Diseases, Disorders information » Drug Dependency

About the hallucinogens

Disorders — Sat, 11 Oct 2008 13:47:44 +0000

I want to say something about the hallucinogens. We are seeing LSD nowadays. It’s in lower concentrations than when we were teenagers and so people aren’t flying out the window thinking they can fly like Art Linkletter’s daughter did which is one of the things that turned people off to LSD. But acid is back in a lower concentration and kids are using it at parties and it is producing problems acutely. Tolerance showing it has a serotonergic effect. It can also produce an adrenergic state. PCP, while developed as an anesthetic, has a very interesting dose response and this is one line I would circle just so it stays in your head. At low dose, it acts like alcohol or the benzodiazepines with ataxia. At the middle dose you get illusions and a propensity to violent outbursts with paranoia. At a high dose, 70 mg or greater, you see coma so it’s a particularly bad therapeutic window assuming you think intoxication is therapeutic. So even there it’s bad.
Management. I still find the urine is the key issue and there are several ways to do this. 10% of mental health patients are abusing anticholinergics, particularly Cogentin and just review why because that’s a likely thing to show up on the test.
The final thing is anabolic steroids. One out of 10 high school kids is using them. Mark McGwire didn’t help because androstenedione, while not excluded from baseball, does increase testosterone levels and the withdrawal is the problem. The stimulus to mania is a problem. Rageful behavioral and aggression on withdrawal.

The main problem in overdose

Disorders — Mon, 22 Sep 2008 15:18:23 +0000

The main problem in overdose is brainstem respiratory CO2 sensitivity falls and the patient stops breathing. The purity of heroin on the streets is strong enough now that we’re seeing this even with inhaled and smoked heroin sometimes. Now, tolerance occurs rapidly particularly to the nausea and that kind of discomfort and it becomes purely pleasurable at that point but only one in ten people who try heroin tend to become addicted to it. So we have to be realistic about this and reasonable, not that heroin could ever be thought of as a legalized substance, but not everybody who walks in who says, you know, “I used heroin at a party” is a heroin addict and we have to do some work to tease out “Do we have a criteria of dysfunction being met?”
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What’s the withdrawal amount? Well, the locus caeruleus is suppressed by chronic heroin use and when that suppression is released we have up-regulation of noradrenerigic receptors and suddenly the adrenergic arousal goes wild. There isn’t up-regulation of the opioid receptors themselves but there is up-regulation in terms of dopamine activity and the two sides are the ventral tegmental area – VTM – and nucleus accumbens which we talked about before but both of these are involved. Heroin is not a one site reinforcer. It seems to involve this system.
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I’m not going to talk about the long term treatment, for instance methadone. Harm reduction is an important goal nowadays because it reduces HIV transmission. So needle exchange works. Even in areas with lots of severe heroin addicts, we see reduction in HIV transmission thanks to needle exchange regardless of what the government’s policy is. Generic viagra 100 mg online at cheap pharmacy mall. Rapid detox can be done in less than five days with a combination of either these two – clonidine or naltrexone – plus or minus buprenorphine which I think actually improves the experience and retention for the patients and the L Group published on this. I think it’s definitely better combined.
Anesthesia detox. You actually can get a full blown heroin addict onto full dose naltrexone totally blockaded at the mu-receptor – they can’t become high now – in five hours using anesthesia. The problem is you don’t know if the therapeutic change has happened so that the patient doesn’t go out and then try and overcome naltrexone and dose themselves so badly that they overshoot and go into coma which has happened now a few times.
LAM – levo acetyl methadone. LAM is now FDA approved. It’s just a long acting type of methadone. So you can dose 100 mg Monday, 100 mg Wednesday, 150 mg on Friday and the patient is covered in the intervening days. They have more freedom. They can return to a more normal life. The patients like it. They retain better on it. Not available in all states. Call for details.
Buprenorphine. I hope it’s going to come out this year from the FDA. I keep saying that. The slowdown has been that the FDA is being pushed to allow dispensing in physicians’ offices. Buprenorphine is another long acting opioid like LAM, like methadone, safer and we may get to use it in office practice.
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Tramadol. Ultram

