What kind of government existed during the Cuban Missile Crisis?

In Cuba, a communist government existed during the Cuban Missile Crisis. In 1959, there was a revolution in Cuba. Fidel Castro led a revolution in which Fulgencio Batista was overthrown. The United States and Cuba had a nonexistent relationship after Castro nationalized U.S. owned businesses in Cuba. Cuba became more dependent on the Soviet Union, economically and militarily. Castro and Nikita Khrushchev, leader of the Soviet Union, worked closely together. The people of Cuba had little political freedom. Newspapers that were against Castro’s actions were closed. There were no free elections. Political opposition was silenced. Many who opposed Castro were put in jail.

There were some improvements in Cuba under Castro’s rule. Unemployed people found work, electricity was brought to rural areas, and there were improvements in the health care and the educational systems. However, people were limited in the amount of land they could own. Privately owned businesses were eliminated, and there was a shortage of consumer goods. Many Cubans fled to the United States in search of a better life both economically and politically.

There were significant differences between our government and economic system and Cuba’s government and economic system.

What are the differences between Rawls’ arguments and Marx and Engels’ arguments against inequality?

Marx and Engels focused on the relationship between the oppressor and the oppressed—that is, they maintained that the world consists of the members of the ruling class, the bourgeoisie, and the members of the subordinate class, the working class (http://www.britannica.com/topic/The-Communist-Manifesto). In their work, The Communist Manifesto, it was stated that the members of the ruling class controlled and expanded their wealth by exploiting the working class, members of which could only work and earn money by being exploited by the powerful. Marx and Engels criticized this system of inequality, and they argued the members of the working class, the proletariat, would unite together and defeat the capitalists. This would result in the workers' society, a classless society, whose every member would enjoy the fruits of equality because no one would be exploited. Everybody would have equal access.

Rawls, on the other hand, was less extreme, and according to him, justice had to do with fairness (http://hubpages.com/education/Key-Concepts-of-the-Philosophy-of-John-Rawls). In his book, A Theory of Justice, he argues that every person should enjoy his or her rights without jeopardizing the rights of other individuals. Most importantly, unlike Marx and Engels, Rawls does justify inequality, but only if the most disadvantaged members of the human society could benefit from it. Therefore, he focuses on the underprivileged and insists that others must make an effort to make the position of the underprivileged more tolerable. There should be no inequality if it will not provide benefits for the poor.

Unlike Marx and Engels' system, the Rawlsian system allows some space for a small degree of inequality in society; however, it maintains that inequality should not be tolerated if the majority of people, despite making an effort, cannot find themselves able to thrive.

In The Merchant of Venice, why does Gratiano say, "Let me play the fool" in Act 1, scene 1?

Gratiano has just told Antonio that he does not look well and that he is much too serious. He tells him that those who care too much about the world tend to lose the little they have. He says that Antonio does not look his old self.  

In reply, Antonio tells him that his vision of the world is just that - it is the world and nothing more. It is a stage on which every man plays a part and his one is a sad role. 

Gratiano suggests that if the world is as Antonio says, then he will play the part of a jester who will encourage laughter, causing faces to wrinkle. He would rather seek pleasure in wine and harm his liver than burden his heart with sad groans which could kill him.

Let me play the fool:
With mirth and laughter let old wrinkles come,
And let my liver rather heat with wine
Than my heart cool with mortifying groans...

Gratiano then asks why a warm blooded man should sit like an old man as if he is made of stone and be asleep when he is actually awake. He further asks why any man should become ill by constantly being irritable. It is obvious that Gratiano wants Antonio to adopt a more pleasant demeanour for he then tells him that he loves him and that he is advising him out of love. 

He mentions the fact that there are many men who hardly ever speak. They develop a certain air about them by being silent. These men adopt a stern look and their faces look like stagnant ponds covered in filth. They attempt to create the impression that they are wise and philosophical men who deserve respect. Their superciliousness demands that others should be quiet and listen when they speak. Even dogs should stop barking.

He furthermore states that he knows such men and that they are only deemed wise because they hardly ever say anything, but when they do speak, it becomes evident what fools they actually are. He concludes his speech by saying that he would lecture Antonio some more about the subject at a later occasion. He suggests that Antonio should not use his melancholy as bait for him to offer any further opinions, for he is but a fool.

