CocaineA powerfully addictive psychoactive chemica

Cocaine
A powerfully addictive psychoactive chemical that stimulates
the central nervous system, cocaine is the subject of songs,
movies, videos, blogs and podcasts.
Cocaine
Debra Hanselman, LMSW, MHA 1500 Winter 2019
Cocaine comes from the coca bush, which grows on the slopes
of the Andes Mountains in South America.
Historically, the Colombian coca chewer carried his coca leaves
in a pouch hung on his shoulder.
He mixes powdered lime (from shells) with his cocaine to
increase absorption.
Native cultures, especially the Incas, have used cocaine for
thousands of years for energy, to ward off cold and hunger.
Image: Fitz Hugh Ludlow Memorial Library

Drinking Cocaine Wine
These ads for cocaine wine appeared at the end of the
Nineteenth century.
Each glass of wine contained the equivalent of a half-line of
cocaine.
Cocaine was also widely used in patent medicines.
In 2006, 1 oz. of cocaine, sold legally, cost about $150 to $200.
When manufactured and sold illegally, 1 oz. costs about
$2,000. A kilogram of the cocaine shown on the right costs an
average of $23,000 wholesale.
Image courtesy of DEA
Popularity of Cocaine
Nearly 34 million Americans have used cocaine at some time in
their lives.
About 2 million people in the United States reported current use
of cocaine.
2.5 percent of young people ages 12 to 17 reported that they had
used cocaine at least 1 time.
16 percent of young adults ages 18 to 25 reported using cocaine
at least 1 time

Who Uses Cocaine?
Adults 18 to 25 years old have a higher rate of current cocaine
use than those in any other age group.
Overall, men have a higher rate of current cocaine use than do
women.
Just a Few Street Names for Cocaine
Base
Big C
Blow
Candy
Coke
Crack
Flake
Gold Dust
Happy Powder
Rock
Roxanne
Seven-up
Snort
Snow
Snow Cone
White Dust
White Horse
Zip

Cocaine can be used in many different ways.
How do people use cocaine? People…
Snort
Snort cocaine powder through the nose
Rub
Rub it into their gums

Inject
Dissolve the powder and inject it into the bloodstream
Smoke
Process the powder and smoke it
Crack Cocaine
Crack is the hard form of cocaine that develops when the drug
is mixed with water and other solvents and then cooked into a
hard, rock form.
The drug is highly potent and extremely addicting despite the
chemical changes that take place when it is cooked.
Crack cocaine is actually more powerful than powder cocai ne,
causes physical dependence to set in more quickly and is far
more dangerous than the powder counterpart.
This Photo by Unknown Author is licensed under CC BY-SA
Crack Cocaine
The name comes from the crackling sound of the rock as it's
heated.
Some people also smoke Crack by sprinkling it on marijuana or
tobacco, and smoke it like a cigarette.

COCAINE AFFECTS YOUR BODY. People who use cocaine
often don’t eat or sleep regularly. They can experience
increased heart rate, muscle spasms, and convulsions. Snorting
cocaine also can permanently damage nasal tissue.
COCAINE AFFECTS YOUR EMOTIONS. Using cocaine can
change your mood and make you feel paranoid, angry, and
anxious.
COCAINE IS ADDICTIVE. Repeated cocaine use changes the
brain circuits that process feelings of pleasure, which can cause
a person to lose interest in other areas of their life, like school,
friends, and sports.
It also damages brain circuits that control stress, decision-
making, and impulse control, making it more difficult to stop
using, even when it has negative effects on your life and health.
COCAINE CAN KILL YOU. Cocaine use can cause seizures,
strokes, and comas. Cocaine can change the way the heart beats
and lead to a heart attack.
People who share needles can contract hepatitis, HIV, and other
diseases.
The Dangers of Cocaine Use
*It also is particularly dangerous to consume cocaine and
alcohol at the same time; they combine to produce a third
chemical, cocaethylene, that is far more toxic than either
cocaine or alcohol alone.
Frequent use also can lead to tolerance and withdrawal, so you
need more of the drug just to feel normal.

