Wasted AN INTRODUCTION TO SUBSTANCE ABUSE
Dr. Brian L. Bethel Child and Family Therapist Independent Trainer and Consultant LPCC-S, LCDC III, RPT-S www.brianlbethel.com INTERPLAY COUNSELING & CONSULTING
COPYRIGHT Copyright 2017 by Brian L. Bethel, PhD, LPCC-S, LCDC III, RPT-S Wasted An Introduction to Substance Abuse. This presentation or contents from this presentation may not be sold, reprinted or redistributed without prior written permission from the author. Direct questions about permissions to: Brian L. Bethel: interplaycounseling@gmail.com www.brianbethel.com
OUR GOALS Overview of substance abuse and its prevalence in American society Increased understanding of the disease of addiction Strategies for assessing risk factors with substance abusing families
What are the most commonly abused drugs in the United States?
MOST COMMONLY ABUSED 1. Sugar 2. Caffeine 3. Nicotine 4. Alcohol 5. Marijuana 6. Heroin 7. Rx. Drugs 8. Meth 9. Synthetic Drugs 10. Cocaine
WHAT IS A DRUG? Something we take into our bodies via ingestion, inhalation, absorption, or injection. Changes the way we think or feel.
WHAT IS A DRUG? Once it is in the blood stream, we cannot stop the drug from working. Includes over the counter, prescription, and illegal drugs (medicine, legal and illegal).
BENEFIT OF DRUGS Fight infection Reverse a disease process Relieve symptoms of illness Restore normal functioning of human organs Aid in diagnosing sickness Maintain health.
WHAT S THE PROBLEM? Drug abuse is a disease. Identified as an epidemic. (Latin) addictus---attached to something, positive.
PREVALENCE
THE NUMBERS There are 2.5 million older adults with an alcohol or drug problem National Council on Alcoholism and Drug Dependence, 2017
THE NUMBERS Six to eleven percent of elderly hospital admissions are a result of alcohol or drug problems 14 percent of elderly emergency room admissions, and 20 percent of elderly psychiatric hospital admissions. National Council on Alcoholism and Drug Dependence, 2017
THE NUMBERS Widowers over the age of 75 have the highest rate of alcoholism in the U.S. National Council on Alcoholism and Drug Dependence, 2017
THE NUMBERS Nearly 50 percent of nursing home residents have alcohol related problems. National Council on Alcoholism and Drug Dependence, 2017
THE NUMBERS Older adults are hospitalized as often for alcoholic related problems as for heart attacks. National Council on Alcoholism and Drug Dependence, 2017
THE NUMBERS Nearly 17 million prescriptions for tranquilizers are prescribed for older adults each year. Benzodiazepines, a type of tranquilizing drug, are the most commonly misused and abused prescription medications. National Council on Alcoholism and Drug Dependence, 2017
PRESCRIPTION DRUGS Between 6 and 7 million Americans have abused prescription medication in the last month
PRESCRIPTION DRUGS An estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012.
PRESCRIPTION DRUGS Persons aged 65 years and older comprise only 13 percent of the population, yet account for more than one-third of total outpatient spending on prescription medications in the United States. NIDA, 2017
MARIJUANA 102 million people have tried marijuana (41 % of the population).
OPIATES It is estimated that between 26.4 million and 36 million people abuse opioids
AN ESTIMATED 467,000 ADDICTED TO HEROIN
METH It is estimated that 8 million Americans have used Meth at some point in their lifetime. This translates to approximately 4% of the population.
BATH SALTS Bath Salts were linked to an estimated 22,904 visits to hospital emergency departments in 2012.
PROGRESSION OF THE DISEASE
PATTERNS OF USE SXS. RELATED TO USE PHYSICAL SYMPTOMS The substance is taken in larger amounts over a longer period of time than was intended Recurrent use resulting in failure to fulfill role obligations. Craving or a strong desire or urge to use There is a persistent desire or unsuccessful efforts to cut down or control the use. Continued use despite having persistent social or interpersonal problems exacerbated by use. Tolerance, as defined by either: need for read amounts of the substance in order to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount A great deal of time is spent in activities necessary to obtain, use, or recover from effects Important social, occupational or recreational activities are reduced due to use. Characteristic withdrawal syndrome for the substance; or the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms Recurrent use in situations that are physically hazardous. Continued use despite knowledge of physical or psychological consequences.