But fish not, with this melancholy bait,
For this fool gudgeon, this opinion.

He then asks Lorenzo to leave with him and greets, stating that he will continue trying to encourage Antonio after dinner.

Gratiano's attempt to encourage Antonio out of his melancholy is quite strange, to say the least. In order to cheer up his friend, he rather criticises the negative qualities of a sombre mood instead of saying something positive, although his suggestion at the start is that he would play the jester and encourage mirth. His speech comes across as more of a stern lecture than an inspiration. I am sure that if I were Antonio, I would be even more depressed after such a 'cheerful' talk! 

As it is, Antonio's mood is not lightened at all and he, somewhat sarcastically, remarks that he will now speak much more after Gratiano's lecture.

In Macbeth, how does Macbeth show commitment?

Macbeth is committed when he shows that he is willing to do just about anything to hang on to the power and status he gained when he killed Duncan.  The Weird Sisters told Banquo that he would never be king but that he would father kings; his descendants, then, would rule.  This angers Macbeth because he doesn't like to think that he went to all this trouble to make royalty out of someone else's children.  He says, 

To be thus is nothing,

But to be safely thus. Our fears in Banquo

Stick deep, and in his royalty of nature

Reigns that which would be feared. (3.1.50-54)

Macbeth feels that it isn't worth being king unless he feels secure in his position; he cannot relax.  Therefore, he determines to kill both Banquo, so he can never have more children, and his living son, Fleance, so that he can never reign or produce heirs of his own.  It's hardly admirable commitment, but Macbeth is committed to holding on to power nonetheless.  Further, he is willing to do more yet in order to retain his power, telling his wife, "We are yet but young in deed" (3.4.150).  In other words, he feels that they have a great deal left to do to secure their throne from threats.

What are the first things Mafatu does when he wakes up and sits up in Chapter 3 of Call It Courage by Armstrong Sperry?

To some extent, the answer to this question depends on what you mean by the word “does.”  There is one answer if you say that “does” refers only to physical actions and another answer if you say that “does” involves mental actions as well.  In other words, if Mafatu realizes something or notices something, are those actions that he is doing?

It is on p. 35 of Call It Courage that Mafatu returns to consciousness on the beach of the island.  He is not able to finally sit up until p. 36.  Once he sits up, his first action (if mental processes are actions) is to remember that he banged his right leg against coral when his canoe hit the reef.  His second action is to notice that his leg is cut and his third action is to think that he needs to deal with it since “coral wounds were poisonous.”

If actions require physical movement, the first thing that Mafatu does is “plunge[d] his face into the pool and [drink] deeply.”  He must have been sitting next to this pool of fresh water because he does not have to stand up to get to the water.  After that, his next action is to lie down again.

Mafatu then goes on to think a great deal about where he is and what he needs to do to survive.  He looks around to take stock of the island where he has found himself.  However, he does not actual do anything more that is physical until p. 38, where he stands up, gets some limes, and treats the coral wound on his leg.

So, most of what happens on these pages is mental.  Mafatu figures out what his physical condition is.  He looks around him to see what he can learn about the island.  He thinks about the things that he will need to do in order to survive.  There is very little physical action until p. 38 when he stands up, treats his leg, and starts to explore.

What is behavioral family therapy?

Introduction

Behavioral family therapy is a type of psychotherapy used to treat families in which one or more members are exhibiting behavior problems. Behavioral therapy was employed originally in the treatment of individual disorders such as phobias (irrational fears). Behavioral family therapy represents an extension of the use of behavioral techniques from the treatment of individual problems to the treatment of family problems. The most common problems treated by behavioral family therapy are parent-child conflicts; however, the principles of this type of therapy have been used to treat other familial difficulties, including marital and sexual problems.

Role of Learning Theory

The principles of learning theory underlie the theory and practice of behavioral family therapy. Learning theory was developed through laboratory experimentation largely begun by Ivan Petrovich Pavlov
and Edward L. Thorndike
during the early 1900s. Pavlov was a Russian physiologist interested in the digestive processes of dogs. In the process of his experimentation, he discovered several properties regarding the production of behavior that have become embodied in the theory of classical conditioning. Pavlov observed that his dogs began to salivate when he entered their pens because they associated his presence (new behavior) with their being fed (previously reinforced old behavior). From this observation and additional experimentation, Pavlov concluded that a new behavior that is regularly paired with an old behavior acquires the same rewarding or punishing qualities of the old behavior. New actions become conditioned to produce the same responses as the previously reinforced or punished actions.

