Carl M. Dawson, M.S., MAC, LPC

Independent Practice

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National Drug Court Institute Faculty (NDCI)

Washington, D.C .

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Missouri State University (MSU)

Department of Psychology

Department of Counseling, Leadership and Special Education

Springfield, Missouri

Why People Abuse Prescription Drugs“The Psychopharmacology of Addiction”

Why People Abuse Prescription Drugs

•POINTS OF REFERENCE.

•A REVIEW OF TERMS AND DEFINITIONS.

•PRESCRIPTION DRUG ABUSE IN PERSPECTIVE.

•A REVIEW OF CONTROLLED “SCHEDULED“ DRUGS.

•THE MOST COMMONLY ABUSED PRESCRIPTION MEDICATIONS: 1. OPIATES/OPIOIDS (Narcotics) 2. ANXIOLYTICS (Barbiturates, Benzodiazepines, Sedative Hypnotics) 3. STIMULANTS

POINTS OF REFERENCE

• “DRUG ABUSE, IS DRUG ABUSE“ . . . DON’T ASSUME THAT PRESCRIPTION DRUG ABUSE IS ANY DIFFERENT THAN ILLICIT DRUG ABUSE.

• ALL OF THE DRUGS DISCUSSED TODAY ARE SAFE AND EFFECTIVE AND TYPICALLY FREE OF ADDICTION POTENTIAL WHEN USED AS MEDICALLY RECOMMENDED.

• REMEMBER: YOU DO NOT HAVE PERMISSION TO TO ADVISE A CLIENT TO STOP TAKING A MEDICATION THAT HAS BEEN LEGALLY PRESCRIBED BY A QUALIFIED MEDICAL PROFESSIONAL.

A REVIEW OF TERMS AND DEFINITIONS

WE WILL BE USING THE DSM-IV-TR (APA, 2000) TERMINOLOGY AS IT APPLIES TO THE DSM-5 (APA, 2013) CRITERIA IN TODAYS PRESENTATION.

SUBSTANCE RELATED DISORDERS

(DSM IV, TR, APA 2000)

(Diagnostic Criteria)

ADDICTION: A behavioural term that refers to

continuing to seek a drug in spite of the consequences.

(“ADDICTION” IS NOT A DIAGNOSTIC TERM)

• ABUSE: Refers to psychological use (only).

• DEPENDENCE: Refers to the occurrence of

predictable physical changes due to the

continued use of alcohol and /or other drugs. •

DSM-5• DSM-5 recommends the use of the term “Substance Use Disorder” and

not the term “Addiction”.

• DSM-5 states that the diagnosis of a “Substance Use Disorder” applies to all 10 classes of substances (drugs).

• DSM-5 uses a “Severity” continuum when ranking the degrees of harmful substance involvement.

1. Mild: 2 to 3 symptoms. (DSM-IV-TR: Abuse “Psychological”) 2. Moderate: 4 to 5 symptoms.(DSM-IV-TR: Dependence Psych/Physical”) 3. Severe: 6 or more symptoms. (DSM-IV-TR: Dependence “Chronic”)

• DSM-5 recommends that you use the name of the specific substance “xanax” rather than the class “anxiolytic” when diagnosing.

Example: 304.10 moderate xanax use disorder. 303.90 severe alcohol use disorder.

• CENTRALLY ACTIVE DRUGS: (aka: PSYCHOACTIVE ) SUBSTANCES (DRUGS) THAT ENTER THE BRAIN AND ALTER THE ELECTRICAL AND CHEMICAL ACTIVITIES OF THE BRAIN AND NERVOUS SYSTEMS.

• DRUGS: AS USED IN THIS PRESENTATION, ANY SUBSTANCE THAT REQUIRES A PRESCRIPTION AND CAN BE FOUND IN THE SCHEDULED CLASSIFFICATION OF MEDICATIONS.

• DRUG ENFORCEMENT ADMINISTRATION (DEA): IS A BRANCH OF THE DEPARTMENT OF JUSTICE. THE DEA WAS CREATED IN 1970 AS A CONSEQUENCE OF THE COMPREHENSIVE DRUG ABUSE PREVENTION AND CONTROL ACT.

