PRESCRIPTION DRUG ABUSE

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Transcript PRESCRIPTION DRUG ABUSE

Why People Abuse Prescription Drugs
“The Psychopharmacology of Addiction”
Carl M. Dawson, M.S., MAC, LPC
Independent Practice
National Drug Court Institute Faculty (NDCI)
Washington, D.C .
Missouri State University (MSU)
Department of Psychology
Department of Counseling, Leadership and Special Education
Springfield, Missouri
Why People Abuse Prescription Drugs
• POINTS OF REFERENCE.
• A REVIEW OF TERMS AND DEFINITIONS.
• PRESCRIPTION DRUG ABUSE IN PERSPECTIVE.
• A REVIEW OF CONTROLLED “SCHEDULED“ DRUGS.
• THE MOST COMMONLY ABUSED PRESCRIPTION MEDICATIONS:
1. OPIATES/OPIOIDS (Narcotics)
2. ANXIOLYTICS (Barbiturates, Benzodiazepines, Sedative Hypnotics)
3. STIMULANTS
POINTS OF REFERENCE
• “DRUG ABUSE, IS DRUG ABUSE“ . . .
DON’T ASSUME THAT PRESCRIPTION DRUG
ABUSE IS ANY DIFFERENT THAN ILLICIT DRUG ABUSE.
• ALL OF THE DRUGS DISCUSSED TODAY ARE
SAFE AND EFFECTIVE AND TYPICALLY FREE OF
ADDICTION POTENTIAL WHEN USED AS MEDICALLY
RECOMMENDED.
• REMEMBER:
YOU DO NOT HAVE PERMISSION TO
TO ADVISE A CLIENT TO STOP TAKING A MEDICATION
THAT HAS BEEN LEGALLY PRESCRIBED BY A QUALIFIED
MEDICAL PROFESSIONAL.
A REVIEW OF TERMS AND
DEFINITIONS
WE WILL BE USING THE DSM-IV-TR (APA, 2000)
TERMINOLOGY AS IT APPLIES TO THE DSM-5
(APA, 2013) CRITERIA IN TODAYS PRESENTATION.
SUBSTANCE RELATED DISORDERS
(DSM IV, TR, APA 2000)
(Diagnostic Criteria)
ADDICTION: A behavioural term that refers to
continuing to seek a drug in spite of the consequences.
(“ADDICTION” IS NOT A DIAGNOSTIC TERM)
• ABUSE: Refers to psychological use (only).
• DEPENDENCE: Refers to the occurrence of
predictable physical changes due to the
continued use of alcohol and /or other drugs.
•
DSM-5
• DSM-5 recommends the use of the term “Substance Use Disorder” and
not the term “Addiction”.
• DSM-5 states that the diagnosis of a “Substance Use Disorder” applies to
all 10 classes of substances (drugs).
• DSM-5 uses a “Severity” continuum when ranking the degrees of harmful
substance involvement.
1. Mild: 2 to 3 symptoms. (DSM-IV-TR: Abuse “Psychological”)
2. Moderate: 4 to 5 symptoms.(DSM-IV-TR: Dependence Psych/Physical”)
3. Severe: 6 or more symptoms. (DSM-IV-TR: Dependence “Chronic”)
• DSM-5 recommends that you use the name of the specific substance
“xanax” rather than the class “anxiolytic” when diagnosing.
Example: 304.10 moderate xanax use disorder.
303.90 severe alcohol use disorder.
•
CENTRALLY ACTIVE DRUGS: (aka: PSYCHOACTIVE )
SUBSTANCES (DRUGS) THAT ENTER THE BRAIN AND
ALTER THE ELECTRICAL AND CHEMICAL ACTIVITIES OF
THE BRAIN AND NERVOUS SYSTEMS.
•
DRUGS: AS USED IN THIS PRESENTATION, ANY SUBSTANCE
THAT REQUIRES A PRESCRIPTION AND CAN BE FOUND
IN THE SCHEDULED CLASSIFFICATION OF MEDICATIONS.
