1. Substance Abuse and Treatment Greg Bohall, M.S., C.R.C., MAC, CADC-II

2. Agenda  Diagnosing  Types of Use  Stages of Addiction  Types of Drugs  Routes of Administration  Treatment

3. Diagnosing  What things do we look for when diagnosing?  Tolerance and withdrawal (Tolerance Tiger)  Taking more of a substance over a longer period than intended  Desire or unsuccessful efforts to cut down/stop use  Time spent to obtain, use, recover from the substance  Social, occupational, recreational activities that have been reduced  Use when you know you shouldn’t (psychological/physiological)  Recurrent use resulting in failure to fulfill role obligations  Recurrent use in physically hazardous situations  Recurrent substance-related legal problems  Continued use despite interpersonal problems  (American Psychiatric Association, 2000)

4. Types of Use  Experimental use  This is short-term, random use of one or more drugs. Usually done out of curiosity, an encouragement by friends, or just to reach an altered state of mind.  Recreational use  Occurs most often when friends get together occasionally to take the drug out of pleasure or interest.  Circumstantial use  At this point, the drug is used to cope with a problem or achieve a certain mood. They may take the drug with friends, strangers, acquaintances, or alone. They may binge and they back of when they need less or when problems from using the drug overcome the benefit.  Compulsive use  This is drug addiction. The person’s life is dominated by getting and using the drug. All other life areas are less important. A person may be able to function quite well as long as they have access to their drug but most frequently the use becomes uncontrollable and many life areas suffer.  (Gahlinger, 2001)

5. Stages of Addiction  Experimental Stage  Taking drugs usually starts with experimental use. It can be simple curiosity, a rite of passage into a social group, or peer pressure.  Social Stage  At this stage, the person still feels normal, but the use of the drug is a big part of social acceptance and the person’s identity.  Instrumental Stage  Person takes the drug for the purpose of pleasure or to cope with anger, shame, guilt, etc. Signs of dependency begin to appear. The user begins to drift away from clean friends and socializes more with people who also use the drug heavily. There is tolerance to the substance leading to more drug use and extreme mood swings. The person no longer feels normal.  Compulsive Stage  The final stage of addiction. The person is preoccupied with the drug and will do anything to get it, i.e. theft, prostitution, etc. The person will hide drugs even from fellow users. MOST PEOPLE DO NOT RECOGNIZE THEIR DEPENDENCE!  (Gahlinger, 2001)

6. Types of Drugs  Amphetamines- Stimulant  Injected, smoked, snorted, ingested  Ex: Methamphetamine and amphetamines (adderal)  Cocaine- Stimulant  Ex: Powder, freebase, crack  LSD- Hallucinogen  Ingested or applied  Marijuana- Hallucinogen  Ingested or smoked  Ecstasy (MDMA)- Stimulant  Ingested, snorted, injected  Opiates- Depressant  Ingested, smoked, snorted, injected  Ex: Heroin, morphine, hydrocodone (Gahlinger, 2001)

7. Routes of Administration  Smoking (Time to Brain= 7 to 10 seconds):  Enters the lungs and quickly absorbed into the bloodstream through tiny vessels lining the air sacs.  Injecting: The most direct way to take the drug but not as fast as smoking. If injected into vein, it returns to the right side of the heart where it is pumped to the lungs, returned to the left side of the heart, then pumped to the brain.  Injecting to vein- “slamming”(15-20 seconds)  Injecting to muscle- “muscling” (3-5 minutes)  Injecting deep into the skin- “skin popping”(3-5 minutes)  Snorting (3 to 5 minutes)  Sniffing the drug. It is sniffed into the nose and absorbed by blood vessels in mucous membranes of the nasal passages. Although they are close to the brain, they still return to the heart and some of it is pumped back to the brain.  Contact  Some drugs can be absorbed directly through the skin or mucous membranes in the eyes (3-5 minutes), mouth (15-30 minutes), vagina(15-30 minutes, or anus (15-30 minutes). Ex: Fentanyl patches, nicotine patches, LSD.  Ingesting (20 to 30 minutes)  A drug that is eaten, drunk, or taken as a pill. It passes to the stomach, moves to the small intestine, then liver (where it is filtered), then the heart where it is pumped to the brain. (Gahlinger, 2001)

8. Treatment…  What does “treatment” mean?  Why is it important for you know what this means?

9. Types of Treatment  Detoxification  First stage of addiction treatment  Safe management of acute physical symptoms of withdrawal associated with stopping drug use  Physicians, nurses  Inpatient  Typically a 28 day program in a hospital setting  Inpatient stays are often shortened and it barely addresses the physical needs of persons.  The basic treatment model has shifted from inpatient to residential treatment.  Residential Treatment  Has become the primary modality for treating substance use  Operated by hospitals or agencies  Removes the client from their maladaptive environment  Optimal timeframe is 3 months  (Stevens & Smith, 2009)

10. Types of Treatment  Partial Hospitalization and Day Treatment  Similar to residential treatment  High degree of structure and treatment happens during the work day then the client leaves.  Most often with dually diagnosed persons  Outpatient  Graduates of residential or inpatient typically go to outpatient after.  Continued care, 2-3 appointments a week.  Intensive outpatient  Big step to “normal”  (Stevens & Smith, 2009)

11. Treatment Topics  What is addressed in substance abuse treatment?  Defense mechanisms  Stages of change  Family and social  Medical issues  Addictive lifestyle  Coping skills  Knowledge of addiction  Self help meeting

12. References American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders-fourth edition-text revision. Arlington, VA: American Psychiatric Association. Gahlinger, P. M. (2001). Illegal Drugs; A complete guide to their history, chemistry, use and abuse. Sagebrush Press. Stevens, P. & Smith, R. L. (2009). Substance abuse counseling; Theory and practice. Upper Saddle River, NJ: Pearson.