1. DRUGS: EDUCATION, PREVENTION AND TREATMENT June 2, 2008

2. Drugs Continuum of behavior: -No use -No use -Use -Use -Abuse -Abuse -Dependency -Dependency

3. Learning the Mood Swing Starting point… shifts mood toward euphoria… finishing point (same as starting point)

4. Seeking the Mood Swing Begins to make a contract with the drug Learned that the drug can improve mood Starting point (feeling down)… moves toward drug- induced mood… finishing point (normal)

5. Harmful Use Uncomfortable effect from drug use: hangover… doing something wrong Most people would say “never again” Minority of users: drug use becomes emerging problem (example: DUI) Crossed a thin line from problem use to harmful use Starting point: normal; use to drug-induced mood; finish worse than when began use

6. Use Drug to Feel Normal The drug is essential just to feel normal Feeling better is no longer the goal May need to avoid withdrawal symptoms Starting point (feeling down)…use drug to achieve normality… finishing point (extreme pain)

7. Prevention EducationRelapse-prevention

8. Painful Outcomes Domestic violence-fractured family systems Drug-induced depression and other affective disorders Financial conflicts Loss of income Many other losses

9. DSM-IV-TR (2000) Substance abuse and substance dependency distinguished Substance dependency = addiction Invisible Line: Lawrence Metzger Treatment facilities: treat person & the addiction

10. Substance Use Alcohol: loosens inhibition Novocain: numbs the gum Caffeine in the morning: get going versus sluggish, fatigued No limitation in functioning Can use or not use with very little difficulty

11. Substance Abuse Take drug to avoid discomfort (e.g., anxiety) Drug effect is first, social interactions are second Cocaine and amphetamines: get excited Rely on drug versus own ability

12. Substance Dependency From creative adjustment to situations (use) to habitual response (addiction) Drug is now primary source of comfort Drug usually not tasted or experienced -gulping -gulping -snorting -snorting -smoking -smoking -injecting -injecting

13. Addiction Compulsive use Loss of ability to control use Continued use despite negative consequences Denial

14. Nightmare of Addiction Nightmare: insanity / prison / suicide “This routine went on with few interruptions for seventeen years. It was really a horrible nightmare, this earning money, getting liquor, smuggling it home, getting drunk, morning jitters, taking large doses of sedatives to make it possible to earn more money…”

15. Physical Deterioration May enter treatment through medical emergency Lying-down drunk Crack user passed out with her pipe Parent who passes out daily after the children go to school

16. Most Well-Known Treatment Programs What works… 12-step programs -Alcoholics Anonymous (AA) (2002) -Alcoholics Anonymous (AA) (2002) -Narcotics Anonymous (NA) (1988) -Narcotics Anonymous (NA) (1988) Employee Assistance Programs (EAP) American Psychiatric Association (2000) World Health Organization

17. Awareness “To Be Aware is To Take Care” (Mary Ann Finch) Practices: the Buddha -meditation -meditation -mindfulness -mindfulness “When we retire at night…” “On awakening…”

18. RECOVERY From “fists” to “open hands” -clients: px.ht.hp.tx. -clients: px.ht.hp.tx. -from “nightmare” to “gratitude” -from “nightmare” to “gratitude” Amazing Grace “I want to keep this life of peace, serenity, “I want to keep this life of peace, serenity, and tranquility that I have found. Today, I and tranquility that I have found. Today, I have found again the home I left…” have found again the home I left…”