• DRUG ENFORCEMENT ADMINISTRATION (DEA): IS A
BRANCH OF THE DEPARTMENT OF JUSTICE. THE
DEA WAS CREATED IN 1970 AS A CONSEQUENCE
OF THE COMPREHENSIVE DRUG ABUSE PREVENTION
AND CONTROL ACT.
•
GENERIC NAME: THE ACTUAL NAME GIVEN TO THE CHEMICAL
MAKE UP OF A DRUG. (BUPROPION FOR WELLBUTRIN)
•
HYPNOTICS: A TERM USED TO IDENTIFY A CLASS OF DRUGS
PRESCRIBED FOR INSOMNIA , OR A DISORDER WHERE AN
INDIVIDUAL HAS DIFFICULTY FALLING OR STAYING ASLEEP.
•
OFF LABEL: A TERM USED TO DESCRIBE A DRUG THAT
IS BEING USED FOR MEDICAL CONCERNS OTHER
THAN IT WAS ORIGINALLY INTENDED OR OTHER
THAN IT WAS MANUFACTURED.
• OPIATES / OPIOIDS: (aka: NARCOTICS): A CLASS OF DRUGS
THAT ARE DESIGNED TO TREAT OR REDUCE THE EFFECTS
OF SPECIFIC OR GENERALIZED PHYSICAL SENSATIONS. (PAIN)
•
OVER THE COUNTER (OTC) MEDICATIONS:
MEDICATIONS USED TO TREAT VARIOUS
PHYSICAL / MEDICAL CONDITIONS THAT
DO NOT REQUIRE A PRESCRIPTION.
• SEDATIVES: DRUGS DESIGNED TO RELAX OR
REDUCE ANXIETY OR STRESS. MEDICATIONS
THAT DEPRESS THE ACTIVITY OF THE CNS .
• SYNERGISTIC EFFECT: WHEN TWO (2) DRUGS
PRODUCE A GREATER EFFECT THAN ONE (1)
DRUG ALONE.
(1+1=3)
•
TRADE OR PATENTED NAME: THE TITLE A DRUG COMPANY
USES FOR THEIR BRAND OF A PARTICULAR DRUG.
(VALIUM FOR DIAZEPAM or XANAX FOR ALPRAZOLAM)
•
TOLERANCE: THE NEED FOR A GREATER AMOUNT OF
A DRUG, IN ORDER TO GAIN THE SAME OR DESIRED
EFFECT.
•
CROSS TOLERANCE and CROSS DEPENCENCY:
A PHYSICAL ADAPTATION WERE THE ABUSIVE USE
OF ONE DRUG (ALCOHOL) MAY CREATE EITHER A
TOLERANCE OR DEPENDENCY ON OTHER SIMILAR
ACTING DRUGS (XANAX).
•
WITHDRAWAL: THE PHYSICAL AND/OR PSYCHOLOGICAL
SYMPTOMS EXPERIENCED ONCE A MEDICATION HAS
BEEN DISCONTINUED.
REMEMBER:
WHATEVER SIGNS AND SYMPTOMS A DRUG
WAS ORIGINALLY DESIGNED TO TREAT . . .
THE WITHDRAWAL AND REBOUND SYMPTOMS,
FROM THAT PARTICULAR DRUG. . . WILL
USUALLY BE THE OPPOSITE ! ! !
ANXIETY
ANTI - WEIGHT
ANTI - SLEEP
ANTI - PAIN
ANTI - DEPRESSION
ANTI -
PRESCRIPTION DRUG ABUSE IN
PERSPECTIVE
PRESCRIPTION DRUG ABUSE IN PERSPECTIVE
• PRESCRIPTION DRUGS ARE THE SECOND MOST
FREQUENTLY ABUSED CLASS OF DRUGS OTHER THAN MARIJUANA.
