Introduction to Drug and alcohol counselling Unit 1 2024 edited.pptx

Counseling for drug-related issues is a critical component in addressing substance use disorders and promoting recovery. It plays a vital role in helping individuals understand their addiction, identify the triggers for their substance use, develop coping strategies, and find healthier ways to deal with life's challenges.

### Types of Counseling in Drug Treatment

1. **Individual Counseling**: This one-on-one approach allows for personalized attention and tailored treatment. Counselors work with the individual to explore the underlying issues contributing to substance use, set goals for recovery, and develop coping mechanisms.

2. **Group Counseling**: Group therapy provides a supportive environment where individuals can share their experiences and learn from others facing similar challenges. It fosters a sense of community and reduces feelings of isolation, which can be intense for those struggling with addiction.

3. **Family Counseling**: Recognizing the impact of substance use on relationships, family counseling involves family members in the recovery process. It aims to address family dynamics, improve communication, and strengthen support systems.

4. **Cognitive Behavioral Therapy (CBT)**: CBT is a structured approach that helps individuals identify and change negative thought patterns and behaviors associated with drug use. It equips clients with practical skills to resist cravings and manage stress.

5. **Motivational Interviewing (MI)**: This client-centered technique addresses ambivalence toward change and enhances intrinsic motivation to recover. Counselors help clients explore their reasons for wanting to change, increasing their commitment to the recovery process.

### Goals of Drug Counseling

- **Understanding Addiction**: Counseling helps individuals recognize the nature of their addiction, its effects on their lives, and the reasons behind their substance use.

- **Behavior Change**: The primary goal is to aid in developing healthier behaviors and coping mechanisms that replace drug use.

- **Relapse Prevention**: Counselors work with individuals to identify triggers for relapse and develop strategies to manage cravings and high-risk situations.

- **Building Life Skills**: Counseling often includes life skills training, helping individuals improve their interpersonal skills, decision-making abilities, and coping strategies for day-to-day challenges.

- **Self-Esteem and Empowerment**: Fostering a positive self-image is essential in recovery. Counseling supports individuals in building confidence and a sense of agency in their lives.

### Importance of Counseling in Recovery

Counseling is universally recognized as a cornerstone of effective drug treatment. It supports individuals in various stages of recovery, offering tools and resources to navigate challenges. Evidence has shown that engaging in counseling significantly increases the chances of long-term sobriety and improves overall quality of life.

1. Unit 1: Nature of drug and alcohol use July, 2024

2. Learning outcomes Apply the drug and alcohol abuse concepts in counselling describe key brain pathways involved in the addictive process; discuss the influence of substances on the brain Describe the signs and symptoms inherent in drug and alcohol abuse

3. Concepts related to drug and alcohol use (Mental Health Nursing: a South African perspective). Apply the following concepts in counselling Drug use Harmful use Hazardous use Substance abuse Substance use disorder

4. Addiction Substance Withdrawal Alcoholism Physical dependency Psycholo gical dependency

5. Substance use disorder A condition in which the use of one or more substances leads to a clinically significant impairment or distress

6. Prevalence Substance abuse has been described as a “chronic relapsing disease” with extremely high relapse rates that range from 56.8% to 81.8% According to the 2022 United States National Survey on Drug Use and Health (NSDUH): 46.8 million (16.7%) Americans (aged 12 and older) battled a substance use disorder in the past year and 10.5% of Americans 12 and older had an alcohol use disorder in the past year. According to the 2015 Swaziland State of the Youth Report, 58.9% of out-of-school youth drink alcohol on a daily or weekly basis With regards to drugs, Eswatini is popular for growing first-grade cannabis or marijuana and illegally export it.

