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Drugs and Child's

23

Few illnesses bring more fear to a parent than alcoholism and drug abuse. But unlike other disorders that can also be devastating to a child and his or her family, addiction feels particularly confusing - and somehow personal.

Where did we go wrong? How did she use all this time without us knowing? Where did he even get the drugs?

Okay, I’m ready to accept that what happened; so can I help, or am I going to make things even worse?

For other physical and mental illnesses, parents routinely turn to medical specialists for advice and expect guidance and typically follow the experts’ recommendations. The very process of charting a course of action with a doctor has significant therapeutic effects for both the child and the parents. Unfortunately, we have come to expect much less from the medical community when it comes to the prevention, diagnosis, and treatment of substance use disorders.

On one hand, we don’t trust that we know all that much about the illness itself. Both science and popular culture keep shifting their opinion on the “true” cause of addiction. In the 1960s and the 1970s, it was all about parenting; in the 1980 and the 1990s, we woke up to the monumental discoveries of genetics; and during the past decade, we have

been greatly attracted to co-occurring psychiatric disorders including posttraumatic stress disorder, bipolar disorder, attention-deficit hyperactivity disorder, and autism. Recently, family system considerations for both prevention and treatment have resurfaced, bringing us full circle to the world of our parents. Scientists now know that what causes one kid to get drunk and another to stay sober is rather complex. A number of interrelated biological, psychological, and social determinants affect the pleasure, reward, motivation, and memory brain neuronal circuitry leading to impairment in behavioral control, craving, and diminished recognition of significant problems in one’s life.

On the other hand, there are very few medical doctors with the appropriate training to address substance use among children and adolescents. The American Board of Psychiatry and Neurology has certified less than 250 psychiatrists in the subspecialty of addiction psychiatry over the past 10 years. Our texts will be straightforward answers to every parent’s questions about preventing, identifying, and treating substance abuse and dependence.

 

 

(11) Drugs & Child’s

Drugs - Brain Dead Children

CD11

My son is into sports at school. What type of drugs might he encounter as an athlete?

As athletes are driven to win, with no room for failure, they are more likely to seek performance-enhancing substances. Male student athletes were at a high risk for heavy alcohol use and steroids as they deal with more stress in meeting the demands of both roles. When taken for a period of 10–20 weeks, a high dose of steroids can increase lean body mass, size, and strength, with or without exercise. Most notably, however, are steroids’ performance-enhancing effects if combined with a training regimen and a high-caloric and high-protein diet.

Anabolic-androgenic steroids (AASs) produce heightened mood and decreased fatigue, prolonging physical exertion. A study (Buckley et al., 1998) found that 6.6% of male high school seniors had tried steroids, with 67% onset of use by age 16, and 40% using multiple cycles. The Monitoring of the Future Study (2008) indicated that 1.4% of eighth graders, 1.4% of tenth graders, and 2.2% of twelfth graders have reported trying steroids at least once in their lifetime. Anabolic steroids are used primarily by males. Annual prevalence rates were 1.2%, 1.4%, and 2.5% for boys in grades 8, 10, and 12, compared with 0.5%, 0.5%, and 0.4% for girls, respectively.

A high level of steroid abuse has been exposed among professional athletes. A number of professional baseball players have been implicated or have disclosed using banned steroids during their careers. Serving as role models, these athletes may well have contributed to adolescents’ decrease in perceived risks of use. The nonmedical use of AASs has been banned by a number of organizations including the International Olympic Committee, the U.S. Olympic Committee, and the National Collegiate Athletic Association. A number of medical associations have likewise denounced their nonmedical use.

AASs have multiple medical uses; they have been used in trauma, extensive surgery, and growth and puberty delays. They also are used for AIDS-associated wasting syndrome. Steroids reverse further breakdown in burns. They also show promising results in muscle wasting for patients with advanced kidney problems.

 What is the usual dosage and period of time for which steroids are administered?

