Do you want to be a drug counselor?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

The need for qualified drug counselors continues to grow.

Pill for that?

Drug Counseling?
Photo courtesy of Pixabay.com

The growing opioid epidemic has highlighted the need for more drug treatment. So has the use of other drugs, methamphetamine, the so-called bath salts, and a whole host of new substances which continue to grow. The need for treatment among the older generation is at an all-time high as many baby boomers have continued to use their drug of choice into their retirement years. While the increasing problem with hard drugs gets a lot of media attention, we can’t forget that the two legal drugs, nicotine and alcohol remain huge killers. In medical settings, most of the patients have illnesses caused by or made worse by the use and abuse of alcohol and drugs.

There are several reasons why you might want to become a drug and alcohol counselor. For over ten years now I’ve taught classes in counseling those with substance use disorders. This week another class is starting. Over the next few weeks, I’d like to talk to you about some of the things drug counselors learn. Let’s begin today with reasons you might want to become a drug counselor and why your reason might help or hinder you in becoming a good drug counselor.

The field of drug counseling continues to evolve. The laws and regulations vary from place to place, and so do the names given to drug counselors. Counselors in this field are sometimes called substance abuse counselors, substance use disorder counselors, drug and alcohol counselors, or AOD counselors which stands for alcohol and other drug counselors.

This field used to separate alcoholics from drug addicts and provide two different kinds of treatment. Today it’s rare to find treatment programs where the two issues are disconnected. People with alcohol only problems usually end up in a drunk driver program or self-help groups such as AA. People with drug problems go to drug programs even though they often also have alcohol problems.

If you are in recovery, you may want to become a drug counselor.

Today’s substance abuse counseling programs mainly grew out of the alumni from drug programs and people who had attended 12 step groups. If you’re in recovery yourself, you may want to give back. The good part about this is that you probably have a lot of knowledge about the process of addiction. Many of my students are former alcoholics or addicts now in recovery. I tell the class, only half-joking, that many of you have done “extensive field research” on drugs and alcohol.

If you’re a recovering person, you probably know a lot about the 12 steps. While a lot of research is being done about what works and doesn’t work in the substance use disorder field, working the 12 steps and attending self-help groups continues to be a significant component of most recovery programs.

The downside to being a recovering person is that you may struggle with the academic, professional part of the curriculum. People in recovery who rushed too rapidly into becoming drug counselors put themselves at risk for relapse. For recovering person to work in the treatment field, they need to not only know the disease of addiction, but they also need to understand the process of recovery. If you’re in early recovery give yourself plenty of time to get used to your new sobriety before beginning to work in the field, otherwise you can put yourself at risk of relapse.

You may have had a family member or friend with an addiction problem.

Many people come into the field because they lost a family member or close friend to the diseases of addiction. I’ve seen some very effective counselors who have not themselves been addicts but have grown up in a home with an addicted parent or partner. If you’ve lost a child to addiction, death, or incarceration, that can be an exceptionally strong motivation to work in the field.

The caution for family members is like the one for recovering people. Make sure you are fully recovered from your experiences of living with an addicted person. Don’t expect to work out your own problems by working with addicts. Living with an addicted person can cause severe emotional trauma. You need to be fully recovered from that trauma if you plan to do this kind of work. A number of my drug counseling students were family members of addicts. They pretty much all told me they benefited by taking the classes. Many however decided they needed to work on themselves rather than trying to fix themselves by fixing addicts.

You have discovered a lot of the people you work with have drug problems.

No matter where you work there’s a strong possibility that many of the people you see each day have a drug problem. One survey estimated that 80% of the people in prison were drunk or high in the 24 hours before the committed the crime that led to their incarceration. VA Hospital estimated half of their hospital beds on the results of patients whose condition was caused by or made worse by alcohol. People who work in the criminal justice system or the medical field need to know about addiction and recovery.

