hbcu student leadership certification academy. participants will: understand the concepts of...

HBCU Student Leadership Certification Academy

INTRODUCTION TO PSYCHOPHARMACOLOGY

ED JOHNSON, MAC, LPCSOUTH CAROLINA PROGRAM MANAGER

SOUTHEAST ADDICTION TECHNOLOGY TRANSFER CENTER

LEARNING OBJECTIVES

Participants will: Understand the concepts of tolerance

and withdrawal. Be introduced to the various classes of

drugs of abuse. Become familiar with the criteria by

which addiction is defined as a chronic disease.

RESOURCES www.justice.gov/dea/pubs/abuse

www.drugabuse.gov/drugpages

[email protected]

http://www.justice.gov/dea/pubs/abuse

http://www.drugabuse.gov/drugpages

mailto:[email protected]

WHY WE DO WHAT WE DO

As human beings we do whatever we do for a reason. We do nothing “just because.” We do whatever we do for one of two reasons and two reasons only:

Increase pleasure Decrease pain

THE BRAIN Drugs enter the blood stream

The “Blood Brain Barrier”

Drugs act on certain parts of the brain

Memory

THE BRAIN: THE PLEASURE PATHWAY

THE BRAIN: WHAT HAPPENS WHERE

THE SUBSTANCE USE SPECTRUM Use – Ingestion of alcohol or other drugs

without the experience of any negative consequences.

Misuse – When a person experiences negative consequences from the use of alcohol or other drugs i.e. drinks too much and gets sick.

Abuse – Continued use of alcohol or other drugs in spite of negative consequences.

Dependence / Addiction – “Compulsive” use of alcohol or other drugs regardless of the consequences.

WHAT FLIPS THE “SWITCH”

Changes to brain chemistryGenetic PredispositionEnvironmental factors

TERMINOLOGY Alcohol Drugs Alcohol and Other Drugs Alcoholism Drug Addiction Chemical Dependency Substance Use Disorders

TERMINOLOGY:DEPENDENCE VERSUS ADDICTION Addiction may occur with or without the

presence of physical dependence. Physical dependence results from the body’s

adaptation to a drug or medication and is defined by the presence of – Tolerance and/or– Withdrawal

TERMINOLOGY: DEPENDENCE VERSUS ADDICTION

Tolerance: the loss of or reduction in the normal

response to a drug or other agent, following use or exposure over a prolonged period a higher dose is required to achieve the same effect.


Dependence: A state in which an organism functions

normally in the presence of a drug. It is manifested as a disturbance when the drug is removed (withdrawal).

Can be physiological, psychological or both


Withdrawal: a period during which somebody

addicted to a drug or other addictive substance stops taking it, causing the person to experience painful or uncomfortable symptoms

OR a person takes a similar substance in

order to avoid experiencing the effects described above.

CONTROLLED SUBSTANCES

Psychoactive chemicals that are found to have abuse liability are placed under restricted use by the Drug Enforcement Administration (DEA) and are called “Controlled Substances”. Those drugs with the highest abuse potential are the ones that produce euphoria and have a rapid onset. Since the DEA focuses on reduction of availability of drugs, those drugs with the highest abuse liability are policed the most aggressively.

CONTROLLED SUBSTANCESSchedule

Description Abuse Liability

Medical Uses Examples

I May lead to severe psychological or physical dependence

High potential for abuse

No medical use; can’t be dispensed by an MD.

PCP, GHB, Ecstasy, Marijuana, Peyote

II May lead to severe psychological or physical dependence

High potential for abuse

Some medical uses with severe restrictions; can be dispensed by Rx from an MD.

Dilaudid, Oxycontin, Seconol, Methadone

III May lead to high psychological or moderate to low physical dependence

Moderate potential for abuse

Accepted medical uses; can be dispensed by Rx from an MD.

