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TO CREATE (Options in Health Care and Education)  
     
     
2009 GW Topics Course:Drug Abuse



Substance Abuse:

Prevention, Intervention & Public Health

(Public Health 209.27: 5/20/2009 - 7/22/2009; Wednesdays 6:10 - 8:40 PM; Ross Hall 224)

COURSE DESCRIPTION:
The epidemiology, pathology and physiology of substance abuse and its treatment will be reviewed, with emphasis on the preventable complications and sequelae of the different stages of use, abuse and addiction. Substance abusers will be examined as a key population for biopsychosocial interventions to protect them, their families, communities and the general public. Various public health interventions will be explored at all possible points of contact with drug abusers, both in and out of treatment. Current national initiatives relevant to drug abusers and related public health issues will be reviewed.

PROFESSOR: Alan Trachtenberg, MD, MPH

OFFICIAL COURSE SYLLABUS


COURSE ANNOUNCEMENTS:

Announcements will be placed here. Please try to check this area each Tuesday night or Wednesday morning. Any last minute changes to Wednesday evening's session will be posted, as will other current events at the intersection of substance abuse and public health and new resources for class use;

FOR INSTANCE:


7/9/2009:
SESSIONS 7-8 HANDOUT POSTED:
SESSIONS 7-8: Addiction Treatment Slides


7/1/2009: CLASS PRESENTATIONS ASSIGNED- All students will be asked to present an informal 5-10 minute presentation on their final project during the 8th or 9th Class session, either 7/8/2009 or 7/15/2009. Presentations should contain all the main elements of the project, but no slides or handouts are expected.


6/29/2009:
SESSION 5-6 HANDOUTS POSTED:
SESSION 5-6: Drug Classes and Routes of Administration.


6/13/2009:
NEW HANDOUT POSTED:
Psychiatric & Behavioral Aspects of Alcohol & Drug Abuse; Initiation & Progression.


5/16/2009:
EVIDENCE BASED PREVENTION INTERVENTIONS
This
searchable database (http://casat.unr.edu/bestpractices/search.php) includes interventions that have been shown to be effective in preventing substance abuse and/or the risk factors for substance abuse. Information is provided regarding training, technical assistance and/or materials that facilitate replication of each practice. Use the check boxes to indicate on which variable(s) you would like to conduct a search of evidence based drug prevention interventions. When you click the button near the bottom of the page ("Find Matching Practices"), an 'OR' search will be completed. Select as many attributes that interest you. The results will be ranked based on how many programs have attributes matching the criteria you specify.
More resources for finding evidence-based prevention programs can be found at http://captus.samhsa.gov/national/resources/evidence_based.cfm.


7/31/2008:
Differential brain changes documented in rats trained to self-administer cocaine, versus animals trained to self-administer natural rewards such as food: The brain changes due to cocaine training persisted for up to three months of abstinence, but the changes in response to natural rewards dissipated after only three weeks. Rats receiving cocaine only passively (whenever the other, trainee, rat pressed the lever) demonstrated neither transient nor long lasting changes, demonstrating the essential role of self-administration in causing the brain changes of addiction.
See NIDA press release at http://www.nida.nih.gov/newsroom/08/NR7-31.html.



TO CONTACT THE PROFESSOR (for GW or class business):

Please call in the evenings: 301-984-8843; EMAIL using: 2create.yourMD@gmail.com;
OR PREFERABLY:
Please use the confidential web-based messaging function on
the 2Create homepage (in the upper right-hand corner, you may have to scroll to the right to see it) or try going directly to the Sign Up New User Page .

OUTSIDE OF CLASSROOM HOURS, questions on class content are best addressed on the 2Create Blog at:
(http://2createyourmd.blogspot.com/) . This is intended to facilitate an ongoing, web-based class discussion for everyone to benefit from everyone else's questions. Email questions of a non-private nature will generally be answered on the Blog, or in class, rather than by reply email. Questions of a private nature will be received and answered via the web-based messaging function on the 2Create website. Remember that (as always) regular email is NEVER confidential.

GRADING METHOD: Grading will be based on classroom participation, timely completion of assignments, one quiz, and a brief student paper on a public health or treatment program intervention against drug abuse or defined health consequence(s) of drug abuse. Optional assignments for extra credit will also be made available at the bottom of this page.

