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RHAB 3975: FINAL
history of drug use
|
widespread ancient
urbanization> social problems
technology>quality/pwr increased, trade>spread
each culture has 2-4 approved drugs
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Status Politics
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Use of law and norms guiding particular behaviors to control minorities in an indirect but more or less deliberate manner.
Ex: Black people - sagging is now a crime
Prohibition controlled white ethnic immigrants
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boundary setting
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use of behavioral choices to determine group membership (in-group)
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ancient societies: alcohol,opium,
marijuana
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drugs used for analgesic,religious, and euphoric effects
opium,hashish,tobacco,hallucinogens,beer/wine
cities emerge,state regulation of private behavior begins
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medieval era
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alcohol safer than h20
linked to islam
capitalism orient to future
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coffee and hemp
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coffee linked with revolution in 1600s
hemp grown in colonies
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bayer 1800-1905
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cocaine toothache drops
heroin cough sedative
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Harrison act
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began as a tax law
restricted entry to ports and mandated paper trails
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Willam Randolph Hearst
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newspaper magnate
anti-Mexican sentiments
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Harry J. Anslinger (pot)
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-commissioner of US bureau of narcotics
-1937- violence (gore files)
-1948- a motivational syndrome
-"the primary reason to outlaw marijuana is its effect on the degenerate races" 1937
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1951 Boggs Act
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Established mandatory minimum sentences for controlled substances.
Didn't work.
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4 Nasty Facts About the US
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1. Highest Crime Rate
2. Highest Imprisonment Rate (Disproportionate in # of minorities)
3. Prison populations increased 4x since 1980 (35% due to drug war)
4. 4.1 decrease in users
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deterrence: crime control policy
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Severity is easily legislated but can only incapacitate.
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War Mentality
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•“Us versus them” = absolute good versus absolute evil justifies force-Evil originates in the enemy, not “us”
•Emphasizes power & unity of the whole (society)
•Any means are justified to achieve our ends
oThe enemy is more evil than any ethical violation we may “need” to commit.
•Discussion of “causes”avoided: Doubters = traitors
•Victory required for safety, satisfaction
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drug war goals
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curtail use/protect youth
reduce drug related crime, public health expenses
enforce morality/set boundaries
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use vs addiction
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use rooted in psycho-social factors
addiction in bio-psychological ones
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use & addiction
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most users never become addicts
biology,family of origin predict addiction
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drive to alter Consciousness
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use & addiction
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Self- Medication
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Use of tobacco, alcohol, or other drugs to soothe emotional reactions to stress
substance or act used to change brain functions
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compulsive behavoir
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repeated despite expectation of consequences
provide some sort of comfort
often have premeditated components
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Impulsive Behaviors
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1. Acting before thinking - don't think about consequences
2. Emotional, reactive
3. May lead to or result from use
4. Involves habit
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Moral-Temperance Model
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Addiction results from evil.
User is weak, criminal, sinful (moral)
Some substances are inherently evil (temperance)
Critical to policy, public opinion
Justifies criminalization,drug war-especially targeting users over addicts.
Basis of law matches the legal system.
Most misguided policy.
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Disease Model
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Addiction is primary , chronic, and progressive disease, probably caused by genetic predisposition
~abstinence is only means of recovery
~recovery means (have not used)
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medicalization
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assets:
explains irrational behavior
encourages treatment-seeking
relieves addicts and family's guilt
problems:
infers consistent symptoms, causes and consequences
relieves user of responsibility
treatment-growth will pwr and social support
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Free Will vs Determinism
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law presumes all people are equally able to make rational choices (equal under law)
medicalization of deviance (drug the problem)
step towards better understanding and greater compassion (confront addiction)
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Substance abuse disorder (SAD) defined in DSM-V
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maladaptive pattern of use leading to clinically significant impairment or distress
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Addictive Experience
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1. Post-use distress is worse than pre-use (guilt)
2. Critical roles are impaired
3. Crowds out sources of joy
4. More anticipation and excitement rather than contentment
Better in the short run (quick fix) but worse in long run - less able to experience happiness, more prone to sadness.
