Transcript Introduction to Psychopharmacology Ed johnson, mac, lpc South

HBCU Student Leadership Certification Academy
INTRODUCTION TO
PSYCHOPHARMACOLOGY
ED JOHNSON, MAC, LPC
SOUTH CAROLINA PROGRAM MANAGER
SOUTHEAST ADDICTION TECHNOLOGY TRANSFER CENTER
LEARNING OBJECTIVES
Participants will:
 Understand the concepts of tolerance and
withdrawal.
 Be introduced to the various classes of drugs of
abuse.
 Become familiar with the criteria by which
addiction is defined as a chronic disease.
RESOURCES

www.justice.gov/dea/pubs/abuse

www.drugabuse.gov/drugpages

[email protected]
WHY WE DO WHAT WE DO
As human beings we do whatever we do for a
reason. We do nothing “just because.” We do
whatever we do for one of two reasons and two
reasons only:
Increase
pleasure
Decrease pain
THE BRAIN

Drugs enter the blood stream

The “Blood Brain Barrier”

Drugs act on certain parts of the brain

Memory
THE BRAIN: THE PLEASURE PATHWAY
THE BRAIN: WHAT HAPPENS WHERE
THE SUBSTANCE USE SPECTRUM
Use – Ingestion of alcohol or other drugs
without the experience of any negative
consequences.
 Misuse – When a person experiences negative
consequences from the use of alcohol or other
drugs i.e. drinks too much and gets sick.
 Abuse – Continued use of alcohol or other
drugs in spite of negative consequences.
 Dependence / Addiction – “Compulsive” use of
alcohol or other drugs regardless of the
consequences.

WHAT FLIPS THE “SWITCH”
 Changes
to brain chemistry
 Genetic Predisposition
 Environmental factors
TERMINOLOGY
Alcohol
 Drugs
 Alcohol and Other Drugs
 Alcoholism
 Drug Addiction
 Chemical Dependency
 Substance Use Disorders

TERMINOLOGY:
DEPENDENCE VERSUS ADDICTION


Addiction may occur with or without the presence of
physical dependence.
Physical dependence results from the body’s
adaptation to a drug or medication and is defined by
the presence of
– Tolerance and/or
– Withdrawal
TERMINOLOGY:
DEPENDENCE VERSUS ADDICTION
 Tolerance:
the loss of or reduction in the normal response
to a drug or other agent, following use or
exposure over a prolonged period a higher dose
is required to achieve the same effect.
TERMINOLOGY:
DEPENDENCE VERSUS ADDICTION
Dependence:
A state in which an organism functions
normally in the presence of a drug. It is
manifested as a disturbance when the drug is
removed (withdrawal).
 Can be physiological, psychological or both

TERMINOLOGY:
DEPENDENCE VERSUS ADDICTION
Withdrawal:

a period during which somebody addicted to a
drug or other addictive substance stops taking
it, causing the person to experience painful or
uncomfortable symptoms
OR

a person takes a similar substance in order to
avoid experiencing the effects described above.
CONTROLLED SUBSTANCES
Psychoactive chemicals that are found to have
abuse liability are placed under restricted use
by the Drug Enforcement Administration (DEA)
and are called “Controlled Substances”. Those
drugs with the highest abuse potential are the
ones that produce euphoria and have a rapid
onset. Since the DEA focuses on reduction of
availability of drugs, those drugs with the
highest abuse liability are policed the most
aggressively.
CONTROLLED SUBSTANCES
Schedule Description
Abuse
Liability
Medical Uses
Examples
I
May lead to severe
psychological or physical
dependence
High
potential for
abuse
No medical use; can’t be PCP, GHB,
dispensed by an MD.
Ecstasy,
Marijuana, Peyote
II
May lead to severe
psychological or physical
dependence
High
potential for
abuse
Some medical uses with
severe restrictions; can
be dispensed by Rx from
an MD.
Dilaudid,
Oxycontin,
Seconol,
Methadone
III
May lead to high
psychological or moderate to
low physical dependence
Moderate
potential for
abuse
Accepted medical uses;
can be dispensed by Rx
from an MD.
Anabolic Steroids,
Ketamine,
Buprenorphine
IV
May lead to limited
psychological and/or
physical dependence
Low
potential for
abuse
Accepted medical uses;
can be dispensed by Rx
from an MD.
Xanax, Klonopin,
Ambien,
V
May lead to limited
psychological and or physical
dependence
Very low
potential for
abuse
Accepted medical uses;
can be dispensed by Rx
from an MD.
Robitussin A-C,
Lomotil
METHODS OF ADMINISTRATION
 Oral
– drink or swallow
 Smoking
 Nasal – snorting, inhaling
 Topical – Rub on skin
 Injection – Intramuscularly (IM),
Intravenously (IV), Subcutaneous (SC)
CLASSES OF DRUGS
NARCOTICS
(OPIATES/OPIOIDS)
DRUGS IN THE CLASS
DRUGS
BRAND OR COMMON NAME SLANG TERMS
Opium
Laudanum, Paregoric
Opium
Morphine
Morphine, Roxanol
“M”, Miss Emma, Monkey
Codeine
Codeine, Tylenol with
Codeine, Robitussin A-C
School Boy
Heroin
Diacetylmorphine
Horse, Smack, Junk
Meperidine
Dilaudid
Little D, Lords
Hydromorphone
Demerol
Dolantol
Methadone
Dolophine, Methadone,
Methadose
Meth, Dolly
Other Narcotics
Percodan, Fentanyl,
Hydrocodone, Loritab,
Darvon
MEDICAL USES
Analgesic, pain relief
 Antitussive
 Antidiarrheal
 Methadone and Buprenorphine can be used for
drug addiction treatment