Disorders — Tue, 09 Sep 2008 15:13:32 +0000

The dopamine agonists – bromocriptine, amantadine, mazindol – this is conclusively disproved now. Amantadine hasn’t done as well as bromocriptine and bromocriptine has had side effects and has had some negative trials now too. So the answer on do we have a treatment for cocaine? No. All we have is longitudinal treatment and then relapse prevention. Isolating from the cues. Reintroducing the cues as the patient succeeds to give them a chance to bolster their techniques of thinking about the consequences, reminding themselves of the spouse’s wishes to stay clean and various counseling techniques. Stress. Coping with stress, learning to pamper one’s self in ways other than the most immediate gratification. These are things our patients really don’t know how to do.
You probably are seeing all the advertisements for tramadol, Ultram. A new pain agent, nonsteroidal but it’s not one of the NSAIDs. It’s a nonopiate analgesic but there is some concern that it can trigger relapse so we have to be careful with it. I haven’t seen a big market in Ultram abuse but there is actually a study assessing that rationally. So far, so good. One of the physiologic effects of the opiates that is helpful to remember for the boards but also for looking at patients in emergency situations, remember that aside from the analgesia and the rush and the euphoria of opioids they also produce smooth muscle inhibition and that’s down at the bottom of page 284. You might just want to put a check mark or a star there. That helps you think of several other things without having to memorize all of them.
Tramadol online – Tramadol is a non-opioid pain relief medication that is meant to help alleviate moderate to moderately severe pain. Tramadol is a synthetic analgesic, not an anti-inflammatory, which means that people who cannot take anti-inflammatories due to the side effects can often take Tramadol to help relieve their pain.
Smooth muscle inhibition. So the pinpoint pupils in patient’s eyes when they’re intoxicated with heroin, that’s because the smooth muscle that opens the iris for a full pupil is being relaxed. So that smooth muscle inhibition allows the pupil to close down that tight. It’s also responsible for some of the initial nausea and vomiting that people have sometimes when they try codeine for the first time. Heroin does it too, by the way. The same thing is true of withdrawal. If smooth muscle inhibition is part of the intoxication what do you think happens in withdrawal? You get smooth muscle hyperactivation so you get all nausea and diarrhea and the loss of appetite and the pupils get enlarged.
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The mu-opioid receptor system is the primary analgesic receptor system. It’s anti nociception. Anti nociception means you don’t feel pain. You can feel pressure but you don’t feel pain when these sites are occupied. Heroin, morphine, methadone, the m’s go with mu. The delta receptors are also supportive for analgesia and the akephalines have the better binding for this. So we have these three major systems. The kappa system you know about. Talwin, pentazocine produces analgesia there but it is also associated with a risk for dysphoria and Talwin is contraindicated in a patient who has mu-opioid dependence – heroin, morphine or methadone. Contraindicated because it will trigger a dysphoric reaction.

