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A group of substance-related disorders involving the ingestion of drugs classified broadly as hallucinogens. A hallucinogen is one of a class of drugs that results in profound alterations in sensory and perceptual experiences. In some cases, users experience vivid visual hallucinations. Common hallucinogens include psilocybin (shrooms), mescaline (peyote), and LSD. These substances also commonly cause hallucinations of body sensations (e.g., feeling as if you are a giant) and a skewed perception of the passage of time.
Regardless of the particular substance, the diagnosis of a substance use disorder is based upon a pathological set of behaviors related to the use of that substance (APA, 2019). These behaviors fall into four main categories:
1. Impaired control: Impaired control may be evidenced in several different ways: using for longer periods of time than intended, or using larger amounts than intended; 2) Wanting to reduce use, yet being unsuccessful doing so; 3) Spending excessive time getting/using/recovering from the drug use; 4) Cravings that are so intense it is difficult to think about anything else.
2. Social impairment: you may recall our definition of addiction: Addiction is repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable. Social impairment is one type of substantial harm (or consequence) caused by the repeated use of a substance or an activity. People may continue to use despite problems with work, school or family/social obligations. This might include repeated work absences, poor school performance, neglect of children, or failure to meet household responsibilities.
3. Risky Use: the key issue of this criterion is the failure to refrain from using the substance despite the harm it causes. Addiction may be indicated when someone repeatedly uses substances in physically dangerous situations. For instance, using alcohol or other drugs while operating machinery or driving a car.
4.Pharmacological indicators: Tolerance and Withdrawal: for many people, tolerance and withdrawal are the classic indicators of advanced addiction. As such, these are particularly important concepts. This criterion refers to the adjustment the body makes as it attempts to adapt to the continued and frequent use of a substance. This adjustment is called maintaining homeostatic balance.
Evidenced-based psychotherapy and psychopharmacologic treatment for Hallucinogen-Related Disorders
There are no FDA-approved medications to treat addiction to hallucinogen addiction. While behavioral treatments can be helpful for patients with a variety of addictions, scientists need more research to find out if behavioral therapies are effective for addiction to hallucinogens. For HPDD, some antidepressant and antipsychotic medications can be used to improve mood and treat psychosis. Behavioral therapies can be used to help people cope with fear or confusion associated with visual disturbances. Management of PCP intoxication mostly consists of supportive care controlling breathing, circulation, and body temperature and, in the early stages, treating psychiatric symptoms. Benzodiazepines, such as lorazepam, are the drugs of choice to control agitation and seizures (when present). Current clinical and research practices suggest that the rationale for combining behavioral therapy and pharmacotherapy is to provide support and skills while the patient is waiting for the medication effects to become apparent, to enhance treatment adherence, to improve treatment and study retention, and to address symptoms and problems that the medication will not address (eg, skills building) (Ciccarone, 2020).
Clinical Features of Hallucinogen-Related Disorders
Some Behavioral/Cognitive Signs of use of Hallucinogens includes: a change in overall attitude/personality with no other identifiable cause, hanges in friends; new hang-outs; sudden avoidance of old crowd; doesn’t want to talk about new friends; friends are known drug users, change in activities or hobbies (e.g., giving up sports), drop in grades at school or performance at work; skips school; late for school; school suspension, change in habits at home; loss of interest in family and family activities, difficulty in paying attention; forgetfulness; blackouts, general lack of motivation, energy, self-esteem, “I don’t care” attitude, sudden oversensitivity, temper tantrums, or resentful behavior, moodiness, irritability, nervousness, aggressiveness, depression or suicidality, silliness or giddiness, paranoia; confusion; hallucinations, and excessive need for privacy; unreachable. Some Physical Signs includes, but not limited to loss of appetite, increase in appetite, any changes in eating habits, unexplained weight loss or gain, slowed or staggering walk; poor physical coordination; lightheadedness; numbness; weakness, inability to sleep, awake at unusual times, unusual laziness, red, watery eyes; pupils larger or smaller than usual; blank stare; jaundice (yellow eyes and skin), puffy face, blushing or paleness, smell of substance on breath, body or clothes, extreme hyperactivity; excessive talkativeness, runny nose; persistent hacking cough, needle marks on lower arm, leg or bottom of feet, nausea, vomiting or excessive sweating, tremors or shakes of hands, feet or head, irregular heartbeat; rapid heartbeat; chest pain (Akindipe, 2018).
Akindipe, T., Wilson, D., & Stein, D. J. (2018). Psychiatric disorders in individuals with
methamphetamine dependence: Prevalence and risk factors. Metabolic Brain Disease,
American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders
Centers for Disease Control and Prevention. (2018). Annual surveillance report of drug-related
risks and outcomes—United States. Surveillance Special Report, Atanta, GA: Centers for
Disease Control and Prevention.
Ciccarone, D. (2020). Stimulant abuse: Pharmacology, cocaine, methamphetamine, treatment,
attempts at pharmacotherapy. Primary Care: Clinics in Office Practice, 38(1), 41-58.
Spronk, D. B., van Wel, J. H., Ramaekers, J. G., & Verkes, R. J. (2018). Characterizing the
cognitive effects of cocaine: A comprehensive review. Neuroscience & Biobehavioral
Reviews, 37(8), 1838-1859.
Zickler, P. (2017). Methamphetamine abuse linked to impaired cognitive and motor skills despite
recovery of dopamine transporters.
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