Monash University2009 Alcohol and Other Drugs

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Monash University-2009Alcohol and Other Drugs

• Presenter Effie Moraitis
• Senior Clinician

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Topics covered today

• What is a drug? some definitions
• Theoretical models of drug use
• Harm minimisation
• Dependence Syndrome
• Classification of drugs and their effects
• AOD assessment some important points
• Stages of Change model
• Effects of Alcohol and Marijuana use. Especially
  Neurological impact.
• Withdrawal Symptoms
• Treatment Options

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Making sense of AOD issues

• What is a drug? Who uses drugs?
• Theoretical models of drug use
• Harm minimisation
• Dependency, tolerance and withdrawal
• Patterns of drug use

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What is a drug? Definitions

• World Health Organisation
• Any substance which when taken into the body,
  alters its function physically and/or
  psychologically, excluding food, water and
  oxygen (cited in McCallum 1994 p 90 WHO 1994)
• Any substance the people consider to be a drug,
  with the understanding that this will change from
  culture to culture and from time to time
  (Krivanek 1995 p 2)

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Who Uses Drugs?

• Drug use occurs across cultures, suburbs, genders
  and class systems.
• Common thought is that people in lower
  socioeconomic communities use more drugs than
  those from affluent communities.
• True or False?

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Theoretical Models of drug use

• Moral Model
• Key assumption
• using drugs is morally wrong and anti-social
• Intervention
• spiritual direction, gaol, providing an
  environment that promotes pro-social values

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Theoretical Models of drug use

• Disease Model (Medical Model)
• Key assumptions
• Some people have a natural predisposition to
  drug use
• Dependency is controlled by physiological /
  genetic factors
• Dependency will inevitably result in a loss of
  control and progression of their condition

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Theoretical Models of drug use

• Disease Model cont
• Interventions
• - Total abstinence
• - Self-help (eg 12 step programs)
• - Supporters of this model suggest that a person
  addicted to a drug / s will be unable to control
  their substance use.

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Theoretical Models of drug use

• Social learning model
• Key assumptions
• Focuses on the interaction between the
  environment, the individual and the drug. Drug
  use is learnt
• Intervention
• Learning new coping strategies
• May use cognitive restructuring techniques

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Theoretical Models of drug use

• Public Health Model
• Key assumptions
• Looks at the availability of the drug, cost, the
  properties of the substance, individual factors
  and socio-political factors (advertising,
  economic gains from drug use, peer pressure)
• Interventions
• Education, political actions, legislation

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Harm minimisation approach

• Has underpinned Australias drug strategy since
  1985
• Harm minimisation accepts that the use of drugs
  is a part of life and that on many occasions,
  drug use is non-problematic. It also recognises
  that drug use can cause harm amount the people
  that use and the wider community. Harm
  minimisation seeks to reduce drug related harm

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National Drug Strategic Framework

• The National Drug Strategy focuses on three core
  elements of harm reduction
• - demand reduction (prevention)
• - supply reduction (law enforcement)
• - harm reduction (education, information

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Dependence, Tolerance and Withdrawal

• Dependence
• Maladaptive pattern of substance use, leading to
  clinically significant impairment or distress.
• The substance is often taken in larger amounts or
  over a longer period than intended
• There is a persistent desire or unsuccessful
  efforts to cut down or control substance use.

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Dependence, Tolerance and Withdrawal

• Tolerance
• The need for increased amounts of the substance
  to achieve intoxication or the desired effect.
• This may vary
• - across individuals
• - across substances
• - across physiological systems

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Dependence, Tolerance and Withdrawal

• Withdrawal
• Maladaptive behavioural change (which may be the
  opposite to the acute effect of the substance
• Withdrawal syndromes may change according to the
  substance
• The same or closely related substances may be
  taken to relieve or avoid withdrawal symptoms

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Patterns of consumption and types of drug use

• Controlled use
• Experimental use
• Social / recreational use
• Circumstantial use / situational
• Intensive use
• Dependency

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Drug Classifications

• Drugs are often classified in two ways
• Legal status
• Central nervous system effects
• Classifications
• Depressants
• Stimulants
• Hallucinogens

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An AOD assessment

• What are some important points to cover in an AOD
  assessment?

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Assessment some points

• Psychosocial history
• Substance use history type of substances used,
  frequency, quantity, when and how they use,
  circumstances
• Medical history and current medications
• Psychiatric history
• Four Ls Liver, Lover, Livelihood, Legal

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Stages of Change Model

• DiClementi Prochaska (1986)
• Illustrates that change is a process, and change
  is a process that can take time
• Is a useful tool in identifying where people are
  at in their change process
• People can go forwards or backwards in this model.

