1. substance misuse awareness and interventions - Simone Black and Sean Wood Plus Service Users

2. drug definitions A heavy smoker? Just the one?

3. definitions • drug • physical vs. psychological dependence • dependency vs. addiction • alcoholic vs. problem drinker • harm reduction vs. abstinence

4. definitions Drug – any substance taken into the body for the purposes of creating a psychoactive effect in the user Tolerance – to require more of the substance to produce the same or original effect Withdrawal – physical and psychological effects user experiences when they stop using for whatever reason Addiction– an absolute Dependency– a continuum Physical dependency – when asubstance effects the body in such a way that when it is removed the body undergoes physical withdrawal symptoms (sweats, shakes etc)

5. definitions Psychological dependency – mental compulsion to use a drug. Most important factor when trying to understand use Abstinence – not using any of the substance. Tolerance subsides after period of abstinence Harm Reduction –reduce harm to the user, their family/friends and society at large Alcoholic/Addict– an identity (big change). Suggests dependence reached level causing serious detrimental effects. Problem Drinker/User – a behaviour (easier to change). Not blindly implying dependence

6. drug related deaths p.a.estimated figures for England and Wales Tobacco c. 114 000 Alcohol c. 36 000 – 60 000 All illicit drugs c. 1500 - 2500

8. drug related deaths • opiate/opioid/GHB overdose [mostly with alcohol] • solvent related deaths – esp. young people • ‘ecstasy’ related deaths [heatstroke, too much water] • stimulant induced heart failure/seizure - • cannabis, LSD , magic mushrooms – no known overdoses

9. national trends • 4% - 8% adults are ‘alcohol dependent’ • 11 -15 year olds - drinking doubled in 10 years • illicit drugs - more choice + more affordable = moreuse • consistent across race, class, gender and geographical area

10. national trends • over 90% of people have been in ‘drug offer’ situations by age of 17. • cannabis = most widely used illicit drug • followed by, ecstasy, amphetamine and cocaine • crack cocaine more and more prevalent

11. the local hit parade [illicit drugs] 1. Cannabis [over 40 years at number one!] 2. Cocaine 3. Ecstasy 4. Amphetamine 5. Heroin [on the way up!]

12. trends - young people “…we urgently need to acknowledge that for many young people drug taking has become the norm ...… their motives appear to be less concerned with peer group status and more with rational consumption as part of their approach to their leisure time.” Howard Parker, University of Manchester 18 – 24 year old males are the biggest risk takers

13. spectrum of use very high risk, social exclusion, homelessness etc chaotic long term problems health, social etc dependent problematic most of us recreational experimental

14. more than just the drug…. set – e.g. why using? feelings? knowledge? substance- e.g. what? how used? what mixed with? the risks and the rewards setting –when? where? who with? culture?

15. drug sources - 3 of them • plants/herbs/fungi e.g. cannabis, magic mushrooms • illicitly produced chemicals e.g. mdma, cocaine hydrochloride, amphetamine sulphate • pharmaceuticals e.g. benzodiazepines, codeine, OTC medications 2 exceptions = reindeer urine and toad-licking!

16. how do we classify them? • legally by class A, B or C and schedules [1 to 5] outlined in The Misuse of Drugs Act 1971 – of limited use • socially ‘hard’, ‘soft’, ‘medicinal’, ‘recreational’, ‘dance’ etc. – of almost no use • by their effecton our bodies - the most helpful DRUGS DO NOT EASILY FIT INTO PIGEON HOLES…

17. types of effect – 3 broad categories • stimulant • depressant • hallucinogenic

18. stimulants energy up concentration social confidence ‘alive’ & ‘alert’ use, craving, tolerance, dependency pos. psychosis big crashes - physical & mental paranoia over agitation

19. depressants life management ‘warm blanket’ euphoria relaxation use, craving, tolerance, dependency treadmill of dependency criminalisation? self neglect/isolation? [fear of] withdrawal

20. hallucinogenics • change ‘reality’ by distorting perception • induce hallucinations – sight, sound, touch • tend to ‘amplify’ mood state • v. unpredictable, ‘bad trips’ etc • often long acting

21. hallucinogen stimulant ? depressant ? ? the scale of effectwhere do they fit? ?

