Transcript Telephone counselling for alcohol and drug issues

Monash University-2009
Alcohol and Other Drugs
Presenter: Effie Moraitis
Senior Clinician
Topics covered today:
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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
Making sense of AOD issues:
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What is a drug? Who uses drugs?
Theoretical models of drug use
Harm minimisation
Dependency, tolerance and withdrawal
Patterns of drug use
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”
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(Krivanek 1995 p 2)
Who Uses Drugs?
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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?
Theoretical Models of drug use:
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Moral Model
Key assumption:
using drugs is morally wrong and anti-social
Intervention:
spiritual direction, gaol, providing an
environment that promotes pro-social values
Theoretical Models of drug use:
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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
Theoretical Models of drug use:
Disease Model con’t
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.
Theoretical Models of drug use:
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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
Theoretical Models of drug use:
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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
Harm minimisation approach:
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Has underpinned Australia’s 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
National Drug Strategic Framework:
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The National Drug Strategy focuses on three
core elements of harm reduction
- demand reduction (prevention)
- supply reduction (law enforcement)
- harm reduction (education, information
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.
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
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
Patterns of consumption and
types of drug use:
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Controlled use
Experimental use
Social / recreational use
Circumstantial use / situational
Intensive use
Dependency
Drug Classifications:
Drugs are often classified in two ways:
 Legal status
 Central nervous system effects
Classifications:
Depressants
Stimulants
Hallucinogens
An AOD assessment:
What are some important points to
cover in an AOD assessment?
Assessment – some points:
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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
Stages of Change Model:
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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.
Six stage model:
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Pre-contemplative stage
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Contemplative stage
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Person is actively pursuing change
Maintenance stage
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Person is preparing to change
Action stage
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Person is weighing up cost / benefits to change
Preparation stage
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Person does not see they have a problem
Person is maintaining the change
Relapse stage
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Person returns to previous levels of drug use
Alcohol: What is it?
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Alcohol is ethyl alcohol or ethanol. It is a
natural product of fermenting sugars. It’s
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
Side Effects
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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.
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…
Neurological side effects con’t.
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Alcohol travels to your stomach
This is where it’s 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
Effects of alcohol on the body
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Alcohol shares many properties with water. It is
highly soluble in water and travels through the
body as water does.
In it’s 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..
Effects con’t
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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?
Effects con’t
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Alcohol’s 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.
Effects con’t
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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
Chronic Alcohol Consumption
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When people consume large quantities of
alcohol, they develop a Thiamine
Deficiency(Vitamin B1).
This causes the neurological disorder called
Wernicke-Korsakoff Syndrome. Wernicke’s
encephalopathy and Korsakoff’s 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.
Chronic Consumption con’t
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.
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.
Withdrawal Symptoms of
Alcohol
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Sweating, facial flushing
Tremors
Agitation
Palpitations, hypertension
Poor appetite, nausea, vomiting, diarrhoea
Poor sleep, anxiety
Cravings, strong desire to drink
Poor concentration
Headaches
More Serious Symptoms
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Severe hypertension
Seizures
Hallucinations, delirium
Arrhythmias
Precipitation/ exacerbation of underlying medical
or psychiatric disorders
Mood swings
Illnesses caused by alcohol
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Sleep and sexual disorders
Psoriasis of the liver
Psychotic and mood disorders
Foetal Alcohol Syndrome
Depression
Heart failure
Wernicke-Korsakoff Syndrome
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.
The Classification
All forms of marijuana are mind-altering. In
other words, they change how the brain
works. They all contain THC (delta-9tetrahydrocannabinol), 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.
Effects of Marijuana
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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
Effects of Marijuana con’t
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Anxiety, panic attacks, and paranoia
Hallucinations/Delusions
Damage to the respiratory, reproductive,
and immune systems
Increased risk of cancer
Psychological dependency
Neurological Effects of
Marijuana
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When someone smokes Marijuana, THC
rapidly passes through the bloodstream.
This carries the chemical to organs
throughout the body, including the brain
Neurological effects con’t..
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
Neurological Effects of
Marijuana con’t..
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.
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 shortterm 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.
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.
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.
Withdrawal Symptoms of
Marijuana
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Anxiety, agitation, restlessness, irritability
Nausea
Dysphoria, lethargy
Cravings, strong desire to use
Sleep disturbances (including vivid dreams,
nightmares, insomnia)
Sweating
Headaches
Mood disturbances
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.
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…
Treatment Options con’t
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).
24/7 Services
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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.
24/7 Services con’t
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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