SUBSTANCE ABUSE - PSY 354 (2018/2019-2019/2020)

Question 1

In real terms, everyone is somehow involved in Substance use, at what point would you accept that an individual is abusing a particular Substance?

Answer 1

Drug/Substance abuse could be viewed as the consistent and excessive use of any Substance that alters the user’s moods without medical need.

Substance abuse is generally established when a Substance impairs the user’s social, physical, mental and emotional wellbeing, resulting to harm, either to the user or his/her society. (UWAOMA 2002)

In other cases, a Substance is abused when it is taken illegally or self-administered to the detriment of the user, the society or both.

Question 2

Examine risk factors in Substance use and abuse.

Answer 2

Risk factors in Substance abuse may include;
• Individual factors like;
- Anti-Social behaviours 
- Alienation and Rebelliousness 
- Depression and Anxiety 
- Locus of control
- Early Exposure to drugs
- Curiosity and High need for excitement 
• Family risk factors like: Divorce, Remarriage, Inconsistent, permissive and uninvolved parenting 
• Peer Pressure Factors
• School Related risk Factors 
• Work Induced Risk Factors 
• Community Related Risk Factors

Question 3

How does a person proceed from substance use to dependence?

Answer 3

A person becomes drug dependent when he/she feels compelled to take a drug on a periodic or continuous basis in order experience it’s effect or avoid the discomfort of its absence. It is characterized by the symptoms of tolerance andwithdrawal. A person can become dependent on a substance in the following stages:

• They start to use drugs for recreation or to ease discomfort. They take them infrequently and in social settings.
• They start using drugs on a regular basis to achieve the desired effects, often abandoning family and friends in favor of drug use. They become concerned about losing access to drugs.
• They become more tolerant to the the effects of the substance and preoccupied with getting them. They may abandon most or all your previous interests and relationships.
• They become dependent on drugs and unable to live without them. Their physical and mental health deteriorates.
• Having a persistent desire or unsuccessful effort to cut down or control substance use or quit entirely
• Withdrawal syndrome sets in, in the absence of the substance, they may indulge in something closely related to relieve withdrawal symptoms.
• They continue to use the substance, despite knowing the adverse consequences or harm that follows, e.g failure to fulfill roles, obligations or use when physically hazardous.

Substance dependence can be established if three or more of these occur at any time in the same 12 month period

Question 4

Change Model and Motivational Intervention

Answer 4

Motivational Intervention is a therapeutic technique geared towards raising and maintaining a councelee’s motivation for change. It is based on the premise of the change process which highlights five stages of change;

• The Pre-Contemplation Stage: This is the stage where individuals are not ready or intending to change. They may be uninformed or under-informed about the consequences of their behaviour or reluctant, Rebellious, resigned or rationalising change. Motivational Intervention can be used in this case to create discrepancy and evoke concerns in such individuals.

• The Contemplation Stage: In this stage, individuals may be conflicted towards change as they still enjoy the simple benefits of the substance to them but are also wary of their future without the substance and the consequences of continued usage. Hence, the individual considers change, but is unsure of its benefits. Motivational approaches suggested for this stage are helping the individual to resolve their ambivalence, to anticipate the barriers, decrease the desirability of the behaviour and to increase self-efficacy.
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Question 5

Change model and motivational Intervention (cont)

Answer 5

• The Preparation Stage: at this stage, individuals are ready and have decided to change this problematic behaviour. However, to achieve this, individuals in this stage must further explore, clarify and resolve their ambivalence. Motivational Intervention will aim at helping them increase the motive to change by raising/clarifying the discrepancy between their current situation and using their hopes for the future to increase motivation.
• Action Stage: This is where effort is put in to ensure behavioral change. Motivational Intervention at this stage would be used to encourage and support the counselee’s efforts and help them stay in the chosen treatment plan.
• Maintenance Stage: Individuals that make it to this stage have successfully achieved behavioral change, the work here now is maintaining it and this will need improved and supporting self-efficacy.