• GENERIC NAME: THE ACTUAL NAME GIVEN TO THE CHEMICAL MAKE UP OF A DRUG. (BUPROPION FOR WELLBUTRIN)

• HYPNOTICS: A TERM USED TO IDENTIFY A CLASS OF DRUGS PRESCRIBED FOR INSOMNIA , OR A DISORDER WHERE AN INDIVIDUAL HAS DIFFICULTY FALLING OR STAYING ASLEEP.

• OFF LABEL: A TERM USED TO DESCRIBE A DRUG THAT IS BEING USED FOR MEDICAL CONCERNS OTHER THAN IT WAS ORIGINALLY INTENDED OR OTHER THAN IT WAS MANUFACTURED.

• OPIATES / OPIOIDS: (aka: NARCOTICS): A CLASS OF DRUGS THAT ARE DESIGNED TO TREAT OR REDUCE THE EFFECTS OF SPECIFIC OR GENERALIZED PHYSICAL SENSATIONS. (PAIN)

• OVER THE COUNTER (OTC) MEDICATIONS: MEDICATIONS USED TO TREAT VARIOUS PHYSICAL / MEDICAL CONDITIONS THAT DO NOT REQUIRE A PRESCRIPTION.

• SEDATIVES: DRUGS DESIGNED TO RELAX OR REDUCE ANXIETY OR STRESS. MEDICATIONS THAT DEPRESS THE ACTIVITY OF THE CNS .

• SYNERGISTIC EFFECT: WHEN TWO (2) DRUGS PRODUCE A GREATER EFFECT THAN ONE (1)

DRUG ALONE. (1+1=3)

• TRADE OR PATENTED NAME: THE TITLE A DRUG COMPANY USES FOR THEIR BRAND OF A PARTICULAR DRUG. (VALIUM FOR DIAZEPAM or XANAX FOR ALPRAZOLAM)

• TOLERANCE: THE NEED FOR A GREATER AMOUNT OF A DRUG, IN ORDER TO GAIN THE SAME OR DESIRED EFFECT.

• CROSS TOLERANCE and CROSS DEPENCENCY: A PHYSICAL ADAPTATION WERE THE ABUSIVE USE OF ONE DRUG (ALCOHOL) MAY CREATE EITHER A TOLERANCE OR DEPENDENCY ON OTHER SIMILAR ACTING DRUGS (XANAX).

• WITHDRAWAL: THE PHYSICAL AND/OR PSYCHOLOGICAL SYMPTOMS EXPERIENCED ONCE A MEDICATION HAS BEEN DISCONTINUED.

REMEMBER:

WHATEVER SIGNS AND SYMPTOMS A DRUG WAS ORIGINALLY DESIGNED TO TREAT . . . THE WITHDRAWAL AND REBOUND SYMPTOMS, FROM THAT PARTICULAR DRUG. . . WILL USUALLY BE THE OPPOSITE ! ! !

ANTI - ANXIETY ANTI - WEIGHT ANTI - SLEEP ANTI - PAIN ANTI - DEPRESSION

PRESCRIPTION DRUG ABUSE IN PERSPECTIVE

PRESCRIPTION DRUG ABUSE IN PERSPECTIVE

• PRESCRIPTION DRUGS ARE THE SECOND MOST FREQUENTLY ABUSED CLASS OF DRUGS OTHER THAN MARIJUANA.

• MOST INDIVIDUALS ABUSING PRESCRIPTION DRUGS SECURE THEIR DRUGS THROUGH:

1. ILLICIT MEANS: (FRIENDS, STEALING, DEALING). 2. FAMILY MEMBERS WHO POSSESS A LEGITIMATE PRESCRIPTION. 3. MANIPULATING PRESCRIBING HEALTH CARE PROFESSIONALS.