Generally, cocaine is not used on a daily basis, rather it is used
in a binge pattern.
A cocaine binge will usually last several days followed by the
“crash”.
People who use cocaine often take it in binges—taking the drug
repeatedly within a short time, at increasingly higher doses—to
maintain their high.
Immediate Psychological Effects
Increased euphoria
Increased energy
Increased sensitivity to sensations:
Sight
Sound
Touch
Increased talkativeness
Increased mental alertness
Increased confidence
Increased feelings of sexual desire

Chronic Psychological Effects
Irritability
Depression
Increasing restlessness
Paranoia
Auditory hallucinations
Bizarre and/or violent behavior
Damaged ability to feel pleasure
HIV or hepatitis C virus exposure
Immediate Physical Effects
Increased
Pupil size
Heart rate
Temperature
Blood pressure
Decreased
Appetite
Sleep
Chronic Physical Effects
Disturbances in heart rhythm
Heart attacks
Chest pain
Pneumonia
Respiratory failure
Strokes
Significant weight loss/malnutrition
Seizures
Headaches

Cocaine, HIV, and Hepatitis
Studies have shown that cocaine use speeds up HIV infection.
According to research, cocaine impairs immune cell function
and promotes reproduction of the HIV virus. Research also
suggests that people who use cocaine and are infected with HIV
may be more susceptible to contracting other viruses, such as
hepatitis C, a virus that affects the liver.
Cocaine Research Report.
Can a Person Overdose on Cocaine? Yes!
An overdose occurs when a person uses enough of a drug to
produce serious adverse effects, life-threatening symptoms, or
death.
Death from overdose can occur on the first use of cocaine or
unexpectedly thereafter.
Some of the most frequent and severe health consequences of
overdose are irregular heart rhythm, heart attacks, seizures, and
strokes. Other symptoms of cocaine overdose include difficulty
breathing, high blood pressure, high body temperature,
hallucinations, and extreme agitation or anxiety.
Alcohol and Cocaine don’t Mix Well
Mixing alcohol and cocaine leads to impulsive behavior and
interferes with learning and thinking.

Some people experience a more intense “high” when they mix
cocaine and alcohol because the liver metabolizes these
substances into cocaethylene; in addition, an increase heart rate
and blood pressure often occur.
This combination substance also increases the risk for sudden
death. It has been suggested that cocaethylene can increase
violent thoughts and threats, and bad behavior.
Cocaine Withdrawal
The Inability to Feel Pleasure
Emotional Depression
Loss of Energy – Fatigue
Increased Appetite
Slowed Thinking
Loss of Motivation
Insomnia & Unpleasant Dreams
Intense Craving
This Photo by Unknown Author is licensed under CC BY-SA-
NC
Most people seek help during the crash
Pregnancy and Cocaine
Increased risk of
Premature birth
Low birth weight
Smaller than normal head size
Shorter than normal length
HIV or hepatitis virus exposure

Cocaine–Exposed Children
As cocaine-exposed children grow up, they may
Have trouble paying attention to tasks
Have trouble thinking things through
Have trouble learning new information
This Photo by Unknown Author is licensed under CC BY-NC-
ND
Treatment Research
While no government-approved medicines are currently
available to treat cocaine addiction, researchers are testing some
treatments that have been used to treat other disorders, such as:
alcoholism
narcolepsy
obesity
opioid addiction
Resources
National Institute on Drug Abuse; National Institutes of Health;
U.S. Department of Health and Human Services.
SAMHSA Latest Statistics
https://www.samhsa.gov/data/nsduh/reports-detailed-tables-
2017-NSDUH

Creative Commons. Open Source Images.
https://creativecommons.org/
Doweiko, H. (2015). Concepts of Chemical dependency. ninth
edition. Cengage learning.
Inaba, D. (2014). Uppers, downers, and all arounders. 8th
Edition. Drug Education Textbook. CNS Productions.
http://www.cnsproductions.com
Substance Abuse and Mental Health Services Administration.
http://www.samhsa.gov/ The Science of addiction: Drugs, brain,
and behavior.
Theories of Addiction
Overcoming addiction is simply a matter of willpower
Myth or Reality
Myth: Prolonged exposure to AODs alters the brain in ways that
result in powerful cravings and a compulsion to use. These
brain changes make it extremely difficult to quit by sheer force
of will.
People who are addicted have to hit rock bottom before they can
get better.
Myth: Recovery can begin at any point in the addiction
process—and the earlier, the better.
Addiction is a disease, so there’s nothing that can be done about
it.
Myth: Although the disease model is widely accepted, this