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epigenetics |
the way the environment influences the expression of a gene
THE AFFECTED EPIGENOME IS PASSED DOWN TO THENEXT GENERATION.
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What are the roots of addiction?
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Genetics and family of origin.
-Genetics: Dopamine reactivity, epigenetics, and self-medication issues.
-Family of origin influences (esp 1st 4-6 years of life): Beliefs about self and others, coping abilities.
-Peers, media, critical for use and not addiction.
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Addiction Threshold
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Point at which use becomes compulsive (via genetics, epigenetics, metabolism).
Reached via biology, biography (what you have experienced), and use
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Limbic-Prefrontal Interaction
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1. Limbic has desire/emotion
2. Prefrontal either inhibits or plans
3. Distress can start in the limbic or the prefrontal (thoughts)
4. Prefrontal searches the environment, memory for the cause of distress and the solution.
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individual are unique in:
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size,activity level and developmental sophistication of different brain areas
level of production and consumption of particular chemicals in various brain areas
number, distribution and shape of receptors for various chemicals in particular brain areas
(same factors that predispose a person to addiction)
|
dopamine |
encodes desire for pleasure guides stress reactions attention movement
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endorphins
|
pain medication, intestinal contraction (opiates, nicotine)
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serotonin |
IMPULSE CONTROL MOOD SLEEP SENSORY PERCEPTION
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Abuse Predictors (All Drugs)
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Impulsivity/Under Controlled Sensation Seekers.
Family of origin>Epigenetics & Assumtions about self and others that guide perception and action.
Sensitivity to a drug (impact Varies)
Over half of causal factors inherited.
Low frontal, high limbic, even as an adult.
Over half of addiction risk is genetic.
Being over sensitive or under sensitive to a drug matters.
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TISSUE DEPENDENCE
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TISSUES AND ORGANS OF THE BODY COME TO DEPEND ON THE DRUG TO STAY IN BALANCE
DESENSITIZATION OCCURS AND NEW LEVELS OF BRAIN/BODY FUNCTION COME TO BE THE NORM
SUDDEN CHANGES CREATE PAINFUL WITHDRAWS
(ALCOHOL, TRANQUILIZERS, OPIATES)
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Brain reorganization
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alteration of motivational pathways and related biochemistry
reward, learning, and bonding systems are hijacked/modifies
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Brain Disease or neural reorganization
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brain networks are always changing to adapt to internal and external circumstances
limbic- prefrontal paths convey survival needs, basic drives
abnormally pwr path,
enough pwr to imbalance paths or reward seeking
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What are the hallmarks of addiction?
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Tolerance and motivational toxicity.
Tolerance: dose must increase to achieve same effects. (desensualization).
Motivational toxicity: reduction of non-drug related motivations & ethics.(creates a cycle of guilt).
Ability to perform critical role decisions
Reliant on use to manage emotions.
Excessive amounts of time given to obtaining, using, and recovering.
|
assumptions of addiction
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assumptions about ourselves others and the world acquired early in life
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entitlements
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felt to be deserved or expected
conscious or non-conscious
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list central nervous system depressants
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alcohol opiates tranquilizers tissue dependence and brain reorganization
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alcohol effects on the brain
|
gaba-judgement,inhibition
dopamine-reward seeking
endorphin-sence of bliss,well-being
serotonin-serenity
glutamate-learning
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World Alcohol Use Rates
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Russia and Europe are the worst
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World Alcohol Use Rates
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Stimulation & sedation. They are a part of metabolization.
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alcohol tissue dependency
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tissue dependence in 6-8 weeks
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polydrug abuse
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misuse of more than 1 drug at a time
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binge drinking
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episodic intake of five or more alcoholic beverages for men or four or more drinks for women.
