1. Module 2: Drug and Alcohol Awareness

2. Objectives To recognise own attitudes towards drugs and alcohol
To understand the reasons why people use drugs and alcohol
To be aware of the legality, effects, routes of use, and risks of alcohol, cannabis, cocaine and opiates

3. Dual Diagnosis Capabilities
Non-Judgemental Attitude: Be aware of ones own attitudes and values in relation to dual diagnosis and be able to suspend judgement when working with service users, and carers. Challenge others’ attitudes in an appropriate and useful manner. Dual Diagnosis Capability 4 level 2
Education and Health Promotion: Be able to offer basic but accurate and up to date information and advice about effects of substances on mental and physical health and vice versa. Dual Diagnosis Capability 8 level 2

4. Substance Use
Substances that alter level of consciousness and/or perception
Levels of use:
Experimental (occassional- not always safe!)
Recreational (regular, but within safe limits)
Bingeing/ dangerous use (high intensity over short length of time)
dependence (increased tolerance and withdrawals if stop)

5. Exercise 1 Ask yourself these questions:
What attitudes do I have about people who use drugs and people who use alcohol?
Where did these attitudes come from? (Parents, school, media, religious beliefs etc)
How might these attitudes affect how I work with people with substance use problems?

6. Exercise 2: Why Use?
Why do I (did I) smoke cigarettes; drink caffeinated drinks e.g. coffee, tea, cola; drink alcohol? Make a list of the reasons why, the benefits, and if there are any, some of the less good aspects of these habits.
why do people with mental health problems use drugs and alcohol? Make a list of the reasons that you are aware of from what service users have told you, or assumptions that you have made.

7. Reasons for use To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day

8. Alcohol Alcohol is a widely used, legal and socially acceptable drug.
It is taken orally.
It is a central nervous system depressant
Dangerous drug; accidents whilst intoxicated, overdose choking on vomit.
Alcohol related to 40% of violent offences;44 per cent for domestic violence and 53 per cent for violence committed against a stranger [British Crime Survey, 2000].

9. Alcohol 2 Safe levels <3 units per day
Males up to 21 units/week; females up to 14 units/week
Unit = volume x ABV/1000 (250mls wine 13%ABV/1000=3.25 units
Physical dependency- ↑tolerance and withdrawals
Signs of withdrawal: nausea, vomiting, sweating, high temperature, hypertension, anxiety, sleeplessness, restlessness, and sometimes hallucinations, epileptic fits.
Withdrawals need immediate medical attention and treatment as can be life-threatening.
Never advise abrupt cessation of heavy drinking without treatment!!

10. Cannabis
Cannabis is a sedative and hallucinogenic drug produced from the leaves and buds of the cannabis sativa plant.
Most commonly used illegal drug.
Cannabis is an illegal substance under class B of the misuse of Drugs Act. dried leaves or black/brown block of resin
Cannabis leaves or resin are smoked (roll-up with tobacco or in a bong)
Signs of Use: reddened eyes, dilated pupils, increased pulse rate, drowsiness, giggling, and a sweet herbal smell.
Effects: relaxation, increased senses, slowing of thoughts, time seems to pass more slowly, sometimes mild hallucinogenic effects.
Risks: mouth and lung cancer, exacerbate other lung conditions, increases likelihood of psychosis, road traffic accidents whilst driving under the influence.

11. Cocaine and Crack Cocaine
Stimulant drugs
Legality- class A drugs
What do they look like: cocaine is a white crystalline powder, and crack is white or off-white crystalline rocks
How taken: Cocaine may be taken orally, snorted, inhaled, or injected. Crack: inhaled from a pipe, but sometimes injected.
Effects: Cocaine, in both forms, increases heart rate, breathing, blood pressure, thoughts and activity levels. It also lifts mood and gives a sense of energy and wellbeing.
Signs of use: dilated pupils, dry mouth, elevated body temperature, teeth grinding, agitation, restlessness, excitability, pressure of speech, flight of ideas, weight loss (appetite suppressant).
Risks: paranoia, confusion, and disorganized patterns of behaviour. The “come down” period causes fatigue, and depressed mood. Heart attacks, hgh blood pressure, stroke, and kidney damage

12. Opiates Derived from the opium poppy.
They include heroin, morphine, methadone and codeine.
Central nervous system depressants
Legality: these are class A drugs
What they look like: heroin is a pale brown powder; also available in pharmaceutically manufactured form such as tablets, green or blue syrup (methadone) and glass ampoules (for injection)
How used: mainly smoked or injected, some opiates are available in tablet and suppository form.
Signs of use: pallor, pinprick pupils “pinned”, sedation/drowsiness (“gouching out”), signs of injecting on body
Effects: people feel emotionally numb, warm and drowsy, with an initial intense rush, especially if injected intravenously.
Withdrawals: gooseflesh, shivering, profuse sweating, feeling feverish, aching limbs, yawning, runny eyes, runny nose, gastrointestinal disturbances such as stomach cramps, nausea, vomiting and diarrhoea.
Risks: overdose, injecting related problems, BBVs, accidents

13. Other Drugs: solvents, ecstasy, LSD, amphetamines

14. Other Drugs Hallucinogens: LSD, magic mushrooms Ecstasy Amphetamines
Distort perceptions for several hours
“psychotic” trip
Can be terrifying “bad trip”
Ecstasy
Stimulant and mildly hallucinogenic
Feelings of empathy, energy
Depression and short term memory problems
Death as a result of kidney failure
Amphetamines
Effects like cocaine
Paranoia and aggression
Solvents and gases
Sniffed, inhaled
Intoxication
Risk of instant death, brain damage, accidents
Caffeine-
“Red Bull”; coffee; cola drinks
Stimulants, irritability, aggression, paranoia
OTC- over the counter (cough linctus, anti-histamines etc)
Prescription drugs- benzodiazepines, anti-cholinergics