Volume B: Psychosocial Treatment Interventions

1. Volume B: Psychosocial Treatment Interventions Treatnet Training Volume B: Module 1 – Updated 24 January 2007

3. Module 1: Drug Addiction and Basic Counselling Skills

4. Module 1: Training goals • Increase knowledge of the biology of drug addiction, principles of treatment, and basic counselling strategies. • Increase skills in basic counselling strategies for substance abuse treatment. • Increase application of basic counselling skills for substance abuse treatment activities.

5. Module 1: Workshops Workshop 1: Biology of Drug Addiction Workshop 2: Principles of Addiction Treatment Workshop 3: Basic Counselling Skills for Drug Abuse Treatment Workshop 4: Special Considerations when Involving Families in Drug Abuse Treatment

6. Icebreaker: If I were the President If you were the President (King, etc.) of your country, what 3 things would you change related to drug policies, treatment, and/or prevention? 15 minutes

7. Workshop 1: Biology of Drug Addiction Source: NIDA (www.projectcork.org)

8. Pre-assessment Please respond to the pre-assessment questions in your workbook. (Your responses are strictly confidential.) 10 minutes

9. Training objectives At the end of this workshop you will be able to: • Understand the reasons people start drug use. • Identify 3 main defining properties of drug addiction • Identify 3 important concepts in addiction • Understand characteristics and effects of major classes of psychoactive substances • Understand why many people dependent on drugs frequently require treatment

10. Introduction

11. What are psychoactive drugs? (1) “…Any chemical substance which, when taken into the body, alters its function physically and/or psychologically....” (WHO, 1989) “…any substance people consider to be a drug, with the understanding that this will change from culture to culture and from time to time.” (Krivanek, 1982) (National Centre for Education and Training on Addiction [NCETA; Australia], 2004)

12. What are psychoactive drugs? (2) Achieve effects by interacting with the central nervous system (CNS) affecting: • mental processes and behaviour • perceptions of reality • level of alertness, response time, and perception of the world (Carmichael, 2001) (NCETA, 2004)

13. Why do people initiate drug use? (1) Much, if not most, drug use is motivated (at least initially) by the pursuit of pleasure. (NCETA, 2004)

14. Why do people initiate drug use? (2) Key Motivators • Fun (pleasure) • Forget (pain amelioration) • Functional (purposeful) (NCETA, 2004) Also initiation starts through: • Experimental use • Peer pressure

15. Why do people initiate drug use? (3) When a person first tries drugs, it is usually a voluntary decision, but… After repeated drug use, deciding to use drugs is no longer voluntary because DRUGS CHANGE THE BRAIN!

16. What is Addiction?

17. What is drug addiction? Drug addiction is a complex illness characterised by compulsive, and at times, uncontrollable drug craving, seeking, and use that persist even in the face of extremely negative consequences. (U.S. National Institute on Drug Abuse [NIDA], 1999)

18. Characteristics of addiction • Compulsive behaviour • Behaviour is reinforcing (rewarding or pleasurable) • Loss of control in limiting intake Source: www.projectcork.org

19. Important terminology • Psychological craving • Tolerance • Withdrawal symptoms

20. Psychological craving Psychological craving is a strong desire or urge to use drugs. Cravings are most apparent during drug withdrawal.

21. Tolerance A state in which a person no longer responds to a drug as they did before, and a higher dose is required to achieve the same effect.

22. Withdrawal When a drug is removed, physical and/or mental disturbances that may include: • Tremors, chills • Cramps • Emotional problems • Cognitive and attention deficits • Hallucinations • Convulsions • Death

23. Drug Categories

24. Classifying psychoactive drugs Adapted from NCETA (2004)

25. Alcohol

26. Alcohol: Basic facts (1) Description: Ethylalcohol (ethanol) present in varying amounts in beer, wine, and liquors. Route of administration: Oral Acute Effects: Sedation, euphoria, lower heart rate and respiration, slowed reaction time, impaired coordination, coma, death.

27. Alcohol: Basic facts (2) Withdrawal Symptoms: • Tremors, chills • Cramps • Hallucinations • Convulsions • Delirium tremens • Death

28. Long-term effects of alcohol use • Decrease in blood cells leading to anemia, disease, and slow-healing wounds • Brain damage, loss of memory, blackouts, poor vision, slurred speech, and decrease in motor control • Increased risk for cancer, especially liver, esophagus, throat, and larynx • Increased risk of high blood pressure, hardening of arteries, and heart disease • Liver cirrhosis, jaundice, and diabetes • Immune system dysfunction • Stomach ulcers, hemorrhaging, and gastritis • Ulcers in the small intestines • Thiamine (and other) deficiencies • Testicular and ovarian atrophy • Harm to a fetus during pregnancy

29. Tobacco

30. Tobacco: Basic facts (1) Description: Nicotine derived from the tobacco plant plus more than 4,000 chemicals and a dozen gases (mainly carbon monoxide) are in tobacco products. Route of administration: Smoking, chewing Acute Effects: Pleasure; relaxation; concentration; release of glucose; increased blood pressure, respiration, and heart rate.

