Monash University-2009 Alcohol and Other Drugs

1. Monash University-2009Alcohol and Other Drugs Presenter: Effie Moraitis Senior Clinician

2. Topics covered today: • 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

3. Making sense of AOD issues: • What is a drug? Who uses drugs? • Theoretical models of drug use • Harm minimisation • Dependency, tolerance and withdrawal • Patterns of drug use

4. 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” (Krivanek 1995 p 2)

5. Who Uses Drugs? • 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?

6. Theoretical Models of drug use: • Moral Model Key assumption: using drugs is morally wrong and anti-social Intervention: spiritual direction, gaol, providing an environment that promotes pro-social values

7. Theoretical Models of drug use: • 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

8. 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.

9. Theoretical Models of drug use: • 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

10. Theoretical Models of drug use: • 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

11. Harm minimisation approach: • 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

12. National Drug Strategic Framework: • The National Drug Strategy focuses on three core elements of harm reduction - demand reduction (prevention) - supply reduction (law enforcement) - harm reduction (education, information

13. 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.

14. 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

15. 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

16. Patterns of consumption and types of drug use: • Controlled use • Experimental use • Social / recreational use • Circumstantial use / situational • Intensive use • Dependency

17. Drug Classifications: Drugs are often classified in two ways: • Legal status • Central nervous system effects Classifications: Depressants Stimulants Hallucinogens

18. An AOD assessment: What are some important points to cover in an AOD assessment?

19. Assessment – some points: • 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

20. Stages of Change Model: • 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.

21. Six stage model: • Pre-contemplative stage • Person does not see they have a problem • Contemplative stage • Person is weighing up cost / benefits to change • Preparation stage • Person is preparing to change • Action stage • Person is actively pursuing change • Maintenance stage • Person is maintaining the change • Relapse stage • Person returns to previous levels of drug use

22. Alcohol: What is it? • 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

23. Side Effects • 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.

24. 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…

25. Neurological side effects con’t. • 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

26. Effects of alcohol on the body • 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..

27. Effects con’t • 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?

28. Effects con’t • 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.

29. Effects con’t • 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

30. Chronic Alcohol Consumption • 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.

31. 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.

32. 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.

33. Withdrawal Symptoms of Alcohol • Sweating, facial flushing • Tremors • Agitation • Palpitations, hypertension • Poor appetite, nausea, vomiting, diarrhoea • Poor sleep, anxiety • Cravings, strong desire to drink • Poor concentration • Headaches

34. More Serious Symptoms • Severe hypertension • Seizures • Hallucinations, delirium • Arrhythmias • Precipitation/ exacerbation of underlying medical or psychiatric disorders • Mood swings

35. Illnesses caused by alcohol • Sleep and sexual disorders • Psoriasis of the liver • Psychotic and mood disorders • Foetal Alcohol Syndrome • Depression • Heart failure • Wernicke-Korsakoff Syndrome

36. 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.

37. The Classification All forms of marijuana are mind-altering. In other words, they change how the brain works. They all contain THC (delta-9-tetrahydrocannabinol), 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.

38. Effects of Marijuana • 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

39. Effects of Marijuana con’t • Anxiety, panic attacks, and paranoia • Hallucinations/Delusions • Damage to the respiratory, reproductive, and immune systems • Increased risk of cancer • Psychological dependency

40. Neurological Effects of Marijuana • When someone smokes Marijuana, THC rapidly passes through the bloodstream. • This carries the chemical to organs throughout the body, including the brain

41. 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

42. 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.

43. 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 short-term 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.

44. 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.

45. 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.

46. Withdrawal Symptoms of Marijuana • Anxiety, agitation, restlessness, irritability • Nausea • Dysphoria, lethargy • Cravings, strong desire to use • Sleep disturbances (including vivid dreams, nightmares, insomnia) • Sweating • Headaches • Mood disturbances

47. 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.

48. 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…

49. 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).

50. 24/7 Services • 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.