Substance Abuse:Trends and Topics

Michelle L. Warren, MA, LPC, CAADC

The Scope of Substance Abuse in America

Substance use, including underage drinking and the non-medical use of prescription and over-the-counter medications, significantly affects the health and well-being of our nation’s youth and people of all ages:

The Scope of Substance Abuse in America - Youth

An estimated 10 million people aged 12 to 20 report drinking alcohol during the past month.1 To put that in perspective, there are more Americans who have engaged in underage drinking than the number of people who live in the state of Michigan.2

Youth Drinking has become more normalized and majority of teens surveyed reporting their first drink of alcohol by age 15 and teens see little risk in heavy drinking

Reasons for teen alcohol use cited were “to have fun”, “to deal with stress”, “forget their problems”, deal with pressures at school and home”

There has been a marked increase in teen use of marijuana over the past 3 years.

1 in 4 teens reported taking prescription drugs not prescribed to them by a doctor and 1 in 5 teens used a prescription pain reliever not prescribed to them.

The Scope of Substance Abuse in American - Youth

Synthetic Drugs (a.k.a. K2, Spice, Bath Salts, etc.)Overview and History

Synthetic marijuana (often known as “K2” or “Spice”) and bath salts products are often sold in legal retail outlets as “herbal incense” and “plant food,” respectively, and labeled “not for human consumption” to mask their intended purpose and avoid FDA regulatory oversight of the manufacturing process.

Synthetic marijuana consists of plant material that has been laced with substances (synthetic cannabinoids) that users claim mimics Δ9-tetrahydrocannabinol(THC), the primary psychoactive active ingredient in marijuana, and are marketed toward young people as a “legal” high.

Use of synthetic marijuana is alarmingly high. According to data from the 2011 Monitoring the Future survey of youth drug-use trends, 11.4 percent of 12th graders used Spice or K2 in the past year, making it the second most commonly used illicit drug among seniors.

Bath salts contain manmade chemicals related to amphetamines that often consist of methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, also known as substituted cathinones

http://www.myfoxdc.com/story/19629103/overdoses-of-synthetic-drug-smiles-on-the-rise-for-teens

Newest Synthetic

“Smiles”Or 2C-I

The Scope of Substance Abuse in America - Adult

Approximately 23 million Americans—roughly the population of Australia—are current illicit drug users.3-4 Marijuana use and non-medical use of prescription medications are the most common types of drug use in America.

Almost 18 million Americans are classified with alcohol dependence or abuse.5

Heavy alcohol use can cause serious damage to the body and affects the liver, nervous system, muscles, lungs, and heart.6

Alcohol is a factor in approximately 41 percent of deaths from motor vehicle crashes.7

The Scope of Substance Abuse in America cont’d

1.Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Results from the

2010 National Survey on Drug Use and Health: Vol. I. Summary of national findings, (Center for Behavioral Health Statistics and Quality, NSDUH Series H 41, HHS Publication No. SMA 11 4658). Rockville, MD: SAMHSA.2.Census Bureau, U.S. Department of Commerce. State and County Quickfacts. Retrieved September 12, 2012, from http://quickfacts.census.gov/qfd/states/26000.html 3.Central Intelligence Agency. The World Factbook. Retrieved September 12, 2012, from https://www.cia.gov/library/publications/the-world-factbook/geos/as.html4.Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Results from the 2010 National Survey on Drug Use and Health: Vol. I. Summary of national findings, (Center for Behavioral Health Statistics and Quality, NSDUH Series H 41, HHS Publication No. SMA 11 4658). Rockville, MD: SAMHSA.5.Ibid.6.U.S. Centers for Disease Control and Prevention (CDC). (2010). Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion. Retrieved December 20, 2011, from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm; National Institute on Alcohol Abuse and Alcoholism. (2010). Beyond Hangovers: Understanding Alcohol’s Impact on Your Health. Retrieved December 20, 2011, from http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.pdf 7.National Highway Traffic Safety Administration. (2010). Fatality Analysis Reporting System (FARS) Encyclopedia. Retrieved December 20, 2011, from http://www-fars.nhtsa.dot.gov/Main/index.aspx

SIGNS AND SYMPTOMS OF

ALCOHOL AND/0R DRUG USE

*It is important to keep in mind that a person showing these signs or symptoms doesn’t always mean they are using substances. The presence of some of these behaviors and symptoms could be related to other problems and issues. Whatever the cause, they warrant attention, especially if they persist or if they occur in a cluster.