Question 6

Differentiate Rehabilitation from Treatment

Answer 6

Treatment means to manage symptoms of a pathology using medical, surgical or other proven therapy methods. Rehabilitation means to return someone to a good, healthy, normal life or condition.

Treatment may not eliminate or find out for certain what the cause is and remedy it, but manage it. Rehabilitation repairs the damage done by addiction and help individuals build skills they need to remain sober in future.

Question 7

Dangerous Drug Act: Who is qualified to possess drugs like Coca and Opium?

Answer 7

According to section 7 of this act:
• Any registered or licensed medical practitioner.
• Any person lawfully keeping open shop for the retailing of poisons in accordance with the provision of the pharmacy act.
• Any person employed or engaged in dispensing medicines at any public hospital or other public institution being a person duly licensed under the pharmacy act.
• Any qualified veterinary surgeon or any person in charge of a laboratory for purposes of research or instruction attached to any public hospitals or institutions approved by the Minister of Health for the purpose.
• Any government Chemists.

Are hereby authorised, so far necessary for the practice of his ptofession or employment in such capacity, to be in possesion of and supply raw opium or coca leaves, but subject to regulation 8.

Question 8

Dangerous Drug Act; Regulation 8

Answer 8

Regulation 8 stipulates that:
In the event that any person authorised by these regulations or by any authority granted by the Minister of Health to be in possession or supply raw opium or coca leaves, is being convicted of an offence against the act, the Minister of Health may, by notice in the Federal Gazette, withdraw the authorization aforesaid in respect of such person, if in the opinion of the Minister of Health, such person cannot properly be allowed to be in possession or supply raw opium or coca leaves.

Question 9

Dangerous Drug Act: Regulation 11-25

Answer 9

• How manufacturers of drugs should be licenced
• How vendors should be licenced ( for sales and distribution)
• The persons to whom drugs should be supplied ( and licenced)
• How and under what conditions drugs could be presctibed and dispensed
• Persons who may possess drugs (apart from authorised and licenced persons) - Reg. 16
• How druv containers must be marked
• How record of the minutes transactions with drug must be kept.

Question 10

Dangerous Drug Act: Section 14

Answer 10

Section 14 provides a prescription for the supply of drugs based on these conditions:

• The prescription must be in writing, must be dated and signed by a registered or licensed medical practitioner, dental surgeon or veterinary surgeon as the case may be. It must also specify the name and address of the person for whose use the prescription is given, including the total amount of the drug to be supplied. A person cannot prescribe these drugs for their own use.
• Prescriptions given by Dental or Veterinary surgeons must be for the purpose of dental treatment or animals and must be marked “for local dental treatment only” or “For animal treatment only”

Question 11

Dangerous Drug Act: Section 14 (cont’d)

Answer 11

• The Minister of Health’s prescription shall only be given with an official form attached, in the absence of the form, it must be indicated that “Official Form not Available” or similar words.
• Registered or licensed medical practitioners, surgeon or veterinary surgeon shall describe for supply of any of the drugs only in accordance with the forgoing conditions.
• Any registered or licensed medical practitioner who dispenses any medicines to which these regulations apply shall enter particulars thereof in his day book or the register herein after specified.

In summary, the Federal Minister of Health reserves the right of licensing and permitting for handling drugs or medicinal substances and any persons otherwise authorised, is illegitimate and if found to possess temporarily, for personal consumption or in trust, has contravened the provisions of the Dangerous Drug Act and is liable to prosecution and punishment.

Question 12

The National Drug Law Enforcement Agency Act, CAP 253LFN, 1990

Answer 12

This Act was enacted in 1989 to establish the National Drug Law Enforcement Agency which is to regulate the cultivation, processing, sale and use of hard drugs and empower the Agency to investigate person’s suspected to have dealings in drugs and other related matters. The law came to force 29th December 1989.

