PRESCRIPTION DRUG ABUSE

Transcription

1 PRESCRIPTION DRUG ABUSE Carl M. Dawson, M.S., MAC, LPC - National Drug Court Institute ( NDCI ) Washington, D. C. - The School of Professional Psychology at Forest Institute Springfield, Missouri ( cdawson1028@yahoo.com )

2 OUTLINE PRESCRITION DRUG ABUSE IN PERSPECTIVE. A REVIEW OF TERMS AND DEFINITIONS. A REVIEW OF CONTROLLED SCHEDULED DRUGS. THE MOST COMMONLY ABUSED PRESCRIPTION MEDICATIONS : 1. OPIOIDS. 2. ( CNS ) DEPRESSANTS. 3. ( CNS ) STIMULANTS. OVER THE COUNTER ( OTC ) MEDICATIONS. ( If we have time ) vocab list

3 A REVIEW OF TERMS AND DEFINITIONS

4 ABUSE : NOT IN REFERENCE TO THE DSM-IV. WHEN USED IN PRESCRIPTION DRUG ABUSE, IT IS REFERRING TO THE MIS- USE OF A DRUG OTHER THAN IT WAS PRESCRIBED FOR BY, EITHER USING MORE THAN RECOMMENDED OR BEING USED DIFFERENTLY THAN DESIGNED. OFF LABLE : A TERM USED TO DESCRIBE A DRUG THAT IS BEING USED FOR MEDICAL CONCERNS OTHER THAN IT WAS ORIGINALLY INTENDED OR THAN IT WAS MANUFACTORED. DRUG ENFORCEMENT ADMINISTRATION ( DEA ) : IS A BRANCH OF THE DEPARTMENT OF JUSTICE. Created in 1970 as a consequence of the Comprehensive Drug Abuse Prevention and Control Act. ADDITIVE EFFECT : When two different drugs produce a greater effect than one of the drugs alone.

5 ANALGESIC : SPECIFIC PAIN RELIEVING. ANESTHETIC : GENERAL PAIN RELIEVING. ANXIOLYTICS : CLASS OF DRUGS DESIGNED TO REDUCE ANXIETY ( BARBITURATES AND BENZODIAZEPINES, SEDATIVE HYPNOTICS ). ANTI-HISTAMINES : REDUCES THE EFFECTS OF HISTAMINE RECEPTORS. BRAND OR TRADE NAME : THE TITLE OR NAME THE DRUG A COMPANY GIVES A DRUG OR MEDICATION. CHEMICAL OR GENERIC NAME : THE ACTUAL NAME GIVEN TO THE CHEMICAL MAKE UP OF A DRUG. CENTRALLY ACTIVE DRUGS MEDICATIONS, ( AKA : PSYCHOACTIVE ).

6 BENZODIAZEPINES : A CLASS OF DRUG DESIGNED TO TREATMENT ANXIETY. GENERALLY CONSIDERED A SEDATIVE, DUE TO IT S CNS DEPRESSIVE EFFECTS ( IE : ALCOHOL IN A PILL ). BARBITURATES : A CLASS OF DRUG DESIGNED TO TREAT ANXIETY. GENERALLY CONSIDERED A SEDATIVE, DUE TO IT S CNS DEPRESSIVE EFFECTS. PRESCRIBER : ANY LICENSED PROFESSIONAL THAT HAS BEEN APPROVED BY THE MEDICAL STATE LICENSING BOARD TO DIAGNOSE AND TREAT MEDICAL OR BEHAVIORS DISORDERS. DRUGS : AS USED IN THIS PRESENTATION, ANY SUBSTANCE THAT REQUIRES A PRESCRIPTION AND CAN BE FOUND IN THE SCHEDULED CLASSIFFICATION OF MEDICATIONS. PARADOXICAL EFFECT : PRODUCING THE OPPOSITE EFFECT.

