Transcript “Drug use on the rise”

Psy 526
Human Drug Use and Abuse
Outline of Supplemental Readings
Ksir, Hart, and Ray
Chapters 1, 2, & 3
© 2006 McGraw-Hill Higher Education. All rights reserved.
Chapter 1
Drug Use : An Overview
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“Drug Use On The Rise”
Why do any of these matter?
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Who Is Taking The Drug?
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Age
Proximity to us
What they do for a living
What Drug Are They Taking?
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Obvious question but often over looked
Alcohol vs. heroin
Inhalants vs. alcohol
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When And Where Are Drugs Used?
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The situation in which the drug is taken makes a
big difference.
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A 1st grade teacher drinking on Saturday night at
home vs. a 1st grade teacher drinking during class.
Even if a subculture accepts the use of an illegal
drug, it will distinguish between acceptable and
unacceptable situations.
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A group might accept marijuana smoking at a party
but not when you are taking the kids to the soccer
game or right before a multi-million dollar deal
meeting.
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Why A Person Takes Drugs?
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Reasons for drug use often determine
whether such use is of concern:
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e.g., Vicodin the doctor prescribed for pain vs.
Vicodin taken for pleasurable effects.
e.g., Drinking alcohol because you are out with
friends vs. drinking alcohol alone in the morning
to help get you out of bed.
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How A Drug Is Taken?
An amount of cocaine that comes from chewing
the coca leaves vs. that much cocaine snorted
will lead to very different responses
How the drug is taken can also depend on how
fast the user becomes addicted, how fast the
response comes and how long it lasts
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How Much Of A Drug Is Taken?
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This is often the difference between normal use
and abuse; the difference between life and death
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Four Principles Of Psychoactive Drugs
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“Drugs” are not good or bad.
Every drug has multiple effects.
Both amount and quality of the drug
influence the effect of the drug.
The effects of a drug also depend on the
person.
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History tells us that as long as humans have been
around some have used, misused and abused
some plants or substances.
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Four Pharmacological Revolutions
1.
2.
3.
4.
Major communicable diseases under
control – vaccines
Pharmacological revolution – antibiotics
to treat illness of the body
Development of psychopharmacology
drugs – treatment of mental illnesses
Development of oral contraception –
drugs gave control over the body
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Cultural Change in U.S.
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After WWII, substance abuse was not a major
concern
Soon after, concerns about alcohol came to the
forefront
In the mid 1960s, LSD became a household word
Although Nixon declared a “War on Drugs”, there
was still tolerance for drug use in the 1960s-70s.
In the 1980s to 1990s, less tolerance of differences
including drugs
2000s, medicinal marijuana and “rave” subculture
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Extent Of Drug Use
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It is not possible to get accurate
information on drug use.
It is not possible to get accurate
information on quantity of drugs imported
or sold.
Even estimates of beer or prescription
drug use based on sales information may
not be entirely accurate.
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How We Get Information
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Survey Based Questionnaires
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What are the benefits?
What are some of the limitations?
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Trends In Drug Use
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Annual High School Senior survey
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Prevalence of reported use
Attitude data and risk
Consider who is included and who is not
included in this survey.
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Marijuana: Trends in perceived availability, perceived risk of
regular use, and prevalence of use in the past 30 days for 12th
graders
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Lifetime Marijuana Use among Persons Ages 12-25, by group: 1965-2002
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National Survey On
Drug Use And Health
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Face-to-face, computer-assisted
interviews
68,000 individuals; carefully sampled
households across the US
Broken down into different age groups
Results
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Trends in reported drug use within the past 30 days for young adults ages 18 to 25
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Correlates Of Drug Use
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Age, gender, racial/ethnic grouping,
education levels
SES- not a significant factor
Personality problems are poor predictors
Risk factors
Protective factors
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Limitations Of Correlation
Studies
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Does smoking marijuana cause the user to
get lower grades?
Are kids who are getting low grades more
likely to smoke marijuana?
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Motives For Drug Use
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We all do things that we know are not
right; e.g., eating too much, driving too
fast, or drinking too much.
Fads and cultural trends influence what
drugs are used.
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Influences on drug use.