Section 3:
Functions of the agency:
• Powers to coordinate all Drug laws and Enforcement functions.
• Adoption of measures to eradicate illicit cultivation, trafficking or demand of narcotic and psychotropic substances.
• Adopt measures to increase the effectiveness of eradication efforts.
• International collaboration with allied overseas groups
• Power to arrest, investigate and prosecute suspected persons.
• Confiscation of property and power to freeze Bank account of offenders.
• Permitted to search private property for the purpose of ensuring that no illicit possession of such substance thrives in the country.

Question 13

NDLEA ACT: Part II

Answer 13

This part of the Act prosecutes anybody who:
• Imports, manufactures, produces, processes, plants or grows cocaine, LSD, heroin etc. If found guilty, these persons are sentenced yo improvement for life.
• Exports, transports or traffics the drugs, if guilty, sentenced to imprisonment for life.
• Sells, buys, exposes or offers for sale or deals in/with these drugs, if found guilty, sentenced to imprisonment for life.
• Knowingly possesses or uses the drugs by smoking, inhaling or injecting, if found guilty, sentenced to imprisonment term not less than 15 years, but not exceeding 25 years.

Question 14

NDLEA Act: Section 11 (i)

Answer 14

Any person who, without lawful authority, commits any of the following offences;
a)

Question 15

Utility of the knowledge of the relevant hard drug laws to psychology students

Answer 15

• Offers an explanation for why addicts, traffickers and others connected to drug buisness behave the way they do. Their lifestyle is usually out of the norms, they live in secrecy, self-alienation etc.
• Gives insight to students on how involvement in drug buisness affects the behaviours of the offenders and those around them.
• A well informed psychologist in these issues will be a better councelor, therapist or witness (in court)
• It would also influence students to make better choices as regards being of good behaviour and living well in his/her society.

Question 16

Global Drug Policy changes: Prohibition Approach

Answer 16

This approach assumes that illicit drug us is immoral and that it violates the collective conscience of the community. The goal of this approach was to eliminate drug trafficking and use globally. However, the approach largely failed because it did not stop the increase of drug related problems, and so, it faced some criticisms

• It’s moral arbitrariness in dividing drugs into limit and illicit
• Marginalisation of drug users
• Straining of the criminal justice system
• Infringement of the civil rights of citizens
• Indirect sustenance of a black market
• inability to curb the availability and consumption of illicit drugs.

Question 17

The Legalisation Approach

Answer 17

This approach, which is the opposite of the prohibition approach, argues for the legalisation of illicit drugs which will lead to the elimination of black markets, enable the regulation of the supply of psychoactive substance and make available more resources for treatment and prevention work.

Some criticism of this approach include:
• Extreme libertarian view
• Mostly, unacceptable because it presents greater risk than what both the public and policy makers are confident or willing to test.
• For a country like Nigeria, such policy will be enabling and even more dangerous as it is like giving individuals loaded guns and permitting them to use as toys.

Question 18

Harm Reduction Approach

Answer 18

This approach is centered on public health concerns. It runs on a belief that it is possible to modify the behaviour of drug users and the conditions in which they use in other to reduce the risks drugs pose to public health and safety.

Over 25 countries around the world have decriminalized drugs to some degree, including Portugal, the Netherlands, the Czech Republic, and Germany. In the US, marijuana use is decriminalized in some states, but it is still illegal at the federal level, making it difficult for marijuana-related businesses to set up shop.

Decriminalization means thata once-banned drug is still prohibited by law, but the legal system will no longer prosecute or criminalize a person for carrying under a certain amount. Decriminalization ensures that drugs remain federally-controlled and regulated.

Switzerland’s federal Council in 1994 announced its endorsement of a new drug policy based on the idea of “four pillars” - Prevention of drug use, Therapy for drug dependence, Harm-reduction and law enforcement/policing (Repression). Czech Republic passed drug law policies that did not include criminal penalties for drug use or possession of illegal drugs in a quantity judged to be appropriate for individual use.

