© 2006 mcgraw-hill higher education. all rights reserved. psy 526 human drug use and abuse outline...

© 2006 McGraw-Hill Higher Education. All rights reserved.

Psy 526Psy 526Human Drug Use and AbuseHuman Drug Use and Abuse

Outline of Supplemental ReadingsOutline of Supplemental Readings

Ksir, Hart, and RayKsir, Hart, and Ray

Chapters 1, 2, & 3Chapters 1, 2, & 3


Chapter 1Chapter 1

Drug Use : An OverviewDrug Use : An Overview


““Drug Use On The Rise”Drug Use On The Rise”

Who?

What?

When and where?

How much?

Why do any of these matter?


Who Is Taking The Drug? AgeAge Proximity to usProximity to us What they do for a livingWhat they do for a living

What Drug Are They Taking? Obvious question but often over lookedObvious question but often over looked Alcohol vs. heroinAlcohol vs. heroin Inhalants vs. alcoholInhalants vs. alcohol


When And Where Are Drugs Used?

The situation in which the drug is taken makes a The situation in which the drug is taken makes a big difference.big difference. A 1A 1stst grade teacher drinking on Saturday night at grade teacher drinking on Saturday night at

home vs. a 1home vs. a 1stst grade teacher drinking during class. grade teacher drinking during class.

Even if a subculture accepts the use of an illegal Even if a subculture accepts the use of an illegal drug, it will distinguish between acceptable and drug, it will distinguish between acceptable and unacceptable situations.unacceptable situations. A group might accept marijuana smoking at a party A group might accept marijuana smoking at a party

but not when you are taking the kids to the soccer but not when you are taking the kids to the soccer game or right before a multi-million dollar deal game or right before a multi-million dollar deal meeting.meeting.


Why A Person Takes Drugs? Reasons for drug use often determine Reasons for drug use often determine

whether such use is of concern:whether such use is of concern: e.g., Vicodin the doctor prescribed for pain vs. e.g., Vicodin the doctor prescribed for pain vs.

Vicodin taken for pleasurable effects.Vicodin taken for pleasurable effects. e.g., Drinking alcohol because you are out with e.g., Drinking alcohol because you are out with

friends vs. drinking alcohol alone in the morning friends vs. drinking alcohol alone in the morning to help get you out of bed.to help get you out of bed.


How A Drug Is Taken? An amount of cocaine that comes from chewing An amount of cocaine that comes from chewing

the coca leaves vs. that much cocaine snorted the coca leaves vs. that much cocaine snorted will lead to very different responseswill lead to very different responses

How the drug is taken can also depend on how How the drug is taken can also depend on how fast the user becomes addicted, how fast the fast the user becomes addicted, how fast the response comes and how long it lastsresponse comes and how long it lasts

How Much Of A Drug Is Taken? This is often the difference between normal use This is often the difference between normal use

and abuse; the difference between life and deathand abuse; the difference between life and death


Four Principles Of Psychoactive DrugsFour Principles Of Psychoactive Drugs

““Drugs” are not good or bad.Drugs” are not good or bad. Every drug has multiple effects.Every drug has multiple effects. Both amount and quality of the drug Both amount and quality of the drug

influence the effect of the drug.influence the effect of the drug. The effects of a drug also depend on the The effects of a drug also depend on the

person.person.


History tells us that as long as humans have been around some have used, misused and abused some plants or

substances.


Four Pharmacological RevolutionsFour Pharmacological Revolutions

1.1. Major communicable diseases under Major communicable diseases under control – vaccinescontrol – vaccines

2.2. Pharmacological revolution – antibiotics Pharmacological revolution – antibiotics to treat illness of the bodyto treat illness of the body

3.3. Development of psychopharmacology Development of psychopharmacology drugs – treatment of mental illnessesdrugs – treatment of mental illnesses

4.4. Development of oral contraception –Development of oral contraception –drugs gave control over the bodydrugs gave control over the body


