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    1

    Drugs of Abuse

    2

    Agenda

    ! What are the commondrugs of abuse?

    ! How are they used?! How can I detect use?! What problems do they

    cause?

    3

    Introduction

    ! Audience experience! Range of use/abuse

    " Casual use" Misuse of medications" Abuse" Dependency

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    4

    Drug Use Facts in U.S.

    ! 22 million engage in binge drinking! 15.9 million currently use illicit

    drugs

    ! 12 million currently use marijuana! 1.7 million currently use cocaine! 12.9 million have five or more

    drinks per occasion, five or moretimes per month

    5

    Drug Use Facts in U.S.

    ! About 100,000 deaths in the United Statesare related to alcohol consumption.

    ! Illicit drug abuse and related acquiredimmunodeficiency syndrome (AIDS) deathsaccount for at least another 12,000 deaths.

    !In 1995, the economic cost of alcohol anddrug abuse was $276 billion. Thisrepresents more than $1,000 for everyman, woman, and child in the United States

    6

    Drug Abuse (DSM IV)! Recurrent use resulting in a failure to

    fulfill major role obligations at work,school, etc.;

    ! Recurrent use in potentially hazardoussituations;

    ! Recurrent legal problems related touse;

    ! Continued use despite persistentproblems of a social or interpersonalnature, caused or exacerbated by theuse of the substance.

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    Drug Dependence (DSM IV)! Increased tolerance;! Development of withdrawal;! Taking larger amounts over longer

    period than intended, developstolerance;

    ! Desire and/or inability to stop;! Excessive time spent in using

    substances;! Interferes with normal daily activities;! Continued use despite consequences.

    8

    Continuum Of Use

    9

    Common Drugs Of Abuse! Alcohol! Marijuana! Cocaine / Crack! Hallucinogens (LSD, mushrooms,

    etc.)! Medications

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    10

    Drug Classifications

    ! Alcohol! Cannabis! Stimulants! Depressants! Narcotics! Hallucinogens! Steroids

    11

    Alcohol

    ! Not the most abused drug in theUS

    ! Effects executive function of forebrain

    12

    Alcohol

    ! Ethyl Alcohol is chemical name! Liquid distilled from fruits, grain

    and vegetables! Effects are intoxication, sensory

    alteration, and anxiety reduction! Symptoms are staggering,

    slurred speech, loss of coordination

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    13

    Alcohol

    ! Withdrawal includes" Sweating" Tremors" Altered Perceptions" Delirium Tremens (which can be

    fatal) can cause psychosis, fearand hallucinations

    14

    Alcohol

    ! Indications of Misuse" Confusion" Disorientation" Poor coordination" Involuntary release of urine or

    feces" Sleepiness" Respiratory Depression" Death

    15

    What is Marijuana

    ! The agent that effects change istetrahyocannabinol (THC)

    ! Usually called pot

    ! Produced from hemp plants

    ! Hashish is a resinous byproduct

    ! Marijuana is the tobacco like substance! Also known as cannabis

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    16

    What is Cannabis (Marijuana)

    ! Effects are:

    " Euphoria followed by relaxation

    " Impaired memory" Poor concentration

    " Loss of coordination

    " Vivid enhancement of most senses

    17

    Cannabis

    ! Symptoms you may recognize

    " Insomnia" Increased appetite (munchies)" Hyperactivity" Sensory exaggeration

    " Mood exaggerations" The smell

    18

    Cannabis (Marijuana)

    ! Withdrawal effects:

    " Insomnia

    " Hyperactivity

    " Decreased appetite

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    19

    Stimulants

    ! Amphetamines

    ! Benzedrine

    ! Butyl Nitrite

    ! Dextroamphetamine

    ! Cocaine

    20

    Stimulant Actions

    ! Used to increase alertness

    ! Relieve Fatigue

    ! Abusive and addictively desiredcharacteristics are euphoria, power,or relief from feeling down, or useof other medications which are

    downers

    21

    Stimulant Physiological Effects

    ! Average dosage brings

    " Increased heart and respiratoryeffects

    " Elevated blood pressure

    " Dilated pupils

    " Decreased appetite

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    Stimulant Physiological Effects

    ! Overdose or long term consistentuse brings

    " Rapid irregular heartbeat

    " Blurred vision

    " Dizziness

    " Restlessness

    " Anxiety

    " Paranoia

    " Death

    23

    Stimulants: Indications of abuse

    ! Excessive activity or talkativeness! Irritability! Argumentativeness! High blood pressure! Increased pulse! Dilated pupils! Long periods without sleep! Euphoria

    24

    Cocaine! Classified as a narcotic (although it isnt)! Causes increased alertness, ending with

    psychosis if used for lengthy periods! Increases heart and respiratory rates,

    increased BP, dilated pupils, perspiration,feelings of restlessness.

    ! Users go long periods without sleep and/oreating, are usually very talkative, irritable,and argumentative.