REQUIRED READINGS: Links to all readings will be found on the class schedule below, underneath the session for which they are due. Please try to read them prior to that class session.

OTHER ASSIGNMENTS: Are also noted on the class schedule below. Assigned work (other than reading) is due by the beginning of the class following when it was assigned.

QUIZ: The quiz will be based on both the required readings and class sessions. The quiz format will be short answer, multiple choice and/or True/False type questions. The quiz will be difficult, but graded on a curve.

FINAL PAPER: This can be thought of as kind of a mini-proposal, in which you will define a specific population and a health outcome relevant to the course (something to do with substance abuse and/or its sequelae) and propose an intervention to be applied to your defined population. The intervention should be expected to beneficially affect that outcome. Specifically, your paper must:

1) Justify the health outcome chosen (prevalence, morbidity, mortality, cost, etc.) as the target of the intervention;

2) Specify the population to whom you plan to apply your intervention, and how you will find/access/reach/identify them;

3) Give the rationale for the intervention, including a summary of the evidence base for it (How does it work? How well does it work?);

4) Describe the intervention, including the resources needed, target population, expected effectiveness, any risks involved and setting (pick a specific agency, program or institution from which you would be conducting the intervention);

5) Describe how the intervention could (and whether it should) be evaluated;

6) Include adequate references appropriate to the topic, with correctly formatted citations that contain adequate information for the reference to be retrievable by the reader from the primary source. (At least a few references are expected to the peer-reviewed literature. To ease their retrievability, weblinks to their abstracts in Medline or on the Journal site are appreciated. Citations from the popular press or ".com" websites are suitable for events or quotations, however, not for claims of scientific or biomedical evidence. Citations from other websites will be evaluated on an individual basis as to their credibility.);

7) Have correct spelling, punctuation and grammar; and

8) Be as long as necessary, but no longer than is necessary, to address items 1-6.

You can choose anything from a prenatal or school-based program for primary prevention of drug abuse to a harm reduction intervention to a treatment-based tertiary prevention approach against HIV progression. You may want to approach the paper as if you are working in a particular agency that has some jurisdiction or mission related to the problem. For instance, a city public school system, an addiction treatment program or a state or county health department. Placing your project in an agency you have worked in or would like to work in might make your paper more relevant and interesting for you. OR, you can choose to place yourself wherever you can best conduct and/or evaluate the intervention in which you are most interested.

EXAMPLES OF PREVIOUS PAPERS ARE POSTED AT:
Papers on Public Health Interventions in Substance Abuse

NOTE: Format, grammar, spelling and other aspects of the written presentation of your ideas are very important to the success of those ideas in the real world of public health and/or policy. Please take advantage of the GWU Writing Center if you have any potential concerns in these areas. The GWU Writing Center conducts free, one-on-one, 50-minute conferences with highly trained undergraduate and graduate students to assist you with course assignments, term papers, theses, applications, and resumes. They can help students at all stages of the writing process.

The George Washington University Writing Center
550 Rome Hall; Phone: (202)994-3765
gwriter@gwu.edu
(http://www.gwu.edu/~gwriter)


DISCLAIMERS & DISCLOSURES: Professor Trachtenberg offers the following opinions, analyses and data under the doctrine of academic freedom; NOT as a representative of any agency with which he is, or may have ever been, associated. What follows is a synthesis of what I believe to be the most current materials from the best experts in the fields of addiction medicine and public health, as seen through the lenses of my own clinical and public health experience. All opinions are subject to change without notice. Stay tuned...



CLASS SCHEDULE & ASSIGNMENTS:
(Wednesday evenings, 6:10-8:40 PM. Attendance will be taken).


Session 1 - 5/20/2009

Topics: Welcome, syllabus, introductions, disclaimers, overview of topic, neurophysiology and pharmacology of substance abuse.

SYLLABUS

OVERVIEW OF SUBSTANCE ABUSE IN PUBLIC HEALTH (handout for sessions 1 & 2)


ASSIGNMENTS - Due by the beginning of session 2:

1. Establish username and password for confidential, HIPAA-compliant web-based messaging w/instructor at
http://www.2create.yourmd.com/. See log-in area at upper right corner of front page (you may have to scroll to the right to see it) or try going directly to:
sign up. Click on the instructor's name, then provide some basic information. Please do include Date of Birth (or at least Year of birth). Do not enter your social security number. Once you are registered, use the "general" message category to send the instructor a message with a couple of sentences about your particular interests in substance abuse or why you wanted to take this class. (Ignore the site's information on paid consultation; You have already paid GW.)