Another component of learning theory was discovered by Thorndike, an American psychologist. Thorndike observed that actions followed closely by rewards were more likely to recur than those not followed by rewards. Similarly, he observed that actions followed closely by punishment were less likely to recur. Thorndike explained these observations on the basis of the law of effect. The law of effect holds that behavior closely followed by a response will be more or less likely to recur depending on whether the response is reinforcing (rewarding) or punishing.

Building on the observations of Thorndike, American behaviorist B. F. Skinner
developed the theory of operant conditioning
in the 1930s. Operant conditioning is the process by which behavior is made to occur at a faster rate when a specific behavior is followed by positive reinforcement—the rewarding consequences that follow a behavior, which increase the rate at which the behavior will recur. An example that Skinner used in demonstrating operant conditioning involved placing a rat in a box with different levers. When the rat accidentally pushed a predesignated lever, it was given a food pellet. As predicted by operant conditioning, the rat subsequently increased its pushing of the lever that provided it with food.

Gerald Patterson and Richard Stuart, beginning in the late 1960s, were among the first clinicians to apply behavioral techniques, previously used with individuals, to the treatment of family problems. Although Patterson worked primarily with parent-child problems, Stuart extended behavioral family therapy to the treatment of marital problems.

Given the increasing prevalence of family problems, as seen by the rise in the number of divorces and cases of child abuse, the advent of behavioral family therapy has been welcomed by many therapists who treat families. The findings of a 1984 study by William Quinn and Bernard Davidson revealed the increasing use of this therapy, with more than half of all family therapists reporting the use of behavioral techniques in their family therapy.

Conditioning and Desensitization

The principles of classical and operant conditioning serve to form the foundation of learning theory. Although initially derived from animal experiments, learning theory also was applied to humans. Psychologists who advocated learning theory began to demonstrate that all behavior, whether socially appropriate or inappropriate, occurs because it is either classically or operantly conditioned. John B. Watson, an American psychologist of the early twentieth century, illustrated this relationship by producing a fear of rats in an infant known as
Little Albert by repeatedly making a loud noise when a rat was presented to Albert. After a number of pairings of the loud noise with the rat, Albert began to show fear when the rat was presented.

In addition to demonstrating how inappropriate behavior was caused, behavioral psychologists began to show how learning theory could be used to treat people with psychological disorders. Joseph Wolpe, a pioneer in the use of behavioral treatment during the 1950s, showed how phobias could be alleviated by using learning principles in a procedure termed systematic desensitization. Systematic desensitization involves three basic steps: teaching the phobic individual how to relax; having the client create a list of images of the feared object (for example, snakes), from least to most feared; and repeatedly exposing the client to the feared object in graduated degrees, from least to most feared images, while the individual is in a relaxed state. This procedure has been shown to be very effective in the treatment of phobias.

Behavioral family therapy makes the same assumptions regarding the causes of both individual and family problems. For example, in a fictional case, the Williams family came to treatment because their seven-year-old son, John, refused to sleep in his own bed at night. In attempting to explain John’s behavior, a behaviorally oriented psychologist would seek to find out what positive reinforcement John was receiving in response to his refusal to stay in his own bed. It may be that when John was younger his parents allowed him to sleep with them, thus reinforcing his behavior by giving him the attention he desired. Now that John is seven, however, his parents believe that he needs to sleep in his own bed, but John continues to want to sleep with his parents because he has been reinforced by being allowed to sleep with them for many years. This case provides a clinical example of operant conditioning in that John’s behavior, because it was repeatedly followed by positive reinforcement, was resistant to change.

Treatment Process

Behavioral family therapy is a treatment approach that includes the following four steps: problem assessment, family (parent) education, specific treatment design, and treatment goal evaluation. It begins with a thorough assessment of the presenting family problem. This assessment process involves gathering the following information from the family: what circumstances immediately precede the problem behavior; how family members react to the exhibition of the client’s problem behavior; how frequently the misbehavior occurs; and how intense the misbehavior is. Behavioral family therapy differs from individual behavior therapy in that all family members are typically involved in the assessment process. As a part of the assessment process, the behavioral family therapist often observes the way in which the family handles the presenting problem. This observation is conducted to obtain firsthand information regarding ways the family may be unknowingly reinforcing the problem or otherwise poorly handling the client’s misbehavior.

