Transcript WHY A FOCUS ON ADDICTIVE BEHAVIORS? Study of Drug Use

WHY A FOCUS ON ADDICTIVE BEHAVIORS?
• Study of Drug Use and Misuse Important
• A part of life in our culture - pervasive
• Affects everyone: we all have choices to make about what
we do and don’t do, what we ingest and what we avoid
• Can have harmful consequences for individual, family,
community, and society
• Substance use disorders are both preventable and
treatable
• We are constantly being presented with information about
licit and illicit substances and activities - how do we
evaluate it?
OVERARCHING PRINCIPLES
• Study of Drug Use and Misuse has Experiential and
Scientific Basis
• Drugs are Neither Good Nor Bad: Context
• The Continuum: Drug Use, Misuse, and Dependence
• All Drugs and Potentially Addictive Behaviors Have a
History and Cultural Context
• e.g., religious, spiritual usage; use for health /
medical reasons
Drug Use, Misuse, and “Addiction”
• What is a drug?
• What is an addiction? An addict?
___________
• Themes associated with “addiction”
• Conceptions and definitions vary
Dependence Potential of Psychoactive Drugs
Very High:
High:
Moderate/High:
Moderate:
Moderate/Low:
Low:
Very Low:
Heroin (IV)
Crack cocaine
Morphine
Opium (smoked)
Cocaine powder
Tobacco cigarettes
PCP (smoked)
Diazedpam (Valium)
Alcohol
Amphetamines (oral)
Caffeine
MDMA(Ecstasy”)
Marijuana
Ketamine
LSD, Mescaline
Psilocybin
Major Stimulants
Major Stimulants - Cocaine
 street cocaine: coca paste and hydrochloric acid =
type of salt--powder sniffed or snorted
more addictive uses:
 can inject it--IV quicker
 smoking: freebase - powder and ether
 crack - dissolve cocaine salt in baking soda solution,
boil off water, left with rock
 Cocaine - ETOH combo (coca-ethylene)
- may alter metabolics of
cocaine, which may be more cardiotoxic via increased half-life of cocaine
Major Stimulants - Speed
Amphetamines - Methamphetamines
 ephedrine, principal chemical in these drugs, has been
known for thousands of years; used as Chinese medicinal
herb
 ephedrine first isolated in late 1800's, and synthesized in
1920s when it was named “amphetamine”
 first medically used in 1920's for treating obesity,
narcolepsy, colds, and much later ADHD
 used to enhance performance, decrease fatigue – sport &
military applications (e.g., go and no-go pills)
Classes/Types of
Depressants
 1. Anesthetics (ex. ether, nitrous oxide)
 2. Barbiturates
 3. Benzodiazepines (anxiolytics - ex. ? )
• 4. GHB
(very similar to GABA)
 GHB = gamma-hydroxy-butyric acid
 GABA = gamma-amino-butyric acid
 Many labels have been used to describe them,
which can be confusing:
-tranquilizers
 -sleeping pills
-anti-anxiety pills
-sedatives or hypnotics
Hallucinogens
Types
1. Serotonergic hallucinogens
chem similar to serotonin
2. Methylated amphetamines
chem similar to norepinephrine...alterations in mood without much
change in senses
3. Anticholinergic - (Ach)
 found in plants: belladonna, mandrake, jimson weed
trance or dream-like states
4. Dissociative anesthetics
can remain conscious in surgery; causes euphoria, numbness,
aggressive behavior, and tactile sense disturbances
MDMA
Cannabis
 Negative effects
- withdrawal symptoms that may occur after
heavy use include:
1.
nausea
2.
irritability
3.
sleep problems
- apathy, decrease in motivation
- short-term memory impairment (hippocampus,
2-AG may play role in memory loss)
- impaired driving
- may trigger paranoia, usually mild forms
Cannabis - Negative Effects
- chronic use associated with low sperm count, abnormal
sperm formation and motility, and possible male
impotence; enlarged breasts in males has also been
reported.
- in females, failure to ovulate has been noted
- if used during pregnancy may be associated with low
birth weight, premature birth (but these women may also
be smokers, drinkers)
- pot as a “gateway” drug (Adolescents tend to use drugs
in this sequence: cigarettes, alcohol, pot, cocaine-heroin)
OPIOIDS
I.
Where do they come from?
 poppy plant: from middle east and Asia
 dried sap from plant is opium; cultivated annually
 major active ingredient in opium: morphine (3-10 x as strong)
/ synthesized in 1803
/ named after the Greek god of dreams Morpheus
/ morphine altered in late 1800s into heroin-a “heroic” TX (10
x as strong as morphine)
/ Fentanyl
At 40% alcohol plus 3 grams of opium
per tablet, it didn't cure you, but you
didn't care...
OPIOIDS
II.
Medical Uses
 As pain reliever (morphine, demerol, codeine, lortab,
lorcet, percodan, percocet, vicodin)
 with chronic pain or terminal patients
 in some cough suppressants
 treatment of diarrhea, which is dehydrating
ALCOHOL
Alcohol’s Pharmacology
 It is a CNS depressant
 Peak concentrations are reached between
30-90 minutes after drinking is stopped
 Alcohol is distributed to all tissues in the
body and passes to the brain easily
 LD 50 is 25 drinks in 1 hour; BAC of .45 .55
(BAC is expressed as a ratio of milligrams or weight of
most of the consumed alcohol metabolized in liver
broken down to acetaldehyde (by ADH alcohol dehydrogenase and then to acetic
acid by aldehyde dehy.)
carbon dioxide and water
excreted by lungs
excreted in urine
Addiction and Withdrawal
Indicators
 Is it Addictive? How do we know?
 Tolerance (cellular & metabolic) develops
 Withdrawal symptoms occur
 BAC can still be above .00 for withdrawal sx to
begin
 Alcohol and Women
Long-term Consequences
 Physical:
 fatty liver, alcohol hepatitis, and cirrhosis
 increased risk of CAD and various types of
cancers
 increased susceptibility to illness; lower
immune system functioning
 GI problems such as pancreatitis
 FAS: small eyes, droopy eyelids, small
head, low intellectual functioning;
associated with low SES
Long-term Consequences
cont.
 Cognitive:
 impairs memory, problem-solving, learning
and reaction time
 neuropsychological damage can be
reversed with prolonged abstinence
 Wernicke-Korsakoff Syndrome
 unable to learn new material due to failure to
transfer
 confabulation
College Drinking
• National Institute on Alcohol Abuse and Alcoholism:
http://www.niaaa.nih.gov/ then page down to college drinking link
• Read “Alcohol in the Vulnerable Lives of College Women”