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Psychopharmacology: What Every Counselor Needs to Know

Stephanie L. Lusk, Ph.D., CRCUniversity of Arkansas

Workshop Goals and Objectives Upon the completion of this workshop, participants will be

able to: Describe the basic principles of pharmacology, neurophysiology and

neuroanatomy, and synaptic transmission;

Describe the key features of major neurotransmitter systems most commonly associated with drug effects;commonly associated with drug effects;

Demonstrate knowledge of the effects and side-effects of major classes (e.g. depressants, stimulants, hallucinogens) of psychotropic drugs; and

Describe how drug use affects individuals of different genders, races/ethnic groups and their families

Routes of Administration Oral Nasal Intramuscular Intravenous Subcutaneous Subcutaneous Topical Buccal Ducal

Bioavailability Absorption

Distribution

Biotransformation Biotransformation Liver enzymes – P450

Elimination

Sites of Action Central Nervous System (CNS) Comprised of the brain and spinal cord Receptor sites on the brain Neurotransmitters

Peripheral Nervous System Somatic Nervous System Autonomic Nervous System – monitors unconscious bodily

functions (fight or flight) Sympathetic (increases heart rate, breathing, etc.) Parasympathetic (reduces heart rate and blood pressure; conserves

energy)

Neurotransmitters (NTs) Neurotransmitters – chemical signals that instruct a

neuron to do something

Neuron – building blocks of the nervous system that receive information from NTs

Excitatory – a NT that tells a neuron to send a message to its targeted cells

Inhibitory – a NT that tells a neuron not to send a message to its targeted cells

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Neurotransmitters (NTs) There are several NTs that are relevant to psychoactive chemical abuse:

Acetylcholine

Norepinephrine

Epinephrine

Dopamine Dopamine

Serotonin

Gamma-amino-butyric (GABA)/Glutamate

N-methyl-D-aspartate (NMDA)

Enkephalins, endorphins, and dynorphins

Addiction as a Brain Disease Areas of the brain most likely be affected by substance

abuse include: Old brain New brain Mesolimbic reward pathway Hippocampus (memory) Cerebellum (balance)

Other Terms Drug Half-Life Effective Dose Lethal Dose Index Therapeutic Index Peak Effects R t k Reuptake Agonist Antagonist Rebound Effects Binge

Drug Scheduling Schedule I

Schedule II

Schedule III Schedule III

Schedule IV

Schedule V

Diagnosing Substance Related Disorders

Substance use disorder in DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe

Whereas a diagnosis of substance abuse previously required only one symptom, mild substance use disorder in DSM-5 requires two to three symptoms from a list of 11, moderate substance use denotes an individual meeting 4 to 5 criteria, and severe substance use includes 6 or more criteria met

Diagnosing Substance Related Disorders

Drug craving will be added to the list of symptoms

Problems with law enforcement will be eliminated because of cultural considerations that make the criteria difficult to apply internationally

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Central Nervous System Depressants

AlcoholBarbiturates

Benzodiazepines

Alcohol Ethyl alcohol (ethanol) Beer Wine Liquor

Methyl alcohol (methanol) Wood alcohol

Isopropyl (isopropanol) Rubbing alcohol

How Alcohol is Produced Yeast – digests sugar through a process known as fermentation

Yeast breaks down carbon, hydrogen and oxygen in the sugar and in the process produces molecules of ethyl alcohol and carbon dioxide

Distillation

Fortified wines

Hard liquors

Pharmacology of Alcohol Soluble in water and lipids

Main route of absorption is through the small intestine

Biotransformed in the liver

Gastric alcohol dehydrogenase

N-methyl-D-aspartate (NMDA)

Gamma-amino-butyric acid (GABA)

Biotransformation of Alcohol

The liver is the primary site of biotransformation

The liver produces alcohol dehydrogenase (the enzyme necessary in breaking alcohol down) and when it interacts with the alcohol molecule, the metabolite acetaldehyde is produced

The body also produces aldehyde dehydrogenase which breaks down acetaldehyde into acetic acid

Acetic acid is then eliminated from the body

Biotransformation of Alcohol Liver can biotransform one drink every 60 to 90 minutes

Zero-order biotransformation

Alcohol flush Alcohol flush

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Alcohol Dependence Early Stage