EFFECTS AND METHODS OF USE

Methods of Use
•

Oral, smoked, nasal, injected
Effects
•
Euphoria, Drowsiness, respiratory suppression,
constricted pupils, nausea, itching skin,
constipation
DURATION OF EFFECTS AND
WITHDRAWAL SYMPTOMS
3-6 hours for Opium, Heroin, Morphine,
Codeine, Meperidine and Hydromorphone. 1236 hours for Methadone and Buprenorphine
Variable for the rest
 Watery eyes, runny nose, loss of appetite,
yawning, irritability, tremors, panic, chills and
sweating, cramps, nausea, diarrhea

SPECIAL ITEMS OF INTEREST
Require Medically Monitored Detoxification
 Death by overdose is common
 Significant synergistic effect
 Medication Assisted Treatment is the most
effective.

NAME THAT DRUG
NAME THAT DRUG
DEPRESSANTS
DRUGS IN THE CLASS
DRUGS
BRAND OR COMMON NAME SLANG TERM
GHB
Liquid Ecstasy, GHB
X, Georgia Home Boy,
Grievous Bodily Harm
Barbiturates
Phenobarbitol, Seconal,
Amytal, Tuinal
Barbs, Yellows, Reds,
Tooies, Phennies
Benzodiazepines
Xanax, Valium, Klonopine,
Ativan, Halcion,Rohypnol
Downers, Benzos, Sleeping
Pills, Nerve pills, Roofies
Methaqualone
Quaalude, Mecquin
Ludes, Mandrex
Other Depressants
Milltown, Placydil
Muscle
DRUGS OF THE CLASS
And then there is Ethyl Alcohol:
•
•
Commonly know as Beer, Wine, Ale,
Liquor, Distilled Spirits
Or Booze / Brew
MEDICAL USES
GHB - none
 Benzodiazepenes –Anti-anxiety, sedative,
anticonvulsant, muscle relaxant
 Barbiturates – Originally anti-anxiety,
anticonvulsant
 Ethyl Alcohol – Mild Sedative, mild sleep
inducement, solvent for other drugs

EFFECTS AND METHODS OF USE
Methods of Use
•
Mainly Oral though some can be injected
Effects
•
Slurred speech, disorientation, “drunken behavior”
without odor of alcohol, diminished coordination,
increased reflex time
DURATION OF EFFECT AND
WITHDRAWAL SYMPTOMS
Duration of effect
•
Can vary from 1 to 16 hours depending on the drug
and amount used.
Withdrawal Symptoms
•
Anxiety, insomnia, tremors, delirium, convulsions
SPECIAL CONSIDERATIONS
Medically monitored detoxification required
 Major synergistic effect with opiates/opioids
 Benzodiazepines are seriously overprescribed
 Fetal Alcohol Syndrome Disorders

NAME THAT DRUG
NAME THAT DRUG
CANNABIS
DRUGS OF THE CLASS
DRUG
BRAND OR COMMON NAME SLANG TERM
Marijuana
Sinsemilla,
Tetrahydrocannabinol
THC, Marinol
Hashish or Hashish Oil
K2 Spice
Pot, Grass, Weed, Smoke,
Dope, Blunt, Reefer
Hash or Hash Oil
MEDICAL USES

Appetite Stimulant, relieves ocular pressure
associated with glaucoma
EFFECTS AND METHODS OF USE

Methods of Use
•

Smoke, Oral
Effects
•
Euphoria, relaxed inhibitions, increased appetite
DURATION, WITHDRAWAL SYMPTOMS