People who work in the welfare system need to be knowledgeable about drugs, alcohol, addiction, and recovery. Many people who are unemployed have substance use issues. Among the homeless population, one drug is almost universal. It’s probably not the drug you are thinking of, the drug of choice among the homeless – is tobacco.

If you’re working in education, you need to know about drugs, alcohol and the problems they’re creating for your students. Surveys tell us that at the college level F students consume twice as much alcohol as A students. Many elementary school students begin experimenting with drugs and drinking around the third or fourth grade. They start by smoking their parent’s cigarettes or drinking their alcohol. With the shift towards legalized marijuana more and more elementary and middle school students are using marijuana. If you work with kids in any capacity part of what you should be doing will be drug prevention and early interventions.

You work in mental health and clients want to talk to you about drug problems.

There’s a substantial overlap between mental health issues and substance use disorders. If you work in a program or facility that treats mental health problems you’re seeing people with substance use disorders whether you know it or not. Please don’t say “I don’t want to work with those people.” You are. If you give off the attitude you don’t want to talk to them about their drug problems, their sex problems, or their gambling problems; they just won’t tell you the truth about those issues.

Roughly half the people with a diagnosed mental illness, abuse substances and many go on to develop substance use disorders. About 60% of the people with substance use disorders also have a mental illness. The area of working with clients with both problems, now called “dual diagnosis” used to be called “co-occurring disorders.” The most effective treatment for people with both disorders is to get them both treated at the same time and either at the same place or with two different providers who work together to coordinate care.

You would like to help “those people.”

If your motivation to become a drug counselor is because you feel sorry for people with a history of substance use disorder, I’m going to suggest, please don’t become a drug counselor. You’re likely to come across as feeling superior and looking down on them. If you want to be helpful, work with them on their other needs, housing, meals, job training, or basic literacy. Leave the drug counseling to people who will put in the time to develop the needed skills.

Stay tuned for more posts on what drug counselors do on the job and how someone would go about becoming a drug counselor. If you have questions as I move through this series of posts, please leave a comment or use the “contact me” form. I will get back to you just as quickly as my schedule allows.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Dextromethorphan and paranoia.

By David Joel Miller.

Sometimes over-the-counter medications cause paranoia.

Fearfulness

Paranoia.
Photo courtesy of Pixabay.com

Dextromethorphan is a common antitussive (cough suppressant) medication found in over-the-counter medications. It is a common ingredient in over 140 over-the-counter medications. Unfortunately, Dextromethorphan has become an increasingly abused substance among those in the 18 to 25-year-old range. Abuse by younger teens is reported to be on the rise.

Because dextromethorphan can be purchased over-the-counter or stolen from grocery stores and pharmacies, many users have underestimated the serious, long-term effects of dextromethorphan abuse.

When taken according to directions most over-the-counter medications are relatively safe. Any medication, including over-the-counter medications, may result in side effects or allergic reactions. Abuse of Dextromethorphan can have some serious health consequences.

When Dextromethorphan is taken in larger than recommended amounts it can produce psychoactive effects. “Use in amounts exceeding those recommended, a practice which is known as “Robotripping,” may result in a toxidrome of psychomotor agitation, hallucinations and paranoia best characterized as Intoxication Delirium (Stanciu, C. et al., 2016.)

Dextromethorphan shares pharmacologic and neurobehavioral properties similar to opiates and phencyclidine (PCP.) Because of its cough suppression action is like the opiate codeine, as the dose increases it can produce dreamlike states and hallucinations somewhat like the “pipedreams” of opium smokers. As the dose increases significant unpleasant and health impairing results occur. At very high doses Delirium and misperceptions occur, resulting in paranoia and violent behavior similar to PCP intoxication.

“Intoxicated excited delirium describes the most serious and potentially deadly DXM-induced medical condition involving psychotic behavior, elevated temperature, and an extreme psychomotor agitation fight-or-flight response by the nervous system. Due to extreme violence frequently encountered such presentations, typically encountered in the emergency room setting with law enforcement involvement, have resulted in sudden death secondary to cardiac or respiratory arrest, an outcome associated with the use of physical restraints” (Stanciu, C. et al., 2016.)

