ATrap! ATrap! NotAnEscape... NotAnEscape... SSubstanceAbuse&Addiction ubstanceAbuse&Addiction 22022-2023LPSANewsletters-OctoberIssue 022-2023LPSANewsletters-OctoberIssue
CONTENTS CONTENTS 3 OVERVIEW 4 THE SUBSTANCE USE DISORDER 11 DRUG ADDICTION VS DRUG ABUSE 13 THE FEDERAL SCHEDULING OF DRUGS 14 ADDICTIVE DRUGS AND THEIR EFFECT ON KK THE BRAIN 19 WHAT IS ACID? 20 MARIJUANA ADDICTION: MYTHS VS FACTS 21 TREATMENT AND WAYS OF RECOVERY 26 ROLE OF THE PHARMACIST 28 HOW TO ESCAPE THE TRAP? TABLE TOF ABLE OF
Overview Overview
Drug addiction and abuse related deaths are among the most pressing health crises of our times. Therefore, the National Institute of Drug Abuse (NIDA) highlights the importance of patient empowerment and education regarding the appropriate use of medications in order to promote individual and public health.
In Lebanon, the war has precipitated drug addiction due to the increased availability of products, the psychological fragility of citizens, the economic crisis and the more permissive sociocultural context.
The most widely used drug is Heroin. It is often used in combination with other drugs like Marijuana or Cocaine by both men and women in a ratio of 8:2.
W h a t I s S u b s t a n c e U s e D i s o r d e r ? W h a t I s S u b s t a n c e U s e D i s o r d e r ?
Based on the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, the two terms "Substance Abuse" & "Substance Dependence" have been replaced by a single category: “Substance Use Disorder ”
Substance use disorder (SUD) is a complex condition characterized by uncontrolled use of a substance despite its harmful consequences.
People with SUD have an intense focus on consuming one or more substances such as alcohol, tobacco, or illicit drugs, to the point where their ability to function in day-to-day life becomes impaired.
What Are the WMajor hat Are the Major Causes of CSUD? auses of SUD? ToFeelGood andexperiencepleasure, a“high”,or ”euphoria”. ToFeelBetter and relieve stress, forget problems,orfeelnumb. ToDoBetter or improve performance andthinking. ForCuriosityordue toPeerPressure or to experiment new things.
What Are the WMajor hat Are the Major Symptoms of SSUD? ymptoms of SUD? A sense of Euphoria or "feeling high" Decreased Cognitive Function and Memory A heightened sense of Visual, Auditory and Taste perception Increased Blood Pressure and Heart Rate Red Eyes Dry Mouth The symptoms differ according to the substance abused. However, they mainly include:
What Are Wthe hat Are the Signs Signs of oSUD? f SUD? Physical PSigns hysical Signs Be Bgns e gns Sudden weight loss or gain Pupils that are smaller or larger than usual Changes in appetite and sleeping patterns Impaired coordination and slurred speech Unusual odors on b body, or clothes Beginning to act in a secretive or suspicious way Using more than originally intended or being unable to control use Neglecting family and friendships, as well as duties at home, school, or work Suddenly changing hobbies, friends, or activities Using the substance under conditions that may not be safe, such as sex without a condom or other barrier method, driving under the influence, or using syringes that are not sterile No longer engaging in previously enjoyed activities due to substance use Psychological PSigns sychological Signs Feeling paranoid, anxious, or fearful Lack of motivation Feeling excessively tired Sudden changes in mood Increased agitation or ger
SUD affects the victims and their Sfamilies UD affects the victims and their families in many iways: n many ways: Physically, Physically, Socially, Economically & SLegally ocially, Economically & Legally What Are Wthe hat Are the Consequences Consequences of oSUD? f SUD?
of SUD are often caught up in a network of other drug users.
may become violent and may
also goes
which often
help and
them from
Victims
They
lose their social connections including friends, family, and professions. Addiction
with stigma and discrimination
discourages
seeking
treatment. It is not only the victim that suffers from substance abuse. Their family and friends are affected as well and suffer from trauma, poor nutrition, violence, and heartbreak. Physically Physically There are both long-term and short-term effects of using drugs. They depend on the type of drug, how much, and for how long it has been used. Changes in heart rate Changes in appetite and behavior Overdose Death Short-term effects Socially Socially Lung cancer Mental illness Addiction Death Long-term effects
EEconomically conomically
Users may spend all their resources acquiring drugs and getting treatment. They may also lose their jobs or not be able to get well-paying ones. Communities spend a lot of money on prevention, treatment, and rehabilitation programs.
