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  2. Orientation and Ground Rules What is Critical Thinking?

  3. Critical Thinking is the process of suspending one’s own belief system, cultural mores and values in order to examine the culture of another.

  4. Critical Thinking includes the concept of person as subject, rather than person as object.


  6. The Disease Concept of Chemical Dependency • “Dis-ease” • A primary disease • Progressive and fatal

  7. Signs and Symptoms of Chemical Dependency • Tolerance • Withdrawal • Psychological dependence • Physiological dependence • Ritualistic behaviors • The phenomenon of craving • Denial

  8. Stages of Chemical Use • Experimental use • Social/recreational using • Daily preoccupation • Dependency

  9. Summary • Addiction is a disease • Addiction = tolerance + withdrawal + ritualistic behavior + craving

  10. The Feeling Chart:Experimental Use 1 → 2 3 ← pain normal euphoria

  11. The Feeling Chart:Social/Recreational Use 1 →→ → 2 3 ← ← ← pain normal euphoria

  12. The Feeling Chart:Chemical Abuse 1 →→→ 2 3 ← ← ← ← ← ← pain normal euphoria

  13. The Feeling Chart:Chemical Dependence 1 → → 2 3 ← ← ← pain normal euphoria

  14. Progression of the Disease Experimental use More regular use Daily preoccupation Dependency Occasional use of alcohol and other drugs Easy to get high Alcohol or other drug use with friends Thinking that “everyone does it” Feeling pride in being able to “handle it” Start having blackouts or overdoing it Use on weeknights begin Hiding how much you use Skipping work/school Feeling guilty Tolerance increases Making excuses about chemical use Planning your day around your chemical use Beginning to worry about your “stash” or supply Changes in friends and meeting places Decreased ability to stop Using alone Unwilling to discuss problem Family/friends express concern Isolation Avoiding family/friends Developing an “I don’t care” attitude Loss of usual interests Difficulty facing the day Daily use Remorseful Work and financial trouble Irrational resentments Lengthy binges Physical deterioration Fear and anxiety Running out of alibis Admitting complete defeat

  15. 12-Step View of Addiction • “An allergy of the body, a malady of the spirit and an obsession of the mind” • Complete abstinence from all mind altering chemicals • Recovery is slow and an on-going process • Natural state of an alcoholic/addict is irritable, restless and discontent • Abstinence requires daily work/maintenance • Fellowship is a key part of recovery

  16. HARM REDUCTION • Accepts, that drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them • Acknowledges that some ways of using drugs are clearly safer than others • Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs • Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other • Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people's vulnerability to and capacity for effectively dealing with drug-related harm. • Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use

  17. Other Modalities of Treatment • Medical Model • Social Model • Rational Recovery

  18. AA Preamble ALCOHOLICS ANONYMOUS is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

  19. CMA Preamble Crystal Meth Anonymous is a fellowship of people for whom crystal meth has become a serious problem. The members of Crystal Meth Anonymous meet regularly, share support and fellowship, and create a safe environment in which to stay clean. The fellowship advocates complete abstinence from crystal meth, alcohol, inhalents…medication taken not as prescribed as well as all other mind altering substances.

  20. ARE YOU A TWEAKER? It doesn’t matter what you call it. It doesn’t matter how you did it. It brought us to our knees, because, without exception, that’s what it does.  Is speed a problem in your life? Are you an addict? Only you can answer those questions. For most of us who have admitted defeat, the answer is very clear. Yes, we had a problem with speed, and no, we couldn’t fix the problem by ourselves. We had to admit defeat to win. Speed was our master.  We couldn’t control our drug use. What started out as weekend or occasional use became daily use, and we soon found ourselves beyond human aid. We truly suffered from a lack of power to fix our problem.  Some of used speed as tool to work harder and longer, but we couldn’t keep a job. Others picked at their faces and arms for hours and hours or pulled out their hair. Some of us had uncontrollable sexual desire. Others endlessly tinkered with projects, accomplishing nothing, but found ourselves so busy we couldn’t get to work on time.  We deluded ourselves into thinking that staying up for nights on end was OK, that our tweaking was under control, and that we could quit if we wanted to, or that we couldn’t afford to quit, or that our using didn’t affect our lives.  Maybe we saw a friend go to jail, or lose their apartment, or lose their job, or lose the trust of their family, or die, but our clouded minds wouldn’t admit we were next.  Most of us saw no way out, believing that we would use until the day we died.  Almost universally, if we had an honest moment, we found that our drug usemade seemingly insurmountable problems in our lives.  The only way out was if we had the courage to admit that speed, our one time friend, was killing us.  It doesn’t matter how you got here. The courts sent some of us; others came for family or friends, and some of us came to CMA on our own. The question is if you want help and are willing to go to any lengths to change your life.