Drinking to escape from social situations Sneaking to drink Feelings of guilt Difficulty stopping once drinking has begun Preoccupation with drinking

Middle Stage Loss of control of drinking behavior

I i d i l l i hi Impaired social relationships Morning drinking Neglect of dietary and health needs

Late Stage Must drink in order to function Drinking to avoid withdrawal Nutritional diseases due to high alcohol intake Frequent intoxication Blackouts

Withdrawal Stage I (Tremors)

May occur approximately 8 hours after heavy drinking Usually peaks 24 to 36 hours after the last drink Person experiences tremors, slurred speech, irritability, sweating, increased

blood pressure and heart rate, poor coordination, loss of appetite, etc.

Stage II (Hallucinations) Auditory and/or visual hallucinations Auditory and/or visual hallucinations

Stage III (Withdrawal Seizures) Occurs 7 to 48 hours after the last drink Grand Mal (full body) seizures

Stage IV (Delirium Tremens) Usually occurs 3 to 5 days after last drink 15% fatality rate Profound confusion, severe agitation, reduced psychomotor activity, fever,

dilated pupils, etc.

Detoxification Medical supervision is required in order to provide

medications, vitamin therapy, and to measure and correct water and electrolyte imbalances

Benzodiazepine Treatment Applications Disulfiram (Antabuse)

Naltrexone (ReVia)

Acamprosate calcium (Campral) Acamprosate calcium (Campral)

Barbiturates

Chloral hydrate was introduced as a hypnotic in 1870 Irritating to the stomach; chronic use could result in significant

damage to the lining Addictive Narrow therapeutic windowp

Early Treatment for Anxiety and Insomnia

Paraldehyde was isolated in 1829 and first used as a hypnotic in 1882 Produced little respiratory or cardiac depression

Noxious taste

Develop a strong odor

Irritation to the mucus membranes in the mouth and throat

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Pharmacology of Barbiturates

Behavioral effects are similar to those of alcohol

Depresses not only the brain but muscle tissue, the heart, and respiration

Metabolized by the liver the excreted through the kidneys

Stimulates GABA and blocks glutamate

The therapeutic dose is very close to the lethal dose

Pharmacology Very short half-lives (4 hours or less)

Short half-lives (4 – 12 hours)

Intermediate half-life (12 – 20 hours) Intermediate half life (12 20 hours)

Long half-life (20 hours or more)

Some benzodiazepines will produce metabolites that are active

Medical Uses

Acute Anxiety Disorders

Generalized Anxiety Disorders

Seizure control

Muscle strains

Chronic insomnia

Medical Uses Depression Alprazolam (Xanax) Adinazolam (Deracyn)

Buspirone/BuSpar Useful in treating anxiety disorders with a depressive

component

OCD

Social phobias

PTSD

Alcohol withdrawal

Aggression and anxiety in older patients

Zaleplon/Sonata Hypnotic; short term treatment of insomnia

Short half life

Rapid tolerance development Rapid tolerance development

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Rohypnol and GHB Rohypnol was initially a pre-surgery medication, muscle

relaxant, and hypnotic in other countries

Date rape drug

S h d l I Schedule I

Zolpidem/Ambien Often mistaken as a benzodiazepine

Sleep inducing (hypnotic)

Schedule IV Schedule IV

Treatment Applications Detoxification/withdrawal Protracted withdrawal – continue for weeks, months, and even

years after last use

Treatment options Same as alcohol and barbiturates

Central Nervous System Stimulants

AmphetaminesRitalin and Similar Stimulants

CocaineCaffeineNicotineOthers

Amphetamines and CNS Stimulants Gladiators in ancient Rome used stimulants at least 2000

years ago to help them overcome fatigue so they could fight longer; later by truckers, students

Used for treating asthma, sinus problems, headaches, and as a food supplement to assist weight loss and enhance pp gathletic performance

Pharmacology of Amphetamines Primarily affects the peripheral regions of the body

Metabolized by enzymes in the liver and produces the following metabolites: 4-hydroxyamphetamine, 4-hydroxynorephedrine Hippuric acid Benzoic acid

Half-life is estimated at between 2.7 and 3.6 hours

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Amphetamines Dextroamphetamine (most common form of amphetamine) Half-life is between 10-34 hours

