HEROIN ADDICTION

Case Study of Elliss Substance Abuse Disorder Final Paper Christine Gregoire SS440-01 Dr. Eszter Barra-Johnson March 4, 2010 Kaplan University

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Case Study of Elliss Substance Abuse Disorder Final Paper History of Heroin Heroin was first introduced in 1874 in the USA. At first it was used mainly for respiratory conditions, as well as with morphine addiction and withdrawal, which is interesting to mention, since heroin was derived from morphine (Heroin 2009). When heroin was first introduced, it was not considered to be addictive. However, it was not long until scientist discovered that heroin was highly addictive. It is considered a downer which in turn affects the brains pleasure systems and also affects the way the brains ability to distinguish pain. In other countries, heroin has been used as a pain killer for the terminally ill; but in the United States heroin is banned and considered illegal. This opiate drug is extracted from the seedpod of the Asian poppy plant. At its purest, it appears as a white powdery substance and is said to be bitter tasting. Heroin is distributed in powder form and may vary in color because of impurities left from the manufacturing process or the dealers cutting their products. Heroin use has devastating effects on society due to its health issues, increasing abuse, and continued availability. Substance Abuse Disorder Substance abuse can only be defined as an outline of any damaging use of any substance for mood-altering reasons. The term substance abuse often refers to the use of a substance with frequency that it causes the person physical or mental harm and impairs their social functioning. Any time someone takes a drug or any substance for that matter, it creates a reaction in the body. Doctors and pharmacists can predict the reactions of prescription drugs when taken according to dosage instructions (Henningfield, 2008). It is in fact that reaction which is the desired result and is beneficial to the persons health.

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However, it is when a person ignores instructions and takes medicine they do not need or in excessive amounts that adverse effects occur. These include dependences and addiction. The latter, addiction has changed in meaning in recent years it originally meant, in pharmacology circles, that a person was becoming tolerant to the effects of a drug and needed to take more and more for it to be effective. To the general public, however, addiction came to mean someone propensity to keep abusing a drug even though they knew it was not good for them. Medicine and science adopted their own definitions as well, largely incorporating the publics view, but adding some significant and important differences as well (Henningfield, 2008). Signs and Symptoms of Drug Abuse Not all drugs have the same physical affects although; the symptoms of addiction are the same no matter what the substance is. (Help guide.org, 2010). The more the drug is used the more it begins to take control of the addicts life. Some of the more common symptoms of a person who uses drugs are: One begins to neglect responsibilities such as not going to work, school, and paying bills, all due to drug use. y Taking excessive risk, for example driving a car, operating machinery, having unprotected sex, sharing needles. y y Legal troubles. The persons drug use affects their personal relationships.

There is a difference between using drugs and abusing drugs. Not everyone that uses drugs will become a drug addict. Some of the symptoms of a drug addict are as follows: (Help Guid.org, 2010).

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The addict builds a tolerance of the drug and requires more of the drug to meet their needs.

The addict takes drugs to prevent withdrawals from the drug. If the addict begins to experience such as vomiting, shakes, insomnia, depression and anxiety the addict will seek out drugs to help relieve the symptoms.

One keeps telling themselves they dont have a problem with drugs, denial they can stop at anytime.

The addict will lose contact with friends, family, and social groups. The addicts life revolves around planning their next fix so to speak.

The addict also stops doing what they enjoy such as: hobbies, sports ect.

Substance Disorder According to the DSM IV TR The DSM IV TR defines substance abuse as how significantly it interferes with the users life. If substances disrupt your education, job, or relationships with others, and put you in a physically dangerous situation (Durand and Barlow, 2007, p.389), however in order to be diagnosed with substance abuse disorder on must meet certain criteria. Addiction is now considered a disease because scientists now believe it affects the brain and because of this stopping the addiction is not as simple as one my think. Case Study: Ellis Substance Abuse Disorder Ellis meets the criteria for substance abuse disorder according to the DSM IV TR because his entire life has been affected. He is on the verge of losing his job, family and has placed himself in dangerous situations and if he continued on the road that he was traveling he would eventually have legal problems because of him stealing to support his habit. Ellis has socially withdrawn

