Altare: Stimulants- Treatment, Therapy and Alternatives

Stimulants- Treatment, Therapy and Alternatives

         

       There are several different types of stimulants, this blog will focus on the treatment and therapy practices of cocaine use disorder. Cocaine use is a serious worldwide health issue and is associated with substantial morbidity and mortality. Overdose deaths within the US are increasing and in some populations are out numbering heroin and opiate overdoses.

        No current medications have been approved at this time through the FDA to treat stimulant abuse. There have been many studies conducted using trials of medications to treat Cocaine Use Disorder, despite these efforts no medications have been proven safe to treat this problem. Although unapproved by the FDA, there are pharmacological strategies that have been developed by physicians whom specialize in cocaine treatments. Some of the strategies used for treatment of Cocaine Use Disorder include the use of dopamine agonists, as example long-acting amphetamines and Modafinil in combination with GABAergic agents as an example Topamax. These of course are off the box treatments and many physicians proceed with caution when prescribing these medications for Cocaine Use Disorder (Laurent Karila, 2010).

Psycho-social treatments remain the treatment of choice for Cocaine Use Disorder, these include cognitive behavioral therapy and contingency management. (Daniel Ciccarone, 2011)

Photo 1 Shows a visual guide Cognitive Behavioral Therapy (Richard Foster, 2019)

Cognitive Behavioral Therapy used for substance disorders is a “Talk Therapy” that has been proven effective in treating many different substance use disorders such as cocaine abuse. Cognitive Behavioral Therapy for substance use disorders was designed to guide clients to learn how to make healthy choices and maintain changes in the habits of their substance abuse. It helps them discover ways to cope with cravings, urges, improve communication, interaction and solve problems (Introduction to Cognitive Behavioral Therapy for Substance Use Disorders, 2019). Please watch the video posted below, Introduction to Cognitive Behavioral Therapy for Substance Use Disorders, it is a YouTube video that explains CBT in layman’s terms https://youtu.be/Otu5Ajlo-_w

Photo 2 Explains Contingency Management (John Schaffer, 2020)

Contingency management is a psychotherapy that uses reward or reinforcement techniques to encourage abstinence. This type of therapy is related to the behavioral Psychologist B.F. Skinner and his operant conditioning theory, which is a learning process that uses rewards to reinforce specific behaviors. Clients who participate in substance treatment programs that use contingency management often receive rewards for meeting specific goals. Some examples of contingency management are requiring daily or weekly urine drug screening tests. If the test comes back negative the client is eligible for a reward. If the test result comes back positive then the client is punished. This type of therapy is commonly used by probation officers when clients are mandated by the court to report for illegal substance charges. When clients violate probation orders and have a positive drug screen they are often sent back to jail or subjected to an extended probationary period, if their urine remains clean and they follow probationary requirements commonly they are released early for good behavior. Studies show that the use of contingency management combined with cognitive therapy significantly improved abstinence among stimulant users (Daniel Ciccarone, 2011).

References

Daniel Ciccarone, M. M. (2011). Stimulant Abuse Pharmacology, Cocaine, Methamphetamine, Treatment, Attempts at Pharmacology. Retrieved from US National Lirbrary of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056348/

Introduction to Cognitive Behavioral Therapy for Substance Use Disorders. (2019). Retrieved from YouTube: https://youtu.be/Otu5Ajlo-_w

John Schaffer, L. (2020). Contingency Management Therapy for Addiction. Retrieved from Rehab Center: https://www.rehabcenter.net/contingency-management-cm-therapy-for-addiction/

Laurent Karila, A. W.-J. (2010). Pharmacological Approaches to Methamphetamine Dependence A Focused Review. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883750/

Richard Foster, L.-C. (2019). Treating Drug Addiction with Cognitive Behavioral Therapy. Retrieved from Rehab Center : https://www.rehabcenter.net/treating-drug-addiction-with-cognitive-behavioral-therapy/

Blog Entry 5 Comorbidity and Addictions

Altare: Stimulants- Comorbidity and Addictions

Psychiatric comorbidities and amphetamine use can cause serious morbidity, studies have shown that depressive disorder symptoms are a common pre-existing mental health disorder and can co-occur with amphetamine dependences. In fact, The National Epidemiologic Survey on Alcohol and Related Conditions accessed the psychiatric diagnosis’s from a sample of 43,093 subjects with amphetamine dependence and found that the lifetime prevalence of mood disorders such as depression was 64% (Ruth Salo, 2010).