Methamphetamine Half-life is between 4 to 5 hours Most commonly abused amphetamine Most commonly abused amphetamine Metabolized into amphetamine; similar chemical structure

Amphetamine Methamphetamine

Amphetamines The chemical structure of amphetamine is similar to that

of norepinephrine and dopamine and is classified as an agonist of these neurotransmitters

Amphetamine Norepinephrine Dopamine Amphetamine Norepinephrine Dopamine

Amphetamines The effects of amphetamines depends on several factors Individual’s mental state Dose Potency of the amphetamine Manner in which the drug is used

Cocaine vs. Amphetamines Cocaine effects are shorter than amphetamine Amphetamines are effective when used orally Amphetamines have a very small anesthetic effect

Tolerance develops quickly

Consequences of Abuse Up to 50% of the dopamine producing cells in the brain may

be damaged

Causes the release of large amounts of glutamate which can become toxic and cause neuronal damage and/or death

Incoherent speech

Flat effect

Psychosis

Formication

Diarrhea/constipation/nausea/vomiting

Ritalin/Methylphenidate Treats ADHD and narcolepsy

Used initially as a “nonaddictive” substitute for amphetamines

80% is biotransformed to ritanic acid

Blocks the reuptake of dopamine

Ritalin/Methylphenidate Used by many college students along with drugs such as

Strattera and Adderall to enhance concentration

Crushed and inhaled or injected when mixed with water

Toxic psychosis similar to paranoid schizophrenia

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Ice

Smokable, concentrated form of meth

Cheaper

Seems more potent and the high last longer

Khat/Methcathinone Production includes: Drain cleaner Epsom salts Battery acid Biotransforms into ephedrine

Cocaine

Erythroxylon coca

Chewing leaves

Reserved for upper classes

Schedule II

Hypodermic needle

Used in popular drinks, wines and elixirs

Bath Salts Related to cathinone, an amphetamine-like stimulant found

naturally in the khat plant

Produce feelings of joy and increased sociability and sex drive

Individuals who abuse bath salts experience paranoia, agitation, and hallucinations; some even lose contact with reality and act violently; deaths have been reported in several cases

Bath salts are typically swallowed, inhaled, or injected, with the worst dangers being associated with snorting or needle injection

Pharmacology of Cocaine Best absorbed when administered as cocaine

hydrochloride, water soluble compound

Cocaine does not cause the release of dopamine but blocks its reuptake

Tolerance develops within hours or days

Diencephalon – regulates body temp

Nucleus Accumbens – responsible for reinforcing the rewarding effects of a substance

Pharmacology of Cocaine Effects are short lived; half-life of a single dose is only 30 to 90

minutes

Biotransformed in the liver and produces about 12 metabolites Benzoylecgonine (BEG) Ecogonine methyl ester Ecogonine methyl ester

Autometabilization (after death)

Cross addiction (heroin; alcohol)

Speedballing

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Withdrawal

Withdrawal from cocaine occurs in three phases: Phase I (lasts for several days)

Crash Depression and anxiety Cravings Exhaustion

Phase II (2-3 days to one week) Muscle twitching Irritability Hypersomnia Loss of concentration

Phase III (can last for several years) Intense cravings Marked reduction in ability to enjoy life and pleasurable events

Caffeine Part of the xanthine family of psychoactive chemicals

Most commonly consumed through coffee, soft drinks, and medicines containing caffeine for pain relief (Midol, Excedrine, BC powder)

Can be traced back to Ethiopia around 1000 AD

Caffeine is also used in products such as No-Doz and Red Bull

Caffeine Caffeine works by increasing norepinephrine and blocking

the effects of adenosine, a transmitter that inhibits the release of dopamine and acetylcholine

This allows an increase of dopamine and acetylcholine activity which in turn stimulates the nervous systemactivity, which in turn stimulates the nervous system

It is absorbed in the GI track and its effects can be felt within 30 minutes

Nicotine

Nicotine is a poisonous, oily liquid that comes from NicatinaTabacum, the tobacco plant

In large doses it is highly toxic and has previously been used as an insecticide

It is argued to be the most harmful psychoactive chemical

Pharmacology of Nicotine Nicotine, the active ingredient, was first isolated in 1828

Its effect on the nervous system was known as early as 1889

4700 compounds have been identified in cigarette smoke (2,550 come from the unprocessed tobacco itself)

