Drug Overdose statistics

Drug Overdose Statistics


 More than 932,000 people have died since 1999 from a drug overdose.1 In 2020, 91,799 drug overdose deaths occurred in the United States. The age-adjusted rate of overdose deaths increased by 31% from 2019 (21.6 per 100,000) to 2020 (28.3 per 100,000).

Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths. 82.3% of opioid-involved overdose deaths involved synthetic opioids.

  •  Opioids were involved in 68,630 overdose deaths in 2020 (74.8% of all drug overdose deaths).
  • Drug overdose deaths involving psychostimulants such as methamphetamine are increasing with and without synthetic opioid involvement


References

CDC. (2021, June 23). Drug overdose deaths. Www.cdc.gov; CDC. https://www.cdc.gov/drugoverdose/deaths/index.html



        

FACTS ABOUT FENTANYL

 Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine 

  • There are two types of fentanyl:  
    • pharmaceutical fentanyl 
    • Illegally made fentanyl 


Illegally made fentanyl (IMF) is available on the drug market in different forms, including liquid and powder. 

In its liquid form, IMF can be found in nasal sprays, eye drops, and dropped onto paper or small candies. 


STREET NAMES FOR IMF INCLUDE: 

  • Apache 
  • Dance Fever 
  • Friend 
  • Goodfellas 
  • Jackpot 
  • Murder 8 
  • Tango & Cash  


Fentanyl and Overdose 

  • fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths.
  • Even in small doses, it can be deadly.  

Over 150 people die every day from overdoses related to synthetic opioids like fentanyl 


  • Drugs may contain deadly levels of fentanyl, and you wouldn’t be able to see it, taste it, or smell it. 
  •  It is nearly impossible to tell if drugs have been laced with fentanyl unless you test your drugs with fentanyl test strips. 
  • Test strips are inexpensive and typically give results within 5 minutes, which can be the difference between life or death.  
  • Even if the test is negative, take caution as test strips might not detect more potent fentanyl-like drugs, like carfentanil 


References 

Fentanyl Facts. (2021, November 10). Www.cdc.gov. https://www.cdc.gov/stopoverdose/fentanyl/ 

 


DSM-5 Criteria for Borderline Personality

 Borderline Personality Disorder


A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:

  1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5)
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging(eg. spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
  5. Recurrent suicidal behavior, gestures,
    threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (eg. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days.)
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Gender Expression

 Cognitive, affective, and behavioral intentions are three components of attitudes (Learning Objectives | Online Resources, n.d.). The cognitive part is our beliefs about something. The affective part is our emotions about that something, and the behavioral part is the course of action we are going to take about something. Our attitudes about things stem from what society and family have taught us about social norms and social roles. Our attitudes impact our view of gender because they represent what society has taught us about gender and how each gender should express themselves. We are taught at an early age the way society categorizes the gender role of men and women and this lays the baseline for attitudes which are our learned beliefs. Many times, these learned beliefs are very rigid and do not allow for any variance. With this in mind, we are conditioned to feel and behave a certain way anytime we encounter someone who expresses their gender role outside of these learned norms. Our personal beliefs are founded on what we have learned which affects our views of normal and abnormal. 


Different cultures have different social norms and roles, and therefore members of different cultures will have different attitudes toward how someone chooses to express their gender. For instance, Wienclaw (2021) writes that in the Tchambuli culture of New Guinea women control economic life, do the fishing, and initiate sexual relations. The men wear flowers and jewelry and are dependent. Now as an example, John is a male who expresses his gender with more effeminate characteristics, and John is in two different situations. In one situation John is walking down a street in New Guinea, and in the other situation, John is walking down a street somewhere in Saudi Arabia. The attitudes, personal beliefs, and people’s views of the way that John chooses to express his gender will differ with diverse cultures. 


