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

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

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

5. ALCOHOL

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

7. Original “Palm Pilot”

8. 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

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

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

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

12. Alcohol Withdrawal

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

14. HEROIN

15. Effects of Heroin Euphoric, drowsy, and warm (being "high") feeling within seconds of injection 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 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 Desire to sleep after the euphoric effects

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

17. Heroin Withdrawal

18. Begins 6 - 8 hours after last use, most severe around 48 to 72 hours after, lasts for about one week Begins 6 - 8 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 Symptoms compared to a bad case of the flu depending on use history Elevations in blood pressure, pulse, respiratory rate and temperature Elevations in blood pressure, pulse, respiratory rate and temperature

19. Heroin Withdrawal Goose bumps, watery eyes, runny nose, yawning, loss of appetite, tremors, panic, chills, nausea, muscle crams, and insomnia 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 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 Methadone or Buprenorphine treatment used for detoxification at some clinics

20. BENZODIAZEPINES

21. Effects of Benzodiazepines Versed (3 hrs), Librium (5-25 hrs), Xanax (6-12 hrs), Klonopin (18-50 hrs), Valium (36-200 hrs), Ativan (10-20 hrs) Versed (3 hrs), Librium (5-25 hrs), Xanax (6-12 hrs), Klonopin (18-50 hrs), Valium (36-200 hrs), Ativan (10-20 hrs) Prescribed for short-term (up to 4 months) relief of Anxiety, Panic Disorders, & Insomnia 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 Long-term use problematic due to development of tolerance and dependency

22. 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

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

24. Common Motives for Use of Depressants

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

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

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

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

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

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

31. CONSEQUENCES OF USE

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

33. Consequences of Substance Use Physical Symptom relapse Symptom relapse Health problems Health problems

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

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

36. Principles of Treatment

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

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

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

40. Thank you for coming!