Transcript Drug use, Drug abuse and DRUG TAKING BEHAVIOR

Drug use, Drug abuse and DRUG
TAKING BEHAVIOR
IS DRUG ABUSE A PROBLEM?
eg…Marijuana?
Other drugs?
How large is the problem
Problem: How to define
• Drug addiction? Is once enough? A
repetitive behavior pattern associated with
increase risk of disease or social problems
(Marlatt, 1988)..often characterized by
immediate gratification and high relapse
rates…but is this the same as “abuse?”
• Drug abuse-how to define?
Drug Abuse
• The self-administration of any drug in a manner
that deviates from the approved medical or
social patterns within a given culture (Jaffe).
• Drug Dependence- a condition in which an
individual requires a drug to function normally. A
distinction is often made between Physical
dependence and Psychological dependence.
Physical Dependence
• An adaptive state produced by repeated use of a
drug which manifests itself by intense
physiological disturbances (withdrawal
syndrome) when use of the drug is halted
(abstinence).
• Withdrawal syndrome- a constellation of
symptoms that occur when an individual stops
using the drug to which dependence has
developed. Symptoms typically in reverse
direction of the effects caused by the drug.
Psychological dependence
• A condition characterized by intense drive
or cravings for a drug.
SO AGAIN…How big is the problem?
Problem: How to measure
(Reactivity and return rate issues)
Illicit drug use reported by state
Accuracy of surveys?
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B.3.1 Screening and Interview Response Rate Patterns
In 2004, respondents continued to receive a $30 incentive in an effort to improve
response rates over years prior to 2002. Of the 142,612 eligible households
sampled for the 2004 NSDUH, 130,130 were successfully screened for a
weighted screening response rate of 90.9 percent (Table B.2). In these
screened households, a total of 81,973 sample persons were selected, and
completed interviews were obtained from 67,760 of these sample persons, for a
weighted interview response rate of 77.0 percent (Table B.3). A total of 9,362
(15.2 percent) sample persons were classified as refusals or parental refusals,
2,918 (3.9 percent) were not available or never at home, and 1,933 (3.9 percent)
did not participate for various other reasons, such as physical or mental
incompetence or language barrier (see Table B.3, which also shows the
distribution of the selected sample by interview code and age group). Among
demographic subgroups, the weighted interview response rate was highest
among 12 to 17 year olds (88.6 percent), females (78.5 percent), blacks (81.9
percent), in nonmetropolitan areas (79.2 percent), and among persons residing
in the South (78.7 percent) (Table B.4).
The overall weighted response rate, defined as the product of the weighted
screening response rate and weighted interview response rate, was 70.0
percent in 2004. Nonresponse bias can be expressed as the product of the
nonresponse rate (1-R) and the difference between the characteristic of interest
between respondents and nonrespondents in the population (Pr - Pnr). Thus,
assuming the quantity (Pr - Pnr) is fixed over time, the improvement in response
rates in 2002 through 2004 over prior years will result in estimates with lower
nonresponse bias.
And How the questions are asked:
eg…
VS. selected age ranges by month
Drug use in the Military?
In Different Ethnic groups?
• So maybe marijuana use is not so
overwhelming?
But Alcohol is a drug
And Tobacco!
And…..
For the Sake of Argument
• Lets say there is significant drug use
and/abuse in our society.
• BUT AGAIN…How big is the problem?
Depends on how you measure
it.
Overdoses? DAWN
Heroin overdose
Not just our problem
COSTS of DRUGS in SOCIETY?
And money is being lost
Incarceration costs- not including
lost productivity for families
And Psychological “WORRY?”
Psychological Impacts?
Drugs and Violence
So Lets War on Drugs!
More money (lost?)
it does cost lots of money
The “WAR on Drugs”
People are being incarcerated
And sent up for treatment
But is it working?
Cocaine production is not
down
Prices are relatively stable
Is the War aimed in the right
directions?
Costs of the “War on Drugs”
Effectiveness of “War?”
AND CONCERNS/COSTS in the
home and Work place
It does create its own economy
Should we use drug testing at
work?
Maybe its necessary
What if tests are too sensitive??
Watch out here they come!
The wild eyed claim that a third of all
people accused of drug use will be
innocent is not so ridiculous after all.
Figure 4 shows that the proportion of
spurious results among people
identified as drug users is surprisingly
sensitive to test accuracy. An accuracy
of 99% is marginal at best. However the
biggest surprise is the fact that the
proportion of spurious results among
people failing drug tests approaches
100% as the proportion of drug users in
the general population approaches zero.
Drug testing in a drug free
population amounts to a witch
hunt.
SO ?
• Whatever your perspective on drug use
and abuse, its difficult to argue that drug
use is in no way problematic.
• Especially when considering the harmful
effects of drug addiction/Abuse to the
individual and to society.
What are the causes of
drug Addiction?
A difficult question.
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MORAL MODEL-character
MEDICAL MODEL-disease
LEARNING MODEL-reinforcement
ENLIGHTENMENT MODE-multifactorial
??
• Genetics
• Environment
• Concordance rates in identical twins
separated at birth…does not completely
rule out environmental factors.