For their performance-enhancing effects, testosterone preparations are usually given by injection at doses of 25–200 mg weekly. Doses are abused to as much as three times the recommended use. Steroids taken by mouth range from 35 to 200 mg weekly and are abused up to four times the recommended dose. Usually, injection and oral forms are used during a 6–12-week cycle. Injectable preparations are less likely to cause liver problems. Oral forms are cleared from the body faster and are preferred to avoid detection. Stacking is when multiple steroids are used at the same time. Pyramiding is when doses are increased through a cycle allowing for doses to be increased 10–40 times the usual dose. These two methods decrease the side effects of steroids. It is common that individuals also take supplements (vitamins, creatine, and other protein supplements) to boost the steroid effects. Others also use other medications like tamoxifen, a cancer medication, to reduce risk of breast enlargement. Sources often include gyms, which procure them illegally (via foreign mail orders and the Internet). Quality or even whether these are actual steroids cannot be ensured.

Terms:

Stacking - The use of multiple steroids at the same time.

Pyramiding - Increasing doses of steroids through a cycle allowing for doses to be increased 10-40 times the usual dose.

 Injectable preparations are less likely to cause liver problems.

 What are the telltale signs of steroid abuse?

 Telltale signs include yellowish discoloration of the skin, high blood pressure, decrease in testicle size, change in voice pitch, breast enlargement, which can be permanent after long-term use, tendon fractures, stopping of growth, severe acne, baldness, abscesses from needle punctures, and pinkish to silver streaks on the skin. Steroids also cause increases in positive mood (mania) or depression, violence, or disordered thinking. The physical examination clearance from physicians, who must have increased awareness of the problem, provides the time to note any changes that can be attributed to AAS abuse.

There are no clear-cut profiles that separate those who abuse steroids from others. Sports requiring strength and power (football, wrestling, and track) are most closely associated with AAS. Other adolescents look to steroids to help attain what is in their eyes a more attractive body.

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(12) Drugs & Child’s

Heroin Drug Addicted - Documentary

DC12

 

What can parents do to prevent their son or daughter from becoming involved in steroid abuse?

 

Educational programs that take place before use starts have been suggested to be more effective over drug testing policies. Discussion as part of providing information has to be balanced and should both cover the desired effects and side effects. Supervised training programs are also key. Steroids do not play any legitimate role in sports. Period.

 

I heard that my son took his classmate’s Adderall. Should I be concerned?

 

Yes. Adderall (dextroamphetamine salts) is a stimulant medication medically approved for ADHD. It can also improve memory and wakefulness in healthy individuals, which makes it a drug of choice during exam preparations. Side effects are the extension of its intended benefits and are dose dependent. These effects include euphoria, agitation, hyperthermia (dysregulated increase in body temperature), seizures, hearing voices, and suspiciousness (paranoia). Some individuals combine opioids (downers) like heroin with stimulants (Ritalin [methylphenidate] or Adderall) to counteract the high. Overdoses can lead to heart rhythm abnormalities, heart attack, and breakdown of muscle, leading to kidney shutdown, status epileptics, and brain hemorrhages.

 

 Terms:

 

 Stimulant - Class of medications that is the first line of treatment for ADHD and is not complicated by drug use.

 

Downers - Drugs whose primary effect is to induce motor slowing and sedation.

 

Overdose - Taking more than what is prescribed or suggested for a medication. It can be intentional or accidental.

 

 My friend gave her Xanax to her daughter to help with her anxiety. Is this safe?

 

No. Xanax (alprazolam) is a potent, short-acting benzodiazepine, which is primarily indicated for anxiety problems (used in severe panic disorder where individuals are not even able to leave their homes to get counseling). Compared to older medications like barbiturates (Phenobarbital or Fioricet [a combination of butalbital and acetaminophen that is used for migraines]), benzodiazepines have less potential for abuse, but nevertheless are still addictive. They cause drowsiness, cross-eye, hypothermia, respiratory depression, stupor, and coma. The shorter acting and more potent these medications are, the more likely that they will cause dependence. Xanax is therefore more addictive than Klonopin (clonazepam) or Valium(diazepam) because it is relatively more potent and stays in the body the shortest time (has the shortest half-life). Five milligrams of diazepam is equivalent to 0.25 mg of alprazolam and is equivalent to 1 mg of clonazepam.

 

Term:

 

 Short-acting - A brief duration of medication/drug effects, usually inversely related to how long it takes for the body to get rid of it.