Cultural Change in U.S.Cultural Change in U.S. After WWII, substance abuse was not a major After WWII, substance abuse was not a major

concernconcern Soon after, concerns about alcohol came to the Soon after, concerns about alcohol came to the

forefrontforefront In the mid 1960s, LSD became a household wordIn the mid 1960s, LSD became a household word Although Nixon declared a “War on Drugs”, there Although Nixon declared a “War on Drugs”, there

was still tolerance for drug use in the 1960s-70s.was still tolerance for drug use in the 1960s-70s. In the 1980s to 1990s, less tolerance of differences In the 1980s to 1990s, less tolerance of differences

including drugsincluding drugs 2000s, medicinal marijuana and “rave” subculture2000s, medicinal marijuana and “rave” subculture


Extent Of Drug UseExtent Of Drug Use

It is not possible to get accurate It is not possible to get accurate information on drug use.information on drug use.

It is not possible to get accurate It is not possible to get accurate information on quantity of drugs imported information on quantity of drugs imported or sold.or sold.

Even estimates of beer or prescription Even estimates of beer or prescription drug use based on sales information may drug use based on sales information may not be entirely accurate.not be entirely accurate.


How We Get InformationHow We Get Information

Survey Based QuestionnairesSurvey Based Questionnaires What are the benefits?What are the benefits? What are some of the limitations?What are some of the limitations?


Trends In Drug UseTrends In Drug Use

Annual High School Senior surveyAnnual High School Senior survey Prevalence of reported usePrevalence of reported use Attitude data and riskAttitude data and risk

Consider who is included and who is not Consider who is included and who is not included in this survey.included in this survey.


Marijuana: Trends in perceived availability, perceived risk of regular use, and prevalence of use in the past 30 days for 12th graders


Lifetime Marijuana Use among Persons Ages 12-25, by group: 1965-2002


National Survey On National Survey On Drug Use And HealthDrug Use And Health

Face-to-face, computer-assisted Face-to-face, computer-assisted interviewsinterviews

68,000 individuals; carefully sampled 68,000 individuals; carefully sampled households across the UShouseholds across the US

Broken down into different age groupsBroken down into different age groups ResultsResults


Trends in reported drug use within the past 30 days for young adults ages 18 to 25


Correlates Of Drug UseCorrelates Of Drug Use

Age, gender, racial/ethnic grouping, Age, gender, racial/ethnic grouping, education levelseducation levels

SES- not a significant factorSES- not a significant factor Personality problems are poor predictorsPersonality problems are poor predictors Risk factorsRisk factors Protective factorsProtective factors


Limitations Of Correlation Limitations Of Correlation StudiesStudies

Does smoking marijuana cause the user to Does smoking marijuana cause the user to get lower grades? get lower grades?

Are kids who are getting low grades more Are kids who are getting low grades more likely to smoke marijuana?likely to smoke marijuana?


Motives For Drug Use Motives For Drug Use

We all do things that we know are not We all do things that we know are not right; e.g., eating too much, driving too right; e.g., eating too much, driving too fast, or drinking too much.fast, or drinking too much.

Fads and cultural trends influence what Fads and cultural trends influence what drugs are used.drugs are used.


Influences on drug use.


Chapter 2Chapter 2

Drug Use As A Social ProblemDrug Use As A Social Problem


Costs Of Drug Use To SocietyCosts Of Drug Use To Society

Cost of maintaining habit

Cost of treating patients

Fetal alcohol syndrome

Cost of criminal behavior

Broken home, illness, shorter lives, etc.

Drugs in the workplace

Others?

Emergency room visits


The Big ChangeThe Big Change

What made the government change What made the government change from a laissez-faire attitude to one of from a laissez-faire attitude to one of control?control? ToxicityToxicity DependenceDependence CrimeCrime


Potency vs. ToxicityPotency 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.


ToxicityToxicity What makes a drug toxic?

• Amount used

• How it is used

• What the user did while on the drug


Examples of Drug-Induced ToxicityExamples of Drug-Induced Toxicity

AcuteAcute Behavioral toxicity – “intoxication” that impairs Behavioral toxicity – “intoxication” that impairs

the user’s actions and increases the danger to the user’s actions and increases the danger to the individual.the individual.

Physiological – overdose that causes the user Physiological – overdose that causes the user to stop breathing, the heart to stop, or causes to stop breathing, the heart to stop, or causes other adverse side effects.other adverse side effects.


