Substance Abuse Issues

A training for Human Service Providers

{Enter Date Here}

Ground Rules for the Day

• Start and Stop on Time

• Maintain Confidentiality

• Participate fully and encourage participation of others

• Respect others’ viewpoints, opinions and needs

• OK to voice concerns and questions

• Make comments in a constructive manner

• Silence cell phones

Welcome• Substance use impacts many families

• Consider mental health, trauma, basic needs

• Safety among home-visitors

• Safety among families

• Actions that can and should be taken

• Building relationships

• Identifying help and helping

Presentation Goals• Review local data on substance use prevalence• Introduce issues related to substance use• Reduce stigma associated with substance use• Identify signs and symptoms of substance use• Screen and referral/intervention tools• Increase participant ability to match client needs

with eligible services• Identify Substance Use Disorder Treatment

Services in our community

Substance use in {Greater Lansing}

• Data from Tri-County Metro

• Data from ISAP Coalition

• Alcohol is the most commonly used and abused drugs

• Getting more common: marihuana (medical), heroin

• Equally bad in all of our community

Alcohol is the Most Common Drug of Abuse

Binge Drinking Defined

Women: more than 3 drinks on any single day AND more than 7 drinks per week.

Men: more than 4 drinks on any single day AND more than 14 drinks per week

Percentage of Adults Who Report Binge Drinking in the

Past 30 Days

Students Who Report Binge Drinking in the Past Two

Weeks

Percentage of Students Who Have Had At Least One Drink of

Alcohol

Students Who Report Ever Smoking Cigarettes

Marijuana use continues to rise among U.S. teens, while alcohol use hit historic lows

• Marijuana use among teens rose in 2011 for the fourth straight year—a sharp contrast to the considerable decline that had occurred in the preceding decade. Daily marijuana use is now at a 30-year peak level among high school seniors.

• “Synthetic marijuana,” which until earlier this year was legally sold and goes by such names as “K2” and “spice,” was added to the study’s coverage in 2011; one in every nine high school seniors (11.4%) reported using that drug in the prior 12 months.

• Alcohol use—and, importantly, Binge drinking—continued a long-term gradual decline among teens, reaching historically low levels in 2011.

• Energy drinks are being consumed by about one third of teens, with use highest among younger teens.

Regional Illicit Drug Forfeitures

2011 Narcotic Seizure Value: $4,046,431

Tri-County Metro Narcotics (MSP)

Heroin & Pills (opiates)

Marihuana (Marijuana)

Methamphetamine

Alcohol

Tobacco

Prescription Drug Abuse

Taking medicine that was not prescribed to you, or us being take for non-medical use

• 60% from a friend or relative

• 8% purchased from a friend or relative

• 4% taken from a friend or relative

• 17% physician prescribed

Addiction• The use of substances as a means to

cope with difficult experiences is common

• Use of substances can lead to addiction, in which the need for the alcohol or drugs is physical & becomes the most important thing in someone’s life

• People who are using have a harder time keeping themselves and their families safe

How is having an Addiction like having Cancer?

• Biologically pre-disposed• Most likely addicted before adulthood• Family history and normalization of use• Trying to find a “normal” brain function

(self-medication)• Some brain responds stronger to drug use• Power/Control Dynamics• Victims are by-products of wealthy suppliers

Drug Use – Why?• Mental Health Diagnosis (50% use drugs)

• Trauma (Seeking Safety)

• Family inter-generational use

• Genetic and Biological Factors

• Escape from the pain of reality

• Medical or Disease Model is Most Effective

• Use / Abuse /Dependence

Substance using behaviors

• Sexual assault– Childhood or current

• Physical assault

• Domestic violence

Addiction Pathology

Child of

a substance

abuser

Child of an alcoholic becomes an alcoholic

Substance abuses

-PhasesRecovery Relapse

Addiction in the Brain

Addiction in the Brain• Neurotransmitters are chemicals in the brain that relay, intensify

and alter signals between neurons and other cells. When someone takes an addictive drug, whether it be alcohol, cocaine, nicotine, heroin, or Valium, just to name a few, the brain gets flooded with a neurotransmitter called dopamine.

• This neurotransmitter is related to feelings of pleasure and excitement, and is associated with the reward center of the brain. In a normal brain, dopamine is released when the person experiences pleasure.

• However, chronic use of addictive substances means that the brain begins producing less dopamine on its own since it’s so used to getting flooded with dopamine as a result of the addiction. This leads to the abuser being unable to experience pleasure from his normal life, thus creating a dependency on the drug to feel pleasure.