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alcohol binge effects
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alcohol poisoning=overdose
more common than alcoholism
impacts brain development
(impacts brain development, smaller hippocampus and lower brain activity
increases probability of later life alcoholism
linked to depression (women)
|
How does alcohol uniquely impact women and children?
|
Women get a higher blood level faster due to fat content, body size, hormones, and stomach enzymes
Children may suffer from fetal alcohol syndrome, symptoms include brain damage, central nervous system dysfunctions, lower IQ, poor motor skills and hand eye coordination, behavioral and learning problems
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current epidemic in addiction
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pain pills
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opiates effects
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very rapid tolerance, tissue dependency, little tissue damage
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symptoms of heroin
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appetite/digestion slowed digestion
histamine release (runny nose, itching)
small pupils, slow response to light
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Severity of withdrawal symptoms is predicted by...
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Dosage
frequency of use (ritual)
User expectations
set and setting
Fear delays de-tox, increases size of habit, crime
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What are the Pharmaceutical Therapeutics?
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Methodone (blocks other opiates, agonist, addictive, synthetic opiate.
Naltrexone is an Antagonist
Buprenorphine comfortable de-tox over 6 weeks. (partial antaginist; partial agonist. Occupies receptors with little psychoactive impact.
Suboxyn=naloxone(blocks) + buprenorphine (reduces cravings). It blocks the end of effects, so you can't get high.
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What are the Pharmaceutical Therapeutics?
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sedative-euphoriant and hormonal properties
popular w/body builders for steroid like effects
recreational dose is very close to OD level
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Minor Tranquilizers: benzodiazepines
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drugs taken to reduce anxiety or tension
(xanax)
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Rohypnol |
Benzodiazepine also called "date rape drug"
10x's more powerful than Valium and causes some memory loss
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Hallucinogens
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Create profound perceptual distortions, alter mood, and affect thinking. Examples are LSD and marijuana.
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Tryptamine psychedelics
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-preferred by recreational users
-LSD, DMT, Rave drugs
-some toad skins contain DMT
-sold as tablets or small "blotter" paper
-serotonin agonists
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synesthesia |
stimulation of one sensory organ results in an experience in another sense (seeing music)
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Entheogen |
Drugs thought to create religious experiences
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phenylethylamines
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stimulate and hallucinogenic effects
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empathogen |
heightens sense of empathy
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entactogen |
sense of touch
effect of ecstacy
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tryptamine vs phenylethylamines
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: rave drugs, OD not fatal but can lead to psychosis (flashbacks)
OD fatal, stimulant and psychedelic effects
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How does tissue dependence differ from “brain disease/Reorganization in terms of drugs involved, brain areas affected and sym
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impacts mainly the body’s routine functions as it renorms the functions of the mid/limbic and lower brain that control these functions (e.g. breathe, digestion). Sudden cessation of use produces relatively extreme withdrawals. TD occurs with alco
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• How does Boundary setting differ from status politics? Be sure to define BOTH concepts. 3 points
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Use of behavioral choices to determine group membership, especially between “in-group” and outcasts; a routine function of all societies
: Use of law and norms guiding particular behaviors to control minorities in a
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: How do 1:tryptamines differ from 2:phenylethyamines in terms of 1) effects on user, 2) dangerousness?
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: How do 1:tryptamines differ from 2:phenylethyamines in terms of 1) effects on user, 2) dangerousness?
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What does the term “entitlement” mean when used to refer to addict perceptions?
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this is what a person wants, deserves or expects (plans on) occurring based on her/his desires/ needs of the moment, generally suggesting that the person should get special treatment when none is normally expected. Failure to examine the rationality of entitlements makes people/addicts appear very ungrateful and demanding, as tho they are always asking for more.
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What is a rebound effect? Give two examples. What drugs are usually involved in the rebound effect?
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Symptoms the opposite of those produced by the drug occur after euphoria fades as body rebalances. Includes hangovers and withdrawal; addiction unnecessary. ALL euphoriants have these effects
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What is a “synergistic reaction”? What drugs are usually involved in synergistic reactions?
II.
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The exponential effect of mixing two CNS depressants which usually produces a super high but can result in seizure disorders or death.
Opiates, Alcohol, tranquilizers/depressants antihistamines.
