1. Central Nervous System Depressants
Alcohol
Barbiturates
Benzodiazepines
Prescription Medications

2. CNS Depressants (prescription)
Valium
Librium
Ativan
Serax
Xanax
Tranzene
Klonopin

3. General Symptoms of Users
“Drunken” Behavior (lack of coordination, slurred speech, staggering
Confusion
Faulty Judgment
Emotional Lability
Irritability
Drowsiness
Hostility
Paranoid ideas

4. Route of Administration
Orally – pill (capsule or tablet)
Or mixed with water and injected

5. Potential for moderate to high dependence
Physical Dependence
Potential for moderate to high dependence

6. Tolerance
Low to Moderate

7. Psychological Dependence
Moderate to High Potential

8. Withdrawal Must be monitored closely due to potential fatalities
Risk of seizures and delirium tremens
Prolonged symptoms can last for months, resolve, then reappear. Especially with Benzodiazepines (Valium, Librium, Tranzene, and Zanax).

9. Depressant Withdrawal – Stage I
Tremors (shakes) occur in the morning after heavy use the night before
Peak intensity is about hours after last dose
“Jitters”, irritability, nausea, vomiting, easily startled, facial flushing, rapid heart rate
Loss of appetite insomnia, inattention, mildly disoriented, poor recent memory, sense of uneasiness.

10. CNS Depressant Withdrawal Stage II
Hallucinations (disordered perceptions) vary in intensity
misinterpreted shadows and movements
Objects seeming distorted and unreal
May occur when the rest of the sensorium is clear, and seem intensely real.

11. CNS Depressant Withdrawal Stage III
Seizures (grand mal)
Bursts of 2-6 full body seizures
90% occur 7-48 hours after the last drink
One third of patients with seizures will go on to develop delirium tremens

12. CNS Depressant Withdrawal Stage IV
Delirium Tremens (Profound Confusion, Delusions, Vivid Hallucinations, Tremor, Agitation, Sleeplessness, Dilated Pupils, Fever, Tachycardia, Profuse Perspiration
Usually occurs 3-5 Days after the last dose
Most cases mild, and end abruptly
Severe cases considered a medical emergency, and carry a 15% fatality rate
Single episode lasts 72 hours or less in 80% of the cases

13. Pharmacological Effects Alcohol (Ethanol):

14. Alcohol as a drug
Alcohol is a psychoactive drug that is a CNS depressant
Alcohol is the second most widely used and abuse of all psychoactive drugs
Q. What drug is the most widely used and abused drug?
A. Caffeine

15. Four types of alcohol Methyl alcohol Isopropyl alcohol poisonous
Ethylene glycol
poisonous
Ethanol
drinking alcohol

16. Physical effects of alcohol
The body is affected by alcohol in two ways:
Direct contact with mouth, esophagus, stomach, and intestine
Influence on almost every organ system in the body after entering the bloodstream

17. Physical Effects of Alcohol
Absorption is the process in which the drug molecules reach the bloodstream
The effects of alcohol on the human body depend on the amount of alcohol in the blood (BAC)

18. Physical effects of alcohol
BAC produced depends on the:
1. Presence of food in the stomach
2. Rate of alcohol consumption
3. Concentration of alcohol
4. Drinker’s body composition
Alcohol beverages have almost no vitamins, mineral, protein, or fat - just large amount of carbohydrates

19. Physical effects of alcohol
Alcohol can cause severe physical and psychological dependence
1. Cross-tolerance
2. Behavioral tolerance compensation of motor impairments by chronic alcohol users through behavioral pattern modification

20. Blood alcohol level
Almost 95% of the consumed alcohol is inactivated by liver metabolism.
The liver metabolizes alcohol at a slow and constant rate and is unaffected by the amount ingested.
Thus, if on can of beer is consumed each hour, the blood alcohol level (BAL) will remain constant.

21. Blood alcohol level
Blood alcohol level (BAL) is the concentration of alcohol expressed as a percentage.

22. How alcohol is absorbed in the body

23. Short-term effects of alcohol
Low to moderate doses
Disinhibition
Social setting and mental state
Euphoric, friendly, talkative
Aggressive and hostile
Interfere with motor activity, reflexes, and coordination

24. Short-term effects of alcohol
Moderate quantities
Slightly increases in heart rate
Slightly dilates blood vessels in arms, legs, skin
Moderately lowers blood pressure
Stimulate appetite
Increases production of gastric secretions
Increases urine output