7 HYPNOTICS : A TERM USED TO IDENTIFY A CLASS OF DRUGS PRESCRIBED FOR INSOMNIA, OR A DISORDER WHERE AN INDIVIDUAL HAS DIFFICULTY FALLING OR STAYING ASLEEP. SEDATIVES : DRUGS DESIGNED TO RELAX OR REDUCE ANXIETY OR STRESS. A MEDICATION THAT DEPRESSES THE ACTIVITY OF THE CNS. INSOMNIA : A SLEEP DISORDER, WHERE THE INDIVIDUAL HAS EITHER DIFFICULTY GETTING TO SLEEP OR CAN NOT STAY ASLEEP. OVER THE COUNTER ( OTC ) MEDICATIONS : MEDICATIONS USED TO TREAT VARIOUS MEDICAL SIGNS AND SYMPTOMS THAT DO NOT REQUIRE A PRESCRIPTION. OPIATES ( AKA : OPIOIDS - NARCOTICS ) A CLASS OF DRUGS THAT ARE DESIGNED TO TREAT OR REDUCE THE EFFECTS OF SPECIFIC OR GENERALIZED PHYSICAL SENSATIONS ( Pain ).

8 TOLERANCE : THE NEED FOR A GREATER AMOUNT OF A DRUG, IN ORDER TO GET THE SAME OR DESIRED EFFECT. HEDONIC EFFECT : THE NEED FOR A GREATER EXPERIENCE, IN ORDER TO GET THE SAME OR DESIRED EFFECT. WITHDRAWAL : THE PHYSICAL AND/OR PSYCHOLOGICAL SYMPTOMS EXPERIENCED ONCE A MEDICATION HAS BEEN DISCONTINUED. TYPICALLY A TERM USED TO INDICATE A DEPENDENCY LEVEL OF HARMFUL INVOLVEMENT. SPONTANEOUS : EXPERIENCE WHEN A DRUG IS SUDDENLY DISCONTINUED. PRECIPITATED : EXPERIENCE WHEN A DRUG IS BEING DISCONTINUED THROUGH THE USE OF AN OPIATE ANTAGONIST.

9 MEANS OF DELIVERING A DRUG TO THE BRAIN

10 1. ORAL ( Enteral ) : The oldest and the easiest route of delivering a drug to the brain... however not the most effective. 2. SUBLINGUAL : Absorbing a drug into the body via the mucosa layer under the tongue. 3. INTRANASAL - INHALATION ( Insufflation ) : Introducing a drug into the body via the nasal mucus membranes. 4. SMOKING : Introducing a drug into the body via the lungs. 5. INJECTIONS ( Parenteral ) : Injecting a needle into the body. Subcutaneous : below the skin. Intramuscular : into the muscle. Intravenous : into the vein. 6. TRANSDERMAL PATCH : Absorbing a drug through the skin.

11 PRESCRIPTION DRUG ABUSE IN PERSPECTIVE

12 PRESCRIPTION DRUG ABUSE IN PERSPECTIVE PRESCRIPTION DRUGS ARE THE SECOND MOST FREQUENTLY ABUSED CLASS OF DRUGS OTHER THAN MARIJUANA. MOST INDIVIDUALS ABUSING PRESCRIPTION DRUGS SECURE THEIR DRUGS THROUGH : 1. ILLICIT MEANS : ( FRIENDS, STEALING, DEALING ). 2. FAMILY MEMBERS POSSESSING A LEGITIMATE PRESCRIPTION. 3. MANIPULATING PRESCRIBING HEALTH CARE PROVIDERS. THE MOST COMMON REASONS INDIVIDUALS ABUSE PRESCRIPTION MEDICATIONS ARE DUE TOO : 1. LEGITIMATE PHYSICAL ( ACUTE - CHRONIC ). 2. MENTAL HEALTH CONCERNS ( MOOD DISORDERS ). 3. SLEEP DISORDERS ( INSOMNIA OR HYPERSOMNIA ). Scheduled drugs

13 CONTROLLED SUBSTANCES ACT ( CSA ) CONTROLLED SUBSTANCES ACT ( CSA ) WAS ENACTED BY THE UNITED STATES CONGRESS IN THE CONTROLLED SUBSTANCES ACT ( CSA ) ALLOWS THE DRUG ENFORCEMENT ADMINISTRATION ( DEA ) AND THE FOOD AND DRUG ADMINISTRATION ( FDA ) TO DETERMINE THE APPROPRIATE PLACEMENT OF PARTICULAR DRUGS AND MEDICATIONS THAT POSSESS A POTENTIAL FOR PSYCHOLOGICAL AND/OR PHYSICAL ABUSE AND DEPENDENCE INTO FIVE ( 5 ) SCHEDULES OR ( CLASSIFICATIONS ).

