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Addiction Counselor's Desk Reference: Substance Abuse and Classification, Exams of Advanced Education

A comprehensive overview of various psychoactive drugs, including opiates, depressants, stimulants, hallucinogens, and anabolic steroids. It covers the pharmacological properties, effects, and potential for abuse and dependence of these substances. The document also discusses the control schedules for abused drugs, highlighting the differences in their medical use and abuse potential. This information is crucial for addiction counselors, healthcare professionals, and individuals interested in understanding the complexities of substance abuse and its management.

Typology: Exams

2024/2025

Available from 10/22/2024

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CADC exam prep Ch 1 (Addiction Counselor's

Desk Reference) 2023

Opiates - A category of psychoactive drugs that are chemically similar to morphine and have strong pain-relieving properties.

  • Opiates cross into blood-brain barrier to produce a rush/feelings of euphoria.
  • Significant respiratory complications, death, cardiac depression.
  • Physical dependence develops dramatically as soon as regular use begins (sometimes even when its administered clinically appropriate). Withdrawal symptoms include: restlessness, irritability, nausea, diarrhea, sweating, and gooseflesh. Subcutaneous - Injection of medication in a liquid form underneath the skin into the subcutaneous tissue GABA - inhibitory neurotransmitter slows or calms things down. Heroin (Opiate) - - Naturally occurring substance extracted from seedpod of various poppy plants.
  • 1898 - commercially marketed as new pain remedy
  • 1914 - designated as controlled substance under the Harrison Narcotic Act
  • Schedule 1 drug.
  • Route of administration: smoked, snorted, or IV. Greatest intensity and most rapid onset of euphoria (7-8 sec) from IV. Peak effects felt by 10-15 min.
  • Crosses the blood-brain barrier, converts to morphine, and rapidly binds to opioid receptors in brain.
  • Serious adverse health side effects: fatal OD, collapsed veins, cardiac depression, and blood- borne infectious diseases (HIV/AIDS, Hep C) + societal consequences such as disruptions in family, work place, etc.
  • Significant increase of OD (slow, shallow breathing, convulsions, coma) &/or death.
  • Street heroin often cut with various other substances (sugar, starch, strychnine, etc) that do not dissolve when injected and cause more issues in body.
  • Major withdrawal symptoms peak btw 48-72 hours after last dose. Subside in about a week. Fentanyl (Rx Opiate) - - Commonly used and abused agent
  • Exists in 2 formulations: 1. Injectable form used with other agents during anesthesia, & 2. A skin patch used as a sustained-release form to treat pain. Various other Rx Opiates - - Morphine, meperidine (Demerol), fentanyl: most commonly appear as prepared injection forms that have been diverted from legal medical use. May be injected either IV or subcutaneously (skin popping).
  • Codeine, propoxyphene: Lower potency and usually appear in pill form and taken orally. Depressants - Drugs (such as alcohol, barbiturates, and opiates) that reduce neural activity and slow body functions.
  • Prescribed to help relieve anxiety, irratibility, and tension.
  • Normally called "downers" because they calm users down.
  • With regular use, high potential for abuse and development of tolerance.
  • Effects are exacerbated when various kinds of depressants mix (alcohol + barbs = not good).
  • Small amounts cause calmness and relaxed muscles while large amounts cause slurred speech, impaired judgment, and loss of motor coordination. Larger amounts may cause decreased breathing rate, coma, and death. Alcohol - - Consumption effects: The more drinks consumed the more depressed and adversely affected one's brain activity becomes ,e.g. Cerebrum (controls advanced functions such as recognition, vision, reasoning, and emotion). Lowest levels: impacts inhibition and judgment. Increased levels: impacts vision, movement, speech (.01% to .30 % BAC).
