Lesson 10

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

When we start to think about the impact of substance abuse we have to understand that substance abuse can affect individuals with or without mental health issues, at any socioeconomic level and at any age.

Watch the following video that helps to explain co-occuring disorders. An individual with a co-occuring disorders refers to a person who is diagnosed with one or more mental health disorders and one or more substance abuse disorders.

There may be many clients you encounter in the field of mental health who also have a substance abuse disorder.

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.

Part of the cycle of substance use and abuse is the physiological cravings the substance creates in a person's body. Craving may be produced by the brain's interpretation due to exposure and the habitual use of the substance of abuse. Anna Rose Childress, from the University of Pennsylvania, may well be the first and only clinical 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 marijuana per milliliter of blood constitutes impairment for driving an automobile. A nanogram is a billionth of a gram!!!! As Maine explores the statewide legalization of marijuana I am hopeful that our lawmakers are also exploring ways to hold individuals accountable who choose to use and then drive on Maine roads.

Power-drinks, so called energy 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. Energy drinks are very popular with teenagers and college students. Here is an article about the facts and myths of the consumption of energy drinks and teenagers: http://www.caffeineinformer.com/is-energy-drink-overdose-in-teens-really-a-problem

In Maine we have a large number of individuals in our commuities being prescribed strong pain medications that have addictive qualities. Maine has a history of employing individuals into the fields of logging, manufacturing and other manual labor jobs. The incidence of a workplace injury is higher in states that have a lot of jobs that require physical labor. When an employee becomes injured in the workplace one of the treatments offered is prescripotion pain medication to dull the pain while the injury is healing. Due to the increased strength and addictive qualities of these medications the individuals taking them have a chance of becoming addicted to these medications. As a person's injury heals the doctor will begin to prescribe less or stop the prescription. This individual then starts to go through withdrawal, wanting the substance that is no longer available. A person may then turn to an alternative substance such as herion or to purchasing prescription medications from others.

A special commission was created to look at the drug problems in Maine. The following information is from the summary of the findings of that commission:

State Epidemiological Outcomes Workgroup (SEOW) Special Report: Heroin, Opioids, and Other Drugs in Maine

by Tim Diomede, MPPM - October 2015

Prescription drugs continue to represent a serious public health concern.
Prescription drug misuse also continues to have a large impact on treatment, mortality/morbidity, and crime in Maine.
Pharmaceutical drugs contribute to the majority of drug overdose deaths.
Lethal co-toxicants such as Benzodiazepines and Fentanyl require closer monitoring.
As the availability of prescription narcotics has leveled off, heroin use and the consequences thereof have been on the rise.
Somerset and Kennebec have persistently observed some of the highest rates for narcotics prescribed per person since 2008.
Based on arrest and treatment data, heroin use is most prevalent among the southern and coastal regions (specifically York, Cumberland, Androscoggin, Kennebec, and Knox).
Rates of heroin trafficking/sales (DEA) arrests are highest in the Midcoast region.
Opioid and heroin treatment is most common among 26 to 34 year olds.
Availability and accessibility of opioids continues to be a problem.
Co-occurring mental health and substance disorders are increasingly common among those seeking treatment.
It’s evident that there is a strong relationship between substance use and mental health.

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, ingredients are all unknowns. Even the medicinal 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 a high "high" would land them in a hospital emergency room. The fields of mental health and addiction studies are now actively studying risk factors for drug and alcohol use and abuse starting with childhood. Family dynamics and heredity are very strong factors in the incidence of substance abuse.

Consider the legal and medical implications for a prescription for medicinal marijuana use. Do you know what medicinal marijuana is used to treat? Research what are some of the medical uses for medicinal marijuana. Keep in mind that the Federal Government still considers marijuana to have no medicinal value and as a result still classifies marijuana as a Class One controlled substance. What are your thoughts about medicinal marijuana and why?