Transcript Substance Abuse Issues - Ingham County, Michigan

Substance Abuse Issues
A training for Human Service
Providers
{Enter Date Here}
Ground Rules for the Day
• Start and Stop on Time
• Maintain Confidentiality
• Participate fully and encourage participation of
others
• Respect others’ viewpoints, opinions and needs
• OK to voice concerns and questions
• Make comments in a constructive manner
• Silence cell phones
Welcome
• Substance use impacts many families
• Consider mental health, trauma, basic
needs
• Safety among home-visitors
• Safety among families
• Actions that can and should be taken
• Building relationships
• Identifying help and helping
Presentation Goals
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Review local data on substance use prevalence
Introduce issues related to substance use
Reduce stigma associated with substance use
Identify signs and symptoms of substance use
Screen and referral/intervention tools
Increase participant ability to match client needs
with eligible services
• Identify Substance Use Disorder Treatment
Services in our community
Substance use in
{Greater Lansing}
• Data from Tri-County Metro
• Data from ISAP Coalition
• Alcohol is the most commonly used and
abused drugs
• Getting more common: marihuana
(medical), heroin
• Equally bad in all of our community
Alcohol is the Most Common
Drug of Abuse
Binge Drinking Defined
Women: more than 3 drinks on any single
day AND more than 7 drinks per week.
Men: more than 4 drinks on any single day
AND more than 14 drinks per week
Percentage of Adults Who
Report Binge Drinking in the
Past 30 Days
Students Who Report Binge
Drinking in the Past Two
Weeks
Percentage of Students Who
Have Had At Least One Drink of
Alcohol
Students Who Report Ever
Smoking Cigarettes
Marijuana use continues to
rise among U.S. teens, while
alcohol use hit historic lows
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Marijuana use among teens rose in 2011 for the fourth straight year—a
sharp contrast to the considerable decline that had occurred in the
preceding decade. Daily marijuana use is now at a 30-year peak level
among high school seniors.
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“Synthetic marijuana,” which until earlier this year was legally sold and
goes by such names as “K2” and “spice,” was added to the study’s
coverage in 2011; one in every nine high school seniors (11.4%)
reported using that drug in the prior 12 months.
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Alcohol use—and, importantly, Binge drinking—continued a long-term
gradual decline among teens, reaching historically low levels in 2011.
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Energy drinks are being consumed by about one third of teens, with use
highest among younger teens.
Regional Illicit Drug Forfeitures
2011 Narcotic Seizure Value: $4,046,431
Tri-County Metro Narcotics (MSP)
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Heroin & Pills (opiates)
Marihuana (Marijuana)
Methamphetamine
Alcohol
Tobacco
Prescription Drug Abuse
Taking medicine that was not prescribed to
you, or us being take for non-medical use
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60% from a friend or relative
8% purchased from a friend or relative
4% taken from a friend or relative
17% physician prescribed
Addiction
• The use of substances as a means to
cope with difficult experiences is common
• Use of substances can lead to addiction,
in which the need for the alcohol or drugs
is physical & becomes the most important
thing in someone’s life
• People who are using have a harder time
keeping themselves and their families safe
How is having an Addiction
like having Cancer?
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Biologically pre-disposed
Most likely addicted before adulthood
Family history and normalization of use
Trying to find a “normal” brain function
(self-medication)
• Some brain responds stronger to drug use
• Power/Control Dynamics
• Victims are by-products of wealthy
suppliers
Drug Use – Why?
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Mental Health Diagnosis (50% use drugs)
Trauma (Seeking Safety)
Family inter-generational use
Genetic and Biological Factors
Escape from the pain of reality
Medical or Disease Model is Most
Effective
• Use / Abuse /Dependence
Substance using behaviors
• Sexual assault
– Childhood or current
• Physical assault
• Domestic violence
Addiction Pathology
Child of
a substance
abuser
Child of an
alcoholic
becomes an
alcoholic
Substance
abuses
-Phases
Recovery
Relapse
Addiction in the Brain
Addiction in the Brain
• Neurotransmitters are chemicals in the brain that relay, intensify
and alter signals between neurons and other cells. When
someone takes an addictive drug, whether it be alcohol, cocaine,
nicotine, heroin, or Valium, just to name a few, the brain gets
flooded with a neurotransmitter called dopamine.
• This neurotransmitter is related to feelings of pleasure and
excitement, and is associated with the reward center of the brain.
In a normal brain, dopamine is released when the person
experiences pleasure.
• However, chronic use of addictive substances means that the
brain begins producing less dopamine on its own since it’s so
used to getting flooded with dopamine as a result of the
addiction. This leads to the abuser being unable to experience
pleasure from his normal life, thus creating a dependency on the
drug to feel pleasure.