 

 My friend gave her Xanax to her daughter to help with her anxiety. Is this safe?

 

No. Xanax (alprazolam) is a potent, short-acting benzodiazepine, which is primarily indicated for anxiety problems (used in severe panic disorder where individuals are not even able to leave their homes to get counseling). Compared to older medications like barbiturates (Phenobarbital or Fioricet [a combination of butalbital and acetaminophen that is used for migraines]), benzodiazepines have less potential for abuse, but nevertheless are still addictive. They cause drowsiness, cross-eye, hypothermia, respiratory depression, stupor, and coma. The shorter acting and more potent these medications are, the more likely that they will cause dependence. Xanax is therefore more addictive than Klonopin (clonazepam) or Valium(diazepam) because it is relatively more potent and stays in the body the shortest time (has the shortest half-life). Five milligrams of diazepam is equivalent to 0.25 mg of alprazolam and is equivalent to 1 mg of clonazepam.

 

Why does prescription drug abuse seem to be such a problem nowadays?

 

Because there are so few studies, no definitive answers have been offered to explain the increased prevalence of adolescent prescription pain relievers (PPRs). In one study (Wu et al., 2008), increased PPR is seen in adolescents with depression or alcohol problems. A number of these adolescents would be missed if strict DSM-IV criteria for abuse or dependence are applied; they nevertheless exhibit impairments. Compared to adolescents with no DSM-IV symptoms, abusers are likely to be younger and not attending school, be in counseling, have impaired physical health, and have developed a major depressive episode. A reason offered for drug use is the relief of psychic or physical pain, as opposed to getting high.

 

In 2005, 1.4 million visits to the emergency room involved substance abuse, 37% of which were for prescription drug abuse. Their abuse is implicated in suicide attempts, 45% of which involved prescription medication and 56% of which involved sedatives and stimulants. Use of a controlled substance for reasons other than that for which it is prescribed, often in doses different than prescribed, results in disability and dysfunction. This is often in the context of illegal activity, aberrant medication-seeking behavior, and risk of harm to the abuser. Teens often use their parents’ or their grandparents’ pain medications, which are easily accessed from medicine cabinets. Remember the epidemic of OxyContin use? The long-term preparation capsule, when crushed, caused an immediate rush, which can cause severe intoxication and loss of breathing control, making it fatal to some individuals.

 

The most common way to obtain medication is from friends or family. (Beware the medicine cabinet!) Other common methods include obtaining medication from a physician, physician hopping, purchasing medication, or theft, usually from friends or relatives.

 

 Teens often use their parents’ or their grandparents’ pain medications.

 

 Terms:

 

 Controlled substance - Substances defined by the Drug Enforcement Agency with varying levels of addictive potential (based on schedules) and medicinal value.

 

 Physician hopping - A form of drug seeking behavior in which an individual sees multiple doctors to obtain the desired drug of abuse

 

 

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(13) Drugs & Child’s

   Adolescent Substance Abuse Risk Factors

 DC13

Who is more likely to abuse prescription drugs?

There are certain individuals who are more likely to misuse prescription drugs. Schepis and Sarin (2008) found the following characteristics: past year history of alcohol, nicotine, cannabis and cocaine or inhalant use; and past history of major depression. Sex differences were found, predominantly for opioids; females are more likely to steal medication or obtain it for free, whereas males are more likely to purchase medication or acquire it from a physician. White adolescents are more likely to buy opioids, whereas African American adolescents are more likely to misuse opioids obtained from a physician. Across medication classes, adolescents who recently acquired medication by purchasing it have the worst risk profile in terms of concurrent substance use and severity of prescription misuse. While opioid withdrawal is relatively benign, drug overdose can be fatal.

Although heroin is an illegal drug, it is worth mentioning here. A number of adults that I treated started abusing prescription opioids when they were younger to treat pain conditions. This pain can result from common things such as a tooth extraction or an injury that results in fractures and back pain. They would then use prescribed opioids more than intended and engage in aberrant drug-seeking behaviors, eventually moving to using street opioids, such as heroin. Heroin is a highly addictive drug and is the most widely abused and rapidly acting of the opiates. It is derived from morphine, a naturally occurring substance from the poppy plant. Pure heroin is a white powder with a bitter taste and is rarely sold on the streets. Color differences are due to impurities. Another form of heroin, black tar heroin, is primarily available in the western and southwestern United States, with its color varying from dark brown to black. Heroin can be injected, smoked, or snorted, and injection is the most efficient way to administer low-purity heroin. Heroin can also be introduced through the skin, known as popping.