Anabolic Steroids, Ketamine, Buprenorphine

IV May lead to limited psychological and/or physical dependence

Low potential for abuse


Xanax, Klonopin, Ambien,

V May lead to limited psychological and or physical dependence

Very low potential for abuse


Robitussin A-C, Lomotil

METHODS OF ADMINISTRATION Oral – drink or swallow Smoking Nasal – snorting, inhaling Topical – Rub on skin Injection – Intramuscularly (IM),

Intravenously (IV), Subcutaneous (SC)

CLASSES OF DRUGS

NARCOTICS (OPIATES/OPIOIDS)

DRUGS IN THE CLASSDRUGS BRAND OR COMMON

NAMESLANG TERMS

Opium Laudanum, Paregoric Opium

Morphine Morphine, Roxanol “M”, Miss Emma, Monkey

Codeine Codeine, Tylenol with Codeine, Robitussin A-C

School Boy

Heroin Diacetylmorphine Horse, Smack, Junk

Meperidine Dilaudid Little D, Lords

Hydromorphone Demerol Dolantol

Methadone Dolophine, Methadone, Methadose

Meth, Dolly

Other Narcotics Percodan, Fentanyl, Hydrocodone, Loritab, Darvon

MEDICAL USES Analgesic, pain relief Antitussive Antidiarrheal Methadone and Buprenorphine can be

used for drug addiction treatment

EFFECTS AND METHODS OF USE

Methods of Use• Oral, smoked, nasal, injected

Effects• Euphoria, Drowsiness, respiratory

suppression, constricted pupils, nausea, itching skin, constipation

DURATION OF EFFECTS AND WITHDRAWAL SYMPTOMS

3-6 hours for Opium, Heroin, Morphine, Codeine, Meperidine and Hydromorphone. 12-36 hours for Methadone and Buprenorphine Variable for the rest

Watery eyes, runny nose, loss of appetite, yawning, irritability, tremors, panic, chills and sweating, cramps, nausea, diarrhea

SPECIAL ITEMS OF INTEREST Require Medically Monitored

Detoxification Death by overdose is common Significant synergistic effect Medication Assisted Treatment is the

most effective.

NAME THAT DRUG

DEPRESSANTS


NAMESLANG TERM

GHB Liquid Ecstasy, GHB X, Georgia Home Boy, Grievous Bodily Harm

Barbiturates Phenobarbitol, Seconal, Amytal, Tuinal

Barbs, Yellows, Reds, Tooies, Phennies

Benzodiazepines Xanax, Valium, Klonopine, Ativan, Halcion,Rohypnol

Downers, Benzos, Sleeping Pills, Nerve pills, Roofies

Methaqualone Quaalude, Mecquin Ludes, Mandrex

Other Depressants Milltown, Placydil Muscle

DRUGS OF THE CLASS

And then there is Ethyl Alcohol:• Commonly know as Beer, Wine, Ale, Liquor, Distilled Spirits

• Or Booze / Brew

MEDICAL USES GHB - none Benzodiazepenes –Anti-anxiety,

sedative, anticonvulsant, muscle relaxant

Barbiturates – Originally anti-anxiety, anticonvulsant

Ethyl Alcohol – Mild Sedative, mild sleep inducement, solvent for other drugs

EFFECTS AND METHODS OF USEMethods of Use

• Mainly Oral though some can be injected

Effects• Slurred speech, disorientation, “drunken

behavior” without odor of alcohol, diminished coordination, increased reflex time

DURATION OF EFFECT AND WITHDRAWAL SYMPTOMS

Duration of effect • Can vary from 1 to 16 hours depending on

the drug and amount used.

Withdrawal Symptoms• Anxiety, insomnia, tremors, delirium,

convulsions

SPECIAL CONSIDERATIONS Medically monitored detoxification

required Major synergistic effect with

opiates/opioids Benzodiazepines are seriously

overprescribed Fetal Alcohol Syndrome Disorders

NAME THAT DRUG

CANNABIS

DRUGS OF THE CLASS

DRUG BRAND OR COMMON NAME

SLANG TERM

Marijuana Sinsemilla, Pot, Grass, Weed, Smoke, Dope, Blunt, Reefer

Tetrahydrocannabinol THC, Marinol

Hashish or Hashish Oil Hash or Hash Oil

K2 Spice

MEDICAL USES Appetite Stimulant, relieves ocular

pressure associated with glaucoma

EFFECTS AND METHODS OF USE Methods of Use

• Smoke, Oral Effects

• Euphoria, relaxed inhibitions, increased appetite

DURATION, WITHDRAWAL SYMPTOMS

Duration of Effect• 2-4 Hours

Withdrawal symptoms• Irritability, insomnia, loss of appetite

SPECIAL ITEMS OF INTEREST

K2 Spice• It is a synthetic cannabinoid, it provides

the same euphoric effect as marijuana.• Is marketed as “incense” on the internet

and in locations where it is not illegal.• Is not detectable on urine drug screens.

