DRUG AWARENESS, YOUNG PEOPLE
& DUAL DIAGNOSIS
Kirsty Partridge
Service Lead – 722
21st January 2014
• What do you understand
about drugs and drug use?
Different drug categories
• Stimulants
• Depressants
• Hallucinogens
• Prescribed drugs
Stimulants
• Cocaine, Crack Cocaine, Amphetamines (speed),
Methamphetamine (crystal meth, ice)
Tobacco,Ecstasy (MDMA), Dexamphetamine (Dexy’s),
Amyl Nitrate (Poppers), Khat/ Quat
Stimulants are drugs that stimulate the brain and
central nervous system, speeding up communication
between the two.
Your everyday coffee is a stimulant, those who stop
drinking coffee may suffer withdrawal symptoms.
Depressants
• Cannabis ,GHB ,Inhalants/ Solvents,Opiates (Heroin,
Morphine, Codeine, Methadone, Opium, Pethidine),
Alcohol, Benzodiazepines (Diazepam/ Valium,
Lorazepam)
Depressants slow down the activity of the brain and central
nervous system, slowing down the communication between
the two. For medical purposes they can calm nerves, relax
muscles and some prescribed depressants are useful for
disorders such as insomnia or anxiety.
If two or more depressants are used together, you are at greater
risk of respiratory failure (eg: alcohol & Benzodiazepines)
Hallucinogens
• LSD, Magic Mushrooms (Psilocybin), PCP
(Phencyclidine), Ketamine, Mescaline
Hallucinogens interfere with the brain and central
nervous system in a way that results in radical
distortions of a user’s perception of reality. Profound
images, sounds and sensations can be experienced,
but they will not actually exist.
Prescribed Drugs
• Painkillers:
Some prescribed painkillers such as Codeine, Co-Codamol &
Dihydrocodeine are Opiate based & if used over a long period
of time may lead to physical dependence.
• Benzo’s:
Many people are prescribed Benzodiazepines (Benzo’s) for
anxiety, panic attacks, insomnia, muscle spasms & agitation
Legal Highs/NPSs (New Psychoactive
Substances)
• 'Legal Highs’ are substances which produce the same
or similar effects, to drugs such as cocaine and ecstasy,
but are not controlled under the Misuse of Drugs
Act. They are however, considered illegal under
current medicines legislation to sell, supply or
advertise for “human consumption”. To get round this
sellers refer to them as research chemicals, plant food,
bath crystals or pond cleaner.
• In many cases, ‘legal highs’ have been designed to
mimic class A drugs, but are structurally different
enough to avoid being classified as illegal substances
under the Misuse of Drugs Act.
The Government has now introduced new powers, meaning
they can place a temporary ban on any potentially harmful
substance, while they await a recommendation from the
Advisory Council on the Misuse of Drugs (ACMD), an
independent group of experts, on whether it should be
permanently controlled under the Misuse of Drugs Act 1971.
When it is used, the temporary ban will come into immediate
effect, but it will have to be agreed by Parliament within 40
days. The drug will not be Class A, B, or C, but called a
temporary class drug. It would not be illegal to posses a
temporary class drug for personal use, but the police could
confiscate it and destroy it. It will be illegal to import, distribute
and sell the drug , and anyone caught could be fined, sent to jail
or both.
There are now 251 known NPSs compared
with 234 controlled drugs.
But the report warns that new varieties are
entering the market at a rate of one per
week, sold through a network of legal
websites, through which even school-age
children can buy drugs.
‘UN/EU report Aug 2013’
Why do young
people use
substances?
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•
•
•
•
•
•
•
•
Experimentation
Boredom
Peer pressure
Fun
The high
Socially acceptable
To block out pain
Addiction
Self medicating
If you feel good/better, what's the
problem?
• Positive effects may be short lived
• Believe can control use, but not always
• Pleasure reduces and use may be to feel
‘normal’
• May need higher dose/more often
• Self-control impaired
• Compulsive seeking & use despite harmful
consequences: physical & mental health,
social, personal, financial, legal
What are the groups we consider
to be vulnerable?
• In the criminal justice system or at risk of offending
• Looked after or at risk of becoming looked after
• Excluded from school, persistent truants or at risk of
exclusion
• NEET
• Drug or alcohol using parents/carer/sibling
• Homeless young people
• Young people abused through sexual exploitation
• Teenage mothers
• MH service users
What protective factors are there?
• Supportive family
environment
• Good social support system
• Caring relationship with at
least one adult
• Attending school
• In employment
• Intellectual/emotional ability
• Positive temperament
• Outside interests
WHAT IS DUAL DIAGNOSIS?
“The concurrent existence in an individual
of substance misuse and one or more
mental disorders”
(Franey & Quirk, 1996)
Brain Chemistry
• Most illegal drugs cause the release of a
neurotransmitter called dopamine
• The release of dopamine is why drugs feel
pleasurable
• However too much dopamine could cause
problems
• Most drugs used to treat schizophrenia work by
reducing dopamine
• Stimulant drugs can also effect the ability to
produce serotonin, which can lead to long lasting
difficult to treat depression
Cannabis & the Brain
- Most drugs usually fall into category of
stimulant, depressant, hallucinogen or
prescribed drugs. Cannabis exhibits a mix but
leans toward hallucinogen due to THC
(Tetrahydrocannabinol)
- THC binds to and activates specific receptors in
parts of the brain that control memory, thought,
concentration, time and depth perception and
coordinated movement.
- By activating these receptors, THC interferes
with the normal functioning of the cerebellum
WHAT CAME FIRST?
‘VULNERABILITY GROUP’
• Use pre-dates illness by 1-5 years.
• Impact of use reduces vulnerability
threshold/coping resources.
‘STRESS GROUP’
• Concurrent onset of illness/substance use.
• Already susceptible and substance use acts as a
stress factor precipitating onset.
‘COPING GROUP’
 Substance use post-dates illness.
 Self-medication of symptoms/side effects.
Source: Hambrecht and Hafner (2003)
PRACTICAL DEFINITION OF DUAL
DIAGNOSIS
Further reading
• Advisory Council on the Misuse of Drugs. (2003)
Hidden Harm: responding to the needs of problem
drug users, London: Home Office
• Kearney, P, Levin, E & Rosen, G. (2003) Alcohol, Drug
& Mental Health Problems: working with families,
London: SCIE
• http://www.nta.nhs.uk/uploads/yp2012vfinal.pdf
•‘Supporting information for the
development of joint local protocols between
drug and alcohol partnerships, children and
family services’ (NTA 2011)
•www.nta.nhs.uk
•www.dh.gov.uk
•www.drugs.homeoffice.gov.uk
•www.scie.org.uk
•www.everychildmatters.gov.uk
•www.talktofrank.com
• Contact details:
• Kirsty Partridge
Service Lead – 722 Waltham Forest
0300 555 1158
kirsty.partridge@nelft.nhs.uk