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Addiction Counselor Exam Review Podcast
Episode 22
Instructor: Dr. Dawn-Elise Snipes, PhD
Executive Director:, Counselor Education and Training
Podcast Host: Counselor Toolbox & Addiction Counselor Exam Review

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~ Review symptoms of intoxication and withdrawal of drugs of abuse
~ Learn about Post Acute Withdrawal Syndrome (PAWS)
~ Identify factors that impact symptomatology
~ Purity of the drug, hydration levels, route of administration and usage patterns all can impact
~ Speed of the effect
~ Intensity of the effect
~ Range and intensity of negative consequences/side effects
~ Injecting can result in blood infections, collapsed veins, kidney and heart problems (Fastest)
~ Inhaling can result in ulcerated nasal passages
~ Oral ingestion must be filtered through the liver and kidneys and often also irritates the GI tract (Slowest)
Drugs of Abuse
~ Alcohol
~ Classified as a sedative-hypnotic, CNS depressant
~ Ethanol/Ethyl alcohol 8 stages of effect as BAC increases
~ Subclinical
~ Euphoria
~ Excitement
~ Excitement/confusion
~ Confusion stupor
~ Coma
~ Death
Drugs of Abuse
~ Alcohol
~ Men drink more
~ Women more likely to
~ Develop drinking problems
~ Experience alcohol related organ damage at lower levels
~ Women’s BAC reaches higher levels with same amounts of alcohol as men
~ Alcohol mixes with water and men tend to have more body water

Drugs of Abuse
~ Alcohol related medical conditions
~ Loss of control of eye muscles
~ Hypoglycemia
~ Gastritis / Pancreatitis
~ Reduced immunity
~ Cardiac arrhythmia
~ Anemia
~ Constant flushing
~ Peripheral neuritis
~ Fatty liver
~ Cirrhosis
~ Blood pressure increases
~ Wernicke/Korsakoff’s syndrome / Alcohol related dementia
Drugs of Abuse
~ Cannabis
~ As of 2016, still considered a schedule 1 by the DEA
~ Schedule 1 substances have no medicinal use and high risk of abuse
~ Legal in 29 states for medical use and in 8 of those states for recreational use
~ 9-17% of occasional users become addicted
~ 25-50% of daily users become addicted
~ Methods of administration
~ Smoked (pipes, bongs, blunts, Dabs) – rapid action
~ Consumed (tea, brownies) –slower action
~ Acts on cannabinoid receptors which influence memory, pleasure, concentration, sensory perception
Drugs of Abuse
~ Cannabis
~ Dabs
~ Concentrated doses of cannabis that are made by extracting THC and other cannabinoids using a solvent like butane or carbon dioxide, resulting in sticky oils
~ Even when home extraction goes well, there’s no way to know the quality or purity of your finished product. “Dirty” oil may contain chemical contaminants or excessive amounts of residual solvents that could present health hazards
~ Cannabis extracts often test between 60-90% THC, which means it doesn’t take much to become profoundly high
~ Can be inhaled using a dab-pen or a e-cig with attachments
~ Besides coughing like a maniac, the second most common side-effect associated with dabbing is sweating like you ran a marathon
Drugs of Abuse
~ Cannabis
~ Effects
~ Respiratory illness
~ Heightened heart attack risk
~ Neurobehavioral effects on fetus
~ Increased depression, anxiety and suicidal thoughts, esp. in adolescents
~ Loss of motivation
~ Exacerbation of schizophrenia
~ Impaired judgement
~ Impaired motor coordination
~ Reduced life satisfaction
~ Lower academic/career success

Drugs of Abuse
~ Synthetic Marijuana (Spice/K2)
~ Synthetic cannabinoids refer to a growing number of man-made mind-altering chemicals sprayed on dried, shredded plant material or vaporized to get high.
~ Synthetic cannabinoids are sometimes misleadingly called “synthetic marijuana” (or “fake weed”) because they act on the same brain cell receptors as THC
~ The effects of synthetic cannabinoids can be unpredictable and severe or even life-threatening.
Drugs of Abuse
~ Synthetic Marijuana (Spice/K2)
~ Synthetic cannabinoid users report some effects similar to those produced by marijuana:
~ elevated mood
~ relaxation
~ altered perception
~ symptoms of psychosis
~ Synthetic cannabinoids can also cause serious mental and physical health problems including:
~ rapid heart rate
~ vomiting
~ violent behavior
~ suicidal thoughts
~ Susceptible to hydration levels
Cocaine, Meth and Other Stimulants
~ Signs of Stimulant Intoxication
~ Dilated pupils
~ Restlessness
~ Hyperactivity
~ Loss of appetite
~ Weight loss
~ Sweating

