Transcript Percentage of U.S. Population Reporting Drug Abuse in Past

Percentage of U.S. Population Reporting Drug
Abuse in Past Month (1995)
Substance
Percentage Reporting Use
Alcohol
52.2
Cigarettes
28.8
Marijuana
4.7
Cocaine
0.7
Hallucinogens
0.7
Inhalants
0.4
Crack
0.2
Heroin
0.1
Substance Dependence
 The person develops tolerance
 Withdrawal occurs upon cessation
 The person uses more of the substance or uses it for a longer
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period of time than intended.
The person recognizes the excessive use but has been unable
to reduce use
Much of the person’s time is spent in efforts to obtain the
substance or recover from its effects
Use continues despite negative consequences
The person gives up or cuts back participation in many
activities because of the use of the substance
Substance Abuse
 Failure to meet major obligations, such as
absences from work or neglect of children
 Exposure to physical dangers, such as
operating machinery or driving while
intoxicated
 Legal problems, such as arrests for
disorderly conduct or traffic violations
 Persistent social or interpersonal problems,
such as arguments with spouse
Alcohol
 Contributing cause to 1/3 of suicides, 1/2 of traffic deaths,
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reason for 1/2 of all arrests, over 1/2 of murders are
committed under influence, and is the leading cause of
mental retardation (fetal alcohol syndrome)
Drug effect is biphasic: initially acts as a stimulant, but after
blood levels peak acts as a depressant
Alcohol stimulates GABA receptors and increases levels of
serotonin and dopamine
The short-term psychological effects of alcohol are strongly
related to the drinker’s expectations about the effects of the
drug.
Physiological effects: malnutrition, amnestic syndrome,
cirrhosis of the liver, CVD
Tobacco Smoking
 Nearly 50 million Americans smoke
 The prevalence of smoking among young adults is
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increasing
More than 60,000 studies link smoking to CVD, cancer,
and lung disease
Causes 170,000 deaths from CVD, 130,000 from cancer,
and 50,000 from COPD annually
Smokers drink more alcohol and caffeine than nonsmokers
Adolescents who smoker are 10 to 30 times more likely to
use illegal drugs
Smokers are less physically active, have poor diets, and are
more likely to engage in safety risks (e.g., seatbelt use)
Other Drugs Frequently Abused
 Marijuana
– Consists of dried and crushed leaves and flowering tops of the hemp
plant, Cannabis sativa
– Delta-9-tetrahydrocannabinol (THC)
– Associated with cognitive functioning, psychological problems, and
lung functioning
 Sedatives
– Opiates: opium, morphine, heroin
– Psychological and physical effects: euphoria, drowsiness, reverie,
and lack of coordination. Heroin has the added effect of a rush, a
feeling of warm, suffusing ecstasy immediately following an
intravenous injection.
– Barbiturates - synthetic sedatives
Other Drugs Frequently Abused
 Stimulants - act on the brain and
sympathetic nervous system to increase
alertness and motor activity
– Amphetamines
– Cocaine
 Hallucinogens - produce hallucinations
– LSD (d-lysergic acid diethylamide)
– Mescaline (from the peyote cactus)
– Psilocybin (from the mushroom psilocybe
mexicana)
Etiology of Substance Abuse and Dependence
 Sociocultural Factors
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Cross-national variation
Occupational
Family
Media
 Psychological Variables
– Mood alteration
– Personality
 Biological Variables
– Predisposition for alcohol abuse
– Ability to tolerate alcohol
Treatments for Alcohol Abuse and Dependence
 Biological Treatments
– Antabuse
– Naltrexone
 Alcoholics Anonymous
– Disease Model
– High drop out, limited follow-up
 Cognitive Behavioral Therapy
– Aversion Therapy
– Contingency Management
– Controlled Drinking
Smoking Cessation Therapies
 90% of Smokers Quit Without Assistance
 Each year 30% of smokers try to quit - fewer than
10% succeed even in the short run
 Formal Behavioral Programs
– American Cancer Society
– American Lung Association
– Church of the Seventh Day Adventists
 Aversive Smoking
 Coping Skills Training
 Health Care Provider Advice
How Well Do Smoking Treatments Do
 Few effective, economical clinical programs have
been developed (Shiffman, 1993).
– Most who quit relapse
– Advantages of smoking immediate, disadvantages
delayed and probabilistic
 Smoking cessation leads to an immediate
constellation of symptoms known as the nicotine
withdrawal syndrome (US DHHS, 1988)
 Overlearned habit + Addictive drug = High Relapse
Attempts to Improve Smoking Treatments
 Nicotine Replacement Therapy
– For the patch: 40% abstinence rates at post-treatment.
At 9-month follow-up, not different than placebo
(Hughes, 1995)
 Matching smokers to “readiness to quit”
(Prochaska & DeClemente, 1983)
 Related to readiness - “teachable moments”
– Following heart attack, during pregnancy
– Clinical trials evidence very promising (Narce-Valente
& Klingman, 1992; Sachs, 1990; Stevens et al., 1993)
Therapy for Illicit Drugs
 Detoxification
 Biological Treatments
– Methadone
– Naloxone
 Psychological Treatments
 Residential Homes
– Separation from social contacts
– Isolation from drugs
– Charismatic role models
– Confrontation
– Respect
Prevention of Substance Abuse
 Self-esteem enhancement - iatrogenic
 Peer-pressure resistance training
 Corrections of normative expectations
 Inoculation against media messages
 Peer leadership
 Information about parental and other adult
influences
 Immediate negative effects of drug use