Night of Cocaine psychotherapy

Disorders — Fri, 29 Aug 2008 14:54:58 +0000

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That’s how the physiologic process is and people turned on him right away, “What’s wrong? What’s wrong?” He told his story. They said, “Look, you know. You can’t use tonight. You’ve been doing too well. You’ve got too much to lose.” He said, “I don’t know if I can help it.” So they said, “Well, how do you use?” He says, “Well I get some cash out of my bank with my ATM card.” So I said, “Do you have your card with you here?” He said, “Yeah.” I said, “Can I have it?” He said, “Yeah.” So I held it up and I said, “This is how you’re going to fall tonight? Do you mind if I cut it in half?” He looked down, calmed down immediately, he had the depressive affect that Melanie Klein talks about and we cut the card in quarters and he didn’t use that night.
So behavioral steps are critical with such a potent agent. You have to disrupt that binge cycle. It’s not daily use but it’s periodic heavy all encompassing use until the drug is all used up. We need a lot of modalities. Not just one. Individual drug counseling is potent but in a cocaine psychotherapy study it did better combined with group therapy than group therapy alone. So this multi-psych study has inclusively shown that group alone is not as effective as group plus individual. Bringing the family and spouse in, very important. Concurrently using the support groups. Big help. Cialis online 20 mg
We saw in the Night of Cocaine psychotherapy study individual plus group did best because it was a 12 step oriented counseling method and it promoted a lot of involvement in AA and NA and CA – the anonymous groups. Even though people tended to stop coming to that treatment earlier than cognitive therapy or supportive expressive therapy but because they were doing so many of their meetings, they had better outcomes with their urines and with their lives.
Education of the family. So the family understands somebody who stops using is not suddenly a nice person who’s pleasant to have around. They’re irritable. They’re frustrated. They’re upset. They’re dealing with affect for the first time since childhood maybe so they need the support of family members. I’ve written a prescription B-I-T-C-H and handed it to my patient to show the spouse. I said he needs a license to bitch. This is a bad time. Let him go through it to get better.
Urine testing and contingencies. Restricting the money, the access. Restricting social activity with people who might promote relapse. So don’t be surprised to see a bunch of these on a multiple choice test and feel quite comfortable calling for multiple concurrent treatment modalities. Canadian viagra online.
So we deal with behavioral techniques but do we have any pharmacologic techniques for cocaine? The answer, unfortunately not great no. A good open trial promises lousy, I would say, control trial conclusions. Desipramine may be the best studied one. Five positive control trials but we have quite a few unsuccessful trials too even though the laboratory shows that they can subdue or even reverse intracranial self stimulation with cocaine. So the laboratory studies of these agents don’t always pan out in the patients. Health articles at canadian pharmacy blog.

Two factors to know about in stereotypy

Disorders — Mon, 11 Aug 2008 16:39:50 +0000

So two factors to know about in stereotypy is one, there is a kind of strange sensitization that occurs. If somebody stays with the same amount of cocaine and starts to develop stereotypy they’ll get more and more and more of it even if they don’t increase their cocaine and that’s sensitization. Viagra Super Active new medication.
Another factor is reverse tolerance and that is somebody who has become dependent on cocaine and begun to show stereotypy might try to use less cocaine but they will have increasing stereotypy. They want to stay healthy. For instance, they might not use for awhile and go back to cocaine at much smaller levels than they last left it and they’ll have much more active stereotypy. So there is a reverse tolerance related to the sensitization.
Kindling you know from other lectures of the course is the ability to yield a seizure focus with progressive generalization of the seizure with what was originally a subthreshold incident whether it was electrical or chemical. Cocaine will produce kindling. That is, it will lead to seizures even at doses that don’t increase. Where is cocaine doing its damage? Actually cocaine acts at multiple sites and they don’t all explain reinforcement or addiction. The anesthesia peripheral effect does not explain addiction. The improvement in attention and wakefulness is happening in the reticular activating system. That is a norepinephrine effect but it’s not primarily responsible for addiction because as you know we’ve got other substances that produce enhanced attention that are not to any great extent addicting, for instance, Ritalin. Canadian viagra erectile dysfunction treatment.
So where else could they lie? Well, we know that cocaine can provoke alarm, anxiety and autonomic arousal throughout the body. That’s an adrenergic effect too and it’s through the locus caeruleus, the alarm center in the midbrain but that is not the region responsible for reinforcement. We have mentioned that the reinforcement center, the pleasure center is the nucleus accumbens and that is a dopaminergic mediated process, not purely, but I want to uncomplicate this so that we are immediately familiar with it when we see it on tests or in our work with patients and can explain it and some basic mechanisms. So nucleus accumbens, reinforcement pleasure center, dopaminergic process. Stereotypy and motor hyperactivity, that’s not part of the pleasure center. That’s happening in the nigra striatal region and it’s a limbic process. Also dopamine, not related to reinforcement. Cialis Jelly at canadian online pharmacy.
We’re now moving to the bottom of page 283 into the treatment and the treatment of such a powerful, deadly and widely available substance has to be vigorous. It’s not a strict conversational process so we use behavioral techniques. Here’s one that I had to use in one of my group members in the men’s cocaine group. He was in recovery, hadn’t used for a month. He had been threatened with losing his job. He came into the group. He was fidgeting. Fidgeting in a group is a sign that somebody either is using or is aching to use.