25. Short-term effects of alcohol
At higher doses
Difficulty in walking, talking, and thinking
Induces drowsiness and cause sleep
In large amounts - severe depression of the brain systems and motor control area of the brain

26. Large Doses of Alcohol
Uncoordination, confusion, & disorientation
Stupor, anesthesia, coma, and even death
Lethal level of alcohol is between 0.4 and 0.6% by volume in the blood

27. ? True of False ?
Drinking black coffee, taking a cold shower, or breathing pure oxygen will hasten the sobering up process
The type of alcohol beverage you drink can influence the hangover that results
Taking an aspirin-caffeine combination before drinking helps the sobering up process and the chances of having a hangover

28. Long-term effects of alcohol
Light or moderate drinking does little permanent harm (exception - FAS)
Heavy drinking
Seriously damages the heart
Kidney and liver damage
Mental disorders, irreversible damage to the brain and peripheral nervous system
Lowers resistance to pneumonia and other infectious diseases
Irritates the gastrointestinal tract

29. Principal control centers of the brain affected by alcohol

30. Alcohol and pregnancy
Women who are alcoholics or who drink heavily during pregnancy have a higher rate of spontaneous abortion.
Infants born to drinking mothers have a high probability of being afflicted with fetal alcohol syndrome.

31. Effects of alcohol on organ systems and bodily functions
Brain and nervous system
Liver
hepatotoxic effect
alcoholic hepatitis
cirrhosis
Digestive system

32. Effects of alcohol on organ systems and bodily functions
Blood
Cardiovascular system
alcoholic cardiomyopathy
Sexual organs
Endocrine system

33. Effects of alcohol on organ systems and bodily functions
Kidneys
Mental disorder and damage to the brain
Wernicke-korsakorr’s syndrome
The fetus (FAS)
Malnutrition

34. Barbiturates Derivatives of barbituric acid First synthesized in 1868
Used as anticonvulsants and sedative hypnotics
High abuse liability
High lethal dose rate

35. Barbiturates
Used with other analgesic combinations (aspirin, codeine) for treatment of tension and migraine headaches
Phenobarbital and belladonna alkaloid combinations used to treat peptic ulcers and irritable bowel syndrome

36. Barbiturates - Medical Uses
Used as an anticonvulsant
Sedative Hypnotic
Detoxification medication for alcohol withdrawal syndrome

38. Route of Administration
Oral (pill form)
Intravenous
Intramuscular (shot)

39. Barbiturates - Short Term Effects
Relieve anxiety and restlessness, relax muscles, induce sleep
Reduce lung function (breathing), heart action, speech, and movement

40. Long-Term Effects Cardiovascular – bradycardia, hypertension
Digestive System – nausea, vomiting, constipation
Nervous System – agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucination, insomnia, anxiety, dizziness, thinking abnormalities

41. Barbiturate – Long Term Effects
Reproductive System – cross the placental barrier and cause fetal abnormalities
Newborn withdrawal symptoms
Respiratory System – hypoventilation, apnea
Other Reactions - headache, injection site reactions, fever, liver damage, megablastic anemia (with long term use)

42. Tolerance Develops quickly
Psychological tolerance develops more quickly than physical
Increased amounts approach lethal dosage
Metabolize faster in the liver as dosage increases

43. Half Life Psychoactive chemicals have age dependent metabolism
Younger people tolerate a higher dose than older (over 50).
Half life = length of time in hours required for one half of the dose taken to be excreted from the body.

44. Toxicity/Overdose Cold, clammy skin Weak, rapid, shallow breathing
Combined with ETOH –suppression of respiratory center of brain
Dependence defined by amounts taken 8-10 times normal taken daily for 30 days
Death will occur if drowsiness, loss of consciousness, depressed breathing, and coma are left untreated.

45. Psychological Effects
Early - calming, tension reduction,
Middle – Euphoria, hypnotizing, impaired judgment, sense of “no worry”
Later – mood swings, depression, irritability, obnoxious behavior, manipulation, drug seeking

46. Withdrawal from Sedative Hypnotics
Within 6-8 hours of last dose
Can be life threatening if breathing and blood pressure problems untreated
Nausea, vomiting, increased heart rate, excessive sweating, abdominal cramps, tremors
Withdrawal deaths more frequent than overdose deaths.

47. National Institute of Drug Abuse http://www.nida.nih.gov/
References - Material from this module was Developed from the following sources, which are recommended reading for the LADAC exam:
Basics Of Addiction Counseling: Desk Reference And Study Guide National Association for Addiction Professionals
National Institute of Drug Abuse
National Institute of Alcohol Abuse and Alcoholism