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Substance Abuse and Crisis Intervention


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Title: Substance Abuse and Crisis Intervention

Substance Abuse and Crisis Intervention
  • Presented by

Overview of Western Region Grant
  • Certifying counties (DHS 34)
  • Training
  • Stabilization services

Goals of the grant
  • Reduce inappropriate/unnecessary restriction of
    rights by using more restrictive placement than
  • Improve access to community based least
    restrictive options

Meet our Presenter
  • Lorie Goeser is an Independent Clinical
    Supervisor, Clinical Substance Abuse Counselor,
    BA with focus on sociology and criminal justice
    specialty. Ms. Goeser has worked in private
    settings and has a combined 12 years of
    experience with the DHS and County systems,
    treating addiction or working on addiction
    policies and statues. Ms. Goeser has 26 years of
    experience in the addiction field including
    working with clients in acute crisis, dual
    diagnosis, consultation for detoxification
    services, county provider for outpatient and on
    call, as well as working within the hospital and
    institution settings providing program
    development and services for dual diagnosis
    adolescents and adults. Ms. Goeser has provided
    training to MDs and medical staff on how to
    intervene with addicted clients, how to address
    addiction issues in the ER setting, training on
    assessment and referral to a variety of providers
    including social workers, child protection
    workers, law enforcement and addiction

What do you think addiction is?
  • What thoughts do you have about it?
  • What prior experience do you have with addiction?
  • What knowledge do you have and where did you
    obtain it from?
  • Do believe addiction is a brain disease?
  • Do think addiction is a problem in WI?

Debunking Myths about Dependence
  • MYTH All someone has to do to overcome
    alcoholism is go to Alcoholics Anonymous (A.A.).
  • FACT A.A. doesnt work for everyone (even for
    many people who truly want to stop drinking). For
    most people, A.A. is a gut-wrenching, lifelong
    working of the 12 steps. Scientists theorize that
    people who get better in A.A. are somehow
    learning how to overcome (or compensate for)
    their brain disease.
  • MYTH Nicotine and marijuana are not addicting.
  • FACT Nicotine is one of the most
    dependence-producing chemicals in existence and
    marijuana has also been proven to create a
    dependence in a percentage of people who smoke it
  • Source Dr. Carl Erickson- University of Texas _at_

Debunking Myths about Dependence
  • MYTH Anyone who drinks or uses drugs too often
    will become addicted.
  • FACT We know this doesnt occur in everyone, any
    more than diabetes occurs in everyone who eats
    too much sugar or food. It now appears that a
    person must have what it takes to become
    dependent on drugs. In many cases, genetics is
    the main risk factor for determining who develops
    the disease.
  • MYTH All addicts are criminals.
  • FACT Evolving research is demonstrating that
    addicts (people who are dependent on drugs or
    alcohol) are not bad people who need to get good,
    crazy people who need to get sane or stupid
    people who need education. Addicts have a brain
    disease that goes beyond their use of drugs.
  • Source Dr. Carl Erickson- University of Texas _at_

Top 10 Addiction Myths and Myth Busters
  • Think you know about addiction? Then these common
    myths may sound familiar
  • Myth 1 Drug addiction is voluntary behavior. You
    start out occasionally using alcohol or other
    drugs, and that is a voluntary decision. But as
    times passes, something happens, and you become a
    compulsive drug user. Why? Because over time,
    continued use of addictive drugs changes your
    brain - in dramatic, toxic ways at times, more
    subtly at others, but virtually always in ways
    that result in compulsive and even uncontrollable
    drug use.
  • Myth 2 Drug addiction is a character flaw. Drug
    addiction is a brain disease. Every type of drug
    - from alcohol to heroin - has its own mechanism
    for changing how the brain functions. But
    regardless of the addiction, the effects on the
    brain are similar, ranging from changes in the
    molecules and cells that make up the brain to
    mood and memory processes - even on motor skills
    such as walking and talking. The drug becomes the
    single most powerful motivator in your life.

