PubH Drug Exam 2

Know the triggers that can set off a slip or lapse in treatment and the de-motivators to keep sober, according to lecture.
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Know the triggers that can set off a slip or lapse in treatment and the de-motivators to keep sober, according to lecture.
• Internal: aspects of one's physical or mental condition that reduces his motivation or interrupts his plans -Example: Feeling tired from sleeping less than usual
• External: situations that interfere with one's plans or lowers her motivation for positive change -Example: ongoing stressful situations, such as being
especially busy with schoolwork or family stressors
• Triggers are the more immediate events that set off a slip or lapse
-Some are practical problems/barriers
-Some are internally affected by one's physical and mental state
• All or nothing: I've already slipped so far back that it's hopeless..."
-Most slips or lapses start with something small, but sometimes they snowball from there.
-One's mental reaction to the first small slip is at the center of that snowball effect
• Guilt and self blame: Guilt & self-blame is usually a de-motivator. Be aware of words like "always" and "never" I'm always screwing up" "I'll never be able to stick to anything"
List three of NIDA's (National Institute on Drug Abuse) principles of drug addiction treatment.
1.Addiction is a complex but treatable disease
that affects brain function and behavior.
2. No single treatment is appropriate for all individuals.
3. Treatment needs to be readily available
4. An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs.
Understand relapse and prolapse, according to lecture.
Relapse: Returning to old behavior (following an initial setback)
Prolapse: Getting back on track in the direction of positive change
According to SAMSHA, does someone need to be willing to go to treatment (for illicit drugs or alcohol use) for the treatment to be effective? What percentage of people who need treatment believe they need the treatment?
Sometimes, they cannot be willing and treatment is still effective. It has to be person driven.
94% did not feel they needed treatment
3.7% felt they needed treatment and didn't make an effort
1.7% felt they needed treatment and DID make an effort
Understand tobacco trends and if smoking has increased, decreased, or stayed the same in the United States.
Smoking has decreased sharply
Overall less than 19% of adult population
Minnesota's smoking rate down to 14.4%
Higher prevalence of occasional smokers
2: Know the two sources of smoke from cigarettes, according to lecture.
Mainstream: when a person smoking, and they are exhaling the smoke, then a second party is inhaling this smoke
Sidestream: Sidestream smoke has higher concentration of carcinogens. Smoke from the end of the lit cigarette
Understand how the age of onset can contribute to dependency of cigarettes and health benefits/health harm.
•Those who start earlier tend to be more dependent
• Risk of lung cancer greater for those who start
earlier, even when adjusted for pack years
smoked
•Smoking usually is initiated in childhood or
adolescence, although some individuals take it up
in their 20s or even later
• Even delaying onset has health benefits
4: Know and understand reasons why e-cigarette users use e-cigarettes instead of regular cigarettes, according to lecture.
Commonly cited reasons for use:
Less harmful, less expensive
Help reduce tobacco craving/withdrawal
Reduce amount smoked and use as reduction/cessation aid
Prevent relapse to regular cigarettes
Be familiar with the negative effects of secondhand smoke, from lecture.
Exposure to secondhand tobacco smoke has been causally linked to cancer, respiratory, and
cardiovascular diseases, and to adverse effects on health of infants and children
Understand the correlation between an individual who abuses or is dependent on opioid pain relievers and the likelihood of them using other substances
people with abuse or dependence on opioid painkillers are 40 times more likely to become dependent or abuse heroin
According to Dana Farley, what is the primary substance of abuse for adult treatment admissions in Minnesota?alcoholWhat US population (age and gender) has the highest percent of deaths from alcohol poisoning?Middle age men, 34% men ages 45-51Explain the correlation between perceived risk and students' use of marijuana in the United States.Daily use is higher than perceived risks As perceived risk increases, use decreases- inverse relationship.Understand and describe why there has been a shift from using the word "pain killer" to "pain reliever" in the healthcare communityit doesn't always remove pain, so no pain killer. Give unrealistic expectations for the patients that a pain killer would remove all pain completely.According to the NIDA article, what is the earliest time in life that prevention can be introduced?early childhood- infancyUnderstand the differences between universal, selective, and indicated prevention programs and be able to give examples of each.Universal: designed to reach the entire population, no targeting of any population. Ex) media campaigns- Tv ads. DARE program Selective: targets certain subgroups, and their membership in that group. Not necessary engaging in substance use but tend to have higher risk. Ex) homeless youth, kids with school performance issues Indicated: population is already indicating they are having issues with the specific drug or alcohol has to be condition specific ex) programs for students who binge drink, fraternitiesBe able to identify primary, secondary and tertiary prevention strategies.Primary:: Prevent initial use AND Minimize chance of problems