100,000 other compounds might also be included in the smoke

Pharmacology of Nicotine Pesticides Other organic or metallic compounds Acetone Carbon dioxide Formaldehyde Hydrogen cyanide Lead Tar

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Pharmacology of Nicotine Cigarette’s Addictive Properties Each “puff” of the cigarette introduces small doses of

nicotine into the circulation that reaches the brain within 10 seconds (400 doses each day)

The smoker “overlearns” the process of nicotine self-padministration through hundreds or thousands or even millions of repetitions over his or her lifespan

Quickly distributed to every blood-rich tissue in the body

Tolerance begins to develop within as little as a few hours of smoking

Pharmacology of Nicotine Cigarette’s Addictive Properties Water and lipid soluble

Nicotine accumulates in the brain

Affects other NTs including epinephrine (stimulates), dopamine Affects other NTs including epinephrine (stimulates), dopamine (pleasure), MAO (breaks down dopamine), GABA, glutamate, and serotonin

Pharmacology of Nicotine Cotinine – 90% of nicotine is biotransformed into this

metabolite; possibly has psychoactive effects

Nicotine-N-oxide – 10% of nicotine is biotransformedinto this metabolite

Acetaldehyde – first metabolite produced by the liver when the body biotransforms alcohol

Narcotics

HeroinOther Opium Derivatives

Narcotics Narcotics are technically only the naturally occurring

psychoactive chemical derived from the opium poppy, Papaver somniferum, or designed to mimic the properties of opium derivatives

This drug can be traced back as far as 1500 BC and was even described in Homer’s Illiad

Morphine is the active ingredient in all narcotics

Pharmacology of Morphine Papaver somniferum plant

Morphine in the active ingredient in opium

Beta endorphin (Opioids peptide that functions as a i i 200 i h neurotransmitter is 200 times more potent than

morphine)

Thalamus (pain perception)

Amygdala (emotion center; releases Opioid peptides)

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Pharmacology of Morphine

• Distributed to the blood rich tissue first and then it is biotransformed in to a metabolite know as morphine-3-glucuronide (M3G)

• Biotransformation takes place in the liverp

• Within 6 minutes, as single dose is biotransformed into a metabolite

• Half life ranges from 1 to 8 hours

Codeine One-fifth as potent as morphine

10% is biotransformed into morphine

Control of cough; suppress the medulla which is Control of cough; suppress the medulla which is responsible for the maintenance of the body’s internal state

Accounts for 12% of all drug related deaths

Methadone Control of severe, chronic pain

Used for detox or as part of an opiate maintenance program

Exerts analgesic effects within 30 minutes

Peak effects in 4 hours

Single dose remains effective 6 to 8 hours

Oxycotin

Long term pain

Controls “break through” pain by providing stable, consistent relief

Users will crush the capsule and inject the drug into the vein

Heroin (Diacetylmorphine) No recognized medical use in the US – Schedule I

Works by activating the naturally present opioid receptors in the brain and limbic systems

Activates endorphins, which are the boy’s natural pain killers

Heroin (Diacetylmorphine) The most desired method of use is to inject the it

intravenously (shooting) or subcutaneously (skin popping)

Developed at the Bayer pharmaceutical company in G i 1898Germany in 1898

Initially sold as a cure for morphine addiction

Suppress cough

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Heroin (Diacetylmorphine) More potent than morphine

Biotransformed by the liver into morphine

More lipid soluble

Crosses the BBB 100 times faster than morphine

Heroin (Diacetylmorphine) When used intranasally, only 25% is absorbed in the body;

when used intravenously, virtually 100% is absorbed into the body

Highly addictive

Tolerance develops quickly

Fentanyl Synthetic narcotic/1968

50 to 3000 times more potent than morphine

Lipid soluble

Half life is 1 to 6 hours

Side effects Somnolence/confusion; dizziness Drug induced amnesia Anxiety/paranoia/depression Hallucinations

Buprenorphine Synthetic analgesic introduced in the 1960s

25 to 50 times more potent than morphine

Treats postoperative and cancer pain

Biotransformed in the liver

Treatment Methadone Synthetic narcotic used to help stabilize heroin-addicted patients Administered orally on a daily basis