• THE MOST COMMON REASONS INDIVIDUALS ABUSE PRESCRIPTION MEDICATIONS ARE DUE TO:

1. LEGITIMATE PHYSICAL (ACUTE-CHRONIC). 2. MENTAL HEALTH (CO-OCCURRING AND MOOD DISORDERS). 3. SLEEP DISORDERS (INSOMNIA OR HYPERSOMNIA).

• UNINTENTIONAL DEATH DUE TO PRESCRIPTION DRUG ABUSE INCREASED IN ADOLESCENCE

150 % BETWEEN 2001 TO 2009. (CERMAK 2009)

• IN 2008, ADOLESCENT DEATH DUE TO DRUG USE EXCEEDED DRIVING FATALITIES. (CERMACK 2009)

• APPROXIMATELY ONE -THIRD (1/3rd) OF ADOLESCENCE CLAIM THEIR FIRST ABUSIVE USE OF A DRUG WAS A PRESCRIPTION MEDICATION.

• RESEACH CONDUCTED AT JOHNS HOPKINS UNIV. INDICATED THAT DEATH DUE TO PRESCRIPTION

DRUG OVERDOSE INCREASED 273% BETWEEN

THE YEARS 2006 AND 2008.

THE CURRENTLY MOST ABUSE PRESCRIPTION DRUGS IN THE U.S.

• PRESCRIPTION OPIATES / OPIOIDS: 1. HYDROCODONE (VICODIN) 2. OXYCODONE (OXYCONTIN, PERCOCET) 3. CODEINE

• PRESCRIPTION BENZODIAZEPINES: 1. DIAZEPAM (VALIUM) 2. ALPRAZOLAM (XANAX) 3. LORAZEPAM (ATIVAN)

ADULTS BETWEEN THE AGES 35 AND 54 ARE THE GREATEST OFFENDERS

CONTROLLED SUBSTANCES ACT (CSA)

• CONTROLLED SUBSTANCES ACT (CSA) WAS ENACTED BY THE UNITED STATES CONGRESS IN 1970.

• THE CONTROLLED SUBSTANCES ACT (CSA) ALLOWS THE DRUG ENFORCEMENT ADMINISTRATION (DEA) AND THE FOOD AND DRUG ADMINISTRATION (FDA) TO DETERMINE THE APPROPRIATE PLACEMENT OF PARTICULAR DRUGS AND MEDICATIONS THAT POSSESS A POTENTIAL FOR PSYCHOLOGICAL AND/OR PHYSICAL ABUSE AND DEPENDENCE INTO FIVE (5) SCHEDULES OR (CLASSIFICATIONS).

A REVIEW OF CONTROLLED SUBSTANCES“SCHEDULED” DRUGS

SCHEDULE I

• NO CURRENT ACCEPTABLE MEDICAL USE IN THE UNITED STATES.

• USED FOR RESEARCH ONLY.

• POSSESS A HIGH POTENTIAL FOR ABUSE AND DEPENDENCE.

• MEDICATIONS THAT ARE CONSIDERED NOT SAFE,

DANGEROUS AND UNPREDICTABLE.

• HEROIN

• MARIJUANA (HASHISH)

• COCAINE • LSD (ACID)

• MDMA (ECSTASY)

• PSILOCYBIN (MUSHROOM)

• METHAMPHETAMINE

• PHENCYCLIDINE (PCP)

• FLUNITRAZEPAM (ROHYPROL)

SCHEDULE II • CURRENTLY CONSIDERED TO

POSSESS MEDICAL VALUE.

• MEDICATIONS AVAILABLE BY WRITTEN PRESCRIPTION ONLY (NON-REFILLABLE).

• POSSESS A HIGH POTENTIAL FOR ABUSE AND DEPENDENCE.

PROLONGED USE MAY PRODUCE SEVERE PSYCHOLOGICAL

DEPENDENCE.

• STRICT RESTRICTIONS REGARDING STORAGE AND ORDERING.

