Research Topics: Morphine Treatment

Why Black have a Higher Tendency to Smoke Marijuana and White Males often Smokes Cigarette

Methodology   This paper will discuss the methods and procedures used and done in the study: the background of the study, hypothesis and aims, the research method, the sample and sampling technique, the data collection method, the validation of the instrument and the statistical treatment of data.   Background, Aims and Hypothesis of the Study Today, drug addiction is one of the major problems of society. This menace has spread throughout the world in both advanced and impoverished countries. Heroin, LSD, marijuana, hashish, cocaine, codeine, morphine, novocaine, ganja and brown sugar – the most commonly used drugs – are openly being sold even in public places, and are readily available on the streets.   In Southwest London, marijuana is widely available illegally. Ecstasy and Special K are uncommon. London has a small snap problem, with the downtown eastside containing a few crack houses and accompanying dealers. Pharmaceutical drugs, such as morphine, oxycodone and other opiates are increasing in use (www.encyclopedia.com). The central eastside of the city is thought of as being less safe than other parts of the city, with the adage “EOA” (East of Adelaide) suggesting that one is in the dangerous part of town.   In this regard, this paper aims to investigate, the issues of marijuana among black males and smoking practices of white males in Southwest London.   Hypotheses For this study, the following null hypotheses shall be tested: 1)      There is no significant relationship between the status of black male respondents and perception about marijuana smoking; 2)     There is no significant relationship between the status of white respondents and perception about cigarette smoking; and 3)     Smoking (both cigarette and marijuana) has no significant impact to current status of drug court programs in London.   Research Method Used             The descriptive approach was used in this study to determine the effects of marijuana and cigarette to its user. Specifically, the study intends to explore the reasons behind marijuana and cigarette smoking.   According to Creswell (1994), a descriptive research tries to explore the cause of a particular phenomenon. It also intends to present facts concerning the nature and status of a situation, as it exists at the time of the study. In addition, such approach tries to describe present conditions, events or systems based on the impressions or reactions of the respondents of the research.   Basically, a descriptive research utilises observations and surveys. For this reason, the researcher chose this approach because it is the intention of the researcher to gather first hand data. This way, the researcher will be able to formulate sound conclusions and recommendations at the end of the study.  The descriptive approach is also quick and more practical financially. Moreover, this method will allow for a flexible approach, thus, when important new issues and questions arise during the duration of the study, a further investigation may be allowed. Further, this type of approach will allow the researcher to drop unproductive areas of research from the original plan of the study.   However, this research is also partly based on quantitative research method so as to permit a flexible and iterative approach. The choice and design of methods are constantly modified during data gathering based on ongoing analysis. This allowed for an investigation of important new issues and questions as they arose.   In addition, this study also employed partly qualitative research method, since this research intends to find theories that would explain the relationship of one variable with another variable through qualitative elements in research. These qualitative elements do not have standard measures; rather, they are behaviour, attitudes, opinions, and beliefs.   The qualitative research is described as multi-method in focus, involving an interpretative, naturalistic approach to its subject matter. This means that a qualitative researcher studies things in their natural settings, attempting to make sense of, or interpret phenomena in terms of the meanings people bring to them. Accordingly, a qualitative researcher deploys a wide range of interconnected methods, hoping always to get a better fix on the subject matter at hand. (Walliman and Bousmaha, 2001)   This research study basically aims to determine why black males have a higher tendency to smoke marijuana and white males often smokes cigarette.  Specifically, the study intends to explore the significant impact of variables related to the reasons of smoking marijuana or cigarette, to determine the needs of the users, to identify if they are satisfied by the current status of drug court programs in London, to illustrate the measures being done by the London government in addressing thee problems of smoking, and to know what must be done to solve the marijuana and cigarette issues in London.   Sample and Sampling Technique             The respondents of the study for came from a rehabilitation centre in Southwest London that is previously engaged in marijuana (for black males) and cigarette smoking (for white males). Due to time constraint and also, for the convenience of the researcher, only thirty (30) respondents were considered for the study. The convenience sampling technique was imposed in the study to pick up the thirty respondents, mainly because the availability of the respondents was considered.               This part of the study is important because the most important data needed to fulfil the objectives of this study will only be supplied by the respondents from Southwest London that are involved in the drug court rehabilitation program.   Data Collection Method to be Used             In gathering the data needed in this study, the survey method, also known as the questionnaire method, was utilised. The researcher constructed a questionnaire and administered them to the respondents. The respondents were requested to answer the inquiries in the survey-questionnaire, each grading the statements using the Likert scale.  The equivalent weights for the answers will be: Range                                                Interpretation             0.00 – 1.49                                        Strongly Agree 1.50 – 2.49                                        Agree 2.50 – 3.49                                        Undecided 3.50 – 4.49                                        Disagree          4.50 – 5.00                                        Strongly Disagree               In the Likert technique, a set of attitude statements are presented, where subjects of a study are asked to express agreement or disagreement using a five-point scale. The degree of agreement is given a numerical value ranging from one to five, thus a total numerical value can be calculated from all the responses. (Underwood, 2004). The researcher also conducted a face-to-face interview for at least 6 respondents (3 for black males and 3 for white males) to ensure the validity of the research.   Validation of the Instrument             For validation purposes, the researcher pre-tested a sample of the set survey questionnaires. This was done by conducting an initial survey to at least five respondents from Southwest London. After the respondents answered, the researchers then asked them to cite the parts of the questionnaire that needs improvement. The researcher even asked for suggestions and corrections from the respondents to ensure that the survey-questionnaire is effective. Automatically, these five respondents were not included as respondents for the study.   Statistical Treatment of Data             After all the data from the researcher-made questionnaire were collected, the following statistical formulae were used: 1.       Percentage – to determine the magnitude of the responses to the questionnaire.             n % = ——– x 100        ;           n – number of responses             N                                 N – total number of respondents 2.       Weighted Mean             f1x1 + f2x2  + f3x3 + f4x4  + f5x5 x= ———————————————;                         xt where:             f – weight given to each response                         x – number of responses                         xt – total number of responses   The researcher will be assisted by the Statistical Package for the Social Sciences (SPSS) in coming up with the statistical analysis for this study. SPSS is one of the most widely available and powerful statistical software packages that covers a broad range of statistical procedures, which allows a researcher to summarise data (e.g., compute means and standard deviations), determine whether there are significant differences between groups (e.g., t-tests, analysis of variance), examine relationships among variables (e.g., correlation, multiple regression), and graph results (e.g., bar charts, line graphs). (Einstein and Abernethy, 2000)    Reference   Creswell, J.W. (1994). Research design. Qualitative and quantitative approaches. Thousand Oaks, California: Sage.   Einstein, Gil and Abernethy, Ken. (2000). Statistical Package for the Social   Sciences (SPSS Version 10.0). Greenville, South Carolina: Furman            University.   Underwood, Mick. (2004). The Likert Scale. In Communication Studies, Cultural Studies, Media Studies (CMMS) Infobase. Available at: [www.cultsock.ndirect.co.uk/MUHome/cshtml/index.html]. Accessed: [07/08/04].   Walliman, Nicholas and Bousmaha Baiche. (2001). Your research project. California: Sage Publications       Credit:ivythesis.typepad.com

Why Black have a Higher Tendency to Smoke Marijuana and White Males often Smokes Cigarette

Methodology This paper will discuss the methods and procedures used and done in the study: the background of the study, hypothesis and...

The Spread of Methamphetamine Use in the U.S.