The sad truth is that these patients can be the most difficult to treat and are less likely to have a successful outcome compared to patients who have only one disorder. The reason being is that amphetamines increase dopamine, this neurotransmitter that allows feelings of motivation, pleasure and increased energy (Meth Addiction and Mental Health Problems, 2020). For a person with depression, using amphetamines can be quite motivating and uplifting for them. Self-medicating is common in amphetamine users because they feel that they are blocking their problematic psychiatric symptoms. When they discontinue the use of amphetamines it can reveal even more severe depressive symptoms than before and require psychiatric treatment or hospitalization due to suicidal ideations and or attempts.

A report from the Journal of Neuropsychiatry showed reported psychiatric symptoms from individuals who were currently amphetamine-dependent comparing them to individuals who denied the use of amphetamines. The percentages showed that the individuals who were amphetamine dependent were in need of or were currently seeking psychiatric treatments, were experiencing suicidal ideations, having issues with anger and had experienced depressive symptoms (Ari Kalechstein, 2000).

 

Photo 1: Shows the association between psychiatric symptoms and self-reported methamphetamine dependence (Ari Kalechstein, 2000).

Sadly women with amphetamine dependence were more likely to report psychiatric problems such as depression, anger and suicidal ideations. Initially studies showed that anger and temper issues were associated with amphetamine use, later studies show that amphetamine dependence is associated with psychosocial outcomes such as loss of employment and lack of health insurance. Because of the further studies it was determined that the resulted outcomes are were contributing to the distress and anger not the actual drug itself (Ari Kalechstein, 2000).

Many individuals who use amphetamine with co-morbiding psychiatric disorders end up in hospital emergency rooms versus receiving routine psychiatric treatment. Studies show that these patients are high risk for hospital readmission and often receive poor treatment responses in both the drug dependence and co-occurring psychiatric disorder (Ruth Salo, 2010). ER physicians should be properly educated on the DSM criteria for substance-induced disorders to ensure that patients with both substance abuse problems are getting the treatment that they deserve. This could prevent suicide and contribute to substance abuse treatment.

 

Photo 2 Shows the DSM criteria for substance-induced disorders (Ruth Salo, 2010).

Below is a video that discusses amphetamine intoxication and withdrawal symptoms, finding, causes and mnemonics (MLE, 2013). Th

https://www.youtube.com/watch?v=o3HTGGECebM

 

References

Ari Kalechstein, P. T. (2000). Psychiatric Comorbidity of Methamphetamine Dependence in a Forensic Sample. Retrieved from The Journal of Neuropsychiatry and Clinical Neurosciences: https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.12.4.480

Meth Addiction and Mental Health Problems. (2020). Retrieved from Mental Help . Net: https://www.mentalhelp.net/substance-abuse/meth/mental-effects/

Ruth Salo, K. F. (2010). Psychiatric Comorbidity in Methamphetamine Dependence. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058719/

Altare: Stimulants-The Family and Addictions

           Stimulant drugs are a wide class of drugs that are abused by over 1.6 million people of 12 years and over in the United States. These drug cause increased energy and alertness. This class of drugs are both legal and illegal, legal medications include medications such as Adderall and Ritalin. Illegal stimulants include substances such as cocaine, crack and meth. Using these drugs not only is highly addictive and dangerous to health but causes problems in the addicts life and the family of the loved one’s lives too (Lauren Brande, 2020).

Photo 1 shows the eye of a person who has been using a stimulant “fully alert” (Lauren Brande, 2020).

The family of an addict often has trouble addressing an addict and their behaviors. This is often because the family members do not know how to discuss the addict’s dependence problem, they are unsure of how the intervention will go and it can be scary. People with addictions can have different reactions to family when they are confronted regarding their problem. Most of the time the reactions will be negative but with the right communication and support family can be a great tool to help a person recover. It is important to understand how to properly communicate with them and how to avoid supportive behaviors.  

Photo 2: Shows confrontation between loved ones (Steven Gifford, 2018).

            Family members who choose to support the person with the addiction can become one of two, the family members can be enablers or codependent. Enabling behaviors happen when another person encourages or helps an addict continue to use. This behavior could be direct or indirect, enabling from the family usually happens because they provide the addict with money or resources with good intentions that they are helping their loved one. Sometimes family members do not realize that there is a difference between helping someone and enabling someone. Helping someone is doing things for them that they cannot do themselves, enabling someone is doing things for someone who can and should do for themselves (Allan Schwartz, 2020).