  22. HIV and AIDS

  23. What is HIV? Human Immunodeficiency Virus is the virus that weakens the immune system and can cause AIDS. The virus can be passed from one person to another through blood-to-blood and sexual contact. Pregnant women can pass HIV to their baby during pregnancy or delivery as well as through breast feeding. People with HIV have what is called HIV infection. Traditionally only AIDS cases have been reported. But recently in California, new cases of HIVinfection are being reported by a unique identifier (no names).

  24. Where did it come from? The earliest known case was from a blood sample collected in 1959 from a man in the Republic of Congo (how he became infected is not known). Genetic analysis of this blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940’s or early 1950’s. The cause of AIDS is a virus that scientists isolated in 1983. The virus was first named HTLV-III (human T-cell lymphotropic virus-type III. Later it was changed to HIV. There are two types of HIV. HIV-1 mostly found in the U.S. HIV-2 mostly found in Europe, Asia, Africa and Sub-Saharan countries.

  25. Some scientists believe HIV spread from monkeys to humans between 1926 – 1946. Recent research indicates HIV most probably first crossed species from chimpanzees to humans as early as 1675 and did not establish itself as a epidemic in Africa until 1930. 1926 History Researchers studied 1,213 plasma samples obtained from Africa between 1959 – 1982. The 1959 sample tested positive HIV-1 becoming the oldest confirmed case of HIV. The case of a Manchester sailor who died of AIDS-like illness in 1959 was reported to be the oldest, but it has not been confirmed. 1959 1978 Gay men in the US & Sweden – heterosexuals in Tanzania and Haiti begin showing symptoms of what later be called AIDS.

  26. 1984 Robert Gallo claims he discovered the virus a year later after the French isolated it. U.S. President Reagan has not mentioned the word AIDS in public. 11,055 cases in the U.S.; 5,620 dead. History CDC notices an alarming rate of of rare cancer (Kaposi's Sarcoma). First called “gay cancer” soon after rename it GRID (gay related immune deficiency). 1,614 AIDS cases diagnosed in the U.S.; 619 dead 1981 CDC warns blood banks of possible problem with the blood supply. Institut Pasteur in France finds the virus. 4,749 cases of AIDS in the U.S.; 2,122 dead. 1983

  27. History continued FDA approves the first HIV-1 antibody test. The first International Conference on AIDS is held in Atlanta, GA. Nothing from President Reagan yet. 22,996 AIDS cases in the U.S.; 12,592 dead – including: Rock Hudson and Ricky Wilson (B-52’s). 1985 1987 AZT becomes the first drug approved by the FDA. 71,176 AIDS cases diagnosed in the U.S.; 41,027 dead – including: Liberace and Michael Bennett (Chorus Line). Ronald Reagan apologizes for his neglect of the epidemic while he was president. Magic Johnson tells the world he has HIV. 257,750 AIDS diagnosed in the U.S.; 157,637 dead – including: Keith Haring (artist), Ryan White. 1990

  28. History continued FDA approves the first Protease Inhibitors for HIV treatment. 534,806 AIDS diagnosis, 332,249 dead in the U.S. 1995 For the first time, death from AIDS plummeted more than 40 percent during the first half of 1997. Scientists say the decline can be traced to new drugs. As well the number of new cases of AIDS are decreasing, but about 40,000 new HIV infections occur each year.'' 1997 For the first time in more than 17 years, the Bay Area Reporter (A SF Gay weekly) contained no obituaries of AIDS victims. 1998 CDC reports that HIV infection rates rising among Gay and Bisexual men. 2003

  29. How HIV infects the body When HIV infects the body, it prefers to attack certain cells of our defense system. These cells are called helper T cells. HIV specializes in these cells since these cells have CD4 molecules on the surface to which HIV binds helper T cell A person normally has between 600 – 1500 T cells

  30. How HIV infects the body The virus anchors itself to the CD4 on the surface of the helper T cell causing the viral membrane to fuse with the host cell’s membrane. This is how the virus genetic information gets inside the cell. The virus’s DNA converts itself into RNA

  31. How HIV infects the body A copy of the RNA genetic information is added to the bubble . This section of the cell membrane turns inside out and new viruses are released. Cell Death The release of new virus particles significantly weakens the host cell which soon dies. That’s how the immune system weakens.