Specific substances of abuse

Disorders — Sat, 19 Jul 2008 16:32:42 +0000

We’re going to move now into specific substances of abuse. Cocaine has a long history of use. The cocaine problem absolutely preceded George W. Bush’s youthful indiscretions. Actually, it even preceded Henry Hyde’s youthful indiscretions and I almost wish, it’s as old at least as Benjamin Franklin but he was public and he didn’t really stop his indiscretions just for political life and I respect a man like that. Some people would say that our president hasn’t really stopped his youthful indiscretions for his political life either. Cheap nexium without prescription.
But it does show that this is a ubiquitous problem. All classes are affected. Cocaine has really gone through the gamut from people at the highest level of society to the bottom and it tells you that one’s morals, one’s upbringing, one’s wealth, education is no defense against the physiological processes of these substances. So when I talk about cocaine I want us to understand what these physiological processes are.
The neuropharmacology of cocaine has been important for understanding addiction but also for understanding how the brain works and that’s partly why there’s such a big investment in this. Reinforcement is so powerful with cocaine in animal laboratory experiments that rats, given freedom to press a lever to get a full squirt of cocaine into the brain or the bloodstream will press it continuously until they stop eating, stop mating, stop drinking and begin dying in 14 days mostly of cardiopulmonary disease. They also develop rapid infection and 90% will be dead in 30 days and that is the most deadly of the common drugs of illicit use. So that’s an important factor to have in mind. Viagra professional canadian medications.
Administration of drugs that are rewarding isn’t limited to the drugs themselves. How do we know where this happens? Well, we know by putting electrodes into the brain at different places and giving the animal free rein to move around the cage and hit the lever once in awhile and get a little microampere jolt, not to do damage but to see is there a synapse that likes this stimulation.
What we find is there is a nucleus accumbens capsule that is the most potent site of the brain. That is, it takes the least amount of current for self administration to be rewarded so the rats or mice or whatever animal we choose will press that lever again and again to get that little tiny bit of current. So we have a site. We know that lesions of this site will block the acquisition of that self administration behavior. So this is convincing evidence.
What else is involved here? Well, endorphins are not primarily involved. Opiates have actually some bearing on it and we’ll talk about that later but they’re not primarily involved and the anesthesia is not the reason that the animal does this. That’s a peripheral effect.
What about other substances? Well, heroin will yield that kind of rapid self administration too. To get a squirt of heroin, animals like rats will press again and again hundreds of thousands of times in a day believe it or not and if they’re given free rein every time they press they get a squirt, about a third will be dead in a month. So you can now compare cocaine’s lethality to heroin’s lethality which is opposite to what we thought in the ‘80s, by the way. We thought heroin was the real killer and cocaine, you know, yeah it’s fun. Some people get carried away with it. Now we know different.
So we have this problem but there are some other physiologic processes with stimulants of cocaine as well. One is stereotypy. What is stereotypy? It will show up on the boards and it is a process of compulsive repetitive purposeless behavior. In a cat, it might be grooming to the point that the cat actually wears off its fur and digs into its skin and is bleeding from it. In human beings stereotypy with cocaine is pacing around the coffee table in the den where he uses his cocaine and wearing out a track in the shag carpet. Generic pharmacy blog.