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Six stage model

• Pre-contemplative stage
• Person does not see they have a problem
• Contemplative stage
• Person is weighing up cost / benefits to change
• Preparation stage
• Person is preparing to change
• Action stage
• Person is actively pursuing change
• Maintenance stage
• Person is maintaining the change
• Relapse stage
• Person returns to previous levels of drug use

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Alcohol What is it?

• Alcohol is ethyl alcohol or ethanol. It is a
  natural product of fermenting sugars. Its
  usually made from grains such as hops, barley,
  rice and/or fruits. It can also be made from
  other plants.
• The concentration of alcohol varies widely
  according to the type of alcoholic drink. Hence
  different standard drink variations.
• ROA Oral/Swallowed

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Side Effects

• Feelings of relaxation, lowered inhibition,
  increased sociability.
• In higher doses alcohol can cause dizziness,
  nausea, slurred speech, slower reflexes,
  sleepiness, dehydration and bad judgement.
• In even higher doses it can cause blackouts,
  organ failure, liver damage, coma and in extreme
  cases death.

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Neurological Side Effects

• When Alcohol hits your lips your whole body is
  affected.
• Within the lining of your mouth a small
  percentage of alcohol is absorbed. It irritates
  the mouth lining as well as the oesophagus,
  acting like an anaesthetic.
• From there

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Neurological side effects cont.

• Alcohol travels to your stomach
• This is where its absorbed into the bloodstream.
• Then it continues to the small intestine and from
  here it it is completely absorbed into the
  bloodstream. Alcohol can reach the small
  intestine within 5 minutes.
• At this point the alcohol can reach every cell in
  the body

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Effects of alcohol on the body

• Alcohol shares many properties with water. It is
  highly soluble in water and travels through the
  body as water does.
• In its circulation through the body, the alcohol
  reaches the brain.
• The feelings of intoxication now begin. They are
  dependant on concentration of alcohol in the body
  and how fast it reaches the small intestine, the
  strength, whether there has been food
  consumption, age gender, body size..

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Effects cont

• The liver metabolises 90 of the alcohol in your
  body. The rest is eliminated by perspiration, or
  via kidneys and lungs.
• The remaining alcohol continues its circulation
  throughout the body.
• Where to from here?

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Effects cont

• Alcohols effect on the brain is abnormal, as the
  brain is usually protected from chemicals and
  drugs by the blood/brain barrier which acts as
  a filter.
• The simple molecular structure of alcohol allows
  the penetration into the brain. This occurs in
  the frontal lobe.

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Effects cont

• At this point there is a loss of reason, caution
  and inhibitions.
• At the Parietal Lobe there is a loss of fine
  motor skill, slower reaction, reflex time and
  shaking.
• In the Temporal lobe occurs the slurred speech as
  well as impaired hearing.
• At the Occipital Lobe blurred vision and
  judgement, and loss of vital functions

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Chronic Alcohol Consumption

• When people consume large quantities of alcohol,
  they develop a Thiamine Deficiency(Vitamin B1).
• This causes the neurological disorder called
  Wernicke-Korsakoff Syndrome. Wernickes
  encephalopathy and Korsakoffs psychosis are the
  acute and chronic phases of this condition
  especially affecting short term memory.
• An absence of Thiamine results in an inadequate
  supply of energy to the brain.

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Chronic Consumption cont

• In chronic heavy alcohol consumers, the
  frontal lobes of the brain shrink. This is
  probably partly due to loss of water and partly
  due to cell death.
• The lobes may expand again if the person stops
  drinking, but evidence of cell death remains in
  impaired function.

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Did You Know?

• When people become intoxicated it is common to
  feel warmth, however this is misleading. Alcohol
  acts as a vasodilator, dilating surface blood
  cells. This actually expands blood vessels
  causing people to lose body heat.

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Withdrawal Symptoms of Alcohol

• Sweating, facial flushing
• Tremors
• Agitation
• Palpitations, hypertension
• Poor appetite, nausea, vomiting, diarrhoea
• Poor sleep, anxiety
• Cravings, strong desire to drink
• Poor concentration
• Headaches

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More Serious Symptoms

• Severe hypertension
• Seizures
• Hallucinations, delirium
• Arrhythmias
• Precipitation/ exacerbation of underlying medical
  or psychiatric disorders
• Mood swings
•  

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Illnesses caused by alcohol

• Sleep and sexual disorders
• Psoriasis of the liver
• Psychotic and mood disorders
• Foetal Alcohol Syndrome
• Depression
• Heart failure
• Wernicke-Korsakoff Syndrome

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Marijuana What Is It?

• Marijuana also known as Cannabis, is a green,
  brown, or grey mixture of dried, shredded leaves,
  stems, seeds, and flowers of the hemp plant. You
  may hear marijuana called by street names such as
  pot, herb, weed, grass, boom, Mary Jane,
  gangster, or chronic. There are more than 200
  slang terms for marijuana.Sinsemilla
  (sin-seh-me-yah a Spanish word), hashish ("hash"
  for short), and hash oil are stronger forms of
  marijuana.