Top 10 Addiction Myths and Myth Busters
  • Myth 3 You can't force someone into treatment.
    Treatment does not have to be voluntary. Those
    coerced into treatment by the legal system can be
    just as successful as those who enter treatment
    voluntarily. Sometimes they do better, as they
    are more likely to remain in treatment longer and
    to complete the program. In 1999, over half of
    adolescents admitted into treatment were directed
    to do so by the criminal justice system.
  • Myth 4 Treatment for drug addiction should be a
    one-shot deal. Like many other illnesses, drug
    addiction typically is a chronic disorder. Some
    people can quit drug use cold turkey, or they
    can stop after receiving treatment just one time
    at a rehabilitation facility. But most people who
    abuse drugs require longer-term treatment and, in
    many instances, repeated treatments.

Top 10 Addiction Myths and Myth Busters
  • Myth 5 We should strive to find a "magic bullet"
    to treat all forms of drug abuse. There is no
    one size fits all form of drug treatment, much
    less a magic bullet that suddenly will cure
    addiction. Different people have different drug
    abuse-related problems. And they respond very
    differently to similar forms of treatment, even
    when they're abusing the same drug. As a result,
    drug addicts need an array of treatments and
    services tailored to address their unique needs.
    Finding an approach that is personally effective
    can mean trying out several different doctors or
    treatment centers before a match is found
    between patient and program.

Top 10 Addiction Myths and Myth Busters
  • Myth 6 People don't need treatment. They can
    stop using drugs if they really want to. It is
    extremely hard for people addicted to drugs to
    achieve and maintain long-term abstinence.
    Research shows that when long-term drug use
    actually changes a person's brain function, it
    causes them to crave the drug even more, making
    it increasingly difficult to quit without
    effective treatment. Intervening and stopping
    substance abuse early is important, as children
    become addicted to drugs much faster than adults
    and risk greater physical, mental and
    psychological harm
  • Myth 7 Treatment just doesn't work. Studies show
    drug treatment reduces drug use by 40 to 60
    percent and can significantly decrease criminal
    activity during and after treatment. There is
    also evidence that drug addiction treatment
    reduces the risk of infectious disease, Hepatitis
    C and HIV infection - intravenous-drug users who
    enter and stay in treatment are up to six times
    less likely to become infected with HIV - and
    improves the prospects for getting and keeping a
    job up to 40 percent.

Top 10 Addiction Myths and Myth Busters
  • Myth 8 No one voluntarily seeks treatment until
    they hit rock bottom. There are many things that
    can motivate a person to enter and complete
    treatment before that happens. Pressure from
    family members and employers, as well as personal
    recognition that they have a problem, can be
    powerful motivators. For teens, parents and
    school administrators are often driving forces in
    getting them into treatment before situations
    become dire.
  • Myth 9 People can successfully finish drug abuse
    treatment in a couple of weeks if they're truly
    motivated. For treatment to have an effect,
    research indicates a minimum of 90 days of
    treatment for outpatient drug-free programs, and
    21 days for short-term inpatient programs.
    Follow-up supervision and support are essential.
    In all recovery programs, the best predictor of
    success is the length of treatment. Patients who
    are treated for at least a year are more than
    twice as likely to remain drug free, and a recent
    study showed adolescents who met or exceeded the
    minimum treatment time were over one and a half
    times more likely to stay away from drugs and

Top 10 Addiction Myths and Myth Busters
  • Myth 10 People who continue to abuse drugs after
    treatment are hopeless. Completing a treatment
    program is merely the first step in the struggle
    for recovery that can last a lifetime. Drug
    addiction is a chronic disorder occasional
    relapses do not mean failure. Psychological
    stress from work or family problems, social cues
    - meeting someone from the drug-using past - or
    the environment - encountering streets, objects
    or even smells associated with drug use - can
    easily trigger a relapse. Addicts are most
    vulnerable to drug use during the few months
    immediately following their release from
    treatment. Recovery is a long process and
    frequently requires multiple treatment attempts
    before complete and consistent sobriety can be
  • (Sources National Institute on Drug Abuse,
    National Institute of Health Dr. Alan I.
    Leshner, former director of the National
    Institute on Drug Abuse The Principles of Drug
    Addiction Treatment A Research-Based Guide
    (October 1999) The Partnership for a Drug-Free