doesn’t mean people are helpless. The brain changes associated
with addiction can be treated and reversed
People who are forced (e.g., courts) into treatment are just as
successful as those who volunteer
Reality: People who are pressured into treatment by their
family, employer, or the legal system are just as likely to
benefit as those who choose to enter treatment on their own
Defective spirit and the inner choice of conscious.
THEORIES OF ADDICTION
MORAL MODEL
Moral weakness and character defects lead to addiction
Very little sympathy or empathy for people that have chronic
addictions.
Individual choices are the main theme of this model.
Treatment?
Recovery or abstinence is achieved through the use of
willpower and discipline, and the development of a virtuous
lifestyle
Religion is required in order to be ethical and moral
It wasn’t until the 1930s that other theories were being
introduced academically.
ENLIGHTENMENT MODEL
Addiction is considered a disease that is lifelong and
progressive.
The dominant proponents of this model are twelve step
fellowships such as Alcoholics Anonymous and Narcotics
Anonymous.
Individuals are held responsible for the problem but not the
solution.
They become enlightened to the nature of their problem and to
the action deemed necessary to

overcome the concern.
Problems were caused primarily by their impulse and behavior
Control of these problems are outside their power -
Solution
lies outside of the individual.
“Every addict, including the potential addict, suffers from an
incurable disease of mind, body and spirit”
From this perspective the answer for the “addict” is to desist
from substance use or any other behaviors fueled by the
addiction.
To change the “addict” must become enlightened, by realizing
that change is possible only by relinquishing personal control to
a ‘higher power’.
HEREDITY
Traits are passed through generations by genetic make-up.
Genes determine eye color, initial structure and chemistry of
the nervous system etc .
Determine responses to stress, temperament, and internal
reactions.

There are over 100 genes associated with alcohol/drug abuse.
DRD2A1 Allele (shortage of dopamine receptors)
MAO-A Monoamine Oxidase (“Warrior Gene”)
Enzymes responsible for breaking down the neurotransmitters —
serotonin, dopamine, and adrenalin
5
MEDICAL/DISEASE MODEL
This model defines AOD addiction as a medical disorder
There is something that is uncharacteristic which leads to
behavioral impairment.
The individual is unable to control their craving for AODs.
An individual is not cured even if they are able to stop using
AODs (dormant).
Substance addiction affects both behavior and the brain, thus
neurochemical and behavioral processes are impaired during the

development of the disease
Treatment?
This concept places a higher priority on neurotransmitter
regulation as a treatment approach and, originally, it was
believed that medical professionals were the most competent to
effectively treat addiction; however, the model has evolved to
include behavioral therapies and self-help groups as part of the
treatment approach.
Psychological or Character Logical Model
Concentrates on what takes place in order for a person to start
using substances.
Biology does not cause a person to take that first drink or drug -
It must be psychologically motivated - views everyone as being
vulnerable to addiction
An abnormal character or personality trait is what causes a
person to become addicted
Degrees of personal and psychological defects that pre-dispose
an individual to these “addictive personality” traits
Assisting in changing the personality of these individuals
Treatment?
Examples?
Poor impulse control, ineffectual coping mechanism to stress,
being manipulative, portraying a big ego

Learning Theory
A series of behaviors, rewards, and experiences that all work in
tandem to reinforce the learned habit of addiction.
There are three different types of learning that
reinforce addiction: classical conditioning, operant
conditioning, and social learning.
*People who find relief in a pleasurable behavior are more
likely to engage in that behavior again.
2 fundamental types of learning that apply to humans and
animals
learning by paired association, called classical conditioning
Examples?
learning from the consequences of a behavioral choice,
called operant conditioning. Examples?
People learn through observation that addictive behaviors can
be used to: Cope with stress, depression, anxiety or anger, feel
more relaxed and sociable, escape from pain.
A third type of learning is called social learning.
*Social learning occurs when we learn something by observi ng
others. Examples?