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The Classification

• All forms of marijuana are mind-altering. In
  other words, they change how the brain works.
  They all contain THC (delta-9-tetrahydrocannabinol
  ), the main active chemical in marijuana. They
  also contain more than 400 other chemicals.
  Marijuana's effects on the user depend on the
  strength or potency of the THC it contains (5).
  THC potency of marijuana has increased since the
  1970s but has been about the same since the
  mid-1980s.

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Effects of Marijuana

• Impaired perception
• Diminished short-term memory
• Loss of concentration and coordination
• Impaired judgement
• Increased risk of accidents
• Loss of motivation
• Diminished inhibitions/Increased heart rate
•  

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Effects of Marijuana cont

• Anxiety, panic attacks, and paranoia
• Hallucinations/Delusions
• Damage to the respiratory, reproductive, and
  immune systems
• Increased risk of cancer
• Psychological dependency

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Neurological Effects of Marijuana

• When someone smokes Marijuana, THC rapidly passes
  through the bloodstream.
• This carries the chemical to organs throughout
  the body, including the brain

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Neurological effects cont..

• Cannabinoids is an active ingredient of
  Marijuana. The most psychoactive cannabinoids
  chemical in Marijuana that has the biggest impact
  on the brain is tetrahydrocannibol, or THC. THC
  is the main active ingredient in marijuana
  because it affects the brain by binding to and
  activating specific receptors, known as
  cannabinoid receptors. "These receptors control
  memory, thought, concentration, time and depth,
  and coordinated movement. THC also affects the
  production, release or re-uptake (a regulating
  mechanism) of various neurotransmitters

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Neurological Effects of Marijuana cont..

• Neurotransmitters are chemical messenger
  molecules that carry signals between neurons.
  Some of these affects are personality
  disturbances, depression and chronic anxiety.
  Psychiatrists who treat schizophrenic patients
  advise them to not use this drug because
  marijuana can trigger severe mental disturbances
  and cause a relapse.

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Memory Loss

• When one's memory is affected by high doses of
  marijuana, short-term memory is the first to be
  triggered. Marijuana's damage to short-term
  memory occurs because THC alters the way in which
  information is processed by the hippocampus, a
  brain area responsible for memory formation. One
  region of the brain that contains a lot of THC
  receptors is the hippocampus, which processes
  memory.

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Emotional Impairment

• Marijuana also impairs emotions. When smoking
  marijuana, the user may have uncontrollable
  laughter one minute and paranoia the next. This
  instant change in emotions has to do with the way
  that THC affects the brain's limbic system. The
  limbic system is another region of the brain that
  governs one's behaviour and emotions.

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Cognitive Impairment

• The chemicals in Marijuana bring cognitive
  impairment and troubles with learning for the
  user. Smoking marijuana causes some changes in
  the brain that are like those caused but cocaine,
  heroin, and alcohol.

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Withdrawal Symptoms of Marijuana

• Anxiety, agitation, restlessness, irritability
• Nausea
• Dysphoria, lethargy
• Cravings, strong desire to use
• Sleep disturbances (including vivid dreams,
  nightmares, insomnia)
• Sweating
• Headaches
• Mood disturbances
•  

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Illnesses caused by marijuana

• Cannabis is linked with Mental Health
  Disorders.
• If there is a predisposition in a persons
  family history of a mental health disorder,
  Marijuana can trigger it to occur.
• Short Term Memory loss
• Research has begun on potential Learning
  difficulties experienced by children whose
  mothers used Marijuana during pregnancy and
  breastfeeding.

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Treatment Options

• Treatment for any drug is more effective when
  tailored to the specific individual requirements.
• It can involve a combination of methods
  including
• Medication and GP/Psychiatric Involvement
• Individual Counselling
• Group Therapy
• Home Based Withdrawal
• Residential Withdrawal
• Long Term Rehabilitation
• And more

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Treatment Options cont

• In Victoria there are over 1,000 Alcohol and
  Other Drug Treatment Services.
• Inclusive in these are 24/7, free and
  immediate Counselling, Information and referral
  services specifically for anyone who has any
  Alcohol and Other Drug related concerns. These
  services are anonymous and confidential (within
  confidentiality limitations).

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24/7 Services

• DirectLine 1800 888 236 for consumers and
  significant others who are experiencing Alcohol
  and Other Drugs related concerns.
• DACAS 1800 812 804 Drug and Alcohol Clinical
  Advisory Service for Health Professionals.
• This service has 24/7 Addiction Specialist
  Medical Consultants.

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24/7 Services cont

• CounsellingOnline www.counsellingonline.org.au A
  web-Based Counselling, Information, Referral and
  Support service 24/7 for consumers and
  significant others specifically related to
  Alcohol and Other Drug concerns. This is a
  National Service.
• All services are staffed by Professional
  Counsellors