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    25

    Depressants

    ! Barbiturates

    ! Methaqualone

    ! Tranquilizers

    ! Chloral Hydrate

    26

    Depressants

    ! Used medicinally to relieve anxiety,irritability, and tension.

    ! Tolerance develops very fast

    ! Intoxicant symptoms are similar toalcohol

    27

    Depressants: PhysiologicalEffects

    ! Nothing bothers them

    ! Slurred speech

    ! Relaxed muscles

    ! Large doses = respiratorydepression, coma and death

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    Depressants: Overdose Effects! Shallow respiration

    ! Clammy skin

    ! Dilated pupils

    ! Weak and rapid pulse

    ! Coma

    ! Death

    29

    Depressants: Withdrawal

    ! Anxiety! Insomnia! Muscle tremors! Loss of appetite! Convulsions upon cessation of use! Delirium! Death

    30

    Narcotics/Opiates

    ! Heroin! Morphine! Opium! Codeine! Oxycontin! Hydrocodone, Hydromorphone! Meperidine! Methadone (synthetic)

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    Opiates

    ! Under classification of Narcotics! Used to relieve pain! Heroin is the morphine derivative

    most commonly abused! Initial reactions are nausea and

    vomiting! Then causes a euphoric high

    32

    Opiate Withdrawal

    ! Watery eyes! Runny nose! Yawning! Cramps, Diarrhea! Loss of appetite! Chills and sweating! Piloerection (chicken skin)

    33

    Opiates: Symptoms of Use

    ! Euphoria! Drowsiness! Respiratory depression! Pin Point Pupils

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    34

    Hallucinogens

    ! Phencyclidine (PCP)! LSD! Mescaline! Peyote! Psilocybin! Ecstasy and other designer drugs

    35

    Hallucinogens

    ! LSD is most commonly abused hallucinogen! Hallucinogens produce behavioral changes

    that are dramatic and of many dimensions! Effects are rapidly changing feelings,

    sometimes violent and erratic behavior,hallucinations, illusions, paranoia, etc.

    ! There are no documented withdrawalsymptoms. Behavioral characteristicsnoted above fade with time.

    36

    Hallucinogens - PCP! Use for long periods can lead to:

    " Memory loss" Difficulties with speech and thinking" Depression" Weight loss" Mood Disorders" Symptoms can persist up to a year after stopping PCP

    use.

    ! PCP has sedative effects! Interactions with other central nervous system

    depressants, such as alcohol andbenzodiazepines, can lead to coma or accidentaloverdose .

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    Steroids! Abused to improve performance in sports.! Attempt to increase their muscle size and/or

    reduce their body fat.! Anabolic steroid abuse has been associated

    with adverse side effects, such as acne andbreast development in men

    ! There are others that are life threatening, suchas heart attacks and liver cancer.

    ! Most are reversible if the abuser stops takingthe drugs, but some are permanent.

    ! Roid rage

    38

    Newer Trends InAdolescent Drug Use

    ! Ecstasy! GHB! Rohypnol! Ketamine! Embalming Fluid

    39

    Dealing With Addiction

    ! Do not fail to confront the obviousresults or consequences of substanceabuse with your employees and theirsupervisors;

    ! Expect resistance and denial, butconfront and educate in spite of theresistance;

    ! Offer help through SEAP referral, andstress the need for follow through.

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    40

    Short and Long TermProblems of Addiction

    ! Trauma! Psychiatric Instability! Intoxication! Acute Withdrawal! Drug Seeking! Loss of employment! Homelessness! Legal Involvement and/or Avoidance! Other medical conditions

    41

    Drug Use Facts

    ! Of all workplace drug users whotest positive, 52% are daily users

    ! Employees who test positive fordrugs are:

    " 60% more likely to responsible foraccidents,

    " use 1/3 more sick leave" have many more unexcused absences.

    42

    Scope of the Problem of Addiction

    Nationally,! About 35% to 45% of emergency room

    visits are in one form or another relatedto substance abuse or dependency;

    ! About 50% of traumas are related tosubstance abuse or dependency;

    ! About 47% of psychiatric admissionshave co-existing substance abuse ordependency disorders;

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    Levels Of Care! Detoxification! Inpatient! Residential (halfway house)

    ! Partial hospitalization! Intensive outpatient program! Traditional outpatient

    44

    Defense Mechanisms! In psychoanalysis, any of a

    variety of unconsciouspersonality reactions which theego uses to protect theconscious mind from threateningfeelings and perceptions .

    ! They include projection, reactionformation, displacement, sublimation,and isolation.

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    ! Denial: an ego defense mechanism thatoperates unconsciously to resolveemotional conflict, and to allay anxiety byrefusing to perceive the more unpleasantaspects of external reality

    " Denial by employee I dont have aproblem; feels persecuted; blamessupervisors for having it in for him/her

    " Denial by supervisor - Hes a goodworker, and he promised me hellimprove his performance

    Problems In Referral

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    Problems in Referral

    ! Audience participation

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