2. Carefully review the instructions for the final class paper and examine one or more examples of the previous class papers posted at:
Papers on Public Health Interventions in Substance Abuse. Questions on these will be entertained at the beginning of session 2.


Session 2 - 5/27/2009

Topics: Overview of drugs, drug classes, drug schedules, drug agencies and drug regulation in the US; Drug Abuse Epidemiology and History; Discussion of final projects.

REQUIRED READING:

Addiction as a Chronic Disorder; White WL and McClellan AT;
http://www.comproviders.com/files/Addiction-as-a-Chronic-Disorder.pdf

Comorbidity: Addiction and Other Mental Illnesses / NIDA 12/2008 (http://www.nida.nih.gov/researchreports/comorbidity/index.html)

NIDA: Commonly Abused Drugs
OR
(local PDF of NIDA Table)

Addiction Versus Dependence in DSM-V by O'Brien, Volkow & Li -Am J Psych 163:764-765, May 2006
OR
(LOCAL PDF COPY)

Drug Schedules and the Controlled Substances Act (CSA) pp 1-9 (http://www.usdoj.gov/dea/pubs/abuse/1-csa.htm)

DEA Introduction to Drug Classes (Note: In general, DEA publications should be taken with a grain of salt,but these are not too bad.)
"Narcotics" (Opioids, really: The term "Narcotics" is a legal one sometimesmisused interchangeably with "Opioids." [+/- cocaine])
Stimulants
Depressants
Cannabis

Drugs of Abuse Chart

"How Do They Measure Up?" Examining Drug Use Surveys and Statistics: Sources (Part 1) & Problems (Part 2) by Earth & Fire Erowid. (Erowid Extracts. Nov 2005; 9:12-21)


OPTIONAL READING:

Historical Themes in Chemical Prohibition By William L. White; From:Drugs in Perspective, National Institute on Drug Abuse, 1979


Session 3 - 6/3/2009

Topics: Overview of drugs, drug classes, drug schedules, drug agencies and drug regulation in the US; Drug Abuse Epidemiology and History (continued);
Sources of data and information on substance abuse in the US; Resources for Online Data Analysis of Drug Abuse Related Data.

REQUIRED READINGS:

NIDA 2007 Publication: Drugs, Brains, and Behavior - The Science of Addiction
OR
(Local PDF: The Science of Addiction; NIDA 2007)

NIDA Research Report: Hallucinogens and Dissociative Drugs.

Pathology of Drug Abuse (NOTE: The statement in this reading about MDMA causing brain damage is unsubstantiated)(http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG.html)

NIDA Research Report: Prescription Drugs: Abuse and Addiction.

NIDA Research Report: Inhalant Abuse.

OPTIONAL READING:

A Drug War Carol: the History of American Drug Control in Comic Book Form

FDA, DEA and the Drug Approval & Scheduling Process


Session 4 - 6/10/2009

QUIZ on readings for this week and 1st three classes.

Topic: Epidemiology and Medical Complications of Drug Abuse.

REQUIRED READING:

Underage Drinking: Frequency, Consequences, and Interventions by RW Hingson et al (Traffic Injury Prevention 5:228-36, 2004).

Medical Consequences Of Substance Abuse by MD Stein in Psychiatric Clinics of North America; June, 1999. 22(2):351-70.

Managing Addiction as a Chronic Condition by M Dennis & CK Scott: NIDA Addiction Science & Clinical Practice 4(1) 45-55 (http://www.drugabuse.gov/ascp/vol4no1.html).

Public Health and Injection Drug Use. MMWR 5/18/2001 Vol 50, No MM19;377

Epidemiology of HIV/AIDS --- United States, 1981--2005MMWR 6/2/2006 Vol 55, No MM21;589

CSAT Treatment Advisory: Anabolic Steroids.

OPTIONAL READING:

Preventable Causes of Death in the United States. Danaei et al (2009).(http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000058)

ASSIGNMENT for session 5: Use the web-based messaging function to send the instructor your proposed topic for the final paper and receive a reply with your quiz grade. Your topic proposal should specifically describe: 1) The intervention you plan to apply; 2) The population you plan to apply it to and how you will find/access/reach them; 3) The health outcome you plan to prevent/affect & how you will measure it; and 4) Categorize your outcome intervention as universal, selective, indicated and/or primary, secondary or tertiary prevention.