Action is going to the AA meetings

Disorders — Sun, 06 Jul 2008 11:22:01 +0000

Action is going to the AA meetings, going to the counselor, seeing a psychiatrist for the evaluation of psychiatric symptoms that might promote relapse, maybe day treatment and so forth. That might be a phase of weeks or months or even years but eventually a patient succeeds and more than 70% of our patients succeed and have good recoveries in which their lives are improved and they reintegrate into society.
But that’s not enough because if they don’t practice periodic maintenance actions, they are vulnerable to relapse. When? Well, maybe the next New Year’s party or maybe their next birthday. Maybe the anniversary of one year of sobriety. So we need maintenance steps to help prevent specific risks after the day to day worry about relapse seems to have been effective and is no longer necessary. When people relapse, what’s the trick? Well, help them get back into contemplation quickly. They can cycle through this much more rapidly with less damage, with less severity and quantity of substances so that they can learn quickly “What was the one thing that blind sided me that I need to work harder on for next time?” Ask google!
Well, the different treatments that we have at our disposal fall into about four categories – hospital care, daily medical management but that’s for people with severe withdrawal risks, 24 hour acute medical care needs, maybe because of liver disease or pancreatitis that’s acute and psych or behavioral complications that need 24 hour care for instance suicidality. But it’s not for housing, it’s not because the urges to relapse are strong. We don’t use the hospitals for that. It’s too expensive and not specific. Instead we use medically monitored inpatient care which is simply a residential program where there is some nursing care and maybe a visiting or consulting physician. For this, there still can be some withdrawal risk and some medical monitoring required or psychiatric monitoring required but the patient shouldn’t have the severe containment needs that a hospital provides. Cheap female viagra at online us pharmacy.
Intensive outpatient can be day treatment or partial hospital or a several times a week evening program and patients with all of these types of problems fit in here as long as the medical and psychiatric ones are not severe. For outpatient once a week care, it’s important that we meet the criteria of no severe withdrawals, no severe medical risks, no severe psychiatric risks and the motivation has to be partial at least. The relapse potential has to be manageable in outpatient so if we discharge somebody from the hospital after acute cellulitis and they use heroin on their way home from the hospital the answer is not to put them in Level 1 care. It’s they all come once a week to therapy and we’ll talk about it even if managed care says that’s without proof and we have this problem with managed care.
You know, there’s plenty of evidence of the cost saving benefit of this treatment to society. California did a huge study, tens of thousands of cases analyzed, to see what does one dollar spent on treatment get you. What they found, and this is on page 281 in the middle, that you spend a dollar on inpatient you save four dollars subsequently. If you spend one dollar on outpatient treatment because it’s so inexpensive you save twelve dollars. On average, and this is probably the thing you should write down here because I wouldn’t be surprised to find it on the boards, the average of those two, taking into account all the different sample sizes, is one dollar spent on addictions treatment saves seven dollars mostly in health and crime costs.
So we see a big societal savings and there’s more to it. What about savings on prison treatment? Well prison treatment can reduce relapse to prison short term three-fold. So if we spent the money, what we would buy would be less crime, probably less homelessness, less unnecessary utilization of our Emergency Rooms and ICUs. So the one dollar per seven dollar ratio is important for you to have in mind. Unfortunately this argument is not yet fully bought although there is a big parity debate that they’ll have in Congress this year and I hope it will go to some lengths to cure the crisis that this slide exemplifies. The mental health services drive-thru.