  32. Transmission These bodily fluids have been proven to spread HIV: • blood • semen • pre-ejaculate or pre-cum • vaginal fluids • breast milk

  33. HIV Symptoms • rapid weight loss • dry cough • recurring fever or profuse night sweats • profound & unexplained fatigue • swollen lymph glands • diarrhea lasting more than one week • white spots or unusual blemishes on the tongue, mouth or throat • pneumonia • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids. • Memory loss, depression, and other neurological disorders

  34. What is AIDS? Acquired Immuno Deficiency Syndrome An HIV infected person receives an AIDS diagnosis after developing one of the CDC-defined opportunistic infections and or a CD4 cell count of below 200. AIDS cases are reportable to the Centers for Disease Control and Prevention.

  35. 1. Candidiasis of bronchi, trachea, or lungs 2. Candidiasis, esophageal 3. CD4 counts below 200, or a CD4 percentage less than 14 4. Cervical cancer, invasive 5. Coccidiomycosis, disseminated or extrapulmonary (Valley Fever) 6. Cryptococcosis, extrapulmonary 7. Cryptosporidiosis, chronic intestinal (>1 month duration) 8. Cytomegalovirus disease (CMV); other than liver, spleen or nodes 9. Cytomegalovirus retinitis (with loss of vision) 10. HIV encephalopathy 11. Herpes simplex: chronic ulcer(s) (>1 month duration); or bronchitis, pneumonitis, or esophagitis 12. Histoplasmosis, disseminated or extrapulmonary AIDS Defining Conditions (Opportunistic Infections)

  36. Opportunistic Infections… continued 13.Isosporiasis, chronic intestinal (>1 month duration) 14. Kaposi's Sarcoma (KS) 15. Lymphoma, Burkitt's (or equivalent term) 16. Lymphoma, immunoblastic (or equivalent term) 17. Lymphoma, primary in brain 18. Mycobacterium avium complex (MAC), disseminated or extrapulmonary 19. Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary) 20. Mycobacterium,, disseminated or extrapulmonary 21. Pneumocystis carinii pneumonia (PCP) 22. Pneumonia, recurrent 23. Progressive multifocal leukoencephalopathy (PML) 24 Salmonella septicemia, recurrent 25. Toxoplasmosis of brain 26. Wasting syndrome due to HIV

  37. Testing Antibody Testing Detects the specific immune response to HIV the body sends out to fight HIV infection (antibodies). Takes 2 weeks to 6 months (window period) to develop enough antibodies for the test to be 99.8 % accurate. • Oral test – OraSure • Blood test • Rapid Test PCR/DNA (Viral Load) Detects the presence of the HIV-1 or HIV-2 in the body. The window period for this test is 14 days to be 100% accurate. • Blood only

  38. Prevention • Not having sex (abstinence) is the safest • Condoms are best protection to prevent the transfer of fluids • Limit the number of sex partners. This may lower your chances of getting infected • Not sharing needles for IV drug use, steroids, vitamins, etc.. • Not sharing toys • Test every 6 months for all STD’s. The presence of an STD increases the chances of HIV infection. • Communicate with your partners about safer sex.

  39. STD 101

  40. Chlamydia Cause Chlamydia Trachomatis (Bacteria) How transmitted Direct contact with infected sexual fluids during genital, oral or anal sex. Symptoms Many males and most females have no symptoms. May have burning on urination, discharge, abdominal pain, pain during sex, or females may bleed during or after sex. Symptoms begin 1-3 weeks or longer after contact Diagnostic tests Swab of urethra in males or cervix in females, urine test, or swab of anus or throat Treatment Antibiotics Complications Can cause Pelvic Inflammatory Disease (PID) in females, which is a serious infection of the reproductive organs that can lead to sterility. It can also cause eye infections or pneumonia in infant during birth.