NAME THAT DRUG

STIMULANTS


NAMESLANG TERMS

Cocaine Coke, Crack Snow, Blow, Crack

Amphetamines / Methamphetamine

Adderall, Crystal Meth, Dexadrine

Crank, Speed, Ice

Methylphenidate Ritalin, Concerta

Caffeine Coffee, tea, chocolate, No-doz, Vivarin

Java, Joe

Nicotine Cigarettes, Smokeless tobacco

Chew, dip, cigs

MEDICAL USES Cocaine and it’s cousins can be a

topical anesthetic Amphetamines can be used for weight

loss, narcolepsy, ADHD Caffeine is a mild stimulant and can be

used to treat headaches Nicotine has no medical use but is a

good insect repellant

METHODS OF USE AND EFFECTS Methods of Use

• Oral, smoked, nasal, injected

Effects• Increased alertness, excitation, euphoria,

insomnia, loss of appetite, increased pulse and blood pressure


Duration of effect• Can vary from a few minutes to 4-6 hours

Withdrawal Symptoms• Apathy, long period of sleep, depression,

irritability, disorientation

NAME THAT DRUG

HALLUCINOGENS

DRUGS OF THE CLASSDRUGS BRAND OR COMMON

NAMESLANG TERMS

MDMA and Analogs MDMA, MDA, MDEA, MBDA

MDMA- Ecstasy; MDA – Love Drug; MDEA – Eve;

LSD Lysergic Acid Diethylamide

Acid, Blotter, Microdot

Phencyclidine and Analogs

Ketamine, PCP, Angel Dust, Special K

Mescaline and Peyote Mescal Cactus, Button, Mesc

Other Hallucinagens Dextromethorphan (DXM), Psilocybe mushrooms

Shrooms,

MEDICAL USES

With the exception of Ketamine which is an anesthetic, none.

EFFECTS AND METHODS OF USEMethods of Use

• Oral, smoked, snorted, PCP and Ketamine can be injected

Effects• Illusions, hallucinations, poor perception of

time and distance, sensory crossover, impaired hand eye coordination.


Duration of Effect• Depending on the substance anywhere

from one to twelve hours. Withdrawal Symptoms

• Muscle Aches, drowsiness. No “withdrawal symptoms” in classic sense.

NAME THAT DRUG

INHALANTS

DRUGS OF THE CLASSDRUGS BRAND OR COMMON

NAMESLANG TERMS

Volatile Solvents Gasoline, Airplane glue, Vegetable Spray, Hairspray, Deodorant, Spray Paint, Paint Thinner, Transmission Fluid, Air Freshener

Sniffing, Huffing

Nitrites Butyl Nitrite, Amyl Nitrite

Rush, Locker Room, Poppers

Nitrous Oxide Laughing Gas, Whippets

MEDICAL USES Amyl Nitrite can be used to treat

Angina. Nitrous Oxide is an anesthetic.

EFFECTS AND METHODS OF USE Methods of use

• Sniffing and inhaling

Effects• Slurred speech, euphoria, rapid heart beat,

stupor, headache


Duration of Effect• Fifteen minutes to two hours

Withdrawal Symptoms• Insomnia, Irritability, Cramps, Nausea,

Tremors, Depression, Headache, Confusion, Convulsions

SPECIAL ITEMS OF INTEREST

Inhalants cause severe damage to the lungs, liver, kidneys, bone marrow and the brain.

Additionally they can cause suffocation, stroke, loss of consciousness and possible death

DISEASE, MORAL FAILURE OR JUST POOR CHOICES?

Is Addiction a

WHAT DEFINES A “DISEASE” – MEDICALLY SPEAKING

A. When any cell tissue or any organ is affected in such a way that the tissue or organ cannot function as it is intended.

