Substance Abuse: An Overview

1. Substance Abuse: An Overview Presenter: Gina Maiorano

2. Pre-Test • Take the pre-test. • Ask your supervisor for it!

3. Quick Facts: Families • Estimates suggest that 50 to 80% of all child abuse and neglect cases substantiated by CPS involve some degree of substance abuse by the parents. • Many chemically involved parents are sincere in their desire to meet their child’s needs but they are limited in their physical, financial, social and/or emotional abilities to do so. • (Department of Health & Human Services)

4. What is a Psychoactive Drug? • Psychoactive drugs are substances that directly affect the central nervous system and cause physical and mental changes. There are three factors that determine the effects and abuse potential: • Route of Administration • Speed of transit to the brain • Effects on nerve cells and neurotransmitters

5. Routes of Administration • There are 5 common ways that drugs enter the body. What are they? • Inhaling • Injecting • Mucous membrane absorption (snorted) • Oral ingestion • Contact absorption

6. Time • The route of administration dictates how long a substance takes to get to the brain. • Inhaling takes 7-10 seconds for the drug to reach the brain. So drugs such as marijuana or nitrous oxide reach the brain in that amount of time. This is the quickest method of use. • Injecting substances such as heroin, cocaine and methamphetamine can be injected through hypodermic needles. There are 3 methods of this: IV: “slamming” directly into the blood stream, (15-30 seconds) intramuscular: into a muscle mass and subcutaneous “skin popping” under the skin. (both 3-5 minutes) This is the most dangerous method because it bypasses many of the body’s natural defenses and exposes the user to various health problems such as hepatitis B/C, abscesses, HIV infection.

7. Pics of Heroin Abscess:

8. Time • Mucous Membrane Absorption is when a substance is snorted such as cocaine, heroin and methamphetamine or placed under the tongue. Effects are usually more intense and occur more quickly because the drug initially bypasses digestive acids, enzymes & liver. (3-5 minutes) • Oral Ingestion takes 20-30 minutes and occurs with drinking alcohol or swallowing tablets. The drug passes through the esophagus and stomach to the small intestine where its absorbed into the capillaries in the intestinal walls • Contact Absorption is when drugs are applied to the skin through saturated adhesive patches and is absorbed over a long period of time. Effects usually begin 1-2 days.

9. Origin of Drugs • Many drugs available today derive from psychoactive plants that have been around for millions of years. It has been estimated that 4,000 plants have psychoactive substances and about 60 are still actively used such as: opium, marijuana, coca, tea, betel, coffee, tobacco and plants that ferment into alcohol. • Different cultures use different substances in religious rituals and social rituals. But today, we are talking about ABUSE of these drugs.

10. What is Substance ABUSE? • There are several levels of use before a person is considered an abuser or addicted. Many doctors and treatment personnel argue that drug abuse and drug addiction are different levels. • In order to judge a person’s level of use it’s necessary to know the frequency and duration. • Abstinence: people do not use a psychoactive substance except accidentally. (Alcohol laced punch, prescription medication with a psychoactive component they don’t know about. It is important to remember that for people who have a strong hereditary and environmental susceptibility to use drugs compulsively, they will never have a problem if they never use. If they never use, there is no possibility of developing a drug craving. • Experimentation: people are curious about the effects of drugs or are influenced by relatives, peers or media. In this level no pattern of use develops and there are only limited negative consequences. The difference between this level and abstinence is that in experimentation the person acts on their curiosity.

11. What is Substance ABUSE? • Social/Recreational: the person seeks out a known drug and wants to experience a known effect but there is no established pattern. • Habituation: There is a definite pattern of use. This includes: 5 cups of coffee every day, ½ gram of cocaine most weekends. No matter what happens that day or week, that person will use that drug. It does not affect that person in a negative way. • Drug Abuse: The definition of drug abuse is “ the continued use of a drug despite negative consequences”. (The alcoholic with diabetes, the chain smoker with emphysema, cocaine in spite of high blood pressure) • Addiction: The step between abuse and addiction is compulsion. They have lost control of their use of drugs. • Here are some signs: use the drugs in larger amounts for longer periods of time, unsuccessfully try to cut down or control the drug use, give up or reduce important social, occupational or recreational activities because of the drug use, continue use despite physical/psychological problems.