Addiction- Definition
  • Addiction is a health condition in which an
    individual manifests a pathological pattern of
    use of alcohol, tobacco or other drugs that
    interact with brain systems of reward. Genetic,
    psychological, environmental and cultural factors
    influence its onset and progression. Persons
    with addiction have altered motivational
    hierarchies so that they are preoccupied with
    procuring supplies of using substances that early
    in the illness can produce euphoria, and
    substance use persists despite a range of
    medical, family, occupational, legal and other
    consequences. Individuals, families, and
    communities suffer when addiction is prevalent
    and not adequately treated.(Adapted from
    definitions of the American Society of Addiction

Substance Use Definition
  • Substance Use refers to the risky, chronic,
    problematic or harmful use of alcohol, tobacco,
    prescription drugs, and controlled substances.
    (Healthiest Wisconsin 2010)

Why is it important to Address Addiction and
Substance Use?
  • Alcohol use is associated with 41 of road
    traffic deaths, 29 of suicides, Suicides and
    road traffic accidents are leading caused of
    death among 15-34 year olds. (WHO Burden of
    Disease Statistics 2001)
  • Alcohol misuse is now the leading risk factor for
    serious injury in the United States, and the
    third leading cause of preventable death. It
    accounts for more than 75,000 deaths annually.
    Little has been done to address the misuse of
    alcohol and drugs a major cause of severe and
    repeat injuries among hospitalized trauma
    patients. (CDC-2003 Conference proceedings on
    Alcohol and Other Drug Problems)

  • Excessive alcohol consumption is the third
    leading preventable cause of death in the United
    States it is associated with multiple adverse
    health consequences, including liver cirrhosis,
    various cancers, unintentional injuries, and
    violence. Alcohol-attributable deaths (ADD) is
    approx. 75,766, and 2.3 million years of
    potential life lost (YPLLs). (Source-CDC-AADs
    YPLLs-US, 2001)

Wisconsin Epidemiological Profile on Alcohol and
Other Drug Use, 2008
  • Key Findings
  • Consequences of Alcohol and Other Drug
  • Many types of mortality, morbidity, and dangerous
    criminal behavior have been linked to the use of
    alcohol and other drugs. Given Wisconsins high
    rate of alcohol consumption, it is not surprising
    that the rates at which Wisconsin experiences the
    consequences associated with alcohol use also
    tend to be higher than the national average.
  • Rates of alcohol dependence, alcohol abuse, and
    alcohol-related motor vehicle fatalities are
    higher in Wisconsin than in the United States as
    a whole. Wisconsin has one-and-a-half times the
    national rate of arrests for operating a motor
    vehicle while intoxicated and more than three
    times the national rate of arrests for other
    liquor law violations. Wisconsin also has the
    highest rate in the nation of self-reported
    drinking and driving.

Wisconsin Epidemiological Profile on Alcohol and
Other Drug Use, 2008
  • Wisconsins rate of alcohol-related motor vehicle
    deaths has been decreasing in recent years,
    although more slowly than the overall rate of
    motor vehicle deaths. One surprising finding
    is that Wisconsin has had a lower rate of
    alcohol-related liver cirrhosis than the national
    average, although this difference may be
    disappearing. Wisconsins rate of other
    alcohol- related deaths (other than liver
    cirrhosis and motor vehicle) has increased since
  • The number of clients receiving publicly funded
    services for alcohol and other drug abuse
    increased 11 between 1997 and 2006, while
    inflation-adjusted public expenditures for those
    services increased just 4.
  • From 1999 to 2006, Wisconsins age-adjusted rate
    of drug-related deaths increased the statewide
    rate of drug-related hospitalizations has also
    increased in recent years. Wisconsins rate of
    arrests for drug law violations remains lower
    than the national average but has increased since