Question 19

Harm Reduction Model (Goals)

Answer 19

The harm reduction approach to drug control is a multidisciplinary approach with an empathic involvement of medical practitioners and mental health professionals. It is also scientifically based, and so it’s model follows a coherent paradigm. It’s goals are expressed below:

Conceptualization Level:
• Value-neutral and humanistic view of drug use and user.
• Focuses on problems, rather than use.
• Does nit insist on abstinence
• Acknowledges the active participation in harm reduction programs.

Practical Level:
To reduce the more immidiate harmful consequences of drug use through pragmatic, realistic and low threshold programs

Policy Level:
• Generates middle-range policy measures
• wide spectrum
• embodied in existing policies

Programs:
The harm reductionist have developed many strategies aimed at minimising the harm associated with drug use, these include:
• Needle exchange 
• Methadone maintenance 
• Outreach 
• Law-enforcement cooperation 
• Illicit drug prescription 
• Tolerance zones
• Alcohol Server intervention 
• Smoking control

Question 20

Theories of Substance Use, Abuse and Addiction: Biological theories

Answer 20

Genetic Theory

Behaviour genetics is the study of the genetics of personality and abnormality. The genetic theory of psychoactive substance use and abuse hypothesize that this behaviour (use and abuse of drugs) runs in the family. That is, it is like having blue or brown eyes, if your parents have it, it is likely that you carry such characteristics in your gene too. However, no one gene has been reported to cause substance abuse or dependence. Rather, this theory has established that genetic factors affect how people experience certain drugs, which in turn, partly determine who will or will not become an abuser.

• The Twin studies have clearly shown that a substantial portion of the family transmission of substance abuse and dependence is due to genetics.
• The evidence for genetic transmission of alcoholism and other drug addictions has been much more consistent for males than females.
• The specific gene that contributes to alcoholism and potentially a large range of substance use disorders are the dapomine receptor genes. The irregularity in this gene causes deficiencies which leads people to seek stimulation with substances.

Question 21

Neurobiological theory

Answer 21

This theory suggests that people may abuse or become dependent on substances because of the pleasurable feeling of reward it gives. Every substance has slightly different effects on the brain, but all addictive drugs, including alcohol, opioids, and cocaine, produce a pleasurable surge of the neurotransmitterdopaminein a region of the brain called thebasal ganglia. This area is responsible for controlling reward and our ability to learn based on rewards. As substance use increases, these circuits adapt. They scale back their sensitivity to dopamine, leading to a reduction in a substance’s ability to produce euphoria or the “high” that comes from using it. This is known astolerance, and it reflects the way that the brain maintains balance and adjusts to a “new normal”—the frequent presence of the substance. However, as a result, users often increase the amount of the substance they take so that they can reach the level of high they are used to.

Question 22

Physiological Reaction Theory and Underlying Biological Depression Theory

Answer 22

Physiological Reaction Theory claims that people who are at risk of developing alcoholism may be better able to appreciate the initial highs of drinking and less sensitive to the lows that come later thereby making them real candidates of continuous drinking.

While Underlying Biological Depression Theory holds that alcoholism and depression are genetically related or perhaps, disorders as a result of family history.

Question 23

Psychological Theories

Answer 23

Positive Reinforcement

When the use of substances produce feelings that are pleasurable, people will continue to take them in order to experience such feelings more and more.

Negative Reinforcement

When faced with social pressures, frustration, academic and family work load or any other uncomfortable realities, people are likely to find solace in psychoactive substance use and abuse as they help to reduce the unpleasantness. That is, most people are likely to initiate and continue drug use to escape harsh conditions in their lives.

The Opponent - Process Theory

This theory asserts that an increase in Positive feelings will be followed by an increase in Negative feelings and vice versa. Many people who use psychoactive substances normally experience a crash after a period of ‘high’, this means that in other to reach this high, they must increase the intake of these substances, and equally, the chanses of a ‘crash’ afterwards increase.