Stimulants have been used medicinally for thousands of years. Chinese physicians have used ma haung, a tea made from the herb Ephedra vulgaris, as a medicinal herb for 5000 years. Chat, another stimulant, was used 2000 years ago by Roman gladiators to overcome fatigue and thus fight longer during contests (Wadler, 1994). Coffee has been in existence since at least A.D. 900, when an Arabian medical book referred to it as useful for a variety of indications, including measles and lust reduction. Coffee drinking was so widespread that coffeehouses were common in England, Arabia, and France as early as the 1600s (Ritzler, Erard and Pettigrew, 2002)   Other drugs used historically for medicinal purposes include opiates, alcohol, and marijuana. Opiates were used as early as the third century B.C. as analgesics, to treat anxiety and psychotic disorders, and were even given to children to ease colic. Fermented honey (mead) may have been used since 8000 B.C. By 6400 B.C., beer and berry wine were being used by Neolithic humans (Ray and Ksir, 2002). Alcohol was also used to reduce anxiety and to help insomnia sufferers fall asleep (Doweiko, 1999). By the 1500s, drugs were big business. Prior to the arrival of the Spanish in South America in 1518, the coca leaf had been chewed by the Incas in their religious ceremonies and was used as a medium for barter (Byck, 1987;). As Spanish landlords realized that chewing the coca leaf reduced thirst, hunger, fatigue, and increased productivity, the practice of chewing the leaves was encouraged and soon became widespread (Mann, 1994) Cocaine was extracted in 1859. Combined with the invention of the syringe in 1853 cocaine use began to increase in popularity. The extracts from the coca leaf were used in a range of medicinal drinks including CocaCola. Cocaine use was widespread; users included many prominent people, among them Sigmund Freud, who was one of cocaine’s greatest proponents (Doweiko, 1999).   Opiates, cocaine, and alcohol were so widely used that, by the early 1900s, when there was great concern with drug use, many patented medicines containing these drugs were sold on the streets by peddlers. The ingredients of these snake oil concoctions were kept secret. No agency existed to regulate the contents or claims made about these drug cordials. When the medical community began to question the claims made about these elixirs, the conflict led to the Pure Food and Drug Act of 1906, which prohibited the distribution of food and drugs that were misbranded.   Another law that passed in the effort to control the manufacture and distribution of opiates was the Harrison Act of 1914. Dr Hamilton Wright thought that the U.S. would improve its trading status with China by helping the Chinese control the importation of opium. In 1912, an international conference was held; at that time, Great Britain wanted to include controlling the importation of morphine, heroin, and cocaine as well. When all talks and compromises were over, the Harrison Act of 1914 was born; its intent was “to provide for the registration of, with collectors of internal revenue, and to impose a special tax upon all persons who produce, import, manufacture, compound, deal in, dispense, or give away opium or coca leaves, their cults, derivatives or preparation, and for other purposes” . The Harrison Act was meant to be solely a tax law and did not prevent the use or distribution of such drugs (Ray and Ksir, 2002). In the 1820s a “new drug” called marijuana (which had been used to make rope and clothing since George Washington grew it) came to the attention of Congress. Medicinal use of marijuana can be historically dated to the year 2737 B.C. when Emperor Shen Nung wrote a pharmacy book recommending the use of marijuana to treat “female weakness, gout, rheumatism, ben ben, constipation, and absent mindedness” (Snyder, 1970). There is also a documented case of physicians using marijuana on a rabies patient to control the terror and excitement that the patient suffered. In the 1800s, American and European physicians used marijuana as a hypnotic, anticonvulsant, analgesic, and as treatment for migraine headaches ( Grinspoon and Bakalar, 1992, 1993, 1995). It was not until the 1920s that marijuana became a concern in the U.S. In 1926, newspaper articles began associating marijuana use with violent crime (no evidence of this existed). Harry Aslinger, who was the U.S. Commissioner of Narcotics, reported in 1931 that marijuana use was not a problem. However, in a Congressional hearing in 1937, Aslinger reported that marijuana trafficking had increased at such an alarming rate “that it has come to be the cause for the greatest national concern”. By this time, newspaper and magazine reports of marijuana had burgeoned to include, not only violent crimes being committed, but also police interviews stating as much. These reports were believed by the public but, in fact, there was no evidence provided to support their validity. This concern led to the passage of the Marijuana Tax Act in 1937. This act required the registration and taxation of those importing, buying, or selling marijuana, but did not make the possession of marijuana illegal.   The Spread of Methamphetamine Use in the U.S.   After the withdrawal of Desoxyn and methedrine from the pharmaceutical market, illicit methamphetamine laboratories emerged in San Francisco late in 1962. Motorcycle gangs took over the manufacture and distribution of methamphetamine in the mid-1960s spreading it north and south along the Pacific Coast. By the 1970s the use of methamphetamine had spread from the blue-collar workers to include college students, young professionals, minorities, and women. By the 1980s intensified law enforcement efforts that targeted the biker subculture, together with new, easier ways of producing methamphetamine, caused the production and distribution to move to the San Diego area. With the move to San Diego, Mexican traffickers became involved in the manufacture and distribution. Large amounts of the illicitly produced methamphetamine and precursor chemicals were smuggled in from Mexico to California, and distributed not only to the traditional market, but also to the southwestern and midwestern states (Anglin et al., 2000). Large amounts of the illicitly produced methamphetamine and precursor chemicals were smuggled in from Mexico to California, and distributed not only to the traditional market, but also to the southwestern and midwestern states (Anglin et al., 2000). Hawaii and Ice   During the 1980s there was a surge in Hawaii of methamphetamine use when a smokeable, highly pure form of D-MA-hydrochloride (ice) became available, imported from Far East sources in the Philippines, Japan, Korea, and Taiwan (Laidler and Morgan, 1997). During the 1990s use of ice in the Hawaiian Islands became rampant. The distribution of methamphetamine in Hawaii was gradually dominated by Mexico- and California-based trafficking organizations. These crime groups are supplemented in Hawaii by extended kinship networks, which sometimes include whole families or neighborhoods (Laidler and Morgan, 1997). The use of ice in Honolulu had led to particularly serious physical and psychological problems and significant social disruption in poor working communities where it replaced marijuana which had become scarce and expensive due to eradication policies (NIDA, 1991-1994, summary).   There are thought to be several influences on the tremendous growth of ice in Honolulu after 1987. Residents were pushed away from marijuana, their staple drug of choice, and pulled toward ice by a well-organized marketing campaign by Asian distributors. Also, the overwhelming drug of choice, marijuana, which had been grown and used throughout the islands for many years, became the target of a government eradication campaign. This drove up prices and left locals without their customary smoke. Also very important, many locals derived either part of or their entire livelihood from marijuana production. Thus, when a new, easy-to-use smokeable product entered the market, one that at first seemed nonthreatening to youthful novitiates, i.e., ice, it was readily accepted.   