Wisconsin Epidemiological Profile on Alcohol and
Other Drug Use, 2008
  • Alcohol Consumption
  • Wisconsin's rates of alcohol use and misuse are
    among the highest if not the highest in the
    nation. As of 2006, Wisconsin adults continue to
    have the highest rates of alcohol consumption,
    binge drinking and heavy drinking among all U.S.
    states and territories, and Wisconsin rates of
    underage drinking (ages 12-20) exceed national
    levels. As of 2007, Wisconsin high school
    students have a binge drinking rate that is the
    third highest of reported states, and the highest
    rate of current alcohol use.
  • In good news, high school students in both
    Wisconsin and the nation are decreasingly likely
    to report they began alcohol use before age 13.
    Also, binge drinking among young adults (ages
    18-24) has declined in Wisconsin since 2000.

Wisconsin Epidemiological Profile on Alcohol and
Other Drug Use, 2008
  • Alcohol Consumption
  • Data for the most recent decade consistently show
    that Wisconsin women of childbearing age are more
    likely to drink and to binge drink than their
    national counterparts. This has important
    implications for unplanned pregnancy and infant

Wisconsin Epidemiological Profile on Alcohol and
Other Drug Use, 2008
  • Other Drug Consumption
  • The use of drugs other than alcohol also remains
    a problem in Wisconsin. As a whole, consumption
    patterns of illicit drugs in Wisconsin mirror
    national trends with few exceptions.
  • One notable trend was in the use of marijuana. In
    1997, the prevalence of both lifetime and current
    use of marijuana was lower than the national
    average. Over the next four years, however,
    these measures rose until they were nearly
    identical to the national averages.
  • Since 2001, both lifetime and current use of
    marijuana in the United States and Wisconsin have
    decreased at similar rates. Both nationally and
    in Wisconsin, the misuse of prescription drugs
    for non-medical purposes has emerged as a
    problem, especially among young adults.

Wisconsin Epidemiological Profile on Alcohol and
Other Drug Use, 2008
  • Conclusion
  • Areas of need are clearly identified in this
    report. Wisconsin data for 2006 reflect a higher
    prevalence of alcohol use and binge drinking in
    adults, especially young adults, compared to the
    country as a whole. Underage drinking and
    underage binge drinking also occur at higher
    rates in Wisconsin, as does drinking among women
    of childbearing age. Concerning illicit drug
    use, Wisconsin rates of death and hospitalization
    from drug use have been increasing. From 1996 to
    2006, Wisconsin's arrest rate for liquor law
    violations was more than three times the national
    rate arrests for operating while intoxicated
    also occur at a higher rate in Wisconsin.
  • The economic and health costs of substance abuse
    in Wisconsin are great, as are the related costs
    to the community of arrests and criminal
    offenses. Focus on these key areas will be
    useful in guiding the states funding decisions
    regarding which problems to address and which
    interventions to use.

Wisconsin Epidemiological Profile on Alcohol and
Other Drug Use, 2008
  • Consequences of Alcohol Consumption
  • In Wisconsin in 2006, at least 1,678 people died,
    5,654 were injured, and 88,000 were arrested as a
    direct result of alcohol use and misuse. Given
    Wisconsins high rate of alcohol consumption, it
    is not surprising that the consequences
    associated with alcohol use also tend to be
    higher than the national average. Rates of
    alcohol dependence, alcohol abuse, and
    alcohol-related motor vehicle fatalities are
    higher in Wisconsin than in the United States.
  • Wisconsin has one-and-a-half times the national
    rate of arrests for operating a motor vehicle
    while intoxicated and more than three times the
    national rate of arrests for other liquor law
    violations. Wisconsin has generally experienced
    a lower rate of alcohol-related liver cirrhosis
    than the national average, although this may be