*The key is change; it is important to watch for any significant changes in the person’s physical appearance, personality, attitude or behavior.

SIGNS AND SYMPTOMS OF ALCOHOL AND/0R DRUG USE

Physical Signs

*Loss of appetite, increase in appetite, any changes in eating habits, unexplained weight loss or gain.*Slowed or staggering walk; poor physical coordination.*Inability to sleep, awake at unusual times, unusual laziness.*Red, watery eyes; pupils larger or smaller than usual; blank stare.*Cold, sweaty palms; shaking hands.*Puffy face, blushing or paleness.*Smell of substance on breath, body or clothes.*Extreme hyperactivity; excessive talkativeness.*Runny nose; hacking cough.*Needle marks on lower arm, leg or bottom of feet.*Nausea, vomiting or excessive sweating.*Tremors or shakes of hands, feet or head.*Irregular heartbeat.

SIGNS AND SYMPTOMS OF ALCOHOL AND/0R DRUG USEBehavioral Signs

*Change in overall attitude/personality with no other identifiable cause.*Changes in friends; new hang-outs; sudden avoidance of old friends; doesn’t want to talk about new friends; friends are known drug users.*Change in activities or hobbies.*Decline in work or school performance and/or attendance; skips altogether or is chronically late.*Change of habits at home; loss of interest in family and family activities.*Difficulty in paying attention; forgetfulness; trouble understanding or remembering.*General lack of motivation, energy, self-esteem, “I don’t care” attitude.*Sudden oversensitivity, temper tantrums, or resentful behavior.*Moodiness, irritability, nervousness, silliness, giddiness, paranoia.*Excessive need for privacy, unreachable.*Secretive or suspicious behavior; chronic dishonesty.*Unexplained need for money, stealing money or items, constantly wanting to borrow money.*Change in personal grooming habits; decline in hygiene.*Possession of drug paraphernalia.

DRUG SPECIFIC SYMPTOMS  Alcohol (Beer, Wine, Hard Liquor) Clumsiness; difficulty walking; slurred speech; sleepiness; poor judgement;

dilated pupils; possession of false identification.

Marijuana (Marijuana, Hashish, Hashish Oil) Glassy, red eyes; loud talking and inappropriate laughter followed by sleepiness; a sweet burnt scent; loss of interest and motivation; unexplained weight loss or gain or increased appetite.

Depressants (Barbituates, tranquilizers, Benzodiazepenes such as Valium, Quaaludes, Phenobarbital, Xanax) Seems drunk as if from alcohol but without the associated odor of alcohol; difficulty concentrating; clumsiness; poor judgement; slurred speech; sleepiness; and contracted pupils.

Stimulants (Crack, Powdered Cocaine, Methamphetamine, Nicotine, Caffeine) Hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods without eating or sleeping; dilated pupils; weight loss; dry mouth and nose; with nicotine-smell of tobacco or stained fingers and teeth.

Inhalants (Glues, aerosols and vapors) Watery eyes; impaired vision, memory and thought; secretions from nose or rashes around nose and mouth; headache and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; an unusual number of spray cans in the trash.

  Narcotics (Opium, Heroin, Oxycontin, Vicodin, Methadone, Vicodin, Morphine) Heroin-needle marks on arms, legs, or feet; sleeping at unusual times; sweating; vomiting; coughing and sniffling;

runny nose; twitching; loss of appetite or unexplained weight loss; contracted pupils; no response of pupils to light.

Hallucinogens (LSD, Shrooms, Phencyclidine, PCP) Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech, confusion.

Progression of Addiction Models

Stage of Addiction, Recovery and Relapse

Levels of Care and Service in ASAM PPC-2R

Level 0.5 – Early InterventionLevel I – Outpatient ServicesLevel II – Intensive Outpatient /Partial

Hospitalization ServicesLevel III – Residential / Inpatient

ServicesLevel IV – Medically Managed

Intensive Outpatient Services

Prochaska and DiClemente’s Stages of Change Model

Precontemplation – no intention to change behavior in the foreseeable future; individuals unaware of their problem

Contemplation – individuals are aware of their problem and seriously thinking about ways to overcome it, but have not yet made the commitment to take action

Preparation – combine intention and behavioral criteria; individuals are intending to take action in the next month and have unsuccessfully taken action in the last year

Action – individuals modify their behaviors, experiences, or environment in order to overcome their problems; commitment of time and energy to behavioral changes

Maintenance – people work to prevent relapse and consolidate the gains attained during action; for addictive behaviors this stage extends from 6 months to an indeterminate period after the initial action

RESOURCESPublications, Data, Brochures, Videos, Etc.