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endorphins defn:
|
pain blockers that provide a sense of well-being and also control intestinal functions affecting nutrition. Opiates, alcohol & nicotine are agonists (sugars also
|
salvia
|
very brief high
|
ecstasy |
more socially aggressive, heightens sexual experience, tranquility, users crave touch
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ecstasy dangers
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overheating of brain and dehydration can kill
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Current Hallucinogenic Research
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Psilocybin - spirituality (person became more open), death anxiety
Ketamine - Depression relief
Ecstasy - PTSD (changes fear chemical -> changes memory)
Mescaline - Spirituality
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symptoms of cannabis
|
relax, eat sleep forget and protect
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symptoms of cannabis
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memory impairment
slowed motor responses
lowers motivation for complex tasks, violence |
inhalants |
solvents-paint, glue massive damage to brain, organs
nitrates (poppers)-sex industry
refrigerants (freon)- potentially fatal)
formaldehyde (embalming fluid) -bizarre behavior
anesthetics (nitrous-oxide-laughing gas)
|
List of stimulants
|
-Cocaine
-Amphetamines
bath salts
-Nicotine
methamphetamine
|
Cocaine |
Type: stimulant
Pleasurable Effects: rush of euphoria, confidence, energy
Adverse Effects: cardiovascular stress, suspiciousness, depressive crash
|
cocain toxity
|
Type: stimulant
Pleasurable Effects: rush of euphoria, confidence, energy
Adverse Effects: cardiovascular stress, suspiciousness, depressive crash
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cocaine control loss predictors/causes
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Escalation of use predicts loss of control
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crack effects/racial groups
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Escalation of use predicts loss of control
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methamphetamine
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aka: meth, crystal, crank
last longer than cocaine
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meth effects:
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weight loss, tremors and tooth grinding
repetivitve action and picking at face
hostility, panic, paranoia
reduced pleasure,
5lbs of toxins for each lb of meth
|
meth withdrawls and group preferral
|
30% more time to recover
(anglo drug)
common in tx. (last 6-12 hrs)
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Stimulant Addictiveness
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Speed in entering brain
Distribution within brain
Meth distributed thru-out brian
Amount of dopamine elicited
speed in clearing (exiting) brain
Meth lingers longer than coke
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bath salts
|
aura, ivory wave, loco-motion, vanilla sky
high risk for OD
|
nicotine addictive mechanism
|
Brain Reorganization as with speed, coke
1.DA, NE released – dopamine depleted
¡Nerves frizzle – less able to feel pleasure
|
nicotine addictive mechanisms creates:
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new acetylcholine receptors:
¡These require stimulation
¡Are partly deactivated by use
1st use sets up hippocampal “memory trace” use recalled as a pleasurable experience
Boosts the desire to repeat use
|
us recreational drugs dependence rates
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32%: tobacco
23% heroin
17% cocaine
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prenatal effects of nicotine
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thinner, lighter brain, all measurable forms of intelligence drop, respiratory problems
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Dopamine-Releasing Behaviors
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1. Food (Bulimia/Binging)
2. Relationships (Codependency)
3. Gambling
4. Sex
5. Cults
6. Performance (Workaholism)
7. Collection/Accumulation (Shopping)
8. Aggression/Rage/Violence
9. Media/Entertainment
|
process addictions
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—Activity or process
—Compulsive repetition of mood-altering behaviors, such as eating disorders, gambling, sexual activity, overwork, and shopping.
—Not universally accepted as distinct disorders
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Workaholism
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1. Job central to identity/self-esteem (job is master status)
2. Health, relationships, spirit. neglected
3. Postpone rest and vacations
4. Takes on extra work
5. Perfectionism --> overly busy
6. Use of work to avoid intimacy
7. Effect to control via job role (control of family)
8. Work-related perspective used in all areas of life
|
burn-out
|
—Emotional Exhaustion and reduced sense of personal accomplishment diminished interest.
—Cynical view of clients
—
Feelings of helplessness, hopelessness & resentment.