Human Needs: Brain Tricks
The Illness Brings with it
Frustrating Behavior
• Deceptive, lying, secretive
• Passive-Aggressive Characteristics, failure to followthrough with responsibilities
• Failure of priorities, chronic tardiness, money problems,
lack of judgment, anxiety, depression
• Disregard for themselves or values of those they love,
poor boundaries
• Legal implications
Blanket Activity
Strengths/Assets
Social Justice
Balance/Independenc
e
Intimacy: closest
Friendship: community
Participation:
clubs/groups
Exchange: paid help
Prescription Drug Abuse Chart http://www.drugabuse.gov/consequences/
* Schedule I and II drugs have a high potential for abuse. They require greater storage security and have a quota on manufacturing, among other restrictions. Schedule I drugs are available for
research only and have no approved medical use; Schedule II drugs are available only by prescription (unrefillable) and require a form for ordering. Schedule III and IV drugs are available by
prescription, may have five refills in 6 months, and may be ordered orally. Most Schedule V drugs are available over the counter.
** Taking drugs by injection can increase the risk of infection through needle contamination with staphylococci, HIV, hepatitis, and other organisms.
*** Associated with sexual assaults.
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Not available by prescription in U.S.
Substances:
Category and Name
Examples of Commercial
and Street Names
DEA Schedule*/
How Administered**
Depressants
Barbiturates
Amytal, Nembutal, Seconal,
II, III, V/injected,
Phenobarbital; barbs, reds, red birds,
swallowed
phennies, tooies, yellows, yellow jackets
Benzodiazepines
(other than
flunitrazepam)
Ativan, Halcion, Librium, Valium,
Xanax; candy, downers, sleeping pills,
tranks
IV/swallowed
Flunitrazepam***+
Rohypnol; forget-me pill, Mexican
Valium, R2, Roche, roofies, roofinol,
rope, rophies
IV/swallowed, snorted
GHB***
Gamma-Hydroxybutyrate: G, Georgia
home boy, grievous bodily harm, liquid
ecstasy
I/swallowed
Methaqualone
Quaalude, Sopor, Parest: ludes,
mandrex, quad, quay
I/injected, swallowed
Dissociative Anesthetics
Ketamine
Ketalar SV; cat Valium, K, Special K,
vitamin K
III/injected, snorted,
smoked
PCP and analogs
Phencyclidine; angel dust, boat, hog,
love boat, peace pill
I, II/injected, swallowed,
smoked
Cannabinoids
Hashish
boom, chronic, gangster, hash, hash oil,
hemp
I/swallowed, smoked
Marijuana
blunt, dope, ganja, grass, herb, joints,
Mary Jane, pot, reefer, sinsemilla,
skunk, weed
I/swallowed, smoked
Hallucinogens
Intoxication Effects/Potential Health Consequences
reduced pain and anxiety; feeling of well-being; lowered inhibitions; slowed pulse and breathing; lowered
blood pressure; poor concentration/confusion, fatigue; impaired coordination, memory, judgment;
respiratory depression and arrest, addiction
Also, for barbiturates—sedation, drowsiness/depression, unusual excitement, fever, irritability, poor
judgment, slurred speech, dizziness
for benzodiazepines—sedation, drowsiness/dizziness
for flunitrazepam—visual and gastrointestinal disturbances, urinary retention,/memory loss for the time
under the drug's effects
for GHB—drowsiness, nausea/vomiting, headache, loss of consciousness, loss of reflexes, seizures,
coma, death
for methaqualone—euphoria/depression, poor reflexes, slurred speech, coma
increased heart rate and blood pressure, impaired motor function/memory loss; numbness;
nausea/vomiting
Also, for ketamine—at high doses, delirium, depression, respiratory depression and arrest
euphoria, slowed thinking and reaction time, confusion, impaired balance and coordination/cough,
frequent respiratory infections; impaired memory and learning; increased heart rate, anxiety; panic
attacks; tolerance, addiction
altered states of perception and feeling; nausea; persisting perception disorder (flashbacks)
LSD
Lysergic Acid Diethylamide: acid,
blotter, boomers, cubes, microdot,
yellow sunshines
I/swallowed, absorbed
through mouth tissues
Mescaline
buttons, cactus, mesc, peyote
I/swallowed, smoked
Psilocybin
magic mushroom, purple passion,
shrooms
I/swallowed
Also for LSD and mescaline—increased body temperature, heart rate, blood pressure; loss of appetite,
sleeplessness, numbness, weakness, tremors
Also, for LSD—persistent mental disorders
for psilocybin—nervousness, paranoia
Marihuana:
most common illegal drug
• Signs & Symptoms
Animated behavior, sleepy,
dilated pupils, bloodshot
eyes, loss of coordination,
odor, paranoia, fragmented
thought.