• MORPHINE (MS CONTIN)

• OXYCODONE ( OXYCONTIN, PERCOCE)

• HYDROMORPHONE (DILAUDID)

• HYDROCODONE (VICODIN)

• MEPERIDINE (DEMEROL)

• PROPOXYPHENE (DARVON)

• METHYLPHENIDATE (RITALIN, CONCERTA)

• AMPHETAMINES (ADDERALL, DEXEDRINE)

SCHEDULE III• CURRENTLY CONSIDERED TO POSSESS MEDICAL VALUE.

• MEDICATIONS REQUIRE A PRESCRIPTION. • MEDICATIONS MAY BE ORDERED BY THE PRESCRIBER VERBALLY. (FOLLOWED BY A WRITTEN PRESCRIPTION)

• POTENTIAL FOR ABUSE IS CONSIDERED LESS THAN FOR SCHEDULED I AND II’s.

• ABUSE MAY LEAD TO MODERATE PHYSICAL DEPENDENCE OR HIGH PSYCHOLOGICAL DEPENDENCE.

• ANABOLIC STEROIDS (BODY BUILDING DRUGS)

• BARBITURATES

• CODEINE COMBINATIONS (EMPIRINE, FIORINAL)

• DRONABINOL (MARINOL, SYNTHETIC

THC)

• OPIUM COMBINATIONS (PAREGORIC)

• BUPRENORPHINE (SUBUTEX-SUBOXONE)

SCHEDULE IV

• CURRENTLY CONSIDERED TO POSSESS MEDICAL VALUE.

• MEDICATIONS REQUIRE A PRESCRIPTION.

• MEDICATIONS MAY BE ORDERED BY THE PRESCRIBER VERBALLY. (FOLLOWED BY A WRITTEN PRESCRIPTION)

• POTENTIAL FOR ABUSE IS CONSIDERED LESS THAN FOR SCHEDULED III’ s.

• ABUSE MAY LEAD TO MILD PHYSICAL DEPENDENCE OR HIGH PSYCHOLOGICAL DEPENDENCE.

• ALPRAZOLAM (XANAX)

• CHLORDIAZEPOXIDE (LIBRIUM)

• CLONAZEPAM (KLONOPIN)

• DIAZEPAM (VALIUM)

• MODAFINIL (PROVIGIL)

• PEMOLINE (CYLERT)

• TEMAZEPAM (RESTORIL)

• TRIAZOLAM (HALCION)

• ZOLPIDEM (AMBIEN)

SCHEDULE V • CURRENTLY CONSIDERED TO

POSSESS MEDICAL VALUE.

• MEDICATIONS MAY OR MAY NOT REQUIRE A PRESCRIPTION.

• MEDICATIONS MAY BE DISPENSED BY A PHARMACIST AS AN OVER THE COUNTER (OTC) DRUG. (WITH A PROPER ID)

• POTENTIAL FOR ABUSE IS CONSIDERED LESS THAN FOR SCHEDULED IV’s.

• ABUSE MAY LEAD TO “ LIMITED “ PHYSICAL DEPENDENCE OR PSYCHOLOGICAL DEPENDENCE RELATIVE TO SCHEDULE IV ‘s.

• MIXTURES TYPICALLY POSSESSING SMALL AMOUNTS OF CODEINE OR OPIUM

• CODEINE PREPARATIONS (ROBITUSSIN-A)

• DIPHENOXYLATE (LOMOTIL)

• OPIUM PREPARATIONS (PAREPECTOLIN, KAPECTOLIN)

• PSEUDOEPHEDRINE OR EPHEDRINE PRODUCTS

THE MOST COMMONLY ABUSED PRESCRIPTION MEDICTIONS

OPIOIDS/OPIATES (aka: Narcotics)

Ptosis and Miosis (constricted) pupils

• OPIATES ARE CONSIDERED ANALGESIC (PAIN-RELIEVING) MEDICATIONS.

• OPIATES IMITATE THE BODY’S OWN PAIN-RELIEVING SUBSTANCES FOUND NATURALLY IN THE HUMAN BODY, TYPICALLY THESE ARE REFERRED TO AS OPIOIDS. (ENKEPHALINES and ENDORPHINS)

• ALL OPIATE SUBSTANCES ARE EITHER MORPHINE BASED OR BREAK DOWN INTO MORPHINE IN THE BODY.