LLegally egally
Research has proven that drug use is linked to crime and affects both those who trade in them and those who consume them. First of all, it is a crime to use, possess, manufacture, or distribute drugs classified as having a potential for abuse. Additionally, the short-term influence of drugs such as alcohol often gets people in trouble as they are more likely to be involved in traffic offenses, violence, and other crimes.
VS DRUG DRUG ABUSE ABUSE
DRUG DRUG ADDICTION ADDICTION VS
The two concepts may coexist Tand he two concepts may coexist and are often used ainterchangeably. re often used interchangeably. HOWEVER, HOWEVER, There IS a distinction to be Tmade here IS a distinction to be made between substance abuse band etween substance abuse and substance saddiction. ubstance addiction. Simply put, a person can Sabuse imply put, a person can abuse drugs without necessarily dbeing rugs without necessarily being addicted to athem. ddicted to them.
DRUG
VS VS DRUG DABUSE RUG ABUSE
Drug DAddiction rug Addiction
Addiction is the result of using a substance (drug or medication) that has a measurable impact on the reward center of the brain. The repeated stimulus of this center is enough to cause a change in the functionality of the brain itself. Eventually, the process of stimulating the reward circuitry becomes of paramount importance above all other aspects of an otherwise “normal” life such as eating, sleeping or engaging in sexual activity.
Drug DAbuse rug Abuse
Drug abuse may lead to addiction but, as a non-clinical concept, "abuse" encompasses any use of illicit substances or inappropriate use of any medication such as taking larger doses than were prescribed.
Briefly, the definition of drug abuse focuses around the way a person uses drugs, while the definition of drug addiction includes the use of drugs but the psychological and physiological effects they have on the body as well.
DADDICTION RUG ADDICTION
Schedule Schedule Classification CCriteria lassification Criteria EExamples xamples C-1 Have a high potential for abuse, no currently accepted medical use, and no accepted safety for use under medical supervision Ectasy or MDMA (3,4 Methylenedioxymethamphetamine), heroin, LSD (Lysergic Acid Diethylamide), marijuana, methaqualone, peyote C-II Have a high potential for abuse and may lead to severe psychological or physical dependence, but have a currently accepted medical use with severe restrictions Hydromorphone, methadone, meperidine, oxycodone, fentanyl, morphine, opium, codeine, cocaine, amphetamine, methylphenidate C-III Have less potential for abuse than substances in C I or C II but have potential for abuse that may lead to moderate or low physical dependence or high psychological dependence Hydrocodone/Acetaminophen (Vicodin), Tylenol/Codeine, buprenorphine, benzphetamine, phendimetrazine, ketamine, anabolic steroids (DepoTestosterone) C-IV Have a low potential for abuse relative to substances in C III Alprazolam, carisoprodol, clonazepam, clorazepate, diazepam, lorazepam, midazolam, temazepam, triazolam Have a low potential for abuse relative to substances in C-IV and mainly consist of preparations containing limited quantities of certain narcotics Robitussin AC, Phenergan/Codeine, ezogabineC-V TheControlledSubstancesAct(CSA)establishedregulationsthatplaced drugsinto“schedules,”fiveofwhichwerecreated. TheDrugEnforcementAdministration(DEA),afederalagency,ischargedof placingeachdruginaschedulebasedonthreequalities: itspotentialforabuse,itspotentialfordependence,anditsmedicaluse. The Federal TScheduling he Federal Scheduling of oDrugs f Drugs
Stimulants Depressants Opioids/Pain Killers Hallucinogens What Are the WDifferent hat Are the Different Classes Cof lasses of Addictive ADrugs? ddictive Drugs? What Are their Effects on the WBrain? hat Are their Effects on the Brain?
Stimulants
This class includes drugs that speed up the central nervous system resulting in increased neural activity. Substances in this category make people feel more alert, active, awake, and euphoric. They are addictive and can be very dangerous at high doses. Stimulants include caffeine, cocaine, and ecstasy.