Human Needs: Brain Tricks

The Illness Brings with it Frustrating Behavior

• Deceptive, lying, secretive

• Passive-Aggressive Characteristics, failure to follow-through with responsibilities

• Failure of priorities, chronic tardiness, money problems, lack of judgment, anxiety, depression

• Disregard for themselves or values of those they love, poor boundaries

• Legal implications

Blanket Activity

Strengths/Assets

Social Justice

Balance/Independence

Intimacy: closest

Friendship: community

Participation: clubs/groups

Exchange: paid help

Prescription Drug Abuse Chart http://www.drugabuse.gov/consequences/ * Schedule I and II drugs have a high potential for abuse. They require greater storage security and have a quota on manufacturing, among other restrictions. Schedule I drugs are available for

research only and have no approved medical use; Schedule II drugs are available only by prescription (unrefillable) and require a form for ordering. Schedule III and IV drugs are available by prescription, may have five refills in 6 months, and may be ordered orally. Most Schedule V drugs are available over the counter. ** Taking drugs by injection can increase the risk of infection through needle contamination with staphylococci, HIV, hepatitis, and other organisms. *** Associated with sexual assaults. + Not available by prescription in U.S.

Substances: Category and Name

Examples of Commercial and Street Names

DEA Schedule*/ How Administered**

Intoxication Effects/Potential Health Consequences

Depressants reduced pain and anxiety; feeling of well-being; lowered inhibitions; slowed pulse and breathing; lowered blood pressure; poor concentration/confusion, fatigue; impaired coordination, memory, judgment; respiratory depression and arrest, addiction Also, for barbiturates—sedation, drowsiness/depression, unusual excitement, fever, irritability, poor judgment, slurred speech, dizziness for benzodiazepines—sedation, drowsiness/dizziness for flunitrazepam—visual and gastrointestinal disturbances, urinary retention,/memory loss for the time under the drug's effects for GHB—drowsiness, nausea/vomiting, headache, loss of consciousness, loss of reflexes, seizures, coma, death for methaqualone—euphoria/depression, poor reflexes, slurred speech, coma

Barbiturates Amytal, Nembutal, Seconal, Phenobarbital; barbs, reds, red birds, phennies, tooies, yellows, yellow jackets

II, III, V/injected, swallowed

Benzodiazepines (other than flunitrazepam)

Ativan, Halcion, Librium, Valium, Xanax; candy, downers, sleeping pills, tranks

IV/swallowed

Flunitrazepam***+ Rohypnol; forget-me pill, Mexican Valium, R2, Roche, roofies, roofinol, rope, rophies

IV/swallowed, snorted

GHB*** Gamma-Hydroxybutyrate: G, Georgia home boy, grievous bodily harm, liquid ecstasy

I/swallowed

Methaqualone Quaalude, Sopor, Parest: ludes, mandrex, quad, quay

I/injected, swallowed

Dissociative Anesthetics increased heart rate and blood pressure, impaired motor function/memory loss; numbness; nausea/vomiting Also, for ketamine—at high doses, delirium, depression, respiratory depression and arrest Ketamine Ketalar SV; cat Valium, K, Special K,

vitamin K III/injected, snorted, smoked

PCP and analogs Phencyclidine; angel dust, boat, hog, love boat, peace pill

I, II/injected, swallowed, smoked

Cannabinoids euphoria, slowed thinking and reaction time, confusion, impaired balance and coordination/cough, frequent respiratory infections; impaired memory and learning; increased heart rate, anxiety; panic attacks; tolerance, addiction Hashish boom, chronic, gangster, hash, hash oil,

hemp I/swallowed, smoked

Marijuana blunt, dope, ganja, grass, herb, joints, Mary Jane, pot, reefer, sinsemilla, skunk, weed

I/swallowed, smoked

Hallucinogens altered states of perception and feeling; nausea; persisting perception disorder (flashbacks) Also for LSD and mescaline—increased body temperature, heart rate, blood pressure; loss of appetite, sleeplessness, numbness, weakness, tremors Also, for LSD—persistent mental disorders for psilocybin—nervousness, paranoia

LSD Lysergic Acid Diethylamide: acid, blotter, boomers, cubes, microdot, yellow sunshines

I/swallowed, absorbed through mouth tissues

Mescaline buttons, cactus, mesc, peyote I/swallowed, smoked

Psilocybin magic mushroom, purple passion, shrooms

I/swallowed

Marihuana:most common illegal drug

• Signs & SymptomsAnimated behavior, sleepy,

dilated pupils, bloodshot eyes, loss of coordination, odor, paranoia, fragmented thought.