• OPIATE OVERDOSE CAN BE LETHAL, EITHER WHEN USED ALONE AND ESPECIALLY WHEN USED WITH OTHER CNS DEPRESSANTS (1 + 1 = 3) EFFECTS.

• OPIATE SUBSTANCES ARE LIPOPHILLIC (LOVES FAT). MEANING THEY INFILTRATE INTO THE HIGH PROTEIN AND FAT CONTAINING ORGANS OF THE BRAIN AND BODY . . . QUICKLY. (HEROIN vs. CODEINE)

• OPIATE ADDICTS BECOMES ADDICTED TO THE “RUSH”.

• OPIATE DRUGS THAT PRODUCE “LESS OF A RUSH“ ARE LESS FAT-SOLUBLE AND ARE MORE EFFECTIVE IN TREATING OPIATE DEPENDENCE. (METHADONE AND BUPRENORPHINE)

OPIOIDS

• OPIATE SUBSTANCES ARE KNOWN TO PRODUCE PSYCHOLOGICAL AND PHYSICAL ABUSE AND DEPENDENCE.

• THE MOST COMMON CAUSE OF OPIATE/OPIOID DEATH IS RESPIRATORY

ARREST. (STOPS BREATHING)

MOOD AND PAIN PATHWAYS FOLLOW SIMILAR ROUTES THROUGH THE BRAIN

MOODCENTERS

ADDICTIONCENTERS

PAINANXIETY

-DEPRESSION

OPIATE “WITHDRAWAL “ SIGNS AND SYMPTOMS

1. CRAVING FOR THE DRUG, ANXIETY.

2. YAWNING, PERSPIRATION, RUNNING NOSE AND EYES.

3. PUPIL DILATION, GOOSE BUMPS (PILORECTIONS), TREMORS (MUSCLE TWITCHING), HOT & COLD FLASHES, ACHING BONES, MUSCLES AND LOSS OF APPETITE.

4. INSOMNIA , RAISED BP, INCREASED TEMP. PULSE RATE, RESPIRATORY RATE AND DEPTH, RESTLESSNESS AND NAUSEA.

5. CURLED-UP POSITION, VOMITING, DIARRHEA, WEIGHT LOSS, SPONTANEOUS EJACULATION OR ORGASM, INCREASED BLOOD SUGAR.

APPROX. HR’s AFTER LAST DOSAGE

HEROIN / MORPHINE METHADONE

6 24

14 34 – 48

16 48 – 72

24 – 36

36 - 48

OPIATE “ANTI-OPIATE“ MEDICATIONS

• METHADONE: A SYNTHETIC OPIATE THAT HELPS ELIMINATE SYMPTOMS OF OPIATE “ MORPHINE “ WITHDRAWAL.

• BUPRENORPHINE: A SYNTHETIC OPIATE, LESS POWERFUL THAN METHADONE, AND APPROVED TO BE USED WITH OPIATE WITHDRAWAL. BUPRENORPHINE BASED MEDICATIONS CAN BE PRESCRIBED IN AN INPATIENT OR OUTPATIENT SETTING.

• NALOXONE: A SHORT-ACTING OPIATE BLOCKER “ANTAGONIST“ THAT CAN USED ALONE OR IN COMBINATION WITH BUPRENORPHONE (SUBUTEX, SUBOXONE).

• NALTREXONE: A LONG-ACTING OPIATE BLOCKER “ANTAGONIST“ THAT CAN ALSO BE USED IN THE TREATMENT OF ALCOHOL ABUSE AND DEPENDENCE. RECENTLY APPROVED FOR OPIATE MAINTANENCE USE. (VIVITROL)

LIST OF OPIATES

COMMONLY PRESCRIBED OPIOIDS AND THEIR TRADE NAMES

• OXYCODONE (OxyContin, Percodan, Percocet) • PROXYPHENE (Darvon) • HYDROCODONE (Vicodin, Lortab, Lorcet) • HYDROMORPHONE (Dilaudid) • MEPERIDINE (Demerol) • DIPHENOXYLATE (Lomotil) • MORPHINE (Kadian, Avinza, MS Contin) • CODEINE• PENTAZOCINE (Talwin) • FENTANYL (Sublimaze) • METHADONE (Dolophine)