Hallucinogens
Just like their name indicates, this class of drugs causes hallucinations, which are distorted perceptions of reality. A user may experience intense emotional swings, hear sounds, see things and experience feelings that are not real. Hallucinogens include LSD and Marijuana.
Depressants
This class includes drugs that produce a
effect. They slow down normal brain activity and induce sleep or make the user relaxed, mellow and calm. They are also known as downers or sedatives.
include alcohol, valium, or sonata.
Substances in this class have
include
in
They
sedative
Depressants
Opioids/Pain Killers
euphoric effects on the brain: they produce a euphoric rush, followed by relaxation and pain relief. Drugs
this group
Morphine, Codeine, Heroin, and Fentanyl.
can be very addictive and dangerous at high doses.
What are Wthe hat are the Phases of P"USE" hases of "USE"
Experimental EUse xperimental Use
This usually is a one off or short term use of a drug. Here, an individual is just trying the drug. He could have yielded to peer pressure, wanted to belong to a group, or tried the drug out of curiosity.
Social or Recreational SUse ocial or Recreational Use
Involves an individual’s regular use of a drug for a desired effect.
this stage,
is still able to control the amount of the drug, when to
Emotional Use (Suppressive
At this stage, the user is looking to generate a mood or elicit some
may also be
Habitual
Frequency is key at this stage. The user is spending more time on
that
Dependent DUse ependent Use
At this stage, the user is not in control of their substance use. They crave to use the
and may suffer
of any possible harmful effect. At this stage, they
At
he/she
use it, and what combinations to use.
or EGenerative) motional Use (Suppressive or Generative)
kind of feeling or emotion. However, the user
looking to suppress a feeling, emotion or state such as depression or to cope with stress as well. 11 2 2 3 3 55 4 4
HUse abitual Use
the drug at the expense of school work, social life, and things
the he/she used to enjoy.
drug regardless
become less social and healthy,
from professional and legal consequences of their abuse.
How Do these HDrugs ow Do these Drugs Affect the ABrain? ffect the Brain?
Drugs affect three key areas of the brain:
The Cerebral Cortex The Limbic TSystem he Brain Stem
1. The Brain Stem is the part of the brain that controls vital functions of life such as breathing, sleeping, and heart rate.
2. The Cerebral Cortex functions in two ways: the first is by controlling sight, hearing, and tasting and the second is by coordinating problem-solving skills, thinking, and decision making.
3. The Limbic System regulates specifically our ability to feel pleasure. It is the reward circuit that registers pleasure and causes us to pursue more pleasure. In simple terms, It controls our emotions, feelings, and moods.
All three parts work together in harmony, but this harmony is disrupted by drug use which interferes with how the brain parts communicate and eventually disrupts the natural balance of the brain’s functions.
For instance, when a person takes a drug for pleasure, the chemicals in the limbic system surge. After the feeling of pleasure subsides, the brain remembers that pleasure and wants more. That feeling to “ go for more ” is very strong and often, the user has no control of the situation.
What
Is W"ACID"? hat Is "ACID"? "ACID” is a slang term for Lysergic Acid Diethylamide (LSD) which is one of the most important drugs when it comes to substance addiction or abuse. It belongs to a group of substances called psychedelics or hallucinogens and can alter a person ’ s thoughts, feelings and perception of the world around them. The Drug Enforcement Administration (DEA) classifies LSD as a Schedule I drug (C-I). Recent studies however suggest that LSD may be used as a treatment for certain mental health conditions such as depression and anxiety. What Are the WSymptoms hat Are the Symptoms of "ACID" oAddiction? f "ACID" Addiction? Hallucinations Intensified feelings or sensory experiences (brighter lights, stronger sounds) Mixed senses (seeing sounds or hearing colors) Changes in perception of time (slower or faster) Impulsiveness and mood swings Loss of appetite, nausea, dry mouth, sweating Increased heart rate, blood pressure, and temperature Paranoia Disorganized thinking Mood disorders Visual disturbances Persistent Hallucinations Neurological symptoms that may mimic a stroke or a brain tumor Short-term Short-term LLong-term ong-term
Marijuanahasnomedicinal ortherapeuticuse. MYTH FACT SmokingCannabiscauses LungCancer. MYTH FACT Marijuana M(Cannabis) arijuana (Cannabis) Marijuana is found in the dried resinous flower buds and leaves of the Cannabis plant. It is widely used - and abused - for its relaxing and calming effects. Myths VS MFacts yths VS Facts Nausea and vomiting related to chemotherapy Anorexia related to advance HIV/AIDS Some rare types of childhood epilepsy There are currently 3 FDA-approved uses for cannabis or cannabisderived products: 1. 2. 3. Some studies reference harmful effects of smoking cannabis such as increased coughing. However, credible cannabis facts suggest that marijuana may help prevent cancer by killing several types of cancer-causing cells.