7. Public concern Violence criminal acts health care needs rehabilitative services reduced labour productivity and judicial expenditure is evident. Individual concerns Societal concerns

8. Two key interventions to tackle substanceuse disorder Prevention Treatment which includes counselling

9. Classification of substance related disorders Substance use disorders Dependence Abuse Substance induced disorders Intoxication Withdrawal Delirium Dementia Amnesia Psychosis Mood disorders (mania/ depression) Anxiety disorders Sexual dysfunction Sleep disorders

10. Brain areas and neurotransmitters affected by drug use and addiction Key brain areas: reward system, prefrontal, cortex and limbic system Key Neurotransmitters: dopamine and serotonin

11. Note that neurons are protected by a blood–brain barrier (BBB) in order to keep many substances or toxins out of the brain, only fat soluble cross the BBB

12. N eurotransmitters and Receptors involved with SUD Dopamine Serotonin Norepinephrine Glutamate Gamma-aminobutyric acid Acetylcholine Endogenous opiate system Cannabinoid system

13. Serotonin is responsible for good feelings, positive moods, appetite, and healthy sleep patterns GABA is an inhibitory neurotransmitter that inhibits the transmission of nerve impulses that contribute to motor control and vision G lutamate is an excitatory neurotransmitter that is associated with learning and memory. Because GABA inhibits neural communication and glutamate mediates neural signals, these neurotransmitters work in collaboration to control many brain processes. Drugs change the stability of glutamate and GABA by having sedating or stimulating effects on the brain.

14. Drugs that increase GABA or decrease glutamate are depressants or tranquilizers, and those that decrease GABA or increase glutamate are stimulants. Overstimulation of glutamate receptors can result in neural cells dying. The impact on these neurotransmitters is categorized as either being agonistic or antagonistic. Agonistic effects will increase neurotransmitter production, increase neurotransmitter release, or activate receptor sites that respond to neurotransmitters

15. Brain structures Brain stem handle motor control, attention, fear and pleasure regulation, cardiac and respiratory function, regulation of the CNS and the maintenance of consciousness Ventral tegmental area (VTA)- substance and reward circuits of the brain, responsible for cognition and emotion, its neurons projects to the prefrontal cortex Substantia nigra play a role in the reward seeking and learning Dorsal raphe nucleus contributes to learning, memory and affect

16. Basal ganglia Nucleus accumbens - cognitive process of motivation, pleasure, reward and reinforcement Amygdala- memory and decision making and emotional process

17. Cortex Anterior cingulate cortex- reward anticipation, empathy, emotion, impulse control Dorsolateral prefrontal process- executive functions which include working memory, cognitive flexibility and planning Orbitofrontal cortex- reinforcement, decision making process Insular cortex- processing of negative emotional experience Hippocampus- memory and emotions

18. various drugs in different categories have been used to experience euphoria. Drugs of abuse that penetrate the BBB have to be fat-soluble to be able to penetrate the barrier to affect our brain cells and neurotransmission

19. Dopamine pathways neurotransmitter Distribution in the CNS Functions affected Drugs that affect it Dopamine midbrain, ventral tegmental area (VTA, cerebral cortex Pleasure and reward, movement, attention, memory all drugs directly and indirectly augment dopamine in the reward pathway Mostly Cocaine, methamphetamine, amphetamine ,

20. 3 dopamine pathways involved in SUD Mesolimbic- runs between the ventral tegmental area to the nucleus accumbens and project to the amygdala, bed nucleus of the stria terminals and lateral hypothalamus Mesocortical - extend to the frontal lobes Nigrostrial - primarily controls movement

21. Serotonin pathways neurotransmitter Distribution in the CNS Functions affected Drugs that affect it Serotonin Midbrain, ventral tegmental area, cerebral cortex, hypothalamus Mood, sleep, sexual desire, appetite Ectasy , LSD, cocaine

22. Norepinephrine and Endogenous pathways neurotransmitter Distribution in the CNS Functions affected Drugs that affect it norepinephrine Midbrain, VTA, cerebral cortex, hypothalamus Sensory processing, movement, sleep, mood memory Cocaine, methamphetamine, amphetamine Endogenous opiods Widely distributed in the brain but regions vary in type of receptors, spinal cord Analgesia, sedatives, controls the rate of blood functions, mood Heroin, morphine, painkillers,

23. Endogenous cannabinoids and acetylcholine neurotransmitter Distribution in the CNS Functions affected Drugs that affect it Endogenous cannabinoids Cerebral cortex, hippocampus, thalamus, basal ganglia Movement, cognition and memory marijuana acetylcholine Hippocampus, cerebral cortex, thalamus, basal ganglia, cerebellum Memory, arousal, attention, mood nicotine

