Drugs of Abuse

Agenda
!What are the common drugs of abuse? !How are they used? !How can I detect use? !What problems do they cause?

Introduction
!Audience experience !Range of use/abuse
" Casual " Misuse " Abuse " Dependency

use of medications

Drug Use Facts in U.S.

!22 million engage in binge drinking !15.9 million currently use illicit drugs !12 million currently use marijuana !1.7 million currently use cocaine !12.9 million have five or more drinks per occasion, five or more times per month
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Drug Use Facts in U.S.

! About 100,000 deaths in the United States are related to alcohol consumption. ! Illicit drug abuse and related acquired immunodeficiency syndrome (AIDS) deaths account for at least another 12,000 deaths. ! In 1995, the economic cost of alcohol and drug abuse was $276 billion. This represents more than $1,000 for every man, woman, and child in the United States
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Drug Abuse (DSM IV)

!Recurrent use resulting in a failure to fulfill major role obligations at work, school, etc.; !Recurrent use in potentially hazardous situations; !Recurrent legal problems related to use; !Continued use despite persistent problems of a social or interpersonal nature, caused or exacerbated by the use of the substance. 6

Drug Dependence (DSM IV)

!Increased tolerance; !Development of withdrawal; !Taking larger amounts over longer period than intended, develops tolerance; !Desire and/or inability to stop; !Excessive time spent in using substances; !Interferes with normal daily activities; !Continued use despite consequences.
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Continuum Of Use

Common Drugs Of Abuse

!Alcohol !Marijuana !Cocaine / Crack !Hallucinogens (LSD, mushrooms, etc.) !Medications

Drug Classifications
!Alcohol !Cannabis !Stimulants !Depressants !Narcotics !Hallucinogens !Steroids
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Alcohol
!Not the most abused drug in the US !Effects executive function of forebrain

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Alcohol
!Ethyl Alcohol is chemical name !Liquid distilled from fruits, grain and vegetables !Effects are intoxication, sensory alteration, and anxiety reduction !Symptoms are staggering, slurred speech, loss of coordination
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Alcohol
!Withdrawal includes " Sweating
" " "

Tremors Altered Perceptions Delirium Tremens (which can be fatal) can cause psychosis, fear and hallucinations
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Alcohol
!Indications of Misuse " Confusion " Disorientation " Poor coordination " Involuntary release of urine or feces " Sleepiness " Respiratory Depression " Death

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What is Marijuana
! The agent that effects change is tetrahyocannabinol (THC) ! Usually called pot ! Produced from hemp plants ! Hashish is a resinous byproduct ! Marijuana is the tobacco like substance ! Also known as cannabis
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What is Cannabis (Marijuana)

!Effects are:
" " " " "

Euphoria followed by relaxation Impaired memory Poor concentration Loss of coordination Vivid enhancement of most senses

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Cannabis
!Symptoms you may recognize
" Insomnia " Increased

appetite (munchies)

" Hyperactivity " Sensory " Mood " The

exaggeration

exaggerations

smell
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Cannabis (Marijuana)
!Withdrawal effects:
" " "

Insomnia Hyperactivity Decreased appetite

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Stimulants
!Amphetamines !Benzedrine !Butyl Nitrite !Dextroamphetamine !Cocaine
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Stimulant Actions
!Used to increase alertness !Relieve Fatigue !Abusive and addictively desired characteristics are euphoria, power, or relief from feeling down, or use of other medications which are downers
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Stimulant Physiological Effects

!Average dosage brings
"

Increased heart and respiratory effects Elevated blood pressure Dilated pupils Decreased appetite
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" " "

Stimulant Physiological Effects

!Overdose or long term consistent use brings
" Rapid

irregular heartbeat vision

"Restlessness "Anxiety "Paranoia "Death

" Blurred

" Dizziness

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Stimulants: Indications of abuse

!Excessive activity or talkativeness !Irritability !Argumentativeness !High blood pressure !Increased pulse !Dilated pupils !Long periods without sleep !Euphoria
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Cocaine
! Classified as a narcotic (although it isnt) ! Causes increased alertness, ending with psychosis if used for lengthy periods ! Increases heart and respiratory rates, increased BP, dilated pupils, perspiration, feelings of restlessness. ! Users go long periods without sleep and/or eating, are usually very talkative, irritable, and argumentative.