14 A REVIEW OF CONTROLLED SUBSTANCE SCHEDULED DRUGS

15 SCHEDULE I NO CURRENT ACCEPTABLE MEDICAL USE IN THE UNITED STATES. USED FOR RESEARCH ONLY. POSSESS A HIGH POTENTIAL FOR ABUSE AND DEPENDENCE. MEDICATIONS THAT ARE CONSIDERED NOT SAFE, DANGEROUS AND UNPREDICTABLE. ANY LEGALLY PRESCRIBED MEDICATION THAT HAS BEEN DIVERTED. HEROIN MARIJUANA ( HASHISH ) COCAINE ( POWDER OR CRYSTAL ) LSD ( ACID MDMA ( ECSTASY ) PSILOCYBIN ( MUSHROOM ) METHAMPHETAMINE ( ICE ) PHENCYCLIDINE ( PCP ) MESCALINE ( PEYOTE CACTUS ) y-hydroxybutyrate ( GHB ) INHALANTS OR SOLVENTS ( GAS, GLUE, NITRATES )

16 SCHEDULE II CURRENTLY CONSIDERED TO POSSESS MEDICAL VALUE. MEDICATIONS AVAILABLE BY WRITTEN PRESCRIPTION ONLY ( NON-REFILLABLE ). POSSESS A HIGH POTENTIAL FOR ABUSE AND DEPENDENCE. PROLONGED USE MAY PRODUCE SEVERE PSYCHOLOGICAL AND PHYSICAL DEPENDENCE. STRICT RESTRICTIONS REGARDING STORAGE AND ORDERING. MORPHINE ( MS CONTIN ) OXYCODONE ( OXYCONTIN, PERCOCET ) OPIUM FENTANYL ( DURAGESIC ) HYDROCODONE ( DILAUDID ) HYDROCODONE ( VICODIN ) MEPERIDINE ( DEMEROL ) PROPOXYPHENE ( DARVON ) PENTOBARBITAL ( NEMBUTAL ) SECOBARBITAL ( SECONAL ) METHYLPHENIDATE ( RITALIN, CONCERTA ) PHENMETRAZINE ( PRELUDIN ) COCAINE AMPHETAMINES ( ADDERALL, DEXEDRINE ) METHAMPHETAMINES ( DESOXYN )

17 CURRENTLY CONSIDERED TO POSSESS MEDICAL VALUE. SCHEDULE III ANABOLIC STEROIDS ( BODY BUILDING DRUGS ). MEDICATIONS REQUIRE A PRESCRIPTION, THAT MAY ALLOW FIVE ( 5 ) REFILLS IN SIX ( 6 ) MONTHS. MEDICATIONS MAY BE ORDERED BY THE PRESCRIBER VERBALLY ( FOLLOWED BY A WRITTEN PRESCRIPTION ). BARBITURATES CODEINE COMBINATIONS ( EMPIRINE, FIORINAL ). DRONABINOL ( MARINOL, SYNTHETIC THC ). POTENTIAL FOR ABUSE IS CONSIDERED LESS THAN FOR SCHEDULED I AND II s. OPIUM COMBINATIONS ( PAREGORIC ). ABUSE MAY LEAD TO MODERATE PHYSICAL DEPENDENCE OR HIGH PSYCHOLOGICAL DEPENDENCE. BUPRENORPHINE ( SUBUTEX SUBOXONE )