• MOST INDIVIDUALS ABUSING PRESCRIPTION
DRUGS SECURE THEIR DRUGS THROUGH:
1. ILLICIT MEANS: (FRIENDS, STEALING, DEALING).
2. FAMILY MEMBERS WHO POSSESS A LEGITIMATE PRESCRIPTION.
3. MANIPULATING PRESCRIBING HEALTH CARE PROFESSIONALS.
• THE MOST COMMON REASONS INDIVIDUALS
ABUSE PRESCRIPTION MEDICATIONS ARE DUE TO:
1. LEGITIMATE PHYSICAL (ACUTE-CHRONIC).
2. MENTAL HEALTH (CO-OCCURRING AND MOOD DISORDERS).
3. SLEEP DISORDERS (INSOMNIA OR HYPERSOMNIA).
• UNINTENTIONAL DEATH DUE TO PRESCRIPTION
DRUG ABUSE INCREASED IN ADOLESCENCE
150 %
BETWEEN 2001 TO 2009. (CERMAK 2009)
• IN 2008, ADOLESCENT DEATH DUE TO DRUG USE
EXCEEDED DRIVING FATALITIES. (CERMACK 2009)
• APPROXIMATELY ONE -THIRD (1/3rd) OF ADOLESCENCE
CLAIM THEIR FIRST ABUSIVE USE OF A DRUG
WAS A PRESCRIPTION MEDICATION.
• RESEACH CONDUCTED AT JOHNS HOPKINS UNIV.
INDICATED THAT DEATH DUE TO PRESCRIPTION
DRUG OVERDOSE INCREASED
THE YEARS 2006 AND 2008.
273%
BETWEEN
THE CURRENTLY MOST ABUSE PRESCRIPTION DRUGS IN THE U.S.
• PRESCRIPTION OPIATES / OPIOIDS:
1. HYDROCODONE (VICODIN)
2. OXYCODONE (OXYCONTIN, PERCOCET)
3. CODEINE
• PRESCRIPTION BENZODIAZEPINES:
1. DIAZEPAM (VALIUM)
2. ALPRAZOLAM (XANAX)
3. LORAZEPAM (ATIVAN)
ADULTS BETWEEN THE AGES 35 AND 54
ARE THE GREATEST OFFENDERS
CONTROLLED SUBSTANCES ACT (CSA)
• CONTROLLED SUBSTANCES ACT (CSA) WAS
ENACTED BY THE UNITED STATES CONGRESS
IN 1970.
• THE CONTROLLED SUBSTANCES ACT (CSA) ALLOWS
THE DRUG ENFORCEMENT ADMINISTRATION (DEA)
AND THE FOOD AND DRUG ADMINISTRATION (FDA)
TO DETERMINE THE APPROPRIATE PLACEMENT OF
PARTICULAR DRUGS AND MEDICATIONS THAT
POSSESS A POTENTIAL FOR PSYCHOLOGICAL AND/OR
PHYSICAL ABUSE AND DEPENDENCE INTO FIVE (5)
SCHEDULES OR (CLASSIFICATIONS).
A REVIEW OF CONTROLLED SUBSTANCES
“SCHEDULED” DRUGS
SCHEDULE I
• HEROIN
• NO CURRENT ACCEPTABLE MEDICAL
USE IN THE UNITED STATES.
• MARIJUANA (HASHISH)
• COCAINE
• USED FOR RESEARCH ONLY.
• POSSESS A HIGH POTENTIAL FOR
ABUSE AND DEPENDENCE.
• LSD (ACID)
• MDMA (ECSTASY)
• PSILOCYBIN (MUSHROOM)
• MEDICATIONS THAT ARE
CONSIDERED NOT SAFE,
DANGEROUS AND UNPREDICTABLE.
• METHAMPHETAMINE
• PHENCYCLIDINE (PCP)
• FLUNITRAZEPAM (ROHYPROL)
SCHEDULE II
• CURRENTLY CONSIDERED TO
POSSESS MEDICAL VALUE.
• MEDICATIONS AVAILABLE BY
WRITTEN PRESCRIPTION ONLY
(NON-REFILLABLE).
• POSSESS A HIGH POTENTIAL
FOR ABUSE AND DEPENDENCE.
