Entrance into System. Arrest. Psych Emergency. Emergency Room. Assessment. Domestic Violence. Family Court. Probation - Parole. Schools. Abuse versus Addiction.
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Probation - Parole
Substance Abuse is distinguished from Addiction by the appearance of tolerance and withdrawal, leading to loss of control over use.
Substance abusers require motivation to stop.
Addicts require treatment to stop.
IOP + Sober Living
Random UDS 6 months
6 tests/90 days
Rapidly spreading outbreak of disease that affects an unexpectedly large number of people within a very short period.
Opiate pain medications
Sleeping pills, muscle relaxants
The user can’t not do it s/he is compelled to use.
Compulsion is not rational and is not planned.
An addict is a person who uses even though s/he knows it is causing problems.
Addiction is staged based on adverse consequences.
The user experiences intense psychological preoccupation with getting and using the drug.
Craving is dysphoric, agitating and it feels very bad.
Under the pressure of intense craving, the user is temporarily blinded to the risks and consequences of using.
A system of data collection to monitor disease (drug use) in the community
Opiate mis-prescribing by local providers
Diversion of prescription opiates/ doctor shopping
School drop out rates, expulsions and suspensions
Emergency room/hospital admissions
Pharmacy thefts/Fake prescriptions
Increased local availability of heroin
Public health clinics monitoring for HIV, Hepatitis B&C, Abscesses
Admissions to local treatment facilities
Jail admissions for possession, car break-ins, residential burglaries
Increased appearance of opiate addicted prostitutes
Data on causes of death from death certificates
Clusters of deaths in a community, school, facility, work site or other institution over a short period.
Clusters of drug use in a community, school, facility, work site or other institution, usually three or more cases over a short period.
Overdoses in younger individuals
DUI arrests with low BAL
Youth falling asleep in school
Youth stealing from parents and friends
Increased schoolyard drug and pill sales
“You’ve Got Drugs V” Prescription Drug Pushers on the Internet. National Center on Addiction and Substance Abuse, Columbia University 2008
Generic: Brand Name Non Tolerant 24 hr. dose
Codeine w/acetaminophen 500 mg
Hydrocodone:Vicodin, Lortab, Norco 20mg-60 mg
Hydromorphone: Dilaudid 20 mg-60 mg
Oxycodone: Percodan, OxyContin 20 mg-60 mg
Morphine sulfate: MS Contin 30 mg-60 mg
Fentanyl: Duragesic (transdermal), Actiq 25 mcg-50 mcg
Tolerant Users only Tolerant 24 hr. dose
Morphine sulfate: MS Contin 60 mg-upward
Fentanyl: Duragesic (transdermal) 75 mcg-300 mcg
Methadone: Methadose 60 mg-300 mg
Buprenorphine: Suboxone, Subutex 6 mg-32 mg
Historically, untreated dependence on prescription opiates led to a trajectory from
Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum of Physicians. (eds: Strain EC, Trhumble JG, Jara GB) CSAT. 2001
Dose Equivalent To Alcohol
(2oz liquor or 2 glasses of wine or 2 cans of beer)
Release of Inhibitions
Unsteady gait (Ataxia)
Slows heart rate
Decreases blood pressure
* Symptom may continue for months
Sweating (Diaphoresis) *
Delirium tremensSedative-Hypnotic Effects
Adderall is a brand-name pharmaceutical psychostimulant composed of mixed amphetamine salts. Adderall is widely reported to increase alertness, concentration and overall cognitive performance while decreasing user fatigue.
Prescription Stimulants are Schedule II drugs under the Controlled Substance Act for the United States.
Concerta, Vyvanse, Dexedrine are similar, often abused, prescription psycho-stimulants.
Effexor XR 150-300 mg
Cymbalta 60 mg
Wellbutrin XL 150-300 mg
Desipramine 100-200 mg
Modafinil 100-200 mg
Methylphenidate LA 10-40 mg
Buproprion 150-300 mg
Concerta 18-54 mg
Dexedrine SR 20-30 mg
Disorders of Sleep
Trazedone 50-300 mg
Seroquel 25-100 mg
Imipramine 100-200 mg
Disorders of Thought
Abilify 2-10 mg
Haldol 1-2 mg Risperdal 1-3 mgMedications for Stimulant Dependence
E W M S
immediate, catastrophic, overwhelming craving stimulated by people, places, things associated with prior drug-use experiences
inadequately treated or untreated
inadequately treated or untreated
Drug pleasure becomes associated with specific people, places, and things; to encounter any of those things in the environment is to trigger craving for the drug. Such triggers persist for decades after use.
Initiation of Abstinence: Stopping Use
Exercise Spiritual Practice Talk Peer Support Groups Counseling Having Fun
• Outpatient 1:1 and group
• Dependency Court
Child Protective Services
• Child Welfare worker
• Dependency Court
• Parenting Class
• Anger Management Class
• Battered Women’s support
Public Health Nursing
• Nurse Practitioner
• 12-Step Programs
• Church/Pastoral counseling
• Halfway housing that
• Section 8
Mental Health Treatment
• Medication Management