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Chapter 2
Drug Use As A Social Problem
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Cost of maintaining habit
Fetal alcohol syndrome
Broken home, illness,
shorter lives, etc.
Emergency room visits
Costs Of Drug Use To Society
Drugs in the workplace
Cost of treating patients
Cost of criminal behavior
Others?
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The Big Change
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What made the government change
from a laissez-faire attitude to one of
control?
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Toxicity
Dependence
Crime
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Potency vs. Toxicity
Potency: the amount of drug necessary to
cause an effect.
Toxicity: the capacity of a drug to do damage
or cause adverse effects in the body.
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Toxicity
What makes a drug toxic?
• Amount used
• How it is used
• What the user did while on the drug
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Examples of Drug-Induced Toxicity
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Acute
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Behavioral toxicity – “intoxication” that impairs
the user’s actions and increases the danger to
the individual.
Physiological – overdose that causes the user
to stop breathing, the heart to stop, or causes
other adverse side effects.
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Examples of Drug-Induced Toxicity
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Chronic
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Social problems
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Personality changes
Effects on friends and family
Change in lifestyle
Health problems
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Heart disease
Lung cancer
Liver danger
Other health effects
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Drug Abuse Warning Network
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A system for reporting incidences of lethal and
non-lethal drug related emergency in some U.S.
metropolitan hospitals.
DAWN included improper use of prescription or
over-the-counter drugs and the use of any other
substance for psychic effect, dependence or
suicide.
See table 2.2 on page 32 (data from 2002)
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The top three mentions in ER episodes were Alcoholin- combination, cocaine, and marijuana.
The top three mentions for fatalities were prescription
narcotics, cocaine, and heroin/morphine.
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Drug Abuse Warning Network
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What it tells us about how
dangerous a drug is?
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What it does NOT tell us about
how dangerous a drug is?
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Blood Borne Diseases
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Specific toxicity for injected drugs
AIDS, HIV and Hepatitis B and C
Why do the blood borne diseases spread
so rapidly with these drug users?
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Substance Dependence
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What does an addict look like?
What do they take? Alcohol, cigarettes,
illicit drugs, food, or computer time
How much time do they spend with their
vice?
How much do they take?
What makes you decide the rules?
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Substance Dependence
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Three Basic Processes
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Tolerance
Physical dependence
Psychological dependence
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Tolerance
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Tolerance is a diminished effect after
repeated use of the same drug.
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When tolerance develops, an increased
amount of the drug is required to produce
the same effects.
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Physical Dependence
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Physical dependence refers to the body’s
requirement for the drug in order to function
normally.
Tolerance may lead to physical dependence
(but not always).
When the drug use is stopped promptly,
withdrawal effect can happen
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From mild (e.g., headaches, nausea) to severe
(e.g., seizures, death).
Withdrawal symptoms differ among users and with
different drugs.
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Psychological Dependence
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Psychological dependence is defined by the
psychological/behavioral inability to stop using a
drug.
Psychological dependence can be observed in
person’s behavior, by the amount of time and
effort the person spends seeking the drug.
It is not any less REAL than physical
dependence.
Like physical dependence, psychological
dependence has a physiological basis.
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i.e., neurophysiological (body - mind are one)
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Changing Views of Dependence
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The medical model aims to treat the
withdrawal symptoms, often associated
with physical dependence.
The positive reinforcement model stresses
that the consequences of drug use
influence dependence.
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Drug use is operant behavior.
Users don’t have to experience withdrawal
symptoms to become addicted.
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Substance Abuse and Dependence:
DSM-IVTR
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Substance abuse is considered
maladaptive.
It is carefully separated from substance
dependence
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The essential feature of dependence is
continued use despite significant substancerelated problems known to user.
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Drugs are not evil
They can not do anything
They can not have power
Even our “War on Drugs” shows the perception that
drugs are so evil that we have to wage a war on them.
Drugs are just objects that have effects
on our body.
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Dependence is Biological
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Biochemical or physiological actions in the
brain
We can not scan the brain to determine if
a person has developed dependence.
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Researchers have searched for genetic,
physiological, or biochemical markers.
To date, none have proven reliable predictors.