Following the assessment, the behavioral family therapist, with input from family members, establishes treatment goals. These treatment goals should be operationalized; that is, they should be specifically stated so that they may be easily observed and measured. In the example of John, the boy who refused to sleep in his own bed, an operationalized treatment goal would be as follows: “John will be able to sleep from 9:00 p.m. to 6:00 a.m. in his own bed without interrupting his parents during the night.”

Applying Learning Theory Principles

Once treatment goals have been operationalized, the next stage involves designing an intervention to correct the behavioral problem. The treatment procedure follows from the basic learning principles previously discussed. In cases involving parent-child problems, the behavioral family therapist educates the parents in learning theory principles as they apply to the treatment of behavioral problems. Three basic learning principles are explained to the child’s parents. First, positive reinforcement should be withdrawn from the unwanted behavior. For example, a parent who meets the demands of a screaming preschooler who throws a temper tantrum in the checkout line of the grocery store because he or she wants a piece of candy is unwittingly reinforcing the child’s screaming behavior. Time-out is one procedure used to remove the undesired reinforcement from a child’s misbehavior. Using time-out involves making a child sit in a corner or other nonreinforcing place for a specified period of time (typically, one minute for each year of the child’s age).

Second, appropriate behavior that is incompatible with the undesired behavior should be positively reinforced. In the case of the screaming preschooler, this would involve rewarding him or her for acting correctly. An appropriate reinforcer in this case would be giving the child the choice of a candy bar if the child were quiet and cooperative during grocery shopping, behavior inconsistent with a temper tantrum. For positive reinforcement to have its maximum benefit, before the specific activity (for example, grocery shopping) the child should be informed about what is expected and what reward will be received for fulfilling these responsibilities. This process is called contingency management because the promised reward is made contingent on the child’s acting in a prescribed manner. In addition, the positive reinforcement should be given as close to the completion of the appropriate behavior as possible.

Third, aversive consequences should be applied when the problem behavior recurs. When the child engages in the misbehavior, he or she should consistently experience negative costs. In this regard, response cost is a useful technique because it involves taking something away or making the child do something unrewarding as a way of making misbehavior have a cost. For example, the preschooler who has a temper tantrum in the checkout line may have a favorite dessert, which he or she had previously selected while in the store, taken away as the cost for throwing a temper tantrum. As with positive reinforcement, response cost should be applied as quickly as possible following the misbehavior in order for it to produce its maximum effect.

Designing Treatment Intervention

Once parents receive instruction regarding the principles of behavior therapy, they are actively involved in the process of designing a specific intervention to address their child’s behavior problems. The behavioral family therapist relates to the parents as cotherapists with the hope that this approach will increase the parents’ involvement in the treatment process. In relating to Mr. and Mrs. Williams as cotherapists, for example, the behavioral family therapist would have the couple design a treatment intervention to correct John’s misbehavior. Following the previously described principles, the couple might arrive at the following approach: They would refuse to give in to John’s demands to sleep with them; John would receive a token for each night he slept in his own bed (after earning a certain number of tokens, he could exchange them for toys); and John would be required to go to bed fifteen minutes earlier the following night for each time he asked to sleep with his parents.

Once the intervention has been implemented, the therapist, together with the parents, monitors the results of the treatment. This monitoring process involves assessing the degree to which the established treatment goals are being met. For example, in the case of the Williams family, the treatment goal was to reduce the number of times that John attempted to get into bed with his parents. Therapy progress, therefore, would be measured by counting the number of times that John attempted to get into bed with his parents. Careful assessment of an intervention’s results is essential to determine whether the intervention is accomplishing its goal.

Detractions

In spite of its popularity, this type of therapy has not been without its critics. For example, behavioral family therapists’ explanations regarding the causes of family problems differ from those given by the advocates of other family therapies. One major difference is that behavioral family therapists are accused of taking a linear (as compared to a circular) view of causality. From a linear perspective, misbehavior occurs because A causes B and B causes C. Those who endorse a circular view of causality, however, assert that this simplistic perspective is inadequate in explaining why misbehavior occurs. Taking a circular perspective involves identifying multiple factors that may be operating at the same time to determine the reason for a particular misbehavior. For example, from a linear view of causality, John’s misbehavior is seen as the result of being reinforced for sleeping with his parents. According to a circular perspective, however, John’s behavior may be the result of many factors, all possibly occurring together, such as his parents’ marital problems or his genetic predisposition toward insecurity.