Methamphetamine continues to be a major problem in Hawaii. Methamphetamine is readily available, with the majority of it converted into ice before it is distributed. In the past few years, ice-related crimes have increased as the drug has increased in popularity and availability. The Arrestee Drug Abuse Monitoring Program in 2001 revealed that 35.9% of males arrested from January to September 2001 tested positive for methamphetamine abuse. Further tests showed arrested males and females in Honolulu tested positive for methamphetamine at a higher rate than for marijuana (28.8%) and for cocaine (11.2%). Among 37 metropolitan areas, Honolulu has the highest percentage of arrested males testing positive for methamphetamine, according to a report from the U.S. Department of Justice. No other city approached 30%. Cities participating in the survey ranged from New York City and Philadelphia to San Diego and Seattle.   Effects of Methamphetamine Use   The cerebral damage caused by methamphetamine intoxication can be formidable. Prolonged use is associated with injury to the dopamine system. Essentially, continued methamphetamine use likely leads to axonic degeneration of the dopamine axon terminals in the striatum, frontal cortex, nucleus accumbens, and amygdala. Hypersensitization of neurons occurs, for example, in increasing sensitivity of D-1 receptors. It is important to note that changes in catecholamines alone cannot explain behavior in humans when they are methamphetamine intoxicated. Animal studies across several species demonstrate that high dosages of methamphetamine damage nerve cells . In rats, one high dose is enough to cause damage to neurons; prolonged administration increases the number of neurons that are killed off. In squirrels, a single dose of MDMA (which is structurally similar to methamphetamine and mescaline) in only slight doses significantly damages brain neurons that produce serotonin. Twelve to 18 months after exposure, serotonin-producing nerves grow abnormally or not at all. MDMA selectively damages serotonin neurons in virtually all species (Fischer et al., 1995).   Not surprisingly, high doses of methamphetamine can cause death. A male under arrest died with a blood content greater than 60 mg per liter after swallowing a “baggie” of methamphetamine. A toxic reaction in humans can occur at levels as low as 50 mg of pure methamphetamine for nontolerant users. Ischemic stroke is associated with methamphetamine inhalation (Shapiro, 1999). Massive strokes are fairly common. The second author conducted a neuropsychological evaluation of a 30-year-old, previously normal, federal employee who suffered multiple strokes and a vascularizing dementia after a single methamphetamine intoxication. Although a family history of strokes for members in their 60s and 70s was revealed, representing a possible vulnerability for the client, methamphetamine appeared to cause the client’s strokes long before they would normally be expected, given his family history. Methamphetamine taken intranasally has caused caudal thalamic infarctions in an abuser . Ischemic stroke is associated with methamphetamine inhalation.   In sum, much of the data suggest there is no way of establishing a “safe” or “unsafe” level of methamphetamine for a particular person, or even for the same person with repeated doses. With other drugs, and certainly with alcohol, use of the particular substance must continue for a given time period (e.g., 12 months) and be accompanied by maladaptive behavior to qualify for a DSM-IV diagnosis of substance abuse. Preliminary data suggest that this is in marked contrast to methamphetamine abuse where a small number of intoxications can create catastrophic changes in physical and mental functioning. There are multiple factors, in addition to its untoward effects on nontolerant users, that cause the effects of methamphetamine to be unpredictable. The properties of methamphetamine itself can create unpredictable reactions. Further, there may be impurities in the drug. Methamphetamine manufactured in clandestine labs is frequently impure. Methamphetamine can be used to “cut” other drugs, which means that interactive effects must be considered. Also, a variety of toxic chemicals can be used as the precursors from which methamphetamine can be formed (e.g., ephedrine and pseudoephedrine, benzyl chloride, benzyl cyanide, methylamine); or as reagents, substances that react with precursors (e.g., hydriodic acid, iodine, mercuric chloride, sodium cyanohydridoborate); or as solvents (e.g., ethanol, ethyl chloroform, acetone). Residues of these substances may contaminate the final product.   There are two basic methods for producing methamphetamine, each of which requires 2 to 4 days to produce a batch. One method involves the reaction of phenyl-2-propanone (P-2-P), phenylacetine, and methylamine. The other method uses ephedrine as a precursor chemical, which does not necessitate use of a controlled precursor. This method, referred to as the ephedrine/red phosphorus method, requires the use of hydrogenator. Red phosphorus is on the list of less restricted chemicals in many states, and information that this chemical can be obtained from the fireworks and matchmaking industries has been widely disseminated on the Internet since 1996 (e.g., see deadlock@paranoia.com). The striking pad on match covers is about 40% red phosphorus and 30% antimony sulfide, with lesser amounts of glue, iron oxide, manganese dioxide, and glass powder. Some of these chemicals, alone or in combination, can cause toxic reactions in the methamphetamine user. In addition, the ephedrine/red phosphorus method often produces “garbage” methamphetamine. Unless simple precautions are followed, which are typically not followed by makers who are often chronic methamphetamine users themselves, high amounts of iodoephedrine and azirine are produced as contaminants.    References Anglin, D., Burke, C., Perrochet, B., Stamper, E., and Dawud-Noursi, S. (2000). History of the methamphetamine problem. J. Psychoactive Drugs, 32(2), 138-139. Byck, R. (1987). Cocaine use and research: three histories. In S. Fisher, A. Rashkin, and E.H. Unlenhuth, Eds., Cocaine: Clinical and Behavioral Aspects. New York: Oxford University Press Doweiko, H.E. (1999). Concepts of Chemical Dependency. Brooks/Cole: Pacific Grove, CA. Fisher, R.P. and Geiselman, R.E. (1992). Memory-Enhancing Techniques for Investigative Interviewing: The Cognitive Interview. Springfield, IL: Charles C Thomas. Grinspoon, L. and Bakalar, J.B. (1992). Marijuana, in Substance Abuse: A Comprehensive Textbook, 2nd ed., Lowenson, L.H., Ruiz, P. Millman, R.B., and Langrod, J.G. (Eds). Baltimore: Williamson and Wilkins. Grinspoon, L. and Bakalar, J.B. (1993). Marijuana: The Forgotten Medicine. New Haven, CT: Yale University Press. Grinspoon, L. and Bakalar, J.B. (1995). Marijuana as medicine. J. Am. Med. Assoc., 273, 1875-1876. Laidler, K. and Morgan, P. (1997). Kinship and the community; the Ice crisis in Hawaii, in H. Klee, Ed., Amphetamines Misuse; International Perspectives on Current Trends. Reading, U.K.: Harwood International Publishers. Mann, J. (1994). Murder, Magic and Medicine. New York: Oxford University Press. National Institute on Drug Abuse (1999). Methamphetamine Abuse Alert. NIDA Notes, 13(6). Ritzler, B., Erard, R., and Pettigrew, G. (2002). A final reply to Grove and Barden: the relevance of the Rorschach Comprehensive System for expert testimony. Psychol Public Policy Law, 8(2), 235-246. Shapiro, D. (1999). Legal milestones. Bull Am. Acad. Forensic Psychol, 20(1), 3, 17-21. Snyder, A.G. (1998). The Neurocognitive Functioning of Dually Diagnosed Patients with Schizophrenia and a Substance Abuse Disorder. Doctoral dissertation. University of Houston. Wadler, G.I. (1994). Drug use update. Med. Clin. North Am., 78(2), 439-455. Credit:ivythesis.typepad.com