Question 24

Assessment of Drug Addicts

Answer 24

A) Clinical Setting: Information is collected to help understand drug use and abuse by:

i. Monitoring and evaluating the process of an individual drug user in a treatment program
ii. As part if a systematic study of treatment methods in a clinical trail

B) Assessment of drug use in a context of a theoretical study to educate the pharmaceutical mechanism and psychological processes involved.

C) Use of epidemiological or other survey methods in order to establish incidence and prevalence rates fir psychological and social studies

Other approaches include:
• Assessment of the different classes of drugs in terms of their routes of administration, patterns of use and physiological, cognitive and emotional effects

• Assessment of the common features of addictive substances in terms of their ability to induce tolerance, physical dependence and withdrawal syndrome and distress if used regularly and in sufficient quantities.

Question 25

The BioPsychoSocial approach to measurement of drug use and abuse

Answer 25

The Physiological Measures
• Urinalysis: This is basically a series of tests done on urine. It is used to check signs of common conditions, disorders or diseases. Urinalysis is helpful in measuring drug use and abuse because;
- It is noninvasive
- It is easy to carry out
- It can check for the presence of a variety of substances in the system
- It provides and objective biological measure of drug use
- It is more likely to give accurate results than self reports.

However, it has some disadvantages;

• It can’t be used to plot a close-response curve as it only quantifies drug use within 72 hours after usage.
• It is not a satisfactory measure of compliance in Methadone maintenance programmes because it cannot show whether a client is taking all or only part of his supplied Methadone.

Methods of Urinalysis
• Enzyme Multiple-Immunoassay Technique (EMIT)
• Chromatography

Blood Serum Analysis
This is tests done on blood, as such it provides biological measure of drugs in the system, so it is comparable or complimentary yo other types of tests. However, blood serum is not the most appropriate routine screening method because:
- The procedures are lengthy and expensive
- Accuracy of the tests may be affected by some factors like age, gender,drug tolerance etc
- Longer history of drug use tend to be associated with lowered serum levels

Symptoms of Withdrawal
Indicators of Withdrawal are physical and subjective in nature and can be used in the assessment of drug use and abuse. The drug users own experiences and reports of Withdrawal and craving are significant aspects of drug use and abuse. This method measures the severity, absence or presence, time of onset of certain Withdrawal symptoms, e.g: profuse sweating, vomiting, gooseflesh, restlessness etc. It requires a client to undergo 12-24 hrs drug fast prior to assessment.

Question 26

BioPsychoSocial Approach: Behavioural Measures

Answer 26

Assessment for Epidemiological Study

This procedure has to do with collecting demographic data, Agency information, drug type,pattern of use, history and treatment, referral details etc. from trained staff, non-specialist staff, local research projects on drug users, and hospital records. One major shortfall against this method is that it depends heavily on the use of relatively skilled interviewers, as such, more suitable for individual in-depth studies than as a national monitoring system.

Assessment in Clinical Setting

Monitoring of drug taking in a clinical setting is almost dependent on self report by the drug user

Question 27

Rehabilitation

Answer 27

Rehabilitation is the process whereby people who have been impaired by injury, illness, or in this case, substance abuse, work together with health service staff and others to achieve their optimum level of physical, psychological, social and vocational wellbeing. It includes all measures aimed at reducing the impact of the handicapping and disabling conditions and helping the individuals get back to the most appropriate condition. Rehabilitation addresses and emphasizes positive capabilities of the individuals and tries to build upon the person’s individual functional and social resources to allow the development that was halted by the illness and to transfer improvement to new areas.

Question 28

Models of Rehabilitation

Answer 28

1. Rehabilitation Based on Conservative Goals: This approach to rehabilitation focuses on maintaining and prevention of further secondary disabilities of the patient in addition to treatment. The relevant components to this model are occupational therapy and entertainment.
2. Rehabilitation Based on Ambitious Goals: This approach is an addition to highly specialised treatment with relatively ambitious goals towards needs to develop specific skills and aim at specific goals. The goals and interventions are carefully planned to meet the patients needs. Social skills training and psychosocial rehabilitation are examples of strategies used under this approach.
3. Rehabilitation Based on Long-Term Aftercare: This model views rehabilitation as a longterm commitment that is comprehensive and highly based on the patients needs for as long as needed/recommended. Under this approach, there is no “once and forever” cure if chronic its, rather, an integration of services and intervention is emphasized.

