Drug Free Work Place

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Drug Free Work Place

• Safdar I. Chaudhary, MD
• Medical Director
• S'eclairer

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Additional Information other teaching /
educational resources

• You can reach Safdar I. Chaudhary, MD at the
  following
• Office 341 Story Road, Export, PA 15632
• Tel [phone]
• Email safdar3_at_gmail.com
• Web www.seclairer.com
• Fax [phone]

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Urine Toxicology
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Why are you all here today ?

• Lets have an bluntly honest conversation

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Weighing the CostsAnnual Cost per Drug Addict
Regular Outpatient Intensive Outpatient Methadon
e Maintenance Short Term Residential Long Term
Residential Incarceration
Physician Leadership on National Drug Policy
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LSD, Inhalants, MJ, Mushroom
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Erythroxylon coca bush
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Coca-Cola used to contain cocaine

• Coca-Cola was named back in 1885 for its two
  "medicinal" ingredients extract of coca leaves
  and kola nuts. Just how much cocaine was
  originally in the formulation is hard to
  determine, but the drink undeniably contained
  some cocaine in its early days.
• Coca-Cola didn't become completely cocaine-free
  until 1929, but there was scarcely any of the
  drug left in the drink by then.

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Positron emission tomography (PET) scan of a
person on cocaine
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Heroine
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Something's get noticed
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Addiction in the U.S.
3-4 MM cocaine addicts
12-15 MM alcoholics
1 MM heroin addicts
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Types of drug classes and their effects

• Broad concepts.
• Why use any drugs ?

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Or pain as

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Pain and emotions
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Warning signs of drug addiction
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It is about changing attitudes and saving lives

• Increasingly children are using drugs at an early
  age.
• Those who smoke cigarettes are more likely to
  drink alcohol.
• Those who smoke and drink are more likely to use
  marijuana
• Those who use all three are more likely to use
  other illicit drugs.

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Good information helps

• We all need to learn from credible sources, the
  dangers and effects of street drugs.
• We need to learn the effects of drugs
• As an example effects of Cocaine can be from
  being hyper to being depressed during crash.

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Making informed decisions

• With good knowledge, responsible behaviors are
  expected.

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Signs your that a colleague may be using drugs

• Change in friends
• Change in sleeping pattern
• Declining performance at work
• Loss of interest in hobbies or favorite
  activities
• Lack of motivation
• Heighten secrecy about actions or possessions

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Signs your peer could be using drugs Cont

• Hostile and uncooperative attitude
• Unexplained disappearance of office items or
  money and other valuables.

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Be alert

• Watch for poor personal appearance
• Isolation, depression and fatigue
• Increase in borrowing money
• Unaccounted for cash especially in small
  denominations

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Physical Changes

• Persistent runny nose
• Red eyes
• Coughing
• Wheezing
• Bruises
• Needle marks

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Evidence of drugs

• Drugs or drug paraphernalia ( e.g. rolling
  papers, eye drops, butane lighters, pipes)
• Use of incense or room deodorant
• Evidence of inhaling products ( such as
  hairspray, nail polish and white out) and
  chemicals used to get high

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Smells to be aware of

• Smell of alcohol on the breath or sudden frequent
  use of breath mints
• Sudden use of strong perfume and cologne
• Alcohol in coke bottles

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Other Psychiatric Conditions

• Although illicit drugs and alcohol can cause
  these behaviors, beware of other psychiatric
  disorders as well.

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Psychiatric Disorder Manifestations

• Major Depression can cause withdrawal, agitation,
  amotivation and declining grades
• Bipolar Disorder can lead to impulsive behaviors,
  grandiose thinking and poor concentration
• Attention Deficit Hyperactivity disorder, Conduct
  disorder

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Medical Disorders

• Anemia
• Thyroid Dysfunction
• Diabetes
• Other Hormonal disorders
• Prescribed medications
• Infections

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Drug use is a choice

• It is a choice you can influence
• Peers need to talk with- not at- about the
  dangers of drugs and alcohol.
• Suggest seeking help.
• Supervisors can monitor time and work related
  activities

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Working with colleagues

• Learn about the dangers of drinking, drugs and
  other harmful substances are less likely to use
  those substances.
• Finding the right words and the right approach is
  important.