developing from use (ex: drink and drive) Secondary: Minimize problems "Turn things around" for people who are using but not yet dependent Examples: Education/skills to recognize warning signs of dependency, Foster personal prevention skills, Foster skills at recognizing abuse in others and how to help Tertiary: Minimize mortality and morbidity Examples: Chemical dependency treatment. Reinforce drug-free lifestyle after non-use Harm Reduction: at this level, attempts to alleviate the social, legal and medical problems associated with unmanaged addiction.List and describe the 5 less effective strategies for the prevention of substance abuse: the scare approach, the pharmacological approach, the decision-making approach, the shotgun approach, and the ex-addict approach. Know names of all 5, but pick 2SCARE: Not effective for most youth. Does reinforce nonuse to those with no intention of using in first place Those who are: 1. thinking of using 2. know someone who is using 3. using themselves ...are seldom influenced by this approach && discredits the person talking about it PHARMACOLOGICAL: Immense levels of scientific knowledge about drugs → People will be less likely to use drugs. Not relatable. Does not apply to me. DECISION_MAKING: Teach decision-making skills. However, people do not making decisions on rational scientific information. Decision-making is a complex process and involves intrapersonal, interpersonal, communal, environmental, societal and political considerations SHOTGUN: people hear speakers, info will hear something (HIT) personal and then they wont use drugs, more relatable because people tell stories and personal experience, only gives info one at a time. EX_ADDICT: was addicted but no longer is and tries to educate info one at a time. Mixed message because they turned their lives around. Modified scare tactic. Very effective tertiary prevention as educator for treatment—provides hope and accountability partner. example) alcohol anonymousList risky sexual behaviors that are associated with high-risk college drinking.Alcohol use is best predictor of teen sexual activity and "risky" sexual behavior Sexual Abuse: Approximately half of sexual assault cases involved alcohol Unsafe Sex: Approx. 1 of 5 college students have reported abandoning safer sex practices when they are drunk (even when they do protect when they're sober).Understand and know skills that NIDA recommends drug prevention programs should include in programs for middle and high school students.Prevention programs should increase academic and social competence with following skills: Study habits and academic support Communication Peer relationships Self-efficacy and assertiveness Drug resistance skills Reinforcement of anti-drug attitudes Strengthening personal commitments against drug abuseBe able to summarize the typical characteristics of the various age populations discussed in lecture: preschool through elementary, middle and high school, college-aged/emerging adulthood, middle adulthood, older populationspreschool through elementary: Behaviors are "adult-oriented", Dualistic thinking; "right" or "wrong", Legality and morality have strong meaning, Focused on bodies (respond well to info and advice that targets their health) middle and high school: Look to peers for social skills messages; adult figures less important. Greater abstract thinking, evaluate all sides of an issue and justify conclusions Peer education and peer advocates have greater impact. Prevention should target socially undesirable or unsexy activities College age: Defining role in society-- see themselves as community citizens and can play a role in influencing others (positively and negatively).Helping the greater good. Peer educators continue to be important. Middle adulthood: Highly complex and individualized phenomenon. Rarely a captive group (except work-based prevention program). Older populations: Prevention approaches should honor life experiences, respect individual needs, empower personal autonomy. Harm reduction. Education on medication safety and importance of coordinating medical and mental health care providers to monitor for potential drug interactions. One-on-one sessions to identify reasons for use, identify coping skills, etcUnderstand the focus and characteristics of effective strategies for prevention programs targeting each age population: preschool through elementary, middle and high school, college-aged/emerging adulthood, middle adulthood, older populations. Be able to explain WHY each of these approaches is less effective.Preschool: Program should target improving academic and social-emotional learning to address risk factors (early aggression, academic failure, school dropout) Self-control, Emotional awareness, Communication, Social problem-solving, Academic support, esp. in reading Middle and High School: Prevention programs should increase academic and social competence with following skills: Study habits and academic support Communication Peer relationships Self-efficacy and assertiveness Drug resistance skills Reinforcement of anti-drug attitudes Strengthening personal commitments against drug abuse College: Behavior interventions reduce alcohol consumption and alcohol-related problems Personalized feedback, Moderation strategies, Expectancy challenge, Identification of risky situations, Goal-setting. Equipping young adults with bystander intervention skills. Environmental strategies should be applied. Address social norms Middle Adulthood: Shift to secondary and tertiary prevention (preventing moving further down line of substance use or adding new substances). Teaching harm reduction. Addressing stress; what is the root cause? how can