LAAM More effective than methadone because it reacts for a longer

period of time L t t 72 h Last up to 72 hours

Buprenorphine Fewer withdrawal symptoms Requires smaller doses

Narcotic Antagonists/Opiate Blockers Naltrexone (ReVia) Naloxone (Narcan)

Hallucinogensg

LSDPCP

MDMA

Other Related Hallucinogens

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History of Hallucinogens 6000 different species of plants contain compounds that

might alter normal consciousness

Used for years in religious ceremonies, healing rituals, predicting the future, or preparing for battle

Used to explore alternative realities or gain self-knowledge

Pharmacology of Hallucinogens Alters perceptions, thoughts, and feelings

Have no approved use in general medicine – Schedule I

Affects serotonin (5-HT) and dopamine Affects serotonin (5 HT) and dopamine

Lysergic Acid Diethylamide-25 (LSD) Explored as a possible chemical warfare weapon

Identified as a controlled substance in the 1970s

Water-soluble

The highest concentrations of LSD are found in regions associated with vision and the limbic system (fight or flight/reward system)

Lysergic Acid Diethylamide-25 (LSD) Tolerance develops quickly

Half-life is 2.5 to 3 hours

Metabolite – 2-oxy-LDS Metabolite 2 oxy LDS

2CE Reports from Illinois note that this drug produces effects

similar to those noted in LSD

Phencyclidine (PCP) First introduced in 1957 as a surgical anesthetic

Continued use as a veterinary medicine until 1978

Schedule II drug Schedule II drug

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Phencyclidine (PCP) Subjective Experiences of PCP Abuse Fluctuations in levels of consciousness Dissociation Sense of euphoria Decreased inhibitions Feelings of immense power Negative effects (anxiety, restlessness, disorientation)

Phencyclidine (PCP) Pharmacology of PCP Weak base (can be destroyed or neutralized in stomach’s

acids) Both water and lipid soluble Accumulates in fatty tissues and in the brain (brain levels can

be 10 to 113 times as high as blood plasma levels)be 10 to 113 times as high as blood plasma levels) Blocks NMDA (N-methyl-D-aspartic acid) Half-life can be as long as 20 to 72 hours

Ecstasy Schedule I drug

MDMA or 3,4-methylenedioxy-N-methylamphetamine

Aids in psychotherapy and in the treatment of PTSD

MDMA is the most commonly abused stimulant in dance clubs

Primarily affects the neurotransmitter serotonin

Ecstasy Pharmacology of MDMA Classified as an hallucinogen and stimulant because of its effect

on the body – semisynthetic hallucinogenic amphetamine Absorbed in the GI track Metabolite – MDA (also a hallucinogen)

Aff i Affects serotonin

Molly Molly provides the user with a “cleaner” or pure form of

MDMA, which is the active ingredient

Ecstasy tables may be adulterated with other substances such as caffeine and/or methamphetamine Cheaper than mollies because it’s “cut”

Other Hallucinogens Mescaline Psilocybin DMT Nutmeg Atropine Atropine

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History of Marijuana Use Used by Chinese doctors to treat malaria, constipation,

the pain of child birth, and when mixed with wine, a surgical anesthetic over 5000 years ago

Used as a hypnotic, analgesic, a treatment for migraine headaches, and as an anticonvulsant in the 19th century

Medicinal Marijuana 1970s

Treatment for nausea in cancer patients Marinol was introduced as a synthetic version of one of the

chemicals found in marijuana, THC

Medicinal Marijuana Glaucoma; treats fluid pressure; the individual would have

to smoke 9 to 10 marijuana cigarettes per day (every 2 to 3 hours)

Amyotrophic Lateral Sclerosis (ALS)

Multiple Sclerosis

Rheumatoid arthritis

Chronic pain conditions

Medicinal Marijuana

Weight loss in AIDS or cancer patients

Asthma

C h ’ di Crohn’s disease

Anorexia

Types of Cannabis Marijuana

Hemp plant Schedule I

Hashish Resin from marijuana Schedule I Hashish oil Hashish oil

Marinol (dronabinol) Legal synthetic medication containing THC Schedule III

Sinsemilla Highly potent type of marijuana Buds of a flowering female plant that have not been pollinated by a male

plant Contains up to 24% THC concentration

Pharmacology of Marijuana Contains at least 400 different compounds

61 have some psychoactive effect

THC (Delta-9-tetrahydrocannabinol) was first id tifi d i 1964identified in 1964

Biotransformed into 11-hydroxy-delta 9 THC (metabolite)