MILD SUBSTANCE USE DISORDERS MODERATE SUBSTANCE USE DISORDERS SEVERE SUBSTANCE USE DISORDERS
FAMILY HISTORY TOLERANCE AGE OF ONSET BLACKOUTS CONSEQUENCES TREATMENT FAILURE
CULTURAL ISSUES Gender Ethnicity Age Dual Diagnosis
UNCOPE U Have you continued to use alcohol or drugs longer than you intended? (Unintended use?) N Have you ever Neglected some of your usual responsibilities because of alcohol or drug use? C Have you ever wanted to Cut down or stop using alcohol or drugs bur couldn t? O Has your family, a friend or anyone else ever told you they Objected to your alcohol or drug use? P Have you ever found yourself Preoccupied with wanted to use alcohol or drugs? E Have you ever used alcohol or drugs to relieve Emotional discomfort, such as sadness, anger or boredom
C.A.G.E. C: Have you ever felt the need to cut down your drinking or drug use? A: Have you ever felt annoyed by people criticizing your drinking or drug use? G: Have you ever felt guilty about your drinking or drug use? E: Have you ever had a drink or used a drug first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
BREAKING ADDICTION
FIRST RULE OF ADDICTION You don t recover from an addiction by stopping using. You recover by creating a life where it is easier to not use.
COMMON PITFALLS OF ADDICTION TREATMENT
THERE IS NO MAGIC CURE FOR ADDICTION
YOU CANNOT USE A COOKIE CUTTER APPROACH
STAGES OF CHANGE EVIDENCED-BASED
MEDICATION-ASSISTED Drug Substitution Treatment, or Medication- Assisted Treatment if you prefer, is a popular method of treatment in the U.S. and abroad. Counseling is recommended with this approach.
MEDICATION ASSISTED TX. Decreases death rates Decreases HIV infections Decreases crime Decreases neonatal opiate withdrawal
SUPPORT Advocated for in the U.S. by most of the large organizations: National Institute of Drug Abuse (NIDA) Substance Abuse and Mental Health Services Administration (SAMHSA) American Society of Addiction Medicine (ASAM) National Association of Alcoholism and Drug Abuse Counselors (NAADAC)
MEDICATION-ASSISTED Methadone Buprenorphine (Subutex, Suboxone) Naltrexone (Vivitrol)
METHADONE Is the most frequently used medication for opioid addiction treatment in opioid treatment programs (OTPs) Is a long-acting medication Comes in several formulations, including oral solution, liquid concentrate, tablet/diskette, and powder
METHADONE Is a full opioid agonist that decreases the painkilling and other effects of opioids Was never formally approved by the Food and Drug Administration (FDA) Is a Drug Enforcement Administration (DEA) Schedule II drug Is available in outpatient treatment programs.
BUPRENORPHINE Is a derivative of the opium alkaloid thebaine Is available as a sublingual tablet Does not activate mu receptors fully, so larger doses of buprenorphine do not produce greater agonist effects Has an increased margin of safety from death by respiratory depression when increased doses of buprenorphine are used
BUPRENORPHINE Was approved by the FDA in 2002 Is a DEA Schedule III drug Can be administered in a physician s office, OTP, or other medical settings.
VIVITROL Extended release formulation of Naltrexone, an opioid receptor antagonist. A shot, once a month. Expensive Blocks craving and effects of use. Pill form Naltrexone has very poor compliance.
HARM REDUCTION A set of practical, public health strategies designed to reduce the negative consequences of drug use and promote healthy individual lifestyles and communities.
TREE MODEL OF ADDICTION Legal Family Medical Job Health Family Trauma Peers Stress Boredom
GOALS Prevent Disease Prevent Mortality Prevent Crime Empower Addicts
EXAMPLES Exchanging used syringes for clean syringes. Implementing methadone and buprenorphine programs. Having Naloxone/Narcan available and teaching overdose prevention. Advocating for the rights of drug users.
DRUG COURT Treat and supervise high risk participants. Provide evidenced-based treatment. Community based supervision. Administer incentives and sanctions.
TREATMENT OBSTACLES Brain dysfunction associated with heroin addiction is sustained even after at least 3 years of abstinence, according to the first brain imaging study to evaluate long-term outcomes of former addicts. Journal of Neuroscience Research, 2015
RELAPSE The National Institute on Drug Abuse states that between 40 and 60 percent of recovering drug addicts will eventually relapse. With heroin, those rates are even higher. NIDA, 2016
RELAPSE Some experts place the rate of relapse for heroin addicts as high as 80 percent, which means that the recovery rate may be as low as 20 percent. NIDA, 2016
TREE MODEL OF ADDICTION Legal Family Medical Job Health Family Trauma Peers Stress Boredom
NO SINGLE TREATMENT IS APPROPRIATE FOR ALL READILY AVAILABLE MULTIPLE NEEDS DOES NOT NEED TO BE VOLUNTARY LONG PROCESS