Deep Impact

 The Effects of a Second Concussion

• Traumatic brain injury (TBI) affects nearly 2 million people annually in the United States, with falls and motor vehicle accidents being the most common causes (Hooley et al., 2019).
• According to Hooley and colleagues (2019), these are the most susceptible demographics to TBI:

1. Children 0 to 4 years old
2. Adolescents 15 to 19 years old
3. Adults 65 years and older

• The DSM-5 categorizes cognitive impairments from head injuries as major or mild neurocognitive disorders.

Explosive blasts in the past have caused an increase in TBI cases among military personnel, and this has caused TBI to become the signature injury of the Iraq War. About 15 percent of soldiers serving in Iraq experienced a TBI. Full recovery may not be possible for many survivers. (Hooley et al, 2019)

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Two types of brain injuries:

1. Closed-head injuries -  The skull remains intact.
1. 
   Close-head injuries cause indirect damage due to forces that cause the brain to actually inadvertently make contact with the skull wall.
2. Rotational forces can also cause the brain to inadvertently twist the brain mass in relation to the brain stem. This injury causes neuron damage due to shearing forces on the nerve fibers and their synaptic interconnections (Hooley et al., 2019).
2. Penetrating head injuries - An object enters the brain such as a bullet.

Severe head injuries will often cause someone to lose consciousness. When this happens there is a major disruption of circulatory, metabolic, and neurotransmitter regulation. These types of injuries usually lead to (Hooley et al., 2019) :

1. Retrograde amnesia - which is an inability to recall the events immediately preceding the injury
2. Anterograde amnesia - which is an inability to effectively store memories of events that happen after the trauma.

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Recovery

Recovery from unconsciousness caused by a head injury varies from minutes to days. It is not uncommon for the survivor to go through stages of stupor and confusion. In some cases, the survivor may remain in a coma for a period of time. This coma may be followed by delirium which is evident by acute excitement, disorientation, and hallucinations. Gradually all of this may clear up and the survivor may actually regain appropriate contact with reality.

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Minor closed-head brain concussions and contusions occur frequently due to car accidents, sports injuries, and falls. Some theme park rides can actually cause high enough G-forces in som individuals by creating small tears in delicate blood vessels in the brain. (Hooley, et al., 2019)

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If you have a concussion, your brain is four to five times more likely to be damaged by a second head injury, and this increased risk lasts for several weeks.

References

Hooley, J. M., Nock, M. K., & Butcher, J. N. (2019). Abnormal Psychology (18th ed.). Pearson Education (US). https://bookshelf.vitalsource.com/books/9780135191033

 

When You're Partying And This Happens

GHB OVERDOSE

 

First of all, if you have ever been in a situation where you were hanging and partying with someone and that person overdosed on GHB and you did not leave their side then I salute you. It is a scary situation, and a recent study by Freestone and colleagues (2023) uncovered some common interventions that people are using when responding to a GHB overdose.

 

 Their study revealed a need for education on how to handle these situations (Freestone et al, 2023), and here are some of their suggestions:

When first notice something is wrong.

 Are they so sleepy that it's hard to stay awake and think clearly?

Do Not Leave Them Alone 

• Check their breathing (Freestone et al, 2023):

• Look, Listen, and Feel for Breathing.

• If non-responsive and not normal breathing, then first aid recommendations are to call EMS and start CPR

 Call emergency medical services if someone is not responsive, assess breathing, and place in the recovery position. To manage airway open mouth and check for foreign material. If foreign material is present roll the patient onto their side and clear the airway. If there is no foreign material, leave the patient in the position found, and open the airway by tilting the head back with a chin lift.

 

References

  Freestone, J., Ezard, N., Bourne, A., Brett, J., Roberts, D., Hammoud, M., Nedanoski, A., Prestage, G., & Siefried, K. (2023). Understandings, attitudes, practices and responses to GHB overdose among GHB consumers [Review of Understandings, attitudes, practices and responses to GHB overdose among GHB consumers]. Harm Reduction Journal, 20(1). https://doi.org/10.1186/s12954-023-00857-z

GHB And What You Don't Know

 

GHB and the Brain

• GHB, found endogenously in the brain, is a precursor of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) (Le & Richards, 2019).
• GHB affects both GABA-B and GHB receptors.