Fear is a reason some might feel uncomfortable validating someone’s gender expression. Someone may worry about repercussions from validating the gender expression of someone who expresses it differently from their own personal beliefs and cultural social norms and social roles. Another reason may be fear of saying the wrong thing or using the wrong pronoun, and they may not want to embarrass themselves by saying the wrong thing. And this is where everyone can benefit from increasing their emotional intelligence on this topic. Increasing emotional intelligence on this topic will ensure that all people, no matter how they choose to express their gender, will receive social justice. 


Amber Hagar (2014) wrote Gender What? Which gives four steps to take to validate someone’s gender expression. The first step is to do your research and see gender as a personal expression of their location on the gender spectrum (Hagar, 2014). Hagar posts the following five websites for additional resources: 


The second step is to be respectful of someone's gender identity, name, and pronouns. The third step is to be an ally, advocate, speak up and support that person. In the fourth step Hagar (2014) posts the following four links for counseling and to answer questions such as religious matters: 


 


 


 


 


References 


Hager, A. (2014). Supporting Gender Identity: A Beginner’s Guide for Friends, Family, and University Staff | myUSF. Myusf.usfca.edu. https://myusf.usfca.edu/caps/supporting-gender-identity 


Learning Objectives / Online Resources. (n.d.). Edge.sagepub.com. https://edge.sagepub.com/node/23655/student-resources/chapter-4/learning-objectives 


‌Wienclaw, R. A. (2021). Gender Roles. Research Starters: Sociology. 

Anxiety, Fear, and Stress

 The autonomic nervous system is a part of the peripheral nervous system that controls physiological processes such as pulse, blood pressure, respiration, digestion, and sexual arousal. Sympathetic, parasympathetic, and enteric nervous systems are all part of the autonomic nervous system. The sympathetic nervous system “controls ‘fight-or-fight' responses” (McCorry, 2007). "The parasympathetic system regulates rest and digest functions” (McCorry, 2007). A balance between these two systems is essential for our mental and physical health. Since the parasympathetic system slows down and relaxes everything and the sympathetic system speeds everything up, when one is active, the other is less engaged. An example of these systems being out of balance would be if the sympathetic system were constantly active at an excessive level. There would be a constant feeling of the fight or flight response even though there is no immediate danger. One way a therapist might help a patient activate the parasympathetic nervous system is by having the patient rub their fingers over their lips. “Parasympathetic fibers are spread throughout your lips so touching them stimulates the parasympathetic nervous system” (Bernhard, 2011). Toni Bernhard J.D. of Psychology Today states that is Toni’s go-to practice calming the mind and body and that it immediately calms someone down. Since both systems are correlated with someone's level of fear, when there is no balance, someone can develop an anxiety disorder. 


“In recent years many prominent researchers have proposed a fundamental distinction between the fear and anxiety response pattern” (Hooley et al., 2019). Fear involves the fight or flight response originating from the sympathetic nervous system and it is an instant reaction to threat. For instance, someone taking a shower and suddenly they see a stranger in a mask standing by the shower holding a knife. The person in the shower will suddenly experience a fight or flight response thanks to the sympathetic nervous system. This is a normal fearful reaction to what is happening, and one that may help the person in the shower survive. Now if the showering person survives this incident, then they will have anxiety about taking another shower. The cognitive, which is subjective, the physiological, and the behavioral components of anxiety and fear are different. The person in the shower is thinking I am in immediate danger, and they are experiencing physical symptoms such as tachypnea, tachycardia, and diaphoresis. Their behavior will indicate a desire to run or escape.  Now the subjective, physical, and behavioral symptoms of anxiety would be chronic worrying about what might happen, chronic muscle tension and wanting to avoid the situation or stressor, respectively. The DSM-5 recognizes anxiety as a disorder. 


“Anxiety disorders are characterized by unrealistic or irrational fears or anxiety that cause significant distress and impairments in functioning” (Hooley et al., 2019). Generalized anxiety disorder and specific phobia anxiety disorder are two anxiety disorders mentioned in the DSM-5. With generalized anxiety disorder, the patient suffers from chronic worry about things that can go wrong with anything. These patients have some panic attacks, but they are not the focus of their anxiety. With a specific phobia, the patient experiences a major fight or flight response when introduced to the feared object or situation. Even the possibility of encountering the feared object or situation causes anxiety for these patients. Anxiety affects society. “During 2019, about one in six (15.6%) adults aged 18 and over experienced symptoms of anxiety in the past 2 weeks that were either mild (9.5%), moderate (3.4%), or severe (2.7%)” (Terlizzi & Villarroel, 2020). With these statistics in mind, anxiety has a close relationship with programmatic themes. 