One online user bulletin board, I will leave the website name out, included a number of user warnings. Users report tolerance to dextromethorphan happens rapidly, often after a single dose. Reports of paranoia were common, both paranoia caused by taking dextromethorphan and users reports of high anxiety which they called “paranoid” about the many other negative results from use.

Users have reported impaired daily functioning for as long as six years afterward.

On the way to psychosis and paranoia, users may experience a variety of alterations in perception. Commonly reported are auditory, visual, and tactile hallucinations. That may pass through a period of excitability and pressured speech which can easily be mistaken for bipolar mania. Nervousness, confusion, and disorientation can occur. A variety of physical symptoms are also likely, including tremors, slurred speech, and occasionally seizures. Some less pleasant symptoms include nausea, vomiting, respiratory depression, coma, and even death.

The particular gene responsible for metabolizing dextromethorphan is polymorphic meaning there are a number of different mutations of this gene in humans. Because of this a new user never knows just how dextromethorphan may affect them. Some people need to take a large amount to feel the effects while other people can have a serious adverse effect even at doses only a little above the label recommendations (Stanciu, C. et al., 2016.)

There are antidotal reports of serious interactions between dextromethorphan and commonly used substances such as alcohol and marijuana. In medical settings, life-threatening interactions between prescribed psychiatric medications and intentional overdoses of dextromethorphan-containing products.

Dextromethorphan is not the only drug of abuse which has been connected to an increased risk of developing paranoia. Reports of paranoia among drug users are common. Paranoia can be difficult to identify and diagnose. It is often only considered in the context of diagnosing the paranoid type Schizophrenia or Paranoid Personality Disorder. Recent studies have suggested that paranoia falls on a continuum and paranoia has rarely been studied outside the seriously mentally ill. Many things about the drug using lifestyle increase the risk of paranoia. Another reason for the shortage of information about rates of paranoia and its treatment among drug users has been the systematic exclusion of those with a substance use disorder from psychological research. Given the large overlap between those with a substance use disorder and a diagnosed mental illness, there’s a lot we haven’t learned about trust issues, suspicion, and various levels of paranoia among those with a co-occurring disorder.

I’ll continue to watch for and read research about the trust to suspicion continuum so watch for future posts on this topic.

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Pseudohallucinations – OK to see things?

By David Joel Miller.

Pseudohallucinations – sometimes we expect people to “see things.”

Sometimes it’s okay to see things that are not really there. When someone is under

Pseudohallucinations

Pseudohallucinations.
Photo courtesy of Pixabay.com

the influence of drugs, particularly hallucinogens or powerful stimulants, it is common for them to see things that others don’t.

When crack cocaine first became common, the emergency rooms in large cities experienced a rash of people who were “seeing things.” Many of these people received a diagnosis of schizophrenia or a related psychosis.

The same phenomenon occurred again when methamphetamine became cheap and readily available. More recently we are seeing people under the influence of “bath salts,” who are hallucinating.

None of these drug-induced hallucinations should be used as symptoms for making the diagnosis of schizophrenia or related psychosis.

True hallucinations can be a feature of several mental illnesses. In addition to schizophrenia, people with severe major depressive disorder, bipolar disorder, and other mental illnesses may experience hallucinations. Sometimes people with severe mental illness also use drugs which can create Pseudohallucinations. Sorting out the meaning of hallucinations is a job for a professional.

Some authorities differentiate between Hallucinations, Pseudohallucinations, and Parahallucinations.

If someone is experiencing hallucinations and they know it is the result of “good drugs,” this is a Pseudohallucination and likely will be diagnosed as a drug intoxication disorder, Hallucinogen Persisting Perception Disorder F16.983 or stimulant-induced psychotic disorder if the hallucinations continue after withdrawal from a stimulant.