The Spread of Methamphetamine Use in the U.S.

Stimulants have been used medicinally for thousands of years. Chinese physicians have used ma haung, a tea made from the herb Ephedra vul...

Morphine Treatment on Neonatal Abstinence Syndrome

Introduction Even pregnancy is insufficient motivation for many women to stop using drugs. There are many drugs of abuse that can readily cross the placenta and affect the fetus. The consequences can be miscarriages, premature deliveries, low birth weight, congenital deformities, and an increased risk of sudden infant death syndrome. The infant of a woman addicted to narcotics, such as morphine, is also likely to develop withdrawal symptoms within a few hours after delivery, but occasionally symptoms do not develop until late in the first week of life. The use of any drugs during pregnancy can lead to many medical complications for the mother and the baby, including elevated rates of premature labor, abruptio placentae, precipitous labor, and growth retardation. Because addictive drugs cross the placenta, a newborn may suffer from withdrawal or neonatal abstinence syndrome after birth when the supply of drugs from the mother is suddenly cut off (Black & Schuler, 1995).   Literature Review Neonatal abstinence syndrome refers to the certain group of symptoms and signs displayed by neonates or infants with drug dependencies. These are usually characteristics of symptoms and signs of withdrawal. There are two major types of neonatal abstinence syndrome, the prenatal neonatal abstinence syndrome and the postnatal neonatal abstinence syndrome. The cause of prenatal neonatal abstinence syndrome which is maternal substance abuse has both developmental and medical effects for the newborn, in addition to the health, economic, and legal outcomes for the mother. Postnatal neonatal abstinence syndrome is a result of an occurrence of an abrupt discontinuation of opioid analgesia, which usually happens after prolonged drug exposure. Neonatal abstinence syndrome is more pronounced in infants with long-term exposure to fentanyl than in those who are exposed to morphine (Belik & Hawes, 2006).             Neonatal abstinence syndrome usually appears within 72 hours of birth; the infant may die if the withdrawal is severe and untreated. Manifestations of neonatal abstinence syndrome depend on a variety of factors, including the drug that was used, the dose of the drug, frequency of use, and the neonate’s own metabolism and elimination of the active compound or compounds (Belik & Hawes, 2006). It is important to note that neonates are more sensitive to many drugs. Newborns are deficient in the liver microsomal enzyme systems that are involved in the metabolism of many drugs. Although neonatal abstinence syndrome depends on type of drug exposure and obstetric factors, it may involve the autonomic (for example, sneezing or yawning), central nervous (for example, tremors, irritability, abnormal suck or poor feeding), pulmonary (for example, increased apnea), and gastrointestinal (for example, diarrhea and vomiting) systems of the newborn (Sun, 2004). Characteristics of neonatal abstinence syndrome include convulsions and tremors, jitteriness, high-pitched crying, increased muscle tone or hypertonicity, diarrhea, irritability, respiratory distress, yawning, sneezing, sweating, mottling, vomiting, and fever (Black & Schuler, 1995). Neonatal abstinence syndrome is often a disorder that affects many systems in the body of the neonate and as previously mentioned frequently involves the gastrointestinal and central nervous systems. In addition, prenatal neonatal abstinence syndrome depends on the neonate’s last exposure to an intrauterine drug and also the drug metabolism and excretion of the mother. The symptom of withdrawal is generally a function of the half-life of the drug (Belik & Hawes, 2006). Although many cocaine-exposed infants do not display signs of neonatal abstinence syndrome, perhaps related to the short half life of the drug, recent research suggests that some cocaine-exposed infants may show signs of withdrawal, described as “excitable.” Infants undergoing withdrawal tend to sleep less than non-drug exposed infants and to suffer from gastrointestinal distress. Infants who are unpredictable, unreadable, or unresponsive are less likely to be involved in effective, rewarding interactions with their mothers. Thus, drug-exposed infants may have temperamental qualities that make caregiving difficult with few immediate rewards (Black & Schuler, 1995). To better understand morphine as treatment for neonatal abstinence syndrome, it is better to discuss first about the effects and action of morphine. Morphine is the principal alkaloid of opium. It is among the drugs that are widely abused. A good grade of opium contains 9-14% morphine. It is also a metabolite of codeine. It is rapidly absorbed after subcutaneous, intravenous, or intramuscular administration. Absorption after oral administration is variable. It is widely distributed in the body, mainly in the kidney, liver, lungs, and spleen with lower concentrations in the brain and muscles. It does not accumulate in the tissues. Morphine, an opium alkaloid, is the prototype of the narcotic analgesics. Morphine thus relieves pain. It provides analgesia at a dose that does not result in severe alterations in consciousness. Morphine is not very affective when given orally. It is biotransformed before reaching the general circulation, undergoing conversion to inactive metabolites in the liver and other tissues. The resulting water-soluble products are then excreted in the urine. It is particularly effective when given intrathecally. There are at least three nonmutually exclusive sites at which opioids, which have morphine-like action, could act to produce analgesia. These are peripherally, at the site of an injury; in the dorsal horn “gate,” where nociceptive fibers synapse on dorsal root ganglion cells; and at more rostral sites in the brain stem (Ganong, 2001).             Opioid receptors are produced in dorsal root ganglion cells and migrate both peripherally and centrally along their nerve fibers. In the periphery, inflammation causes the production of opioid peptides by immune cells, and these presumably act on the receptors in the afferent nerve fibers to reduce the pain that would otherwise be felt.             Morphine is mainly excreted in the urine as the 3-glucuronide (65-70%) with only 10% as the free compound. Thus, for sensitive screening, the urine must be hydrolyzed. This can be done by enzymatic or acid hydrolysis. Since morphine and codeine are often found together the thin layer chromatographic system described was developed to separate both of these compounds. People have used opium and its derivatives (opiates) for thousands of years to relieve pain and stress. Opiates such as morphine are generally extracted from the seedpods of certain varieties of poppy plants. Heroin, however, is a chemically altered form of morphine. Opiates such as morphine can produce the most intense effects on both the mother and the infant. Aside from the withdrawal symptoms characteristic of neonatal abstinence syndrome, the usual findings in infants exposed to opiates include low birth weight, intrauterine growth retardation, and prematurity. Some delayed withdrawal signs and symptoms may occur up to 6 days to one week after birth (Belik & Hawes, 2006)             In spite of the escalating clinical burden of neonatal abstinence syndrome, optimal managementstill remains unclear as clinical trial evidence is not sufficient. Conservative measures such as minimal stimulation and holdingmay be sufficient if symptoms are non-progressive and mild. However,the more critical symptoms require plenty of pharmacotherapy. There are manypharmaceutical agents that have been used historically to treat neonatal abstinence syndrome,including clonidine, chloral hydrate, chlorpromazine, opioids,opiates, and phenobarbitone. Studies up to the present can be criticizedon their problemswith randomization, lack of standardization of outcome measures, and the failure to use a pre-evaluated system of scoring to allow standardization of the start of treatment, termination of pharmaceutical treatment, and dosage alterations (Jackson, et al, 2003). Infants who have neonatal abstinence syndrome secondary to maternal drug treatment during pregnancy for addiction to opiate must have a treatment for her withdrawal and this often results in a lengthy hospital stay. The results of a case study to determine if there are modifiable factors that influence the length of hospital stay of infants with neonatal abstinence syndrome indicate that receiving doses of neonatal opiate solution every 3 to 4 hours instead of every 6 hours may decrease the length of hospital stays for the infants. 41 infants who were born to mothers who were receiving drug treatment for opiate addiction at time of delivery were the participants in the study. There are factors that were analyzed to see if they were connected with an increased length of hospital stay. These factors were maternal methadone dose, number of Finnegan scores over 8 prior to initiation of therapy, Finnegan score at initiation of therapy, day of life when therapy was initiated, initial and peak dose of neonatal opiate solution. It was found out in the study that the peak dose of neonatal opiate solution and dosing interval are significantly related to length of hospital stay. The researcher of this study believes that more frequent dosing of the neonatal opiate solution may decrease the length of hospital stays for these infants (Rose, 1999). In one particular study using morphine as treatment, oral morphine sulphate was selected as a treatment option since opiates are the predominant class of drugsused by drug dependent pregnant women in the area relative to the study. A sample size of 80 was estimated todetect a 0.5 SD difference in the total duration of pharmacologicaltreatment between the treatment groups. After obtaining informed written parental consent, neonateswith a history of maternal drug use and two sequential scoresof > 4 using the Lipsitz tool were considered eligiblefor randomization in the study. Alternative diagnoses for a babywho is irritable were not included by clinical examination and biochemical analysis(Jackson, et al, 2003). By random, the infants were to receive morphine sulphate or phenobarbitoneorally, both labeled as substance A and substance B respectively.The morphine sulphate was prescribed in a doseof 50 µg/kg and a dose of 2 mg/kg for the phenobarbitone. Bothof these drugs were administered four times a day in equal volumes as identical colorlessand odorless solutions (Jackson, et al, 2003). Data from this study and various others reveal that in comparison, the use of opiates with other agents to treat symptomatic neonatal abstinence syndrome are limited. Morphine all alone was superior to the combination of phenobarbitoneand diazepam, and to the combination of morphine, phenobarbitone,and diazepam. In another randomized study, pregnant women who were dependent on opiates or who abusedpolysubstances were treated with slow release morphine of intermediatelength half life and the results showed that this did not reduce neonatal abstinence syndrome more than methadone did. Women who received slow release morphine used fewer opiates and benzodiazepines additionally than women who received methadone.All the children were born healthy according to the study (Fischer, et al, 1999). Most interventions for drug-dependent pregnant women have been directed at the prenatal period, with significant positive effects. More recent programs feature postpartum intervention components. In contrast to the absence of data on postpartum interventions for drug-dependent mothers and their infants, there is a rapidly growing literature on drug rehabilitation programs for drug-abusing adults. A recent review of this literature has suggested that outpatient treatment is at least as effective as inpatient treatment. In three studies, follow-up clinical outcome was superior, treatment was shorter, and costs were lower for outpatients than for inpatients. The absence of data on interventions for specific drugs used by mothers, particularly teenagers, and their infants highlights the importance of further research (Field, et al, 1998). This 4-month intervention program consisted of several components, including drug and social rehab, parenting and vocational classes, and relaxation therapy (aerobics, progressive muscle relaxation, music mood induction, and massage therapy), and took place afternoons in a vocational high school the mothers attended. Mornings were spent in high school or prep classes. The infants of these mothers received day care while they were in classes and the rehab program. In addition, the mothers spent approximately 1-2 hours per day in the nursery school, helping to take care of their infants. The nursery was designed for multilevel infant enrichment and was staffed by a head teacher, two assistant teachers, and three of the mothers, who served as teacher-aid trainees. It served 12 infants at a time (Field, et al, 1998). Neonatal abstinence syndrome babies are treated with low doses of drugs that answer their bodies’ inborn craving for narcotics and calm their overwrought nervous systems. These medications may include tincture of opium, methadone, phenobarbital and others. The doses are decreased over time in a weaning process that can take several weeks or longer. During this time, babies must be intensively monitored to ensure they’re not overmedicated, which could lead to cardiac or respiratory arrest, brain damage and death. In one healthcare setting, each tiny bedside is crowded with equipment — heart monitors, oxygen sensors, feeding tubes, vital sign recorders, intravenous pumps and more. Once they’re relatively stable, babies may be transferred to the less-hectic neonatal continuing care nursery and then to the general pediatric unit (Haskell, 2006).   Conclusion Treatment of addiction requires months or years of individualized rehabilitation. Brain alterations and behavior patterns consolidated by long-term drug exposure do not disappear with detoxification or short- term, inpatient rehabilitation programs. While the preferred goal of treatment is complete abstinence, relapses are likely. Consequently, a prolonged period of outpatient care is necessary. While most drug- related addictions are improvable, there are no cures. Newborn infants rarely die from drug withdrawal, but long term effects have not been thoroughly studied. Most crucial in the management of infants of mothers who have a drug addiction is the evaluation of the home situation to determine if the infant will be safe following discharge from the hospital. The support of the relatives, friends, and health professionals may enable the mother to care for the infant. Otherwise, an alternative care plan may be in the best interests of the infant. Credit:ivythesis.typepad.com