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from life spending little or no time with his issues with children and his wife. At first Ellis was able to maintain work and family however since that point he has lost all touch of reality and can no longer maintain his current lifestyle due to his addiction to drugs. The Role of Neurotransmitters in Developing Heroin Addiction Neurotransmitters influence behavior heroin is a disease that affects the brain and because of this stopping the addiction is not as simple as one my think. Being addicted to heroin is considered a chronic condition often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted (Understanding drug abuse, 2008). It is now said that having a drug addiction is like having a brain disease because using drugs changes the whole structure of the brain and its functions. People have the choice whether to use drugs or not when a person begins the use of drugs the brain takes over their ability to say no. They no longer have the impulses to resist the drug. Using drugs affect the way the brain receives and processes information and attacks the nerve cells, sending abnormal messages (Understanding drug abuse, 2008)

Dopamine is a neurotransmitter that is found in the brain its what makes us happy or sad; it is sometimes called the pleasure chemical. Using drugs will cause surges in the neurotransmitter Dopamine and the brain eventually will decrease the amount of the neurotransmitter it produces. When first used, heroin has a troublesome effect on the brains dopamine system; the transporters will be blocked and will return dopamine to its home cell (Understanding drug abuse, 2008). Since the dopamine system helps us know pleasurable experiences and seek to repeat them, heroin long-term dopamine effects add to the craving addicts feel, and the decreased enthusiasm, underdeveloped emotion and uncomfortable withdrawal they face. A heroin addict

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continues to use drugs to bring their dopamine level to normal and to do this they may require more and more heroin just to maintain their levels.

Genetic Contributions to Heroin Addiction

Research Suggest no two people are the same and not everyone who tries an addictive drug will become an addict. When looking at addictive conditions small variations in few genes can increase or decrease the probability of some people developing an addiction of heroin (Science daily, 2008). A study was conducted using a sample size of 400 severe heroin addicts, Rockefeller University researchers have identified several genetic variations in American and Israeli Caucasians that influence the risk for becoming addicted to one of the worlds most powerful substances (Science daily, 208). Increasing evidence has supported that certain people may be genetically prone to drug addiction, although, most research on genetic connection to addictive substances have been on alcoholism (Barlow & Durand, 2007).

Brain Abnormalities with Heroin Addictions

Brain influence with addiction is strong; research has looked closely on the frontal part of the cortex which controls a person ability to make decisions. Researchers also believe that people may be predisposition to addiction because they feel this part of the brain is malfunctioning (Innovations, 2008). Scientist at the University of Nottingham conducted test using MRI scans to investigate the addicted brain to see if the brain is indeed abnormal due to a defect in the addictive person decisions making part of the brain. Because of this connection to abnormalities in the brain with addiction researchers are debating whether an addict is responsible for the addictive behaviors.

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Case Study

Comparing biological factors against Elliss case it can be determined that he could have a predisposed genetic factor based on his fathers addiction to alcohol. There are many biological factors that are involved with the addicted brain. It was said that when Ellis used drugs and alcohol his mother did little or nothing to intervene and his father laughed,(Case study 4) which only rewarded his behaviors which in turn encouraged him to do it more. It is said that individuals who grow up with alcoholic parents may be more inclined to develop a problem with alcohol or other substances (Henningfield, 2008, p.51).

Environmental Influences Environmental factors play a role in a person that uses drugs. Information has discovered the development of addictive disorders to be a multifaceted process involving an individuals weakness and influences from the environment (OBrien, 2003). Still what makes a person turn to drugs? Researchers have identified a number of traits of the individual and the environment (1) poor impulse management and an inclination to seek out feelings rather than avoid harm (which may have a biochemical foundation and may show up in the kindergarten period). (2) family influences (such as a genetic predisposition to alcoholism, parental use or acceptance of drugs, poor or inconsistent parenting, family conflicts, troubled or distant family relationships, and not living with two biological parents (Feldman, R., & Olds, S., & Papalia, D., 1999, p.528). Nature of Environmental Influences

