2. Uppers and Mental Health Disorders “What goes up...... must... come... down.”

3. Cocaine  “Coke, C, Cane” (powdered) “Blow, snow, flake, nose candy, toot” (crack cocaine) “Crack, rock, base”  Cocaine is derived from the densely-leafed coca plant native to South America.  Cocaine is the world's most powerful naturally occurring stimulant.

4. Cocaine is considered the second-most addictive substance of common use – can anyone guess what the #1 most highly addictive substance is?

5. How is Cocaine used?  Coca and its derivatives are most commonly used as follows: Cocaine hydrochloride, or cocaine powder, a white crystalline powder with a bitter, numbing taste is sniffed, or diluted and then injected.

6. How is Cocaine used?  Freebase or crack cocaine is made by cooking cocaine hydrochloride with ammonia or baking soda. Freebase was originally produced in an explosive, multi-step process. Crack is safer to produce - no explosions. Crack and freebase are smoked from pipes; burnt on a piece of tin foil; or mixed with tobacco or marijuana in a smokeable joint.

7. Does anyone remember the incident that Richard Pryor had with exploding freebase?

8. What’s the pay-off?  “Cocaine provides a stimulating, alert, and sexually arousing high:” Increased talkativeness and sociability Extreme mental alertness Feelings of euphoria

9. What’s the cost of using Cocaine?  Nervousness and jumpiness, insomnia  Anxiety, irritability, paranoia  Diminished decision-making ability  Tremors and dizziness  Muscle twitches and spasms  Loss of self-control, violent behavior

10. Long-term costs of Cocaine use  Irritability and mood disturbances;  Auditory hallucinations (imaginary sounds that seem real);  Formication (The sensation that insects are crawling under the skin);  Often immediate addiction;

11. Dual Disorder concerns...  Co-occurring thought disorders  Co-occurring mood disorders  Co-occurring personality disorders

12. Amphetamine / Methamphetamine  “Meth, crystal meth, speed, ice, crank, glass”  Amphetamine / Methamphetamine are powerful, tremendously addictive, psychomotor stimulants.  Methamphetamine is a white, odorless, bitter- tasting crystalline powder that easily dissolves in water or alcohol. Another common form of the drug is called crystal meth, or "ice," because it comes in large chunky crystals that look like ice chunks or rock candy.

13. How is Methamphetamine used?  The powder form of the drug may be snorted, swallowed, or diluted and injected.  The "crystal" form of the drug is smoked in a glass pipe like crack cocaine.

14. What’s the pay-off?  Immediately after smoking, snorting, or injecting methamphetamine, the user experiences an intense "rush" of excitement and pleasure, lasting between 15 and 30 minutes.  Methamphetamine gives users dramatic bursts of energy, talkativeness, and excitement. On meth, users don’t feel the need for sleep or food, and they can keep going and going for hours.

15. What’s the cost?  The other effects of methamphetamine tend to last from 6 to 12 hours. During these hours, the user generally feels nervous and agitated.

16. What’s the cost?  Under the influence of meth, users feel "wired" and edgy. They are often unpredictable, acting friendly and sociable, and then suddenly lashing out in suspicion and violence. Many users compulsively repeat meaningless tasks for hours or pick at imaginary bugs on their skin until it bleeds.

17. Longer-term costs of Meth use  As the high wears off, the user enters a stage called "tweaking." Tweakers experience delusions, compulsive behavior, paranoia, and a tendency to violence.

18. Longer-term costs of Meth use  Many users try to avoid the "crash" at the end of a meth high by continuing to use the drug until they run out of money or collapse. A binge and crash cycle like this is called a "run."

19. Dual Disorder concerns...  Co-occurring thought disorders  Co-occurring mood disorders  Co-occurring personality disorders

20. What about Caffeine?  Vivarin, No-Doz, coffee, tea, soft drinks  Caffeine intoxication and withdrawal are recognized as diagnosable conditions in the DSM-IV  Individuals with co-occurring mental/emotional health disorders may need to be careful about their use of caffeine...

21. Restlessness Nervousness Excitement Insomnia Flushed face Diuresis Gastrointestinal disturbance Muscle twitching Rambling flow of thought and speech Tachycardia / cardiac arrhythmia Periods of inexhaustibility Psychomotor agitation Caffeine Intoxication – Five or more of the following:

22. Prolonged daily caffeine use is abruptly stopped or reduced, with the following symptoms:  Headache  Marked fatigue / drowsiness  Marked anxiety or depression  Nausea or vomiting Caffeine Withdrawal – Five or more of the following:

23. Dual Disorder concerns...  Co-occurring thought disorders  Co-occurring mood disorders  Co-occurring personality disorders