Treatment Tof reatment of Addiction Aand ddiction and Ways Wof ays of Recovery Recovery
Addiction treatment is NOT a “ one size fits all” approach. In other words, what works for one person may not work for the other. Generally, once an individual recognizes the negative impact that a substance has on their life, many treatment options are available.
Treatment options depend on several factors, such as the type of addictive disorder, the length and severity of use, as well as its effects on the individual. However the most common treatment approach involves a combination of medications, psychological interventions and personalized rehabilitation programs.
Treatment of TAddiction reatment of Addiction & Ways of &Recovery Ways of Recovery
1Medical Detoxification
Medical Detox is considered the first step in overcoming Substance Use Disorder. It is the optimal treatment to clear a person ’ s body from drugs while getting him/her safely through withdrawal symptoms and preventing relapses.
Medical detox treatment is personalized as it depends on the current situation of the abuser as well as the substance abused.
Which medications are used to treat Opioid Use Disorder ?
Clonidine
Clonidine belongs to a class of medications called "centrally acting alpha-agonist hypotensive agents." It is more commonly used than any other drug to treat opioid withdrawal, but it is best reserved for those who are not heavily addicted to opioids. Since clonidine is not an opioid itself and does not occupy the same receptors in the brain that opioids do, it cannot treat withdrawal symptoms of opioids such as craving. However, it is very effective at minimizing certain symptoms associated with opioid withdrawal such as anxiety, muscle and bone pain, agitation, sweating, runny nose and cramps.
Treatment of TAddiction reatment of Addiction & Ways of &Recovery Ways of Recovery
Methadone
Methadone is an opioid agonist used to treat opioid withdrawal in all its forms, whether caused by abuse of the drug or not. Not only can it relieve withdrawal symptoms and make the detox process smoother, but it can serve as a "long term maintenance medicine for opioid dependence."
Methadone is often used for those who require intensive treatment for opioid withdrawal. Individuals with severe pain and other intense symptoms are often better treated with methadone than any other medication.
Buprenorphine
Buprenorphine is a partial opioid agonist. It has many of the properties of other opioids like methadone but its effects are not as intense as those of other drugs. However, it possesses a ceiling effect: if taken in high doses, it eventually stops producing an effect. Buprenorphine is normally paired with Naloxone when prescribed.
What Are the Risks &/or Side Effects?
Methadone and buprenorphine are themselves opioids, thus possess some of the risks of opioid overdose, such as slowed breathing, heart problems, sweating, constipation, and sexual problems. People with asthma or other breathing problems should not take methadone. Buprenorphine is slightly safer than methadone because it is harder to overdose on it.
Treatment of TAddiction reatment of Addiction & Ways of &Recovery Ways of Recovery
2Counseling&BehavioralTherapy
Following detoxification, Counseling and Behavioral Therapy may occur on a one-to-one, group or family basis depending on the needs of the individual. It is usually intensive at the outset of treatment with the number of sessions gradually reducing over time as symptoms improve. Different types of therapy include:
Helps people recognize and change ways of thinking that have associations with substance use.
Therapy
Improves family function around an adolescent or teen with a substance-related disorder.
Maximizes an individuals willingness to change and make adjustments to their behaviors.
abstinence through positive reinforcement.
In 2017, the United States Food and Drug Administration (FDA) approved the first-ever mobile application, reSET®, for use alongside outpatient management for marijuana, cocaine, alcohol, and stimulant use disorders.
Cognitive Behavioral Therapy
Multi-dimensional Family
Motivational Interviewing Encourage
Motivational Incentives
Treatment of TAddiction reatment of Addiction & Ways of &Recovery Ways of Recovery
3Rehabilitation Programs
Longer-term treatment programs for substance-related and addictive disorders can be highly effective. They typically focus on remaining drug-free and resuming function within social, professional, and family responsibilities.