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What Are Narcotics?

• For the most part, the opioid narcotics possess
  abuse potential, but they also have important
  clinical value (analgesic, antitussive).
• The term narcotic has been used to label many
  substances, from opium to marijuana to cocaine.

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What Are Narcotics?

• The term narcotic currently refers to naturally
  occurring substances derived from the opium poppy
  and their synthetic substitutes.
• These drugs are referred to as the opioid (or
  opiate) narcotics because of their association
  with opium.

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The History of Narcotics

• A 6000-year-old Sumerian tablet
• The Egyptians
• The Greeks
• Arab traders
• China and opium trade
• The Opium War of 1839
• American opium use

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The History of Narcotics
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History Of Alcohol
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Alcohol
Structure of Ethanol
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The Path of Alcohol in the Body
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In low doses,alcohol produces

• a relaxing effect
• reduces tension
• lowers inhibitions
• impairs concentration
• slows reflexes
• impairs reaction time
• reduces coordination

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In high doses, alcohol produces

• vomiting
• breathing difficulties
• unconsciousness
• coma

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Preclinical evidence suggests a neurochemical
Mechanism may contribute to alcohol dependence
Dopamine Increased release Serotonin Decreased
release GABA Increased sensitivity to
GABA Opioid Increased endogenous opioid activity
(endorphin release) and stimulation of opioid
receptors
Chronic Alcohol Consumption
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Alcohols Effect on the Brain
From US News and World Report March 7, 2001
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Chronic alcohol use can
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This shows an alcohol-dep 20-year old female's
response to the spatial working memory task.
Brain activation bright colors.
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Impact on Glucose Metabolism
Normal Brain
Heroin 25 Years
Alcoholic 17 Years
Abstinent 1 Year
By permission from Dr. Daniel G. Amen, M.D.
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The Target Organ
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Alcoholism-neurochemical profile

• Alcohol-preferring vs. Nonpreferring Rate Profile
• Fewer serotonin neurons in the hypothalamus
• Higher levels of enkephalin n the hypothalamus
• Higher levels of GABA neurons in the NA
• Reduced dopamine supply in the NA
• Reduced densities of dopamine D2 receptors in the
  mesolimbic areas
• Implications
• Four-part cascade sequence
• D2 receptor agonists vs. antagonists

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Effects of Alcohol on the Nervous System

• Damage the frontal lobes of the brain
• Cause an overall reduction in brain size and
  increase in the size of the ventricles.
• Addiction to alcohol
• Cause a vitamin deficiency. Because the digestion
  system of alcoholics is unable to absorb vitamin
  B-1 (thiamine), a syndrome known as "Wernicke's
  Encephalopathy" may develop. This syndrome is
  characterized by impaired memory, confusion and
  lack of coordination. Further deficiencies of
  thiamine can lead to "Korsakoff's Syndrome".

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Lifestyle Changes

• Abstinence from all psychoactive substances.
• Attend AA, get a sponsor work the steps
• Avoid people places connected with using
• Improve health through
• Exercise
• Healthy diet

- Clinicians Guide to Substance Abuse/Smith
Seymour Hazelden/McGraw Hill
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The Disease of Alcohol Dependence Contributing
Factors
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Fetal Alcohol Syndrome (FAS).
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Psychosocial Intervention

• Intervention before hitting bottom can decrease
  medical complications
• Should involve intervention specialist, family,
  employer/coworkers
• Can be undertaken by family doctor or other
  primary health care provider.