DIATHESIS - STRESS MODEL
The result of an interaction between a predispositional
vulnerability (biological and/or genetic) and a stress caused by
life experiences.
Stressful conditions/experiences play a precipitating or
facilitating role.
If the individual is resilient or has low biological vulnerability,
it would take extremely high levels of stress to trigger
symptoms.
If the individual has high biological vulnerability to the
disorder, then it would take lower levels of stress for symptoms
to be exhibited.
Until this critical level of stress is reached, the individual will
function normally, and the biological vulnerability would not
manifest.
Therefore, this model helps to explain why some, but not all ,
people exhibit psychological/behavioral disorders, even though
they may all experience similar environmental stressors.
Protective vs. Risk Factors?
Implications?

As the addiction treatment field has evolved, it continues to
move away from punitive dogmatic approaches to more client
centered holistic approaches.
Strengths based models of addiction treatment integrate a
variety of influential components that enhance our
understanding and ability to effectively treat the entire
individual within his or her social, cultural, psychological,
spiritual and biological contexts.
Addiction is recognized as a complex disorder that involves
biological, psychological, social, and spiritual components and
therefore must be conceptualized and treated utilizing the
biopsychosocial-spiritual model.
Biological section – includes information about the client’s
medical history (past and present, including medications),
family history of medical illnesses, substance abuse history,
developmental history, and physical functioning and abilities
Spiritual section – includes information on the client’s spiritual

beliefs, participation in faith-based activities, connections to
organized religion, and spiritual practices and resources
Social section – includes information on the client’s social
functioning, living situation, personal and family relationships,
sexuality, family background, history of abuse, educational
background, legal history, employment history, potential risks,
and strengths and resources available to support the client
Psychological section – includes information about any
psychiatric symptoms or illnesses the client is currently
experiencing, or has experienced in the past, mental status,
family history of mental illness, psychiatric medications or
treatments (past and present), and psychosocial stressors or
traumatic events
Cultural section – includes information about the client’s
cultural background, participation in cultural activities and
traditions, cultural norms surrounding health, mental health, and
social roles, worldview, and cultural practices and resources
MORAL MODEL
People who become addicted are seen as morally weak with
poor willpower, and they must will their way through addiction
in order to recover.

THE ENLIGHTENMENT MODEL
The enlightenment model is espoused by Alcoholics Anonymous
and other 12-step philosophies and requires people to seek
recovery by turning the problem over to a higher power.
Emerged in response to the moral and enlightenment models
that placed blame on the addict for his or her problem.
In the medical model, the addict is responsible neither for the
development of the problem nor for its resolution.
Biological/genetic predisposition for addiction, an underlying
disease process, and assumes that the disease is progressive.
Only treated through medical intervention and by medical
professionals
THE MEDICAL/DISEASE MODEL
Most illnesses, disorders, and syndromes, including substance
use disorders, are caused by the interaction of numerous factors
– biological, psychological, social, cultural, cognitive,
environmental, and spiritual.
As such . . . ALL must be taken into consideration in prevention
and treatment efforts
BIOPSYCHOSOCIAL-SPIRITUAL MODEL (BPSS)
Timeline

How Do Drugs Affect the Brain?
Sara Garofalo
Narration by Addison Anderson
TED-ED Video
References
Hanselman, D. & Dudek, D. (2017). Peer Recovery Coach: The
Art of Mentoring. Marygrove College.
Inaba, D. (2014). Uppers, downers, and all arounders. 8th
Edition. Drug Education Textbook. CNS Productions.
http://www.cnsproductions.com
National Institute on Drug Abuse (NIDA).
http://www.nida.nih.gov/index.html
Noble, E. (2000). The DRD2 gene in psychiatric and
neurological disorders and its phenotypes. Alcohol Research
Center, Department of Psychiatry and Biobehavioral Sciences

and the Brain Research Institute, University of California, Los
Angeles
http://www.samhsa.gov/
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1
Industry-funded Tufts Center for the Study of Drug
Development, manufacturers have posited that it costs
about $2.6 billion dollars to develop a new drug.
The cost, according to consumer advocacy groups like Public
Citizen, is actually closer to $161 million—an amount
manufacturers can sometimes make back within days of