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How do they work? Living in a community with little or no excess to education, jobs, or affordable housing can influence a person choice to use drugs as a means of escape. However, this does not mean that someone that lives in a wealthy community will not use drugs it simply means that in lower income neighborhoods drugs are more readily available. An important factor here is children that grow up around drugs either because their parents are users or they live in a neighborhood that is a drug dealers paradise will more than likely become users themselves. Youth living in urban neighborhoods about 76% have witnessed or been victimized by violence in their community. This experience puts them at risk for posttraumatic stress disorder, depression, anxiety, and substance abuse use (Bukatko, D., 2008, p.570). Most Important Environmental Influence Early education is the most important factor in the fight against drug addiction. There are many prevention programs aimed at helping kids at risk and current drug users to stop using drugs and many of these programs are aimed at preventing the use of drugs among children such as, after school programs, another program of this sort, which is well known and very popular in most school systems is the D.A.R.E. program. Children that have access to such programs are less likely to use drugs. Education is thought to be a key factor in the war against drugs. It is believed that if both parents and children are well aware of what drugs can do to an individual, then drug use will decline. Some programs also work with the community to make deterrence systems in order to support healthy and drug free communities. Some of these programs work collectively with the police to help get rid of drug dealers, and the users off the streets. One thing is for sure whatever the program is; the plan is to form healthy lifestyles by discouraging the use of drugs (Bukatko, 2008).

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Nature versus Nurture Genetics versus environmental which one has the most impact on heroin addiction. Drug addiction is a disease of the brain. Genetic Contributions in addiction small variations in few genes can increase or decrease the probability of some people developing an addiction to heroin (science daily, 2008). Rockefeller University researcher have identified several genetic variations in American and Israeli Caucasians that influence the risk for becoming addicted to one of the worlds most powerful substances (Science daily, 2008). Increasing evidence has supported that certain people may be genetically prone to drug addiction, although, most research on genetic connection to addiction substance have been on alcoholism (Durand and Barlow, 2007). So can a lack of hugging and nurturing cause a person to use drugs? Some will say yes and others will say no. Scientist have debated many years about this Biology Factors Biological viewpoints believe that abnormal actions can be caused by genetics, the brain, central nervous system, and the environment that a person is raised in. This particular viewpoint is supported by a variety of medical research. Research has proved that certain characteristics of an individual, such as a chemical imbalance in the brain, can be hereditary and passed from parent to child. Other research has proved that some people are born with abnormalities in the brain or in the nervous system, such as too much of one chemical and not enough of another for example too much of serotonin (Abrams, 2005). Environment Interact with a Persons Biological System with Heroin Addiction Biological factors interacting with environmental issues which one has a greater influence? If a child is born with brain abnormalities and has a parent that is a drug user then as stated

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earlier that child has a great chance of becoming an addict. In the case of heroin addiction a persons environment can have a greater chance of drug use. If drugs are openly available and the person lives in a community that is high in drug trafficking then environment may win out. However if a person is born with a chemical imbalance their chances are good as well if no treatment is received earlier in life. Case Study Others and environment can have an influence on whether a person uses drugs or not. Ellis grew up in a home that alcohol and abuse was a factor, part of the home so to speak (Case study 4). During Elliss teen years when it is normal for teens to explore he had no one to tell him that it was wrong instead he got rewarded for his negative behaviors. His father planted the seeds for his adulthood by re-enforcing his behavior instead of correcting his behaviors through discipline and other punishments for his coming home late and his excessive drinking and drug use. How an individual thinks about drugs is a learned behavior what is seen around him. If it is in the home, then it will become a part of the childs life and his thinking because he has never been shown otherwise.

Medical Approaches to Heroin Addiction

Treatments that are available are in-house detoxification, according to data collected admission in a substance abuse clinic have increased from 228,000 in 1995 to 254,00 in 2005 (See appendix A); however primary heroin admission has remained steady at about 14 to 15 percent (Dasis Report, 2007). Detoxification programs can assist the addict with the horrific withdrawals. Usually addicts are given a pharmacological agent usually methadone, to help the addict successfully rid their body of heroin over time; however detoxification is just the first

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step. To successfully treat the addict one must also treat psychological, social and some time even legal issues that the addict may have, in other words reasons why the addict turned to the drug to begin with. Once the addict has successfully completed a detoxification program addicts must continue to attend therapy sessions and it is highly recommended that the addict get involved in a 12-step program.