So there are treatment approaches

Disorders — Sat, 28 Jun 2008 11:14:48 +0000

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So there are treatment approaches to deal with all of these and patients have different contributions of these. So the patient who goes for pleasure really needs their motivation enhanced but the person who is reinforced because of withdrawal like many IV heroin addicts I see they need an adequate duration of detox in addition to these other things, otherwise they’re sitting ducks for relapse.
Where there is a habit conditioned to positive or pleasure reinforcement, we need an intervention that takes away the pleasure of getting high or the associated pleasure and the cues. For instance, maybe somebody shouldn’t pick up their paycheck and cash it themselves. Maybe the spouse should cash the paycheck because the role of money starts to remind them of having a straw and having a straw starts to feel good and makes them fidgety and it’s very hard to resist that once the dopamine is starting to fly.
The genetic model. Here’s the genetic model in action. This bartender’s saying to this guy, “Your mom wants to buy you a drink.” I also like this because it typifies the isolation in addicted families but maybe I’m reading too much into it. Well, when we do and the one point you should take a look at in the outline is the genetic model is not just a model. Canadian pharmacy viagra 100 mg. There’s proof of it. In alcoholism it is quite strong. At least 50% of the vulnerability to becoming alcoholic is genetically transmitted and there are now good laboratory models in rats that have been recombinantly inbred, even genes being identified that support this. So it’s quite true and it’s important to teach patients about it because it helps them accept that the disease truly is a disease and not a moral weakness.
So there are these models. Take a look at the social model in the outline but what do we do with all that? Well we have to deliver some form of treatment and at the bottom of page 280 you’ll see this list of stages of change. Now, I assume many people have heard of the stages of change. How many people have heard of at least the idea of stages of change? Good. This is really taking hold not just in the world of addiction treatment but in psychotherapy in preventive medicine. It’s having a lot of benefit because it teaches us that it’s not just that somebody’s motivated to change or unmotivated, they’re in a process. It’s a transition from “I don’t even think I have a problem” to “I have a problem, I don’t know what I should do.” “I know what I should do but I need to get going on it. I’m doing what I need to do.” “I did it. I think of it once in awhile and I need to be careful.” Then perhaps relapse. Canadian cialis online.
So stages of change please be familiar with the terminology. Precontemplation. It’s exactly what it says. Before the patient is even thinking about it and the goal of the therapist is to say, “Did you ever think five years ago that this is where you’d be today?” That’s a very upsetting question to a heroin addict with cellulitis, hospitalized with diabetes in their arms and the patient that night, hopefully after a consultation, will sit with that and be upset as they lie on their pillow and the next day as you come back for followup they’ll be thinking, “Gee, that really bugged me when that guy said that to me. Things aren’t really going well for me at all.”
Now the patient’s in contemplation. Thinking about it but doesn’t know what to do or if he can even do something about it and we have to promote a concept that yes you can change. There is something called self efficacy that can be enhanced especially with support so we say to the patient, “Well, where do you want to be five years from now? “What would you like to be in your life? I realize you’re worried you’re going to lose your house. Your kids aren’t in your custody but what do you wish could be?” Then you say, “Well, what supports have you ever used to try and achieve that goal of five years and let’s talk about what you could have at your disposal.” At that point the patient will have some determination or preparation to act and we have to think, well, what’s the best action. So that’s where treatment planning comes in and we’re going to talk about that in the next slide.