WI EPI Study 2008
  • Motor Vehicle Injuries and Fatalities
  • Many motor vehicle injuries and fatalities are a
    direct consequence of alcohol use and abuse.
  • In 2006, 364 people in Wisconsin died in
    alcohol-related motor vehicle crashes
    according to the national Fatality Analysis
    Reporting System. Approximately 51 of all
    Wisconsin motor vehicle fatalities in 2006 were
    alcohol-related (Figure 3).
  • Wisconsins mortality rate from alcohol-related
    motor vehicle crashes has been higher than
    the United States rate since 2000 (Figure 4, page
    15). In 2006, the alcohol-related motor
    vehicle mortality rate was 6.6 per 100,000
    population in Wisconsin and 5.9 per 100,000
    in the United States.
  • Between 1997 and 2006, the total number of
    nonfatal alcohol-related motor vehicle injuries
    in Wisconsin dropped 17, from 6,797 to 5,654.
    The rate of nonfatal injuries in alcohol-related
    crashes has also fallen during this period, to a
    low in 2006 of 102 injuries per 100,000
    population (Figure 5, page 15).

WI EPI Profile 2008
  • Non-Medical Use of Prescription Drugs
  • Findings from a recent survey report indicated
    that lifetime non-medical use of prescription
    stimulants among college students in the United
    States was approximately 7, and past-year use
    was an estimated 4. The study also found that
    non-medical prescription drug use was associated
    with use of alcohol, cigarettes, marijuana and
    other illicit drugs.
  • During 2005-2006, 5 of Wisconsin residents ages
    12 and older reported using pain relievers for
    non-medicinal purposes (Figure 45). This
    percentage has not changed since 2003-2004, and
    is the same prevalence reported nationally. The
    prevalence of use was highest among young adults
    ages 18 to 25 (12, Figure 38).

WI EPI Profile 2008
  • Non-Medical Use of Prescription Drugs
  • Other than marijuana, pain relievers and
    psychotropics were the most commonly reported
    drugs consumed for non-medical reasons. During
    2002-2004, 18 of Wisconsin residents age 12 and
    older reported non-medical use of psychotropics
    and 12 reported non-medical use of pain
    relievers at some point in their lifetime (Table
    27, page 64). During the same time period, 6
    reported using psychotropics and 4 reported
    using pain relievers for non- medical reasons
    in the past year(Table 27).
  • In 2007, the Youth Risk Behavior Survey found
    that 23 of Wisconsin high school students had
    used prescription pain relievers for non-medical
    purposes at some point in their lives, and 16
    had used other prescription drugs non-medically
    at some point (data not shown). No comparable
    data for earlier years or the United States were

WI EPI Study 2008
  • Alcohol Use by Women of Childbearing Age
  • Alcohol use can impair decision-making and result
    in risk-taking behaviors, including sexual
    behaviors an unplanned pregnancy may be one
    result. Studies also have shown that alcohol use
    during pregnancy can harm the developing fetus.
    The Centers for Disease Control and Prevention
    (CDC) has reported that Wisconsin is among the
    states that report the highest rates of drinking
    among pregnant women and high-risk drinking among
    women of childbearing age.
  • Wisconsin women of childbearing age are more
    likely to drink than women nationally (Figure
    35). In 2006, 66 of Wisconsin women ages 18-44
    said they had at least one alcoholic drink in the
    past 30 days this compares with 54 of women in
    the United States.
  • Binge drinking is also more prevalent among
    Wisconsin women of childbearing age, compared
    with their national counterparts. In 2006, among
    women ages 18-44, 24 in Wisconsin and 16
    nationally said they had consumed four or more
    drinks on one occasion in the past 30 days
    (Figure 36).

WI EPI Profile 2008
  • Other Alcohol-Related Mortality
  • Alcohol use contributes to many different causes
    of death in varying degrees. For example, it
    contributes to 100 of alcohol-related liver
    cirrhosis deaths, but a smaller percentage of
    deaths from stroke. Alcohol-Related Disease
    Impact (ARDI) software from the Centers for
    Disease Control and Prevention identifies
    fractional alcohol-related mortality for a total
    of 63 chronic and acute conditions.
  • For each of these 63 conditions, ARDI specifies a
    distinct fraction of cases attributable to
    alcohol. The number of alcohol-attributable
    deaths can be estimated by multiplying the
    number of deaths for each condition by the
    specified alcohol-attributable fraction and
    summing over conditions. This method was used to
    estimate the total number of alcohol- related
    deaths in Wisconsin, as well as the subset of
    other alcohol-related deaths (other than those
    from alcoholic liver cirrhosis and motor vehicle

