Effective Strategies with Substance Abusers

Jane E. Pfeifer

Who are our clients?

What are their challenges?

Specific drugs

AlcoholMarijuanaOpiatesCocaine

MethamphetamineHallucinogens

• A depressant that is present with & potentiates effects of most other drugs of abuse

• Involved in MOST cases of Domestic Violence

• A Known Teratogen

Alcohol

Alcohol Effects on Society

• Alcohol related traffic deaths account for twice as many deaths among teens as drugs.

• 60% of tardiness, absenteeism, and poor work quality is the result of light and moderate drinking.

• 40% is caused by heavy drinkers and alcoholics.

Alcohol Effects on Society

• 52% of college students in 1997 reported they drank to get drunk as compared to 39% in 1993.

• 40% reported binge drinking, and 20% report doing so once a week.

• NIAAA report that drinking is involved in more than 50% of sexual assaults.

Alcohol• Signs of Abuse

– drowsiness– aroma– gait ataxia– irrational– lack of restraint– slurred speech– high accident rate

• Signs of Withdrawal– hypertension

– sweating

– anxiety

– tremors

– insomnia

– disorientation

– physical complaints

– cravings

Alcohol• Blood Alcohol Levels

– .1% BAL motor coordination is impaired– .2% BAL user is obviously intoxicated– .3% BAL physical and mental activity

decreases as user enters a stupor– .35% BAL anesthesia is present– .4% BAL most die from respiration cessation– .6% BAL most are dead

Marijuana• THC (delta-9-tetrahydrocannabinol) content

generally much more potent today than a few decades ago

• Typically used to achieve relaxation

• Impairs short-term memory and decreases motivation

• Can alter perceptions, impair coordination, cause anxiety, panic, and paranoia in higher doses

Marijuana• Signs of Abuse

– dry mouth

– bloodshot eyes

– altered time

– impaired recall

– slowed motor skills

– depersonalization

– distorted perception

– munchies

• Signs of Withdrawal– no specific

syndrome

– insomnia

– hyperactivity

– decreased appetite

– paranoia

Opiates: Heroin, Demerol, Oxycontin, Vicodin

• Higher levels of street purity leading to increased intranasal use;

• Narcotic use historically follows stimulant epidemic

• Diversion of prescription painkillers =new epidemic

• Hepatitis C epidemic.

Opiates• Signs of Abuse

– euphoria– pupil constriction– constipation– drowsiness– itching– nausea– slowed speech

• Signs of Withdrawal– acute anxiety

– craving

– aches and cramps

– sweats

– insomnia

– vomiting

– increased body functions

Cocaine• Signs of Abuse

– euphoria

– increased energy

– increased alertness

– decreased appetite

– insomnia

– anxiety

– irritability

– increased sex drive

• Signs of Withdrawal– crash

– agitation

– depression

– craving

– fatigue

– eating binges

– paranoia

– weakness

Methamphetamine• Signs of Abuse

– rapid weight loss– nervous energy– no “need” for sleep– aggressive– mean temperment– compulsive– excited talk

• Signs of Withdrawal– long crash– apathy– depression– fatigue– anxiety– suicidal ideation– cravings

Hallucinogens• Signs of Abuse

– euphoria– altered perception– illusions– anxiety– psychosis– depersonalization– mystical experiences

• Signs of Withdrawal– no identified

withdrawal syndrome

– flashbacks

What’s going on?

• Use

• Abuse

• Dependence

The Disease of Addiction

• Is similar to brain injury-you should view this as similar to a stroke or accident victim.

• Be kind, repetitive and reinforce your message.

• Does not stop without treatment

• Treatment must be evidence-based and must continue throughout life

• Addiction is a disease of the brain

• It is a chronic, relapsing, life long disease.

• External intervention is necessary

• Treatment works…but only if a person goes.

• Many abusers/addicts are poly substance abusers. You should assume the person is likely using more than one drug.

Addiction Basics

Addiction Basics

• Addicts do not take drugs to feel good. They take drugs to feel “less bad”.

• Most people in early treatment don’t feel better, they feel worse.

• And many are not in any type of treatment.

Brain’s Limited Range & Duration of “Emotional”

Experience l-------------l--------------l-------------l-------------lSuicidal BAD GOOD VERY GOOD Euphoric NORMAL BRAIN RANGE

l l l l l l l l

l------------l------------l-------------l------------l

Suicidal BAD GOOD VERY GOOD Euphoric

RECOVERING BRAIN RANGE

What challenges are you having?

Strategies

• Because cognitive distortions are common:– Sequence tasks– Shorter, more frequent meetings– Repeat, remind, encourage – Write things down – Ask for a support person

• Above all: Patience

Strategies

• If you sense hostility, let them go and try again another day.– The interactions of drugs can cause violence– There is a strong correlation between mental

illness and addiction.

• Call for assistance if needed. • Do not put yourself or the person at risk.• Do not be alone with a client without

someone else nearby.

Substance abuse is nota moral failing

• Once addiction takes hold, it is a neurological process. The brain is described as being “hijacked”.

• It is not about willpower.• It takes significant work to resume control

over the hijacked brain.• Patience is critical.

janepfeifer@msn.com