Cocaine, Meth and Other Stimulants
~ Signs of Stimulant Withdrawal
~ Initial
~ Dysphoria
~ Anxiety, and agitation
~ Intense drug craving
~ Rapid eye movements
~ Concise but quivery speech
~ Brisk, somewhat jerky movements
~ Thinking is scattered and subject to paranoid delusions

Cocaine, Meth and Other Stimulants
~ Signs of Stimulant Withdrawal
~ Middle
~ Anxiety and agitation are followed by a period of fatigue, increasing depression, and anhedonia with decreased mental and physical energy.
~ An intense desire for sleep, often accompanied by insomnia, usually replaces the drug craving.
~ During this part of the crash, users may use alcohol, benzodiazepines, or opiates to induce and prolong sleep.
~ The middle crash phase lasts 24 to 36 hours during which time any attempt at therapy or other intervention is inappropriate.

Cocaine, Meth and Other Stimulants
~ Signs of Stimulant Withdrawal
~ Late/Protracted
~ The user experiences symptoms that are opposite to those of stimulant intoxication: fatigue, loss of physical and mental energy, depression, anhedonia, and a limited interest in his surroundings.
~ Symptoms may increase in intensity over the 12 to 96 hours immediately following the crash, and may wax and wane over several weeks.
~ A severe and persisting depression in this phase can result in suicidal ideation or suicide attempts
~ Anhedonia and dysphoria usually dissipate over a 6- to 18-week period.
~ Periods of drug craving may reemerge, triggered environmental cues and emotional states.

Cocaine, Meth and Other Stimulants
~ Tolerance
~ Tolerance to many of the initial effects, often after only a few weeks of use.
~ Tolerance develops rapidly to the euphorogenic and anorectic effects of stimulants and weight loss stops after several weeks.
~ Tolerance also appears to develop to the cardiotoxic effects of large doses that many users survive.
~ Many of the initial symptoms of stimulant intoxication disappear with chronic use: Blood pressure may be normal, and nausea and vomiting are seldom seen.

Cocaine, Meth and Other Stimulants
~ Sensitization
~ Sensitization is essentially the reverse of tolerance, and is a unique phenomenon of stimulants
~ Users are especially vulnerable to psychosis-inducing effects
~ After one psychotic episode is experienced following use, a lower dose of may induce another psychotic episode

Stimulants Misc…
~ Cocaine users are more likely than MA users to present with serious and potentially lethal physical complications (e.g., cardiac arrhythmia, chest pains, strokes, toxic seizures, hypertension crises, hyperthermia).
~ Cocaine users are also more likely than MA users to use multiple substances, especially alcohol, benzodiazepines, or opiates.

Hallucinogens (PCP)
~ Signs of PCP abuse include:
~ Sedation
~ Immobility
~ Amnesia
~ Numbness
~ Slurred speech and other speech difficulties
~ A sense of invulnerability
~ Blank stare
~ Rapid, involuntary eye movements
~ Hallucinations
~ With the loss of the self, the user may feel intense alienation — as though the world and the people in it make no sense — and feelings of depression.
~ Delusions
~ High blood pressure
~ Rapid heartbeat
~ Reduced pain sensitivity
~ Apathy

Hallucinogens (PCP)
~ Low doses are characterized by numbness in the hands and toes as well as general drunken-like behavior.
~ Moderate doses produce partial or full anesthesia, where the person cannot move their limbs or any part of their bodies.
~ High doses have the potential to cause convulsions and even death.
~ Can be added to marijuana or other smoked material

Hallucinogens (PCP)
~ There are other symptoms that may show up in a person who has used PCP over a long period of time, such as:
~ Stuttering
~ Impaired memory
~ Inability to think clearly
~ Inability to speak
~ Suicidal thoughts
~ Anxiety
~ Depression
~ Isolation and withdrawal

Hallucinogens (LSD “Acid”)
~ Some common signs of LSD abuse include:
~ Sweating.
~ Dry mouth.
~ Dilated pupils.
~ Numbness.
~ Dizziness.
~ Loss of appetite.
~ Tremors.
~ Increased blood pressure and heart rate.
~ Mood swings.
~ Hallucinations.
~ Distorted thinking and sense of time.
~ Impulsiveness.
~ Impaired judgment.
~ Intensified sense of smell and hearing

~ Flashbacks, lasting long after intoxication has ended.