• Whatever the original causes,
• 2 additional factors are necessary before
drug addiction will occur…..
• Availability – prohibition?
• Trying it.-”turning on.”
• But what then leads to dependence?
Commonalities in Drug
addiction/abuse
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Availability/ Taking the drug
Reward
Tolerance
Dose-stabilization
Periods of abstinence
Cravings
relapse
Dose-stabilization
Periods of abstinence
• Associated with Cravings
– (psychological…but obvious physical
dependence is not a common denominator.
And unfortunately..RELAPSE
RELAPSE
Principles of drug study:
-Multiple effects (side-effects)
-No new behaviors
-Drug use is neither good nor bad
Other factors contributing to drug
effect
• Type of drug
Different drugs can produce different
effects…but class systems only take us so
far…
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Drugs of Abuse
Acid/LSD
Alcohol
Club Drugs
Cocaine
Ecstasy/MDMA
Heroin
Inhalants
Marijuana
Methamphetamine
PCP/Phencyclidine
Prescription Medications
Smoking/Nicotine
Steroids (Anabolic)
MJ
• euphoria, slowed thinking and reaction
time, confusion, impaired balance and
coordination/cough, frequent respiratory
infections; impaired memory and learning;
increased heart rate, anxiety; panic
attacks; tolerance, addiction
For sedatives, benzodiazepines,
Rohypnol
• reduced anxiety; feeling of well-being; lowered
inhibitions; slowed pulse and breathing; lowered blood
pressure; poor concentration/fatigue; confusion; impaired
coordination, memory, judgment; addiction; respiratory
depression and arrest, death
Also, for barbiturates—sedation, drowsiness/depression,
unusual excitement, fever, irritability, poor judgment,
slurred speech, dizziness, life-threatening withdrawal.
for benzodiazepines—sedation, drowsiness/dizziness
for flunitrazepam—visual and gastrointestinal
disturbances, urinary retention, memory loss for the time
under the drug's effects
Ketamine, PCP and analogs
• increased heart rate and blood pressure,
impaired motor function/memory loss;
numbness; nausea/vomiting
Also, for ketamine—at high doses, delirium,
depression, respiratory depression and arrest
for PCP and analogs—possible decrease in
blood pressure and heart rate, panic,
aggression, violence/loss of appetite, depression
Hallucinogenics
• altered states of perception and feeling; nausea;
persisting perception disorder (flashbacks)
Also, for LSD and mescaline—increased body
temperature, heart rate, blood pressure; loss of
appetite, sleeplessness, numbness, weakness,
tremors
for LSD —persistent mental disorders
for psilocybin—nervousness, paranoia
Opiate compounds
• pain relief, euphoria, drowsiness/nausea,
constipation, confusion, sedation, respiratory
depression and arrest, tolerance, addiction,
unconsciousness, coma, death
Also, for codeine—less analgesia, sedation, and
respiratory depression than morphine
for heroin—staggering gait
For stimulants
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increased heart rate, blood pressure, metabolism; feelings of exhilaration, energy,
increased mental alertness/rapid or irregular heart beat; reduced appetite, weight
loss, heart failure, nervousness, insomnia
Also, for amphetamine—rapid breathing/ tremor, loss of coordination; irritability,
anxiousness, restlessness, delirium, panic, paranoia, impulsive behavior,
aggressiveness, tolerance, addiction, psychosis
for cocaine—increased temperature/chest pain, respiratory failure, nausea,
abdominal pain, strokes, seizures, headaches, malnutrition, panic attacks
for MDMA—mild hallucinogenic effects, increased tactile sensitivity, empathic
feelings/impaired memory and learning, hyperthermia, cardiac toxicity, renal failure,
liver toxicity
for methamphetamine—aggression, violence, psychotic behavior/memory loss,
cardiac and neurological damage; impaired memory and learning, tolerance,
addiction
for nicotine—additional effects attributable to tobacco exposure, adverse pregnancy
outcomes, chronic lung disease, cardiovascular disease, stroke, cancer, tolerance,
addiction
Other factors contributing to drug
effect
Dose and time
-All drug effects are
dose and time dependent
Other contributing factors to drug
dependence/abuse
• Type of drug…
• Route of administration
Consider heroin vs. an oral opiate
drug
Structure of
heroin…diacetylmorphine
Other contributing factors
• Set and setting
Effects also determined by brain
specific circuits affected…receptor
binding
Factors influencing drug
effects:Systems that the drug affects..
opioid receptors in the brain
And receptor subtypes affected
Agonism and antagonism
Agonism and antagonism
• Agonist drugs- promote what ever the natural
effect of the NT receptor interaction would
normally be
• Antagonist drugs- block or inhibit what ever the
natural effect of the NT receptor interaction would
normally be
• Consider agonism and antagonism at the GABA
synapse vs the Glut synapse
Direct vs Indirect actions
How drugs can affect the nervous
system
Eg…Drugs can affect synthesis
…L-DOPA
…Reuptake
Indirect agonism ACHE inhibitors
Direct receptor antagonism
Competitive vs non-competitive
drug actions
Noncompetitive binding
Drug addiction and the brain?