introducing a product.
Federal government funds 84 percent of initial drug research,
and charitable organizations additionally contribute on top of
that.
*A recent study showed that all 210 of the new drugs approved
by the FDA between 2010 and 2016 were funded by the
National Institutes of Health.
Big Pharma’s Big Lie
Reference
Cleary, E. G., Beierlein, J. M., Khanuja, N. S., McNamee, L.
M., & Ledley, F. D. (2018). Contribution of NIH funding to new
drug approvals 2010–2016. Proceedings of the National
Academy of Sciences, 115(10), 2329-2334.
While the drug industry purports to focus on cures
for Alzheimer’s, rare cancers, and other neglected diseases, it
actually prioritizes drugs for non-life-threatening conditions
like male baldness.
78% of patents recently approved by the FDA were for
medications already on the market
1 % of R&D funding was allotted to rare and neglected diseases
2
https://www.youtube.com/watch?v=YQZ2UeOTO3I

3
High drug prices reflect the value of a drug; if a drugs cures a
condition, it will allow patients to avoid the costs of future
treatment.
Myth or Reality
Myth: Many high-cost drugs help individuals manage chronic
conditions and are not cures.
Most drugs dispensed are generic, and only the prices of brand-
name blockbuster drugs are increasing dramatically.
Myth: Drug manufacturers have increased the prices even for
older, generic drugs that are widely used.
Myth: Eight out of 10 major drug manufacturers spend more on
advertising than on research and development
Myth: Big Pharma has gamed the system by “evergreening”
patents, colluding to fix prices, and
engaging in “pay-for-delay” schemes
High prices are necessary to fund the development of new drugs
Myth: it took an act of Congress, known as the Orphan Drug
Act, nearly 35 years ago to get drug manufacturers to be
willing to develop drugs for people suffering from rare
diseases
Without special incentives, drug manufacturers would be

unable to afford to develop drugs for rare diseases and
conditions.
The pharmaceutical industry is interested public health over
profit
A Brief Introduction to the Science of Pharmacology
This Photo by Unknown Author is licensed under CC BY-NC-
ND
4
What is “pharmacology”?
What is Pharmacology - Video
5
“The science concerned with drugs, their sources, appearance,
chemistry, actions and uses.” (Farlex Partner Medical
Dictionary, 2012)
There are two broad divisions of pharmacology:
Pharmacokinetics (PK) refers to the movement of drugs through
the body.

Pharmacodynamics (PD) refers to the body’s biological
response to drugs.
6
Efficacy
Safety Profile
Route Of Administration
Route Of Elimination
Dosing Frequency
Cost
What are some considerations when prescribing or taking drugs?
**Risks and benefits of the drug should always be assessed;
every drug poses some risk
(The ability to produce the desired or intended result)
Also, one’s . . .
Age
Sex
Other Medical Problems
Likelihood Of Pregnancy
Other Genetic Determinants

Pharmacology and Drugs of Abuse
Drugs of abuse work by changing the biological function of
target cells through chemical action.
They strengthen or weaken a potential that already exists in the
body.
Drugs of abuse target the cells of the central nervous system.
7
Prime Effect and Side Effect
Prime Effect ~ the desired effect the drug is expected to have.
Side Effect ~ the unwanted effects of the drug.
Side effects intensity can vary from mild and to severe – even
life threatening.
?
8
Name a medication you have used. What was the desired effect?
What was the undesired side effect?
Can you name a desired effect and unwanted side effect from an
illicit drug?

Method (Route) of Administration (how it is taken)
Influences the intensity of the drug’s primary and side effects.
The method of taking the drug impacts . . .
The speed with which the compound begins to have an effect
(speed of onset)
The way the compound is distributed throughout the body
The intensity of its effects
The speed of onset of the side effects
9
Method of Administration (how it is taken)
Inhalation (Inhaling)
Intravenous Injection (Into the vein)
Intramuscular Injection (Into the muscle)
Subcutaneous Injection (Under the skin)
Intranasal (Snorting)
Ingesting (Oral)

Transdermal (Through the skin)
Sublingual (Under the Tongue)
Rectal (In the Rectum)
Debra Hanselman, LMSW, MHA 1500 Fall 2018
10
Do you remember which mode of administration has the fastest
onset? (7 – 10 seconds)
Which mode of administration, other than transdermal, has the
slowest onset? (20 – 30 minutes)
11
The Process: From Use to Elimination
The chemical must be . . .
Absorbed into the system
Distributed throughout the cells of the body
Transported through the blood system
Water-soluble chemicals intermix with blood plasma (Ex.