18 SCHEDULE IV CURRENTLY CONSIDERED TO POSSESS MEDICAL VALUE. MEDICATIONS REQUIRE A PRESCRIPTION, THAT MAY ALLOW FIVE ( 5 ) REFILLS IN SIX ( 6 ) MONTHS. MEDICATIONS MAY BE ORDERED BY THE PRESCRIBER VERBALLY ( FOLLOWED BY A WRITTEN PRESCRIPTION ). POTENTIAL FOR ABUSE IS CONSIDERED LESS THAN FOR SCHEDULED III s. ABUSE MAY LEAD TO LIMITED PHYSICAL DEPENDENCE OR HIGH PSYCHOLOGICAL DEPENDENCE. ALPRAZOLAM ( XANAX ) CHLORDIAZEPOXIDE ( LIBRIUM ) CLONAZEPAM ( KLONOPIN ) DEXFENFLURAMINE ( REDUX ) DIAZEPAM ( VALIUM ) ESTAZOLAM ( PROSOM ) ETHCHLORVYNOL ( PLACIDYL ) FENFLURAMINE ( PONDIMIN ) FLUNITRAZEPAM ( ROHYPNOL ) MODAFINIL ( PROVIGIL ) PEMOLINE ( CYLERT ) TEMAZEPAM ( RESTORIL ) TRIAZOLAM ( HALCION ) ZOLPIDEM ( AMBIEN )

19 SCHEDULE V pres drugs CURRENTLY CONSIDERED TO POSSESS MEDICAL VALUE. MIXTURES OR COMBINATIONS TYPICALLY POSSESSING SMALL AMOUNTS OF CODEINE OR OPIUM. MEDICATIONS MAY REQUIRE A PRESCRIPTION. CODEINE PREPARATIONS ( 200mg/100ml ) ( ROBITUSSIN A ) MEDICATIONS MAY BE DISPENSED BY A PHARMACIST AS AN OVER THE COUNTER ( OTC ) DRUG. DIPHENOXYLATE PREPARATIONS ( 2.5mg ) ( LOMOTIL ) POTENTIAL FOR ABUSE IS CONSIDERED LESS THAN FOR SCHEDULED IV s. ABUSE MAY LEAD TO LIMITED PHYSICAL DEPENDENCE OR PSYCHOLOGICAL DEPENDENCE RELATIVE TO SCHEDULE IV s. OPIUM PREPARATIONS ( 100mg/100ml ) ( PAREPECTOLIN, KAPECTOLIN ) PSEUDOEPHEDRINE OR EPHEDRINE PRODUCTS.

20 THE MOST COMMONLY ABUSED PERSCRIPTION MEDICTIONS opiates

21 OPIATES ( aka : narcotics )

22 OPIATES ARE CONSIDERED ANALGESIC ( PAIN RELIEVING ) MEDICATIONS. OPIATE SUBSTANCES ORIGINATED FROM OPIUM, A PRODUCT OF THE POPPY PLANT. OPIATES IMITATE THE BODY S OWN PAIN RELIEVING SUBSTANCES FOUND NATURALLY IN THE HUMAN BODY, TECHNICALLY THESE ARE REFERRED TO AS OPIOIDS. ( ENKEPHALINES and ENDORPHINS ) ALL OPIATE SUBSTANCES ARE EITHER MORPHINE BASED OR BREAK DOWN INTO MORPHINE IN THE BODY.

23 OPIATE OVERDOSE CAN BE LETHAL, EITHER WHEN USED ALONE AND ESPECIALLY WHEN USED WITH OTHER CNS DEPRESSANTS. ( = 3 ) EFFECTS. OPIATE SUBSTANCES ARE FAT SOLUBLE. MEANING THEY INFILTRATE INTO THE CELLS OF THE BRAIN AND BODY QUICKLY. ( HEROIN vs. CODEINE ). THE OPIATE ADDICTS BECOMES ADDICTED TO THE RUSH. OPIATE DRUGS THAT PRODUCE LESS OF A RUSH ARE LESS FAT SOLUBLE AND ARE MORE EFFECTIVE IN TREATING OPIATE DEPENDENCE ( METHADONE AND BUPRENORPHINE ).

