GW Topics Course on Substance Abuse: PubH 209.27

Substance Abuse:
Prevention, Intervention & Public Health
(PubH 209.27: 7/5/2007 - 8/9/2007)

PROFESSOR: Alan Trachtenberg, MD, MPH

COURSE ANNOUNCEMENTS:
Announcements will be placed here. Please try to check this area each Wednesday night or Thursday morning. Any last minute changes to Thursday evening's session will be posted, as will other current events at the intersection of substance abuse and public health.
FOR INSTANCE:

4/14/2007: FDA bans "Cocaine" (Street Drug Alternatives)



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 performance*, timely completion of assignments, one quiz, and a brief student paper on a public health or treatment program intervention against drug abuse or one or more of the health consequences of drug abuse.
(*NOTE: A wrong answer gets more credit than when no answer is offered. To make this work, I must ask that you raise your hand and be recognized prior to giving your answer.)

REQUIRED READINGS: Links to all required 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.

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, you must:

1) Justify the health outcome chosen (prevalence, morbidity, mortality, 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, setting, target population, expected effectiveness and any risks involved;

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

6) Include references appropriate to the topic, with correctly formatted citations;

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. EXAMPLES of previous papers are posted at: Public Health Interventions in Substance Abuse

NOTE: 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. Format, grammar, spelling and other aspects of the presentation of your ideas are very important to the success of those ideas. Please take advantage of the Writing Center if you have any potential concerns in these areas.

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


DISCLAIMERS & DISCLOSURES: Alan Trachtenberg, MD, MPH, 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. This is subject to change without notice. Stay tuned...



CLASS SCHEDULE & ASSIGNMENTS:

Class: Thursday evenings, 6:10-8:40 PM, 7/5/2007 - 8/9/2007
(Attendance will be taken).


Session 1 - 7/5/2007: Welcome, syllabus, introductions, disclaimers, overview of topic, neurophysiology and pharmacology.

SYLLABUS

OVERVIEW OF SUBSTANCE ABUSE IN PUBLIC HEALTH


ASSIGNMENT: Establish username and password for confidential 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.



Session 2 - 7/12/2007: Overview of drugs, drug classes, drug schedules, drug agencies and drug regulation in the US; Drug Abuse Epidemiology and History; Sources of data and information on substance abuse in the US.

REQUIRED READINGS:

Mokdad A, Marks J, Stroup D, Gerberding J. Actual causes of death in the United States, 2000. JAMA 2004;291:1238--45.

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

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

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

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


OPTIONAL READINGS:

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 sometimes misused interchangeably with "Opioids." [+/- cocaine])
Stimulants
Depressants
Cannabis
Drugs of Abuse Chart

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

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

FDA, DEA and the Drug Approval & Scheduling Process

NIDA Research Report: Hallucinogens and Dissociative Drugs.



Session 3 - 7/19/2007: QUIZ ON READINGS for last week and this week; AND Medical Complications of Drug Abuse.

REQUIRED READINGS:

Pathology of drug abuse

Comorbidity between substance use disorders and psychiatric conditions by Marc A. Schuckit [ADDICTION, Vol. 101 Issue s1 - September 2006]

NIDA Research Report: Prescription Drugs: Abuse and Addiction.

NIDA Research Report: Inhalant Abuse.

CSAT Treatment Advisory: Anabolic Steroids.

OPTIONAL READING:

MEDICAL CONSEQUENCES OF SUBSTANCE ABUSE

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

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

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

ASSIGNMENT: 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 4 - 7/26/2007: Substance Abuse Treatment; discussion of paper topics.

REQUIRED READINGS:

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

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

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

OPTIONAL READINGS:

NIDA Research Report: Therapeutic Community.

12-Step Participation as a Pathway to Recovery

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

Ira Marion: Methadone Treatment at Forty

Neurobiology of Opioid Dependence-Implications for Treatment



Session 5 - 8/2/2007: Prevention Interventions; policy issues.

REQUIRED READINGS:

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

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

CDC: Access to Sterile Syringes

CDC: Syringe Disinfection for Injection Drug Users

OPTIONAL READINGS:

TESTING DRUGS VS. TESTING FOR DRUG USE: PRIVATE RISKMANAGEMENT IN THE SHADOW OF THE CRIMINAL LAW by Dr.Robert MacCoun

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

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



Session 6 - 8/9/2007: Topics of special class interest; Evaluations; Turn in final papers; Fond farewells.






















Extra Credit Exercise for the Student:
Psychosis After Ultrarapid Detox & Switch Methadone to Hydrcodone for 12 Days / SHREERAM, McDONALD & DENNISON; Falls Church, VA