12. Categories of Substance Abuse • There are actually 7 broad categories, but today we are going to talk about three, which are the most common. • Stimulants • Depressants • Hallucinogens

13. Stimulants-Uppers • Stimulants are known as uppers because they increase the chemical & electrical activity in the central nervous system. • What are some examples of stimulants? • Cocaine • Smokable cocaine (crack, freebase) • Amphetamines (adderall, Vicks inhaler, Ritalin) • Over the counter diet pills • Caffeine • Nicotine

14. Stimulants-Uppers • Why do people begin using stimulants? • Remember this: people begin using for a desired effect. • What is the desired effect of a stimulant? • Answer: creates energy • So what’s the problem? The problem is the body is tricked into supplying more & more energy and the body is trying to use up the surplus. The nerve cells become depleted and the body is left without reserves… its exhausted. Can someone give a common example of this happening? • (Coffee use…) • Symptoms of Stimulant Use • Side effects: heart rate increased, blood pressure increases, increases confidence, induces euphoria, restless, paranoid, talkative, insomnia • Withdrawal Symptoms: loss of motivation, emotional depression, increased appetite, intense craving

15. Cocaine & Neonatal Effects • Cocaine and amphetamines are of particular danger to the fetus. When a women uses cocaine, within SECONDS her baby will be exposed to the drug. The chances of miscarriage, stroke and sudden infant death syndrome increase b/c of the raised blood pressure. • Infants born to mothers who abuse stimulants may appear lethargic and unresponsive during the first few days following birth. • Then, the babies go through withdrawal are often called “jittery babies”. The rate of mild or greater mental delays is double the rate of nonexposed children

16. Nicotine, Neonatal effects & Effects in General • Statistic: Nicotine (tobacco) is the most addicting psychoactive drug. In the U.S. at least 46 million people are addicted to cigarettes compared to the 15 millions addicted to alcohol. • Tobacco is addictive because of the need it gives the smoker to maintain a certain level of nicotine in the body to avoid withdrawal symptoms. • When mothers smoke during pregnancy, the newborns have the same nicotine level as adult smokers. • About 15% of women smoke during pregnancy, so when they give birth the baby goes through withdrawal. • The risk of miscarriage is increased 1.2 fold for every 10 cigarettes smoked. • Pregnant women who smoke are twice as likely to miscarry than non-smokers. • The carbon monoxide and nicotine reduces oxygen carrying capacity of a pregnant mother’s blood, so less oxygen gets to the baby causing SIDS and lower birth weight. • Smoking has also been linked to ADHD, early onset conduct disorder and drug dependence.

17. Smoking cessation • Video only available at PCA-NJ training • Explain Mom’s Quit Connection. It is a toll free hotline for mothers to get support with their attempts to quit smoking.

18. Depressant-Downers • Depressants are drugs that depress or slow the central nervous system • Alcohol • Opiates (from the opium poppy): heroin, morphine, codeine, oxycontin, and methadone • What is the desired effect from a depressant? • Answer: pain reduction, suppress cough

19. Alcohol Use & Abuse • Statistic: A survey of pregnant women in the U.S. found that 12.4% drank alcohol during several months of pregnancy. (SAMHSA, 2002) • Alcohol is the oldest and widely used psychoactive drug. • “ I had been using for years before I got pregnant and when I got pregnant, I tried to stop but I just couldn’t do it. I wanted the drug more than I wanted the baby.” 27-year-old recovering alcoholic • What is your reaction to this? Has anyone ever encountered a mother such as this? What did you do? What would you do?

20. Fetal Alcohol Syndrome • Statistic: Over 7,000 children each year are born with FAS. • Fetal Alcohol Syndrome has three factors: • 1) Prenatal and postnatal growth retardation • 2) Central nervous system involvement (tremulousness, poor suckling, abnormal muscle tone, hyperactivity, attention deficit, and mental retardation) and • 3) Characteristic facial features including microcephaly (a small head), a thin upper lip, a short upturned nose, a flattened nasal bridge (upper portion of the nose) and general underdevelopment of the midface area.  

21. FAS • Picture of baby with FAS

22. FAS • As the child matures, problems with learning, attention, memory and problem solving are common, along with impulsiveness and hyperactivity.

23. Heroin & Neonatal Effects • Most opioids quickly cross the placental barrier between the fetus and the mother, therefore sending large doses of the drug to the infant. Pregnant heroin users have a greater chance of miscarriage, premature labor, still birth. When the baby is born to an addicted mother, the baby is addicted too. Their tissue dependence and withdrawal symptoms are more severe b/c they are much smaller. For the pregnant heroin abuser, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. • Babies become symptomatic with 72 hours after birth. The Baby symptoms include: low birth weight, high-pitched cry, tremors, exaggerated reflexes, sweating, vomiting, diarrhea. Babies in withdrawal can die. Symptoms can last 5-8 weeks.