- Clinicians Guide to Substance Abuse/Smith
Seymour Hazelden/McGraw Hill
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Sobering Thoughts

• Alcohol consumption by college students is linked
  to at least 1,400 student deaths and 500,000
  unintentional injuries each year

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The Time Course of Alcohol Dependence
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Lifestyle Changes

• Abstinence from all psychoactive substances.
• Attend AA, get a sponsor work the steps
• Avoid people places connected with using
• Improve health through
• Exercise
• Healthy diet

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Treatment Assessment
Plea to offense Go to Jail
Enter Drug Court
Eligibility Screening
Ongoing Program Participation
Arrest
Re-Entry Drug Court
Non-Compliance with Drug Court Program Go to
Jail
Prison-Based Treatment Program
Jail-Based Treatment Program
Closing the circle
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Treatment works

• Slowly and Gradually

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Engagement in Care

• Personality disorders are common in substance
  abusers
• Treat with firmness but dignity
• Limit Setting
• Clear expectations
• Relapses are common

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Therapeutic Touch
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Pharmacotherapy

• Major Depression SSRIs, TCIs
• Mood Stabilizers for Bipolar Disorder
• Antipsychotics for Psychotic symptoms
• Do not use addictive medications

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Motivational Enhancement Therapy

• Is a directive, empathic patient centered
  counseling style that addresses the patients
  ambivalence and denial.

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Dialectical Behavioral Therapy

• It is a comprehensive, behaviorally oriented
  treatment designed for highly dysfunctional
  patients meeting criteria for borderline
  personality disorder
• DBT has been been shown to be more effective than
  other treatments in treating drug abuse in women
  with BPD.

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Network Therapy

• The network therapy approach develops a support
  group that is tailored to the patient involving
  family and friends who are not addicted
  themselves.
• Network therapy uses a CBT approach regarding
  triggers it uses community reinforcement and
  support of the patients social network.

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Cognitive Behavioral Therapy

• The assumption of CBT is that abuse and
  dependence on substances are learned behavior and
  can be changed
• Patient works to to identify and modify
  maladaptive thought patterns that lead to
  feelings that lead to use.

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Psychotherapy

• Dialectical behavioral therapy ( DBT)
• CBT
• Motivational interviewing
• Pschodynamically oriented for those who have
  problem with identity, separation and
  individuation, affect regulation, self governance
  and self care.

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Practical tips for you

• Teaching the teachers
• Adoption of any program, scientifically based and
  nationally recognized
• Updated regularly
• Locally delivered and validated
• Booster shots

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Innovate ideas

• Internship for teachers, students and parents in
  addictive disorder treatment , clinics.
• Focus groups and field trips of parents, teachers
  to various sites
• Youth peership/ leadership groups
• Understanding the pulse of your community.
• Working at locations of natural hangouts

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Why was this legislation passed?

• Methadone maintenance has been shown to be highly
  effective in reducing heroin use and the
  incidence of co-morbidities such as HIV
• Access to methadone is limited by regulation and
  stigma

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Buprenorphine Hydrochloride
Buprenex
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Treatment Implications

• Depression due to variety of causes
• Due to drug use
• Underlying disorders, like Bipolar, Unipolar
  depression, Dysthymia
• Psychosocial Circumstances I.e Poverty,
  Incarcerations, drug related charges, loss of
  job, family support and status.

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Treatment for Depression for Addicts

• Related to the cause
• Pharmacotherapy management
• Psychotherapy
• Support groups
• Individual
• Monitoring for drug use

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Psychotherapy

• Dialectical behavioral therapy ( DBT)
• CBT
• Motivational interviewing
• Pschodynamically oriented for those who have
  problem with identity, separation and
  individuation, affect regulation, self governance
  and self care.

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Additional Information other teaching /
educational resources

• You can reach Safdar I. Chaudhary, MD at the
  following
• Office 341 Story Road, Export, PA 15632
• Tel [phone]
• Email safdar3_at_gmail.com
• Web www.seclairer.com
• Fax [phone]