Hallucinogens (LSD “Acid”)
~ Many individuals may take LSD and be unaware that it takes between 20 and 90 minutes to elicit its effects
~ Does are not standardized
~ LSD overdose symptoms (Serotonin Syndrome) include:
~ Markedly dilated pupils
~ Dangerously elevated blood pressure and temperature
~ Tachycardia (rapid heart rate) or irregular heartbeat
~ Muscle shakes or tremors
~ Extreme drowsiness
~ Nausea/Diarrhea
~ Excessive sweating
~ Flushing
~ Tingling or prickling sensations/Goose bumps
~ Breakdown of muscle tissue, which may lead to kidney failure (Rhabdomyolysis)

Drugs of Abuse
~ Prescription Drugs
~ Opiates
~ Ranks #2 behind marijuana as most abused drug
~ 60% of people who abuse it got it free from friends/relatives
~ Treat
~ Pain
~ Depression

~ Depressants (Benzos / Barbiturates)
~ Anxiety
~ Sleep disorders
~ Stimulants
~ Narcolepsy
~ Obesity
Drugs of Abuse
~ Prescription and OTC (i.e. DXM, pseudoephederine) drugs can be abused by:
~ Taking medication prescribed for someone else
~ Taking drugs in a higher amount or via a different method than intended
~ Taking drugs for a different purpose than intended
~ Combining drugs
~ Same class
~ Different class
Withdrawal from Drugs of Abuse
~ Sustained use of addictive substances of behaviors causes reversible adaptations within the body
~ Reduce the effects of the drug (tolerance, dependence)
~ Withdrawal
~ Euphoria producing drugs act on the nucleus accumbens (pleasure center)
~ Alcohol and benzodiazepine withdrawal can be life threatening
Post Acute Withdrawal Syndrome
~ Describe the rollercoaster of intermittent withdrawal symptoms, especially mood, sleep, and pain related that can continue after acute withdrawal symptoms have gone away.
~ Each episode of PAWS can last for a few days or weeks followed by symptom-free periods and can continue cyclically for a year
~ It can be just as intense as acute withdrawal and puts a person at risk of relapse in an attempt to stop the discomfort.
~ A good initial relapse prevention plan prepares the person for PAWS
PAWS Symptoms
~ Mood Swings
~ Anhedonia
~ Sleep Disturbances
~ Cognitive impairment (memory, learning, concentration)
~ Fatigue
~ Drug Cravings
~ Stress sensitivity
~ Lower pain threshold

~ Many people are polysubstance users
~ Signs of withdrawal are often opposite those of intoxication
~ Pupil dilation and nystagmus are good indicators of potential intoxication
~ Protracted withdrawal can last for up to a month for many drugs
~ LSD can trigger serotonin syndrome
~ Post Acute Withdrawal Syndrome refers to the mood, cognitive and (sometimes) pain related symptoms that may persist intermittently for up to a year

~ American Society of Addiction Medicine (ASAM) 2017
~ University of Oklahoma Department of Medicine (2017)
~ Center for Substance Abuse Treatment (2009)
~ DEA Drugs of Abuse (2017)
~ White, W. & Cloud, W. (2008). Recovery capital: A primer for addictions professionals. Counselor, 9(5), 22-27.
~ Davidson, L & Roe, D (2007) Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health, August 2007; 16(4): 459 – 470

Documenting the treatment process
~ The client file is the official legal record of the treatment process and is subject to numerous legal and administrative requirements as well as clinical practice standards
~ HIPPA states that clients have the right to:
~ Receive a copy of their record
~ Request at any mistakes corrected
~ Receive a notice about how their health information is used
~ Specify how one where they want to be contacted by the service provider
~ File a complaint if they think any of these rights have been violated

Documenting continued
~ The HIPPA security role requires that Health Care provider said a physical and administrative and technical safeguards to protect Electronic Health information
~ Some safety measures that may be built into electronic health records include:
~ Access controls like passwords and pin numbers
~ Encrypting stored information
~ An audit trail that records to access information

Measuring Client Progress
~ Progress can be measured in terms of:
~ Achievement of goals set out on the clients treatment plan
~ Scores on pre and post test measures
~ Many instruments designed to measure client progress are cumbersome and costly to administer
~ The most frequent indicator that is measured as abstinence from alcohol or other drugs, but that indicator alone is not sufficient to measure client progress or document recovery since the person often has problems in multiple life domains