31. Tobacco: Basic facts (2) Withdrawal Symptoms • Cognitive/attention deficits • Sleep disturbance • Increased appetite • Anger • Hostility • Aggression • Slow regaining of emotional equilibrium

32. Long-term effects of tobacco use • Aneurysm • Cataracts • Cancer (lung and other types) • Chronic bronchitis • Emphysema • Asthma symptoms • Obstructive pulmonary diseases • Pneumonia • Heart disease (stroke, heart attack) • Vascular disease • Harm to a fetus during pregnancy • Low weight at birth • Sudden Death Syndrome (babies) • Death

33. Cannabinoids Marijuana Hashish

34. Cannabis: Basic facts (1) Description: THC is the active ingredient • Marijuana: tops and leaves of the plant Cannabis sativa, • Hashish: more concentrated resinous form of the plant • Hash oil: sticky black liquid Route of administration: • Smoked as a cigarette or in a pipe • Oral, brewed as a tea or mixed with food

35. Activity 1 Think of all the names for marijuana in your community and how this drug is consumed. Share your thoughts with the rest of the group.

36. Cannabis: Basic facts (2) Acute Effects: • Relaxation • Increased appetite • Dry mouth • Altered time sense • Bloodshot eyes • Reduced short-term memory • Increased blood pressure

37. Cannabis: Basic facts (3) Withdrawal Symptoms: • Insomnia • Restlessness • Loss of appetite • Irritability • Sweating • Tremors • Nausea • Diarrhea

38. Long-term effects of cannabis use • Increase in activation of stress-response system • brain damage, changes in dopamine levels • increased risk for cancer, especially lung, head, and neck • Respiratory illnesses (cough, phlegm) and lung infections • immune system dysfunction (bacterial infections and tumors) • harm to a fetus during pregnancy

39. Stimulants METHAMPHETAMINE CRACK COCAINE

40. Types of stimulant drugs (1) Amphetamine Type Stimulants (ATS) • Methamphetamine • Speed, Crystal, Ice, Yaba, Shabu • Amphetamine • Pharmaceutical products used for ADD and ADHD Methamphetamine half-life: 8-10 hours

41. Types of stimulant drugs (2) Cocaine • Powder cocaine (Hydrochloride salt) • Smokeable cocaine (crack, rock, freebase) Cocaine half-life: 1-2 hours

42. Activity 2 Think of all the names for cocaine and methamphetamine in your community and how these drugs are consumed. Share your thoughts with the rest of the group.

43. Stimulants: Basic facts (1) Description: A group of synthetic drugs (ATS) and plant-derived compounds (cocaine) that increase alertness and arousal by stimulating the central nervous system. Route of administration: Intravenous, intrarectal, intranasal, smoking, and oral.

44. Stimulants: Basic facts (2) Acute effects: • Euphoria • Rush or flash (extremely pleasurable) • Wakefulness, insomnia • Increased physical activity • Decreased appetite and extreme anorexia • Increased respiration • Hyperthermia • Irritability • Tremors, convulsions • Anxiety • Paranoia • Aggressiveness

45. Stimulants: Basic facts (3) Withdrawal Symptoms: • Dysphoric mood (sadness, anhedonia) • Fatigue • Insomnia or hypersomnia • Psychomotor agitation or retardation • Craving • Increased appetite • Vivid, unpleasant dreams

46. Long-term effects of stimulants • Strokes, seizures, and headaches • Depression, anxiety, irritability, anger • Memory loss, confusion, attention problems • Insomnia • Paranoia, auditory hallucinations, panic reactions • Suicidal ideation • Loss of sense of smell, nosebleeds, chronic runny nose, hoarseness, sinus infection • Dry mouth, burned lips • Worn teeth (due to grinding during intoxication) • Chest pain, cough, respiratory failure • Disturbances in heart rhythm and heart attack • Loss of libido • Malnourishment, weight loss, anorexia • Weakness, fatigue, tremors • Sweating, oily skin complexion

50. Meth use leads to severe tooth decay “Meth Mouth” (New York Times, June 11, 2005)