Integration with Other Therapies

Partially in response to this criticism, attempts have been made to integrate behavioral family therapy with other types of family therapy. Another major purpose of integrative efforts is to address the resistance often encountered from families during treatment. Therapeutic resistance is a family’s continued attempt to handle the presenting problem in a maladaptive manner in spite of having learned better ways. In the past, behavioral family therapists gave limited attention to dealing with family resistance; however, behavioral family therapy has attempted to improve its ability to handle resistance by incorporating some of the techniques used by other types of family therapy.

In conclusion, numerous research studies have demonstrated that behavioral family therapy is an effective treatment of family problems. One of the major strengths of this type of therapy is its willingness to assess objectively its effectiveness in treating family problems. Because of its emphasis on experimentation, behavioral family therapy continues to adapt by modifying its techniques to address the problems of the modern family.

Bibliography

Atwood, Joan, ed. Family Therapy: A Systemic Behavioral Approach. Chicago: Nelson, 1999. Print.

Clark, Lynn. The Time-Out Solution. Chicago: Contemporary, 1989. Print.

Falloon, Ian R. H., ed. Handbook of Behavioral Family Therapy. New York: Guilford, 1988. Print.

Gladding, Samuel T. Family Therapy: History, Theory, and Practice. Boston: Prentice, 2011. Print.

Goldenberg, Herbert, and Irene Goldenberg. Family Therapy: An Overview. 7th ed. Belmont: Brooks, 2008. Print.

Gordon, Thomas. Parent Effectiveness Training: The Proven Program for Raising Responsible Children. Rev. ed. New York: Three Rivers, 2000. Print.

Nichols, Michael P. “Cognitive-Behavioral Family Therapy.” Family Therapy: Concepts and Methods. Ed. Michael P. Nichols and Richard C. Schwartz. 8th ed. Boston: Allyn, 2008. Print.

Podell, Jennifer, and Philip Kendall. "Mothers and Fathers in Family Cognitive-Behavioral Therapy for Anxious Youth." Jour. of Child & Family Studies 20.2 (2011): 182–95. Print.

Rasheed, Janice M., Mikal N. Rasheed, and James A. Marley. Family Therapy: Models and Techniques. Los Angeles: SAGE, 2011. Print.

Robin, Arthur L., and Sharon L. Foster. Negotiating Parent-Adolescent Conflict: A Behavioral Family Systems Approach. New York: Guilford, 2003. Print.

What is a drug overdose?

Causes

Overdoses result from taking too much of a dangerous substance, whether an illicit substance of abuse or medications (such as prescriptions and over-the-counter drugs ) approved by the US Food and Drug Administration (USDA). For example, accidental overdose can occur when a person mistakenly ingests a repeated or double dose of a prescription. Excessive drug ingestion can occur with a single drug or with a combination of drugs that have overlapping effects.

Fatal overdoses primarily involve dangerous drug mixtures, such as concomitant alcohol and benzodiazepine use or a mixture of heroin and benzodiazepine. Combinations of alcohol with street drugs appear to be the most deadly.

The amount of a drug needed to cause an overdose varies by person, by type of drug, and by substance purity or potency. For example, increased potency of heroin products in the early twenty-first century compared with their historical content resulted in greater rates of heroin-associated fatal overdose.

Prescription-associated overdoses most often involve sedatives or painkillers, such as hydrocodone, methadone, oxycodone, and oxymorphone. In 2013, there were twenty-seven thousand accidental overdoses in the United States. Prescription drug abuse is a growing cause of fatal overdoses, particularly as a result of opioid misuse. According to the Centers for Disease Control and Prevention (CDC), overdose deaths increased from 1999 to 2004 because of painkillers, cocaine, and sedatives, and not because of heroin or methamphetamine. By June 2015, overdose deaths became the number one cause of death from injury in the United States. The number of deaths caused by overdose more than doubled between 2000 and 2014 , with half of those deaths related to prescription drugs.

