Module Seven ALCOHOL & SUBSTANCES ABUSE

1. Module SevenALCOHOL & SUBSTANCES ABUSE • Lesson 1: Alcohol (2 training hours) • Lesson2: Other substances (2 training hours) • Lesson 3: Social issues (2 training hours)

2. Lesson 1 ALCOHOL

3. Step 1: Discussion Alcohol is the most popular toxic substance to man. Most of us use it for pleasure, but in some cases alcohol drinking might end to be a serious problem. What is the secure alcohol consumption ? Specialized organizations have determined that The limit of safe consumption is 21 units per week for men and 14 for women. One unit corresponds to half a pint of beer, a glass of wine or a 40gr of whiskey/vodka/liquer.

4. Step 2: Slide projection Slide 7.1.1: Some terms Exceeding alcohol consumption The regular consumption on daily or weekly basis that exceeds the recommended limit.

5. Step 2 (continued) Disorder caused by alcohol Any psychological, physical or social damage that derives from exceeding consumption.

6. Step 2 (continued) Problematic alcohol consumption Consumption that causes any disorders that can derive from alcohol drinking, but has not yet caused dependence on it.

7. Step 2 (continued) Dependence on alcohol A situation in which physical and mental disorders develop, when alcohol use is stopped.

8. Step 2 (continued) Toxicosis Is the intoxication, that is the situation that follows when alcohol levels in the blood exceed a certain limit.

9. Step 3 Slide 7.1.2: Characteristics of the dependence in alcohol Withdrawal syndrome • Trembling hands, tongue and eyelids • Nausea, vomiting, diarrhea • Intense heart beat, perspiration, high blood pressure • Fever • Headache • Irritability, excitement, anxiety, insomnia • Temporary hallucinations or delusions

10. Step 3 (continued) Tolerance Need for increasing quantity to achieve the same outcome Furthermore : • Pressurizing need to drink • Standard manner of drinking regularly • Priority to drinking than to other activities • Failures to quit

11. Step 4: Slide projection Slide 7.1.3: Damages from alcohol abuse Physical It can be an immediate effect of alcohol drinking, or an indirect effect from malnutrition (lack of vitamins), accidents and general neglecting of oneself. • Gastric ulcer, hepatic damage • Brain damage (and dementia) • Peripheral neuritis with loss of sensing • Anemia, heart failure • In women that abuse alcohol during pregnancy, the infant might have low weight and other abnormalities.

12. Step 5 (continued) Psychiatric • Anxiety • Depression • Aggression • High possibility of committing suicide • Psychosis with delusions or jealousy ideation Social • Family problems (quarrels, violence, divorce) • Professional problems • Illegal actions • Accidents (car accidents or others)

13. Step 5: Theory presentation It is essential to recognize persons that abuse alcohol, as they tend not to reveal their alcohol problems. The therapy is recommended to: • Treatment of withdrawal syndrome • Psychotherapies : • Recognizing and admitting the problem • Try to quit drinking habit • Keeping up the effort when it starts to give results • The existence of support groups (like Alcoholic Anonymous) has been proved efficient.

14. Step 6: Questions and comments (5΄)

15. Lesson2 OTHER SUBSTANCES

16. Step 1: Introduction The issue of other substances must be examined in a similar way to alcohol. The most extreme effects and problems are related to the dependence on these substances. There are of course a lot of addictive substances and the problems and dangers differs from one to another.

17. Step 2: Brainstorming Which substances have you encountered in your practice? • Opiates, f. ex. Heroine, morphine • Stimulants, f ex amphetamines, ecstasy, cocaine • Hallucinogens, f ex. LSD • Drugs, f ex benzodiazepines, barbiturates • Solutions, f ex glue and aerosol • Cannabis • Nicotine • Caffeine

18. Step 3: Slide projection Slide 7.2.1: Characteristics of the most common substances Opiates (heroine, morphine) WAY OF TAKING :ingestion, intramuscularly,intravenously,subcutaneously PSYCHOLOGICAL EFFECT: euphoria, relaxation, dizziness, personality change, hypo activity, loss of appetite, low libido PHYSICAL EFFECT: constricted pupils (pinpoint), low heart rate, itching, nausea, constipation WITHDRAWAL SYNDROME : intense desire for the substance, uneasiness, rapid heart rate, dilated pupils, sweating/perspiration, yawning, diarrhea, abdominal pain, dehydrated skin DEPENDENCE: YES