*Substance Abuse and Mental Health Services Administration (SAMHSA)

www.samhsa.gov/ *National Institute on Drug Abuse (NIDA) www.drugabuse.gov/ *Michigan Department of Community Health

(MDCH) www.michigan.gov/mdch

RESOURCES *Berrien County

Harbortown Treatment Center 269-926-0015Berrien County Health Department 269-926-

7135Community Healing Center 269-684-7741

*Van Buren CountyVan Buren Cass District Health Department Hartford office 269-621-3143

*Cass CountyWoodlands Behavioral Healthcare Network269-445-2451

RESOURCES

Medicaid Cass

Venture Behavioral Health Substance Use Disorder

Hotline(877) 252-0916

Kalamazoo Community Mental Health and Substance Abuse

Services(KCMHSAS)

(888) 373-6200

Medicaid

RESOURCESCass

Van Buren

Kalamazoo Community Mental Health and Substance Abuse Services

(KCMHSAS)(888) 373-6200

Indigent Patients

Harbortown Treatment Center

HTC Outpatient Services

Brief History

1988 - Dr Smith agrees to establish Eastside Substance Abuse Clinic in Muskegon County to assume the responsibility of Medication Assisted Treatment from the Muskegon County Health Department.

1992 - Eastern Clinic, a second Opiate Treatment Program, is established in Grand Rapids.

2005 - Harbortown Treatment Center is established with the intent of providing an assortment of substance abuse related services including Medication Assisted Treatment for opiate addicted individuals.

Harbortown Treatment CenterHTC Outpatient Services

CARF accredited since 2006

Licensed by the DEA for Medication Assisted Treatment

Fully licensed to provide Outpatient Methadone and Other Outpatient Treatment Services by the Michigan Department of Community Health - Bureau of Health Systems

Harbortown Treatment CenterHTC Outpatient Services

We currently offer the following services:AssessmentDrug TestingMIPI ClassesAlcohol / Highway Safety ClassesDriver’s License EvaluationIndividual and Group CounselingMedication Assisted Treatment

Advantages of Medication Assisted Treatment(Methadone)

Many people believe that it is preferable for opiate users to stop taking drugs altogether. Although for some users this is achievable, for others there is a high risk of relapse into opiate use. Methadone maintenance has helped many people reduce the recurrence of compulsive use.

Methadone treatment, like any other drug treatment, is not a 'cure' for opiate dependence. However, research has shown that it can improve the health of people dependent on opiates in a number of ways; concept of harm reduction.

People are less likely to use opiates that may be contaminated with other substances. Methadone is taken orally, which makes it cleaner and safer than injecting heroin. This reduces the

risks of sharing equipment and becoming infected with blood-borne viruses such as hepatitis B, hepatitis C (which may lead to long-term liver problems) and HIV - the virus causing AIDS.

The routine involved in methadone treatment encourages people to lead a balanced and stable lifestyle - including improved diet and sleep.

People are less stressed, as they do not have to worry about where their next 'hit' is coming from. Methadone lasts longer in the body than opiates, so it only has to be taken once a day. It allows people to handle the withdrawal process with less discomfort. Criminal activities conducted to obtain illegal drugs are reduced. It helps people cut their connections with the drug scene. It's cheaper - although there is usually a dispensing fee with methadone, this is relatively cheap

compared to the cost of illicit drugs. It is required that clients on a methadone program also receive professional counseling. Patient can undergo a Medically Supervised Withdrawal (MSW) when they are ready to complete

Medication Assisted Treatment

Michelle L. Warren, MA, LPC, CAADC

Program / Clinical DirectorHarbortown Treatment Center

HTC Outpatient Services 1022 E. Main St.

Benton Harbor, MI 49022Phone 269-926-0015 Ext. 18

Fax 269-926-0123michelle@harbortownclinic.com

Thank You