• UsageSmoked in joints, pipes, bongs,

or blunts. Can be mixed in food or brewed in tea. Change lasts 3-5 hours or until the next day.

• SlangMary Jane, pot, reefer, skunk,

weed, yerba, bluns, dope, ganja, grass, herb, hydro, kif, bud, boom, and 420.

Marihuana:Michigan Medical Marihuana

• Federal Law trumps State Law

• Caregiver and Patient Cards Issued by State of Michigan, Licensing And Regulatory Affairs

• Caregivers may grow up to 72 plants in an enclosed, locked facility

• Patient limit is 12 plants per Patient

• Safety in homes is primary concern

• Marihuana is active in the body for 7 hours

• Impaired Driving is increasing

Marihuana

K2/Spice:alternative to marihuana

• Signs & SymptomsRapid heart rate, high blood

pressure, hallucinations, delusions, paranoia, changes in perceptions and behavior, seizure and death.

• UsageLeafy herbs with psychoactive

chemicals sprayed on and then smoked. Chemical changes make some forms illegal, some legal.

• SlangIncense, potpourri, Spice, K2, K3,

fake pot, Chemical Compound is JWH-018 and not THC.

Methamphetamine:One Pot Meth Labs urban/rural

• Signs & SymptomsDilated pupils, euphoria, rapid speech,

depression, violent, nasal congestion, insomnia, weight loss, dry mouth, lack of interest in food and sleep. Skin abscess, paranoia, volatile mood, movement disorders, lead poisoning, and meth-mouth.

• UsageSmoked, snorted, taken orally or

injected. Ingestion produces euphoria for 12 or more hours. The One-Pot Meth Lab has increased use, and brought meth into cities. Pacifiers and glow lights supplement use at Raves.

• SlangSpeed, chalk, crank, ice, glass, meth,

shards, speed, stove top, tweak, yaba, yellow bam, glass, crystal, go-fast, ecstasy, rollin’, E, X.

Methamphetamine:Manufacturing Products

• Signs & SymptomsChemical smell in home and on

person. Multiple chemicals - together in kitchen or garage used for cooking meth.

• Combination of several household products may indicate Cooking Meth

Batteries, camp fuel/gasoline, lye, drain cleaner, allergy medicine containing pseudoephedrine or ephedrine, plastic bottles, tubing, match heads

Prescription Drug Abuse:Pills not prescribed to you

• Signs & SymptomsPinpoint pupils, nausea, drowsy, confused,

relaxed, blood pressures high or low, heart rate and respiration high or low. Anxiety, euphoria, depression, irritable, shaky, trouble sleeping, coma. Tolerance

• UsagePills can be swallowed, crushed, snorted &

injected. Pain patches. Pharm Parties/Skittle Parties: mix stimulants, narcotics and depressants. Pain pills should not be combined with alcohol, antihistamines or benzodiazepines.

• Medication Suppliers• Most Prescription Drugs come from your

medicine cabinet. Properly dispose of all expired, un-used and un-wanted medications. Visit www.michigan.gov/deqreswastecontacts for local collection programs.

• ADD medications, pain pills and OTC pills are often combined with unknown outcomes.

Inhalants• Signs & SymptomsDrunk or disoriented appearance, paint or

other stains on face, hands, or clothing, hidden empty spray paint or solvent containers, chemical soaked rags or clothing, slurred speech, strong chemical odors on breath or clothing, nausea or loss of appetite, red or runny nose, sores or rash around nose or mouth. Hidden empty containers. Nail polish, nail polish remover, perfume samples

• UsageSniffed or Inhaled. Local deaths have

occurred with first time use.

• SlangHuffing, bagging, buzz-bomb, laughing gas,

poor man’s pot, poppers, rush, snappers, and whippets.

Mandatory Reporters• Physicial Neglect

» E. If the allegations involve parental drug use:» • How do you know the parents are using drugs?» • What kind of drugs are they using?» • Do the parents use drugs in front of the child?» • Are the parents selling drugs out of the home?» Are the parents allowing other people to use drugs in the home or to

sell drugs out of the home? Mandated Reporters Resource Guide (http://www.michigan.gov/documents/dhs/Pub-112_179456_7.pdf)

• Medical Neglect• Improper Supervision• Abandonment• Failure to Protect• Abuse Physical/Sexual

Continuum of Services: Continuum of Need

Case Study #1Father of baby (FoB) lives with Mother of Baby (MoB) in a rural community. FoB was previously shot in the leg, is disabled, and uses a wheel chair. He reports that he suffers from chronic pain, but refuses opiate painkillers. FoB has a medical marihuana card for his pain and grows his own marihuana. He does not provide caregiver services for others. The plants are kept in a locked closet and there is a water bong on top of the refrigerator. The home visitor has reported no smell of marihuana in the home at any time.