24 OPIATES OPIATE SUBSTANCES ARE KNOWN TO PRODUCE PSYCHOLOGICAL AND PHYSICAL ABUSE AND DEPENDENCY. THE MOST COMMON CAUSE OF OPIATE DEATH IS RESPIRATORY ARREST ( STOPS BREATHING ). OVERDOSE : SINCE OPIATE SUBSTANCES ARE KNOWN TO PRODUCE RESPIRATORY DEPRESSION THE FOLLOWING SYMPTOMS ARE REFERRED TO AS AN OPIATE ( NARCOTIC ) TRIAD. 1. COMA 2. SUPPRESSED RESPIRATION 3. PINPOINT PUPILS MORE SIGNS

25 OPIATE WITHDRAWAL SIGNS AND SYMPTOMS APPROX. HR s AFTER LAST DOSAGE HEROIN / MORPHINE METHADONE 1. CRAVING FOR THE DRUG, ANXIETY YAWNING, PERSPIRATION, RUNNING NOSE AND EYES PUPIL DILATION, GOOSE BUMPS ( PILORECTIONS ), TREMORS ( MUSCLE TWITCHING ), HOT & COLD FLASHES, ACHING BONES, MUSCLES AND LOSS OF APPETITE INSOMNIA, RAISED BP, INCREASED TEMP. PULSE RATE, RESPIRATORY RATE AND DEPTH, RESTLESSNESS AND NAUSEA CURLED UP POSITION, VOMITING, DIARRHEA, WEIGHT LOSS, SONTANEOUS EJACULATION OR ORGASM, INCREASED BLOOD SUGAR. detoxification 36-48

26 MEDICALLY SUPERVISED DETOXIFICATION 1. A NECESSARY FIRST STEP IN DISCONTINUING OPIATE USE. 2. MEDICAL DETOXIFICATION IS USUALLY CONDUCTED IN A INPATIENT RESIDENTIAL TREATMENT SETTING UNDER MEDICAL SUPERVISION. 3. THE MEDICALLY SUPERVISED DETOXIFICATION OPTION IS DESIGNED TO LESSEN ANY OR ALL OPIATE WITHDRAWAL SYMPTOMS, AND AVOID ANY POSSIBLE MEDICAL EMERGENCIES THAT MIGHT OCCUR DURING THIS PHASE OF RECOVERY. OPIATE WITHDRAWAL IS NOT CONSIDERED LIFE THREATENING. 4. MEDICALLY SUPERVISED DETOXIFICATION ALLOWS THE TREATMENT TEAM TO DISCUSS, WITH THE PATIENT, POSSIBLE OPTIONS FOR FURTHER FOLLOW UP TREATMENT AND / OR THE USE OF ANTI OPIATE MEDICATIONS. ANTI - MEDICATIONS

27 OPIATE ANTI OPIATE MEDICATIONS METHADONE : A SYNTHETIC OPIATE THAT HELPS ELIMINATE SYMPTOMS OF OPIATE MORPHINE WITHDRAWAL. BUPRENORPHINE : A SYNTHETIC OPIATE, LESS POWERFUL THAN METHADONE, AND RECENTLY APPROVED TO BE USED WITH OPIATE WITHDRAWAL. BUPRENORPHONE BASED MEDICATIONS CAN BE PRESCRIBED IN AN INPATIENT OR OUTPATIENT SETTING. NALOXONE : A SHORT ACTING OPIATE BLOCKER ANTAGONIST THAT CAN USED ALONE OR IN COMBINATION WITH BUPRENORPHONE ( SUBUTEX, SUBOXONE ). NALTREXONE : A LONG ACTING OPIATE BLOCKER ANTAGONIST THAT CAN ALSO BE USED IN THE TREATMENT OF ALCOHOL ABUSE AND DEPENDENCE. NOT CURRENTLY APPROVED FOR OPIATE MAINTANENCE USE.

28 COMMONLY PRESCRIBED OPIOIDS AND THEIR BRAND NAMES OXYCODONE ( OxyContin, Percodan, Percocet ). PROXYPHENE ( Darvon ). HYDROCODONE ( Vicodin, Lortab, Lorcet ). HYDROMORPNONE ( Dilaudid ). MEPERIDINE ( Demerol ). DIPHENOXYLATE ( Lomotil ). MORPINE ( Kadian, Avinza, MS Contin ). CODEINE PENTAZOCINE ( Talwin ). FENTANYL ( Sublimaze ). METHADONE ( Dolophine ). Non - Opiate prescribed analgesic medications with the potential for abuse : TRAMADOL ( Ultram ).

