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 needed
 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 therapists.
What do you think addiction is?
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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
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MYTH: All someone has to do to overcome alcoholism is go to
Alcoholics Anonymous (A.A.).
FACT: A.A. doesn’t work for everyone (even for many people who
truly want to stop drinking). For most people, A.A. is a gutwrenching, 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
regularly.
Source: Dr. Carl Erickson- University of Texas @ Austin
Debunking Myths about Dependence
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MYTH: Anyone who drinks or uses drugs too often will become
“addicted.”
FACT: We know this doesn’t 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 @ Austin
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
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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
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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
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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
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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
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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.
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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 alcohol.
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 achieved.
(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 America)
Addiction- Definition:
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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 Medicine.)
Substance Use Definition
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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?
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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)
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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 (YPLL’s). (Source-CDC-AADs &YPLLs-US, 2001)
Wisconsin Epidemiological Profile on
Alcohol and Other Drug Use, 2008
Key Findings
Consequences of Alcohol and Other Drug Consumption
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Many types of mortality, morbidity, and dangerous criminal behavior
have been linked to the use of alcohol and other drugs. Given
Wisconsin’s 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.
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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
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Wisconsin’s 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.
Wisconsin’s rate of other alcohol- related deaths (other than liver
cirrhosis and motor vehicle) has increased since 1999.
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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%.
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From 1999 to 2006, Wisconsin’s age-adjusted rate of drug-related
deaths increased; the statewide rate of drug-related hospitalizations
has also increased in recent years. Wisconsin’s rate of arrests for
drug law violations remains lower than the national average but has
increased since 1997.
Wisconsin Epidemiological Profile on
Alcohol and Other Drug Use, 2008
Alcohol Consumption
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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.
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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 1824) has declined in Wisconsin since 2000.
Wisconsin Epidemiological Profile on
Alcohol and Other Drug Use, 2008
Alcohol Consumption
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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 health.
Wisconsin Epidemiological Profile on
Alcohol and Other Drug Use, 2008
Other Drug Consumption
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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 nonmedical 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.
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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 state’s 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
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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 Wisconsin’s 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.
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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
changing.
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).
 Wisconsin’s 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
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Findings from a recent survey report indicated that lifetime nonmedical 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.
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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
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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 nonmedical 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 nonmedical reasons in the past year(Table 27).
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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 available.
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
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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 alcoholrelated mortality for a total of 63 chronic and acute conditions.
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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 crashes).
WI EPI Profile 2008
Other Alcohol-Related Mortality
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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 suicide.
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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 2006.
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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 SubstanceRelated Disorders
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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
Levels and Patterns of Drinking
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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)
Mortality
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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
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. JAMA (2004). 29:1238-45; Mokdad AH, Marks JS, Stroup DF,
Gerberding JL. (2005). JAMA 19;293:293-4.
Assessing Quantity ‘Backwards’
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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)
‘HOW MANY DO YOU BUY PER WEEK?’
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
TIP45 Training Curriculum
5
Module 1-5
Alcohol Withdrawal
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Restlessness, irritability, anxiety and agitation
Anorexia, nausea, and vomiting
Tremors, elevated heart rate, and increased blood pressure
Insomnia, intense dreaming, and nightmares
Poor concentration, impaired memory, and judgment
Increased sensitivity to sound, light, and tactile sensations
Hallucinations—auditory, visual, or tactile
Delusions
Grand mal seizures
Hyperthermia
Delirium
TIP45 Training Curriculum
7
Module 1–7
Intoxication and Withdrawal from Heroin and
Other Opioids
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 discomfort.
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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
8
Module 1–8
Intoxication and Withdrawal from Heroin and
Other Opioids
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 Opioids
Management of Withdrawal from Heroin and Other Opioids
 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 patient’s
response to administered methadone.
 Methadone can be given once daily and generally tapered over 3 to
5 days in 5 to 10mg daily reductions.
 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.
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Intoxication and Withdrawal from Cannabis
(Marijuana)
Fast Facts:
 Marijuana and hashish are the two substances containing THC (delta9-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 functions
 Impaired coordination and balance
 Increased heart rate
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Intoxication and Withdrawal from Cannabis
(Marijuana)
Cannabis Withdrawal Symptoms
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Anxiety
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Restlessness
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Irritability
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Sleep disturbance
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Change in appetite
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Tremor
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Sweating
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Elevated heart rate
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Nausea, vomiting, diarrhea
Management of Withdrawal From Cannabis
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There are no medical complications of withdrawal from THC, and medication
is generally not required to manage withdrawal.
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Screening the patient for suicidal ideation or other mental health problems is
warranted.
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The patient should be encouraged to maintain abstinence from THC as well
as other addictive substances.
Intoxication and Withdrawal From Other
Drugs: An Overview
Nicotine
 Two issues regarding tobacco smoking merit
consideration by staff of substance abuse detoxification
programs. The first is the program management’s 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 patient’s
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 Overview
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.
Assessment
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Quantity / Frequency Questions
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‘Standard Drink’ =
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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
TIDBITS
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Ask if any other herbals or substances taken
Bring any medications to hospital or
assessment appt.
List of providers prescribing medications
Who is supportive contact
Evaluate-Stabilize- Readiness-Referral
Options to access services:
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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
area
Substance Abuse Counseling services for your
county
CAGE Questions
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C—Cut 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?)
A—Annoyed (Have people Annoyed you by
criticizing your drinking?)
G—Guilty (Have you ever felt bad or Guilty
about your drinking?)
E—Eye-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:
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DAST- Drug Abuse Screening Test
MAST-Michigan Alcohol Screening Test
AUDIT-Alcohol Use Disorders Identification Test-WHO
GAIN Short Screen-www.chestnut.org
Many are available on-line to self-administer
Tips for addressing a concern:
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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 drinking
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 DiClemente’s Stages of Change
Model
The stages of change are:
 Precontemplation (Not yet acknowledging that there is a
problem behavior that needs to be changed)
 Contemplation (Acknowledging that there is a problem
but not yet ready or sure of wanting to make a change)
 Preparation/Determination (Getting ready to change)
 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
– www.nattc.org
– www.hbo.com/addiction
– www.cdc.gov
– www.who.org
– www.jointogether.org
Additional resources:
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Ordering Information
TIP 45
Detoxification and Substance Abuse Treatment
Three Ways to Obtain FREE Copies of All TIPs
Products:
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Call SAMHSA’s National Clearinghouse for Alcohol and Drug
Information (NCADI) at 800-729-6686, TDD (hearing impaired)
800-487-4889.
Visit NCADI’s Web site at: www.ncadi.samhsa.gov.
You can also access TIPs online at: www.kap.samhsa.gov.
Contact Information:
Lorie Goser
Email: lorie.pcpa@centurytel.net
Email: lagoeser@btsmailbox.com
Phone: 608-635-2146-clinic
Phone: 608-215-9114-work cell
Poynette Counseling & Psychotherapy Associates Inc.
415 N. Main Street Suite #3, Poynette, WI 53948
Locations- Baraboo, Mauston, Monona, & Poynette