Non-Opiate prescribed analgesic medications with the potential for abuse:

• TRAMADOL (Ultram)

CENTRAL NERVOUS SYSTEM (CNS) DEPRESSANTS

ANXIOLYTICS: Anti-anxiety Barbiturates, Benzodiazepines

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Sedative-Hypnotics (Sleep aids)

LET’S DISCUSS ANXIETY . . . WHAT’S THE DIFFERENCE BETWEEN

FEAR AND ANXIETY ?

• EACH CLASS OF THE FOLLOWING MEDICATIONS ARE KNOW TO PRODUCE THE FOLLOWING:

1 . MEETS THE DSM-IV & 5’S CRITERIA FOR ABUSE AND DEPENDENCE, MILD TO SEVERE.

2 . PRODUCE AN “1 + 1 = 3“ EFFECT WHEN COMBINED WITH ALCOHOL AND OTHER CNS DEPRESSANTS.

3 . PRODUCE A “REBOUND“ EFFECT WHEN ABRUPTLY DISCONTINUED.

4 . ROUTINELY PRESCRIBED FOR EITHER ANXIETY, ANXIOUS SYMTOMS ASSOCIATED WITH OTHER PSYCHIATRIC DISORDERS (MOOD DISORDERS) AND SLEEP DISORDERS. (A.M./P.M. INSOMNIA)

5 . EACH OF THESE DRUGS MAY PRODUCE A “PARADOXICAL“ or OPPOSITE EFFECT.

6 . EACH IMPACTS THE LEARNING AND MEMORY CENTERS OF THE BRAIN.

7 . THE MOST COMMON CAUSE OF DEATH WITH SEDATIVE DRUGS IS RESPIRATORY SUPPRESSION. (STOPS BREATHING)

8. ANTEROGRADE AMNESIA (BLACKOUTS) ARE COMMON. PARTIAL (Temporary) EN-BLOC (Complete)

AMYGDALA AND HIPPOCAMPUS STRUCTURES OF THE BRAIN

BARBITURATES

BARBITURATES

• BARBITURATES ARE MORE POWERFUL THAN BENZODIAZEPINE TYPE MEDICATIONS.

• BARBITURATES ARE NOT PRESCRIBED AS ROUTINELY AS BENZODIAZEPINES . . . DUE TO A RAPID PHYSICAL TOLERANCE AND DANGEROUS WITHDRAWAL SYMPTOMS. • BARBITURATES HAVE A HIGH POTENTIAL FOR LOW DOSAGE SEIZURE ACTIVITY.

• BARBITURATES POSSESS A HIGH POTENTIAL FOR ABUSE AND DEPENDENCE.

COMMONLY PRESCRIBED BARBITURATES AND THEIR TRADE NAMES

• AMOBARBITAL (Amytal, Tuinal) • SECOBARBITAL (Seconal, Tuinal) • MEPROBAMATE (Miltown, Equanil) • MEPHOBARBITAL (Mebaral) • PENTOBARBITAL (Nembutal) • LUMINAL

BENZODIAZEPINES

Benzodiazepines

• Benzodiazepines medications possess a Mild potential for abuse and dependence.

• Benzodiazepines abuse typically does not result in a fatal drug overdose.

• Benzodiazepines medications are not recommended for use in combination with Anti-alcohol or Anti-opioid medications.

Benzodiazepines

• Benzodiazepines are metabolized by the body similar to alcohol.

• They directly inhibit short term memory and long term learning. • Detoxification from Benzodiazepines may take a long time (2 to 6 months) in order to be effective or else the potential for relapse is high.