Alcohol can also cause hallucinations.

When chronic alcoholics are withdrawing from alcohol that can experience a condition called delirium tremens or the DT’s for short. DT’s consists of shakes and hallucinations when the level of alcohol in the bloodstream declines. This is a very serious condition and can lead to death. If someone has ever had the shakes or hallucinated while withdrawing from alcohol they should be sent to a hospital to detox. Friends don’t let friends die from DT, s.

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Abusing prescription drugs.

By David Joel Miller.

Almost 24 million Americans abuse prescription medication each year.

The majority (87%) of the people who get Rx’s use the meds responsible. The abuse is

Drug Abuse

Abuse of Prescription Drugs.
Photo courtesy of Pixabay.com

the result of misuse by the other 13%. Many people underestimate the risks involved in using prescription drug incorrectly.

Abuse of a prescription drug can result in addiction, permanent health damage, or even death.

Just because you get your drugs with a prescription doesn’t make them safe, particularly when you don’t use them as prescribed.

What meds are abused?

The national survey on drug use and health tracks the abuse of four types of prescription medication. Besides prescription pain meds many other prescriptions meds get abused. The other big abuse culprits? Tranquilizers (5.7 million) and RX stimulants (4.8 million, and sedatives (1.4 million.) Many other medications can be misused. Prescriptions don’t work well when you take them some days and not others. I’ve learned in working with mental health clients not task them if they are taking their meds. They almost always say yes. If I asked them how many days, they took their meds last week, I get answers like two or three days. Most prescriptions will be effective if you take them sporadically. You can’t make up for missed doses by taking extra on other days.

Pain medication abuse.

One-third of the US adult population, almost 92 million people, use prescription pain meds. Of those 92 million about 11.5 million abused their prescription pain meds. The majority of people (63.4%) who abuse prescription pain medication do so because of physical pain. Given the current publicity the people abusing prescription opiates, this is significant. The main reason people with a chronic pain condition abuse meds is because they are still in pain.

Approximately 40% abuse prescription pain meds for mental or emotional reasons, to relax, to sleep, to get high or to simply see what it would be like to experiment with the drug. I think it’s important to note that much of the high-powered opiates being abuse are being manufactured or brought into the US illegally.

Even over-the-counter pain meds, while not included in many studies, are subject to abuse. People with emotional pain may experience this as pain in the body. Over-the-counter pain meds are not effective for treating depression or anxiety. Taking excessive amounts of over-the-counter pain medications can result in damage to your liver or kidney.

Abuse of prescription tranquilizers.

About one-third of the people prescribed tranquilizers abuse them. Of those abusing tranquilizers, two-thirds were using them for the reasons they have been prescribed but not in the way the doctor had prescribed them. The remaining one-third of abusers do so for emotional or recreational reasons.

A very dangerous way of abusing tranquilizers is to take them while consuming alcohol. This combination can result in death.

Abuse of prescription stimulants.

The primary legal use of these medications is to treat ADHD. About 30% of those taking prescription stimulant medications abuse them. Weight loss, to help study, or to get high are some of the reasons people reported abusing prescription stimulants.

What are some of the ways prescription meds are abused?

  1. Taking meds prescribed to someone else.
  2. Taking more pills or taking them more often than the doctor prescribed.
  3. Using prescription meds in a way other than the way the doctor recommended.

Over the counter medications were not included in the government’s survey of drug misuse despite the serious health consequences of abusing over-the-counter medications. I’ve tried to highlight some of the issues involved in abusing over-the-counter meds in the paragraphs above.

For more on this issue see SAMHSA report at https://www.samhsa.gov/data/sites/default/files/report_3210/ShortReport-3210.html

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Commonly abused stimulant drugs.

By David Joel Miller.

A few stimulant drugs account for a major portion of drug abuse.

