Central Nervous System Depressants Alcohol Barbiturates Benzodiazepines Prescription Medications

CNS Depressants (prescription) Valium Librium Ativan Serax Xanax Tranzene Klonopin

General Symptoms of Users “Drunken” Behavior (lack of coordination, slurred speech, staggering Confusion Faulty Judgment Emotional Lability Irritability Drowsiness Hostility Paranoid ideas

Route of Administration Orally – pill (capsule or tablet) Or mixed with water and injected

Potential for moderate to high dependence Physical Dependence Potential for moderate to high dependence

Tolerance Low to Moderate

Psychological Dependence Moderate to High Potential

Withdrawal Must be monitored closely due to potential fatalities Risk of seizures and delirium tremens Prolonged symptoms can last for months, resolve, then reappear. Especially with Benzodiazepines (Valium, Librium, Tranzene, and Zanax).

Depressant Withdrawal – Stage I Tremors (shakes) occur in the morning after heavy use the night before Peak intensity is about 24-36 hours after last dose “Jitters”, irritability, nausea, vomiting, easily startled, facial flushing, rapid heart rate Loss of appetite insomnia, inattention, mildly disoriented, poor recent memory, sense of uneasiness.

CNS Depressant Withdrawal Stage II Hallucinations (disordered perceptions) vary in intensity misinterpreted shadows and movements Objects seeming distorted and unreal May occur when the rest of the sensorium is clear, and seem intensely real.

CNS Depressant Withdrawal Stage III Seizures (grand mal) Bursts of 2-6 full body seizures 90% occur 7-48 hours after the last drink One third of patients with seizures will go on to develop delirium tremens

CNS Depressant Withdrawal Stage IV Delirium Tremens (Profound Confusion, Delusions, Vivid Hallucinations, Tremor, Agitation, Sleeplessness, Dilated Pupils, Fever, Tachycardia, Profuse Perspiration Usually occurs 3-5 Days after the last dose Most cases mild, and end abruptly Severe cases considered a medical emergency, and carry a 15% fatality rate Single episode lasts 72 hours or less in 80% of the cases

Pharmacological Effects Alcohol (Ethanol):

Alcohol as a drug Alcohol is a psychoactive drug that is a CNS depressant Alcohol is the second most widely used and abuse of all psychoactive drugs Q. What drug is the most widely used and abused drug? A. Caffeine

Four types of alcohol Methyl alcohol Isopropyl alcohol poisonous Ethylene glycol poisonous Ethanol drinking alcohol

Physical effects of alcohol The body is affected by alcohol in two ways: Direct contact with mouth, esophagus, stomach, and intestine Influence on almost every organ system in the body after entering the bloodstream

Physical Effects of Alcohol Absorption is the process in which the drug molecules reach the bloodstream The effects of alcohol on the human body depend on the amount of alcohol in the blood (BAC)

Physical effects of alcohol BAC produced depends on the: 1. Presence of food in the stomach 2. Rate of alcohol consumption 3. Concentration of alcohol 4. Drinker’s body composition Alcohol beverages have almost no vitamins, mineral, protein, or fat - just large amount of carbohydrates

Physical effects of alcohol Alcohol can cause severe physical and psychological dependence 1. Cross-tolerance 2. Behavioral tolerance - compensation of motor impairments by chronic alcohol users through behavioral pattern modification

Blood alcohol level Almost 95% of the consumed alcohol is inactivated by liver metabolism. The liver metabolizes alcohol at a slow and constant rate and is unaffected by the amount ingested. Thus, if on can of beer is consumed each hour, the blood alcohol level (BAL) will remain constant.

Blood alcohol level Blood alcohol level (BAL) is the concentration of alcohol expressed as a percentage.

