1. Downers and Dual Recovery   How do depressant drugs affect mental health?

2. What comes to mind when you hear “Downers” ?

3. Downers (depressants) are…
Alcohol, Heroin, Benzodiazapine, ?
All depress the Central Nervous System (CNS)
Reduce heart rate, breathing rate, blood pressure
Mild doses cause mild euphoria
High doses can cause depression, drowsiness, confusion, lack of coordination, irrational behavior

4. ALCOHOL

5. Effects of Alcohol Nervous System
Alters, kills brain cells; impairs memory, coordination, and judgment
Damages nerve connections, causes irreversible damage
Causes blackouts - no recollection of what was said and done, but appearing to behave normally

6. Original “Palm Pilot”

7. Effects of Alcohol Gastrointestinal System
irritates the stomach and digestive system
blocks absorption of essential nutrients, contributes to malnutrition
causes Gastritis (stomach lining inflammation)
causes ulcers in the stomach and first part of intestine
contributes to cancer development in lip, esophagus, stomach, and liver
causes Alcoholic Hepatitis, Cirrhosis, and Pancreatitis

8. Effects of Alcohol Circulatory System causes high blood pressure
causes cardiomyopathy (deterioration of the heart muscle)
Skeletal System
leeches Calcium from the bones; worsen existing osteoporosis
reduces muscle mass

9. Effects of Alcohol Reproductive System
Men - reduces testosterone in men; breast enlargement, shrinking of testicles, impotence
Women - causes menstrual irregularities, infertility, loss of sex drive
Causes Fetal Alcohol Syndrome, or Fetal Alcohol Effects, if drinking while pregnant

10. Effects of Alcohol Immune System
impedes functioning of immune system cells
increases susceptibility to infectious diseases and cancer

11. Alcohol Withdrawal

12. Alcohol Withdrawal Begins first several days after last use
Causes anxiety, nausea, cravings, sleep disturbances, difficulty concentrating, hallucinations, seizures, delirium tremens
Detoxification should be medically supervised

13. HEROIN

14. Effects of Heroin
Euphoric, drowsy, and warm (being "high") feeling within seconds of injection
Slowed breathing, arms and legs feeling heavy or weighted, itchy skin, dry mouth, slowed heartbeat, constricted pupils, and feeling sick
Desire to sleep after the euphoric effects

15. Effects of Heroin
Changed into morphine-like chemical within the brain, which then binds quickly to opioid receptors
Feelings of depression caused when body's normal production of brain chemicals that produce feelings of pleasure, are impaired

16. Heroin Withdrawal

17. Heroin Withdrawal
Begins hours after last use, most severe around 48 to 72 hours after, lasts for about one week
Symptoms compared to a bad case of the flu depending on use history
Elevations in blood pressure, pulse, respiratory rate and temperature

18. Heroin Withdrawal
Goose bumps, watery eyes, runny nose, yawning, loss of appetite, tremors, panic, chills, nausea, muscle crams, and insomnia
Depression, so deep and overwhelming, that they are not able to make it through the withdrawal process
Methadone or Buprenorphine treatment used for detoxification at some clinics

19. BENZODIAZEPINES

20. Effects of Benzodiazepines
Versed (3 hrs), Librium (5-25 hrs), Xanax (6-12 hrs), Klonopin (18-50 hrs), Valium ( hrs), Ativan (10-20 hrs)
Prescribed for short-term (up to 4 months) relief of Anxiety, Panic Disorders, & Insomnia
Long-term use problematic due to development of tolerance and dependency

21. Effects of Benzodiazepines
Benzodiazepines and Tranquilizers belong to the same class of drugs; Sedative-Hypnotics
There is a great potential for cross addiction with alcohol, if tolerance is already developed for the other

22. Benzodiazepine Withdrawal
Lasts 6 weeks
High level of psychological problems (anxiety, agitation, insomnia, depression)
Serious physical problems; seizures
Detoxification should be medically supervised

23. Common Motives for Use of Depressants

24. Socializing Feel less anxious around other people when using
Feel pressured by others to use
Helps to feel “normal” and “accepted” by others; don’t feel they have a mental illness or are different from others when using

25. Self-medication (Reduce the effects of) unpleasant symptoms
Might be temporarily effective
Usually unsuccessful in the long run

26. Most common symptoms people report using substances to self-medicate
depression
anxiety
sleep problems
nervousness
tension
hallucinations
medication side effects
loss of interest

27. Pleasure enhancement
Substances are one of the few sources of pleasure they experience
Use because they believe it enhances other enjoyable activities
Very tempting to use because they are easy to get and effects are rapid

28. Habit or routine
Using becomes part of a daily routine if using for a long period of time
Substance use is second nature
Use substances automatically, without much thought (like brushing teeth)

29. Relieving cravings or withdrawal symptoms
Cravings for substances developed in individuals who use larger quantities
May experience withdrawal symptoms if they stop using suddenly
Use primarily motivated by the desire to avoid cravings or withdrawal symptoms

30. CONSEQUENCES OF USE

31. Consequences of Substance Use
Behavioral
Social relationships
Work or role functioning
Money problems
Legal problems
Housing instability
Dangerous situations

32. Consequences of Substance Use
Physical
Symptom relapse
Health problems

33. Long-Term Consequences (Addiction)
Psychological
Giving up important activities
Spending large amounts of time getting or using substances
Using more of a substance than planned
Repeated attempts to cut down or quit

34. Long-Term Consequences (Addiction)
Physical
Tolerance
Cravings
Withdrawal symptoms

35. Principles of Treatment

36. Principles of Treatment
Medication adherence
Decreased stress
Treatment of both mental illness and substance abuse
Individualized treatment
Collaboration

37. Principles of Treatment
Dual diagnosis groups
Increased structure
Rehabilitation
Self-help groups
Individual therapy

38. Principles of Treatment
Motivational strategies
Family support and problem solving
Keeping hope alive

39. Thank you for coming!