Terms:

Black tar - A form of heroin that is primarily available in the western and southwestern United States, with its color varying from dark brown to black.

Popping - Introducing heroin into the top layers of the skin.

 What are scheduled drugs?

The Drug Enforcement Administration (DEA), a federal arm of the Department of Justice, has issued guidelines and classification of drugs with addictive potential. Prescription and dispensing practices are governed by regulations, and violations result in penalties.

In some states, stimulant medications prescribed for ADHD are written in triplicate forms and can only be given monthly. The original prescription is given to the patient, one is kept by the physician for his or her records, and the other is kept by the pharmacy for record keeping. This aims to encourage appropriate medication monitoring and avoid misuse and diversion. In New York, although benzodiazepines are classified as Schedule IV drugs, they are also written in triplicate forms to discourage misuse and diversion.

Physicians are given licenses to prescribe controlled substances; the license comes with a DEA number, without which no controlled medications can be prescribed. In New Jersey, there is an additional license number, the controlled drug substance number, which has to be renewed by physicians annually to prescribe these medications. The DEA has allowed physicians to electronically prescribe stimulants, which allows the patients better access to their medication and still offers physicians the ability to monitor use of the medications.

 What is methamphetamine, and what are its effects?

Methamphetamines are highly addictive central nervous system stimulants that can be injected, snorted, smoked, or orally ingested. Methamphetamine users feel a short yet intense rush when the drug is initially administered. The immediate effects of methamphetamine include increased activity and decreased appetite. Most methamphetamines distributed to the black market are produced in fly-by-night laboratories, which are sometimes even found in households. The ease of production and significant profits obtained from selling methamphetamine resulted in increased availability of illicit supply in the United States.

Of particular concern is how pseudoephedrine, a drug commonly found in cough and cold medicines, has been used to illegally manufacture methamphetamines. Requiring that this otherwise safe and effective over-the counter (OTC) medication be available only by prescription may make it difficult to access for those who use it for its intended purposes. One way to reduce product misuse while also allowing access to the drug for consumers is to maintain the lowest effective dose in OTC preparations, which is 10 mg for pseudophedrine, and to restrict the maximum amount allowed for a single purchase.

 

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(14) Drugs & Child’s

National Geographic Drugged High on Cocaine

DC14

What happens when someone abuses cough preparations?

Dextromethorphan (DMX) is a cough suppressant found in a variety of over-the-counter cold and cough medications. Like PCP and ketamine, dextromethorphan is adissociative anesthetic, meaning its effects can include hallucinations. These preparations are available without prescriptions. Psychological effects depend on the amount ingested. Symptoms of abuse include confusion, dizziness, double or blurred vision, slurred speech, impaired physical coordination, abdominal pain, nausea and vomiting, rapid heartbeat, drowsiness, numbness of fingers and toes, and disorientation. Some users even experience plateaus ranging from mild distortions of color and sound to visual hallucinations and out-of-body, dissociative sensations and loss of motor control. I have treated a number of male adolescents with these problems; some have ingested as much as 240 mg daily. They have obtained DMX by shoplifting from drugstores. Serotonin is decreased by chronic abuse.

Addicts needed antidepressant treatment due to prominent depressive symptoms resulting from low serotonin levels. In addition to drug use, two of these youngsters also suffered from ADHD. They eventually ended up in longer term residential treatment programs.

Term:

Dissociative anesthetic - Drugs primarily used in surgical operations whose effects can include hallucinations.

 My friend’s daughter was seen huffing something at home. Should my friend be worried?