stress be managed? Self-care. Older Populations: Prevention approaches should honor life experiences, respect individual needs, empower personal autonomy. Harm reduction. Education on medication safety and importance of coordinating medical and mental health care providers to monitor for potential drug interactions. One-on-one sessions to identify reasons for use, identify coping skills, etcWhat is NAS?Neonatal abstinence syndrome: it happens when a fetus is exposed to the drugs in the womb. The baby is going through withdrawals and trauma and they are so small lots of damage can be doneKnow the significance of each trimester of pregnancy in terms of their role in the development of Fetal Alcohol Spectrum Disorders in utero. Is there a trimester that is particularly significant for the development of the child and the child's susceptibility to harmful effects from alcohol and drugs?1st trimester: significant effect of fetal. Embryonic stage: 3rd post conception week is considered most critical for alcohol teratogens; More severe features of FAS. Average of 3 drinks/day following conception increases risk of having a child with FAS. Bones and brain and organs are just being developed, more opportunities to have abnormal growth and developmentAccording to lecture, how fast can a fetus metabolize alcohol compared to the mother?Alcohol diffuses through placenta. Concentration in fetal blood same as mother's within a few minutes ● Fetus is able to metabolize alcohol 10% as fast as the motherKnow what schedule of drug marijuana is in on the federal level.Schedule 1 defined as drugs with no currently accepted medical use and a high potential for abusewhat are the benefits of marijuana?Promote appetite [cancer, AIDS] ● Decrease nausea [chemotherapy] ● Potential anti-tumor activity [cancer] ● Treatment for glaucoma (reducing pressure of fluid within the eye) ● Multiple Sclerosis & other disorders that produce impaired muscle control, seizures, chronic pain and migraine headaches [used as muscle relaxant and analgesics (pain relievers) ----However, many studies do not show conclusive evidence of benefits.How much THC is still in the body after 24 hours of smoking? Why is this so?Approx. ½ of THC is still present 24 hours after smoking. THC stays in fatty deposits of body [extremely fat soluble!]How likely is it for someone to overdose by using marijuana?Very unlikely. Virtually impossibleWhich drug classes have life-threatening withdrawal symptoms, according to lecture?Benzos , BarbituratesKnow the effect that the creation of benzodiazepines had on the use of barbituratesdecreased the rates of barbitutes use. Benzos do not suppress breathingWhat were the different uses for barbiturates, according to lecture?Phenobarbital: used to treat epilepsy Amobarbital: used as "truth serum" Pentobarbital: used in anesthesia for surgery, euthanasia, capital punishmentKnow what Heroin was first marketed for. Who first marketed it? When was it first marketed?Bayer in 1895. It was first marketed as new OTC opiodExplain why withdrawal from barbiturates and benzodiazepines need to be done under medical supervision. Include the neurotransmitter(s) involved and the symptom(s) this causes.All of these agents increase the action of GABA • Sudden withdrawal of these drugs will cause unregulated neuron firing, which can lead to seizures.What types of feelings come from using a CNS depressant?First there is a sense of relaxation and a reduction of anxiety- a general "mellow" feeling. At higher doses, this is followed by lightheadedness, vertigo, drowsiness, slurred speech and muscle incoordination. Learning is impaired and memory for events that occurred while under the influence of these chemicals, esp benzo may be impairedKnow the specific receptors that opioids work on versus barbiturates and benzodiazepines.Opioids: opioid receptors Barb/benzo: GABA receptorsKnow the different types of sleep aid agents as discussed in lecture and mentioned in Buzzed.Non-benzo sleep agents: Ambien, Lunesta, Sonata (work on GABA receptors but not at same site as benzos) Newer sleep agents: Rozerem (melatonin receptors), BelsomraAccording to Buzzed, what are the current trends in GHB usage? What are a few reasons why might this be?Common drug of abuse for teenagers and young adults. There are instructions for making it in home labs, it can be lethal, it is easy to manufacture, and it is difficult to detect in a drink. It is on the rise, and very popular in clubs. Date rape drug.What does the 21st century drug policy emphasize, according to lecture?Science-based plan guided by the latest Research. Current drug policy emphasizes prevention and access to treatment over incarcerationAccording to lecture, approximately how many people nationally have a substance use disorder? Approximately how many get treatment annually?Approx. 22 million Americans need treatment for substance abuse disorder 2 million receive treatmentWhat were the recommendations that the "Smart on Crime" approach presented instead of "incarcerating our way out of a problem"? Know at least half.• Drugs and crime often linked • Addressing drug related crime and violence is a vital part of protecting public health and safety • However, cannot arrest our way out of the drug problem • Administration policy is not to focus on individual drug users • Substantial reforms required to criminal justice system to lower incarceration rates and reduce recidivism • Expand specialized courts • Diversion programs • Provide community health services instead of jail or an arrest record • Giving voice to Americans in recovery by removing barriers such as: Lack of access to housing, Employment, Driver's license, Student loans