     Emotional intelligence and self-care are essential when dealing with anxiety disorders. Emotional intelligence increases with the knowledge of the relationship between the sympathetic and parasympathetic nervous systems, and how they affect anxiety. Increased emotional intelligence allows people to approach anxiety disorders scientifically. Increases in emotional intelligence also contribute to everyone's awareness of self-care. Self-care is also essential in maintaining physical and mental health. 


 


References 

‌ Bernhard, T. (2011, September 13). 4 Tips for Slowing Down to Reduce Stress. Psychology Today. https://www.psychologytoday.com/us/blog/turning-straw-gold/201109/4-tips-slowing-down-reduce-stress 

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

McCorry, L. K. (2007). Physiology of the Autonomic Nervous System. American Journal of Pharmaceutical Education, 71(4). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959222/#:~:text=The%20sympathetic%20system%20controls%20%E2%80%9Cfight 

Terlizzi, E., & Villarroel, M. (2020, September 21). Symptoms of Generalized Anxiety Disorder Among Adults: United States, 2019. Www.cdc.gov. https://www.cdc.gov/nchs/products/databriefs/db378.htm 

2 Big Changes to the DSM in the 1980's

 In the 1980s, the American Psychiatric Association added PTSD into the DSM and phased out homosexuality as a diagnosis. Today the DSM does not even list homosexuality as a disease, and the DSM has revised the criteria for PTSD and reclassified it. And while the LGBTQ community and PTSD victims benefit from these changes, they did not occur overnight. 


  This change in the DSM regarding homosexuality occurred from conflicting theories about homosexuality throughout history. Pathology, Immaturity, and normal variation were the main categories of theories about homosexuality (Drescher, 2015a). Pathology saw homosexuality as a disease. Richard von Krafft-Ebbing was a German psychiatrist who stated that homosexuality was the result of a disorder. His theory stated that people could have a predisposition to being gay, but the tendencies of homosexuality constituted a disease. He wrote Psychopathia Sexualis in 1886, and this defined the framework for deviant human sexual behavior diagnostic manuals of the mid-twentieth century.  


Sigmund Freud believed in the immaturity theory which stated that homosexual feelings at an early age were a normal step toward adult development of sexuality (Drescher,2015). With this theory, homosexuality resulted from stunted growth and the development of adult heterosexuality. Mid-nineteenth century Karl Heinrich Ulrichs, Magnus Hirschfeld, and Hungarian journalist Karl Maria Kertbeny all believed there was some normal variation in nature. Kertbeny coined the phrase homosexual and homosexuality (Drescher, 2015a). After Freud died in 1939, Sandor Rado impacted the mid-twentieth century with his theory that homosexuality was a phobia of heterosexuality and pathological. Rado stated that this was caused by inadequate parenting. In 1952 homosexuality was classified as a “sociopathic personality disturbance” (Drescher, 2015a). Psychiatrists reclassified homosexuality as a sexual deviation in 1968. The pendulum swung back and forth on the topic until finally in 1973 gay activists disrupted the 1970 and 1971 APA meetings. This led to the APA removing homosexuality from the DSM in 1973; however, they only changed the name to sexual orientation disturbance diagnosis. This allowed for insurance-endorsed sexual conversion therapies if the individual’s same-sex attractions caused self-distress. In 1973 the DSM-III replaced it with Ego-dystonic homosexuality disorder and in 1987 the DSM-III-R finally removed this diagnosis. 