PROLONGED USE MAY
PRODUCE SEVERE PSYCHOLOGICAL
DEPENDENCE.
• STRICT RESTRICTIONS
REGARDING STORAGE
AND ORDERING.
•
MORPHINE (MS CONTIN)
•
OXYCODONE ( OXYCONTIN,
PERCOCE)
•
HYDROMORPHONE (DILAUDID)
•
HYDROCODONE (VICODIN)
•
MEPERIDINE (DEMEROL)
•
PROPOXYPHENE (DARVON)
•
METHYLPHENIDATE (RITALIN,
CONCERTA)
•
AMPHETAMINES (ADDERALL,
DEXEDRINE)
SCHEDULE III
• CURRENTLY CONSIDERED TO
POSSESS MEDICAL VALUE.
• ANABOLIC STEROIDS
(BODY BUILDING DRUGS)
• BARBITURATES
• MEDICATIONS REQUIRE A PRESCRIPTION.
• MEDICATIONS MAY BE ORDERED
BY THE PRESCRIBER VERBALLY.
(FOLLOWED BY A WRITTEN PRESCRIPTION)
• POTENTIAL FOR ABUSE IS CONSIDERED
LESS THAN FOR SCHEDULED I AND II’s.
• ABUSE MAY LEAD TO MODERATE
PHYSICAL DEPENDENCE OR HIGH
PSYCHOLOGICAL DEPENDENCE.
• CODEINE COMBINATIONS
(EMPIRINE, FIORINAL)
• DRONABINOL
(MARINOL, SYNTHETIC
THC)
• OPIUM COMBINATIONS
(PAREGORIC)
• BUPRENORPHINE
(SUBUTEX-SUBOXONE)
SCHEDULE IV
• CURRENTLY CONSIDERED TO
POSSESS MEDICAL VALUE.
• MEDICATIONS REQUIRE A PRESCRIPTION.
• MEDICATIONS MAY BE ORDERED
BY THE PRESCRIBER VERBALLY.
(FOLLOWED BY A WRITTEN PRESCRIPTION)
• POTENTIAL FOR ABUSE IS CONSIDERED
LESS THAN FOR SCHEDULED III’ s.
• ABUSE MAY LEAD TO MILD
PHYSICAL DEPENDENCE OR HIGH
PSYCHOLOGICAL DEPENDENCE.
•
ALPRAZOLAM (XANAX)
•
CHLORDIAZEPOXIDE
(LIBRIUM)
• CLONAZEPAM (KLONOPIN)
• DIAZEPAM (VALIUM)
• MODAFINIL (PROVIGIL)
• PEMOLINE (CYLERT)
• TEMAZEPAM (RESTORIL)
• TRIAZOLAM (HALCION)
• ZOLPIDEM (AMBIEN)
SCHEDULE V
• CURRENTLY CONSIDERED TO
POSSESS MEDICAL VALUE.
• MEDICATIONS MAY OR MAY NOT
REQUIRE A PRESCRIPTION.
• MEDICATIONS MAY BE DISPENSED
BY A PHARMACIST AS AN OVER
THE COUNTER (OTC) DRUG.
(WITH A PROPER ID)
• POTENTIAL FOR ABUSE IS CONSIDERED
LESS THAN FOR SCHEDULED IV’s.
• ABUSE MAY LEAD TO “ LIMITED “
PHYSICAL DEPENDENCE OR
PSYCHOLOGICAL DEPENDENCE
RELATIVE TO SCHEDULE IV ‘s.
• MIXTURES TYPICALLY
POSSESSING SMALL AMOUNTS
OF CODEINE OR OPIUM
• CODEINE PREPARATIONS
(ROBITUSSIN-A)
• DIPHENOXYLATE
(LOMOTIL)
• OPIUM PREPARATIONS
(PAREPECTOLIN, KAPECTOLIN)
• PSEUDOEPHEDRINE OR
EPHEDRINE PRODUCTS
THE MOST COMMONLY ABUSED
PRESCRIPTION MEDICTIONS
OPIOIDS/OPIATES
(aka: Narcotics)
Ptosis and Miosis (constricted) pupils
• OPIATES ARE CONSIDERED ANALGESIC
(PAIN-RELIEVING) MEDICATIONS.