24. Glutamate and Gamma-aminobutyric acid (GABA) neurotransmitter Distribution in the CNS Functions affected Drugs that affect it Glutamate(called an excitatory neurotransmitter) Widely distributed in the brain Mediate the rewarding effects of drugs Increased rate of neuron activity, learning, cognition, memory Ketamine, phencyclidine, alcohol Gamma-aminobutyric acid (GABA) Widely distributed in the brain Slows the rate of neuron activity, memory Sedatives, tranquilizers, alcohol

25. Reward Pathway: the pleasure centre, or limbic system. The basic actions of the limbic system when mood-altering substances crossed the BBB- mechanisms of the limbic system in response to drugs NB* chemical structure of many drugs have similar chemical structure to our naturally occurring brain chemicals that help alleviate pain, or help stimulate energy production.

26. Reward System normally. Frontal cortex- functions in personality expression, decision making, and behaviour Ventral tegmental area (VTA) is a group of neurons at the centre of the brain that is connected to the prefrontal cortex and nucleus accumbens , and it receives information to see if a person's biological needs are getting met. VTA- mediates dopamine release to control desire and inhibition, Nucleus accumbens

27. Reward system cont. When the VTA gets information that something is satisfying the body, the VTA will then forward this information by the dopamine neurotransmitter. The increase in the level of dopamine overwhelms the nucleus accumbens and tells the prefrontal cortex, “Do that behaviour again; it feels good.” This pathway is a natural process and is activated by behaviours that are pleasurable (e.g., eating favourite food). Through the amygdala and hippocampus, our brains remember which behaviours will result in us feeling pleasure. Drugs overstimulate this reward system by producing large amounts of dopamine that create euphoric effects, which generates a powerful reinforcement Positive reinforcement strongly motivates people to engage in drug-taking behaviours and creates a cycle of addiction.

28. So with substance abuse The nucleus accumbens and VTA are activated in the binge/intoxication stage. As discussed earlier, the reward pathway results in a positive reinforcement to keep engaging in a behaviour. The nucleus accumbens and amygdala are important in the withdrawal/negative affect phase. Constant exposure to drugs results in a reduction in the number of dopamine receptors in the nucleus accumbens ; thus more drug-taking behaviour is needed for a person to feel normal. It has been found that changes to the amygdala have been related to drug withdrawal symptomatology (i.e., irritability, anxiety, stress) In this process, negative reinforcement is at work facilitating drug-taking behaviour.

29. The main brain structures involved in the preoccupation/anticipation stage are the frontal cortex and hippocampus (resp. for decision making). The choice to try a drug is a decision that that is centred in the executive portion of the brain, the prefrontal cortex. Once consumed, the drug delivers a powerful stimulus to the nucleus accumbens , a cluster of nerve cells below the cerebral cortex, which responds quickly by releasing a flood of dopamine. The neurotransmitter dopamine is often called “the pleasure molecule,” but it is more correctly defined as a chemical that underlies motivation. It focuses attention on and drives people to pursue specific goals

30. D rugs of abuse primarily act on the brain’s reward circuitry, increasing the dopamine in larger than normal amounts. Dopamine, remember, is considered to be one of the principal neurotransmitters to create feelings of well-being and the euphoric experiences associated with mood-altering drugs of abuse It then signals many other neurons to get excited, thus bringing about a cascade of well-being, superior sensations of joy, relaxation, empowerment, confidence, strength, and many other pleasurable sensations that comprise euphoria

31. Brain areas Nucleus accumbens , a cluster of cells below the cortex in the basal forebrain that produces the urge to pursue a goal. Sometimes called the “pleasure center ” of the brain, it is a key player in the reward circuitry of the brain and releases dopamine in response to positive experiences and the anticipation of such experiences. Dopamine neurons , which are concentrated in the nucleus accumbent and form pathways of connection to other parts of the brain when activated by positive experiences.

32. Prefrontal cortex, responsible for executive functions as judgment, decision-making, impulse control; it gradually weakens in response to overactivation of the reward circuits by drugs of abuse. Amygdala , which registers emotional significance of perceptions, is highly responsive to drug-related cues and sets in motion the rise and fall of craving. Hippocampus , seat of memory; under the influence of dopamine, the memory of an expected reward results in overactivation of the reward and motivation circuits and decreased activity in the cognitive control centres of the prefrontal cortex.