A few types of facility can provide a therapeutic environment, such as:
Short-term Residential Treatment
Focuses on detoxification and preparing an individual for a longer period within a therapeutic community through intensive counseling.
Therapeutic Communities
A person seeking long-term treatment for severe forms of addictive disorder would live in a residence for 6 to 12 months with on-site staff and others in recovery. The community and staff serve as key factors in recovering from substance use and in inducing changes in attitudes toward drug use.
Recovery Housing
Provides a supervised, short-term stay in housing to help people engage with responsibilities and adapt to a new, independent life without on-going substance use.
Role of Rthe ole of the Pharmacist Pharmacist
Pharmacists have a unique and comprehensive knowledge about the safe and effective use of medications and the adverse effects associated with their inappropriate use.
Therefore, they are responsible for ensuring a safe medication-use system, including legal and organizational responsibilities for medication distribution and control across the continuum of practice settings.
Indeed, Pharmacists play a huge role in Prevention, Education and Assistance of individuals who have fallen victim to substance abuse.
Prevention Prevention
Pharmacists should be involved in substance abuse prevention by:
Participating in public substance abuse education and prevention programs in primary and secondary schools, colleges, healthcare organizations and shedding the light on the potential adverse health effects of the misuse of legal drugs and the use of illegal drugs.
Establishing a multidisciplinary controlled-substance inventory system, in compliance with statutory and regulatory requirements, that discourages diversion and enhances accountability.
Working with local and federal authorities in controlling substance abuse, including participating in state prescription drug monitoring programs and encouraging participation in appropriate prescription disposal programs.
Discouraging prescribing practices that foster drug abuse behavior such as prescribing a larger quantity of pain medication than is clinically needed for treatment of short term pain.
EEducation ducation
Pharmacists should be involved in substance abuse education by:
Providing recommendations and counseling tips about the appropriate use of mood altering substances to healthcare providers and the public, including those persons recovering from substance dependency. Fostering the development of undergraduate and graduate college of pharmacy curricula on the topic of substance abuse prevention, education, and assistance.
Providing substance abuse education to fellow pharmacists and other healthcare professionals such as psychiatrists and nurses at rehab centers, which would enhance inter-professional collaboration and patient care.
Pharmacists should be involved in substance abuse assistance by:
Assisting in the identification of patients, coworkers, and other individuals who may suffer from substance abuse, and referring them to the appropriate people for evaluation and treatment.
Participating in multidisciplinary efforts to support and care for the healthcare organization’s employees and patients who are recovering from substance dependency.
Providing pharmaceutical care to patients being treated for substance abuse and dependency.
1. 2. 3.
1. 2. 3. 4.
1. 2. 3.
Assistance Assistance
How to Escape Hthe ow to Escape the TTrap? rap?
Having the will to “Get Back On Track”
Join a Solid Support Group
Make sure to open up to supportive family members and friends. They will help you find the right resources to deal with the ups and downs of recovering from drug addiction and help you get back on track.
It’s YOU VS YOU! Admitting that there is a problem and willing to reach out for help is the first step to recovery. This takes a lot of courage and strength!
Find a New Hobby
Focus on Day-to-Day Improvement
If you allow yourself to think about the challenges you will face in the future, you will surely get overwhelmed. You should take one day at a time and celebrate every small victory you make.
Maintain a Healthy Mind and Body
You will learn so many skills during your journey to recovery that will be useful in many instances and that will help you build a newfound mental, emotional, and physical strength.
It could be exercise, like walking, boxing, rock climbing, dancing, or painting. Building new, healthy and enjoyable habits is key to dealing with drug addiction.
Avoid Triggers
Knowing your triggers is a vital part of recovering from any addiction.
It’s important to avoid your triggers even after you have been sober for a while. It can be easy to get overconfident and believe you will never go back to your old habits. This is a trap many people fall into!
Drug addiction can drive you to your lowest point, but there is always hope.
Going through recovery is difficult, but it will make you strong and help you heal in many ways.
Keep
in mind, there is NOTHING that can hold you back!
REMINDER OKAY?