29 CENTRAL NERVOUS SYSTEM ( CNS ) DEPRESSANTS ( ANXIOLYTICS : Anti -anxiety ) Barbiturates Benzodiazepines ---- Sedative ( Hypnotics ) ( Sleep aids )

30 LET S DISCUSS ANXIETY... WHAT S THE DIFFERENCE BETWEEN ANXIETY AND FEAR?

31 EACH CLASS OF THE FOLLOWING MEDICATIONS ARE KNOW TO PRODUCE THE FOLLOWING : 1. MEETS THE DSM-IV-TR S CRITERIA FOR ABUSE AND DEPENDENCE ( TOLERANCE AND WITHDRAWAL ). 2. PRODUCE AN = 3 EFFECT WHEN COMBINED WITH ALCOHOL AND OTHER CNS DEPRESSANTS. 3. PRODUCE A REBOUND EFFECT WHEN ABRUPTLY DISCONTINUED. 4. ROUTINELY PRESCRIBED FOR EITHER ANXIETY, ANXIOUS SYMTOMS ASSOCIATED WITH OTHER PSYCHIATRIC DISORDERS ( MOOD DISORDERS ) AND SLEEP DISORDERS ( A.M. / P.M. INSOMNIA ). BARBS

32 5. EACH OF THESE DRUGS MAY PRODUCE A PARADOXICAL EFFECT. 6. EACH IMPACTS THE LEANING AND MEMORY CENTERS OF THE BRAIN. 7. PARTIAL ( Temporary ) and EN BLOC ( Complete ) AMNESIA ( BLACKOUT ) ARE COMMON. 8. THE MOST COMMON CAUSE OF DEATH WITH SEDATIVE DRUGS IS RESPIRATORY SUPPRESSION.... Let s discuss memory

33 THE MEMORY SYSTEMS SENSORY MEMORY : INFORMATION THAT IS ENCODED INTO THE MEMORY SYSTEM VIA THE SENSORY ( VISION, TOUCH, TASTE, SMELL, HEARING ) SYSTEMS. A ONE TO SEVEN SEC. MEMORY. TYPICALLY DOWN LOADED INTO THE AMYGDALA STRUCTURES OF THE BRAIN. SHORT TERM MEMORY : INFORMATION THAT IS ENCODED INTO THE MEMORY SYSTEM VIA ECHOIC HEARING LEARNING. A TEN TO THIRTY MINUTE MEMORY. TYPICALLY DOWN LOADED INTO THE HIPPOCAMPUS STRUCTURES OF THE BRAIN. LONG TERM MEMORY : INFORMATION THAT IS ENCODED INTO THE MEMORY SYSTEM VIA ICONIC VISUAL LEARNING. TYPICALLY DOWN LOADED THOUGHOUT THE BRAIN AND NOT IN ANY SPECIFIC REGION. LONG-TERM MEMORY IS CONSIDERED HOLOGRAPHIC.

34 PET SCAN AMYGDALA AND HIPPOCAMPUS STRUCTURES OF THE BRAIN

35 BARBITURATES

36 BARBITURATES BARBITURATES ARE NOT PRESCRIBED AS ROUTINELY AS BENZODIAZEPINES... DUE TO A RAPID PHYSICAL TOLERANCE AND DANGEROUS WITHDRAWAL SYMPTOMS. BARBITURATES HAVE HIGH POTENTIAL FOR LOW DOSAGE SEIZURE ACTIVITY. BARBITURATES POSSESS A HIGH POTENTIAL FOR ABUSE AND DEPENDENCY... AND... ENTER THE BODY THROUGH THE GABA SYSTEM. BARBITURTES ARE MORE POWERFUL THAN BENZODIAZEPINE TYPE MEDICATIONS.