How alcohol is absorbed in the body

Short-term effects of alcohol Low to moderate doses Disinhibition Social setting and mental state Euphoric, friendly, talkative Aggressive and hostile Interfere with motor activity, reflexes, and coordination

Short-term effects of alcohol Moderate quantities Slightly increases in heart rate Slightly dilates blood vessels in arms, legs, skin Moderately lowers blood pressure Stimulate appetite Increases production of gastric secretions Increases urine output

Short-term effects of alcohol At higher doses Difficulty in walking, talking, and thinking Induces drowsiness and cause sleep In large amounts - severe depression of the brain systems and motor control area of the brain

Large Doses of Alcohol Uncoordination, confusion, & disorientation Stupor, anesthesia, coma, and even death Lethal level of alcohol is between 0.4 and 0.6% by volume in the blood

? True of False ? Drinking black coffee, taking a cold shower, or breathing pure oxygen will hasten the sobering up process The type of alcohol beverage you drink can influence the hangover that results Taking an aspirin-caffeine combination before drinking helps the sobering up process and the chances of having a hangover

Long-term effects of alcohol Light or moderate drinking does little permanent harm (exception - FAS) Heavy drinking Seriously damages the heart Kidney and liver damage Mental disorders, irreversible damage to the brain and peripheral nervous system Lowers resistance to pneumonia and other infectious diseases Irritates the gastrointestinal tract

Principal control centers of the brain affected by alcohol

Alcohol and pregnancy Women who are alcoholics or who drink heavily during pregnancy have a higher rate of spontaneous abortion. Infants born to drinking mothers have a high probability of being afflicted with fetal alcohol syndrome.

Effects of alcohol on organ systems and bodily functions Brain and nervous system Liver hepatotoxic effect alcoholic hepatitis cirrhosis Digestive system

Effects of alcohol on organ systems and bodily functions Blood Cardiovascular system alcoholic cardiomyopathy Sexual organs Endocrine system

Effects of alcohol on organ systems and bodily functions Kidneys Mental disorder and damage to the brain Wernicke-korsakorr’s syndrome The fetus (FAS) Malnutrition

Barbiturates Derivatives of barbituric acid First synthesized in 1868 Used as anticonvulsants and sedative hypnotics High abuse liability High lethal dose rate

Barbiturates Used with other analgesic combinations (aspirin, codeine) for treatment of tension and migraine headaches Phenobarbital and belladonna alkaloid combinations used to treat peptic ulcers and irritable bowel syndrome

Barbiturates - Medical Uses Used as an anticonvulsant Sedative Hypnotic Detoxification medication for alcohol withdrawal syndrome

Route of Administration Oral (pill form) Intravenous Intramuscular (shot)

Barbiturates - Short Term Effects Relieve anxiety and restlessness, relax muscles, induce sleep Reduce lung function (breathing), heart action, speech, and movement

Long-Term Effects Cardiovascular – bradycardia, hypertension Digestive System – nausea, vomiting, constipation Nervous System – agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucination, insomnia, anxiety, dizziness, thinking abnormalities

Barbiturate – Long Term Effects Reproductive System – cross the placental barrier and cause fetal abnormalities Newborn withdrawal symptoms Respiratory System – hypoventilation, apnea Other Reactions - headache, injection site reactions, fever, liver damage, megablastic anemia (with long term use)

Tolerance Develops quickly Psychological tolerance develops more quickly than physical Increased amounts approach lethal dosage Metabolize faster in the liver as dosage increases

Half Life Psychoactive chemicals have age dependent metabolism Younger people tolerate a higher dose than older (over 50). Half life = length of time in hours required for one half of the dose taken to be excreted from the body.

Toxicity/Overdose Cold, clammy skin Weak, rapid, shallow breathing Combined with ETOH –suppression of respiratory center of brain Dependence defined by amounts taken 8-10 times normal taken daily for 30 days Death will occur if drowsiness, loss of consciousness, depressed breathing, and coma are left untreated.

Psychological Effects Early - calming, tension reduction, Middle – Euphoria, hypnotizing, impaired judgment, sense of “no worry” Later – mood swings, depression, irritability, obnoxious behavior, manipulation, drug seeking

Withdrawal from Sedative Hypnotics Within 6-8 hours of last dose Can be life threatening if breathing and blood pressure problems untreated Nausea, vomiting, increased heart rate, excessive sweating, abdominal cramps, tremors Withdrawal deaths more frequent than overdose deaths.

National Institute of Drug Abuse http://www.nida.nih.gov/ References - Material from this module was Developed from the following sources, which are recommended reading for the LADAC exam: Basics Of Addiction Counseling: Desk Reference And Study Guide National Association for Addiction Professionals www.naadac.org National Institute of Drug Abuse http://www.nida.nih.gov/ National Institute of Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/