• Usage
Smoked in joints, pipes,
bongs, or blunts. Can be
mixed in food or brewed in
tea. Change lasts 3-5
hours or until the next day.
• Slang
Mary Jane, pot, reefer, skunk,
weed, yerba, bluns, dope,
ganja, grass, herb, hydro,
kif, bud, boom, and 420.
Marihuana:
Michigan Medical Marihuana
• Federal Law trumps State Law
• Caregiver and Patient Cards Issued by State
of Michigan, Licensing And Regulatory Affairs
• Caregivers may grow up to 72 plants in an
enclosed, locked facility
• Patient limit is 12 plants per Patient
• Safety in homes is primary concern
• Marihuana is active in the body for 7 hours
• Impaired Driving is increasing
Marihuana
K2/Spice:
alternative to marihuana
• Signs & Symptoms
Rapid heart rate, high blood
pressure, hallucinations,
delusions, paranoia,
changes in perceptions and
behavior, seizure and
death.
• Usage
Leafy herbs with psychoactive
chemicals sprayed on and
then smoked. Chemical
changes make some forms
illegal, some legal.
• Slang
Incense, potpourri, Spice, K2,
K3, fake pot, Chemical
Compound is JWH-018 and
Methamphetamine:
One Pot Meth Labs urban/rural
• Signs & Symptoms
Dilated pupils, euphoria, rapid
speech, depression, violent, nasal
congestion, insomnia, weight loss,
dry mouth, lack of interest in food
and sleep. Skin abscess,
paranoia, volatile mood,
movement disorders, lead
poisoning, and meth-mouth.
• Usage
Smoked, snorted, taken orally or
injected. Ingestion produces
euphoria for 12 or more hours.
The One-Pot Meth Lab has
increased use, and brought meth
into cities. Pacifiers and glow
lights supplement use at Raves.
• Slang
Speed, chalk, crank, ice, glass, meth,
shards, speed, stove top, tweak,
yaba, yellow bam, glass, crystal,
go-fast, ecstasy, rollin’, E, X.
Methamphetamine:
Manufacturing Products
• Signs & Symptoms
Chemical smell in home and on
person. Multiple chemicals together in kitchen or garage used
for cooking meth.
• Combination of several
household products may
indicate Cooking Meth
Batteries, camp fuel/gasoline, lye,
drain cleaner, allergy medicine
containing pseudoephedrine or
ephedrine, plastic bottles, tubing,
match heads
Prescription Drug Abuse:
Pills not prescribed to you
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Signs & Symptoms
Pinpoint pupils, nausea, drowsy, confused,
relaxed, blood pressures high or low, heart
rate and respiration high or low. Anxiety,
euphoria, depression, irritable, shaky,
trouble sleeping, coma. Tolerance
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Usage
Pills can be swallowed, crushed, snorted &
injected. Pain patches. Pharm
Parties/Skittle Parties: mix stimulants,
narcotics and depressants. Pain pills
should not be combined with alcohol,
antihistamines or benzodiazepines.
• Medication Suppliers
• Most Prescription Drugs come from your
medicine cabinet. Properly dispose of all
expired, un-used and un-wanted
medications. Visit
www.michigan.gov/deqreswastecontacts
for local collection programs.
• ADD medications, pain pills and OTC pills
are often combined with unknown
outcomes.
Inhalants
• Signs & Symptoms
Drunk or disoriented appearance, paint or
other stains on face, hands, or clothing,
hidden empty spray paint or solvent
containers, chemical soaked rags or
clothing, slurred speech, strong chemical
odors on breath or clothing, nausea or
loss of appetite, red or runny nose, sores
or rash around nose or mouth. Hidden
empty containers. Nail polish, nail polish
remover, perfume samples
• Usage
Sniffed or Inhaled. Local deaths have
occurred with first time use.
• Slang
Huffing, bagging, buzz-bomb, laughing gas,
poor man’s pot, poppers, rush, snappers,
and whippets.
Mandatory Reporters
• Physicial Neglect
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E. If the allegations involve parental drug use:
• How do you know the parents are using drugs?
• What kind of drugs are they using?
• Do the parents use drugs in front of the child?
• Are the parents selling drugs out of the home?
Are the parents allowing other people to use drugs in the home or to
sell drugs out of the home?