When the APA added PTSD to the DSM-III, it only applied to victims of such events such as war, torture, the Nazi holocaust, major war bombings, natural disasters, and human-caused disasters such as mass shootings, crashes, and bombings (PTSD History and Overview - PTSD: National Center for PTSD, n.d.). Since the APA separated traumatic events from life stressors such as divorce, rejection, failure, etc..., they categorized these life stressors as adjustment disorders instead of PTSD. In 1987 and 1994 the DSM-IIIR and the DSM-IV revised PTSD diagnostic criteria. The 1994 DSM-IV stated that the patient had exhibited a history of traumatic event exposure and symptoms from the following three clusters: intrusive recollections, avoidant/numbing symptoms, and hyperarousal symptoms (PTSD History and Overview - PTSD: National Center for PTSD, n.d.). The fifth criterion defined the duration of symptoms and the sixth criterion stated that the severity of the symptoms must cause a lot of distress and/ or impairment of necessary functions. The DSM-IV-TR also revised PTSD diagnosis. In 1980 no one knew the actual prevalence of PTSD, so the DSM-5 made evidence-based revisions to PTSD (PTSD History and Overview - PTSD: National Center for PTSD, n.d.). The American Psychiatric Association categorized PTSD as a Trauma-stressor-related disorder with the DSM-5 in 2013. The DSM expanded diagnostic criteria to include disruptive behaviors such as anger, impulsiveness, recklessness, and self-destruction. Also, the patient can experience trauma directly or indirectly. A dissociative subtype was added to the DSM-5, along with a preschool subtype for children up to six. Due to these changes in the DSM, there are more effective treatments including the FDA-approved use of SSRIs. There is also a psychological first aid kit online (Psychological First Aid: Field Operations Guide - PTSD: National Center for PTSD, 2014). 


Research trends in the DSM include changes to the DSM on homosexuality and the addition and revision of PTSD. Due to these research trends, public emotional intelligence regarding these topics increased and public stigmas surrounding them decreased. Social justice is also achieved when public stigma and discrimination are reduced. 


References 


Drescher, J. (2015a). Out of DSM: Depathologizing Homosexuality. Behavioral Sciences, 5(4), 565–575. https://doi-org.ezproxy.snhu.edu/10.3390/bs5040565 


Psychological First Aid: Field Operations Guide - PTSD: National Center for PTSD. (2014). Va.gov. https://www.ptsd.va.gov/professional/treat/type/psych_firstaid_manual.asp 


‌ 


PTSD History and Overview - PTSD: National Center for PTSD. (n.d.). Www.ptsd.va.gov. https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp#:~:text=In%201980%2 

The Evolution of Abnormal Behavior

         

Humans have been documenting abnormal behavior for thousands of years. The Egyptians recorded treatments and diseases of humans back in the sixteenth century. The Egyptians were the first to connect the brain with mental functions. The Egyptians also relied on magic to treat these unfamiliar conditions. The Chinese, Egyptians, Hebrews, and Greeks blamed abnormal behavior on demonic possession and the wrath of God. One extreme treatment used in the beginning was drilling holes in the afflicted person's head to
release evil spirits from their head. China was one of the earliest civilizations to relate mental disorders and medicine. The Chinese introduced the concept of the yin and yang, which was about the balance of positive and negative forces in the human body. Balancing these forces in the human body led to physical and mental health. 

During the Middle Ages, the scientific approach of the Greeks carried over into the Islamic countries, and the first mental hospital was set up in Baghdad in A.D 792 (Hooley et al., 2019). In these hospitals, patients suffering from mental illness received more humane and ethical treatment. Avicenna from Persia wrote The Canon of Medicine, which referred to the following conditions: hysteria, epilepsy, manic reactions, and melancholia. 