The National Institute on Drug Abuse reported in February 2015 a study from the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) that from 2001 to 2013, the number of deaths caused by an overdose of prescription drugs increased 2.5 times, from just under 10,000 deaths to approximately 23,000 deaths; deaths caused by an overdose of prescription opioid pain relievers increased 3 times, from under 6,000 to over 17,000; deaths caused by an overdose of heroin increased 5 times in that same time period, from approximately 1,700 in 2001 to over 8,000 in 2013.

Risk Factors

The populations at greatest risk for overdose are illicit drug users, youth, and elderly prescription-drug users. The risk of overdose increases when multiple drugs are prescribed or when illicit drugs are mixed with each other drugs or with alcohol. In addition, risks increase in recovering drug users who regress, traditionally called relapsing. Many who regress and use their previous drug of choice often use the same level of the drug they did when deep in their addiction. After a period of sobriety, however, their tolerance is much lower and the result of an unintentional fatal overdose.

Long-term illicit drug users tend to overdose because their tolerance for the drug has increased and they become overconfident; many times they use drugs alone, which presents added danger and risk. Taking drugs by inhalation or injection is also more likely to result in toxicity because drug concentrations reach the brain more rapidly.

Painkiller overdose is associated with risk populations distinct from those of illicit drug use. Prescription misuse and overdose most commonly develop in middle-aged persons and with people living in poverty or in rural areas. Long-term prescription opioid users or people who receive painkiller prescriptions from multiple prescribers are more likely to receive unsafe drug quantities and to ingest toxic dosages. People with existing mental health problems, such as depression or anxiety, also experience greater rates of overdose with prescription or illicit drugs.

Symptoms

Side effects of overdoses are often particular to the type of drug ingested, although some signs of overdose are consistent with general toxicity. Common symptoms of overdose include nausea and vomiting, prolonged sleep or lack of consciousness whereby the individual is impossible to rouse, snoring and gurgling, blue lips, and blue nails. Additional symptoms relate to sedative or stimulatory effects on nervous system and organ functions. These symptoms include abnormal breathing, slurred speech, poor coordination, slow or fast pulse, high or low body temperature, large or small pupil size, flushing and perspiration, nonresponsive sleep, violent outbursts, and delusions or hallucinations.

Typically, overdose symptoms mimic and extend the clinical effect of the drug, whether the drug is sedating or stimulatory. For example, such stimulants as cocaine can cause seizures and heart arrhythmias, whereas sedating benzodiazepines or opioids can induce coma. However, paradoxical effects are possible, and toxic amounts of both sedatives and stimulants impair crucial breathing functions.

Screening and Diagnosis

Identification of people at risk for substance abuse or prescription misuse is critical to screening for potential overdose. These users have lower inhibitions about drug dosing, blunted emotional responses and impulse control to guide appropriate drug use, and lower likelihood of having social contacts that discourage inappropriate drug use. Although identification of a substance abuse problem does not guarantee an ingestion of toxic dosages, it does lead to active monitoring of a risk group.

Polydrug use is a large overdose risk factor that can be identified in a screening of patient-specific prescription habits or pharmacy refill rates. Alcohol is the most frequent substance identified in combination overdoses, so screening for levels of alcohol use before prescribing high-risk medications is another useful way to identify overdose likelihood.

Recognition and diagnosis of an overdose in the emergency room setting should be done quickly for appropriate care. Considerations include consciousness, shallow breathing, and slurred speech as traditional signs of substance abuse. Blood tests should be performed to screen for substances in the system so that the appropriate treatment can be employed to counteract damaging symptoms. Diagnosis of a drug overdose is particularly challenging when the patient is unconscious and the substances remain unknown.

In a community setting, early signs that can indicate an increased risk for potential drug overdoses include frequent morning hangovers from alcohol abuse, red streaks in the whites of the eyes, purchase of large drug quantities, appetite changes, and new sleep patterns. Extreme behavior changes, such as hostility, depression and mood swings, secretive actions, confusion, and social isolation, likewise represent uncontrolled drug use that can lead to overdose.