GHB influences dopamine in a two-phase manner. At lower doses, it triggers the release of dopamine by interacting with GHB receptors. On the other hand, higher doses initially suppress dopamine release due to their agonist effects on GABA-B receptors, which results in neuro-inhibition and depression of the central nervous system (CNS). However, following this initial suppression, there is an increase in dopamine release via the GHB receptor.

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• This dual action of GHB explains its sedative and excitatory effects. The primary concern with GHB toxicity is the depression of the central nervous system and respiratory system.

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Substitutes for GHB, namely Gamma-butyrolactone and 1,4-butanediol, were previously marketed as industrial solvents or dietary supplements. Upon oral consumption, these substances quickly transform into GHB, thereby replicating the same clinical impacts associated with GHB toxicity. (Le & Richards, 2019)

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• GHB is rapidly absorbed into the body
• Average time of five to fifteen minutes for onset of action.
• Initially, The user experiences a wave of euphoria (Le & Richards, 2019).
• Symptoms typically peak within thirty to sixty minutes after administration.
• You can usually count on the effects lasting for two to four hours.
• Its half-life elimination ranges from twenty to sixty minutes.

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According to Le and Richards (2019) here are some dosing considerations:

• Lower doses of GHB (10 mg/kg) can cause memory loss and varying degrees of sedation.
•  Doses ranging from 20 mg/kg to 30 mg/kg induce cycles of rapid eye movement (REM) sleep.
• 
  Higher doses (50 mg/kg) can lead to slower heart rate, respiratory depression, and even coma. 
  
  The presence of other intoxicants, particularly alcohol, can enhance the effects and prolong the duration of symptoms.

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So how much are you actually taking??

The typical dosage of the substance falls between 1 and 5 grams, which equates to about 1-2 teaspoons mixed into a drink, depending on the purity of the compound. However, the concentrations in these homemade concoctions can vary significantly, often leaving users uncertain about the actual dosage they are consuming. (WHAT IS GHB?, n.d.)

Analogues

• Substances often used as alternatives to GHB include GBL (gamma-butyrolactone) and 1,4 BD (also known as “BD”), which stands for 1,4-butanediol.

 

These analogues are legally available as industrial solvents used in the production of various products such as polyurethane, pesticides, elastic fibers, pharmaceuticals, and coatings on metal or plastic.

• Illegally, they are also sold as supplements for purposes like bodybuilding, fat loss, reversing baldness, improving eyesight, and combating aging, depression, drug addiction, and insomnia. GBL and BD are marketed under innocuous labels like “fish tank cleaner,” “ink stain remover,” “ink cartridge cleaner,” and “nail enamel remover,” with a price tag of approximately $100 per bottle — a cost significantly higher than similar products. (WHAT IS GHB?, n.d.)

References

Le, J. K., & Richards, J. R. (2019, January 20). Gamma-Hydroxybutyrate (GHB, “G”, Liquid X, Liquid E, Juice, Mils, Fantasy) Toxicity. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430781/

‌WHAT IS GHB? (n.d.). https://www.dea.gov/sites/default/files/2020-06/GHB-2020.pdf

‌

 

A New Study Illuminates A Need for GHB Overdose Education

 GHB Overdose: Education Can Save Lives

Objective 

The objective of this study was to understand how bystanders respond to Gamma-hydroxybutyrate (GHB) overdose. This situation is frequently found within sexuality and gender diverse communities carrying a high risk of fatality.

Methods

• This qualitative study involved interviewing 31 Australian residents who reported using GHB on three or more occasions in the previous twelve months.
• These participants were asked about their experiences witnessing GHB overdose more specifically:
1. Their actions
2. Their decision-making processes throughout the overdose.


• Their responses were analyzed according to dominant themes.

Results 

• All of these participants witnessed the overdoses in private settings and were involved in sexual situations.
• These participants reported their situations as ranging from GHB-induced symptoms of distress (Freestone et al., 2023) to comatose intoxication.
  
• These participants reported their drastic actions to keep someone alert and responsive after their GHB ingestion (Freestone et al., 2023). 
• Most of these participants reported many variables that influenced their decision to call or not call for EMS.
• The majority of these participants did not call the EMS and resorted to interventions that deviated from established first-aid protocols (Freestone et al., 2023).