Duration of Effect
•

2-4 Hours
Withdrawal symptoms
•
Irritability, insomnia, loss of appetite
SPECIAL ITEMS OF INTEREST

K2 Spice
•
•
•
It is a synthetic cannabinoid, it provides the same
euphoric effect as marijuana.
Is marketed as “incense” on the internet and in
locations where it is not illegal.
Is not detectable on urine drug screens.
NAME THAT DRUG
NAME THAT DRUG
STIMULANTS
DRUGS IN THE CLASS
DRUGS
BRAND OR COMMON NAME SLANG TERMS
Cocaine
Coke, Crack
Snow, Blow, Crack
Amphetamines /
Methamphetamine
Adderall, Crystal Meth,
Dexadrine
Crank, Speed, Ice
Methylphenidate
Ritalin, Concerta
Caffeine
Coffee, tea, chocolate, Nodoz, Vivarin
Java, Joe
Nicotine
Cigarettes, Smokeless
tobacco
Chew, dip, cigs
MEDICAL USES
Cocaine and it’s cousins can be a topical
anesthetic
 Amphetamines can be used for weight loss,
narcolepsy, ADHD
 Caffeine is a mild stimulant and can be used to
treat headaches
 Nicotine has no medical use but is a good
insect repellant

METHODS OF USE AND EFFECTS

Methods of Use
•

Oral, smoked, nasal, injected
Effects
•
Increased alertness, excitation, euphoria, insomnia,
loss of appetite, increased pulse and blood
pressure
DURATION OF EFFECT AND
WITHDRAWAL SYMPTOMS

Duration of effect
•

Can vary from a few minutes to 4-6 hours
Withdrawal Symptoms
•
Apathy, long period of sleep, depression, irritability,
disorientation
NAME THAT DRUG
NAME THAT DRUG
NAME THAT DRUG
NAME THAT DRUG
HALLUCINOGENS
DRUGS OF THE CLASS
DRUGS
BRAND OR COMMON NAME SLANG TERMS
MDMA and Analogs
MDMA, MDA, MDEA, MBDA
MDMA- Ecstasy; MDA –
Love Drug; MDEA – Eve;
LSD
Lysergic Acid Diethylamide
Acid, Blotter, Microdot
Phencyclidine and Analogs
Ketamine, PCP,
Angel Dust, Special K
Mescaline and Peyote
Mescal
Cactus, Button, Mesc
Other Hallucinagens
Dextromethorphan (DXM),
Psilocybe mushrooms
Shrooms,
MEDICAL USES

With the exception of Ketamine which is an
anesthetic, none.
EFFECTS AND METHODS OF USE
Methods of Use
•
Oral, smoked, snorted, PCP and Ketamine can be
injected
Effects
•
Illusions, hallucinations, poor perception of time
and distance, sensory crossover, impaired hand eye
coordination.
DURATION OF EFFECT AND
WITHDRAWAL SYMPTOMS

Duration of Effect
•

Depending on the substance anywhere from one to
twelve hours.
Withdrawal Symptoms
•
Muscle Aches, drowsiness. No “withdrawal
symptoms” in classic sense.
NAME THAT DRUG
INHALANTS
DRUGS OF THE CLASS
DRUGS
BRAND OR COMMON NAME SLANG TERMS
Volatile Solvents
Gasoline, Airplane glue,
Vegetable Spray, Hairspray,
Deodorant, Spray Paint,
Paint Thinner, Transmission
Fluid, Air Freshener
Sniffing, Huffing
Nitrites
Butyl Nitrite, Amyl Nitrite
Rush, Locker Room,
Poppers
Nitrous Oxide
Laughing Gas, Whippets
MEDICAL USES

Amyl Nitrite can be used to treat Angina.
Nitrous Oxide is an anesthetic.
EFFECTS AND METHODS OF USE

Methods of use
•

Sniffing and inhaling
Effects
•
Slurred speech, euphoria, rapid heart beat, stupor,
headache
DURATION OF EFFECT AND
WITHDRAWAL SYMPTOMS

Duration of Effect
•

Fifteen minutes to two hours
Withdrawal Symptoms
•
Insomnia, Irritability, Cramps, Nausea, Tremors,
Depression, Headache, Confusion, Convulsions
SPECIAL ITEMS OF INTEREST
Inhalants cause severe damage to the lungs,
liver, kidneys, bone marrow and the brain.
 Additionally they can cause suffocation, stroke,
loss of consciousness and possible death