WI EPI Profile 2008
  • Other Alcohol-Related Mortality
  • Alcohol-related causes other than alcoholic liver
    cirrhosis and motor vehicle crashes accounted for
    an estimated 1,075 deaths in Wisconsin in 2006
    (see Figure 1, page 11). The most frequent
    causes of other alcohol-related deaths are
    mental and behavioral disorders due to alcohol,
    alcohol dependence syndrome, unspecified liver
    cirrhosis, homicide, non-alcohol poisoning, and
  • The Wisconsin mortality rate from other
    alcohol-related causes increased from 16.0 deaths
    per 100,000 in 1999 to 19.3 deaths per 100,000 in
  • Based on combined data for 1999-2006 at the
    county level (Table 4, next page), the mortality
    rate from other alcohol-related causes ranged
    between 8.7 per 100,000 in Calumet County to 29.2
    per 100,000 in Marquette and Milwaukee counties.

Addiction is only one of the Substance-Related
  • Addiction (Substance Dependence)
  • Problem Use (Substance Abuse)
  • Intoxication States
  • Withdrawal States
  • Substance-Induced Medical Problems
  • Substance-Induced Psychiatric Problems
  • Health Problems linked to Secondary Use
  • Codependency and ACOA Syndromes

(No Transcript)
Levels and Patterns of Drinking
  • Heavy drinking
  • For women, more than 1 drink per day on average.
  • For men, more than 2 drinks per day on average.
  • Binge drinking
  • For women, more than 3 drinks during a single
    occasion or 7 drinks in one week
  • For men, more than 4 drinks during a single
    occasion or 14 drinks in one week
  • Excessive drinking includes both binge drinking
    and heavy drinking.
  • (Source- NIAAA)

  • Illicit Drugs - 25,000/year USA
  • Alcohol - 100,000/year USA
  • Tobacco - 450,000/year USA

Actual Causes of Death,1 United States - 2000
Actual Cause No () in 2000

Tobacco 435,000 (18.1)
Poor diet and physical inactivity 365,000 (15.2)
Alcohol Consumption 85,000 (3.5)
Microbial agents 75,000 (3.1)
Toxic agents 55,000 (2.3)
Motor vehicle 43,000 (1.)
Firearms 29,000 (1.2)
Sexual behavior 20,000 (0.8)
Illicit drug use 17,000 (0.7)
1Actual causes of death are the major external (nongenetic) modifiable factors that contribute to death in the United States 1Actual causes of death are the major external (nongenetic) modifiable factors that contribute to death in the United States
Mokdad AH, Marks JS, Stroup DF, Gerberding JL.
JAMA (2004). 291238-45 Mokdad AH, Marks JS,
Stroup DF, Gerberding JL. (2005). JAMA
Assessing Quantity Backwards
  • 6 pack -- 12 pack -- 18 pack -- 24 pack
  • 1/2 pt -- pint ---1/5 gal (27 oz or 18 drinks)
  • 4/5 quart of wine -- 1/2 gal of wine
  • 1.75 liters 57 oz ( 12 drinks of wine, 38
    drinks of 80-proof, 48 drinks of 100-proof)

Alcohol Intoxication
Blood Alcohol Level Clinical Picture
20-100mg percent Mood and behavior changes
Reduced Coordination
Impaired ability to drive a car
101-200mg percent Reduced coordination
Speech Impairment
Trouble walking
General impairment in thinking and judgment
201-300mg percent Marked impairment of thinking, memory, and coordination
Marked reduction in level of alertness
Memory blackouts
Nausea, vomiting, blackouts
5 TIP45 Training Curriculum Module 1-5
Alcohol Withdrawal
  • Restlessness, irritability, anxiety and agitation
  • Anorexia, nausea, and vomiting
  • Tremors, elevated heart rate, and increased blood
  • Insomnia, intense dreaming, and nightmares
  • Poor concentration, impaired memory, and judgment
  • Increased sensitivity to sound, light, and
    tactile sensations
  • Hallucinationsauditory, visual, or tactile
  • Delusions
  • Grand mal seizures
  • Hyperthermia
  • Delirium
  • TIP45 Training Curriculum

