Important course concepts Flashcards
Controlled Substances Act of 1970
First measure to control drug use.
Created “schedule” system, rated based on abuse potential and medical use.
Schedule 1
high abuse potential, no accepted medical use.
Examples: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote
Schedule 2
High abuse potential, psychological or physiological dependence liability, medically used
Examples: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin
Schedule 3
Some abuse potential
Examples: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone
Schedule 4
Less abuse potential
Examples: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol
Schedule 5
Least abuse potential, over the counter drugs
Dispositional tolerance
The body speeds up the metabolism of a drug to eliminate it by up-regulating enzyme production
Pharmacodynamic tolerance
Down regulation of receptors.
Nerve cells become less sensitive to the effect of a drug. Body can also produce antagonist to the drug. For example: use of opioids causes the brain to make fewer opioid receptor sites
Behavioral tolerance
The brain learns to compensate for the effects of the drug by using unaffected parts. “overriding” the effects of the drug with will power.
Reverse tolerance
In response to destruction of tissues from prolonged use, the user becomes more sensitive and less able to handle moderate amounts of the substance.
Acute tolerance (tachyphylaxis)
Brain and body begin to adapt instantly in response to initial use of a substance.
Select tolerance
Body develops tolerance to mental and physical effects at different rates. Dose to reach emotion high is not the same as the physical level of tolerance.
Inverse tolerance (kindling)
A person becomes more sensitive to the effects of a drug as the brain chemistry and neuron pathways adapt to the drug’s effects.
Cross tolerance
Developing tolerance to one drug increases tolerance to other drugs with similar biological pathways as well
Non-purposive withdrawal
Characterized by objective physical signs that are a direct result of developing tissue dependence
Purposive withdrawal
A false portrayal of severe withdrawal symptoms by an addict to gain drugs from prescribers.
Can also be caused by psychic conversion reaction: emotional expectation of physical effects.
Protracted withdrawal
Flashback or recurrence of the addiction withdrawal symptoms triggers heavy craving even after detox is complete. Caused by environmental triggers.
“Levels of use” progression
Abstinence, initial contact, experimentation, social/recreational, habituation (integrated use), abuse (excessive use), addiction
Stages of recovery
Withdrawal, honeymoon, the Wall, adjustment, resolution
Withdrawal
0-15 days after use
Low energy, need more sleep
Difficulty concentrating, cravings, short term memory problems
Hostility, confusion, fear, depression, doubt, shame
Honeymoon
16-45 days after use
High energy, poorly directed behavior, secondary drug use
Shorter attention span, denial about relapse potential
Optimistic and overly confident
Desire to return to “normal” may cause conflicts with family members
The Wall
46-120 days after use
Low energy, apathetic, sleep disturbances, discontinuation of recovery behaviors
Romancing use, rehearsal of relapse, increased cravings
Anxiety, depression, fatigue, boredom, irritability, anhedonia
Blaming, devaluation of progress
Adjustment
121-180 days after use
Return to risky situations, decrease in recovery /abstinence promoting behaviors
reduced thoughts of use and cravings
reduced depression, anxiety and irritability but continued boredom and loneliness
Resistance to assistance with relationship problems
Resolution
181+ days after use
Emergence of other excessive use behaviors
Questions need for long term support
Emergence of emotional material, boredom with abstinence
Pre-treatment stages
Denial, ambivalence, motivation (extrinsic), motivation (intrinsic) readiness for change, readiness for treatment
Treatment-related stages
De-addiction, abstinence, continuance, integration and identity change
Recovery model
Self-directed, individualized, person-centered, empowerment oriented, holistic, non-linear, strengths-based, peer supported, respectful, emphasizes personal responsibility, and fosters hope.
Solution Focused
Builds on clients strengths, client-identified goals, assumes client is cooperating, looks for exceptions, explores hypothetical frames, looks for clues for possible solutions
EARS
Elicit, Amplify, Reinforce, Start Again
Solution focused style questions
What is your goal?
How did you stay clean for the time before you relapsed?
How will you know when things are going better?
Tell me about a time when you felt more in control of your drug use
Disorders with high substance abuse comorbidity
Antisocial personality disorder/conduct disorder affective disorders anxiety disorders PTSD ADHD
Prioritizing Treatment Tasks
Safety»_space; Stabilization»_space; Lawðics»_space; Development/growth»_space; Relapse prevention
Considerations for multiple disorders
Safety, stabilization, and maintenance.
Which came first? What should be treated first/concurrently?
Will treatments interact? Can they be integrated?
Prevention strategies
Reduce Supply: interdiction of drug supplies, legislation against use, and legal penalties for possession, distribution, and use
Reduce Demand: treating drug dependency, fostering prevention through education, emotional development, moral growth
Harm reduction: promoting temperance, providing medication replacement treatment, providing resources to lessen the consequence of abuse, and decriminalization/legalization of use.
Primary prevention
Tries to anticipate and prevent initial drug use.
Programs target young people with no use experience:
promote abstinence, develop skills to refuse drugs, delay the age of first use
**receives the least amt of federal, state, local funding
Secondary prevention
Seeks to stop drug use once it has begun, targets nondependent users
Prevent further experimentation, social/recreational or habitual use
Adds intervention strategies to education and skill building
Barriers: adverse effects take time to manifest, drug use is difficult to detect in the early stages.
Tertiary prevention
Tries to stop further damage from habituation, abuse, and addiction and to restore abusers to health.