Morphine Treatment on Neonatal Abstinence Syndrome

Introduction Even pregnancy is insufficient motivation for many women to stop using drugs. There are many drugs of abuse that can rea...

Sample Essay Morphine Treatment on Neonatal Abstinence Syndrome

Morphine treatment on Neonatal Abstinence Syndrome   Introduction Even pregnancy is insufficient motivation for many women to stop using drugs. There are many drugs of abuse that can readily cross the placenta and affect the fetus. The consequences can be miscarriages, premature deliveries, low birth weight, congenital deformities, and an increased risk of sudden infant death syndrome. The infant of a woman addicted to narcotics, such as morphine, is also likely to develop withdrawal symptoms within a few hours after delivery, but occasionally symptoms do not develop until late in the first week of life. The use of any drugs during pregnancy can lead to many medical complications for the mother and the baby, including elevated rates of premature labor, abruption placenta, precipitous labor, and growth retardation. Because addictive drugs cross the placenta, a newborn may suffer from withdrawal or neonatal abstinence syndrome after birth when the supply of drugs from the mother is suddenly cut off (Black & Schuler, 1995).   Literature Review Neonatal abstinence syndrome refers to the certain group of symptoms and signs displayed by neonates or infants with drug dependencies. These are usually characteristics of symptoms and signs of withdrawal. There are two major types of neonatal abstinence syndrome, the prenatal neonatal abstinence syndrome and the postnatal neonatal abstinence syndrome. The cause of prenatal neonatal abstinence syndrome which is maternal substance abuse has both developmental and medical effects for the newborn, in addition to the health, economic, and legal outcomes for the mother. Postnatal neonatal abstinence syndrome is a result of an occurrence of an abrupt discontinuation of upload analgesia, which usually happens after prolonged drug exposure. Neonatal abstinence syndrome is more pronounced in infants with long-term exposure to fontanel than in those who are exposed to morphine (2006).             Neonatal abstinence syndrome usually appears within 72 hours of birth; the infant may die if the withdrawal is severe and untreated. Manifestations of neonatal abstinence syndrome depend on a variety of factors, including the drug that was used, the dose of the drug, frequency of use, and the neonate’s own metabolism and elimination of the active compound or compounds (2006). It is important to note that neonates are more sensitive to many drugs. Newborns are deficient in the liver microtonal enzyme systems that are involved in the metabolism of many drugs. Although neonatal abstinence syndrome depends on type of drug exposure and obstetric factors, it may involve the autonomic (for example, sneezing or yawning), central nervous (for example, tremors, irritability, abnormal suck or poor feeding), pulmonary (for example, increased apnea), and gastrointestinal (for example, diarrhea and vomiting) systems of the newborn (Sun, 2004). Characteristics of neonatal abstinence syndrome include convulsions and tremors, jitteriness, high-pitched crying, increased muscle tone or hyper tonicity, diarrhea, irritability, respiratory distress, yawning, sneezing, sweating, mottling, vomiting, and fever (Black & Schuler, 1995). Neonatal abstinence syndrome is often a disorder that affects many systems in the body of the neonate and as previously mentioned frequently involves the gastrointestinal and central nervous systems. In addition, prenatal neonatal abstinence syndrome depends on the neonate’s last exposure to an intrauterine drug and also the drug metabolism and excretion of the mother. The symptom of withdrawal is generally a function of the half-life of the drug (2006). Although many cocaine-exposed infants do not display signs of neonatal abstinence syndrome, perhaps related to the short half life of the drug, recent research suggests that some cocaine-exposed infants may show signs of withdrawal, described as “excitable.” Infants undergoing withdrawal tend to sleep less than non-drug exposed infants and to suffer from gastrointestinal distress. Infants who are unpredictable, unreadable, or unresponsive are less likely to be involved in effective, rewarding interactions with their mothers. Thus, drug-exposed infants may have temperamental qualities that make care giving difficult with few immediate rewards (Black & Schuler, 1995). To better understand morphine as treatment for neonatal abstinence syndrome, it is better to discuss first about the effects and action of morphine. Morphine is the principal alkaloid of opium. It is among the drugs that are widely abused. A good grade of opium contains 9-14% morphine. It is also a metabolite of codeine. It is rapidly absorbed after subcutaneous, intravenous, or intramuscular administration. Absorption after oral administration is variable. It is widely distributed in the body, mainly in the kidney, liver, lungs, and spleen with lower concentrations in the brain and muscles. It does not accumulate in the tissues. Morphine, an opium alkaloid, is the prototype of the narcotic analgesics. Morphine thus relieves pain. It provides analgesia at a dose that does not result in severe alterations in consciousness. Morphine is not very affective when given orally. It is biotransformed before reaching the general circulation, undergoing conversion to inactive metabolites in the liver and other tissues. The resulting water-soluble products are then excreted in the urine. It is particularly effective when given Intrathecal. There are at least three no mutually exclusive sites at which uploads, which have morphine-like action, could act to produce analgesia. These are peripherally, at the site of an injury; in the dorsal horn “gate,” where nociceptive fibers synapse on dorsal root ganglion cells; and at more rostra sites in the brain stem (Gaming, 2001).             Upload receptors are produced in dorsal root ganglion cells and migrate both peripherally and centrally along their nerve fibers. In the periphery, inflammation causes the production of upload peptides by immune cells, and these presumably act on the receptors in the afferent nerve fibers to reduce the pain that would otherwise be felt.             Morphine is mainly excreted in the urine as the 3-glucuronide (65-70%) with only 10% as the free compound. Thus, for sensitive screening, the urine must be hydrolyzed. This can be done by enzymatic or acid hydrolysis. Since morphine and codeine are often found together the thin layer chromatographic system described was developed to separate both of these compounds. People have used opium and its derivatives (opiates) for thousands of years to relieve pain and stress. Opiates such as morphine are generally extracted from the seedpods of certain varieties of poppy plants. Heroin, however, is a chemically altered form of morphine. Opiates such as morphine can produce the most intense effects on both the mother and the infant. Aside from the withdrawal symptoms characteristic of neonatal abstinence syndrome, the usual findings in infants exposed to opiates include low birth weight, intrauterine growth retardation, and prematurely. Some delayed withdrawal signs and symptoms may occur up to 6 days to one week after birth (Belk & Hawes, 2006)             In spite of the escalating clinical burden of neonatal abstinence syndrome, optimal managementstill remains unclear as clinical trial evidence is not sufficient. Conservative measures such as minimal stimulation and holdingmay be sufficient if symptoms are non-progressive and mild. However,the more critical symptoms require plenty of pharmacotherapy. There are manypharmaceutical agents that have been used historically to treat neonatal abstinence syndrome,including coniine, chloral hydrate, chlorpromazine, uploads,opiates, and phenobarbitone. Studies up to the present can be criticizedon their problemswith randomization, lack of standardization of outcome measures, and the failure to use a pre-evaluated system of scoring to allow standardization of the start of treatment, termination of pharmaceutical treatment, and dosage alterations (Jackson, et al, 2003). Infants who have neonatal abstinence syndrome secondary to maternal drug treatment during pregnancy for addiction to opiate must have a treatment for her withdrawal and this often results in a lengthy hospital stay. The results of a case study to determine if there are modifiable factors that influence the length of hospital stay of infants with neonatal abstinence syndrome indicate that receiving doses of neonatal opiate solution every 3 to 4 hours instead of every 6 hours may decrease the length of hospital stays for the infants. 