Alcohol)
Lipid-soluble chemicals bind to molecules in the blood and
become concentrated in the brain (Ex. Marijuana)
*Biotransformation is the body’s process of filtering dangerous
chemicals (Metabolized by kidneys, lungs, sweat glands, liver,
gall bladder and bile ducts)
*Elimination is the process of removing the chemical from the
system.
Drug Half-Life
Elimination half-life – the time the body needs to eliminate 50%
of a single dose of a chemical. Also known as t ½
13
Why is this important?
Drug Dosages
Effective Dose – desired response of the drug in the system
Overdose – too large a dose alters the body’s functions and can
lead to -
Lethal Dose – too large a dose alters the body’s function so

much the user dies
14
*LD50 is the dose which causes death in 50% of the
participants.
Therapeutic Threshold and Peak Effects
Therapeutic threshold is the minimal level at which the drug is
effective
Peak Effects is greatest effect the drug will deliver
15
Site of Action
Where the chemical carries out its main effects.
Psychoactive chemicals carry out the action in the central
nervous system (CNS)
Thus psychoactive chemicals can become drugs of abuse and
dependence

The CNS has approximately 100 billion neurons
One neuron releases chemical molecules (neurotransmitters) to
transmit the brain chemical across the space (synapse) to the
receiving neuron.
There are over 150 brain chemicals that function as
neurotransmitters
Only some are affected by drugs of abuse.
16
Neurotransmitter Reuptake
The process where the releasing neuron takes back some of the
chemical that did not make it across the synapse to be reused.
Neurons can “fire” (send brain chemicals) up to 200 times per
second.
Reuptake makes it possible for the neuron to use less energy
because it can make less new neurotransmitter chemicals.
17
Tolerance

Tolerance to a chemical means a shorter duration and less
intensity of the drug effects after repeated use.
In other words – it take more of the chemical than before to get
the desired effect.
Therefore – one must use more of the chemical to get the
desired effect.
18
Types of Tolerance
Metabolic Tolerance – The proficiency of metabolizing the
chemical
Behavioral Tolerance – Behavior of the individual indicates a
lower dose despite having used much more of the chemical.
Cross Tolerance – When two chemicals target the same neuron
receptor sites the receptors will become less sensitive to one of
the chemicals (so they don’t work as well)
Reverse Tolerance – When lower doses of the chemical
produces the same effect as higher doses taken before …
example?
19

Agonists and Antagonists
Agonists – The drug activates a receptor site by mimicking or
enhancing the actions of a natural neurotransmitter
Antagonists – Bind to the receptor site without activating it
(blocking transmission)
20
Blood Brain Barrier
Blood actually touching the neurons of the brain is not good for
it and cause a great deal of harm – even death.
Therefore, blood capillaries are surrounded by a thin layer of
cells (screen) that separate the brain from direct contact with
the circulatory system, yet allows molecules such as glucose,
iron, and vitamins to enter the neurons.
This protects the brain from toxins or micro-organisms that
would destroy it.
21

22
The Blood-Brain Barrier
A network of blood vessels and tissue that is made up of closely
spaced cells and helps keep harmful substances from reaching
the brain.
Bioavailability?
Epidemiology
Epidemiology is the researched study, analysis, and outcomes of
the distribution (who, when, and where) and determinants of
health and disease conditions in defined populations.
23
Can anyone give an example of an epidemiological study or
suggest one?
24
Pharmacotherapy is the treatment of a disorder or disease with
medication.
In the treatment of addiction, medications are used to . . .
reduce the intensity of withdrawal symptoms,

reduce alcohol and other drug cravings, and
reduce the likelihood of use or relapse for specific drugs
How/why is this information important within the context of
AOD-related fields?
25
THERE ARE 3 PRIMARY CLASSES OF MEDICATIONS TO
TREAT SUBSTANCE USE DISORDER
Agonists
Antagonists
Mixed Agonist-Antagonists
Heroin, oxycodone, methadone, hydrocodone, morphine, opium
Naltrexone & naloxone
Buspirone & buprenorphine
References
Farlex Partner Medical Dictionary © Farlex 2012