• OPIATES IMITATE THE BODY’S OWN PAIN-RELIEVING
SUBSTANCES FOUND NATURALLY IN THE HUMAN BODY,
TYPICALLY THESE ARE REFERRED TO AS OPIOIDS.
(ENKEPHALINES and ENDORPHINS)
• ALL OPIATE SUBSTANCES ARE EITHER MORPHINE
BASED OR BREAK DOWN INTO MORPHINE IN THE
BODY.
• OPIATE OVERDOSE CAN BE LETHAL, EITHER
WHEN USED ALONE AND ESPECIALLY WHEN USED
WITH OTHER CNS DEPRESSANTS (1 + 1 = 3) EFFECTS.
• OPIATE SUBSTANCES ARE LIPOPHILLIC (LOVES FAT).
MEANING THEY INFILTRATE INTO THE HIGH PROTEIN
AND FAT CONTAINING ORGANS OF THE BRAIN AND
BODY . . . QUICKLY. (HEROIN vs. CODEINE)
• OPIATE ADDICTS BECOMES ADDICTED TO
THE “RUSH”.
• OPIATE DRUGS THAT PRODUCE “LESS OF A RUSH“
ARE LESS FAT-SOLUBLE AND ARE MORE EFFECTIVE
IN TREATING OPIATE DEPENDENCE.
(METHADONE AND BUPRENORPHINE)
OPIOIDS
• OPIATE SUBSTANCES ARE KNOWN
TO PRODUCE PSYCHOLOGICAL AND
PHYSICAL ABUSE AND DEPENDENCE.
• THE MOST COMMON CAUSE OF
OPIATE/OPIOID DEATH IS RESPIRATORY
ARREST.
(STOPS BREATHING)
MOOD AND PAIN PATHWAYS FOLLOW SIMILAR ROUTES THROUGH THE BRAIN
MOOD
CENTERS
ADDICTION
CENTERS
ANXIETY
DEPRESSION
PAIN
OPIATE “WITHDRAWAL “
SIGNS AND SYMPTOMS
APPROX. HR’s AFTER LAST DOSAGE
HEROIN / MORPHINE
METHADONE
1. CRAVING FOR THE DRUG, ANXIETY.
6
24
2. YAWNING, PERSPIRATION, RUNNING
NOSE AND EYES.
14
34 – 48
3. PUPIL DILATION, GOOSE BUMPS
(PILORECTIONS), TREMORS (MUSCLE
TWITCHING), HOT & COLD FLASHES,
ACHING BONES, MUSCLES AND LOSS
OF APPETITE.
16
48 – 72
4. INSOMNIA , RAISED BP, INCREASED TEMP.
PULSE RATE, RESPIRATORY RATE AND
DEPTH, RESTLESSNESS AND NAUSEA.
5. CURLED-UP POSITION, VOMITING,
DIARRHEA, WEIGHT LOSS, SPONTANEOUS
EJACULATION OR ORGASM, INCREASED
BLOOD SUGAR.
24 – 36
36 - 48
OPIATE “ANTI-OPIATE“ MEDICATIONS
• METHADONE: A SYNTHETIC OPIATE THAT HELPS
ELIMINATE SYMPTOMS OF OPIATE “ MORPHINE “ WITHDRAWAL.
• BUPRENORPHINE: A SYNTHETIC OPIATE, LESS POWERFUL THAN
METHADONE, AND APPROVED TO BE USED WITH OPIATE WITHDRAWAL.
BUPRENORPHINE BASED MEDICATIONS CAN BE PRESCRIBED IN AN
INPATIENT OR OUTPATIENT SETTING.