Treatment and Therapy

Effective treatment hinges on early recognition of the overdose. In the recent past, treatment was often administered in an emergency room setting. More and more first responders, such as EMTs and police, are now trained in administering and carry Naloxone (also called Narcan). Naloxone is a synthetic opioid antagonist that is used as an antidote for opioid overdose. It reverses the life-threatening respiratory depression caused by natural and synthetic opioids, including heroin, morphine, oxycontin, propoxyphene, and methadone. Naloxone is not a controlled substance and was once only available by prescription. Beginning in 2014 and in response to the growing opiate epidemic in the United States, however, pharmacies across the country also began carrying the drug for sale over-the-counter.

Care after an actual or suspected overdose begins with basic functions: If Naloxone or Narcan is available, it should be administered immediately. Emergency personnel must be called regardless, because even if Naloxone/Narcan is used and the overdosing individual appears to recover, it is quite possible that they will regress into an overdose state again because the half-life of Naloxone/Narcan is much shorter than opiates. If Naloxone is not available and after 911 has been called, any airway barriers in the overdosing individual must be cleared and oxygen levels should be restored by using mouth-to-mouth resuscitation and/or CPR. Once in a hospital setting, intravenous fluids are often provided to assist with electrolyte balance; monitoring of vital organs, such as the cardiac and pulmonary systems, confirms stability and treatment response and can aid in diagnosing what drugs were involved.

As an overdosed patient achieves stable heart and lung function, considerations begin for substance removal. Gastric lavage and activated charcoal remove excessive medication from the stomach through the esophagus or through binding within the stomach, respectively. However, these methods are not recommended for every substance, and they do not fully remove drugs, which are already circulating in the blood. In some circumstances, hemodialysis can be used to filter substances from the blood and to prevent kidney damage. Infrequently, antidotes to specific substances cause rapid resolution of overdose symptoms. For example, the benzodiazepine antagonist flumazenil blocks toxic amounts of benzodiazepine at their receptors to counteract overdose symptoms.

To supplement emergency treatment, psychological needs must be evaluated, especially for cases of intentional overdose and in patients who suffer from substance use disorder. Mental health counseling or behavioral care should be implemented as part of a holistic approach to treatment of substance use disorder.

Prevention

The CDC encourages state and federal tracking of overdose trends and increased education about these trends to improve substance abuse and overdose prevention efforts. Public health strategies emphasize avoidance of prescription drug sharing and awareness of available prescription-medication disposal programs. The Office of National Drug Control Policy enforces initiatives to restrict illicit drug use through education, drug tracking, and law enforcement options.

Known illicit drug users should be advised about the greater risks of overdose during withdrawal or relapse periods after tolerance diminishes. Prevention of accidental overdose in particular hinges on counseling and communication. Family members and loved ones of opiate addicts should be trained in the use of Naloxone/Narcan and carry it with them at all times. While Naloxone cannot prevent an overdose or by itself cause an addicted individual to recover, it prevents death and provides the opportunity for the individual to choose recovery and then get additional help.

Overdose of prescription medications has the most potential for prevention success. Limiting access to the highest-risk drugs, providing proactive mental health care, reducing insurance coverage of multiple painkillers, and increasing health professional awareness and education all support lower rates of overdose in the general population. Trained health professionals can identify at-risk patients, such as those with multiple prescriptions, before an overdose occurs. With increased prescription drug monitoring and pain clinic oversight, professionals and patients can minimize the occurrences of prescription drug overdose.

Bibliography

"Opioid Addiction Disease: 2015 Facts and Figures." ASAM. American Society of Addiction Medicine, 2015. Web. 29 Oct. 2015. PDF file.

"Overdose Death Rate." DrugAbuse.gov. National Institute on Drug Abuse, Feb. 2015. Web. 29 Oct. 2015.

Paulozzi, Leonard, et al. “CDC Grand Rounds: Prescription Drug Overdoses—A US Epidemic.” MMWR Weekly 61.1 (2012): 10–13. Print.

Pollack, Harold. "100 Americans Die of Drug Overdoses Each Day. How Do We Stop that?" Washington Post. Washington Post, 7 Feb. 2014. Web. 29 Oct. 2015.

Shannon, Michael W., Stephen W. Borron, and Michael J. Burns, eds. Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia: Saunders, 2007. Print.

Substance Abuse and Mental Health Administration. “Drug Abuse Warning Network, 2006: National Estimates of Drug-Related Emergency Department Visits.” Aug. 2008. Web. 3 Apr. 2012.