Mandated Reporters Resource Guide
(http://www.michigan.gov/documents/dhs/Pub-112_179456_7.pdf)
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Medical Neglect
Improper Supervision
Abandonment
Failure to Protect
Abuse Physical/Sexual
Continuum of Services:
Continuum of Need
Case Study #1
Father of baby (FoB) lives with Mother of Baby (MoB)
in a rural community. FoB was previously shot in the
leg, is disabled, and uses a wheel chair. He reports
that he suffers from chronic pain, but refuses opiate
painkillers. FoB has a medical marihuana card for his
pain and grows his own marihuana. He does not
provide caregiver services for others. The plants are
kept in a locked closet and there is a water bong on
top of the refrigerator. The home visitor has reported
no smell of marihuana in the home at any time.
MoB has recently delivered her baby. She entered
prenatal care at six months, and had received home
visiting services to assist with medical coverage,
transportation to medical appointments, and tangible
needs. MoB has a history of substance use (heroin),
but is in recovery and reports that she does not use
Case Study #2
Mother of Baby (MoB) is four-months
pregnant and has three other children in the
home (ages 12, 8, and 6). She receives food
assistance, and lives with her boyfriend. He is
on SSI and pays the rest of the bills.
MoB has participated in two previous home
visits. Today, she enters the home visitors car
with red glassy eyes and a light smell of
marihuana. The home visitor asks if MoB is
doing ok, since her eyes are red. MoB states
that she was at Michigan Works all day looking
at the computer screen.
Case Study #3
This same MoB is now requesting assistance in obtaining a
birth certificate for one of her children. At the next visit, MoB
gets in
the car and says that she can’t live with her boyfriend because
he drinks alcohol and takes Vicodin daily. MoB reports that the
boyfriend is a mean drunk and is verbally abusive towards her.
She reports that he steals her money to buy alcohol, even when
it means that she can’t take the bus to go to Michigan Works.
MoB states that she probably should not judge him since she
has a medical marihuana card for carpal tunnel syndrome.
MoB braids hair to make pocket money and uses marihuana to
ease the pain that it causes. MoB reports that she only uses
marihuana if she is going to braid hair, and does not use it when
the kids are around.
MoB states that she has not used marijuana during the four
Authentic Messages get Results:
non-violent communication (NVC)
Empathetically listening
• Observations
• Feelings
• Needs
• Requests
Honestly Expressing
• Observations
• Feelings
• Needs
• Requests
Both sides of the NVC Model: Empathetically listening and
honestly expressing; use of the four steps of the model:
Observations, Feelings, Needs, Requests
Small Changes can make a
Big Difference
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Keeping Track
Counting and Measuring
Setting Goals
Pacing and Spacing
Avoid “Triggers”
Planning to Handle Urges
Knowing your “NO”
Find Safe Support
Best Practices: Assess/Refer
Every Encounter
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Varied Resources Offered
Genuine Concern and Care
Authentic Relationship
Motivational Interviewing
Capitalize on the Moment
Follow the Client’s Lead – it’s their life and
their priority and readiness
Assessment and Interventions
CAGE Assessment
C
Have you every tried to Cutback on your
use?
A
Have you ever been Annoyed/Angered
when
questioned about your use?
G
Have you ever felt Guilt about your use?
E
Have you ever had a Eye-opener to get
started in the morning?
Local Collaboration
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Power of We
– http://powerofwe.org/
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ISAP Coalition
– www.drugfreeingham.org
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Ingham Great Start Collaborative
– www.inghamgreatstart.org
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Care Coordination Center
– www.ceicmhca.org
– (888) 230-7629 or (517) 346-8458
Continuum of local services:
Home visitation
• Capital Area Community Services
– Early Head Start
• Community Mental Health
– Parent Infant Program (PIP)
– Parent Young Child Program (PYC)
• Ingham County Health Department
– Family Outreach Services (FOS)
– Public Health Nursing
• Ingham Intermediate School District
– Early On ®
– Great Parents-Great Start
Continuum of local services:
Recovery meetings
• Central Alcoholics Anonymous
– http://www.aalansingmi.org/
• Narcotics Anonymous
– www.na.org
• Smart Recovery
– www.smartrecovery.org
• Celebrate Recovery
– www.celebraterecovery.com
• Al-anon and Alateen (family/friend support)
– www.al-anon.alateen.org
Continuum of local services:
Treatment options
Community Mental Health
www.ceicmhca.org
Toll Free: 1.888.230.7629
Local Calls: (517) 346-8458
Hours: 8:30- 4:30 (M-F)
Care Coordination Center
Responsibilities
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Screening, Referral, Follow-Up
– Warm Transfers
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Utilization Review
– Next Day Openings
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Care Management
– List of Care Coordination Center providers
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Resource Consulting
Care Coordination Center
Eligibility
• Medicaid, Adult Benefit Waiver (ABW),
or MiChild Requirements
• Resident of one of the following
Counties:
– Clinton, Eaton, Gratiot, Hillsdale, Ingham,
Ionia, Jackson, or Newaygo
Thank you!
{Name
Agency
Email address}