•
NALOXONE: A SHORT-ACTING OPIATE BLOCKER
“ANTAGONIST“ THAT CAN USED ALONE OR IN COMBINATION
WITH BUPRENORPHONE (SUBUTEX, SUBOXONE).
• NALTREXONE: A LONG-ACTING OPIATE BLOCKER
“ANTAGONIST“ THAT CAN ALSO BE USED IN
THE TREATMENT OF ALCOHOL ABUSE AND DEPENDENCE.
RECENTLY APPROVED FOR OPIATE MAINTANENCE USE. (VIVITROL)
COMMONLY PRESCRIBED OPIOIDS AND THEIR
TRADE NAMES
•
•
•
•
•
•
•
•
•
•
•
OXYCODONE (OxyContin, Percodan, Percocet)
PROXYPHENE (Darvon)
HYDROCODONE (Vicodin, Lortab, Lorcet)
HYDROMORPHONE (Dilaudid)
MEPERIDINE (Demerol)
DIPHENOXYLATE (Lomotil)
MORPHINE (Kadian, Avinza, MS Contin)
CODEINE
PENTAZOCINE (Talwin)
FENTANYL (Sublimaze)
METHADONE (Dolophine)
Non-Opiate prescribed analgesic
medications with the potential for abuse:
• TRAMADOL (Ultram)
CENTRAL NERVOUS SYSTEM (CNS) DEPRESSANTS
ANXIOLYTICS: Anti-anxiety
Barbiturates, Benzodiazepines
---Sedative-Hypnotics
(Sleep aids)
LET’S DISCUSS ANXIETY . . .
WHAT’S THE DIFFERENCE BETWEEN
FEAR AND ANXIETY ?
• EACH CLASS OF THE FOLLOWING MEDICATIONS
ARE KNOW TO PRODUCE THE FOLLOWING:
1 . MEETS THE DSM-IV & 5’S CRITERIA
FOR ABUSE AND DEPENDENCE, MILD TO SEVERE.
2 . PRODUCE AN “1 + 1 = 3“ EFFECT WHEN
COMBINED WITH ALCOHOL AND OTHER
CNS DEPRESSANTS.
3 . PRODUCE A “REBOUND“ EFFECT WHEN
ABRUPTLY DISCONTINUED.
4 . ROUTINELY PRESCRIBED FOR EITHER ANXIETY,
ANXIOUS SYMTOMS ASSOCIATED WITH OTHER
PSYCHIATRIC DISORDERS (MOOD DISORDERS)
AND SLEEP DISORDERS. (A.M./P.M. INSOMNIA)
5 . EACH OF THESE DRUGS MAY
PRODUCE A “PARADOXICAL“ or
OPPOSITE EFFECT.
6 . EACH IMPACTS THE LEARNING AND
MEMORY CENTERS OF THE BRAIN.
7 . THE MOST COMMON CAUSE OF DEATH
WITH SEDATIVE DRUGS IS RESPIRATORY
SUPPRESSION. (STOPS BREATHING)
8. ANTEROGRADE AMNESIA (BLACKOUTS)
ARE COMMON.
PARTIAL (Temporary)
EN-BLOC (Complete)
AMYGDALA AND HIPPOCAMPUS STRUCTURES OF THE BRAIN
BARBITURATES
BARBITURATES
• BARBITURATES ARE MORE POWERFUL
THAN BENZODIAZEPINE TYPE MEDICATIONS.
• BARBITURATES ARE NOT PRESCRIBED AS
ROUTINELY AS BENZODIAZEPINES . . . DUE
TO A RAPID PHYSICAL TOLERANCE AND
DANGEROUS WITHDRAWAL SYMPTOMS.
• BARBITURATES HAVE A HIGH POTENTIAL
FOR LOW DOSAGE SEIZURE ACTIVITY.
• BARBITURATES POSSESS A HIGH POTENTIAL
FOR ABUSE AND DEPENDENCE.