How drugs are used

Drugs.
Photo courtesy of Pixabay.com

Abuse of stimulant drugs has become a major problem in America. Some of these stimulant drugs have some limited medical uses. Recreational drug use seems to run in cycles. A new drug or a new form of a drug becomes popular for a while only to be replaced by the next “in” drug. Here is a brief description of the primary types of stimulant drugs being abused today.

Cocaine.

Cocaine comes from the coca plant which was originally found growing wild in the Andes Mountains of South America. Coca leaves were used there, probably for thousands of years, by the native population who would chew the leaves or mix them with roasted sea shells and hold the mixture next to their gum similar to the way chewing tobacco is used. Chewing a few leaves produces a mild stimulant effect which allowed the natives to work more effectively at high altitudes.

In the late 1800’s European chemists isolated the active ingredient, cocaine. Cocaine was promoted by Doctors, particularly Freud, for treatment for a variety of illnesses. The first great cocaine epidemic occurred in the 1880’s.

Cocaine can be used in a variety of ways; powdered cocaine can be snorted, and crack cocaine can be smoked. The 1980’s saw a second cocaine epidemic with the introduction much cheaper crack cocaine. Cocaine was used for a while to treat depression but this is no longer an acceptable use because when a stimulant drug wears off the depression is worse than before.

The only currently accepted medical uses for cocaine are eye and nose surgeries.

Amphetamines.

Amphetamines became popular during World War II when both sides used them. Initially, they were thought of as wonder drugs and were used for the treatment of respiratory problems, obesity, and to increase attention and prevent sleep. Amphetamines were widely prescribed for both weight loss and to increase productivity.

In the 1960’s the dangerous properties of amphetamines were recognized. Today use of the older amphetamines is largely restricted to the treatment of ADHD.

Methamphetamine.

There had been some use of injectable methamphetamine in the 1970’s. In the 1990’s methamphetamine began to replace other stimulant drugs, first in Hawaii and later, on the West Coast of the United States, ultimately spreading throughout America. Methamphetamine manufactured synthetically in large quantities became considerably cheaper and lasts longer than other stimulant drugs. Methamphetamine is used as an injectable drug and is available in a smokable crystal form.

From a mental health standpoint, methamphetamine is diagnosed as an amphetamine use disorder. Substance abuse treatment often provides separate categories for amphetamine and methamphetamine disorders. While amphetamines are usually prescription grade medical pharmaceuticals which are diverted for illegal use, methamphetamine is produced by illegal labs in huge quantities for recreational use and abuse. See drug diagnoses.

The sight of the meth addict, sucked up from loss of weight, often covered with scabs, frequently paranoid and hallucinating, has become a common sight in hospital emergency rooms and on the streets of America’s cities.

Khat.

Khat is a stimulant plant which grows wild in East Africa, where it was chewed by natives the same way coca leaves were chewed in South America. The leaves are most stimulating when chewed fresh. Khat contains two stimulant chemicals, Cathine, and cathinone. Both of these chemicals and many other related compounds are now produced synthetically.

Bath Salts.

Bath salts have nothing to do with bathing. These synthetic stimulant drugs, largely related to cathinone, are imported into the United States labeled “not for human consumption.” These are often mixed and sold under various labels such as “bath salts, herbal incense, water pipe cleaner,” and many other names. This family of chemicals can produce strong stimulant effects as well as hallucinations. Because these are mixtures of chemicals and are sold labeled “not for human consumption” they have been very difficult to regulate. As quickly as federal regulators ban one chemical, the manufacturers and marketers of bath salts change their formulations. There are frequent reports of permanent neurological damage because of using these drugs.

Caffeine and related compounds.

Caffeine is one of the milder stimulant drugs and is the most widely used drug on planet earth. It is estimated that 90% of the world’s population consumes caffeine or a related compound on a regular basis. Occasionally someone receives a caffeine overdose and presents in an emergency room. Caffeine overdoses usually result from consuming energy drinks which are high in caffeine combined with alcohol or by consuming large quantities of caffeine pills to stay awake longer than the human body should.