REWARD SYSTEMS OF THE
BRAIN?
Animal Models of drug reward and
dependence
• James Olds and Intra-cranial Selfadministration…
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Place preference
2 lever choice
Progressive ratio
Conflict tests
ICSS and brain reward centers?
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LH
Medial forebrain bundle (MFB)
VTA-Accumbens
DA agonist and antagonist effects
From ICSS to DSA
Drugs that are self-administered by
laboratory animals
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alcohol
amphetamine
barbiturates
caffeine
cocaine
nicotine
opiates e.g. morphine
procaine
phencyclidine (PCP)
THC (active component in
marijuana)
Drugs that are not self-administered by
laboratory animals
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imipramine
mescaline
phenothiazines
scopolamine
Brain ccts of drug reward:
Intra-cranial drug infusion
Microdialysis techniques
ICCS increases DA release in
Nucleus Accumbens
Drugs increase DA release in
accumbens
What about ICSS in Humans
What about reward Circuits in the
Human? Human ICSS
• Heath 1962
• The pleasure seekers
• Hedonism makes our world go round, but it goes a lot deeper
than our obsession with sex, drugs, rock 'n' roll and chocolate.
Neuroscientists are completely rethinking how our brains give
us pleasure, and as a result are starting to believe that the
quest for pleasure may underpin every decision we make. It
may even have laid the foundations of consciousness, as Helen
Phillips explains.
• IT WAS an outlandish, ethically questionable experiment, but this
was the 1960s after all. Psychiatrist Robert Heath of Tulane
University in New Orleans hoped to cure his patients' depression,
intractable pain, schizophrenia, suicidal feelings, addiction, and
even homosexuality - which in those days was considered a
psychiatric disorder - by drowning them out with pleasure, induced
by an electrode implanted deep in their brains.
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In our own experience, pleasurable sensations were observed in three patients with psychomotor
epilepsy. The first case was V.P., a 36-year-old female with a long history of epileptic attacks
which could not be controlled by medication. Electrodes were implanted in her right
temporal lobe and upon stimulation of a contact located in the superior part
about thirty millimeters below the surface, the patient reported a pleasant
tingling sensation in the left side of her body "from my face down to the bottom
of my legs." She started giggling and making funny comments, stating that she
enjoyed the sensation "very much." Repetition of these stimulations made the
patient more communicative and flirtatious, and she ended by openly
expressing her desire to marry the therapist. Stimulation of other cerebral points failed
to modify her mood and indicated the specificity of the evoked effect. During control interviews
before and after ESB, her behavior was quite proper, without familiarity or excessive friendliness.
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The second patient was J.M., an attractive, cooperative, and intelligent 30-year-old female
who had suffered for eleven years from psychomotor and grand mal attacks which resisted
medical therapy. Electrodes were implanted in her right temporal lobe, and stimulation of one of
the points in the amygdala induced a pleasant sensation of relaxation and considerably
increased her verbal output, which took on a more intimate character. This patient openly
expressed her fondness for the therapist (who was new to her), kissed his hands, and
talked about her immense gratitude for what was being done for her. A similar increase in
verbal and emotional expression was repeated when the same point was stimulated on a different
day, but it did not appear when other areas of the brain were explored. During the control
situations the patient was rather reserved and poised.
• In another controversial experiment in 1972, Dr. Heath
wired up a homosexual man's pleasure centers in order
to help him "cure" his homosexuality. During the initial
three-hour session, subject "B-19" stimulated
himself some 1,500 times. Dr. Heath wrote of the
experiment, "During these sessions, B-19 stimulated
himself to a point that he was experiencing an almost
overwhelming euphoria and elation, and had to be
disconnected, despite his vigorous protests." Since
unnatural methods can bring about unnatural results,
energizing the man's electrodes as he looked at erotic
pictures of women temporarily "cured" him of his
homosexuality, but once the electrodes were removed,
he went back to normal.
• It is interesting to note that while the animal literature suggests that
brain stimulation has positive, reinforcing effects, the human
literature indicates that relief of anxiety, depression and other
unpleasant affective conditions may be the most common "reward"
of electrical brain stimulation in humans. Patients with electrodes in
the septum, thalamus, and periventricular gray of the midbrain often
express euphoria because the stimulation seems to reduce existing
negative affective reactions (even intractable pain appears to loose
its affective impact). However, many psychiatrists caution that this
may not reflect an activation of a basic reward mechanism (Delgado,
1976; Heath et al., 1968). Relief from chronic anxiety has been
reported during and even long after stimulation of frontal cortex.
Again, the experiential response appears to be relief rather than
reward per se (Crow&Cooper, 1972).
• Compulsive thalamic self-stimulation: a case with
metabolic, electrophysiologic and behavioral
correlates
by
Portenoy RK, Jarden JO, Sidtis JJ,
Lipton RB, Foley KM, Rottenberg DA.
Pain. 1986 Dec;27(3):277-90
ABSTRACT
• A 48-year-old woman with a stimulating electrode
implanted in the right thalamic nucleus ventralis
posterolateralis developed compulsive selfstimulation associated with erotic sensations and
changes in autonomic and neurologic function.