Chapter 2Social Issues: Substances, Addiction and Related Disorders

Changing AttitudesChanging Attitudes

What made the government change from the laissez-faire What made the government change from the laissez-faire attitude of the 1800s to one of control?attitude of the 1800s to one of control? ToxicityToxicity Dependence (in relation to substance use)Dependence (in relation to substance use) CrimeCrime

Toxicity

Toxic = poisonous, deadly, or dangerous

What makes a drug toxic?

Amount used

How it is used

What the user did while on the drug

Physiological toxicity & behavioral toxicity

Acute effects & chronic effects

Acute effects & chronic effects

Drug-Related Toxicity

Examples of acute toxicity

• Behavioral:“Intoxication” that impairs the actions of drug users and increases the danger to themselves and others

• Physiological: Overdose that causes the user to stop breathing

Examples of chronic toxicity

• Behavioral: Personality and lifestyle changes; effects on relationships

• Physiological: Lung cancer, cirrhosis, heart disease & other health effects

Toxicity & DAWN

A system for collecting data on drug-related deaths and emergency room visits at some U.S. metropolitan hospitals

DAWN collects data on improper use of legal prescription and over-the-counter drugs as well as illicit drugs

What it tells us about how dangerous a drug is - Simply gives us total deaths/ER visits

What it does not tell us about how dangerous a drug is

Consider relative danger vs. total impact of the drug

Number of users vs. number of reported problems

Alcohol is reported only in combination with other drugs

Drug-alcohol and drug-drug combinations are very common

Toxicity & Blood-Borne Diseases

Specific toxicity for users who inject drugs

AIDS, HIV infection, and hepatitis B and C

Sharing needles passes infectious agents directly into the bloodstream

Some states, cities prohibit needle purchase without Rx

Syringe exchange programs

The Concept of Dependence

In relation to substance use, substance-related and addictive disorders dependence has recently undergone extensive review

Text: Three basic processes

Tolerance

Need for increased amount

Diminished effect with continued use

Physical dependence - withdrawal symptoms/syndrome

Psychological dependence

Mental preoccupation

Interference

Different views on dependence

Drugs & Crime: Why We Regulate Drugs

We want to protect society from the dangers of some types of drug use

What are the real costs to a society?

Some laws are not developed as part of a rationally devised plan and may not be realistic or effective

Based on 4 ideas of drugs and crime:

1. Drug use changes personality; creates “criminal type”

2. People under the influence may commit crimes (e.g., many cases of homicide, domestic violence, etc.)

3. Crimes may be carried out to obtain money for drugs

4. Drug use is a crime