  • Impacts part of the brain in charge of movement - causing problems with coordination, reflexes, and balance (.15% to .35% BAC). Impacts Medulla (controls basic survival functions i.e. breathing & heartbeat) resulting ij the reduction of brains ability to control respiration and heart rate.
  • Death can result at .30% BAC> Alcohol absorption - - Absorption: 20% absorbed in stomach, 80% absorbed in small intenstine.
  • Alcohol absorption depends on:
  1. Alcohol concentration - the greater the concentration, the faster the absorption.
  2. The type of drink: Carbonated beverages tend to speed up the absorption of alcohol.
  3. Full or empty stomach: Food slows down alcohol absorption. Alcohol excretion - Alcohol leaves body in 3 ways:
  4. Kidney eliminates 5% of alcohol in urine
  5. Lungs exhale 5% of alcohol
  6. Liver breaks down the remaining 90% of alcohol into acetic acid. Barbiturates (depressants) - - EX: Seconal, Nembutal.
  • the "al" endings.
  • Usually in pill or sometimes in liquid form or suppositories.
  • Affect the central nervous system (CNS) by slowing or decreasing neurological activity in the mind/body.
  • Prescribed for treatment for sleeplessness, anxiety, tension, epileptic seizures.
  • Short term effects: Lasting 15 hours after ingestion (include relief of tension, anxiety, sleepiness, feeling of intoxication, slurred speech, memory impairment, emotional instability, and inability to control simple bodily functions.
  • Long term effect: chronic tiredness, general lack of coordination, vision problems, dizziness, slowed reflexes/response time, sexual dysfunction, menstrual irregularities, breathing disorders.
  • tolerance indicated.
  • WIthdrawals: restlessness, anxiety, insomnia, sometimes convulsions, maybe even death. Benzodiazepines (depressants) (also known as: anxiolytics, tranquilizers, sleeping pills) - - anti- anxiety drugs that depress CNS and induce relaxation and sleep; often prescribed to relieve tension, sleep problems, anxiety, panic attacks.
  • the "am" endings.
  • Triazolam (Halcion) & estazolam (ProSom) used more for short-term tx of sleep disorders.
  • another CNS depressant
  • Benzos work in the brain affecting emotional reactions, memory, control of consciousness, muscle tone, and coordination by enhancing the action of the neurotransmitter gamma- aminobutyric acid (GABA).
  • Long term effects: depression, aggression, subtle personality changes, fatigue, passivity, and sx of cognitive impairment.
  • Memory function is markedly and measurably impaired, especially the ability to acquire and store knowledge in long-term memory. Stimulants - - Drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, methamphetamines, and ecstasy) that excite neural activity and speed up body functions and increase mental alertness.
  • Produce euphoria, feelings of super strength, and absolute self-confidence.
  • With cocaine, but not amphetamines, there is also an anesthetic effect (dulling of pain.
  • Users become hyperactive (talkative, nervous, fidgety), release of inhibitions and ability to perceive time and distance is affected. Easily confused and lose ability to concentrate or think clearly.
  • Lasting effects vary depending on which stimulant is used. Cocaine (stimulants) - - History: Comes from the leaves of the South American coca plant. Mid- 19th century and used in tonics and elixirs. Two chemical forms: hydrochloride and freebase (crack). Powered form dissolves in water and can be abused by IV or intranasally. Freebase is smokeable.
  • Routes of administration: snorting (absorbed into bloodstream through nasal tissues), injecting, smoking (freebase/crack).
  • Interferes with the re-absorption process of dopamine
  • The faster the absorption, the more intense the high and duration of effects depends on route of administration. But, the faster absorption, the shorter the duration of action. Ex: Snorting - 15 - 30 min vs. smoking - 5 - 10 min.
  • With continued use, person is no longer able to feel positive reinforcement or pleasure of natural rewards (food, water, sex, etc)

