1. Module Seven ALCOHOL & SUBSTANCES ABUSE Lesson 1: Alcohol (2 training hours) Lesson 2: 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. Lesson 2 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, liver and kidney 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΄)