The codependent is essentially the person who is enabling or supporting the other person engage in harmful behaviors. This type of behavior can be thought of as an inverted narcissism and in the family setting it can be dangerous because it forces dependence on another person instead of themselves. Family members commonly use this behavior instinctively thinking that they are helping the situation when in fact it is making it worse. Some examples of  how codependency can cause negative effects that trigger a person’s addiction include, making excuses, supplying financial assistance and avoidance. Family members often make excuses for the addict to cover up their behaviors, this is a negative behavior because it teaches them that there are no consequences for their behavior. Supplying the addict with finances is the most common mistake that family members make. Family members often do this because they are fearful that the person will begin to steal or perform in risky behaviors to get the drugs that they need. Giving money sends the message that the addiction is acceptable and enables the situation to higher levels. Choosing to look away and avoid the problem also enables the problem. People with addictions go through emotional mood swings which can turn into aggression, violence and reckless behaviors. By avoiding the confrontation is does not provide a consequence and enables the behavior. Family members may choose to avoid confrontation in fear that the addict will harm themselves or choose to leave. Codependency often becomes an addiction for family because they feel the constant need to provide for the addicted family member, only their contribution is making the situation worse. (Allan Schwartz, 2020)

Family can be of a great help and act as a support system during the recovery process of a loved one. The first step is to educate yourself, find a counselor or contact Alcoholics Anonymous to connect with other families. Stop enabling the person who is addicted, this means not providing money or a place to live instead insist that they get the help that they need. Offer assistance to a drug rehab or treatment center if necessary. The last important thing to do is stand up and not give in. When the enabling behavior discontinues the addict has to make the choice to get help. This step is the hardest part for family because they often have to watch their loved one hit rock bottom, meaning that they become homeless, get in trouble with the law and even end up in jail (Ashcroft, 2018).

How to approach a family member who has an addiction problem.

https://youtu.be/Cdn-N9pBw6o (Centers, 2018)

References

Allan Schwartz, L. P. (2020). Codependent and Enabling Behaviors. Retrieved from American Addiction Centers Resource: https://www.mentalhelp.net/blogs/codependent-and-enabling-behaviors/

Ashcroft, T. K. (2018). Family-focused Practices in Addictions. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781095/

Centers, A. A. (2018). 1:00 / 2:13 Intervention: How to Talk to a Family Member with an Addiction Part 1. Retrieved from You Tube: https://youtu.be/Cdn-N9pBw6o

Lauren Brande, M. (2020). Stimulant Drug Abuse. Retrieved from American Addiction Centers Resource: https://drugabuse.com/stimulants/

Steven Gifford, L. L. (2018). Family Involvement is Important in Substance Abuse Treatment. Retrieved from Psych Central: https://psychcentral.com/lib/family-involvement-is-important-in-substance-abuse-treatment/

Altare Stimulants Attitudes of the Culture

This blog entry is about the attitudes and beliefs of college students regarding addictions and the use of the stimulant Adderall in comparison to the attitudes of parents and college administrators. Dangerous myths formed by college students are also discussed along with the dangers of high potential for abuse.

Photo 1: College aged student contemplating the use of Adderall (Study: ADHD Drugs do not Improve Cognition in Healthy College Students, 2020)

The attitudes of college students are what shape this behavior, college students who choose to use this stimulant for many reasons. The number one reason is because among students, it is socially acceptable and comes without stigma unlike other drugs. For example, students who drink alcohol are often labeled as a drunk, students who smoke marijuana regularly are labeled as a pot head, students who take opioid pills such as Norco are labeled as pill heads (Gray, 2010). On the contrary the use of Stimulants such as Adderall is openly accepted and often encouraged by peers, students who use these drugs are overlooked as drug users. They are actually viewed as motivated, studious and students need not fear judgement of fellow peers.

While the college aged students believe that the use of stimulants such as Adderall is not a problem, teachers, school counselors and parents are becoming concerned with the potential risks and dangers. Mental health campaigns are being used to address current student campus culture,  discourage the use of Adderall and to spread awareness of the dangers (Siberman, 2018). Faculty and parents are hoping to de-stigmatize the college mentality that Adderall poses by making students aware of the psychological dangers, physiological dangers and legal problems that this drug can cause. Campus awareness campaigns have been proven to successfully educate students and change their outlook, attitudes and behaviors towards health concerns related to substance use.  