Finally, around 400 B.C.E., the Greeks realized that abnormal behavior was pathological and not the result of supernatural forces. Hippocrates emphasized” the importance of heredity and predisposition and pointed out that injuries to the head could cause sensory and motor disorders” (Hooley et al., 2019). Hippocrates “was a harbinger of a basic concept of modern psychodynamic psychotherapy” (Hooley et al., 2019). Plato, Aristotle, and Galen’s teachings looked at these abnormal behaviors with a scientific approach. Plato even suggested that people suffering from mental health disorders were not accountable for their actions like ordinary people. Aristotle and Galen also first started investigating depression in the Greek and Roman era. In the Middle Ages, religious persecution hindered the scientific approach to studying mental disorders; however, Hildegard, a nun who was noted as the first female of medicine to publish studies, still believed in the pre-modern view of depression.  Philippe Pinel was a French physician who believed in the more humane treatment of mental health patients during the humanitarian reform. William Tuke, an English Quaker, introduced theories of treatment that involved treating mental illness patients with kindness and acceptance.  During the humanitarian reform because of Pine and Tuke, asylums ended inhumane practices such as chaining mental health patients and therapies such as near drowning mental illness patients.” The success of Pinel’s and Tuke’s humanitarian experiments revolutionized the treatment of patients with mental illness throughout the Western world” (Hooley et al., 2019). 


    Back in America, Benjamin Rush, the founder of American Psychiatry, carried on the humanitarian reform. He also wrote the” first systematic treatise on psychiatry in America, Medical Inquiries, and Observations upon Diseases of the Mind in 1812 (Hooley et al., 2019). Rush was also the first to introduce a course in psychology. Dorothea Dix encouraged legislatures and people to raise standards in mental hospitals in the U.S. between 1841 and 1881. The humanitarian movement continued to positively influence the treatment of people with mental illness into the 1800s and 1900s. Psychiatrists and physicians started running mental health facilities and raising the standards of caring for mentally ill patients, as well as incorporating a more scientific approach. During this time and into the twentieth- century, the stigma of mental illness changed for the better. Clifford Beers published A Mind That Found Itself in 1908 and led a campaign that shifted peoples’ views away from inhumane therapies used to treat mental illness. Mental facilities grew for the first part of the twentieth century, as did the length of their hospitalization. In 1946, Mary Jane Ward’s The Snake Pit inspired increased humane treatments for mental health patients. That same year, the National Institutes of Mental Health was born, which eventually affected research and training in mental health.  The Hill-Burton and Community Mental Health Act of 1963 helped develop outpatient treatment centers. Finally, during the later part of the twentieth century, most of these mental institutions closed, and most of these patients returned to society because of better therapies and outpatient centers. 

While there is no universal indicator for diagnosing abnormal behavior, three main areas can indicate an abnormality. The first area is subjective distress, such as anxiety and depression, or some people may describe psychological pain. Another area is maladaptiveness, which is behavior that inhibits our well-being and relationships. Another area is” Statistical deviancy “(Hooley et al., 2019). In other words, the behavior is rare and not seen in everyday situations. And while these indicators provide the first piece of the puzzle, contributing factors to abnormal behavior give another piece. 

Biological, psychological, social, and cultural perspectives contribute to abnormal behavior.” In examining biologically based vulnerabilities, we must consider genetic abnormalities, brain dysfunction and neural plasticity, neurotransmitter and hormonal abnormalities in the brain or other parts of the central nervous system, and temperament” (Hooley et al., 2019). A vulnerability in someone’s genetics can affect the development of mental illness as well as the outcome of their exposure to external stimuli. Psychodynamic, behavioral, and cognitive-behavioral factors contribute to abnormal behavior. Early life trauma, parenting problems, divorce, unemployment, discrimination, and dysfunctional relationships are contributing social factors that also contribute to abnormal behavior. The norms of a culture can also define abnormal behavior. Cultural perspectives can also contribute to abnormal behavior. Typical behavior in one culture may be offensive or not accepted in another culture. 

Social factors contributing to abnormal behavior are also related to the programmatic theme of social justice. People of low socio-economic classes have often experienced issues such as unemployment and discrimination. These events can lead to abnormal behavior. But is this abnormal behavior or an adaptive behavior necessary for their survival? So, diagnosing abnormal behavior and providing treatment is a puzzle. One cannot draw conclusions or diagnose one puzzle piece because all the puzzle pieces not only form the complete picture but also give each other contextual meaning. 


References 


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




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