Examples of Drug-Induced ToxicityExamples of Drug-Induced Toxicity

ChronicChronic Social problemsSocial problems

Personality changesPersonality changes Effects on friends and familyEffects on friends and family Change in lifestyleChange in lifestyle

Health problemsHealth problems Heart diseaseHeart disease Lung cancerLung cancer Liver dangerLiver danger Other health effectsOther health effects


DDrug rug AAbuse buse WWarning arning NNetworketwork

A system for reporting incidences of lethal and A system for reporting incidences of lethal and non-lethal drug related emergency in some U.S. non-lethal drug related emergency in some U.S. metropolitan hospitals.metropolitan hospitals.

DAWN included improper use of prescription or DAWN included improper use of prescription or over-the-counter drugs and the use of any other over-the-counter drugs and the use of any other substance for psychic effect, dependence or substance for psychic effect, dependence or suicide.suicide.

See table 2.2 on page 32 (data from 2002)See table 2.2 on page 32 (data from 2002) The top three mentions in ER episodes were Alcohol-The top three mentions in ER episodes were Alcohol-

in- combination, cocaine, and marijuana.in- combination, cocaine, and marijuana. The top three mentions for fatalities were prescription The top three mentions for fatalities were prescription

narcotics, cocaine, and heroin/morphine.narcotics, cocaine, and heroin/morphine.


DDrug rug AAbuse buse WWarning arning NNetworketwork

What it tells us about how What it tells us about how dangerous a drug is?dangerous a drug is?

What it does NOT tell us about What it does NOT tell us about how dangerous a drug is?how dangerous a drug is?


Blood Borne DiseasesBlood Borne Diseases

Specific toxicity for injected drugsSpecific toxicity for injected drugs AIDS, HIV and Hepatitis B and CAIDS, HIV and Hepatitis B and C Why do the blood borne diseases spread Why do the blood borne diseases spread

so rapidly with these drug users?so rapidly with these drug users?


Substance DependenceSubstance Dependence

What does an addict look like?What does an addict look like? What do they take? Alcohol, cigarettes, What do they take? Alcohol, cigarettes,

illicit drugs, food, or computer timeillicit drugs, food, or computer time How much time do they spend with their How much time do they spend with their

vice?vice? How much do they take?How much do they take? What makes you decide the rules?What makes you decide the rules?


Substance DependenceSubstance Dependence

Three Basic ProcessesThree Basic Processes ToleranceTolerance Physical dependencePhysical dependence Psychological dependencePsychological dependence


ToleranceTolerance

Tolerance is a diminished effect after Tolerance is a diminished effect after repeated use of the same drug.repeated use of the same drug.

When tolerance develops, an increased When tolerance develops, an increased amount of the drug is required to produce amount of the drug is required to produce the same effects.the same effects.


Physical DependencePhysical Dependence

Physical dependence refers to the body’s Physical dependence refers to the body’s requirement for the drug in order to function requirement for the drug in order to function normally.normally.

Tolerance may lead to physical dependence Tolerance may lead to physical dependence (but not always).(but not always).

When the drug use is stopped promptly, When the drug use is stopped promptly, withdrawal effect can happenwithdrawal effect can happen From mild (e.g., headaches, nausea) to severe From mild (e.g., headaches, nausea) to severe

(e.g., seizures, death).(e.g., seizures, death). Withdrawal symptoms differ among users and with Withdrawal symptoms differ among users and with

different drugs.different drugs.


Psychological DependencePsychological Dependence Psychological dependence is defined by the Psychological dependence is defined by the

psychological/behavioral inability to stop using a psychological/behavioral inability to stop using a drug.drug.

Psychological dependence can be observed in Psychological dependence can be observed in person’s behavior, by the amount of time and person’s behavior, by the amount of time and effort the person spends seeking the drug.effort the person spends seeking the drug.

It is It is not any less REALnot any less REAL than physical than physical dependence.dependence.