B. It is a primary condition.C. It has a predictable and progressive course.D. There is an established etiological agent or

cause.E. The disorder has a recognizable,

measurable set of signs and symptoms which permit an accurate diagnosis

ADDITIONAL “DISEASE” CHARACTERISTICS

Can be short or long acting• Acute versus Chronic

Potentially fatal• Or not

Treatable • Or not

Curable• Or not

CHRONIC OR ACUTE

Acute DiseaseRapid onsetShort courseMay be severe

Chronic DiseaseGradual onsetLifetime courseMay have “acute” episodes

IF ADDICTION IS A “DISEASE” THEN:

What is the “affected cell tissue or organ?”• The Brain, and it is expressed in the form of

“compulsive behavior.” Is it a “primary condition?”

• Yes, it is not the effect of any other disease. Is there a “predictable, progressive

course?”• Yes

Are there “recognizable, measureable signs and symptoms?”• Yes, outlined in the DSM IV

IF ADDICTION IS A “DISEASE” THEN:

Is it Chronic or Acute• “Gradual onset with acute episodes”

accurately describes it, chronic. Is it a “potentially fatal?”

• Yes. Is it “treatable?”

• Yes, with abstinence and lifestyle / behavioral modification changes

Is it “curable?”• At present No.

BRAIN DISORDERS

Brain disorders are characterized by uncontrollable involuntary behaviors.

Schizophrenia – Hallucinations Depression – Mood swings Parkinson’s Disease – Muscle Tremors

Addiction- Drug seeking, Antisocial behaviors

TREATMENT OF CHRONIC DISEASES

Since the causes are usually multi-factorial, treatments must usually be multi-modal.

Response rates are variable and depend on the patient, the treatment itself, and outside factors.

CHRONIC DISEASE COMPARISON

Diabetes• Genetic predisposition• Lifestyle choices are a

factor in development of the disease

• Severity is variable• There are diagnostic

criteria• Once diagnosed,

you’ve got it

Addiction• Genetic predisposition• Lifestyle choices are a

factor in development of the disease

• Severity is variable• There are diagnostic

criteria• Once diagnosed,

you’ve got it

DISEASE COMPARISON (CONT.)Diabetes• Primary treatment is

lifestyle modification• Small percentage of

patients comply with same

• Medications can help• Patients often don’t

comply with medical regimen

Addiction• Primary treatment is

lifestyle modification• Small percentage of

patients comply with same

• Medications can help• Patients often don’t

comply with medical regimen

DISEASE COMPARISON (CONT.)Diabetes• Patients who are

partially compliant are the rule, and outcomes are better than those who do not get treatment

• Support systems improve outcomes

Addiction• Patients who are

partially compliant are the rule, and outcomes are better than those who do not get treatment

• Support systems improve outcomes

DISEASE COMPARISON (CONT.)Diabetes• Since suboptimal

patient compliance is expected, medication use is titrated to maximize outcome

Addiction• Since suboptimal

patient compliance is expected…….wait till motivated? let them do more “research”? withhold medication till they try harder?

DISEASE COMPARISON (CONT.)Diabetes• Even in highly

motivated patients, only a small percentage will succeed without medication. “Abstinence” from medication is lowest priority

Addiction• Abstinence is still

often the underlying goal, without which treatment (and the patient) is judged a failure???

DISEASE COMPARISON: CONCLUSION

Chronic disease may be controllable, but not usually curable

Medications, if available, are useful to promote this “disease control”

Results will be suboptimal There is a “disconnect” between

treatment of addiction vs. other chronic diseases

DISEASE VERSUS MORAL FAILUREHow do we deal with “moral failures” or

“crimes?’Punishment, “consequences”, Incarceration.

How do we deal with “diseases?”Medical care, treatment, meeting the patient

“where they are at”, helping them to move toward a healthier life

IF ADDICTION IS A DISEASE, WHY ARE WE TREATING IT LIKE A MORAL FAILURE. IF ADDICTION IS A CHRONIC DISEASE WHY DO WE TREAT IT LIKE AN ACUTE DISEASE?

QUESTIONS?

[email protected]

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