Crack (stimulants) - - processed from hydrochloride with ammonia or sodium bicarbonate (baking soda) and water, heated to remove the hydrochloride. Freebase is the result.

  • Popular in mid 1980's due to almost immediate high and cheapness.
  • Smoking crack delivers large amounts of drug to the lungs, producing effects comparable to IV use.
  • When cocaine and crack are used together the liver combines them to manufacture a third substance, cocaethylene.
  • Prolonged use of cocaine and crack can trigger paranoia and aggression. When use is stopped, depression ensues. Amphetamines (stimulants) - - Drugs that stimulate neural activity, causing sped-up body functions and associated energy and mood changes.
  • History: First used on nasal decongestants and bronchial inhalers for teh tx of narcolepsy, obesity, and ADD. Methamphetamines (stimulants) - - A powerfully addictive drug that stimulates the central nervous system, with speeded-up body functions and associated energy and mood changes; over time, appears to reduce baseline dopamine levels.
  • Route of admin: oral, intranasally, IV, smoking. Oral ingestion takes about 20 min while smoking takes about 5 min. Oral/intranasal produces euphora (a high but not a rush) vs. smoking produces an intense sensation (a rush or flash).
  • Releases high levels of dopamine in the brain and stimulates cells that enhance mood, pleasurable feelings, and body movements with effects lasting up to 12 hours.
  • Neurotoxic effects - > damaging brain cells that contain dopamine and serotonin. Overtime levels of dopamine are reduced which can result in sx similar to Parkinson's disease (severe movement disorder).
  • Effects: wakefulness/insomnia, increased physical activity, decreased appetite, hyperthermia, ^ respiration, respiratory problems, euphoria. CNS effects: irritability, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. ^ Heart heart and blood pressure which can cause irreversible damage to blood vessels in the brain, producing strokes. Possible cardiovascular collapse, death.
  • Chronic use can cause psychotic behaviors that includes intense paranoia, visual/auditory hallucinations, "out of control" violent rage episodes. Cannabis - - Hemp plant. Marijuana, hasish (made from marijuana resin found in tops of flowering marijuana plants where THC is most concentrated), hashish oil, tetrahydrocannabinol (THC).
  • Routes of admin: smoked or taken orally.
  • THC stronger now than 30 years ago. THC levels range between 7-20%.
  • THC triggers brain cells to release dopamine.
  • THC finds neurons (brain cells) called cannabinoid receptors and binds to them. When attached to neuron, THC interferes with the normal communication between neurons.
  • Hippocampus (controls learning and control), cerebellum (controls balance and coordination), basal ganglia (controls movement), and cerebral cortex all have a high concentration of cannabinoid receptors.
  • Chronic smokers can experience withdrawal sx such as irritability, depressed mood, anxiety, panic attacks, and cravings. Hallucinogens - - A diverse group of drugs that have powerful effects on mental and emotional functioning, marked most prominently by distortions in sensory and perceptual experience (thinking, emotions, self-awareness).
  • Some are natural from plants (mescaline from peyote cactus) and others are synthetic (LSD). Lysergic Acid Diethylamide (LSD) - - History: 1938 Swiss chemist synthesixed LSD as a circulatory and respiratory stimulant. Later used as a possible medical treatment for schizophrenia. 1960's recreational using. No medical use even under supervision.
  • Schedule 1.
  • Odorless/colorless with bitter taste sold on street in tablets or capsules orally consumed or inliquid form applied to blotter paper, sugar cubes, etc.
  • Effects are often unpredictable and depends on amount taken, the surroundings of which it is used, and user's personality/mood/expectations. (ex: good trip vs. bad trip_
  • Not considered addictive drug, does not produce drug seeking behaviors. Tolerance CAN be developed though.
  • 30 to 90 minutes after ingestion, user feels first effects of drug and can last for an extended period of time (clearing around 12 hours).
  • Powerful visual hallucinations and delusions that may cause acute panic reactions when user cannot control them.
  • Synthesia can occur ( the blending of different senses, such as "seeing" sounds
  • Some users can experience flashbacks of their experience without taking the drug again. Psilocybin ("Mushrooms"), peyote, mescaline - - Psilocybin: mushroom typically eaten or smoked.
  • Members of Native American Church legally use peyote for religious ceremonies.
  • Mescaline is the active ingredient in peyote cacti.
  • Use to alter consciousness and/or to have a mystical or spiritual experiences. "Entheogen" = "god within" is a term that has been used to describe this class of drugs.
  • boundary between self and others disappears and a connectedness with other and universe may be experienced. Feelings of elation, awe, & bliss. Inhalants - - Household and commercial products with substances whose fumes are sniffed and inhaled to achieve a mind altering effect.
  • Easy accessibility, low cost, and ease of concealment makes these popular among teens.
  • Most slow body's functions producing effects similar to anesthetics and in some cases can cause heart failure.
  • Permanent effects can cause hearing loss, peripheral neuropathies (limb spasms), CNS/brain damage, bone marrow damage. LIver/kidney damage.

