1. Substance Abuse and You Essential Skills to Success Authors: Jonathan Mong & Marianne Schwarz; VFMP UBC Medicine 2015 Presenters:

2. Outline Who we are Topics: ▫1. Commonly used drugs + what they do to the body ▫2. Reasons for use and risk factors for abuse ▫3. Consequences of abuse ▫4. Recovery: mental tapes, coping strategies, stages of recovery, etc.

3. Addiction – physiological and mental Different from “dependence” Physical and psychological need for something Accompanied by self- destructive behaviours

4. Withdrawal Physical and psychological symptoms that appear when off of a substance Can have common symptoms for many substances

5. Sleeping pills Some people use these to stay or fall asleep Common drug: Ativan, Imovane Work by blocking electrical signals from going to your brain

6. Sleeping Pills The Good ▫Helps to sleep ▫Relaxant The Bad ▫Addiction ▫Nausea, headaches ▫Memory impairment The Ugly ▫Comatose ▫Death

7. Acetaminophen The Good Reduce pain (e.g. headache, muscle aches) The Bad ▫Overdose causing vomiting, which can lead to… The ugly ▫Overdose (causing liver failure, kidney failure, death)

8. Anabolic Steroids Similar actions to testosterone Often taken to try to build muscle mass Can affect cells everywhere and not just in your muscles

9. Anabolic Steroids The Good ▫Bulk up ▫Appear “manly” The Bad ▫Acne ▫Bruising ▫Cancer ▫Depression ▫Aggression ▫Testicular shrinking ▫Stunted growth The Ugly ▫...

10. …

11. Marijuana Taken for a variety of reasons: to relax, reduce pain, etc. Increases amount of substance in your brain that makes you feel good “Opening a door”

12. Marijuana The ‘Good’ ▫Pain control ▫Relaxant The Bad ▫Loss of motivation ▫Decreased awareness The Ugly ▫Increased risk of schizophrenia ▫Legal complications

14. Cocaine Prevents substance in brain from being broken down normally “Can’t clean up the mess”

15. Cocaine The Good ▫Gives you energy ▫Gives you a “high” The Bad ▫Heart troubles  Infections, enlarged heart, irregular rhythm ▫Seizures The Ugly ▫Sudden heart attack ▫Stroke

16. Case Jack is 28 year-old Confused wandering Downtown Eastside “Jerky” movements Fever and chills “Muscles hurt all over.” Feels ants crawling under his skin Agitated

17. Questions/Ideas What did you notice is happening to Jack? Any ideas to explain this?

18. Patterns of Use Non User ▫People who do not use the substance Initial User ▫People who try the substance for the first few times Irregular User ▫People who use the substance in social settings Regular User ▫People who use the substance in many settings ▫This is non-harmful regular or planned use Problem User ▫People who show addictive behaviour towards the substance Dependent User ▫People who are fully addicted to the substance ▫Physical and mental withdrawal symptoms can present ▫People driven to acquire and use substance

19. Motivations Mental or physical pain To fit in socially To treat the symptoms of an illness To prevent withdrawal Escape from reality

20. Risk Factors Genetics Personal characteristics Health or mental illness Gender Early drug use Lack of healthy relationships

21. Risk Factors Family Physical abuse Culture Stress Trauma Availability of substances Peer group

22. Case, part 2 Calms down Car accident 1 year ago No major trauma, but had trouble sleeping after Prescribed a sleeping pill by his doctor Jack says he became “dependent on it” After prescription, he ran out and he started drinking heavily

23. Ideas/Questions Any new ideas about what is happening with Jack? What substances could he potentially be abusing?

25. Social Consequences Can have minimal impact or affect: Family Relationships Job and finances Housing Physical health Mental health

26. Case Jack remembers his father using alcohol extensively when work was hard Father was abusive towards Jack and his mother Left the house, has not seen his father since Felt more popular when drinking

27. Ideas/questions What do you think are Jack’s motivations for using alcohol and sleeping pills? What are his risk factors for substance abuse?

28. Recovery – Stages of Change Precontemplation Contemplation Preparation Action Maintenance Relapse

29. Recovery – Assessing your thoughts Mental tapes are old recordings of voices that play in our head from time to time These tapes can be distracting to the process of recovery, e.g. ▫“I’m worthless because I’m not able to kick my drug habit.” ▫“I’ll never be able to live a real life because I drink too much alcohol and there’s nothing I can do about it.” ▫“If I don’t use alcohol then nobody will like me.” ▫“When I got high last time I had the best time of my life. The same thing will happen when I get high again tonight.”

30. Recovery – HALT Principles Relapse is more likely to happen if you are: ▫Hungry ▫Angry ▫Lonely ▫Tired If you feel like you’re being overwhelmed by any of these, it’s important to “check in with yourself.”

31. Case 1 year later Sees same doctor Has tried to stop drinking several times but has always started up again Wants to “kick the habit” Staying in a friend’s basement Currently unemployed but optimistic

32. Back to Jack… Jack sounds like he wants to stop his substance abuse. Do you think he is prepared to start the process of recovery?

33. Resources Your doctor Community clinics Needle exchange programs Dial 211 - Alcohol and Drug Line - Refers to a full range of counselling and treatment services across BC. BC Dial 811 - HealthLink BC Online resources ▫Mood gym

34. Thank you! Questions?