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Why Pharmacokinetics matters.

By David Joel Miller.

What is pharmacokinetics and why does it matter?

Drugs affect the body.

Why Pharmacokinetics matters.
Drugs affect the body.
Photo courtesy of Pixabay.com

Drugs are everywhere in our society. Not just Street drugs, or the legal drugs such as tobacco and alcohol. Most of us are exposed to drugs all day, every day. Even the people who say they “don’t do drugs” should be concerned about drugs and pharmacokinetics. When we hear about drugs, most of us think illegal drugs. It’s easy to overlook the long-term effects of use and abuse of prescription medication, over-the-counter medication, and the vitamins and herbal remedies all around us every day.

Pharmacokinetics deals with how drugs enter the body, how they get absorbed, how they get transported and delivered throughout the body, and ultimately how are drugs eliminated from the body. In a past post, we talked about routes of administration; the way drugs get into the body.

How much of that drug did you take?

For most drugs the more you take, the stronger the effect. Let’s take a simple, common drug, alcohol to illustrate this principle. If someone drinks a twelve-ounce beer, they consume about half an ounce of pure alcohol. Drinking twelve ounces of whiskey will result in the consumption of about six ounces of alcohol. With whiskey, you drink the same amount of liquid, but because the whiskey is more concentrated, you received a much higher dose of Alcohol than the beer drinker does. Measurement of alcohol consumption requires the use of an idea called the standard drink.

Drug dose is computed based on body weight.

A three-hundred-pound man will need to take a higher dose of medicine than a twenty-pound child. Heavier people contain more volume of liquids, so any chemical they take into their system becomes more dilute. For most medications, your Doctor will want to know your body weight, so they know how much medication to give you.

When it comes to Street drugs or even alcohol, most people don’t consider the effect that body weight has on the drug using experience. Thin people will get higher blood concentrations of the drug even when they take the same amount. Recently we have seen many people who had weight loss surgery, lost a large amount of weight, and developed a significant problem when they consume alcohol or other drugs.

Drug absorption matters.

Some drugs are readily absorbed into the bloodstream. When you consume liquid drugs or very soluble ones, they readily pass through the stomach, into the intestine, and are absorbed into the bloodstream. Solid drugs vary a great deal in their bioavailability, which is the part of the drug that becomes absorbed into the bloodstream and reaches the site of action.

An example of the problem of bioavailability involves pregnant women. Calcium is often added to the diet of a pregnant woman to help the fetus develop strong bones. Limestone is high in calcium, but no matter how much you grind it up, most of the limestone will pass through the body undigested. How much of the calcium in your vitamin supplement will be absorbed into your bloodstream, it’s bioavailability, matters.

Drug distribution varies from drug to drug.

Drugs that are highly water-soluble travel readily throughout the body. Blood nourishes all the cells in the body, and the parts of the body that received the most blood also received the largest doses of drugs. Drugs tend to accumulate in the heart, brain, kidney, and liver. Parts of the body that get little blood flow, the muscles and fat, received little of the active drug. Can you see why taking an oral supplement to “melt away fat” is unlikely to work?

A few drugs, such as THC in marijuana, are fat soluble. These drugs will tend to accumulate in the parts of the body which have the largest fat content.

Drug elimination – how the drug leaves the body.

Eventually, any drugs that go into your body will get broken down and eliminated. Many drugs are metabolized by enzymes produced in the liver. These drugs are especially hard on the liver when taken in excessive quantities. This process is the reason heavy alcohol consumption increases the risk for four separate types of liver disease.

Some drugs are metabolized in the kidneys or the G.I. tract. Regardless of where the metabolism takes place, the majority of all drugs are removed from the body by the kidney. Some drugs, especially in large quantities, can be very hard on the kidneys. Drug abuse can result in impaired kidney function resulting in the need for kidney dialysis.