—
Distinct from high Stress: feeling empty, devoid of motivation, and beyond caring
|
1: stress vs 2: burn-out
|
1:
—Over engagement
—Over reactive Emotions
—Urgency & hyperactivity
—Loss of energy
—Anxiety disorders
2:
—Disengagement
—Emotionally detached
—Helplessness & hopelessness
—Loss of motivation, ideals & hope
—Depression
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difference in damage between 1: stress and 2: burn-out
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biological damage
and
emotional damage
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compare sex addicts with sex offenders
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most are abuse victims
30% treated are women
(women under represented)
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Key Traits of Sexual addiction
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Out-of-control ; Compulsive
Obsessed - Neglect of other activities for sex
Inordinate amount of resources/time spent on sex & recovery
Sex/fantasy are main coping mechanism
Increasing # of sexual experiences
Mood changes with sexual activity
Feels degraded, guilty afterwards
|
3 levels of sex addiction
|
level one- normal accepted behavior (low police priority
harmless, minor crimes, obscene calls
serious harm and severe consequences (public outrage, incest, rape)
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Precursors to Sex Addiction
|
1. Early use of sexual pleasure to escape pain (usually by accident)
2. Shame regarding activities (esp. in teens)
3. Ritualization of settings, preparations (onset to compulsivity)
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Core Beliefs of a sex addict
|
"I am basically a bad, unworthy person."
"No one would love me as I am."
"My needs will never be met if I have to depend on others."
"Sex is my most important need."
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double bind
|
contradictory demands require a person to violate one rule to follow another
|
suds |
seemingly unimportant decisions
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psychobiology
|
fantasy may overwhelm reality of perceptions.
tolerance and withdrawal
sub other addictions or shame reducing activities during remorse pd.
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types of gamblers
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risk takers-thrill seeking
gamble w/others_-seek competition
self-med- gamble to feel numb
prefer isolated games- slots, bingo online poker
|
Four stages of problem gambling
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a. Winning
b. Losing
c. Desperation
Hopelessness
|
social networking for gambline
|
appears to support for emotional health and social life
deepen previous mental-emotional issues
companion sub.
instant response
|
eating disorders
|
—Not clearly an addiction
—Anorexia
—Bulimia
—Compulsive overeating/carb craving
—Sufferers often OCD, perfectionists,
—Serotonin implicated
Most lethal of all mental disorders
|
anorexia |
Lack of appetite or desire to eat
|
Bulimia |
An eating disorder characterized by binges on large quantities of food, followed by purges of the food through vomiting or the use of laxatives.
|
Compulsive Eating
|
Eating disorder characterized by uncontrollable binge eating
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What disease (eating disorder) has the highest premature fatality rate of any mental illness?
|
anorexia nervosa
|
Chemical Dependency vs. Process Addiction
|
Most process addicts have pre-existing mental disorders
A small portion of chemical dependents have diagnosis prior to onset of abuse
Process addictions grade off into bad habits
|
eating disorders lethal?
|
most lethal of all mental disorders
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what treatment works
|
length
cognitive therapy
self-awareness/monitoring
spirituality
|
cognitive therapy?
|
decision-making processes examined and irrational beliefs challenged
|
Minnesota model
|
Emerged at Hazelden in 1949 as a reaction to the reigning moral approach
Alcoholism/Addiction is a multiphasic illness with physical, mental &spiritual aspects
|
12 Step Groups (AA, NA)
|
-Most widely used
-High success rate
-Support, meetings, change addictive thinking/behavior
|
Spiritual Model
|
AA and 12 Steps
Relapse=sin or loss of contact with God
Person responsible for addiction but not responsible for changing it
|
anonymity |
avoids discrimination, promotes focus on length of sobriety, ability to serve others
|
focus of cbt
|
•Focus: Current, Conscious Thoughts & Choices
|
goals of cbt
|
Challenge and replace irrational assumptions/beliefs about self, others and the world that support/cause the self-talk that leads to irresponsible actions
|
Responsible Actions
|
1. Meets one's own needs (takes self-awareness)
2. Without interfering with others' efforts to meet theirs
|
how a addiction remains functional to an addict
|
Avoid, distract or substitute
|
1: assets and 2: liabilities for addiction
|
1:
•Well-researched,
•supports wide variety of trtmts
•Here & now
•1 symptom stressed
2:
•Narrow focus on observable problems
•Ignores past life, unconscious
|
confrontation
|
Direct feedback regarding client’s behavior/beliefs
An appeal for honesty with self and others
An appeal for responsible behavior
Ranges from polite assertion to adversarial attacks
Alternates with support
May create defensiveness, close communication
|
Motivational Interviewing
|
•Let client’s goals, ethics guide therapy
▫i.e., client centered
•Create dissonance between client’s actions & client’s goals/values
•Move client slowly from denial to treatment-seeking on client’s terms
•Best with client’s with the fewest, least serious issues
•Keep client positive about therapy
•Stress power to choose
|
stages of recovery
|
1.Precontemplation. Denies that a problem exists.