41 infants who were born to mothers who were receiving drug treatment for opiate addiction at time of delivery were the participants in the study. There are factors that were analyzed to see if they were connected with an increased length of hospital stay. These factors were maternal methadone dose, number of Finnegan scores over 8 prior to initiation of therapy, Finnegan score at initiation of therapy, day of life when therapy was initiated, initial and peak dose of neonatal opiate solution. It was found out in the study that the peak dose of neonatal opiate solution and dosing interval are significantly related to length of hospital stay. The researcher of this study believes that more frequent dosing of the neonatal opiate solution may decrease the length of hospital stays for these infants (Rose, 1999). In one particular study using morphine as treatment, oral morphine soleplate was selected as a treatment option since opiates are the predominant class of drugsused by drug dependent pregnant women in the area relative to the study. A sample size of 80 was estimated todetect a 0.5 SD difference in the total duration of pharmacologicaltreatment between the treatment groups. After obtaining informed written parental consent, neonateswith a history of maternal drug use and two sequential scoresof > 4 using the Lipchitz tool were considered eligiblefor randomization in the study. Alternative diagnoses for a babywho is irritable were not included by clinical examination and biochemical analysis(Jackson, et al, 2003). By random, the infants were to receive morphine soleplate or phenobarbitoneorally, both labeled as substance A and substance B respectively.The morphine soleplate was prescribed in a doseof 50 µg/kg and a dose of 2 mg/kg for the phenobarbitone. Bothof these drugs were administered four times a day in equal volumes as identical colorlessand odorless solutions (Jackson, et al, 2003). Data from this study and various others reveal that in comparison, the use of opiates with other agents to treat symptomatic neonatal abstinence syndrome are limited. Morphine all alone was superior to the combination of phenobarbitoneand diazepam, and to the combination of morphine, phenobarbitone,and diazepam. In another randomized study, pregnant women who were dependent on opiates or who abusedpolysubstances were treated with slow release morphine of intermediatelength half life and the results showed that this did not reduce neonatal abstinence syndrome more than methadone did. Women who received slow release morphine used fewer opiates and benzodiazepines additionally than women who received methadone.All the children were born healthy according to the study (Fischer, et al, 1999). Most interventions for drug-dependent pregnant women have been directed at the prenatal period, with significant positive effects. More recent programs feature postpartum intervention components. In contrast to the absence of data on postpartum interventions for drug-dependent mothers and their infants, there is a rapidly growing literature on drug rehabilitation programs for drug-abusing adults. A recent review of this literature has suggested that outpatient treatment is at least as effective as inpatient treatment. In three studies, follow-up clinical outcome was superior, treatment was shorter, and costs were lower for outpatients than for inpatients. The absence of data on interventions for specific drugs used by mothers, particularly teenagers, and their infants highlights the importance of further research (Field, et al, 1998). This 4-month intervention program consisted of several components, including drug and social rehab, parenting and vocational classes, and relaxation therapy (aerobics, progressive muscle relaxation, music mood induction, and massage therapy), and took place afternoons in a vocational high school the mothers attended. Mornings were spent in high school or prep classes. The infants of these mothers received day care while they were in classes and the rehab program. In addition, the mothers spent approximately 1-2 hours per day in the nursery school, helping to take care of their infants. The nursery was designed for multilevel infant enrichment and was staffed by a head teacher, two assistant teachers, and three of the mothers, who served as teacher-aid trainees. It served 12 infants at a time (Field, et al, 1998). Neonatal abstinence syndrome babies are treated with low doses of drugs that answer their bodies’ inborn craving for narcotics and calm their overwrought nervous systems. These medications may include tincture of opium, methadone, Phenobarbital and others. The doses are decreased over time in a weaning process that can take several weeks or longer. During this time, babies must be intensively monitored to ensure they’re not overmedicated, which could lead to cardiac or respiratory arrest, brain damage and death. In one healthcare setting, each tiny bedside is crowded with equipment — heart monitors, oxygen sensors, feeding tubes, vital sign recorders, intravenous pumps and more. Once they’re relatively stable, babies may be transferred to the less-hectic neonatal continuing care nursery and then to the general pediatric unit (Haskell, 2006).   Conclusion Treatment of addiction requires months or years of individualized rehabilitation. Brain alterations and behavior patterns consolidated by long-term drug exposure do not disappear with detoxification or short- term, inpatient rehabilitation programs. While the preferred goal of treatment is complete abstinence, relapses are likely. Consequently, a prolonged period of outpatient care is necessary. While most drug- related addictions are improvable, there are no cures. Newborn infants rarely die from drug withdrawal, but long term effects have not been thoroughly studied. Most crucial in the management of infants of mothers who have a drug addiction is the evaluation of the home situation to determine if the infant will be safe following discharge from the hospital. The support of the relatives, friends, and health professionals may enable the mother to care for the infant. Otherwise, an alternative care plan may be in the best interests of the infant.   Annotated Bibliography  (2000). Textbook of Medical Physiology 10th Edition. Harcourt Asia Pte Ltd.             To the authors of this book, the importance of whole-body physiology for understanding organ and cellular physiology and for designing meaningful cellular or molecular biologic experiments cannot be overemphasized today. The understanding of whole-body physiology is the basic prerequisite for health care professionals practicing clinical medicine and is the main reason for this book. This book is very useful for practicing health care professionals as well as students in the health care field.   (2001). Review of Medical Physiology 20th Edition. McGraw-Hill.             This book still focuses on physiology. It is published with hope that the new research and clinical experience that are mentioned in the book can broaden knowledge of health care professionals and help in the changes in treatment and drug therapy that are required. The author and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication.   (2006). The Merck Manual of Diagnosis and Therapy, 18th ed. Wiley.             The Merck Manual is a book that serves as a guide and a helping companion useful for health care professionals and patients or caregivers alike. All health care professionals need ever more information, and review of large areas of subject matter covered succinctly and completely is increasingly required. The Merck Manual continues to meet these needs, excluding mainly details of surgical procedures. The simplicity and the detailed account of conditions of which the book has been written makes it useable for individuals outside the health care profession.    (2004). Fundamentals of Nursing. Mosby.             Fundamentals of Nursing provides a contemporary approach to nursing practice, discussing the entire scope of primary, acute, and restorative care. This textbook is useful for nursing instructors, nursing students, and other health care professionals. But basically, this book is designed for beginning students since it has a comprehensive coverage providing fundamental nursing concepts, skills and techniques. Credit:ivythesis.typepad.com