Is Addiction a
DISEASE, MORAL FAILURE OR JUST
POOR CHOICES?
WHAT DEFINES A “DISEASE” –
MEDICALLY SPEAKING
A.
B.
C.
D.
E.
When any cell tissue or any organ is affected in
such a way that the tissue or organ cannot
function as it is intended.
It is a primary condition.
It has a predictable and progressive course.
There is an established etiological agent or
cause.
The disorder has a recognizable, measurable set
of signs and symptoms which permit an accurate
diagnosis
ADDITIONAL “DISEASE”
CHARACTERISTICS

Can be short or long acting
•

Potentially fatal
•

Or not
Treatable
•

Acute versus Chronic
Or not
Curable
•
Or not
CHRONIC OR ACUTE
Acute Disease
 Rapid
onset
 Short course
 May be severe
Chronic Disease
 Gradual
onset
 Lifetime course
 May have “acute” episodes
IF ADDICTION IS A “DISEASE” THEN:

What is the “affected cell tissue or organ?”
•

Is it a “primary condition?”
•

Yes, it is not the effect of any other disease.
Is there a “predictable, progressive course?”
•

The Brain, and it is expressed in the form of
“compulsive behavior.”
Yes
Are there “recognizable, measureable signs
and symptoms?”
•
Yes, outlined in the DSM IV
IF ADDICTION IS A “DISEASE” THEN:

Is it Chronic or Acute
•

Is it a “potentially fatal?”
•

Yes.
Is it “treatable?”
•

“Gradual onset with acute episodes” accurately
describes it, chronic.
Yes, with abstinence and lifestyle / behavioral
modification changes
Is it “curable?”
•
At present No.
BRAIN DISORDERS
Brain disorders are characterized by
uncontrollable involuntary behaviors.
 Schizophrenia – Hallucinations
 Depression – Mood swings
 Parkinson’s Disease – Muscle Tremors

Addiction- Drug seeking, Antisocial behaviors
TREATMENT OF CHRONIC DISEASES
Since the causes are usually multi-factorial,
treatments must usually be multi-modal.
 Response rates are variable and depend on the
patient, the treatment itself, and outside
factors.

CHRONIC DISEASE COMPARISON
Diabetes
•
•
•
•
•
Genetic predisposition
Lifestyle choices are a
factor in development of
the disease
Severity is variable
There are diagnostic
criteria
Once diagnosed, you’ve
got it
Addiction
•
•
•
•
•
Genetic predisposition
Lifestyle choices are a
factor in development of
the disease
Severity is variable
There are diagnostic
criteria
Once diagnosed, you’ve
got it
DISEASE COMPARISON (CONT.)
Diabetes
•
•
•
•
Primary treatment is
lifestyle modification
Small percentage of
patients comply with
same
Medications can help
Patients often don’t
comply with medical
regimen
Addiction
•
•
•
•
Primary treatment is
lifestyle modification
Small percentage of
patients comply with
same
Medications can help
Patients often don’t
comply with medical
regimen
DISEASE COMPARISON (CONT.)
Diabetes
•
•
Patients who are
partially compliant are
the rule, and outcomes
are better than those
who do not get
treatment
Support systems
improve outcomes
Addiction
•
•
Patients who are
partially compliant are
the rule, and
outcomes are better
than those who do not
get treatment
Support systems
improve outcomes
DISEASE COMPARISON (CONT.)
Diabetes
•
Since suboptimal
patient compliance is
expected, medication
use is titrated to
maximize outcome
Addiction
•
Since suboptimal patient
compliance is
expected…….wait till
motivated? let them do
more “research”?
withhold medication till
they try harder?
DISEASE COMPARISON (CONT.)
Diabetes
•
Even in highly motivated
patients, only a small
percentage will succeed
without medication.
“Abstinence” from
medication is lowest
priority
Addiction
•
Abstinence is still often
the underlying goal,
without which treatment
(and the patient) is
judged a failure???
DISEASE COMPARISON: CONCLUSION
Chronic disease may be controllable, but not
usually curable
 Medications, if available, are useful to promote
this “disease control”
 Results will be suboptimal
 There is a “disconnect” between treatment of
addiction vs. other chronic diseases

DISEASE VERSUS MORAL FAILURE
How do we deal with “moral failures” or “crimes?’
Punishment, “consequences”, Incarceration.
How do we deal with “diseases?”
Medical care, treatment, meeting the patient “where
they are at”, helping them to move toward a
healthier life
IF ADDICTION IS A DISEASE, WHY
ARE WE TREATING IT LIKE A
MORAL FAILURE. IF ADDICTION IS
A CHRONIC DISEASE WHY DO WE
TREAT IT LIKE AN ACUTE DISEASE?
QUESTIONS?
[email protected]