Drugs And Alcohol

A

Dopamine

GABA

Theycause the brain to increase its excitatory neurotransmitters

79%

23%

Single males, 18-24 years of age

54%

12%

They have a short half-life,requiring repeat dosing within an hour

Methadone

Crackis a CNS stimulant that interferes with the reabsorption of dopamine, achemical messenger associated with pleasure

Get metabolized by the body within 1hour

44.5%

Marijuana

A decreased libido

Diuretic

200 mg

Caffeineimproves performance on tasks requiring the remembering of small amounts ofinformation

30%

20-24 year olds

Daily smokers have increased theamount they smoke

Cognitive behavioural therapy

Drugs introduce new receptors to the brain

Serotonin

90%

B

Acondition in which repeated doses of the same amount of drug becomediminishingly effective and progressively larger doses are required to secure adesired effect

Developsto different degrees across drug classifications

Userbecomes more resistant to effects; body has adapted

For example,tolerance to the various actions of benzodiazepines develop differently:tolerance to hypnotic effects develop rapidly, tolerance to antixiolytic effectsdevelops more slowly

A maladaptivebehavioural change, with physiological and cognitive concomitants, that occurswhen blood or tissue concentrations of a substance decline in an individual whohad maintained prolonged or heavy use of substance

Intensityvaries by drug class; for example, it is more apparent for opioids, alcohol,other depressants and less apparent with stimulants

Abstinencereaction may be opposite of drug effect (this is the case for opioids, amphet,nicotine, depressants)

Majority of individuals drink responsibly;however, the risks associated with drinking, increase as the amount of alcoholconsumed increases

Currentguidelines: F: 10/week, 2/day; M: 15/week, 3/day

Stay within weekly limits, drink in safe environments, to avoid risk of injury orother harms, do not exceed 3 drinks if female, 4 drinks if male- on any singleoccasion- and no more than 3 drinks every 2 hours

Chemicals thattransmit information from cell to cell

Psychoactive drugsenter the brain and affect which transmitters get released into the synapses: somestimulate, some block, and other drugs act instead of neurotransmitters

The major neurotransmitters are dopamine, norepinephrine,serotonin, GABA, and endorphins

Other neurotransmitters include glutamate,anandamide, acetylcholine

Significantly effectthe rate at which a drug enters the bloodstream and reaches the brain

In general, thefaster the drug reaches the brain, the more intense the response; The faster it enters,the shorter its half life

Due to effects onintensity and half-life, route of administration effects abuse potential

From slowest to fastest:oral, mucosa, inhalation, injection (for example, since heroin is injected ithas high abuse potential)

CNS stimulantsinclude cocaine, amphetamines, and caffeine

Produced increased activity in cerebral cortex resulting in elevatedmood, increased vigilance and postponement of fatigue

May be used as appetite suppressants, decongestants, and to treat ADHD

Reduceactivity of CNS: produce disinhibition and relieve anxiety; slow the body’s metabolism and the CNS; enhances mood

Usedtherapeutically as anti-anxiety agents, sleeping pills, anesthetics, sedatives

Produceeffects along continuum: antianxiety - sedation - hypnosis - anesthesia - coma - death

Includes alcohol,barbiturates, benzodiazepines, antihistamines, inhalants

Ameasure of the rate of metabolism of a drug; Indicates the length of timeneeded for a drug’s concentration to fall by 1⁄2

Longerthe half life, the longer the duration of action in the body; Shorter half life= more intense high and greater abuse potential

Halflife effects dosage, frequency of dosing; Half life of many drugs increaseswith users age

Alcoholdoes not have a half-life: eliminated at constant rate from the body

Also called psychedelics, they produce changes in thought, perception,cognition and mood; “produce a generalized disruption in the brain”

Include mescaline, psilocybin, lysergic acid dyethylmadine (LSD),phencyclidine and cannabis

Many have stimulanteffect though cannabis closer to CNS depressant

Elevate mood; disrupt perception; impair cognition and motor function;increase appetite

Harm reduction is a set ofpractical strategies and ideas aimed at reducing negativeconsequences associated with drug use

Harm Reduction is also amovement for social justice built on a belief in, and respect for, the rightsof people who use drugs

This includes thedistribution of harm reduction supplies, supervised injection and nursing careto people who use illegal drugs (for example, heroin drug users)

C

Use of the word “disorder” to replace “dependence” and “abuse” – low reliabilityand validity of “abuse”

Dependence remains only as for pharmacological dependence but notconsidered a disorder

No more abuse vs. dependence – now based on a severity scale (mild,moderate, severe)

Recurrent legal issues criteria removed

Gambling disorder added to substance use disorder as well as internet gaming,caffeine use disorder and cannabis withdrawal

· E-cigarettesbeing openly sold in: specialty shops, head shops, kiosks, convenience stores,gas stations

Effectiveas a replacement for tobacco smoking

Useas Nicotine Replacement Therapy

Lessharmful than cigarettes / no combustion

Anecdotalevidence that it is changing lives for the better

Harmreduction technique and public health benefits

Unproven, untested & unregulated

Health concerns re: propylene glycol

Renormalizing smoking?

Will it addict new smokers?