The Free Dictionary On-line. https://medical-
dictionary.thefreedictionary.com/pharmacology
The American Heritage® Stedman's Medical Dictionary
Copyright © 2002, 2001, 1995 by Houghton Mifflin Company.
Published by Houghton Mifflin Company.
The Brain – Lesson 2 – How Neurotransmission Works. (2011).
TheProfessorTed. YouTube video.
26
A depressant (also called a central nervous system depressant)
is a chemical compound that manipulates neurotransmission
levels, thereby reducing arousal or stimulation in various parts
of the brain.
Depressants are also occasionally referred to as “downers”
because they lower the level of arousal in the brain when taken.
Depressants
Alcohol
Barbiturates
Benzodiazepines

Barbiturates are a class of drugs that were used extensively in
the 1960s and 1970s as a treatment for anxiety, insomnia,
seizure disorders and as an anesthetic.
Apart from a few specific indications, they are not commonly
prescribed these days, having been largely superseded by
benzodiazepines.
Barbiturates
Side Affects
Confusion
Diarrhea
Dizziness
Drowsiness
Headaches
Irritability
Low blood pressure
Nausea and vomiting
Vertigo.
Barbiturates are extremely dangerous and addictive
Overdose Symptoms:
Difficulty concentrating
Impaired judgment
Incoordination

Sluggishness
Speech disturbances
Staggering
Unusually slow and shallow breathing
Coma and death.
Street Names: Yellows, Barbs, Yellow Jackets, Phennies, Red
Birds, Reds, Downers, Red Devils, Blue Birds, and Rainbows
Most Common: Mephobarbital, Phenobarbital, Butabarbital,
Butalbital
Benzodiazepines (Benzos)
Prescribing Practices
Alcohol & Opiate Withdrawal
Anxiety & Depression
Bipolar Disorder
Borderline Personality Disorder
Epilepsy &Seizures
Insomnia & Night Terrors
Muscle Spasm
Nausea/Vomiting
They are some of the most commonly prescribed & abused
medications in the United States.
Most Common

Xanax
Klonopin
Librium
Valium
Ativan
Restoril
Halcion
Although more than 2,000 different benzodiazepines have been
produced, only about 15 are currently FDA-approved in the
United States.
Intoxication Effects
Trouble breathing or inability to breathe.
Bluish fingernails and lips.
Confusion and disorientation.
Extreme dizziness.
Blurred vision or double vision.
Weakness.
Uncoordinated muscle movements.
Tremors.
Profoundly altered mental status.
Stupor.
Coma.

ALCOHOL
Types of alcohol
Ethyl alcohol or ethanol – grain alcohol
Methyl – wood alcohol
Isopropyl – rubbing alcohol
By 1790, Americans consumed an average of 5.8 gallons of
alcohol per person each year; by 1830, this figure peaked to 7.1
gallons (compared to 2.3 gallons today).
A brief History of Alcohol Production & Consumption
The Temperance Movement (early-mid 1800s) ?
In 1919, the 18th Amendment banned the manufacturing and
selling of alcohol
In 1935, Bill Wilson (Bill W.) and Dr. Bob Smith (Dr. Bob)
formed Alcoholics Anonymous (AA) and published Alcoholics
Anonymous in 1939
In 1952, the American Medical Association first defined
alcoholism.

In 1967, the AMA redefined alcoholism as a complex disease
The temperance movement spearheaded by female or religious
groups; wanted to cease alcohol drinking; preceded the
constitution
5
Scope of the Problem
2.4 million people worldwide lose their lives to alcohol -related
illness or injuries.
In the U.S. 90% of adults will consume alcohol at some point in
their lives.
60+% of U.S. adults have drunk to the point of intoxication in
the last year.
10 – 20% of adults who consume alcohol will meet criteria for
an AUD
An individual’s pattern of alcohol use changes over time.
Some social drinkers become problem drinkers – while – some
abusive drinkers can become abstinent or controlled.
AUD – Related Info
Most alcohol dependent people experience their first

psychosocial or medical problem related to drinking in their 20s
or 30s.
Most will seek treatment in their 40s.
Most are not like the “skid-row” vision of a daily drinker.
Debbie Hanselman, LMSW OCC MH1500 Winter 2019
Tolerance
As a person consumes alcohol on a regular basis the body
adapts to the continued presence of alcohol.
This causes the person to drink more for the same effect –
known as metabolic tolerance.
What were the 3 other types of tolerance
We discussed?
Behavioral Tolerance – Behavior of the individual indicates a
lower dose despite having used much more of the chemical.
Cross Tolerance – When two chemicals target the same neuron