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Personality
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It is difficult to determine whether drug use
changes personality.
Many other factors play a role in
developing someone’s personality.
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Dependence as a “Disease”
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This is a popular notion.
Alcoholics Anonymous is based on this idea. Its
founders and advocates believe that drug
dependence should be treated as such.
Others argue that there are no tests that
diagnose alcoholism.
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There are ways to test and treat the effects but not
the disease itself.
What are some potential problems with this
label?
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Drugs and Crime
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Do drugs turn the person into the criminal type?
Do people under the influence of a drug commit
crime?
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More than half the murders in our nation in 2000 were
associated with alcohol, as were two-thirds of all
domestic violence.
What are the implications of these statistics?
Some forms of drug use are criminal behavior.
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If someone is willing to commit one crime, they might
be more willing to do other crimes.
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Chapter 3
Drug Products and Their Regulation
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Reformism
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Race and fear used
Laws came to regulate moral behavior
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Issues Leading To Legislation
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Fraud in patent medicine
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Opium
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1890 federal act allowed only American citizens to
import opium
Morphine
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Hostetter’s Bitters 44% pure alcohol
Birney’s Catarrh Cure 4% cocaine
“Morphinism”
Cocaine
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Mail order cocaine
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Two Bureaus, Two Types Of
Regulation
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The Pure Food and Drug Act
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Department of Agriculture
Ensures drugs were pure and honestly
labeled
Harrison Act
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Treasury Department
Taxing of drug for revenue
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Regulation
1906 Pure Food And Drugs Act
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Purity
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Safety
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The contents of the product must be correct and
labeled correctly
1912 Sherley Amendment
Set up FDA as gatekeeper
Directions must be included
Effectiveness
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1962 Kefauver-Harris Amendments
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Making Of A New Drug
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Preclinical research and development
Clinical research and development
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Phase I
Phase II
Phase III
Permission to market
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Making Of A New Drug
Exceptions
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Fast-track rule
Orphan Drug Law
Dietary Supplements
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Controlled Substance
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Early enforcement of the Harrison Act
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18th Amendment
The Narcotic Division
Arresting physicians and pharmacists
Stiffer Penalties
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Jones-Miller Act
Prohibited the importing of opium for heroin
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Controlled Substance
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Mandatory Minimum sentences
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The Bureau of Narcotics
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Drug Czar
Marijuana Tax Act
1956 Narcotic Drug Control Act
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Drug Abuse Control Act
Amendments Of 1965
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Comprehensive Drug Abuse Prevention and
Control Act 1970
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Replaced or updated all laws
Federal vs State
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Prevention and treatment
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Control, not tax
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Summary of Controlled Substance Schedules
Schedule
I
Criteria
a.
b.
c.
II
a.
b.
c.
III
a.
b.
c.
IV
a.
b.
c.
V
a.
b.
c.
Examples
High potential for abuse
No medical use
Lack of accepted safety
Heroin,
Marijuana
High potential for abuse
Current accepted medical use
Abuse may lead to psychological or physical dependence
MDMA,
Morphine,
Cocaine
Potential for abuse less then I and II
Current accepted medical use
Abuse may lead to physical dependence or high
psychological dependence
Low Potential for abuse less then III
Current accepted medical use
Abuse may lead to limited physical or psychological
dependence relative to III
Potential for abuse less then I and II
Current accepted medical use
Abuse may lead to physical dependence or high
psychological dependence
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Anabolic steroids,
most barbiturates
Vanax, barbital,
Chloral hydrate,
fenfluramine
Mixture having small
amounts of codeine or
opium
Drug Abuse Control Act
Amendments Of 1965
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Possession and Selling Penalties
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Omnibus Drug Act
Loss of Benefits
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Drug precursors
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Drug paraphernalia
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Office of National Drug Control Policy
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Americans in Prison
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State And Local Regulations
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Difference in penalties from state to state
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Federal Support for Urine Screening
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Federal law overrides state
Military led the way
More advanced screening
Transportation and private companies test
Schools test
Testing methods
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Different test different results
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Impact Of Drug Enforcement
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People
Budget
International programs
Other costs
Effectiveness of Control
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