Sample Essay Morphine Treatment on Neonatal Abstinence Syndrome

Morphine treatment on Neonatal Abstinence Syndrome Introduction Even pregnancy is insufficient motivation for many women to stop usi...

Sample Research Paper PSYCHOLOGICAL ASSESSMENTS IN ALCOHOL AND DRUG ADDICTION

PSYCHOLOGICAL ASSESSMENTS IN ALCOHOL AND DRUG ADDICTION             Introduction                 People have the normal tendency to try things either out of curiosity or out of necessity.  There is an inclination to engage in certain behaviors or indulge in certain substances to determine their effects on one’s life.  Alcohol and drugs are two of the most common things that people use and often lead them to dependence.  Alcohol and drugs are not detrimental by their nature.  Both have normal effects when used appropriately.  People take drugs, for instance, because of their physical effects (Marsden 2005) or to treat some physical illnesses.  Alcohol is a normal indulgence during relaxation and leisure.  Both substances when used accordingly actually make people better.  The problem occurs when the people using them lose control and are overcome by their power.             Addiction in not merely the chronic use of something.  Addiction rather involves compulsion, loss of control over the time and amount of the thing used, and continued use despite negative consequences.  These consequences may range from impairment in physical, cognitive, psychological, emotional, social, and spiritual health (Landry 1994, p. 7).   Drug addiction and alcoholism can begin with only a few “tries”.  Depending on the “rush” or pleasurable sensation that happens to make a user tick, drug addiction and alcohol addiction over time is when the need for this sensation begins to consume a person’s mind, inhibits the ability to rationalize clearly, and becomes the very reason for which that person lives and thrives (Narconon Stone Hawk Rehabilitation Center 2006).             Alcohol and Drug Addiction               According to Addiction Intervention Resources Inc. (2006) addiction, drug addiction, alcoholism and chemical dependency are all common clinical vernacular for dependence upon alcohol, drugs or other harmful behaviors. The word “drug” is defined as “a chemical substance that affects the central nervous system, causing changes in behavior and often addiction.”   The symptoms of addiction include an inability to stop drinking or using drugs despite physical, mental, family, social, financial, legal, or other consequences.  Those who are addicted to drugs or alcohol exhibit a strong craving, loss of control, physical dependence and tolerance (Alcohol/Drug Council of North Carolina 2005).                         It is essential to understand that when dealing with addicts, we are dealing with individuals whose brains have been altered by alcohol, drug or behavioral abuse. Thus, they need addiction treatment                                                        (Addiction Intervention Resources 2006).   Treatment is the most effective way to help an addict begin the life long journey of recovery.  It removes the sufferer from the environment where they used alcohol and/or drugs and surrounds them with others who suffer from the same problems. Time in treatment can be short or long, but it provides a solid foundation for the process of change to begin (Alcohol/Drug Council of North Carolina 2005).   The Treatment Method               Millions of Americans are apparently “hooked”, not only on heroin, morphine, amphetamines, tranquilizers and cocaine, but also nicotine, caffeine, alcohol, sugar, and steroids.  There seems no end to their dependencies, their bewildering intractability, the glib explanations for their causes and even more glib solutions (Rodgers 1994, p.1).               Landry (1994) argued  that the most effective treatment for alcoholism, and indeed for addiction to any psychoactive drug, combines early intervention, education, counseling, self-help programs, neuro-feedback, a healthy diet, and pharmacological adjuncts that improve nutrition, particularly brain nutrition             (p. 313).               Moreover, there are different types of therapies that can support the treatment of the dependence. Cognitive behavioral therapy is a therapy in which a specially trained therapist tries to change the thoughts, feelings and conduct of the dependent person that lead to relapse, use or undesired behavior. The therapist also tries, together with the client, to teach certain behavior to prevent the person from relapsing: for example learning how to reject drinks or drugs that are being offered. The client learns how to deal with his intense need to use.  The therapy also teaches clients how to deal with life without the dependence. Other forms of therapy are psychodynamic psychotherapy, group therapy, family therapy, and self-help groups. Since addicts often use drugs to suppress unpleasant feelings, one goal of therapy often is to teach people to learn to accept unpleasant feelings and to handle them in constructive ways                 (Moelker 2006).     The Role of Psychological Assessments in the Treatment Method                 The recent news is that brain, mind, and behavior specialists are rethinking the whole notion of addiction. With help from neuroscience, molecular biology, pharmacology, psychology, and genetics, they’re challenging their own hard-core assumptions and popular “certainties” and finding surprisingly common characteristics among addictions.  They’re using new imaging techniques to see how addiction looks and feels and where cravings “live” in the brain and mind (Rodgers 1994, p.1).             Once an alcohol or drug dependent agrees to undergo treatment, two programs are available for him or her.  These are inpatient treatment or outpatient treatment.  Inpatient treatment, or often referred to as primary treatment, takes place in an alcohol and drug unit of a general medical-surgical hospital or in a freestanding treatment facility.  A good inpatient program uses a multifactorial approach of assessments which include medical, social and psychological assessments.  Detailed psychological assessments which consist mostly of testing are done early in treatment.  Two commonly used tests are the Minnesota Multiphasic Personality Inventory (MMPI) and the Shipley Institute of Living Scale (SILS) (Milhorn 1994, pp. 126-127). The Minnesota Multiphasic Personality Inventory-2 (MMPI-2)             The MMPI-2 instrument as reported by Butcher and Megargee (2006) is the most widely researched and widely used test of adult psychopathology to assist clinicians with the diagnosis of mental disorders and the selection of appropriate treatment methods. The test can be used to help assess major symptoms of social and personal maladjustment; give a strong empirical foundation for a clinician’s expert testimony; assess medical patients and design effective treatment strategies; and evaluate participants in substance abuse programs and select appropriate treatment approaches. The MMPI has two sets of scales. The first set reflects the patient’s degree of cooperation with the testing and indicates whether or not the other scale should be considered valid. The second set reflects his personal characteristics, as well as delusional, disorganized, or psychotic thinking (Milhorn 1994, pp. 126-127).   The MMPI has ten clinical scales that are used to indicate different psychotic conditions.  These scales are hypochondriasis, depression, hysteria, psychopathic deviate, masculinity/femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion (Van Wagner 2006).             