Definitely. Inhalants include solvents (such as varnish), glues, adhesives, aerosol propellants (cleaning fluid, spray paint, and correction fluid), paint thinners, and fuels (gasoline, kerosene, and lighter fluid). Symptoms of intoxication include dizziness, incoordination, unsteady gait, involuntary movement of the eyes, slurred speech, lethargy, psychomotor retardation, generalized muscle weakness, tremors, blurred vision, double vision that could be as severe as disorientation, stupor, or coma. These drugs can easily be accessed and are of low cost, making them ideal for abuse. They are very toxic, can affect the white matter (supportive tissues) part of the brain, and can result in irreversible damage manifested as lasting motor incoordination, memory impairment, and forgetfulness.

 What are the effects and dangers of club drugs?

Club drugs are a diverse group of psychoactive compounds that tend to be abused by teens and young adults at a nightclub, bar, rave, or trance scene. Raves are dance gatherings that continue for hours with repetitive and monotonous music where a cocktail of pills are given. Due to prolonged dancing and altered consciousness, individuals suffer from dehydration from lack of fluid intake. Gamma hydroxybutyrate (GHB), Rohypnol (flunitrazepam), ketamine, MDMA (ecstasy), and methamphetamines are some of the drugs in this group.

MDMA is a synthetic drug similar to methamphetamine and the hallucinogen mescaline. Rohypnol and GHB have been used as date rape drugs as they sedate unsuspecting victims. GHB, available in an odorless, colorless liquid form or as a white powder material, is taken orally and is frequently combined with alcohol. These increase the risk of unintentional overdose which can result in respiratory depression. In addition to being used to incapacitate individuals for the commission of sexual assault/rape, GHB is also sometimes used by bodybuilders for its alleged anabolic effects. Xyrem (sodium oxybate), a product that contains GHB, is an approved prescription drug for narcolepsy, a medical condition characterized by excessive sleepiness. Xyrem is also prescribed for cataplexy, which is a medical condition characterized by the sudden loss of muscle tone usually in response to extreme of emotions. A commonly experienced form of cataplexy is falling down with bouts of laughter or anger. Whereas GHB is a schedule I drug, Xyrem is a schedule II drug; however, diversion is subject to schedule I penalties. GHB is hard to detect because it is not routinely tested for during drug screens. The Project GHB has extensive information on this subject and has also identified a number of support groups and a list of providers who can offer treatment and counseling.

 Terms:

 Club drugs - A diverse group of psychoactive compounds that tend to be abused by teens and young adults at a nightclub, bar, rave, or trance scene.

Date rape drugs - Drugs used to sedate unsuspecting victims for purposes of sexual advances.

 What happens if humans use drugs meant for animals?

Ketamine, a tranquilizer used in animals, became popular in the 1980s. It is similar to reactions induced by PCP, such as dreamlike states and hallucinations. Ketamine is used to lace marijuana, and youngsters sometimes report a dreamlike and even paranoid experience that they would not otherwise routinely report. A recent study (Liao et al., 2010) provided direct evidence of damage to white matter brain in the frontal and temporoparietal (front and side) areas among chronic adult users. The degree of damage is correlated with the severity of drug use.

How is cocaine used?

 The medical uses of cocaine are now obsolete due to the development of more effective medications that have a lower or no potential for abuse. Cocaine is the most potent natural stimulant. It can be snorted, smoked, or injected. When combined with heroin and used by injection, it is called speed balling. The powder form is inhaled and thereby absorbed into the bloodstream through the nasal tissues. Injection into the veins introduces the drug directly with immediate euphoric effects. Inhaling the vapor through the lungs is as rapid as via injection. Crack is a cocaine base that comes in a rock crystal that is heated to produce vapors, which are smoked. The term crack refers to the crackling sound produced by the rock as it is heated.

 Terms:

Speedballing - Injecting a combination of cocaine and heroin.

Crack - A cocaine base that comes in a rock crystal that is heated to produce vapors, which are smoked. The term crack refers to the crackling sound produced by the rock as it is heated.

 The term crack refers to the crackling sound produced by the rock as it is heated.

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(15) Drugs & Child’s

Inside LSD - Trip Into Hell? (Drugs Documentary)

DC15

What are LSD and PCP?