No alcohol inresidence 


No alcohol duringorientation week

No alcohol in glassbottles 


Limits on size andnumber or events licensed to serve alcohol on campus 


Limits on servingsize, number any person can purchase at one time

intoxicatedat the time


toobtain, or because drug dependent

62% male inmates and 64% female inmates had used illicit drugs duringsix months prior to arrest; 90% of each had used alcohol

AlcoholDependence Scale found 16% of male federal to be alcohol dependent; DrugAddiction Severity Test indicated 31% dependent on one or more illicit drug

Alcohol and drug users, particularly dependent ones’ reported highervolume of crimes committed

54% of new federal inmates reported being under the influence at thetime of the most serious crime

The ACE Study used asimple scoring method to determine the extent of each study participant'sexposure to childhood trauma

Growing up experiencing any of the following conditions in the householdprior to the age of 18: Recurrent physical abuse, Recurrent emotional abuse, contactsexual abuse, An alcohol and/or drug abuser in the household, An incarceratedhousehold member, Someone who is chronically depressed, mentally ill,institutionalized, or suicidal, Motheris treated violently, One or no parents, Emotional or physical neglect

Adverse childhoodexperiences are surprisingly common, although typically concealed andunrecognized.

ACEs still have aprofound effect 50 years later, although now transformed from psychosocialexperience into organic disease, social malfunction, and mental illness.

Adverse childhood experiences are the main determinant of the health and social well- being of the nation

Found a similar dose-response pattern; the likelihood of injection of street drugs increases strongly and in a graded fashion as the ACE Score increases

Our findings are disturbing to some because they imply that the basic causes of addiction lie within us and the way we treat each other, not in drug dealers or dangerous chemicals

Insite: Vancouver’s supervised injection site

Fewer people areinjecting drugs

More are accessingaddiction treatment

HIV transmissionrelated to injection drug use has plummeted

“invariant” series of stages of change

Stages represent distinct but related periods of time that seems to bemarket by different kinds of activities

Stages are different along 2 dimensions: behaviour and attitude

Focus on modification and change, not how behaviour was acquired

Pathways to change are not usually linear, may become stuck at one,circular pathway (“revolving door schema” – several ways to exit)

the stage in which people are unaware of having problems or for otherreasons are not thinking seriously about changing

the stage at which people become aware that a problem exists

sometimes precedes stage of action

the stage in which people change their overt behaviour and theenvironmental conditions that affect their behaviour

the stage at which people work to continue gains attained during actionand to prevent relapse

return to problematic behaviour; may represent a separate stage ofchange or movement to another stage of change (may return to contemplation orprecontemplation)

does not occur until the person no longer experiences any temptation toreturn to trouble behaviours and no longer has to make any efforts to keep fromrelapsing

1) Bea REGISTERED client at SHC (through NSP or HCV)

2) Be16 or older

3) Bea person who uses opioids and is at risk for overdose

4) Noallergies to naloxone or incipients

5) Beable to give consent and understand the risks of giving/not giving naloxone

6) CompleteSHOOPP training (incl pre/post-test)

Training includes how to respond to opioid overdose, rescue breathing, recovery position, and how to administer naloxone

D

Set - personality of user (attitude of the person atthe time of use)

Setting - social setting in which drug is consumed

Thepower of social setting + power of cultural and social attitudes = influence ondrug effect

Sociallearning – social sanctions become internalized

Social sanctions define whether and how a particulardrug should be used; Theymay be informal and are commonly shared by a group (e.g. don’t drink and drive)

Many soldiers after Vietnam did not continue to use heroin (likely due to change insocial setting)

Boththe onset of pleasurable effect and the amelioration of the withdrawal effectcreate a reward for the subject; Thereward positively reinforcing the behaviour

Animal studies: “going back for more”

The key is in self-administration; sharedhardwiring between animals and humans

Habituation– the diminishing of a physiological or emotional response to a frequentlyrepeated stimulus

Chronicrelapse disorder – those clients that may have been in multiple treatments,they have had long periods of recovery, they know the lingo, the tools, and“The Program”, but they can’t seem to stay clean and sober; Negativereinforcement (relieving withdrawal)

“cues” and craving: Cravings aretriggered by memories, affective states and situations associated with bothout-of-control behaviors and drug use

Cue-induced behaviors likely evolved along side the pleasure system toprovide a memory of both rewarding as well as aversive stimuli

The reward circuit isclosely tied with the executive function/decision- making centers of the brain,the prefrontal cortex and orbitofrontal gyrus

Addiction in the absence of drug taking is referred to as behavioural addictions, impulsecontrol disorders, compulsive behaviours and process addictions

Both have onset inadolescence and young adulthood and higher rates in these age groups than amongolder adults

Both have naturalhistories that may exhibit chronic, relapsing patterns, but with many peoplerecovering on their own without formal treatment (so- called “spontaneous”quitting)

Behavioral addictionsare often preceded by feelings of “tension or arousal before committing theact” and “pleasure, gratification, or relief at the time of committing the act”

Diminishing returns – less pleasure,more out of habit

Negative reinforcement (relievingwithdrawal)

Cues, stimuli

Urges, cravings

Experience of a “high”

Negative consequences

May respond to the same treatments

Behaviouraladdictions: Reward pathways implicated—dopamine & opioid systems “mostinfluential in regulating rewarding behaviours”

Repetitive behavioral patterns help establishand maintain the cue-induced behaviors associated with addiction throughneuroadaptation

Naloxone(aka NARCAN)