Drug abuse treatment and intervention/drug diversion techniques
Intensive, comprehensive treatment for dependent users
The goals of motivational enhancement
Use connection with client
Assess readiness to change
Connect the pain in their life with AOD use
Explore benefits and problems of AOD use
Give feedback that is direct, but not harsh/punitive
Offer options for change
Stages of change
Pre-contemplation» Contemplation» Determination»_space; Action»Maintenance» Permanent Exit OR relapse back to contemplation
Principles of motivational interviewing
Express empathy
Roll with resistance: use to help explore the clients ideas
Avoid argumentation
Develop discrepancy: help clients recognize discrepancies between where they are and where they want to be
Support self-efficacy
Pre-contemplation
Not considering possibility of change, no acknowledgement of problems, surprise rather than defensiveness at confrontation, needs info and feedback to raise awareness about problem/need for change
Contemplation
Some awareness of problem, considers change and rejects it, ambivalent about problem.
Task: tip the balance in favor of change
Determination
Motivated client
Task: make change strategy that is acceptable, accessible, appropriate, and effective
Action
Stage most assoc. with counseling
Person actively participates in behaviors to bring about change
Goal is to produce change in the problem areas
Maintenance
Prevent relapses
Try to maintain changes made in action stage
May require different skills and strategies than those used in previous stages
Relapse
Normal part of recovery
Help client avoid discouragement, continue contemplation, renew determination, and resume action/maintenance efforts
Motivational interviewing definition
Non-confrontational style to involve clients in their own recovery process and helps them change ambivalence about drug use into motivation to make changes that lead to recovery
Uses: collaboration, evocation, autonomy
De-emphasis on labels
Emphasis on personal choice and responsibility
Objective evaluation but prompts client to share own concerns
Resistance is not unidirectional, influenced by therapist’s behavior
Resistance is met with reflection
Goals and changes are negotiated
Motivational interviewing characteristics
OARS
Open questions, Affirmation, Reflective Listening, Summarizing
Substance Dependence Criteria
Tolerance, withdrawal
Substance taken in larger amounts/ over longer periods of time than intended
Persistent desire/unsuccessful efforts to cut down
Great deal of time spent in activities necessary to obtain substance/recover from effects
Important activities given up/reduced
Use continued despite physical/psychological problems
Universal prevention
Applied to everyone in an eligible population, targets general public
Selective prevention
Focus on individuals or subgroups of the population whose risk of developing problems of AOD dependence is above average
Distinguished by: age, gender, family history, SES, past experiences or behavior
Indicated prevention
Apply to persons who exhibit specific risk factors or conditions that individually identify them as being at risk for developing AOD abuse
Indications of CD
More than one DUI, AOD use taking higher priority, using more than intended, conflicts with others around AOD use, AOD use related health consequences, daily use
Indications assessment for CD is warranted
History of use reported Suspected use reported Signs/symptoms of substance intox./withdraw. Symptoms of mood disorder Mild hallucinations reported Sleep disturbances Paranoia present Financial/employment problems Domestic violence or discord reported Legal problems
Johari window
- Open self: known to self and others, public knowledge
- Hidden self: known to self but not to others; secrets
- Blind self: Known to others but not seen by self; blind spots
- Unknown self: subconscious, the future, dreams: unknowable to humans
Addictive thinking
Having a “right”: entitlement, privileges
Blaming: not taking responsibility
Overgeneralization
Filtering: focusing on a single aspect of a situation
Emotional reasoning: “I feel therefore I am”
Heaven’s reward thinking
Control fallacy: all powerful or victim
Polarization
Needing to be right
Fallacy of fairness: things aren’t fair when they go wrong
Cycle of addictive relationships
Denial: “it’s not so bad”
Discomfort/pain
Confrontation
Key to moving forward is taking responsibility to contributions
Transitioning from addictive to healthier relationships
Individuation/self-differentiation
Self-resolution: “I am enough”
Us, We: two contributing members of the relationship
Developing a greater cause
Drama triangle
Persecutor (bad guy): angry, critical, demanding, blames victim
Rescuer (good guy): avoids own needs in favor of those of the victim. Enables victim behavior, keeps them in dependent role.
Victim: feels angry, helpless, and incompetent. Looks for rescuer and persecutor to maintain role.
Metabolism and half-life
Age, race, heredity, gender, health status, privilege, emotional state, drug interactions, body composition, hormones, enzyme inhibition
Sobriety vs. recovery
Sobriety: process of completely abstaining from drugs and alcohol throughout life. Must undergo the recovery process in order to successfully maintain their sobriety.
Recovery: Process that involves restructuring life, and finding sustainable alternatives to AOD use and healthier cope mechanism. Often requires multiple rounds of treatment and continued engagement in support systems such as 12-step programs
Treatment options
Medical model detox programs
Residential/inpatient treatment
Partial hospitalization/day treatment
Methadone maintenance and other replacement therapies
Social model detox programs
Therapeutic communities: 1-3 year self contained residential programs with full rehab and social services
Halfway houses
Faith-based treatment initiatives
Sober-living and transitional living programs
Harm reduction programs
Disease model of addiction
The disease model of addiction describes an addiction as a disease with biological, neurological, genetic, and environmental sources of origin.
Addiction manifests in response to the confluence of predispositional vulnerability factors and stressful life experiences.
Support groups vs. self help groups
Support groups are lead by a trained professional whereas self help group are peer lead
What is the fastest route of administration?
Inhalation: 7-10 seconds before drug reaches brain
How quickly does a substance reach the brain after being injected intravenously?
15-30 seconds
Via which route of admin. does it take a drug 3-5 minutes to reach the brain?
Mucous membrane absorption