Inhibits the release of excitatory neurotransmitters

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Pharmacology of Marijuana Un-metabolized THC is stored in fat

Allows significant amounts to be slowly released back into the blood

Test positive weeks after last use

Half-life is anywhere from three days to a week for a single dose

65% excreted in feces and the rest in urine

Tolerance develops rapidly

Consequences of Chronic Abuse Reduction in ability to learn new information

Reduction in cognitive performance

Changes in electrical activity of the brain Changes in electrical activity of the brain

Stroke

Amotivational syndrome

Addiction Potential Smoking as little as three marijuana cigarettes a week may

result in some degree of physical tolerance; however psychological tolerance is extremely common

Positive experiences with marijuana early in life leads to an increased likelihood of addictionan increased likelihood of addiction

Withdrawal is possible

Spice/K2 Synthetic marijuana and is marketed as a safe and legal

alternative; also marketed as potpourri or incense

The ingredients contained in these products are mimics, not copies of THC

Spice users report experiences similar to those produced by marijuana—elevated mood, relaxation, and altered perception—and in some cases the effects are even stronger than those of marijuana.

Some users report psychotic effects like extreme anxiety, paranoia, and hallucinations.

Crazy Clown A form of synthetic marijuana that is most commonly

smoked or burned in a small bowl and inhaled

Symptoms linked to include nausea, vomiting, dry mouth, weakness, cardiac problems and an inability to move Solvents/Inhalants/

AnestheticsVolatile SolventsVolatile Nitrites

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Definitions Solvents – usually liquids that are used to dissolve

another substance

Inhalants – gases that are administered to the body via breathing through the mouth

Volatile – a form of psychoactive chemical that can be inhaled

Nitrous oxide – the oldest abused inhalant; frequently used by dentist and physicians for small surgical procedures; whippets

Pharmacology of the Inhalants

When chemicals are inhaled, they enter the bloodstream without its chemical structure being changed by the liver

Lipid soluble (crosses BBB quickly and easily) Lipid soluble (crosses BBB quickly and easily)

Four categories Solvents Propellants for spray cans Paint thinners Fuels

Pharmacology of the Inhalants Anesthetic gases are eliminated from circulation without

extensive biotransformation taking place

Affects the neurotransmitters GABA and NMDA

H lf lif i h f h d d di h Half-life might range from hours to days depending on the chemical

Half-life of inhalants tends to be longer in obese abusers

Methods of Administration Sniffing/snorting

Bagging

Huffing Huffing

Spraying directly into the mouth

Boiling substances

Subjective Effects of Inhalants Initial action begins within seconds to minutes and last for

up to 45 minutes

Behavioral inhibitions

Feelings similar to alcohol or benzodiazepine intoxication

Tolerance and Withdrawal Tolerance develops very quickly

There do not appear to be any withdrawal effects associated with the cessation of abusing inhalants and solvents

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Psychotropic Medicationsy p

AntidepressantsAntipsychotics

Anxiolytics

Psychotropics Dual diagnosis/Co-occurring Disorder - approximately

50% of individuals with chemical dependence suffer from at least one mental illness

Major Categories of Antidepressants Tricyclics

Monoamine Oxidase Inhibitors (MAOI)

Selective Serotonin Reuptake Inhibitors (SSRI)

Selective Norepinephrine/Serotonin Reuptake Inhibitors (SNRI)

Norepinephrine Reuptake Inhibitors (NRI)

Monoamine Oxidase Inhibitors (MAOI)

Tricyclics

Dirty drugs

Most severe/unpleasant side effects

Bl k th t k f t i d t h l i Block the reuptake of serotonin and catecholamines

Toxic; even small overdoses can be lethal

SSRIs

Fewer unpleasant side effects

Safer in overdosage

Cl (i t t littl ith th t ) Clean (interact very little with other receptors)

Prevents 5-HT from being reuptaken

SNRIs

Dual action in that they affect both serotonin and norepinephrine

Somewhat more effective in treating severe depressiondepression

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NRIs

Effective in improving energy and cognition

Have little or no effect on sexual function

M i t l f tit d d ti May cause anxiety, loss of appetite, and sedation

MAOIs

First generation antidepressant

Prevents the breakdown of serotonin, norepinephrine, and dopamine

Used mainly when other antidepressants have failed or when panic disorders are present