  41. Gonorrhea Cause Neisseria Gonorrhea (Bacteria) How transmitted Direct contact with infected sexual fluids during genital, oral or anal sex. Symptoms May have no symptoms - especially females. May have burning while urinating, and thick yellowish discharge. Diagnostic tests Swab of urethra in male and cervix in female, urine test, and throat swab. Treatment Antibiotics Complications Can cause PID in females, which can lead to sterility. Can cause heart and brain infection. Can cause blindness in infants if infected during birth.

  42. Syphilis Cause Treponema Pallidum (Bacteria) How transmitted Direct contact with sores of infected person. Case remains infectious for up to 2 years after infected. Symptoms A painless open sore (chancre) appears between 10 days and 3 months after exposure. May also cause skin rash on hands and feet. All symptoms go away without treatment. Diagnostic tests Blood test. Swab of chancre. Treatment Antibiotics Complications Can cause heart, brain, spinal cord, bone and joint damage. Can cause death if untreated.

  43. Genital Herpes Cause Herpes Simplex Virus How transmitted Direct skin-to-skin contact with the site of infection to the site of contact during genital, oral or anal sex. Symptoms Painful sores appear on the genital, rectum, or other parts of the body. Symptoms usually disappear causing victims to mistakenly think they are cured. Repeated outbreaks are common. Diagnostic tests Swab of the sores or blisters. A blood test is not a good indicator of infection. Treatment Antiviral creams or pills. There is no cure. Complications Can pass to other sites if not careful with hand washing after touching sores. Infants can be infected at birth causing serious medical problems including death.

  44. Genital Warts Cause Human Papilloma Virus How transmitted Direct skin-to-skin contact with an infected person or previously infected person. Warts may show up anywhere from 1 1/2 to 8 months after exposure. Symptoms Causes a wart usually on genitals. May cause itching or burning. Usually found on the penis, vulva (vagina), but also may be found on the mouth, throat, cervix and anus. Diagnostic tests Direct visual exam. Pap tests in females. Treatment Warts may be removed with either liquid, freezing or laser. Surgery may be required if severe.

  45. Hepatitis B(Also known as HBV) Cause and Transmission: The virus can be spread by percutaneous routes (e.g. needle sharing, acupuncture, ear piercing, tattooing, transfusions, receiving blood products) and through very close personal contact involving the exchange of blood or secretions (e.g. sex, child birth, breast feeding, anal rimming, etc.). The most common means of transmission of HBV in the U.S. is via the sexual route. Symptoms • Fatigue • Anorexia; recovery follows regaining appetite. • Nausea pain and fullness in the upper right quadrant • Fever • Arthritis and rash • Liver shrinkage • Severe liver damage and bleeding; can be fatal.

  46. Hepatitis B(Also known as HBV) cont. At high risk for HBV infection: • Intravenous drug users • Patients undergoing blood transfusions or hemodialysis lab • Personnel in contact with blood and blood products • Individuals with multiple sexual contacts (heterosexual and homosexual) • Immunosuppressed individuals (e.g. people who are HIV +) • Infants born to mothers with chronic HBV • Residents and staff members of institutions for the mentally handicapped.

  47. Crabs Cause Phthirus Pubis (Pubic Lice) How transmitted Close physical contact with an infected person (especially sexual contact) Also possible through sharing bedding, clothes, towels and possibly toilet seat. Symptoms persistent itch in pubic hair - usually worse at night. May see live crab or brown specks in underwear. Diagnostic tests Visual examination Treatment Medicated lotion applied to pubic hair. Complications Secondary infections from scratching.

  48. Community Acquired Methicillin-Resistant Staph Aureus

  49. Clinical Aspects • Aggressive skin involvement with rapid progression of large, painful abscesses • Cellulitis, impetigo, folliculitis, furunculosis, and infected lacerations also seen • Incision and drainage = first line of therapy • Cultures and sensitivities to determine treatment agents

  50. Modes of Transmission - Skin to skin contact with another person infected or colonized with MRSA - Contact with a surface contaminated with the organism