MoB has recently delivered her baby. She entered prenatal care at six months, and had received home visiting services to assist with medical coverage, transportation to medical appointments, and tangible needs. MoB has a history of substance use (heroin), but is in recovery and reports that she does not use drugs.

Case Study #2

Mother of Baby (MoB) is four-months pregnant and has three other children in the home (ages 12, 8, and 6). She receives food assistance, and lives with her boyfriend. He is on SSI and pays the rest of the bills.

MoB has participated in two previous home visits. Today, she enters the home visitors car with red glassy eyes and a light smell of marihuana. The home visitor asks if MoB is doing ok, since her eyes are red. MoB states that she was at Michigan Works all day looking at the computer screen.

Case Study #3This same MoB is now requesting assistance in obtaining a birth certificate for one of her children. At the next visit, MoB gets in the car and says that she can’t live with her boyfriend because he drinks alcohol and takes Vicodin daily. MoB reports that the boyfriend is a mean drunk and is verbally abusive towards her. She reports that he steals her money to buy alcohol, even when it means that she can’t take the bus to go to Michigan Works.

MoB states that she probably should not judge him since she has a medical marihuana card for carpal tunnel syndrome. MoB braids hair to make pocket money and uses marihuana to ease the pain that it causes. MoB reports that she only uses marihuana if she is going to braid hair, and does not use it when the kids are around.

MoB states that she has not used marijuana during the four months of this pregnancy. She asks you for help finding other housing so she can leave her boyfriend.

Authentic Messages get Results: non-violent communication (NVC)

Empathetically listening• Observations• Feelings• Needs• Requests

Honestly Expressing• Observations• Feelings• Needs• Requests

Both sides of the NVC Model: Empathetically listening and honestly expressing; use of the four steps of the model:

Observations, Feelings, Needs, Requests

Small Changes can make a Big Difference

• Keeping Track

• Counting and Measuring

• Setting Goals

• Pacing and Spacing

• Avoid “Triggers”

• Planning to Handle Urges

• Knowing your “NO”

• Find Safe Support

Best Practices: Assess/ReferEvery Encounter

• Varied Resources Offered

• Genuine Concern and Care

• Authentic Relationship

• Motivational Interviewing

• Capitalize on the Moment

• Follow the Client’s Lead – it’s their life and their priority and readiness

Assessment and InterventionsCAGE Assessment

C Have you every tried to Cutback on your use?

A Have you ever been Annoyed/Angered when questioned about your use?

G Have you ever felt Guilt about your use?

E Have you ever had a Eye-opener to get started in the morning?

Local Collaboration• Power of We

– http://powerofwe.org/

• ISAP Coalition – www.drugfreeingham.org

• Ingham Great Start Collaborative– www.inghamgreatstart.org

• Care Coordination Center– www.ceicmhca.org– (888) 230-7629 or (517) 346-8458

Continuum of local services: Home visitation

• Capital Area Community Services – Early Head Start

• Community Mental Health – Parent Infant Program (PIP)– Parent Young Child Program (PYC)

• Ingham County Health Department– Family Outreach Services (FOS)– Public Health Nursing

• Ingham Intermediate School District– Early On ®– Great Parents-Great Start

Continuum of local services: Recovery meetings

• Central Alcoholics Anonymous – http://www.aalansingmi.org/

• Narcotics Anonymous– www.na.org

• Smart Recovery– www.smartrecovery.org

• Celebrate Recovery– www.celebraterecovery.com

• Al-anon and Alateen (family/friend support)– www.al-anon.alateen.org

Continuum of local services: Treatment options

Community Mental Healthwww.ceicmhca.org

 Toll Free: 1.888.230.7629Local Calls: (517) 346-8458

Hours: 8:30- 4:30 (M-F)

Care Coordination Center Responsibilities

• Screening, Referral, Follow-Up

– Warm Transfers

• Utilization Review

– Next Day Openings

• Care Management

– List of Care Coordination Center providers

• Resource Consulting

Care Coordination CenterEligibility

• Medicaid, Adult Benefit Waiver (ABW), or MiChild Requirements

• Resident of one of the following Counties:– Clinton, Eaton, Gratiot, Hillsdale, Ingham,

Ionia, Jackson, or Newaygo

Thank you!

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Agency

Email address}