2.Contemplation. A plan is made to change.
3.Preparation. Setting a quit date.
4.Action. An enormous commitment.
5.Maintenance. Focused to avoid relapse.
6.Termination. The problem no longer exists.
|
eeg biofeedback
|
•Usually based on brain maps
•Desired patterns of electrical activity rewarded with video, audio
•High efficacy rates (60-90%)
•30 + sessions required,@ 3 per week
▫Costly, time consuming, requires commitment
|
spirituality
|
linked to long term recovery
distinct from religion
required to except in power greater than oneself
addiction is loss of contact w/ AA members
|
pharmaceutical therapies
|
no magic bullets
blockers, subs, reduce cravings, relieve rebound, create adverse reaction, address co-morbid Dx's
|
Discipline/ Parenting Patterns
|
•Authoritative- high control, high support
•Authoritarian: high control, low support
•Permissive: low control, high support
•Neglectful: low control, low support
|
Troubled Family
|
Inconsistent
Unpredictable & out of control
Cold, hostile source of unreasonable demands
Unstable, emotionally and/or physically dangerous
|
Malevolence Assumption
|
Evil begets evil, bad kid ↔ bad family
Social or personal pathology as root cause
Common view in treatment
|
enabling |
attempts to rescue
feels guilt over addiction
attempts to control addict
|
2 Views of Family Impacts on Social/Behavioral Problems
|
1. Malevolence Assumption
2. Loss of family power as a latent function of progress
|
how does family modifies genetic predisposition affects behavior choices
|
Time horizon: capacity to consider future impacts of current choices
1.Ability to link means & outcomes, acts & consequences (vs. fatalism)
|
Children's Adaptive Roles
|
Personalities form in attempts to stabilize environment***
Seeks safety, normality
Behavior patterns that may predispose to abuse, neurosis, crime
Make adult mental health treatment more difficult
Predicted by
innate traits of child
location in family (birth order)
|
what a child needs to know it:
|
—Disease concept
◦Relieve guilt, promote understanding, appropriate perception of addict
—Blackouts
◦Explains many broken promises, reframes incidents that diminish child's sense of self-worth, importance
—Personality Changes
—Limbic/addicted parent vs. “regular” parent
—Enabling
—Relapse
|
Emotional Rules of AODA Households
|
Behavior-perception patterns common in addicts & their children
Increases probability of self-medication
Emotional dysfunction
Poor coping abilities
A “set up” for later addiction/compulsivity
|
do not talk about it:
|
—Denial
—Secrecy
—Poor interpersonal communication skills
—Excuse-making
|
dont trust anyone
|
—Unpredictable parental behavior, co-alcoholic also
◦Broken promises
—Embarrassment & insecurity
—Mixed messages
|
dont feel
|
Deny emotions
Further destabilization
|
families always need to be included in recovery:
|
vPersonalities have formed
vFamily members see themselves as non-pathological but survival in a pathological situation assures that they too have issues
vExpect fear, anger-resentment, guilt, manipulation
vPatterns of interaction, coping & power must change
|
The Post-Treatment Family
|
-Expect fear, anger-resentment, guilt, manipulativeness
-Children & spouse have had much responsibility AND POWER
-Return of addict threatens this
-Family interaction patterns organized around the addiction
-Family loses this with recovery
|
5 brain function affect by dopamine?
|
stress
pleasure
time
focus/salience
movement
|