37 COMMONLY PRESCRIBED BARBITURATES AND THEIR BRAND NAMES AMOBARBITAL ( Amytal, Tuinal ). SECOBARBITAL ( Seconal, Tuinal ). MEPROBAMATE ( Miltown, Equanil ). MEPHOBARBITAL ( Mebaral ). PENTOBARBITAL ( Nembutal ). LUMINAL BENZO S

38 BENZODIAZEPINES

39 BENZODIAZEPINES BENZODIAZEPINE MEDICATIONS POSSESS A HIGH POTENTIAL FOR ABUSE AND DEPENDENCY CONCERNS. BENZODIAZEPINE MEDICATION ABUSE TYPICALLY DOES NOT RESULT IN FATAL OR LETHAL DRUG OVERDOSE. BENZODIAZEPINE WITHDRAWAL POSSESS A POTENTIAL FOR POSSIBLE DRUG RELATED SEIZURES. BENZODIAZEPINE MEDICATIONS ARE NOT RECOMMENDED WHEN ALSO PRESCRIBED ANTI ALCOHOL AND ANTI OPIATE MEDICATIONS.

40 BENZODIAZEPINES BENZODIAZEPINES ARE METABOLIZED BY THE LIVER SIMILAR TO ALCOHOL. THEY DIRECTLY INHIBIT LONG TERM LEARNING BY IMPACTING THE NEUROPLASTICITY OF THE BRAIN. BENZODIAZEPINES ARE KNOW FOR PRODUCING AMNESIA ( ROHYPNOL, VERSED ). DETOXIFICATION FROM BENZODIAZEPINES MAY TAKE A LONG TIME TO BE EFFECTIVE OR THE POTENTIAL FOR RELAPSE IS HIGH.

41 COMMONLY PRESCRIBED BENZODIAZEPINES AND THEIR BRAND NAMES DIAZEPAM ( Valium ) CHLORDIAZEPOXIDE HYDROCHLORIDE ( Librium ) ALPRAZOLAM ( Xanax ) ESTAZOLAM ( ProSom ) CLONAZEPAM ( Klonopin, Clonopin ) LORAZEPAM ( Ativan ) Less Frequently Prescribed Benzodiazepines : CLORAZEPATE ( Tranxene ) OXAZEPAM ( Serax ). OXAZOLAM ( Serenal ) SED HYPNOTICS

42 SEDATIVE ( HYPNOTICS ) SLEEP AIDS Let s discuss sleep

43

44 PINEAL LOCATION IN THE BRAIN ( Primary Sleep Center )

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46 SEDATIVE ( HYPNOTICS ) SLEEP AIDS SEDATIVE ( HYPNOTICS ) MEDICATIONS ARE CONSIDERED SLEEP AIDS. SEDATIVE ( HYPNOTICS ) ARE TYPICALLY PRESCRIBED FOR SLEEP DISORDERS ( INSOMNIA : DIFFICULTY BEING ABLE TO PRODUCE SLEEP, OR THE INABILITY TO STAY A SLEEP ). SEDATIVE ( HYPNOTICS ) ARE CONSIDERED CNS DEPRESSANTS AND ARE CREATED FROM VARIATIONS OF BARBITURATES, BENZODIAZEPINES OR NON BENZODIAZEPINES MEDICATIONS. CURRENTLY MOST SEDATIVE ( HYPNOTIC ) MEDICATIONS ARE NOT RECOMMENDED TO BE TAKEN LONGER THAN TWO ( 2 ) TO SIX ( 6 ) WEEKS.

47 COMMONLY PRESCRIBED SEDATIVES AND THEIR BRAND NAMES CHLORAL HYDRATE ( Noctec ). ESTAZOLAM ( ProSom ). ETHINAMATE ( Placidyl ). FLURAZAEPAM ( Dalmane ). ESZOPICLONE ( Lunesta ). TEMAZEPAM ( Restoril ). TRIAZOLAM ( Halcion ). ZALEPLON ( Sonata ) a non Bz. ZOLPIDEM ( Ambien ) a non Bz. STIMULANTS

48 CENTRAL NERVOUS SYSTEM ( STIMULANTS )

49 CNS STIMULANTS STIMULANT MEDICATIONS ARE TYPICALLY PRESCRIBED FOR THE FOLLOWING : 1. ATTENTION - CONCENTRATION ADOLESCENT / ADULT DISORDERS ( ADD, ADHD ) 2. WEIGHT MANAGEMENT AND CONTROL 3. SPECIFIC SLEEP DISORDERS ( NARCOLEPSY ) 4. LIMITED PSYCHIATRIC DISORDERS ( MOOD DISORDER ) STIMULANT MEDICATIONS MEET THE CRITERIA FOR THE DSM-IV- TR S DIAGNOSIS OF ABUSE AND DEPENDENCE. LONG-TERM ABUSE OF STIMULANT MEDICATIONS CAN RESULT IN MODERATE TO SEVERE TOLERANCE AND WITHDRAWAL SYMPTOMS CHARACTERISTIC OF MOOD AND/OR PSYCHOTIC DISORDERS. COMMON STIMU.