19. Step 4 (continued) Cocaine WAY OF TAKING: chewing, inhale through nose, smoking, intravenous injection PSYCHOLOGICAL EFFECT: Euphoria, enthusiasm, Confusion, Paranoid psychosis PHYSICAL EFFECT: dilated pupils(constricted pupils (pinpoint)), fear, increase heart rate,, runny nose (rhinorrhea), fever, heart respiratory attack WITHDRAWAL SYNDROME : intense desire for the substance, depression, insomnia, agitation. DEPENDENCE: YES

20. Step 3 (continued) Amphetamines WAY OF TAKING: ingestion, intravenous injection PSYCHOLOGICAL EFFECT: Euphoria, enthusiasm, hyperactivity, irritability, hostility, Paranoid ideation, Delusions PHYSICAL EFFECT: constricted pupils, increase heart rate, increase of reflexes WITHDRAWAL SYNDROME : sadness, unemployment DEPENDENCE: YES

21. Step 3 (continued) Hallucinogens (LSD) WAY OF TAKING: ingestion PSYCHOLOGICAL EFFECT: Depersonalization, Deobjectivation, Overestimation of abilities, Anxiety, Effect ideas, low judgment ability, Psychotic characteristics, Mood swings PHYSICAL EFFECT: red eyes, constricted pupils, ataxia, increased heart rate WITHDRAWAL SYNDROME : None DEPENDENCE: NO

22. Step 3 (continued) Cannabis (hashish, marijuana) WAY OF TAKING : smoking PSYCHOLOGICAL EFFECT: euphoria, relaxation, acute perception PHYSICAL EFFECT: red eyes, dry mouth, increased heart rate, respiratory problems WITHDRAWAL SYNDROME : none DEPENDENCE: YES

23. Step 3 (continued) Barbiturates WAY OF TAKING: ingestion PSYCHOLOGICAL EFFECT: Anxiety reduce PHYSICAL EFFECT: Repression of respiratory system, Repression of Central Nervous System WITHDRAWAL SYNDROME : Uneasiness, Insomnia, Nausea, Spasms, Delirium DEPENDENCE: YES

24. Step 3 (continued) Benzodiazepines WAY OF TAKING: Intramuscularly, intravenously, ingesting PSYCHOLOGICAL EFFECT: Anxiety reduce, Disturbances in concentration, judgment, memory PHYSICAL EFFECT: ataxia, Nausea, CNS repression WITHDRAWAL SYNDROME : Uneasiness, Insomnia, Fear DEPENDENCE: YES

25. Step 3 (continued) Ecstasy WAY OF TAKING: ingestion PSYCHOLOCICAL EFFECT: Euphoria, increased perceptions, Anxiety, Psychotic characteristics PHYSICAL EFFECT: anorexia, increased heart rate, jaw tension, sweating, High temperature , blood vessel thrombosis WITHDRAWAL SYNDROME : None DEPENDENCE: NO / YES

26. Step 3 (continued) Solutions (glues, aerosol) WAY OF TAKING: inhaling PSYCHOLOGICAL EFFECT: Euphoria followed by apathy, rejection of Inhibitions, poor judgment PHYSICAL EFFECT: : Sore eyes, sore throat, rushes breathing difficulty,CNS repression, ataxia,sleepiness, peripheral neuropathy, multiple kidney failure, arrhythmias, liverandkidney damage, kidney damage, aplastic anaemia WITHDRAWAL SYNDROME: None DEPENDENCE: RARE

27. Step 4: Slide projection Slide 7.2.2: Treatment of substance use Pharmacotherapies: (Methadone, Naltrexone, Klonidine, etc ) Psychotherapies. Have as a target to: • Intervene in possible psychological, social, environmental factors that persist. • Increase person’s awareness. • Develop alternative mechanisms of treating the problems. • Inform for the strategies of treatment of intense desire for substance use.

28. Step 7: Questions and comments (5΄)