Like physical dependence, psychological Like physical dependence, psychological dependence has a physiological basis.dependence has a physiological basis. i.e., neurophysiological (body - mind are one)i.e., neurophysiological (body - mind are one)


Changing Views of DependenceChanging Views of Dependence

The medical model aims to treat the The medical model aims to treat the withdrawal symptoms, often associated withdrawal symptoms, often associated with physical dependence.with physical dependence.

The positive reinforcement model stresses The positive reinforcement model stresses that the consequences of drug use that the consequences of drug use influence dependence.influence dependence. Drug use is operant behavior.Drug use is operant behavior. Users don’t have to experience withdrawal Users don’t have to experience withdrawal

symptoms to become addicted.symptoms to become addicted.


Substance Abuse and Dependence: Substance Abuse and Dependence: DSM-IVTRDSM-IVTR

Substance abuse is considered Substance abuse is considered maladaptive.maladaptive.

It is carefully separated from substance It is carefully separated from substance dependencedependence The essential feature of dependence is The essential feature of dependence is

continued use despite significant substance-continued use despite significant substance-related problems known to user.related problems known to user.


Drugs are not evil They can not do anything

They can not have power

Drugs are just objects that have effects on our body.

Even our “War on Drugs” shows the perception that drugs are so evil that we have to wage a war on them.


Dependence is Biological Dependence is Biological

Biochemical or physiological actions in the Biochemical or physiological actions in the brainbrain

We can not scan the brain to determine if We can not scan the brain to determine if a person has developed dependence.a person has developed dependence. Researchers have searched for genetic, Researchers have searched for genetic,

physiological, or biochemical markers.physiological, or biochemical markers. To date, none have proven reliable predictors.To date, none have proven reliable predictors.


Personality Personality

It is difficult to determine whether drug use It is difficult to determine whether drug use changes personality.changes personality.

Many other factors play a role in Many other factors play a role in developing someone’s personality.developing someone’s personality.


Dependence as a “Disease” Dependence as a “Disease”

This is a popular notion.This is a popular notion. Alcoholics Anonymous is based on this idea. Its Alcoholics Anonymous is based on this idea. Its

founders and advocates believe that drug founders and advocates believe that drug dependence should be treated as such.dependence should be treated as such.

Others argue that there are no tests that Others argue that there are no tests that diagnose alcoholism.diagnose alcoholism. There are ways to test and treat the effects but not There are ways to test and treat the effects but not

the disease itself.the disease itself. What are some potential problems with this What are some potential problems with this

label?label?


Drugs and CrimeDrugs and Crime

Do drugs turn the person into the criminal type?Do drugs turn the person into the criminal type? Do people under the influence of a drug commit Do people under the influence of a drug commit

crime? crime? More than half the murders in our nation in 2000 were More than half the murders in our nation in 2000 were

associated with alcohol, as were two-thirds of all associated with alcohol, as were two-thirds of all domestic violence.domestic violence.

What are the implications of these statistics? What are the implications of these statistics? Some forms of drug use are criminal behavior. Some forms of drug use are criminal behavior.

If someone is willing to commit one crime, they might If someone is willing to commit one crime, they might be more willing to do other crimes.be more willing to do other crimes.


Chapter 3Chapter 3

Drug Products and Their RegulationDrug Products and Their Regulation


ReformismReformism

Race and fear usedRace and fear used Laws came to regulate moral behaviorLaws came to regulate moral behavior


Issues Leading To LegislationIssues Leading To Legislation

Fraud in patent medicineFraud in patent medicine Hostetter’s Bitters 44% pure alcoholHostetter’s Bitters 44% pure alcohol Birney’s Catarrh Cure 4% cocaineBirney’s Catarrh Cure 4% cocaine

OpiumOpium 1890 federal act allowed only American citizens to 1890 federal act allowed only American citizens to

import opiumimport opium MorphineMorphine

““Morphinism”Morphinism” CocaineCocaine

Mail order cocaineMail order cocaine


Two Bureaus, Two Types Of Two Bureaus, Two Types Of RegulationRegulation

The Pure Food and Drug ActThe Pure Food and Drug Act Department of AgricultureDepartment of Agriculture Ensures drugs were pure and honestly Ensures drugs were pure and honestly

labeledlabeled Harrison ActHarrison Act

Treasury DepartmentTreasury Department Taxing of drug for revenueTaxing of drug for revenue