  • Module 17

Intoxication and Withdrawal from Heroin and Other
  • Fast Facts
  • Opioids are highly addicting.
  • Chronic use of opioids leads to withdrawal
    symptoms that, although not medically dangerous,
    can be highly unpleasant and produce intense

Opioid Intoxication
  • Opioid Intoxication Signs
  • Slow pulse
  • Low blood pressure
  • Low body temp
  • Sedation
  • Pinpoint pupils
  • Slowed movement
  • Slurred speech
  • Head nodding
  • Opioid Intoxication Symptoms
  • Euphoria
  • Imperviousness to pain
  • Calmness

TIP45 Training Curriculum

Module 18
Intoxication and Withdrawal from Heroin and Other
  • Opioid Withdrawal Signs Symptoms
  • Fast Pulse, Abdominal cramps, High body
    temperature, Vomiting, Enlarged pupils, Nausea,
    Sweating, Diarrhea, Increased respiratory rate,
    Anxiety, Yawning, Bone and muscle pain, High
    blood pressure, Insomnia, Abnormally heightened
    reflexes, Gooseflesh, Tearing (as in crying),
    Runny nose

Intoxication and Withdrawal from Heroin and Other
  • Management of Withdrawal from Heroin and Other
  • It is not recommended that clinicians attempt to
    manage significant opioid withdrawal symptoms
    without effective detoxification agents.
  • The management of opioid withdrawal with
    medication is most commonly achieved through the
    use of methadone.
  • The initial dose requirements for methadone are
    determined by estimating the amount of opioid use
    and gauging the patients response to
    administered methadone.
  • Methadone can be given once daily and generally
    tapered over 3 to 5 days in 5 to 10mg daily
  • Clonidine can also be used to treat opioid
    withdrawal, but it is usually ineffective for
    common symptoms such as insomnia, muscle aches,
    and drug craving.

Intoxication and Withdrawal from Cannabis
  • Fast Facts
  • Marijuana and hashish are the two substances
    containing THC (delta-9-tetrahydrocannabinol)
    commonly used today.
  • The THC abstinence syndrome usually starts within
    24 hours of cessation. The amount of THC that one
    needs to ingest in order to experience withdrawal
    is unknown. It can be assumed, however, that
    heavier consumption is more likely to be
    associated with withdrawal symptoms.
  • Symptoms of Cannabis Intoxication
  • Impaired short term memory
  • Impaired attention, judgment, and other cognitive
  • Impaired coordination and balance
  • Increased heart rate

Intoxication and Withdrawal from Cannabis
  • Cannabis Withdrawal Symptoms
  • Anxiety
  • Restlessness
  • Irritability
  • Sleep disturbance
  • Change in appetite
  • Tremor
  • Sweating
  • Elevated heart rate
  • Nausea, vomiting, diarrhea
  • Management of Withdrawal From Cannabis
  • There are no medical complications of withdrawal
    from THC, and medication is generally not
    required to manage withdrawal.
  • Screening the patient for suicidal ideation or
    other mental health problems is warranted.
  • The patient should be encouraged to maintain
    abstinence from THC as well as other addictive

Intoxication and Withdrawal From Other Drugs An
  • Nicotine
  • Two issues regarding tobacco smoking merit
    consideration by staff of substance abuse
    detoxification programs. The first is the program
    managements desire to establish a smoke-free
    treatment environment to comply with workplace
    ordinances and to safeguard the health and
    comfort of patients from exposure to second hand
    smoke. The second issue is the patients
    dependence on nicotine as a drug of abuse.
  • Drugs That Do Not Produce a Withdrawal Syndrome
  • Chronic use of PCP can cause toxic psychosis that
    takes days or weeks to clear however, PCP does
    not have a withdrawal system. LSD and ecstasy do
    not produce physical dependence.