COMMONLY PRESCRIBED BENZODIAZEPINES AND THEIR TRADE NAMES

• DIAZEPAM (Valium) • CHLORDIAZEPOXIDE HYDROCHLORIDE (Librium) • ALPRAZOLAM (Xanax) • ESTAZOLAM (ProSom) • CLONAZEPAM (Klonopin) • LORAZEPAM (Ativan)

Less Frequently Prescribed Benzodiazepines:

• CLORAZEPATE (Tranxene) • OXAZEPAM (Serax) • OXAZOLAM (Serenal)

SEDATIVE (HYPNOTICS) “SLEEP AIDS“

SEDATIVE (HYPNOTICS) “SLEEP AIDS“

• SEDATIVE (HYPNOTIC) MEDICATIONS ARE CONSIDERED SLEEP AIDS.

• SEDATIVE (HYPNOTICS) ARE TYPICALLY PRESCRIBED FOR SLEEP DISORDERS INSOMNIA: DIFFICULTY BEING ABLE TO PRODUCE SLEEP, OR THE INABILITY TO STAY A SLEEP.

• SEDATIVE (HYPNOTICS) ARE CONSIDERED CNS DEPRESSANTS AND ARE CREATED FROM VARIATIONS OF BARBITURATES, “FAST ACTING” BENZODIAZEPINES OR NON-BENZODIAZEPINES MEDICATIONS.

• CURRENTLY MOST SEDATIVE (HYPNOTIC) MEDICATIONS ARE NOT RECOMMENDED TO BE TAKEN LONGER THAN TWO (2) TO SIX (6) WEEKS.

COMMONLY PRESCRIBED SEDATIVES AND THEIR BRAND NAMES

• CHLORAL HYDRATE (Noctec) • ESTAZOLAM (ProSom) • ETHINAMATE (Placidyl) • FLURAZAEPAM (Dalmane) • TEMAZEPAM (Restoril) • TRIAZOLAM (Halcion) - • ZALEPLON (Sonata) a non-Bz.• ZOLPIDEM (Ambien) a non-Bz. • ESZOPICLONE (Lunesta) a non-Bz.

CENTRAL NERVOUS SYSTEM (STIMULANT

“Cognitive Enhancers”

WHAT DO PURPLE EAR LOBES AND COCAINE HAVE IN COMMON ???

PRESCRIPTION CNS STIMULANTS “Cognitive Enhancers”

• STIMULANT MEDICATIONS ARE TYPICALLY PRESCRIBED FOR THE FOLLOWING: 1 . ATTENTION-CONCENTRATION “ADOLESCENT/ADULT “ DISORDERS (ADD, ADHD), 2 . WEIGHT MANAGEMENT, 3 . SPECIFIC SLEEP DISORDERS (NARCOLEPSY), 4 . LIMITED PSYCHIATRIC DISORDERS (MOOD DISORDER),

• STIMULANT MEDICATIONS MEET THE CRITERIA FOR THE DSM-5 DIAGNOSIS OF ABUSE AND DEPENDENCE.

• LONG-TERM ABUSE OF STIMULANT MEDICATIONS CAN RESULT IN MODERATE TO SEVERE TOLERANCE AND WITHDRAWAL SYMPTOMS CHARACTERISTIC OF MOOD AND/OR PSYCHOTIC DISORDERS.

POINTS OF REFERENCE “GENDER DIFFERENCES“

• RESEARCH ON WOMEN AND STIMULANT DRUG USAGE FINDS . . .

• WOMEN ARE MORE LIKELY TO DEVELOP A DEPENDENCY ON METHAMPHETAMINE AND COCAINE SOONER THEN MEN,

• THEY ARE PRONE TO USE STIMULANT DRUGS MORE IMPULSIVELY THAN MEN AND . . .

• EXPERIENCE A HIGHER RATE OF DRUG RELAPSE THAN MEN. .

GENDER DIFFERENCES

• COCAINE, METHAMPHETAMINE AND OPIATES ARE CONSIDERED “DRUGS OF CHOICE” BY MOST SUBSTANCE ABUSING INDIVIDUALS WHO ARE ALSO STRUGGLING WITH EMOTIONAL / PSYCHOLOGICAL TRAUMA. (PTSD)

• ALCOHOL, MARIJUANA AND PRESCRIPTION MEDICATIONS ARE ROUTINELY USED AS

“BACK UP” OR “REBOUND” SUBSTANCES..