The dependence criteria

Disorders — Thu, 12 Jun 2008 11:09:16 +0000

Slightly more complex is dependence and the dependence criteria. There are seven different categories but only three criteria to make the diagnosis. So the first two are physiologic – tolerance and withdrawal – but the others are strictly behavioral. You need to know that only three of the behavioral ones can be sufficient to make the dependence diagnosis. You don’t have to have withdrawal. You don’t have to have tolerance.
I have a lovely woman who tells me, “I never get drunk. I do not have increasing use of alcohol. I can control my alcohol. I never have more than three or four drinks and nobody ever says it’s a problem.” “So why are you here?” “Well, my doctor thinks that my diabetes is off the wall and blames my drinking and it’s true my weight is up. He says I’m tremulous from it. So what if I am.” So we make the diagnosis, she substantially cuts down but is not completely abstinent on a more than two week basis at a time but what she notices is that her golf game has shaved ten points so she says, “Gee, there must be something to that.” So it does not have to be a physiologic syndrome to make the diagnosis. Canadian pharmacy with special discounts.
By the way, is there anybody familiar with absolute or relative tolerance? The meaning of those terms. Let me just clarify that because that is something that it’s not nit picking. There is a meaning to it. Absolute tolerance is to get a certain high that I’m seeking I have to drink two drinks initially, then after I’m a full member of the fraternity I have to drink four drinks and by the time I’m an officer I have to drink a six pack or two. That’s absolute tolerance. Relative tolerance is when I joined the fraternity I was drinking two beers, I got tipsy, I was all over the place. I threw up once. I was very sensitive to it. Now I drink two beers nothing happens to me. I don’t even notice it. That’s relative tolerance. We haven’t increased the quantity but the effects on the body have become tolerant.
Another thing to review for the boards is on page 280, that table at the top of urine toxicology. One of these years I gave this lecture and one of the questions was how do you know how long the substances last in the urine? It’s a beautiful board’s question so take a look at that and circle these two items. Phencyclidine which can last up to week, phencyclidine PCP and the last one in the cannabinoid group, the principal active ingredient in marijuana delta-9-THC circle because that can be found in chronic users for up to a month. Hgh online at online canadian pharmacy.
There are a number of models to try and explain addiction and also to clue us into good treatment and these models are in some cases conflicting, in other cases contributory. Since the conceptual understanding of all the different drugs of abuse unifies them, it’s good to understand what that means. The first model I want to condemn and that is the addictive personality. There is no evidence that there is a single developmental fixation that leaves people with an oral phase gratification need that promotes alcoholism or addiction. No evidence to support that. The self medication hypothesis, we’ll talk more about that tonight in the seminar but I’ll just say the data does not support that as an etiology. However, it is relevant clinically in that patients explain or rationalize their substance use in the sense of self medication. So it has some value in our clinical work but on the boards, not substantiated by the data.
What is substantiated by data? The behavioral model is extremely powerful. It’s a laboratory model and it teaches us not just how all the drugs of abuse tend to be similar but also routes to treating. So if we look at pleasure, most of the drugs of abuse make us feel good. That’s positive and so we do it again and again. That’s reinforcement. That’s all we mean by positive reinforcement. Many drugs of abuse, though not all, have a withdrawal syndrome that’s upsetting and painful. Some are physiological painful like alcohol withdrawal, others are emotionally painful like cocaine withdrawal but during the withdrawal it feels bad, therefore I keep doing that substance. So that’s negative. It feels bad therefore I keep doing the substance. So that’s negative. I feel bad. Reinforcement. I keep doing it. That’s all there is to self medication in the sense of negative reinforcement. Drugs information
Often people quit using the substances but they still have an urge, a habit. Think of smokers who like to fidget with their fingers or do something with their mouth. Why do they do that? There’s an important reason and it comes from behavioral theory. Fidgeting with the fingers in a smoker is a conditioned positive “it makes me feel good” reinforcement. Therefore I’d like to do it again. Other habits are when the weekend comes I have many patients who find it’s very hard to resist doing drugs. The weekdays when they’re working and busy they don’t have time to think about it, they do great. But the free time of the weekend is a disaster. Why? I feel bad. I’m lonely. I’m bored. Maybe I might not have a date. That is a conditioned cue. It’s not a drug if you don’t have a date but it is connected to the urge to use the drug because then you don’t care if you have a date and you are reinforced to use.