Methadone maintenance is when an addict receives a fixed dose of methadone on a regular schedule to maintain a normal range in their system so the body will act normal. By addicts receiving a dose of methadone it helps the addict fight off the extreme cravings for the drug so the addict may go back living a normal life. As with anything some people believe this is only a substitute and not a cure. However, using methadone the addicts does not get a high and if the addict does use heroin they also will not get high (Ferreiro, C 2003).

Other treatments using buprenorphine and Levo-alpha-acetylmethadol (LAAM) have been used for detoxification. Buprenorphine is a partial opioid agonist medication that is safe, even at high doses, and less severe withdrawal symptoms than methadone when stopped (Ferreiro, 2008, p.69). LAAM is a long acting analogue of methadone but still under investigation and instead of receiving a dose weekly like methadone LAAM requires an injection three times a week hence the cost is more (Ferreiro, 2003)

Most Successful Treatments According to Research

Highly successful treatment of heroin is methadone. This is the most popular treatment for heroin users because it allows the addict to level off their levels and maintain a normal live as well. Methadone is considered a narcotic and is a powerful substance with a high success rate.

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An adult addict, methadone is usually given as an oral drug in doses ranging from 5-20 mg. If an addict is using methadone as a detoxification method then a higher dose is given until the addict has successfully withdrawn from heroin. Methadone treatment is monitored by health professionals and is carefully withdrawn according the addicts addiction, however, some addicts stay on it from two years to a life time, every addict is different and so are their needs. Some argue that methadone is not a means to end type of program because there is no set time frame to stop the treatment (Centre for addiction and mental Health, 2009).

How the effects of these Medications have with the Chemistry in the Brain

Brain chemistry and neurotransmitter activity is severely affected because as stated earlier drug addicts are considered to have a brain disease. Dopamine is a neurotransmitter that gives the body pleasure and the more a person is high the lower this level goes the more the person craves the drug. The brain is the way the body communicates, if one is taking drugs the messages that are sent are disrupted. Drugs modify synaptic transmission, changing the way neurons communicate with each other. A drug that affects dopamine synaptic transmission can increase the dopamine that reaches the receiving neuron (West, 2007, p.1). A research was conducted on an ex-addict or was clean for 12 months and what was found was the brain was not of a normal brain (West, 2007). So drug use does interfere with normal brain growth and how the brain processes and receives information.

Psychosocial Treatments Commonly Used Treating heroin using psychosocial treatments does show promise but, research has shown that other treatments must be used as well, such as therapy and Narcotic Anonymous (NA). The

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fact that no two people are alike also means no two people will respond to treatment the same way. Psychosocial treatment means a study of a person culture, family background, as well as the psychological influences. These approaches include: cognitive, behavioral, and interpersonal methods (Durand and Barlow, 2007, p.g7). Since memory and pleasure zones are tangled in the brain, researchers use psychological approaches to help stop the use of drugs. Rehabilitation centers use a form of classical conditioning methods to rehabilitate addicts. The therapist will expose the addict to drugs and with cognitive scripts, for example using how drugs destroy lives and families and what can be accomplished without the use of drugs. By the therapist using classical conditioning it shows the addict the negative side of drug use. Treatment Plan Combine treatments using both medical and psychosocial methods would best suit Ellis current heroin addiction. Ellis a thirty year old male has presented with a heroin addiction. His family history has shown some physical abuse and his father had an alcohol problem. His mother never worked outside the home, but had little say with discipline of the children (Case study 4). The best treatment plan for Ellis would be a inpatient hospital stay so that he can be medically monitored during his withdrawal stage also it is highly recommended that he participate in individual therapy that would emphasize psychological approaches like classical conditioning to help change his negative behaviors with more positive behaviors. It is also recommended that he attend NA meetings with a 12 step program daily until he feels comfortable with his addiction. In conclusion addiction is a disease that affects both the addict and society all around them. Biological and environmental factors play a major role with addiction. Being raised surrounded by drugs will influence a person choice in whether to use or not to use. Also carrying the