24. Hallucinogens • Psychedelics were originally found in plants and cause intensified sensations, crossed sensations (visual input becomes sound), illusions, and delusions. Hallucinations, stimulation impaired judgment and distorted reasoning. • Common drugs: • LSD, Psilocybin Mushrooms, Ecstasy, PCP, Ketamine, Marijuana • What is the desired effect from psychedelics? • Answer: escaping from reality, intensify senses

25. LSD/PCP: • The most commonly used hallucinogens are lysergic acid diethlamide (LSD, "acid") and phencyclidine (PCP, "angel dust"). The effects on the mother are significant because users tend to put themselves in dangerous situations, which can lead to harm of the mother and her fetus. Users can become violent which may lead to direct trauma. The direct effects of these substances on the fetus are not well defined. • There are some reports in the literature suggesting that use of hallucinogens is associated with decreased birth weight and decreased head circumference, but these findings may be attributable to environmental factors. Neonates, nonetheless, can withdraw from hallucinogens with such symptoms as tremors, jitteriness, and irritability. The long-term effects are still being investigated but may involve developmental delays

26. Marijuana: • Marijuana has multiple effects on the mother including producing a fast heart rate, exercise intolerance, bronchitis (inflammation of the airways in the lungs), sinusitis (inflammation of the sinuses), and pharyngitis (inflammation of the back of the mouth and throat). The effects of marijuana on the fetus are the subject of some debate. There are reports in the literature of decreased body length, intrauterine growth retardation, neurobehavioral effects, and an increased incidence of prematurity. These findings, however, have not been consistent in all studies so there are no firm conclusions about the effects of marijuana on a fetus.  

27. Lingo Game: • Directions: Divide the class into four groups. Give each group a drug card. They must come up with the street terms they know for the drug. • Discussion ?: Why is it important for FAW’s, FSW’s and Supervisor’s to be aware of the street terms? • Because families, clients may use term in assessment or during conversation in home.

28. Addiction & the Family • Physical/Behavioral Indications of Substance Abuse in Families: • Personality changes and inconsistent behaviors • Financial problems • Sudden, unexplained wealth • Self-defeating behaviors (missed appointments, absences from work, etc) • Altered mental status • Withdrawal Symptoms • Skin lesions • Drug Paraphernalia • Family member consistently making excuses for an absent family member • (Department of Health & Human Services)

29. Addiction & the Family • Physical/Behavioral Indications of Perinatal Substance Abuse: • Lack of prenatal care • Previous delivery of a prenatally exposed infant • Intrauterine growth retardation for no other reason • Placental Abruption for no other reason

30. Needs of Children and Parenting Tasks Affected by Substance Abuse • Children need to live in a home with sufficient and well-managed income so that the family’s basic economic needs are met. (Chemically involved parents may spend money on alcohol and other drugs and fail to provide for their children’s basic needs. Thus, these parents may not meet their children’s nutritional, housing and medical requirements.) • Children must receive appropriate and consistent discipline so that they understand and internalize the rules of the family and of the culture. (Dramatic mood swings that accompany drug use can make it very difficult for chemically involved parents to exercise good judgment and respond appropriately and consistently to their child’s behaviors.) • Children need parents who are responsible for dealing with community agencies and major social systems. (Chemically involved parents often may neglect to obtain medical care or needed educational services for their child. They may forfeit eligibility for low-income housing, public health services, public assistance because they are often absent to do so.)

31. Needs of Children and Parenting Tasks Affected by Substance Abuse • Children need parents who accept responsibility for home maintenance and housekeeping. (Chemically involved parents often find it difficult to run a household, keep the home safe and clean and often leave these tasks to the children to complete.) Has anyone ever encountered this scenario? • Children need to experience appropriate roles and boundaries within the family. (In households with parents who use drugs, its not uncommon to fins a child who “rules the roost”. Also, with boundaries not clear it is not unusual for children to being victims of sexual abuse.

32. How to Help your Families when you are NOT the Expert! • Listen to their needs and the needs of their support program. • Encourage them to avoid “triggers” such as people, places and things • Be flexible but firm, willing to accommodate their substance related program and its guidelines, while making your expectations of your home visits clear. • Provide referrals when needed for smoking cessation

33. Reporting • Only when there is reason to believe that a parent’s alcohol or other drug abuse is so severe that the child has been or is likely to be harmed due to such substance abuse, should a report be made. Look up state law! • Follow your site’s policies.

34. Referrals: • Talk to your supervisor about your community resources! • END OF SELF-STUDY • Take post-test