Some myths regarding the use of Adderall include the current student outlook and wide acceptance of this drug. Students do not view or consider unprescribed Adderall as an illicit drug nor do they believe that they are abusing it when used unprescribed for academic reasons (Gray, 2010). Stimulants are the most widely used of the illicit drugs, a study performed using students from the University of Michigan found that out of 1,800 students as many as 81 percent do not believe the use of Adderall is dangerous. In fact physiological and legal consequences of illicit use are just as bad as using cocaine and meth (Siberman, 2018). Adderall is considered a Schedule II drug by the Drug Enforcement Administration, schedule II drugs are considered high potential for abuse. According to Michigan Law (Controlled Substance Schedules, 2020), a person who is prescribed a schedule II drug and is distributing it illegally will face felony and jail time (Siberman, 2018).

Photo 2: Statistics regarding college students and the use of Adderall (Siberman, 2018).

References

Controlled Substance Schedules. (2020). Retrieved from DEA: https://www.deadiversion.usdoj.gov/schedules/

Gray, R. (2010). Shame, labelling and stigma: Challenges to counselling clients in alcohol and other drug settings. Retrieved from Academia: https://www.academia.edu/368519/Shame_labelling_and_stigma_Challenges_to_counselling_clients_in_alcohol_and_other_drug_settings

Siberman, J. (2018). Let's Talk about Adderall. Retrieved from The Michigan Daily: https://www.michigandaily.com/section/editorials/daily-let%E2%80%99s-talk-about-adderall

Study: ADHD Drugs do not Improve Cognition in Healthy College Students. (2020). Retrieved from Global Health News Wire: https://globalhealthnewswire.com/2018/07/20/study-adhd-drugs-do-not-improve-cognition-in-healthy-college-students/

Teter CJ1, M. S. (2006). Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pubmed/16999660

Altare Stimulants Current Events

The article titled ‘Nobody talks about it because everyone is on it’: Adderall presents esports with an enigma was published by the Washington Post on February 13, 2020. This article discusses the use of the stimulant prescription drug Adderall among the online gaming community. The Post interviews several “competitive gamers” whom openly admit to taking stimulants before logging on to play their favorite game. One of the interviewees says that every Friday and Saturday he takes his Adderall, it keeps him from becoming exhausted and losing motivation. With Adderall he claims that it aids him in becoming the best player that he can be and can play for over 12 hours. 

 Photo 1: Shows a gamer sitting in front of the computer screen (Institute, 2018).

(Hamstead, 2020). With the number of professional gamers on the rise many are asking, what exactly constitutes a performance enhancing drug and should prescribed substances be regulated by a league at all? The article goes on to discuss that some Esport leagues have formulated anti-doping codes and begun drug testing gamers prior to tournaments. Some leagues allow the use of stimulant medication if the drug is prescribed, but for most leagues their policies state that unauthorized use or possession of prescriptions, alcohol and illegal drugs are prohibited. According to Ian Smith, commissioner of the ESIC, “there have been zero anti-adopting rule violations since testing began” (Hamstead, 2020). Maria St. Pierre, a Clinical Project Manager at the Neurological Clinical Research Institute at Massachusetts General Hospital believes that there are “clear” advantages to using stimulant medication to enhance competitive gaming and believes that Adderall and similar drugs should be banned. She claims that physically Adderall is similar to taking speed or meth and mentally can cause psychosis, paranoia and can be very addicting (Hamstead, 2020).

The use of prescription stimulants in the gaming community is clearly a cultural issue that has been unspoken of publicly until recent. Policies have been put into place by some of the major Esport leagues to prohibit use of such drugs and improve the gaming culture’s knowledge of the dangers, but some pros are willing to take the risk to win. In December of 2019 the total prize pool for the Fortnite Winter Royal weighed out at 23 million, participants played from remote locations (Hamstead, 2020). Testing the participants was not physically possible, hopefully policies and education can steer this community to enhance awareness of the potential damage.

                       Photo 2: Shows the pill form of Adderall (Hamstead, 2020).

Prevention and intervention are necessary in relation to the use of stimulants in combination with the participation of Esports and in general because amphetamines such as Adderall have such a high potential for abuse and addiction. It is important to educate the Esports community of the dangers of unprescribed Adderall use. Many gamers use this drug to increase cognition, perception and to improve motivation. Besides the high risk for addiction, Adderall can cause side horrible effects such as hallucinations, epilepsy, psychosis and malnutrition (PharmD, 2020).