COMMONLY PRESCRIBED STIMULANTAND THEIR TRADE NAMES

• DEXTROAMPHETAMINE (Adderall, Dexedrine) • AMPHETAMINE (Adderall , Dexedrine, Vyvanse) • METHYLPHENIDATE (Ritalin, Concerta) • COCAINE • FENFLURAMINE (Pondimin, Ponderal) • MODAFINIL (Provigil) • PEMOLINE (Cylert) • METHAMPHETAMINE (Desoxyn)

Non-Stimulant ADHD medications:• ATOMOXETINE (Strattera)

PRESENTATION REVIEW

• A REVIEW OF TERMS AND DEFINITIONS.

• PRESCRITION DRUG ABUSE IN PERSPECTIVE.

• A REVIEW OF CONTROLLED “SCHEDULED“ DRUGS.

• THE MOST COMMONLY ABUSED PRESCRIPTION MEDICATIONS:

1. OPIATES/OPIOIDS 2. (CNS) DEPRESSANTS. 3. (CNS) STIMULANTS.

CONTACT INFORMATION:

CARL M. DAWSON, M.S., MAC, LPC

1320 E. KINGSLEY SUITE “A“SPRINGFIELD, MO 65804

e-mail: (CarlMDawson@MissouriState.edu)

References and Suggested Readings

• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services

Administration Center for Substance Abuse Treatment TREATMENT IMPROVEMENT PROTOCOL (TIP) SERIES Rockwall II, 5600 Fishers Lane Rockville, MD. 20857

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th, 5theds). Washington, DC: American Psychiatric Association.

• Buelow, G., Herbert Suzanne (1995). Counselor’s Resource on Psychiatric Medications, Issues of Treatment and Referral. Brooks/Cole Publishing Co., Pacific Grove, Ca.

• Buprenophine.samhsa.gov

• Cozolino, L. (2006) “ The Neuroscience of Human Relationships, Attachment and the Developing Social Brain” W.W. Norton & Co. New York.

• Cermak T. ( 2009 ), “ A Blueprint for Adolescent Addiction Treatment “ , CSAM Review Council .

• Galanter, M. , Kleber, H. ( 2008). Textbook of Substance Abuse Treatment. 4th ed., American Psychiatric Publishing, Inc., Washington, D.C.

• National Institute on Drug Abuse ( NIDA). “Selected Prescription Drugs with Potential for Abuse”, and “

Preventing and Recognizing Prescription Drug Abuse “ , and “Prescription and Over-the-Counter Medications” www.nida,nih.gov/DrugPages/PrescripDrugsChart.html .

• Stahl, S.M. (2003), Essential Psychopharmacology, Neuroscientific Basis and Practical Applications (2nd ed). Cambridge University Press.

• Strain, E.C., Stizer M.L. (eds): The Treatment of Opioid Dependence . Baltimore, MD, Johns hopkins University Press,

2006, pp 213-276 .

• Erickson, C., ( 2007), The Science of Addiction. W.W. Norton and Company, New York, London.

• Suboxone.com

• Kinney, J., ( 2003 ) “ Loosening the Grip : A Handbook of Alcohol Information “ . Seventh Ed., McGraw Hill, New York, N.Y..

• Ray, O., Ksir, C., ( 2004 ) “ Drugs, Society, and Human Behavior “. Tenth Ed., McGraw Hill, New York, N.Y..

• Maxmen, J., Ward, N., ( 2002 ) “ Psychotropic Drugs, Fast Facts “. (Third Edition), W.W. Norton and Company.

• Taber’s Cyclopedic Medical Dictionary , ( 15th Edition ), ( 1985 ), F.A. Davis Company.

• Smith, David., Nosal, Barbara., Troxell, Mickey., Sowle, Scott., ( 2010 ) “Treating the Traumatized, Addicted Adolescent”, Counselor Vol.11, No.3,

46-52 .