33. Repeated use of a drug changes the wiring of the brain in a number of ways. It stimulates the nucleus accumbens , and overactivity of the nucleus accumbens progressively weakens its connectivity to the prefrontal cortex Result in impaired judgment, decision-making, and impulse control The biological weakening of decision-making areas in the brain suggests why addicts pursue and consume drugs even in the face of negative consequences or the knowledge of positive outcomes that might come from quitting the drugs.

34. Signs and symptoms of substance abuse Neuropsychological issues relevant to specific substance use and some process addictions relevant to counselling are mainly: thought, emotion, and/or behaviour. (NB reason for using CBT in drug and alcohol counselling)

35. Alcohol Cognitive deficits inherent in alcohol use-disordered clients Two of the more severe examples of adverse influences of alcohol on cognition are Wernicke-Korsakoff Syndrome (WKS) and alcohol-induced dementia. WKS is a common alcohol-induced cognitive impairment caused by a lack of vitamin B1 (thiamine) in the brain as a result of malnutrition. WKS primarily presents as a dramatic decline in memory capability Alcohol-induced dementia, caused by overconsumption of alcohol, produces severe cognitive impairments in such areas as executive functioning and emotion regulation

36. Particularly relevant to counselling significant neuron loss in the frontal cortex area. This area governs memory, attention, mood regulation, and various skills involved in judgment and risk taking Thus executive functioning deficits are also linked with relapse Other neurological deficits are visuospatial deficits, which impact the ability to focus on relevant stimuli for a task. In addition, critical deficits exist in the social-cognition arena related to difficulty in emotional Processing Recovering alcohol use-disordered individuals struggle with memory coding and retrieval issues to note in counselling.

37. Cocaine Cocaine use leads to changes in several brain areas, including the prefrontal cortex and anterior cingulate cortex Cocaine use may inhibit new cell development in the hippocampus, thus impairing memory. In addition, cocaine use may cause new extensions on dendrites More dendrite branches in the Neucleus Accumbens may collect a greater volume of nerve signals coming from areas such as the hippocampus and amygdala. The additional linkages to the hippocampus and amygdala may explain the intense craving

38. Other issues include prefrontal and temporal brain region changes potentially contributing to memory deficits, poor facial emotion expression and executive functioning deficits predicting poor treatment engagement and poor treatment outcomes

39. Opioids Opiates impair cognitive functioning with specific impairments to the frontal cortex and hippocampus. Deterioration of the brain’s white matter, which may impact decision-making abilities, behaviour regulatory ability, and responses to stress

40. cannabis There still exists a debate regarding specific neuropsychological impairment due to cannabis use disorder, though some evidence indicates possible problems with daily life tasks Deficits in learning, memory, verbal language, and various executive functions

41. Methamphetamine Deficits in abstract reasoning, cognitive flexibility and behavioural regulation Most methamphetamine use-disordered individuals show behaviours common for those with frontal systems dysfunction such as impulsivity, apathy, and sensation seeking Risky decision making and poor judgment linked to the toxic effects of methamphetamine on the dopaminergic system

42. Users also experience learning and memory issues In addition, failure to sustain long-term attention may be linked to damaged areas such as the anterior cingulate cortex Other deficient brain areas (e.g., prefrontolimbic ) may be responsible for the difficulties with facial affect recognition

43. Inhalants Chronic inhalant use has serious neurological and neuropsychological effects, likely due to damage of neuronal membranes Inhalants cause brain stem dysfunction and a variety of motor, cognitive, and sensory deficits Symptoms could include irritability, tremor, ataxia, slurred speech, or decreased visual acuity, and difficulty with attention and executive functions

44. QUESTIONS COMMENTS

45. Reflection on Brain disease model of addiction Disease model of Addiction Moral failing

46. Activity 1 Study the brain areas and neurotransmitters involved in substance use and addiction and describe the signs and symptoms inherent in cannabis, alcohol, tobacco, cocaine, pethidine use Describe Societal and cultural perspectives on substance use (influence and consequences) Describe Health and Mental Health problems associated with dagga and alcohol use disorder and addiction with reference to the brain areas, neurotransmitters and body systems involved in SUD