Lysergic acid diethylamide (LSD) and phencyclidine (PCP) are hallucinogens. Persons under the influence of hallucinogenic drugs often report seeing images, hearing sounds, and feeling sensations that seem real, but are not. Most of these substances are synthetically made to provide more potent effects. LSD is found in ergot, a fungus that grows on rye and other grains. PCP was initially used as an anesthetic but was discontinued because it caused agitation and delusions (false beliefs and paranoia) in patients. It can be snorted, smoked, or ingested. For smoking, PCP is often applied to a leafy material such as marijuana. Other drugs in the hallucinogens class include psilocybin, mescaline, and foxy. Psilocybin is obtained from certain mushrooms found in South America, Mexico, and the United States. Once ingested, psilocybin is broken down to another hallucinogen, psilocin. Mescaline is the active hallucinogenic ingredient in peyote, a small, spineless cactus, which has been used for religious reasons by Mexican natives to induce mystical and spiritual experiences.

Foxy, also known as foxy methoxy, is available in powder, capsule, and tablet form and is usually ingested orally.

 The term crack refers to the crackling sound produced by the rock as it is heated.

 Term:

 Hallucinogen - Drugs causing perceptual experiences that do not exist in actuality, including visual (seeing things) and auditory (hearing things) Perceptions

 How is drug use related to other high-risk behaviors, like promiscuous sex?

Sexual development is an integral phase of adolescence that adolescents are expected to respond to in a healthy and responsible way. Drugs and sexual behavior can become intertwined. Drugs cause disinhibition that increases exposure to unsafe and nonconsensual sexual intercourse, leading to contraction of sexually transmitted diseases like gonorrhea, syphilis, chlamydia, hepatitis, and AIDS. It is also not unlikely that sexual intercourse can be a means for drug solicitation.

Among men, drug use is associated with earlier onset of sexual activity and increased lifetime sexual partners. A history of illicit drug use is related to decreased condom use (Galvez-Buccollini 2009), increasing the risk for sexually transmitted diseases.

How is drug abuse diagnosed?

Substance use and abuse falls on a continuum and the diagnosis of dependence and abuse can become arbitrary, especially in adolescents. In cases where symptoms do not meet the full criteria for the disorder, there is a risk to misinterpret those cases as less severe and thereby lose the opportunity for prevention efforts. This is more relevant in cases where risk factors are identified. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) IV-TR criteria are used to diagnose abuse and dependence among adolescents. Once dependence diagnosis is fulfilled for a specific drug, abuse diagnosis cannot be made, too.

Abuse, as defined by DSM-IV (APA, 1997) is a repetitive pattern of substance use resulting in significant impairment or distress to the individual, characterized by one (or more) of the following: failure to fulfill responsibilities at work, home, or school; usage of drug even when it is dangerous, such as before driving; continued drug use despite drug-related legal problems; and continued drug use despite negative consequences.

Substance dependence is characterized by a repetitive pattern of substance use resulting in significant impairment or distress to the individual. It has to fulfill at least three of the following criteria: tolerance (a reduced effect of the drug when used at the same amount or need for increased amounts of use to achieve the same high as a result of continued use); withdrawal (characteristic signs and symptoms manifest with cessation of drug use, or the same or similar drug is used to avoid or minimize withdrawal symptoms that occur as a result of repeated use); the use of more of the drug than that which is intended; the inability to control use of the drug; an increase in the amount of time spent obtaining the  drugs or recovering from the effects of the drugs; the replacement of other activities with drug seeking behaviors; and continued use of the drug despite adverse consequences.

The presence of these criteria is necessary for at least one year for a diagnosis of substance abuse or dependence. If the criteria are met for less than a year, only a provisional diagnosis can be made. Criteria for substance dependence include several specifiers, one of which outlines whether substance dependence is with physiologic dependence (evidence of tolerance or withdrawal) or without physiologic dependence (no evidence of tolerance or withdrawal). In addition, remission categories are classified into four subtypes:

(1) Full, (2) Early partial, (3) Sustained, and (4) Sustained partial, on the basis of whether any of the criteria for abuse or dependence has been met over a set time frame. The remission category also can be used for individuals receiving agonist therapy (such as methadone maintenance or suboxone) or for those living in a controlled, drug-free environment, including hospitals, inpatient drug rehabilitation programs, or therapeutic communities.

 

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