Cannot be combined with tyramine in certain foods

Other Antidepressants Tetracyclics

Dibenzoxazepines

Tirazolopyridine Tirazolopyridine

Antipsychotics

The goal of medication treatment is to reduce symptoms so that the person can function better and benefit more from other forms of treatment such as individual, group, or family therapy and social or vocational rehabilitation

An important part of treatment is educating the patient about the side effects of the medication

Anxiolytics Used to treat co-occurring anxiety disorders by

regulating the synthesis and function of neurotransmitters such as epinephrine and norepinephrine

Anabolic Steroids

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Terms

Anabolic The action of this family of drugs to increase the speed of

growth of body tissues The ability of this group of chemicals to force body cells to

retain nitrogen

Androgenic Chemically similar to testosterone (male hormone) Causes the masculinizing effects

Introduction Members of this group include: Progesterone Adrenocortical hormones Bile acids Poisons produced by toads Carcinogenic compounds Carcinogenic compounds

The abuse of these drugs do not produce euphoria but are abused in an effort to increase athletic performance

Medical Uses of Steroids Promote tissue growth Help damaged tissue recover from injury Anemia Help patients regain weight after illness Endometriosis Delayed puberty Delayed puberty Adjunct to breast cancer treatments Promote bone tissue growth Osteoporosis AIDS-related weight loss (wasting syndrome) Chronic kidney failure

Pharmacology of Steroids Steroids force the body to increase protein synthesis

Inhibit the breakdown of muscle tissue by glucocorticoids

Schedule III Schedule III

Risk of Abuse The adverse effects of anabolic steroids depends on the: Route of administration Specific compound utilized Dosage levels Frequency of use Health of the individual Age of the individual

Atypical Antipsychotics

Atypical antipsychotic are strong serotonin blockers and produce varying degrees of dopamine blockage

Effective for both positive and negative symptoms

Clozapine is a first line atypical antipsychotic

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Over-the-Counter Medications

History Willow bark was prescribed by Hippocrates for the

treatment of headache, fever, and labor pain

The active ingredient, salicin, in willow bark was isolated in the 1880s

Salicin was then used to produce salicyclic acid which is easier to produce

Aspirin, also known as acetylsalicylic acid, was originally produced by Bayer Pharmaceuticals

Pharmacology of Aspirin Acetylsalicyclic acid is biotransformed into salicyclic acid

(active ingredient)

Aspirin does not seem to work within the cortex of the brain, but at the site of the injury, in the hypothalamic region, and within the spinal cord

Pharmacology of Acetaminophen Blocks COX-3 synthesis which is causes fever and

inflammation

COX-3 is produced mainly in the CNS, which is where acetaminophen seems to have its main effect

Propionic Acids Ibuprofen, Naproxen, and Ketoprofen Fever Inflammation Pain (Arthritis, Gout, etc.) Combined with narcotic analgesics to treat cancer pain Alzheimer’s disease

Pharmacology of Ibuprofen Inhibits the action of the enzyme cyclooxygenase (COX-

3)

Not as irritating to the stomach

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Pharmacology of Naproxen Suppress the synthesis of prostaglandins in the

hypothalamus

Metabolized in the liver into the inactive metabolite 6-desmethylnaproxen Theories of Addiction, Addicted Families,

Gender, Ethnicity and Other Considerations

Why Include the Family in the Treatment Process?

Theories and Models of Addiction Moral model Psychodynamic model Social learning theory Personality theory Medical/disease model Medical/disease model Opponent-process theory Bipsychosocial-spiritual model

Characteristics of Addicted Families Poor communication Rules and secrets Inability to express feelings Inappropriate roles

Addict Enabler Scapegoat Hero Mascot/clown Lost child

Domestic violence Abuse Rigid or enmeshed boundaries Triangulation Codependency Parentification Enabling

Why Family Counseling? Intake process/Drug-taking history Change in system Psychoeducation Power shifts

Gender, Ethnicity, and Other Issues Women

Why does race and ethnicity matter?

Other issues Other issues Co-occurring physical and psychological disorders Process addictions (e.g., eating, shopping, technology, etc.) Employment Legal and ethical issues

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Questions/CommentsQ /