Lesson 10: Community Mental Health Problems: Substance Abuse


Attention

With no exceptions, since the publication of the first Diagnostic and Statistical Manual, DSM-I, 1952, the American Psychiatric Association, the category for diagnosis and classification of substance related disorders has grown and expanded exponentially compared to any other clinical concern.

Your textbook divides this area into nine major categories. At best, this is a shadow of the range and variety of substances with potential for abuse in human history. Oliver Sacks' latest book, "Hallucinations,' 2012, scratches the surface as well. However, the surprise is the extent and duration of HIS use of various substances to alter awarness and experience!!!

He could never have revealed this at the start of his career. It would have derariled his credibility as a physician and specialist in neurology. Another famous neurologist too, was dependent on substances of abuse, cocaine, and nicotine!!! Do you know who???

Hint: Not ME!!!!


Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Differentiate between the terms substance abuse, addiction, tolerance, and dependence.
  • Analyze the role of mental health professionals in working with substance abusers.
  • Define how community mental health professionals can asisist with nicotine/substance cessation.

Teaching

Reading

  • Lunder Library has two sets of DVD's on addiction, in addition to accompanying textbook for use by students. One is on reserve, my set on loan to the library, the other in general circulation. Important viewing. Brings you up-close and personal with topic. It is simply not possible that you don't know somebody who has an addiction problem. It may well be you. Treatable, BUT, probably not subject to cure currently.

Lecture

During holiday seasons, social get togethers, meeting friends to dine out, routinely an offer of some beverage is made. Rarely is it alcohol FREE. If you decline a drink, it may well raise questions about "why not?' You could say you are designated driver, or, on a medication for which alcohol is a no-no. However, if you identify an issue with alcohol that involves abuse or dependance, you have entered an entirely different realm.

On July 4th, 2013, in the town to which I reside next to, a car went into a turn in the road posted for 30 mph. Car was estimated to be travelling at 93 mph. I know that road very well. Impossible to make turn at that speed. Hit telephone pole. Car literally wrapped around pole, and split pole. First responders initially believed all occupants were dead!

One occupant died, two others injured, one severely. Sheriff Trafton said that it was the worst accident he had ever seen. Remember, that is coming from someone who sees more accidents than you would ever want to understand and reconstruct. Alcohol was in the driver's system. A life-changing event, all around.

The enemy is at hand, and it is yours to defeat at will.

Not really, the enemy is at hand, but it is craving, produced by the brain's interpetation by exposure and habituation to substanes of abuse. Anna Rose Childress, Universiy of Pennsylvania, may well be the first and only clinial health professional in the area of substance abuse to actually IMAGE craving. She does this by showing with PET scan technology, area(s) of the brain the respond to cues of substance contact, not actual intoxication, in patients being treated for drug related problems.

You know that a certain percentage of blood by volume. anywhere between .06 and above may give rise to impairment while driving. In an era of legalization for medical, and, in some jurisdictions, recreational use of marijuana, a standard for impairment has also been necessitated. At least in Colorado, 5 or more nanograms of per mililiter of blood constitutes impairment for driving an automobile. A nanogram is a billionth of a gram!!!!

Power-drinks, so called enery boosters, are highly concentrated beverages with caffeine and sugar(s), that can stimulate metabolism. Coffee, average 8 ounce cup, might contain 150 to 250 milligrams of caffeine. While over-dosing on coffee does not seem likely, believe it or not, 100 cups, which will introduce 10,000 milligrams of caffeine to the body, and can resullt in death. It will so over-stimulate the nervous system, that the attempt to re-balance the dynamics results in a"backlash" effect, and can give rise to shutting down cardiopulmonary function!

Apparently "sudden" deaths for drug use, usually heroin, or cocaine, have been documented. But the kill-factor is not quantity or quality of drug. It is location. Drug use off-site of regular exposure use can represent a new physical and METABOLIC challenge for the body, to which previous tolerance does NOT apply. Formula for disaster.

I know you wouldn't eat food that has fallen to the floor, without first considering if it has been compromised by dirt, dust, etc. BUT ingesting drugs purchased on the street, represents a quantum leap of faith. Purity, concentration, contamination- all unknowns.

Even the medicial marijuana dispensaries aren't certain of strength for available THC. It can range from as low as 2%, to as potent as 20%. The latter, unless the individual knew what to expect, and could handle "high," will land them in an emergency room of hospital having a panic attack. Really! Not fun for anyone in this situation.

We are now actively studying risk factors for drugs and alcohol starting with childhood. Family dynamics, and, heredity cross here very strongly. High-tolerance to alcohol, i.e., it takes a great deal to feel intoxicated, and, a family history of alcoholism puts individual here in double jeopardy. Other drugs will eventually be understood better through this dual lens of the nature/nurture paradigm.


Assessment

Lesson 10 Quiz

  1. List and discuss the impact of substance abuse on the brain, the body, the family, the community in the mental health enterprise.
  2. Explain and discuss the withdrawal process. This is at the very heart of treatment, and recovery. It starts with detoxification, but, must extend to socio-emotional rehabilitation as well.

Lesson 10 Discussion A

Consider the legal and medical implictions for marijuana prescription. Do you know what marijuana may help in terms of medical usage? Consider also that fact that the federal government still considers marijuana to have NO MEDICNAL value, and as such classifies it as a Class One controlled substance!!!

Lesson 10 Discussion B

Listen in on a few segments of Addiction Talk Radio and comment on what you have learned.

Addiction Talk Radio is an app that allows you to review and listen to several shows.