Drug metabolism is a sequential process.

Many drugs are broken down in stages. The first breakdown product is then metabolized into a second breakdown product and so on. These breakdown products or metabolic byproducts may also be psychoactive. When both cocaine and alcohol are present in the system, they and their metabolic byproducts can combine to produce Cocaethylene which is even longer lasting than the original cocaine and alcohol.

For more on this topic see – Drug Use, Abuse, and Addiction and Recovery

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

How drugs change your feelings.

By David Joel Miller.

Drugs of abuse alter the chemical balance in your brain.

PNG of brain.

Brain
Photo courtesy of Pixabay.com

The human brain is a very complex organ. Everything you think, feel, experience, or do is the result of brain activity. Drugs, especially drugs of abuse, can alter the chemical balance in your brain either temporary or sometimes permanently.

The brain is made up of millions of tiny nerve cells called neurons. These nerve cells connect to each other through billions of tiny nerve endings. In the early days of physiological psychology, this all seemed so simple.

Electricity moves information within a nerve cell.

Early on, we discovered that a nerve cell can develop an electrical charge and when this charge moved down the nerve cell, it transmitted information. Electrically stimulating a rat’s brain might cause him to move the leg.

Electrical stimulation doesn’t explain everything. Between one nerve cell and the next, there are infinitesimal, small gaps. Scientists refer to those gaps as synaptic gaps, or sometimes they speak of the connections between cells as synapses. It turns out that electricity doesn’t flow very well from one brain cell to another through the brain fluid.

Information moves from one nerve cell to another chemically.

The human nervous system manufacturers a large number of chemicals, some of which are called neurotransmitters. When I first studied the subject in the 1960s, we study two neurotransmitters. Today hundreds of neurotransmitters have been identified and studied. The more research I read, the more newly identified neurotransmitters I encounter.

Drugs of abuse alter the way information moves between cells chemically.

For a drug of abuse to affect the way you think, feel, or behave, it needs to do two things. First, it needs to get into your brain. The brain contains a large amount of fluid. Protecting that fluid from contamination is the blood-brain barrier. This membrane is designed to keep undesirable material out of your brain. All drugs of abuse must have molecules that can get through this blood-brain barrier.

Each neurotransmitter has a shape which fits a receptor in the next cell.

You hear a gun go off and your nervous system produces a stimulant chemical that gets your heart pounding and prepares you for action. That stimulant chemical is sometimes called adrenaline. A similar chemical is found in the nervous system. We, here in the US, call that chemical norepinephrine, in some other countries it is called noradrenaline. This chemical fits into receptors on other cells and causes them to act.

One of the explanations for how drugs of abuse affect your nervous system is called the “lock and key theory.” Each naturally occurring neurotransmitter has a shape, and other cells have a receptor designed to accept that shape. So, when your nervous system sends out norepinephrine, it fits into receptors throughout your nervous system to prepare you to take immediate action.

Drugs of abuse mimic the shapes of naturally occurring neurotransmitter.

Stimulant drugs, such as cocaine or methamphetamine, are shaped in a way that is similar to norepinephrine. Because they mimic a natural neurotransmitter’s shape, they can make all the circuits in your nervous system fire.

Drugs of abuse not only activate a few cells, but they can activate many cells in far more emphatic ways than your naturally occurring neurotransmitters do. Because of this, drugs of abuse can feel very pleasurable, but only for brief periods of time. Each time you use a drug, it changes the chemical balance in your brain. Over time it changes the balance so much, you are unable to feel the things you used to feel unless the drug is present in your system.

Of course, the process in the brain is far more complicated than this simple description. Many other things are taking place every time you think a thought or the chemistry in your brain changes. Understanding how drugs of abuse mess with the way your nervous system works helps to explain a large part of how those drugs can lead to abuse, dependence, addiction, and a whole range of disorders we call substance use disorders.

For more on this topic see – Drug Use, Abuse, and Addiction and Recovery

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.