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addiction gene can be a factor on whether one is predisposed to an addictive personality. Drug addiction is a disabling disease that can ruin an individuals life. The psychological aspect of addiction is that it is human nature to repeat behaviors especially ones that bring pleasure (Henningfield, 2008). People just dont wake up one day and become an addict; it takes time and doesnt happen overnight, addiction just doesnt happen that way. For some, society and a persons ability to handle the stresses of everyday life play a role with addiction. The medical profession believes that there is something in the individuals psychological make-up that can lead to addiction (Henningfield, 2008, p.19). Is it heredity? Some believe that it is. Researcher are looking at genes that control dopamine a neurotransmitter responsible for pleasure and sensation its what makes a person happy as a starting point. Treatment is available for the addict if he/she wants the help. In order for treatment to be successful the addict must be a willing participant because given anything less than one hundred percent will deem failure in treatment. Ellis has a bright future if he continues with his treatment as ordered and changes his beliefs on his life. Ellis needs to address his childhood and learn to accept life at face value. Treatment for substance abuse using both psychological and psychosocial methods can be successful if applied to individuals needs. No two people are alike so it stands to reason that no two people will respond to the same treatment. Ellis needs to commit to sobriety and also needs to re-think his social settings for examples his surroundings, home, work, and circle of friends these may need to change in order for him to be successful in his treatment.

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Reference Bukatko, D. (2008). Child and Adolescent Development: A chronological approach. Mason Ohio: Cenage Learning. Dasis Report, (2007). Heroin-changes in how it is used: 1995-2005. Retrieved January 18, 2010 from http://www.oas.samhsa.gov/2k7/heroinTX/heroinTX.htm

Durand, V.M., and Barlow, D.H. (2007). Essentials of Abnormal Psychology (5th ed.). Belmont, CA: Thomson Wadsworth.

Ferreiro, C. (2003). Drugs the straight facts: heroin. New York NY: Infobase. Henningfield, J. (2008). Addiction in America: Society, Psychology, and Heredity. Broomall, PA: Mason Crest Publisher Inc. Heroin. (2009). Columbia electronic encyclopedia. http://web.ebscohost.com.kaplan.uah.edu/ehost/delivery?vid=8&hid=101&sid=b35cfd92c Innovations, Report. (2008, October 23). Could Brain abnormality predict drug addiction?. Retrieved from http://www.innovationsreport.com/html/reports/medicine_health/brain_abnormality_predi

Kaplan University (2010) Abnormal Psychology SS440:Case study four: Ellis Substance Abuse Disorder.

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O'Brien, C. (2003). Research advances in the understanding and treatment of addiction. American Journal on Addiction, 2(12), Retrieved March 10, 2010: from http://web.ebscohost.com.kaplan.uah.edu

Papalia, D. Olds, S., Feldman, R. (1999). A Child's World (eighth ed). Madison, WI: McGraw Hill. Science, Daily. (2008, October 05). Variations in key genes increase Caucasians' risk of heroin addiction. Retrieved January 18, 2010 from http://methadonenews.blogspot.com/2008/11/variations-in-key-genes-increase.html Understanding drug abuse and addiction. (2008, June). Retrieved from http://drugabuse.gov/PDF/infofacts/understanding08.pdf Understanding, prevent & resolve life's challenges. (2010). Retrieved March 3, 2010 http://www.helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatm ent.htm West, C. (2007). Addiction studies program. Retrieved March 3, 2010 from http://www.addictionstudies.org/journalists/stories-west-brainchem.html

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Appendix A

Figure 3. Primary Heroin Admissions, by Service Setting and Route of Administration: 1995 and 2005

Figure 3 Table. Primary Heroin Admissions, by Service Setting and Route of Administration: 1995 and 2005 Inhalation Injection 1995 2005 1995 2005 Ambulatory Detoxification 59% 54% 71% 48% 9% 15% 29% 32% 20% 37% Residential/Rehabilitation 12% 14%

Source: 2005 SAMHSA Treatment Episode Data Set (TEDS)

Dasis Report, (2007). Heroin-changes in how it is used: 1995-2005. Retrieved from http://www.oas.samhsa.gov/2k7/heroinTX/heroinTX.htm

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