50 COMMONLY PRESCRIBED STIMULANTS AND THEIR BRAND NAMES DEXTROAMPHETAMINE ( Adderall, Dexedrine ). AMPHETAMINE ( Adderall, Dexedrine, Vyvanse ). METHYLPHENIDATE ( Ritalin, Concerta ). COCAINE. FENFLURAMINE ( Pondimin, Ponderal ). MODAFINIL ( Provigil ). PEMOLINE ( Cylert ). METHAMPHETAMINE ( Desoxyn ). Non-Stimulant ADHD medications : ATOMOXETINE ( Strattera ). ( OTC)

51 OVER-THE-COUNTER ( OTC ) MEDICATIONS

52 ( OTC ) OVER -THE -COUNTER PRODUCTS OVER-THE-COUNTER ( OTC ) DRUGS ARE MEDICATIONS THAT HAVE BEEN SELF PRESCRIBED AND SELF ADMINISTERED FOR THE GENERAL RELIEF OF SIGNS AND SYMPTOMS OF A SELF DIAGNOSED ILLNESS. THE FOOD AND DRUG ADMINISTRATION ( FDA ) ESTIMATES THAT CONSUMERS SELF DIAGNOSE AND SELF - TREAT FOUR ( 4x s ) MORE THAN DOCTORS, USING OTC MEDICATIONS. AMERICAN CONSUMERS SPEND APPROXIMATELY EIGHTEEN ( 18 ) BILLION PER YEAR ON OTC MEDICATIONS.

53 CONTACT INFORMATION : CARL M. DAWSON, M.S., MAC, LPC 1320 E. KINGSLEY SUITE A SPRINGFIELD, MO ( cdawson1028@yahoo.com )

54 References and Suggested Readings U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment TREATMENT IMPROVEMENT PROTOCOL (TIP) SERIES Rockwall II, 5600 Fishers Lane Rockville, MD 20857

55 American Psychiatric Association. (2000 ). Diagnostic and statistical manual of mental disorders (4 th ed). Washington, DC: American Psychiatric Association. Buelow, G., Herbert Suzanne (1995). Counselor s Resource on Psychiatric Medications, Issues of Treatment and Referral. Brooks/Cole Publishing Co., Pacific Grove, Ca. Buprenophine.samhsa.gov Galanter, M., Kleber, H. ( 2008). Textbook of Substance Abuse Treatment. 4 th ed., American Psychiatric Publishing, Inc., Washington, D.C.

56 National Institute on Drug Abuse ( NIDA). Selected Prescription Drugs with Potential for Abuse, and Preventing and Recognizing Prescription Drug Abuse, and Prescription and Over-the-Counter Medications Stahl, S.M. (2003), Essential Psychopharmacology, Neuroscientific Basis and Practical Applications (2 nd ed). Cambridge University Press. Strain, E.C., Stizer M.L. (eds): The Treatment of Opioid Dependence. Baltimore, MD, Johns hopkins University Press, 2006, pp Erickson, C., ( 2007), The Science of Addiction. W.W. Norton and Company, New York, London. Suboxone.com

57 Kinney, J., ( 2003 ) Loosening the Grip : A Handbook of Alcohol Information. Seventh Ed., McGraw Hill, New York, N.Y.. Ray, O., Ksir, C., ( 2004 ) Drugs, Society, and Human Behavior. Tenth Ed., McGraw Hill, New York, N.Y.. Maxmen, J., Ward, N., ( 2002 ) Psychotropic Drugs, Fast Facts. (Third Edition), W.W. Norton and Company. Taber s Cyclopedic Medical Dictionary, ( 15 th Edition ), ( 1985 ), F.A. Davis Company.