receptor sites the receptors will become less sensitive to one of
the chemicals (so they don’t work as well)
Reverse Tolerance – When lower doses of the chemical
produces the same effect as higher doses taken before
Alcohol is metabolized by a healthy liver at the rate of – 1 oz
eliminated every 3 hours
When too much alcohol is consumed the liver cannot metabolize
it at the same rate.
This can cause alcohol overdose or alcohol poisoning – because
alcohol depresses the CNS – it causes pass-out, respiratory and
cardiac failure, coma and death can occur
Critical Signs for Alcohol Poisoning
Mental confusion, stupor, coma, or person cannot be roused.
Vomiting.

Seizures.
Slow breathing (fewer than eight breaths per minute).
Irregular breathing (10 seconds or more between breaths).
Hypothermia (low body temperature), bluish skin color,
paleness.
What Can Happen to Someone With Alcohol Poisoning That
Goes Untreated?
Victim chokes on his or her own vomit.
Breathing slows, becomes irregular, or stops.
Heart beats irregularly or stops.
Hypothermia (low body temperature).
Hypoglycemia (too little blood sugar) leads to seizures.
Untreated severe dehydration from vomiting can cause seizures,
permanent brain damage, or death.
ALCOHOL RELATED DISEASES
Alcoholic Hepatitis – Inflammation of Liver

Cirrhosis – Kills Liver Cells / Causes Scarring
Fatty Liver – Accumulation of Fatty Acids
Gastritis – Stomach Inflammation
Pancreatitis – Inflammation of The Pancreas
Cardiomyopathy – Enlarged Heart
Hypertension
Hyperglycemia / Hypoglycemia
Alcohol related brain dysfunctions include:
Wernicke-Korsakoff’s Disease
Symptoms of Wernicke’s Encephalopathy
Ataxia - lack of muscle control or coordination of voluntary
movements
Mental Status Changes - dementia and delirium as well as
psychiatric illnesses
Nystagmus or ocular changes - involuntary eye movement
Korsakoff’s syndrome – Thiamine depletion induced brain
damage.
Symptoms of Korsakoff’s syndrome
Memory loss

Inability to retain new information
Disconnection of the neural between neurons are destroyed
14
Severe Alcohol Withdrawal Symptoms
Usually begins 8 – 12 hours after last drink
Includes all of the previously mentioned and
Perceptual Distortion
Hallucinations
Hyperthermia
Sepsis
Cardiac Arrhythmias
Seizure
Convulsions
Fetal Alcohol Spectrum Disorder

Fetal alcohol spectrum disorders (FASDs) are a group of
conditions that can occur in a person whose mother drank
alcohol during pregnancy.
These effects can include physical problems and problems with
behavior and learning. Often, a person with an FASD has a mix
of these problems.
It is 100% preventable!!!!
17
Slide 5-16
Fetal damage from alcohol is often not apparent at birth. Much
of the damage is to the nervous system. ARND may not be
recognizable for years. (pp. 223–225)
It is 100% preventable!!!!
There is no known safe amount of alcohol during pregnancy or
when trying to get pregnant.

There is also no safe time to drink during pregnancy.
All types of alcohol are equally harmful, including all wines
and beer.
THE FACE OF FETAL ALCOHOL SYNDROME
References
Center for Disease Control.
http://www.cdc.gov/ncbddd/fasd/facts.html
Gearing, R., McNeill, T., & Lozier, F. (2005). Father
Involvement and Fetal Alcohol Spectrum Disorder: Developing
Best Practices. Hospital for Sick Children, Department of Social
Work, Toronto, Ontario. JFAS Int. 2005.
http://www.motherisk.org/JFAS_documents/JFAS%205003F_e1
4.pdf

Hanselman, D. & Dudek, D. (2017). Peer Recovery Coach: The
Art of Mentoring. Marygrove College.
Inaba, D. (2016). Uppers, Downers, and All Arounders. CNS
Productions.
http://www.samhsa.gov/

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