Topic: Treatment of Addictions

Discussion Prompts:  Answer the following in 1-2 solid paragraphs for each question:

Week 1: 

1).  What distinctions are important to you about substances?   Discuss your opinions on at least three of the following:  dangers of using legal vs. illegal substances, “soft” drugs vs.  “hard” drugs, hallucinogenic (“teaching”) substances vs. pleasurable ones,  using socially vs. alone, using on weekends vs. weeknights, only to the point of getting mildly intoxicated vs. highly intoxicated, social acceptance of the use of caffeine, nicotine, medications, and alcohol vs. other substances.

2). We will discuss various definitions of addiction in our zoom meeting.  We will cover the American Medical Association (disease), the ICD-10 (abuse & dependence), and the DSM-5 (disorder) terminology, amongst others.  Present your preferred definition of addiction, preferred terminology (addiction, disorder, abuse, dependence, other?), and your rationale. 

Week 2:

1). How should society respond to individuals who a) use, and b) over-use substances?  Discuss your stance on topics like decriminalization, legalization, and locking humans in cages for non-violent drug charges.  Your position may be that all drug use is bad and everyone who uses drugs should be executed (something similar to the current approach in The Philippines), or that use of any drug at any time is a personal choice that should not be of concern to the state (something similar to what Portugal appears to be moving towards), or anywhere in between.

2). How should health care licensing boards (such as the one you hope to be under the jurisdiction of) respond to licensees who a) use and b) over-use substances?  Potential controversies to consider include:  Should licenses be suspended, revoked, penalized?  Should treatment be required?  What psychoactive substance use is acceptable while conducting psychotherapy (caffeine?  prescribed medications including amphetamines (e.g. adderall, vyvanse, desoxyn), benzodiazepines (e.g. xanax, klonopin, ativan), and opiates (e.g. fentanyl, oxycontin, percocet, vicodin) from a physician but not from the street?)

Week 3:

1).  Watch this TED talk and write two solid paragraphs in response.  (if the link doesn’t work, google ‘Johann Hari Addiction Ted Talk’).

2)  Review this article and do at least 10 minutes of your own research into Heroin-Assisted Treatment (HAT).  Be sure to consider Switzerland’s implementation of HAT in 1994 in response to what was then one of the largest open-drug scenes in Europe.  Based on what you find in your research, articulate your rationale in two solid paragraphs as to whether or not the United States should implement HAT as part of its response to the opioid epidemic.  (if the link doesn’t work, google ‘hat a decade later a brief update on science and politics’). 

Week 4:

1).  The debate about whether addiction is or is not a disease remains a hotly contested topic.  Write two paragraphs in support or rejection of the attached article from the New England Journal of Medicine, Addiction as Learning Not Disease.pdf

2).  A key takeaway from this course is that when it comes to any drug, the dose is the poison.  The LD50 is a pharmacological term for the median lethal dose (kills ½ the test population).  The ED50 is a pharmacological term for the median efficacious dose, and the ratio between LD50 and ED50 is the therapeutic index, also referred to as the therapeutic ratio, or therapeutic window.

Consider the following therapeutic indices:   cannabis=1000:1, valium=100:1, morphine=70:1, cocaine=15:1, alcohol=10:1

 Try to formulate a rational argument, in the face of the data above suggesting that alcohol is the most dangerous substance of them all, for alcohol being federally legal for recreational use when none of the other substances are.  If you do not believe there is a sound rational argument that can be made, elaborate on what you think would be a rational setup – should alcohol also be made illegal?  Should the other substances be made legal?  How might the changes you argue for be implemented?

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