Conclusions

The study illuminated an urgent need for GHB overdose prevention and how to respond to these situations for people who use GHB. According to Freestone and colleagues (2023), educational interventions need to address the following:

1. Addressing inaccuracies that inform street remedies for GHB overdose
2. Techniques for safely checking someone's breathing and responsiveness.
3. They should promote basic first-aid principles
4. They should address perceived barriers to contacting EMS.

References

 Freestone, J., Ezard, N., Bourne, A., Brett, J., Roberts, D., Hammoud, M., Nedanoski, A., Prestage, G., & Siefried, K. (2023). Understandings, attitudes, practices and responses to GHB overdose among GHB consumers [Review of Understandings, attitudes, practices and responses to GHB overdose among GHB consumers]. Harm Reduction Journal, 20(1). https://doi.org/10.1186/s12954-023-00857-z

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Splendor In The Grass

 A Coming of Age

Alcohol addiction has been around for centuries, and its early days were marked by a lack of understanding about the nature of addiction. Alcohol was often seen as a social lubricant and a way to relax and unwind. It was not until the 20th century that alcohol addiction began to be recognized as a serious problem.

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Video gaming addiction is a more recent phenomenon, and its early days were marked by a similar lack of understanding. Video games were often seen as harmless entertainment, and there was little concern about the potential for addiction. However, in recent years, there has been growing awareness of the dangers of video gaming addiction.

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Video gaming addiction is becoming a serious problem. To validate its seriousness, I want to compare the coming-of-age of alcohol addiction to where video gaming addiction is at now.

1. Availability: Alcohol has always been readily available, but video games have become increasingly accessible in recent years. With the advent of handheld consoles, smartphones, and tablets, people can now play video games anywhere, at any time.
2. Social acceptance: Alcohol use has always been socially acceptable, but video gaming addiction is still stigmatized. Many people still view video games as a waste of time, and they may not take the addiction seriously.
   
3. 
   Symptoms: The symptoms of alcohol addiction and video gaming addiction are similar, but there are some key differences. For example, people with alcohol addiction may experience withdrawal symptoms such as sweating, tremors, and nausea. People with video gaming addiction may experience withdrawal symptoms such as anxiety, irritability, and difficulty sleeping.
4. Treatment: There are a variety of treatment options available for alcohol addiction, including counseling, medication, and 12-step programs. There are also a growing number of treatment options available for video gaming addiction, but they are not as well-established as those for alcohol addiction.

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1. Both alcohol addiction and video gaming addiction are serious problems that can have a devastating impact on individuals and families. It is important to be aware of the risks of addiction and to seek help if you or someone you know is struggling.

988

 

Suicide Prevention:

If you ever have a chance to intervene and help someone going through a suicide crisis and have surveyed the scene for safety, do not worry about not knowing what to do or say. Follow your heart to that person.  988 on your phone will connect you to someone who is trained and they will guide you.

Burnt Offerings

 Released Through Unrequited Channels

A few nights ago, I could not sleep and I was excessively worrying about a particular situation that I had under control. It was a situation that I had handled before. So why was I worrying so much? I felt an almost apocalyptic worry over this situation. In my head I spiraled thousands of situations
of how this particular situation and other situations would spawn off of it. I started having straight up old school panic attacks. I was using all my challenging tools to show myself that this situation did not warrent this level of anxiety, but they just were not working. And then I remembered.

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Everyone experiences anxiety which is a normal human emotion that keeps us alert and motivated. Repression is a psychological defense mechanism that pushes uncomfortable thoughts and feelings out of our conscious awareness. Which sounds great until it isn't because that anxiety does not actually leave rather it hangs around out of sight and deep in mind.

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The mind will hold onto that anxiety and release it when the mind feels that it can be done so safely. A podcast that I was listening to reminded me of this defense mechagnism. With my anxiety that night my awareness was heightened enough to realize that the situation I was dealing with did not warrent this level of anxiety and I let go of it.

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My thought challenging tools immediately became effective and I felt my anxiety burn away. I came back to the present and enjoyed the peace and quite in and around myself.

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This was a huge milestone for myself. For once I did not attempt to bury my anxiety or put out the flames by using alcohol or maybe even getting high. I haven't dealt with panic attacks like that in several years, and several years ago they would have sent me running to the liquor store, or looking up an old acqaintance.

 

Cognitive and CBT works. Your mind is yours to control. You have to get in, lay down the ground work and reclaim your territory.