Intoxication and Withdrawal From Other Drugs An
  • Polydrug Use
  • People who abuse substances rarely use just one
    substance. Typical combinations and preferred
    modes of treatment are as follows
  • Alcohol and stimulant Treat alcohol abuse.
  • Cocaine and opiate Treat opiate dependence
  • Cocaine and amphetamine No detoxification
    protocol is known.

  • Quantity / Frequency Questions
  • Standard Drink
  • 0.6 oz of 100 ethanol 13 gm.
  • 12 oz of 5 beer
  • 5 oz of 12 wine
  • 1.5 oz of 80-proof liquor

Assessment for detox
  • Considerations
  • History of previous delirium tremens or
    withdrawal seizures
  • No Capacity for informed consent
  • Suicidal/homicidal/psychotic condition
  • Able/willing to follow tx recommendations
  • Co-occurring medical conditions
  • Supportive person

  • Ask if any other herbals or substances taken
  • Bring any medications to hospital or assessment
  • List of providers prescribing medications
  • Who is supportive contact
  • Evaluate-Stabilize- Readiness-Referral

Options to access services
  • EAP contact
  • Primary MD
  • Call on medical insurance card
  • Call National Tx Directory for service provider
    in your area- 1-800-662-HELP
  • Yellow pages for providers of MH and SA in your
  • Substance Abuse Counseling services for your

CAGE Questions
  • CCut Down (Have you ever felt you ought to Cut
    Down on your drinking or--did you ever try to
    reduce your drinking but found you were unable to
    do so?)
  • AAnnoyed (Have people Annoyed you by criticizing
    your drinking?)
  • GGuilty (Have you ever felt bad or Guilty about
    your drinking?)
  • EEye-Opener (Have you ever had a drink the first
    thing in the morning to steady your nerves or get
    rid of a hangover?)

Other screens available
  • DAST- Drug Abuse Screening Test
  • MAST-Michigan Alcohol Screening Test
  • AUDIT-Alcohol Use Disorders Identification
  • GAIN Short
  • Many are available on-line to self-administer

Tips for addressing a concern
  • Be respective and non-reactive
  • Open ended questions
  • Remember cognitive thinking distortions are a
    part of Addiction
  • Keep in mind-most people are aware of the
    probable problem
  • Addiction is a brain disease like any other
    chronic progress disease
  • Change is a process
  • Never underestimate the effect you can have by
    just asking about possible SA/Addiction
  • Need to hit bottom a myth-Not True!
  • Do not glamorize binge, heavy, or excessive
  • Alcohol any type or drugs any type-it does not
    matter any can be a problem
  • Be aware of your own biases and patterns of use

Prochaska and DiClementes Stages of Change Model
  • The stages of change are
  • Precontemplation (Not yet acknowledging that
    there is a problem behavior that needs to be
  • Contemplation  (Acknowledging that there is a
    problem but not yet ready or sure of  wanting to
    make a change)
  • Preparation/Determination (Getting ready to
  • Action (Changing behavior)
  • Maintenance (Maintaining the behavior change) and
  • Relapse (Returning to older behaviors and
    abandoning the new changes)

Where to learn more
  • Numerous resources- internet helpful
  • Websites by Federal agencies handout

Additional resources
  • Ordering Information
  • TIP 45
  • Detoxification and Substance Abuse Treatment
  • Three Ways to Obtain FREE Copies of All TIPs
  • Call SAMHSAs National Clearinghouse for Alcohol
    and Drug Information (NCADI) at 800-729-6686, TDD
    (hearing impaired) 800-487-4889.
  • Visit NCADIs Web site at
  • You can also access TIPs online at

Contact Information
  • Lorie Goser
  • Email
  • Email
  • Phone 608-635-2146-clinic
  • Phone 608-215-9114-work cell
  • Poynette Counseling Psychotherapy Associates
  • 415 N. Main Street Suite 3, Poynette, WI 53948
  • Locations- Baraboo, Mauston, Monona, Poynette