22. 4 main ways of taking drugs • injection [very quick, very economical] • smoking [quick, not so economical] • snorting[fairly quick] • orally [slower] many drugs can be takenat least 2of these ways

23. the scale of effect STIMULANTS Crack Cocaine Speed Tobacco Ecstasy Caffeine Magic M’rooms LSD Cannabis HALLUCINOGENS Glue/Solvents Alcohol Ketamine Benzos Methadone Heroin DEPRESSANTS

24. cycle of dependence - depressants use to manage or suppress feelings feelings return mood changes/ feelings hidden OUT? drug effectiveness decreases dependency pattern reinforced tolerance increases

25. stimulants - crash and craving 1. USE [Highs & Lows ] 5.The ‘MISSION’ [anticipation] Users may ‘bounce’ between 1 and 2 2. EARLY CRASH [big comedown] 4. FEELING OK [‘normal’] 3. LATE CRASH [regret]

26. all inter-related… HEROIN BENZOS CRACK METHADONE

27. cannabis – things to know • more home grown, less resin • smoked/eaten • use in young people rising • paranoia = v. common • increases likelihood of psychotic episode • linked to schizophrenic illness • affects memory, learning and co-ordination • long term carcinogenic? [lungs, head, neck] • detectable in urine for up to 28 days

28. cannabis as a treatment? • MS • acute pain? • crohn’s and IBS (Irritable bowel syndrome)? • glaucoma • mental health and general stress • asthma • epilepsy • AIDS/cancer

29. “the weed keeps me sane, man”

30. ecstasy – things to know • neurotoxicity – research inconclusive • long term use - memory impairment? depression? • harm reduction advice = key to preventing deaths • ‘ecstasy’ = MDMA and other things [LSD, speed etc] • poly drug patterns [10:1 smokers] • comedowns can be crashes [heroin?, benzos?]

31. crack/cocaine - dopamine flood

32. crack/cocaine what goes up …. N dopamine depletion – thereafter adrenaline buzz only TIME COCAINE CRACK

33. amphetamine

34. benzodiazepines

35. cannabis

36. cannabis paraphernalia

37. cocaine and crack

38. crack paraphernalia

39. ecstasy

40. heroin

41. heroin paraphernalia

42. ketamine

43. LSD

44. magic mushrooms

45. HEROIN METHADONE methadone Intensity 0 hr Duration 24 hr

46. volatile substances

47. benzodiazepines • widely available prescription drugs [class C] • many varieties, short & long-acting [3 – 9 hours] • NOT anti-depressants • tolerance develops quickly [symptoms return] • high levels of dependency • withdrawal = protracted and potentially fatal

48. benzos – common symptoms • fearand phobias • sleepdisturbancese.g. insomnia, nightmares etc • mooddisorders – e.g. anger, anxiety, depression • sensoryeffects – e.g. tinnitus, giddiness, blurred vision • physical – e.g. exhaustion, twitching, aches and pains • extreme – e.g.delirium, convulsion and even death!

49. street leakage • benzos! – especially diazepam and nitrazepam • methadone and subutex! • dihydrocodeine, MST, diconal • coproxamoland some codeine based painkillers • cyclizine - potentiates heroin, users report more cerebral or ‘trippy’ effect • some tricyclics – esp. amitriptyline and dothiepin • procyclidine [rare] – apparently psycho-active

50. OTC drugs of misuse • codeine based medications [e.g. Nurofen Plus - Solpadeine] • decongestants [e.g. Sudafed, Dodo] • sleep aids [e.g. Nytol] • cough/cold cures [e.g. Collis Browne, Benylin] • antihistamines[e.g. Piriton] – esp. with alcohol • Ephedrine, Caffeine – stimulants • Codeine, Dextromethorphan- depressants • Diphneydramine/Promethazine Hydrochloride - sedatives