Effective Strategies with Substance Abusers Jane E. Pfeifer

Who are our clients?

What are their challenges?

Specific drugs Alcohol Marijuana Opiates Cocaine Methamphetamine Hallucinogens

A depressant that is present with & potentiates effects of most other drugs of abuse Involved in MOST cases of Domestic Violence A Known Teratogen Alcohol

Alcohol Effects on Society Alcohol related traffic deaths account for twice as many deaths among teens as drugs. 60% of tardiness, absenteeism, and poor work quality is the result of light and moderate drinking. 40% is caused by heavy drinkers and alcoholics.

Alcohol Effects on Society 52% of college students in 1997 reported they drank to get drunk as compared to 39% in % reported binge drinking, and 20% report doing so once a week. NIAAA report that drinking is involved in more than 50% of sexual assaults.

Alcohol Signs of Abuse –drowsiness –aroma –gait ataxia –irrational –lack of restraint –slurred speech –high accident rate Signs of Withdrawal –hypertension –sweating –anxiety –tremors –insomnia –disorientation –physical complaints –cravings

Alcohol Blood Alcohol Levels –.1% BAL motor coordination is impaired –.2% BAL user is obviously intoxicated –.3% BAL physical and mental activity decreases as user enters a stupor –.35% BAL anesthesia is present –.4% BAL most die from respiration cessation –.6% BAL most are dead

Marijuana THC (delta-9-tetrahydrocannabinol) content generally much more potent today than a few decades ago Typically used to achieve relaxation Impairs short-term memory and decreases motivation Can alter perceptions, impair coordination, cause anxiety, panic, and paranoia in higher doses

Marijuana Signs of Abuse –dry mouth –bloodshot eyes –altered time –impaired recall –slowed motor skills –depersonalization –distorted perception –munchies Signs of Withdrawal –no specific syndrome –insomnia –hyperactivity –decreased appetite –paranoia

Opiates: Heroin, Demerol, Oxycontin, Vicodin Higher levels of street purity leading to increased intranasal use; Narcotic use historically follows stimulant epidemic Diversion of prescription painkillers =new epidemic Hepatitis C epidemic.

Opiates Signs of Abuse –euphoria –pupil constriction –constipation –drowsiness –itching –nausea –slowed speech Signs of Withdrawal –acute anxiety –craving –aches and cramps –sweats –insomnia –vomiting –increased body functions

Cocaine Signs of Abuse –euphoria –increased energy –increased alertness –decreased appetite –insomnia –anxiety –irritability –increased sex drive Signs of Withdrawal –crash –agitation –depression –craving –fatigue –eating binges –paranoia –weakness

Methamphetamine Signs of Abuse –rapid weight loss –nervous energy –no “need” for sleep –aggressive –mean temperment –compulsive –excited talk Signs of Withdrawal –long crash –apathy –depression –fatigue –anxiety –suicidal ideation –cravings

Hallucinogens Signs of Abuse –euphoria –altered perception –illusions –anxiety –psychosis –depersonalization –mystical experiences Signs of Withdrawal –no identified withdrawal syndrome –flashbacks

What’s going on? Use Abuse Dependence

The Disease of Addiction Is similar to brain injury-you should view this as similar to a stroke or accident victim. Be kind, repetitive and reinforce your message. Does not stop without treatment Treatment must be evidence-based and must continue throughout life

Addiction is a disease of the brain It is a chronic, relapsing, life long disease. External intervention is necessary Treatment works…but only if a person goes. Many abusers/addicts are poly substance abusers. You should assume the person is likely using more than one drug. Addiction Basics

Addicts do not take drugs to feel good. They take drugs to feel “less bad”. Most people in early treatment don’t feel better, they feel worse. And many are not in any type of treatment.

Brain’s Limited Range & Duration of “Emotional” Experience l l l l l Suicidal BAD GOOD VERY GOOD Euphoric NORMAL BRAIN RANGE l l l l l l l l l Suicidal BAD GOOD VERY GOOD Euphoric RECOVERING BRAIN RANGE

What challenges are you having?

Strategies Because cognitive distortions are common: –Sequence tasks –Shorter, more frequent meetings –Repeat, remind, encourage –Write things down –Ask for a support person Above all: Patience

Strategies If you sense hostility, let them go and try again another day. –The interactions of drugs can cause violence –There is a strong correlation between mental illness and addiction. Call for assistance if needed. Do not put yourself or the person at risk. Do not be alone with a client without someone else nearby.

Substance abuse is not a moral failing Once addiction takes hold, it is a neurological process. The brain is described as being “hijacked”. It is not about willpower. It takes significant work to resume control over the hijacked brain. Patience is critical.