COMMONLY PRESCRIBED BARBITURATES
AND THEIR TRADE NAMES
•
•
•
•
•
•
AMOBARBITAL (Amytal, Tuinal)
SECOBARBITAL (Seconal, Tuinal)
MEPROBAMATE (Miltown, Equanil)
MEPHOBARBITAL (Mebaral)
PENTOBARBITAL (Nembutal)
LUMINAL
BENZODIAZEPINES
Benzodiazepines
• Benzodiazepines medications possess a Mild
potential for abuse and dependence.
• Benzodiazepines abuse typically does not result
in a fatal drug overdose.
• Benzodiazepines medications are not
recommended for use in combination
with Anti-alcohol or Anti-opioid medications.
Benzodiazepines
• Benzodiazepines are metabolized
by the body similar to alcohol.
• They directly inhibit short term
memory and long term learning.
• Detoxification from Benzodiazepines may
take a long time (2 to 6 months)
in order to be effective or else the
potential for relapse is high.
COMMONLY PRESCRIBED BENZODIAZEPINES
AND THEIR TRADE NAMES
•
•
•
•
•
•
DIAZEPAM (Valium)
CHLORDIAZEPOXIDE HYDROCHLORIDE (Librium)
ALPRAZOLAM (Xanax)
ESTAZOLAM (ProSom)
CLONAZEPAM (Klonopin)
LORAZEPAM (Ativan)
Less Frequently Prescribed Benzodiazepines:
• CLORAZEPATE (Tranxene)
• OXAZEPAM (Serax)
• OXAZOLAM (Serenal)
SEDATIVE (HYPNOTICS)
“SLEEP AIDS“
SEDATIVE (HYPNOTICS) “SLEEP AIDS“
• SEDATIVE (HYPNOTIC) MEDICATIONS ARE CONSIDERED
SLEEP AIDS.
• SEDATIVE (HYPNOTICS) ARE TYPICALLY PRESCRIBED FOR
SLEEP DISORDERS INSOMNIA: DIFFICULTY BEING ABLE TO
PRODUCE SLEEP, OR THE INABILITY TO STAY A SLEEP.
• SEDATIVE (HYPNOTICS) ARE CONSIDERED CNS
DEPRESSANTS AND ARE CREATED FROM VARIATIONS
OF BARBITURATES, “FAST ACTING” BENZODIAZEPINES OR
NON-BENZODIAZEPINES MEDICATIONS.
• CURRENTLY MOST SEDATIVE (HYPNOTIC) MEDICATIONS
ARE NOT RECOMMENDED TO BE TAKEN LONGER THAN
TWO (2) TO SIX (6) WEEKS.
COMMONLY PRESCRIBED SEDATIVES AND THEIR
BRAND NAMES
•
•
•
•
•
•
CHLORAL HYDRATE (Noctec)
ESTAZOLAM (ProSom)
ETHINAMATE (Placidyl)
FLURAZAEPAM (Dalmane)
TEMAZEPAM (Restoril)
TRIAZOLAM (Halcion)
• ZALEPLON (Sonata) a non-Bz.
• ZOLPIDEM (Ambien) a non-Bz.
• ESZOPICLONE (Lunesta) a non-Bz.
CENTRAL NERVOUS SYSTEM
(STIMULANT
“Cognitive Enhancers”
WHAT DO PURPLE EAR LOBES AND COCAINE HAVE IN
COMMON ???
PRESCRIPTION CNS STIMULANTS “Cognitive Enhancers”
• STIMULANT MEDICATIONS ARE TYPICALLY PRESCRIBED
FOR THE FOLLOWING:
1 . ATTENTION-CONCENTRATION “ADOLESCENT/ADULT “
DISORDERS (ADD, ADHD),
2 . WEIGHT MANAGEMENT,
3 . SPECIFIC SLEEP DISORDERS (NARCOLEPSY),
4 . LIMITED PSYCHIATRIC DISORDERS (MOOD DISORDER),
• STIMULANT MEDICATIONS MEET THE CRITERIA FOR THE
DSM-5 DIAGNOSIS OF ABUSE AND DEPENDENCE.