Regulation Regulation 1906 Pure Food And Drugs Act1906 Pure Food And Drugs Act

PurityPurity The contents of the product must be correct and The contents of the product must be correct and

labeled correctlylabeled correctly 1912 Sherley Amendment1912 Sherley Amendment

SafetySafety Set up FDA as gatekeeperSet up FDA as gatekeeper Directions must be includedDirections must be included

EffectivenessEffectiveness 1962 Kefauver-Harris Amendments1962 Kefauver-Harris Amendments


Making Of A New DrugMaking Of A New Drug

Preclinical research and developmentPreclinical research and development Clinical research and developmentClinical research and development

Phase IPhase I Phase IIPhase II Phase IIIPhase III

Permission to marketPermission to market


Making Of A New DrugMaking Of A New Drug

ExceptionsExceptions Fast-track ruleFast-track rule Orphan Drug LawOrphan Drug Law

Dietary SupplementsDietary Supplements


Controlled SubstanceControlled Substance

Early enforcement of the Harrison ActEarly enforcement of the Harrison Act 18th Amendment18th Amendment The Narcotic DivisionThe Narcotic Division Arresting physicians and pharmacistsArresting physicians and pharmacists

Stiffer PenaltiesStiffer Penalties Jones-Miller ActJones-Miller Act Prohibited the importing of opium for heroinProhibited the importing of opium for heroin


Controlled SubstanceControlled Substance

Mandatory Minimum sentencesMandatory Minimum sentences

The Bureau of NarcoticsThe Bureau of Narcotics Drug CzarDrug Czar Marijuana Tax ActMarijuana Tax Act 1956 Narcotic Drug Control Act1956 Narcotic Drug Control Act


Drug Abuse Control Act Drug Abuse Control Act Amendments Of 1965Amendments Of 1965

Comprehensive Drug Abuse Prevention and Comprehensive Drug Abuse Prevention and Control Act 1970Control Act 1970 Replaced or updated all lawsReplaced or updated all laws Federal vs StateFederal vs State

Prevention and treatmentPrevention and treatment

Control, not taxControl, not tax


Summary of Controlled Substance SchedulesSummary of Controlled Substance Schedules

Schedule Criteria Examples

I a. High potential for abuse

b. No medical use

c. Lack of accepted safety

Heroin,

Marijuana

II a. High potential for abuse

b. Current accepted medical use

c. Abuse may lead to psychological or physical dependence

MDMA,

Morphine,

Cocaine

III a. Potential for abuse less then I and II


c. Abuse may lead to physical dependence or high psychological dependence

Anabolic steroids, most barbiturates

IV a. Low Potential for abuse less then III


c. Abuse may lead to limited physical or psychological dependence relative to III

Vanax, barbital, Chloral hydrate,

fenfluramine

V a. Potential for abuse less then I and II


c. Abuse may lead to physical dependence or high psychological dependence

Mixture having small amounts of codeine or

opium


Drug Abuse Control Act Drug Abuse Control Act Amendments Of 1965Amendments Of 1965

Possession and Selling PenaltiesPossession and Selling Penalties Omnibus Drug ActOmnibus Drug Act Loss of BenefitsLoss of Benefits

Drug precursorsDrug precursors

Drug paraphernaliaDrug paraphernalia

Office of National Drug Control PolicyOffice of National Drug Control Policy


Americans in Prison


State And Local RegulationsState And Local Regulations

Difference in penalties from state to stateDifference in penalties from state to state Federal law overrides stateFederal law overrides state

Federal Support for Urine ScreeningFederal Support for Urine Screening Military led the wayMilitary led the way More advanced screeningMore advanced screening Transportation and private companies testTransportation and private companies test Schools testSchools test

Testing methodsTesting methods Different test different resultsDifferent test different results


Impact Of Drug EnforcementImpact Of Drug Enforcement

PeoplePeople BudgetBudget International programsInternational programs Other costsOther costs Effectiveness of ControlEffectiveness of Control

© 2006 mcgraw-hill higher education. all rights reserved. psy 526 human drug use and abuse outline...

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