Session 5 - 6/17/2009

Topics: Epidemiology and Medical Complications of Drug Abuse (continued);
Discussion of paper topics.

REQUIRED READING:

Alcoholism and Substance Abuse by Donald Warne (chapter from Rakel's INTEGRATIVE MEDICINE, 2nd Edition, 2007).

Increasing deaths from opioid analgesics in the United States by Paulozzi et al (pharmacoepidemiology and drug safety 2006; 15: 618-27).

CDC Fact Sheets on Substance Abuse Treatment: 6 items, 22 pages total

OPTIONAL READING:

Nestler E: The Neurobiology of Cocaine Addiction.NIDA Science & Practice Perspectives Volume 3, Number 1 - December 2005

Ira Marion: Methadone Treatment at Forty Neurobiology of Opioid Dependence-Implications for Treatment


Session 6 - 6/24/2009

Topics: Substance Abuse Treatment and Prevention; Discussion of paper topics.

REQUIRED READING:

NIDA: Principles of Drug Addiction Treatment: A Research Based Guide

NIAAA Alcohol Alert #66: Brief Interventions (2005) [ PDF ]

National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices (National Quality Forum) (http://www.qualityforum.org/pdf/reports/sud/sudexesummary.pdf)
OR
LOCAL PDF COPY

NIDA Research Report: Therapeutic Community.

12-Step Participation as a Pathway to Recovery

OPTIONAL READING:

Principles of Drug Abuse Treatment for CRIMINAL JUSTICE POPULATIONS:A Research Based Guide


Session 7 - 7/1/2009

Topics: Substance Abuse Treatment and Prevention (continued).

REQUIRED READING:

NIDA: Preventing Drug Abuse among Children and Adolescents, A Research Based Guide

Safety First: A Reality-Based Approach to Teens and Drugs; by Dr. Marsha Rosenbaum
OR
http://www.safety1st.org/images/stories/pdf/safetyfirst.pdf


Session 8 - 7/8/2009

Topics: Substance Abuse Treatment and Prevention (continued); Drug testing; Harm reduction. Discussion of extra credit requests.

REQUIRED READING:

CDC: Access to Sterile Syringes

CDC: Syringe Disinfection for Injection Drug Users

CDC: Drug Users and the Structure of the Criminal Justice System, August 2001

CDC: Women, Injection Drug Use, and the Criminal Justice System; August 2001

Testing Drugs vs. Testing For Drug Use: Private Risk Management In The Shadow Of The Criminal Law by Dr. Robert MacCoun.
OR
(LOCAL PDF COPY)

ASSIGNMENT: CLASS PRESENTATIONS ASSIGNED - All students will be asked to present an informal 5-10 minute presentation on their final project during the 8th or 9th Class session, either 7/8/2009 or 7/15/2009. Presentations should contain all the main elements of the project, but no slides or handouts are expected.



Session 9 -7/15/2009

Topics: Harm Reduction; Drug Policy.

REQUIRED READING:

Drug Use Prevention & Education (And Comments on DARE) by Dr. Jeff Ratliff-Crain

OPTIONAL READING:

Beyond Zero Tolerance: A comprehensive, cost-effective approach to high school drug education and student assistance


Session 10 - 7/22/2009

Topics of special class interest; Evaluations; Turn in final papers; Fond farewells...






Extra Credit Exercises for the Student:

1.
Psychosis After Ultrarapid Detox & Switch Methadone to Hydrocodone for 12 Days /
SHREERAM, McDONALD & DENNISON; Falls Church, VA


2. Use online data analysis of drug abuse related data from 1-3 primary sources (surveys or datasets) to make an interesting point or support a hypothesis about the epidemiology of substance abuse or it's consequences. Twice as much credit for using 2 sources and three times as much for using three such sources (for supporting the same point). Document your work with URLs used and copies or screen shots of relevant search strategies and results. Other web-based data may also be used to support the arguments from your online data analysis. Examples of sources to use can be found at:
Resources for Online Data Analysis of Drug Abuse Related Data. Final product should be emailed to the instructor.