According to A.S. (2006) the Addiction Acknowledgment Scale (AAS) is a Minnesota Multiphasic Personality Inventory (MMPI) subscale for assessing personality dimensions underlying the development of addictive disorders. It is a true/false questionnaire. It detects personality characteristics that are associated with developing alcohol abuse problems. The Shipley Institute of Living Scale (SILS)             The SILS is used to estimate verbal intelligence quotient (IQ). It also estimates cognitive quotient (CQ), which is an indication of the patient’s ability to think and reason. The verbal IQ is usually minimally affected by years of drug abuse, but the CQ may be depressed, indicating some degree of loss of brain functioning (Milhorn 1994, p. 127). CQ provides a measure of abstract ability, a skill that appears especially vulnerable to the effects of sustained abusive drinking (Campbell et. al 1999, p.1).  Repeat testing in three to four weeks will determine if this loss of intellectual functioning is reversible or permanent (Milhorn 1994, p. 127).             Senior (2001) wrote that the SILS is a self-administered test and consists of two subtests.  The first is the Vocabulary subtest of forty multiple choice questions in which the respondent is asked to choose which of four words is closest in meaning to a target word.  This subtest relies on verbal skills which include reading ability, verbal comprehension, acquired knowledge, long-term memory, and concept formation.  The second subtest in the Abstraction subtest of twenty questions in which sequences of numbers, letters, or words with the final element in each sequence omitted.  The respondent is required to complete each of the sequences. The Abstraction subtest relies more heavily on attentional abilities, letter, word, and number concept formation, abstract thinking, cognitive flexibility, analysis and synthesis, processing speed, long-term memory, and specific vocabulary and arithmetic skills.  Assessing a client’s abstract reasoning skills can assist with matching the client to a program with a strong cognitive -behavioral orientation (Salter 2005).  SILS’ use reflects the tests potential for detecting the presence of intellectual deterioration.  Another role for which the SILS is commonly employed is the assessment of general intellectual ability (Senior 2001).   Other Psychological Assessments Used in Alcohol and Drug Addiction Treatment   The Addiction Severity Index (ASI)                           The Addiction Severity Index (ASI) has also been used to predict the outcome of substance abuse treatment. The ASI, now in its fifth iteration, was commissioned by the National Institute on Drug Abuse, as a measure for the assessment of severity levels in the domains known to be affected by both alcohol and drug abuse. These domains are medical, employment, family/social, legal, and psychiatric/psychological (Craig and Olson 2004, pp.1,3).  Each of these areas is examined individually by collecting information regarding the frequency, duration, and severity of symptoms of problems both historically over the course of the patient’s lifetime and more recently during the thirty days prior to the interview (Book Rags 2006).  The higher the score on the ASI indicates a greater need for treatment in each of these areas. The ASI scores can be used to profile patients’ problem areas and then plan effective treatment (Gustafson 2005).  The instrument also provides separate severity levels for both alcohol and drug abuse. Factor analysis of the ASI revealed that the test has four dimensions: labeled chemical dependence, criminality, psychological distress, and health-related problems.  The ASI consists of approximately two hundred items and yields computer-generated, quantitative composite scores (CS) of problem severity ratings in each of the seven domains during the 30-day period prior to the interview for each of the domains. The ASI takes approximately 45 minutes to administer via the computer (Craig and Olson 2004, pp.1,3).             The ASI is particularly useful in the diagnosis and treatment of alcohol problems. It provides information on the frequency, duration, and intensity of alcohol and drug use. The ASI also examines psychosocial functioning which is crucial to understanding alcohol dependency. The ASI is a cost-effective alternative for the assessment of alcohol problems—when compared to the Structured Clinical Interview for DSM-III-R (SCID), a more formal and more expensive approach (Book Rags 2006).     Alcohol Use Inventory (AUI)             Alcohol Use Inventory (AUI) is a 147-item, paper-and-pencil, self-report instrument which reviews drinking practices and attitudes toward drinking. It produces sixteen-factor analytically derived primary scales, five secondary higher order scales, and a single third-order scale that is regarded as a general measure of alcoholism severity (Campbell et. al 1999).  Horn, Wanberg and Foster (2006) stated that the AUI test can be used by psychologists, social workers, chemical dependency counselors, and physicians to help differentiate drinking styles and develop individual treatment plans; provide an objective assessment of alcohol-related problems; and identify treatment-relevant classification of alcohol abusers based on DSM-IV classifications.   It provides a basis for describing different ways in which individuals use alcohol, the benefits they derive from such use, the negative consequences associated with its use, and the degree of concern individuals express about the use of alcohol and its consequences.     The Personality Assessment Inventory (PAI)               The Personality Assessment Inventory (PAI) is a recently developed multidimensional objective personality measure designed to assess psychological functioning across several different clinical domains. In addition to eleven clinical scales (most with subscales), it also contains four validity scales, two interpersonal scales, and five scales related to treatment and case management. Although it is a relatively new instrument, the PAI has generated considerable interest among psychologists, due in large part to the inventory’s general format and the rational-quantitative methods used to develop its scales. The PAI contains two scales, Alcohol Problems (ALQ) and Drug Problems (DRG) that are particularly relevant to the assessment of individuals who may misuse psychoactive substances. These scales are designed to measure the presence and severity of the core features of substance dependence (e.g., withdrawal symptoms, loss of control over drinking) and consequences often associated with such use (e.g., legal entanglements, interpersonal conflicts, family difficulties). Data presented in the PAI test manual indicate that the ALC and DRG scales have adequate reliability and validity. The PAI also contains a scale, Positive Impression (PIM), which is designed to detect the degree of positive impression management among examinees.  Fals-Stewart, in a study in 1996, evaluated the ability of individuals with psychoactive substance use disorders to dissimulate successfully on the PAL.  As expected, patients receiving treatment for drug abuse who were instructed to respond honestly had significantly higher scores on the DRG and ALC scales than (a) patients instructed to respond defensively, (b) respondents suspected of abusing psychoactive substances, referred for an evaluation by the criminal justice system, who had reasons to conceal their drug use, and (c) respondents from a non-substance-abusing control group                 (Fals-Stewart and Lucente 1997, pp. 455-456). Credit:ivythesis.typepad.com

Sample Research Paper PSYCHOLOGICAL ASSESSMENTS IN ALCOHOL AND DRUG ADDICTION

PSYCHOLOGICAL ASSESSMENTS IN ALCOHOL AND DRUG ADDICTION Introduction People have the normal tendency t...