Drugs in American Society

CHD 601Unit 3 – Diagnosis and Tobacco

Updated: March 9, 2015 Edward Pierce. LCSW

OverviewDaylight Savings TimeQuiz 1Harm ReductionAssessmentOur other legal drug – Tobacco

Physiology Addiction Sociology Treatment

Quiz 1The quiz on the last page of the handoutMark your answers on the scoring sheetI’ll grade and scan, giving you back the originalWe will go over the answers immediately after

Harm ReductionTreatment was based on confrontation.It still is in some programsThe research shows this is not very effective, but we do what we believe will work.Harm Reduction works for most individuals, but not all.

Sobell’s At Patton State Hospital

Mark and Linda Sobell did an experiment years ago which was importantThey had two groups of patients, one where the goal was abstinence, one not.Follow-up studies showed a higher rate of recovery in those that were not abstinent.They were accused by many of falsifying the resultsThis result did not fit what everyone “knew” to be true, that is, the most effective route to recovery was abstinence.

Harm reduction videoAlan Marlatt at the University of Washington the one who created the concept of Harm ReductionLet’s find this videoWe can use the NU counseling video link on my website

LabelingAny diagnosis involves labelingThis type of labeling is different than a medical diagnosis like a broken arm One may feel diminished and want to disprove itIt impacts identityOne may feel hopeless, like nothing can be done

Assessment of Chemical Dependency

Alcohol Abuse Many tests exist to assess alcohol abuse None are perfect, but the one used the most in this

area is the AUDIT (Alcohol Use Disorders Identification Test)

You can try this 10 question screening test is on-line at http://www.testandcalc.com/etc/tests/audit.asp

This can be useful in identifying the need for further assessment

It should not be used alone for diagnosis

Assessment of Chemical Dependency

Several students have been surprised to see themselves in a problem range

Remember that all screening tests over-identify the problem

Further assessment is important Some people think this type of test should

be part of any health assessment What do you think?

Assessment of Chemical Dependency

DrugsAgain, many tests are availableOne used often in this area is the DAST (Drug Abuse Screening Test)There is a version on-line at http://counsellingresource.com/quizzes/drug-abuse/index.htmlTry it – See what your score isAs before, this is a screening test. It only indicates the need for further assessment.

Issues of assessment - Age

People over 65 need a different assessmentThey have different social roles than working peopleTests like the MAST-G have been shown to be effective

Issues of assessment - Age

Children under 18 also require specialized tests

A version of the AUDIT has been designed for this group

Is it important to screen children?

Why? Where should this be

done?

Tobacco

Used by native AmericansGiven to Christopher Columbus by the “Indians”Tobacco was rapidly adopted by EuropeansSeveral types are popularMost are grown in the United StatesU. S. became a country by growing tobaccoIllegal only in Bhutan

Tobacco and Self-Image

Important to people, particularly in Southern CaliforniaImages of men and women work on our desires to be manly, or sexyCould be a major focus in treatment

Tobacco and Anxiety

Nicotine, the active ingredient in tobacco, calms us.Stopping smoking has the opposite effect, it causes anxiety.Reducing anxiety has been an important focus of treatment

Tobacco and Weight Loss

Weight gain is about 8 pounds on averageSmoking tends to suppress appetite, hence with an appetite not suppressed, one gains weight.Can be part of self-image work in treatment.One can be too thin

Usage by teens

Tobacco use among teens has been rising outside the United States

It has decreased slightly in this country

Some attribute this to advertising

Some feel it is stress related

Much of the increase has been among young women

TAR

One of the active ingredients in TobaccoThe major element filtered out Is found on live plants(I picked tobacco when younger. It looks like road tar on live plants. And it gives you skin cancer.)Contributes to satisfactionContributes to the development of cancer.

Nicotine

The major addictive element in tobaccoA neurotoxin with a lethal dose of 50-100 to 1000 milligrams, child to adult.Used in e-cigarettes5 mg is usual blood level for smokersEffective as an insecticideOne cigarette has about 1 mg of nicotine

Carbon Monoxide

Carbon Monoxide is a by-product of all combustion

This reduces the lungs capacity to absorb oxygen (hemoglobin)

This causes heart and circulatory damage

Oxygen to the heart can be reduced as much as 40%

If pregnant, oxygen to the fetus is reduced also

Tobacco – What should we do?

Questions to think aboutThe harm to the fetus is clear when the mother smokes.What can society do to protect it’s most vulnerable?What types of interventions would work?How important is this?

Tobacco Risks

95% of all lung cancer deaths are attributable to tobaccoSigmund Freud died of tobacco-related cancerAn expensive habit in AmericaRisks for heart disease, lung problems and other cancers increase

Tobacco Risks - COPD

Chronic Obstructive Pulmonary Disease is another by-product of smoking

TAR kills off the cilia in the lungs These beat environmental toxins out of the lungs The lack of cilia can lead to bronchitis and

pneumonia This may result in death in the vulnerable people Sometimes those diagnosed use oxygen Should smoking be ok for these people?

Treatment

E-cigarettes (maybe)Nicorette and nicotine replacementThe patchCue exposureRelapse PreventionNegative stimulus

E-cigarettesUse is doubling every year, now about 12% of teens.Quite popular, but negative effects are not yet assessed.Usually illegal for purchase by minors or for use in public places.

Nicotine Replacement

Compounds exist which replace the nicotine in tobacco to ease withdrawal symptomsOne of these is nicorette gumOne can taper off over time and stop using the gumFor more see http://nicorette.quit.com/

The Patch

This is another nicotine replacement therapySmokers need to sustain the level of nicotine, which is why they smoke when they get upThe patch releases a small dose continually so the person does not feel the craving to smoke

Cue Exposure

Human behavior responds to social cuesEach smoker has cues which remind them to light upAnother person smoking, a good meal or drinking may be cuesCue Exposure inoculates the person resist these cues

How do we discourage smoking?

How do we encourage young people not to start?How do we help smokers to stop?Should we do anything special with pregnant women?

Summary

Diagnosis is our way of having a set of criteria to distinguish between those who are have problems with substance useTobacco is a dangerous drug, and use by teenagers and pregnant women is problematicNext time: Read Chapter 2