Below is a video that discusses Your Brain on Adderall (Mitchell Moffit, 2018)

            https://youtu.be/ifutqKQ6KQE

References

Hamstead, C. (2020). ‘Nobody talks about it because everyone is on it’: Adderall presents esports with an enigma. Retrieved from The Washington Post: https://www.washingtonpost.com/video-games/esports/2020/02/13/esports-adderall-drugs/

Institute, O. I. (2018). Nothing clinically "wrong" with obsessive gamers, new study finds. Retrieved from University of Oxford: http://www.ox.ac.uk/news/2019-10-18-nothing-clinically-%E2%80%9Cwrong%E2%80%9D-obsessive-gamers-new-study-finds

Mitchell Moffit, G. B. (2018). Your Brain on Adderall. Retrieved from YouTube: https://youtu.be/ifutqKQ6KQE

PharmD, C. S. (2020). Adderall Addiction and Abuse. Retrieved from The Recovery Village: https://www.therecoveryvillage.com/adderall-addiction/

Altare Stimulants Introduction

                   Stimulants are substances that increase the levels of psychological activity and or nervousness in the body and brain. Stimulants affect the body in many different ways, when taken, stimulants can cause increase in blood pressure, heart rate and respiration's. Stimulants can also cause upset stomach, sweating and muscle cramps. When discontinued promptly a person becomes at risk for withdrawal. Some of the common withdrawal symptoms include extreme fatigue, depression, dizziness, tremors, chest pain, headaches and even hot flashes (Stimulant Drug Types, Effects and Addiction Signs, 2019).  

              Stimulants can be both legal and illegal. Legal stimulants are prescribed and include amphetamines, ephedrine, caffeine and nicotine Common names of prescription stimulants that are commonly prescribed and recognized include Ritalin, Adderall, Concerta, Dexedrine and Vyvanse. These types of prescriptions are prescribed to treat an array of conditions such as attention deficit hyperactivity disorder ADHD, ADD, mild depression and narcolepsy (Stimulant Drug Types, Effects and Addiction Signs, 2019). These medications can be very habit forming and lead to addiction if used inappropriately for long periods of time. 

Common forms of Stimulant drugs (Stimulants Drugs Market, 2019).

Illegal stimulants, also known as street drugs include methamphetamines (meth), crack and cocaine. Cocaine is highly addictive and among one of the most well-known and most used of the illegal stimulants. Cocaine comes from the coca plant and comes in two forms, white powder which is usually inhaled through the nasal cavity or in crystal form (crack) in which it is smoked. Some of the common signs of cocaine use are dilated pupils, weight loss, runny nose, nosebleeds and excitability (Stimulant Drug Types, Effects and Addiction Signs, 2019). Methamphetamine “Meth” is also a very highly addictive stimulant. Like cocaine, meth comes in powder and crystal form but is used more ways such as injecting intravenously, smoking and inhaling. Meth can cause severe itching, dry mouth causing dental problems, cognitive issues and fainting due to high body temps (Stimulant Drug Types, Effects and Addiction Signs, 2019). 

Illegal Stimulant Drugs (Stimulant Drug Types, Effects and Addiction Signs, 2019)

The history of stimulant use began in South America where coca chewing was common and then became popular after a medical publication in 1884. Shortly after that cocaine which is derived from the coca plant was incorporated into medicines and beverages such as Coca-Cola. In 1914 the Harrison Act banned over the counter cocaine use. In the 1930’s amphetamines were discovered for clinical uses and still remains popular today. Methamphetamines became popular in the 1960’s. Because of the high amounts of abuse, the Controlled Substances Act of 1971 was created which drove down the popularity of stimulants. Stimulants resurged in the 1990’s where methamphetamine commonly was produced from home “meth labs”. (Daniel Ciccarone, 2011). Today prescription stimulants are commonly recommended to treat children, adolescents, college students and adults for ADHD, a recent meta-analysis and systematic review have substantiated the availability, use, and misuse of prescription stimulants has risen sharply among college students without the disorder” (Lisa Weyandt, 2016). College students often use the medications for cognitive and academic enhancement. They also are used for recreational reasons and weight loss.

References

Daniel Ciccarone, M. M. (2011). Stimulants Abuse: Pharmacology, Cocaine, Methamphetamine, Treatment, Attempts at Pharmacotherapy. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056348/

Lisa Weyandt, P. N. (2016). Prescription Stimulant Medication Misuse. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113141/

Stimulant Drug Types, Effects and Addiction Signs. (2019). Retrieved from American Addiction Centers: https://americanaddictioncenters.org/stimulant-drugs

Stimulants Drugs Market. (2019). Retrieved from Worldwide Public Relations: https://www.openpr.com/news/1526547/rapid-growth-of-stimulants-drugs-market-top-leading-key-company-s-neos-therapeutics-amedra-pharms-novartis-janssen-noven-therapeutics-tocris-teva-global-forecast-to-2024.html