• LONG-TERM ABUSE OF STIMULANT MEDICATIONS CAN
RESULT IN MODERATE TO SEVERE TOLERANCE AND
WITHDRAWAL SYMPTOMS CHARACTERISTIC OF MOOD
AND/OR PSYCHOTIC DISORDERS.
POINTS OF REFERENCE “GENDER DIFFERENCES“
•
RESEARCH ON WOMEN AND STIMULANT
DRUG USAGE FINDS . . .
• WOMEN ARE MORE LIKELY TO DEVELOP
A DEPENDENCY ON METHAMPHETAMINE
AND COCAINE SOONER THEN MEN,
• THEY ARE PRONE TO USE STIMULANT
DRUGS MORE IMPULSIVELY THAN MEN
AND . . .
• EXPERIENCE A HIGHER RATE OF DRUG
RELAPSE THAN MEN. .
GENDER DIFFERENCES
• COCAINE, METHAMPHETAMINE AND OPIATES
ARE CONSIDERED “DRUGS OF CHOICE”
BY MOST SUBSTANCE ABUSING INDIVIDUALS
WHO ARE ALSO STRUGGLING WITH
EMOTIONAL / PSYCHOLOGICAL TRAUMA. (PTSD)
• ALCOHOL, MARIJUANA AND PRESCRIPTION
MEDICATIONS ARE ROUTINELY USED AS
“BACK UP” OR “REBOUND” SUBSTANCES..
COMMONLY PRESCRIBED
STIMULANTAND THEIR TRADE NAMES
•
•
•
•
•
•
•
•
DEXTROAMPHETAMINE (Adderall, Dexedrine)
AMPHETAMINE (Adderall , Dexedrine, Vyvanse)
METHYLPHENIDATE (Ritalin, Concerta)
COCAINE
FENFLURAMINE (Pondimin, Ponderal)
MODAFINIL (Provigil)
PEMOLINE (Cylert)
METHAMPHETAMINE (Desoxyn)
Non-Stimulant ADHD medications:
• ATOMOXETINE (Strattera)
PRESENTATION REVIEW
• A REVIEW OF TERMS AND DEFINITIONS.
• PRESCRITION DRUG ABUSE IN PERSPECTIVE.
• A REVIEW OF CONTROLLED “SCHEDULED“ DRUGS.
• THE MOST COMMONLY ABUSED PRESCRIPTION
MEDICATIONS:
1. OPIATES/OPIOIDS
2. (CNS) DEPRESSANTS.
3. (CNS) STIMULANTS.
CONTACT INFORMATION:
CARL M. DAWSON, M.S., MAC, LPC
1320 E. KINGSLEY SUITE “A“
SPRINGFIELD, MO 65804
e-mail:
([email protected])
References and Suggested Readings
• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services
Administration
Center for Substance Abuse Treatment
TREATMENT IMPROVEMENT PROTOCOL
(TIP) SERIES
Rockwall II, 5600 Fishers Lane
Rockville, MD. 20857
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders (4th, 5theds). Washington, DC: American Psychiatric Association.
•
Buelow, G., Herbert Suzanne (1995). Counselor’s Resource on Psychiatric
Medications, Issues of Treatment and Referral. Brooks/Cole Publishing Co.,
Pacific Grove, Ca.
• Buprenophine.samhsa.gov
• Cozolino, L. (2006) “ The Neuroscience of Human Relationships, Attachment and
the Developing Social Brain” W.W. Norton & Co. New York.
• Cermak T. ( 2009 ), “ A Blueprint for Adolescent Addiction Treatment “ , CSAM
Review Council .
• Galanter, M. , Kleber, H. ( 2008). Textbook of Substance Abuse Treatment. 4th
ed., American Psychiatric Publishing, Inc., Washington, D.C.
• National Institute on Drug Abuse ( NIDA).
“Selected Prescription Drugs with Potential for Abuse”, and “
Preventing and Recognizing Prescription Drug Abuse “ , and “Prescription
and Over-the-Counter Medications”
www.nida,nih.gov/DrugPages/PrescripDrugsChart.html .
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