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Depressants
!Barbiturates !Methaqualone !Tranquilizers !Chloral Hydrate

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Depressants
!Used medicinally to relieve anxiety, irritability, and tension. !Tolerance develops very fast !Intoxicant symptoms are similar to alcohol

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Depressants: Physiological Effects

!Nothing bothers them !Slurred speech !Relaxed muscles !Large doses = respiratory depression, coma and death
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Depressants: Overdose Effects

! Shallow respiration ! Clammy skin ! Dilated pupils ! Weak and rapid pulse ! Coma ! Death

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Depressants: Withdrawal
!Anxiety !Insomnia !Muscle tremors !Loss of appetite !Convulsions upon cessation of use !Delirium !Death

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Narcotics/Opiates
!Heroin !Morphine !Opium !Codeine !Oxycontin !Hydrocodone, Hydromorphone !Meperidine !Methadone (synthetic)
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Opiates
!Under classification of Narcotics !Used to relieve pain !Heroin is the morphine derivative most commonly abused !Initial reactions are nausea and vomiting !Then causes a euphoric high

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Opiate Withdrawal
!Watery eyes !Runny nose !Yawning !Cramps, Diarrhea !Loss of appetite !Chills and sweating !Piloerection (chicken skin)

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Opiates: Symptoms of Use

!Euphoria !Drowsiness !Respiratory depression !Pin Point Pupils

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Hallucinogens
!Phencyclidine (PCP) !LSD !Mescaline !Peyote !Psilocybin !Ecstasy and other designer drugs

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Hallucinogens
! LSD is most commonly abused hallucinogen ! Hallucinogens produce behavioral changes that are dramatic and of many dimensions ! Effects are rapidly changing feelings, sometimes violent and erratic behavior, hallucinations, illusions, paranoia, etc. ! There are no documented withdrawal symptoms. Behavioral characteristics noted above fade with time.

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Hallucinogens - PCP
! Use for long periods can lead to:
" " " " " "

Memory loss Difficulties with speech and thinking Depression Weight loss Mood Disorders Symptoms can persist up to a year after stopping PCP use.

! PCP has sedative effects ! Interactions with other central nervous system depressants, such as alcohol and benzodiazepines, can lead to coma or accidental overdose.

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Steroids
! Abused to improve performance in sports. ! Attempt to increase their muscle size and/or reduce their body fat. ! Anabolic steroid abuse has been associated with adverse side effects, such as acne and breast development in men ! There are others that are life threatening, such as heart attacks and liver cancer. ! Most are reversible if the abuser stops taking the drugs, but some are permanent. ! Roid rage

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Newer Trends In Adolescent Drug Use

!Ecstasy !GHB !Rohypnol !Ketamine !Embalming Fluid

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Dealing With Addiction

!Do not fail to confront the obvious results or consequences of substance abuse with your employees and their supervisors; !Expect resistance and denial, but confront and educate in spite of the resistance; !Offer help through SEAP referral, and stress the need for follow through.
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Short and Long Term Problems of Addiction

!Trauma !Psychiatric Instability !Intoxication !Acute Withdrawal !Drug Seeking !Loss of employment !Homelessness !Legal Involvement and/or Avoidance !Other medical conditions
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Drug Use Facts

!Of all workplace drug users who test positive, 52% are daily users !Employees who test positive for drugs are:
" 60%

more likely to responsible for accidents, " use 1/3 more sick leave " have many more unexcused absences.

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Scope of the Problem of Addiction

Nationally, !About 35% to 45% of emergency room visits are in one form or another related to substance abuse or dependency; !About 50% of traumas are related to substance abuse or dependency; !About 47% of psychiatric admissions have co-existing substance abuse or dependency disorders;
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Levels Of Care
!Detoxification !Inpatient !Residential (halfway house) !Partial hospitalization !Intensive outpatient program !Traditional outpatient

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Defense Mechanisms
!In psychoanalysis, any of a variety of unconscious personality reactions which the ego uses to protect the conscious mind from threatening feelings and perceptions. !They include projection, reaction formation, displacement, sublimation, and isolation.

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Problems In Referral
! Denial: an ego defense mechanism that operates unconsciously to resolve emotional conflict, and to allay anxiety by refusing to perceive the more unpleasant aspects of external reality
" Denial

by employee I dont have a problem; feels persecuted; blames supervisors for having it in for him/her " Denial by supervisor - Hes a good worker, and he promised me hell improve his performance
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Problems in Referral
!Audience participation

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