Most professionals would use a combination of two or more of these approaches, however, the goals and needs of the client usually dictate the model most appropriate for them.

Question 29

The Process of Organizing Rehabilitation Programs

Answer 29

• Characteristics of the Patients

In organizing rehabilitation programs, first thing to do is understand the characteristics of your target population. The target population of addicts requiring rehabilitation is represented by those who have become disabled as consequence of substance addiction. So, people who have become incapacitated to function normally as a result of substance addiction should be your focus. To find these people, you have to carry out:
• Assessment: This involves using tools to evaluate the extent of disability, these tools include questionnaires, semi-structured interviews and direct observations. These will help you gather specific information on individual behaviors, and you could gather these from the Patients, significant others or staff members (in clinics or help centers where they’ve been to)
• Predictors of Outcome: This is to help uou assess how much impact the rehabilitation program will make on the patient.
i. The best predictor of rehospitalization is the previous hospitalization
ii. The best predictor of employment is the employment history factors.
iii. To check for unfavorable outcomes, you should consider these social and situational factors:
- Having spent five years in hospital
- Having poor social contacts
- Being older than 65
- Having an IQ of less than 90
- Having stayed in locked ward
iv. When checking the vocational capacity of addicts consider that:
- Symptomatology and diagnosis are poor predictors of future work performance
- A person’s ability to function in one environment is not predictive of that person’s ability to function in a different one
- Work activity in the hospital has no connection with subsequent community employment.
- The best clinical predictor of future work perfomance is work adjustment (getting along with co-workers and supervisors, and also being dependable)

Question 30

The Process of Organizing Rehabilitation Programs (contd)

Answer 30

• Rehabilitation Goals
Two major goals guide rehabilitation programs for addicts, living goals and working goals.

a. Living Goals

• Ward based rehabilitation
  The aim of rehabilitation in a ward-based program is to prepare patients for community placement or prevent further deterioration. The degree of structural change the ward can afford determines the number and quality of different skills in which patients can be trained. Two strategies can be applied;
  ~ Milieu Therapy: This therapy is based on the findings of social psychology studies regarding the impact of environment on individuals behavior. It is aimed at enhancing engagement through sharing, discussing and understanding individual differences through group interaction. When addicts are placed in such conditions, there is a pressure to change. Basically, three laws guide this program:
  a. Expectancy: Positive feedback (e.g “you’re doing well! Etc)
  b. Involvement: Taking responsibility, making decisions, solving problems, “trying again”
  c. Group cohesion: Working together and depending on each other.
  ~ Token Economy: This therapy is a behavior modification strategy where plastic tokens are given to patients after performing activities/deserving behavior in exchange for goods and privileges. That is, the patients are rewarded for good behavior, and then, they can use the tokens to “purchase” goods or privileges. Tokens could be earned by engaging in appropriate informal conversations, attending meetings, classes and other forms of associations that show appropriate growth, etc. The strategy is basically about using behavior Reinforcement to shape new behavior patterns.

- Community-Based Rehabilitation 
This is basically providing a support system for addicts withing their communities by providing:
- Client identigication snd outreach
- Health and dental services
- Crisis response services
- Housing
- Income support
- Peer support
- Family and communinty support
- Rehabilitation services
- Protection and advocacy
- Case mangement
- System integration

b. Work Goals
We live in a work oriented society, so it is important to encourage working and earning a living in addicts as it is an integral part of being a member of the society. Addicts in rehabilitation should be prepared for satisfactory work living through:
- Resettlement 
- Rehabilitative workshops 
- Work cooperatives
- Transitional employment programmes
- finding-job clubs
- supported employment.