Drug Dependency

Disorders — Sun, 04 May 2008 13:59:32 +0000

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In a year’s time, we’ve seen a huge increase in the teen use of illicit drugs and the average age is decreasing with kids as young as 16 averaging their start with marijuana. The estimates of use in the U.S. is 14 million Americans are using substances and heroin is increasing in its use because of greater purity and decrease in cost. It’s being marketed by the same people that used to bring you cocaine so cocaine’s desirability is going down. We’re seeing it more in the unglamorous crowds and heroin is part of the glamour crowd. Why is that? We’ll talk about that a little bit later.
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First I want to cover stimulants even though cocaine is being relegated to female, older and mentally ill chemically abusing populations, MICA, and that concept which we’ll cover more tonight if you attend the dual diagnosis seminar, MICA is primarily psychotic severely disabled mentally ill patients who dabble in substance abuse as opposed to people who have primary substance abuse – the majority of people with a substance abuse problem in the U.S. who have secondary symptoms but we’ll talk about that more tonight. Methamphetamine, big problem in Hawaii, the West Coast. Some East Coast areas now but more in the south. We’re not seeing it really in the Northeast for some reason but easily cooked up in my kitchen and I haven’t tried this by the way so I can’t explain exactly how you do it but I’m told that I can do better than academia.
It does seem to damage dopaminergic and serotonergic terminals in the brain. This is rat brain. We don’t know the clinical significance in humans but it’s important to know that. MDMA, another amphetamine derivative popularly known as ecstasy. Methamphetamine is known as crank, speed, ice. Ecstasy for MDMA. The neurons themselves are damaged in rat brain. We don’t know the clinical significance in humans.
The big problem with heroin is it’s so pure now that inhaled alone is sufficient to make people dependent. It’s not just a gateway anymore that leads them to IV use. It does lead people to IV use but it’s enough to get people so dependent that I’ve had to refer patients who are just heroin smokers or snorters to methadone treatment because they can’t get off the stuff.
Marijuana is now the choice of teenagers throughout the land. It’s been increasing since 1992 and there are lots of combination lacings of marijuana now to improve the marketing. You may have heard of embalming fluid being laced to marijuana and fry is the mixture. Fry. And I think that’s a rye comeback on the advertisement we used to see, “This is your brain on drugs.” You know, it was the egg being fried in the frying pan. Now the kids are saying, “Oh, yeah. Let’s do it.” So this is one of the crises of raising teenagers in America. Mine aren’t quite teenagers and I’m just bracing for the experience.
Club drugs. Rohipnol – the date rape drug. Sedative. GHB, gamma hydroxybutyrate. These are mostly sedatives but LSD is being used, MDMA ecstasy, big rave party drug. Raves are these all night nonstop very crowded sweaty trance-like dance parties with music, I guess, that’s the second generation of disco which really shows you how the taste is going in America.
Pregnancy. 5.5% of pregnant women in studies are found to be using drugs of abuse which is pretty shocking. Almost 20% alcohol and smoking cigarettes despite all that we know about the effects of fetal alcohol syndrome and low birth weight, low head circumference with smoking. So a lot of important trends and epidemiology and we can talk about that maybe in questions if people are particularly interested.
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But I want to stress that some familiarity with this is important. It can appear on the boards but at least have down the basics of diagnosis. Now, there are many syndromes of psychiatric disturbance that are associated with intoxication or withdrawal and so we want to be familiar with these names. So Roman numeral II on your outline which I think is page 279 has the substance induced syndromes and these are listed separately along with the dependent syndromes.
The two to be most aware of are the delusional or psychotic induced syndrome which many of these substances can induce and delirium and hallucinosis which just about all of the hallucinatory, stimulatory and even the sedative substances can produce delusions, delirium… well, at least delirium and hallucinosis. Sometimes in intoxication, in other cases like a sedative withdrawal or alcohol withdrawal during withdrawal. Of course, not caffeine or nicotine. So an easy point to remember. It can easily show up as a multiple choice test with all of the above. You just have to know that the all of the above probably does include all of the above. Generic viagra pharmacy.
But what is abuse? Separate from these substance induced syndromes, abuse is a very simple problem. It’s just any one persisting problem – role failure, use in hazardous situations or recurrent legal or social problems. So it’s a good diagnosis for the alcohol intoxication driving arrest and the patient says, “This has never happened to me before. I drink when I come home from work. At the bar I stop off with my pals and I make it home fine and this arrest has nothing to do with alcoholism.” Well, that may be true but it is alcohol abuse to drink and then drive. So that’s an easy diagnosis to make.