Steroids (anabolic-androgenic) - - Anabolic - refers to increased muscle building

  • Androgenic - refers to increase masculine characteristics.
  • Legally available only by Rx to treat conditions that occur when the body produces abnormally low amounts of testosterone. also used to treat body wasting in AIDS patients/other disease that result in loss of lean muscle mass. Used mostly by people seeking to enhance their athletic performance or improve overall physical appearance.
  • Route of admin: taken orally, injected intramuscularly, rubbed on skin as gel or cream.
  • Used in varying patterns:
  1. Cycling - taking multiple doses of steroids for a specific period of time (weeks or months), stopping for period, and starting again.
  2. Pyramiding - slowly escalating steroid use reaching a peak amount at midcycle and gradually tapering the dose toward the end of the cycle. 3.Stacking - combining several different steroids to maximize their effectiveness while minimizing any negative effects.
  • Health consequences - liver tumors and cancer, jaundice, fluid retention, high blood pressure, heart attacks, increases in LDL (bad cholesterol), and decreases in HDL (good cholesterol).
  • Adverse side effects for men: testicle shrinkage, reduced sperm count, infertility, baldness, acne, increased risk for prostate cancer, development of breasts.
  • Adverse side effects for women: facail hair growth, male-pattern baldness, changes or cessation in menstrual cycle, enlargement of clitoris, deepened voice.
  • For adolescents use my prematurely stop the lengthening of bone resulting in stunted growth.
  • Standard withdrawal symptoms + depression, and manic like symptoms leading to violence. Designer drugs - - Synthetic substances meant to imitate the effects of narcotics and hallucinogens. They are compounds whole chemical structure closely resembles that of the drug they are designed to copy.
  • Most common: ecstasy 3,4 - Methylendioxymethamphetamine (MDMA or Ecstasy) - - Has properties of both stimulants and hallucinogenics and most tablets contain more than just MDMA but also caffeine, coke, ephedrine, meth, etc.
  • Effects last 4-6 hours.
  • Typically produced in capsule or tablet form, sometimes injected or snorted.
  • Works in brain by increasing the activity levels of at least 3 neurotransmitters: serotonin, dopamine, and norepinephrine. MDMA causes a release of these neurotransmitters from their storage sites resulting in increases brain activity. Due to large amounts of serotonin released (regulation of mood, sleep, pain, emotion, appetite, etc), MDMA significantly depletes it. For those taking MDMA in high doses, serotonin depletion may be long-term. Ketamine - - "Special K" - A club drug that is a fast-acting general anesthetic which has sedative hypnotic, analgesic, and hallucinogenic properties.
  • Small amounts can result in loss of attention span, learning ability, and memory.
  • Higher amounts can cause delirium, amnesia, high blood pressure, depression and severe breathing problems. Gamma Hydroxybutyrate (GHB) - - designer drug. Small amounts induce relaxation but large doses can result in coma or death. Rohypnol - - Date rape drug. May cause amnesia.
  • Tasteless, odorless, mixes well in carbonated beverages.
  • Effects: dizziness, low blood pressure, drowsiness, confusion, stomach upset. Control schedules for abused drugs - Schedule I: heroin, hallucinogens, marijuana, methaqualone (Quaalude) are considered as having high potential for abuse with no legally recognized medical use. Schedule 2: Opium or morphine, codeine, synthetic opiates (such as meperidine or "Demerol"), barbiturates such as secobarbital (Seconal), amphetamines, methylphenidate (Ritalin), PCP, cocaine, methadone, and methamphetamine have high potential for abuse but are currently accepted for medical use with severe restrictions. Cannot by prescribed by phone and no refills allowed. May lead to severe psychological and/or physical dependence. Schedule 3: Anabolic steroids, codeine, and hydrocodone with aspirin or tylenol, and some barbs that have an abuse potential less than Schedules 1 & 2 and currently have an accepted medical use in US. Requires new Rx after 6 months or 5 refills. May lead to moderate or low physical dependence and/or high psychological dependence. Schedule 4: Chlordiazepam (Librium),propxyphene (Darvon), equanil, xanax, valium, have low abuse potential compared to Schedule 3 drugs and currently have an accepted medical use in US. Abuse may lead to limited physical dependence and/or psychological dependence. Schedule 5: Narcotic-atropine (Lomotil) and codeine mixtures (less than 200 mg) have a low potential for abuse relative to Schedule 4 drugs and currently have an accepted medical use. MA recognizes Schedule 6 drugs to be adhesives, glues, and medications (ibuprofen, penicillin) that have little or no addictive potential.