorders tend to be very distrustful.
What interventions do family and parent programs use?
• Informational Programs- information provided to the parents regarding substances, what to look for, current substances of abuse, etc. • Parenting Skills- communication, decision making skills, setting goals and limits, and saying no to your child. • Parent Support Groups • Family Interaction- families work together as a unit to examine, discuss, and confront substance related issues. Tends to improve family communication and strengthens parents’ knowledge and skill.
6 types of prevention?
• (1)Primary Prevention- aimed at those who have not yet tried the substance. Abstinence or attitudes toward drug is the goal. • (2)Secondary Prevention - aimed at those who have tried substances. The goal is usually prevention of the use of more dangerous drugs, or prevention of more dangerous forms of substances already used. • (3)Tertiary Prevention - Relapse prevention. • (4)Universal- program for an entire population. Ex. School children. • (5)Selective- high risk groups in the population. Ex. Poor neighborhoods. • (6)Indicated- individuals showing signs of developing problems. Ex. DUI.
What is the author’s opinion on casual sex during early recovery?
• It is no good. Although this seems mostly harmless if two consenting adults are involved, there are a few complications that at least should be considered. i. The first is that many people, let alone addicts in early recovery, have difficulty separating sex and intimacy. Often, feelings develop despite the belief that they never would. ii. A second consideration is the tendency of those who have been sexually abused to sexualize intimacy. This occurs when a friendship develops, secrets are shared, and a sexual attraction becomes apparent, even though none had existed prior to the friendship getting closer. Because of the high prevalence of sexual abuse among addicts and the nature of sharing on a personal level in the 12-step programs and groups, this is a very real and serious risk. iii. Another consideration is the effect of casual sex on self-esteem. Although some believe it is possible to have casual sex with no guilt or remorse, this is often not the case. Casual sex often goes against the morals and values that one was taught. Any time that we behave in a manner that goes against our morals we experience guilt. Guilt can have a detrimental effect on self-esteem.
What defines repeated exposure to the same does of the drug resulting in a lesser affect?
What is the most common cluster of personality disorders in those that have an addiction?
Cluster B = the most common personality disorders with a co-occurring addiction are Cluster B Personality Disorders. / They include the dramatic, erratic, and emotional behaviors.
How does addiction affect the family unit?
• Negative feelings about unfulfilled role expectations. i. Hurt and anger • Parents feeling shame and guilt if their child is the addict. • Siblings experiencing jealousy at different treatment. • Shame and embarrassment in the child if a parent has an addiction. • Battles for control, thinking the right formula can help the addicted individual.