Chapter 7

1. Chapter 7 Drug Use and Abuse

2. Did You Know? • An estimated 20.1 million people in the U.S. currently use illicit drugs. • Marijuana is the most common illicitly used drug. • College students tend to vastly overestimate how many of their peers use drugs illicitly.

3. Learning Objectives • Describe the prevalence of drug use among college students. • Define drug misuse, drug abuse, addiction, and dependence. • Describe three common methods of drug administration. • Identify commonly abused drugs and describe their mechanisms, effects, and health risks. • Discuss the prevention and treatment of drug abuse.

4. Terms • Drug: A chemical substance that alters the body physically or mentally for a non-nutritional purpose. • This includes legal and illegal drugs, from caffeine and aspirin to marijuana and heroine. • Psychoactive drug: A drug that alters feelings, mood, perceptions, or psychological functioning.

5. DRUG USE ON CAMPUS

6. Drug Use by Full-Time College Students • Nearly half of full-time college students binge drink or abuse prescription or illegal drugs. • Nearly one in four meets the medical criteria for drug addiction or dependence. • The proportion of students abusing stimulants such as Ritalin and Adderall has jumped 93% since 1993. • The number of students who use marijuana every day now exceeds 300,000 (more than double the number in 1993). • The proportion of students who use cocaine, heroin, and other illegal drugs (other than marijuana) increased 52% between 1993 and 2005.

7. National Survey on Drug Use and Health (1998) • Patterns of drug use vary by educational status. • Illicit drug use is higher in those without high school diplomas. • College graduates were more likely to have experimented with illicit drugs during their lifetime. • Students reported believing that 77% of their peers used marijuana—but only 14.5% of their peers actually used the drug.

8. Illicit drug use in the U.S.

9. MISUSE, ABUSE, ADDICTION, AND DEPENDENCE

10. Misuse, Abuse, Addiction • Drug misuse: The inappropriate use of a legal drug, either for a reason for which it was not medically intended or by a person without a prescription. • Drug abuse: The use (most often excessively) of any legal or illegal drug in a way that is detrimental to health. • Addiction: A complex, relapsing condition characterized by uncontrollable craving for a substance or behavior despite harmful consequences.

11. Addiction Has Psychological and Physical Roots • Euphoria: A feeling of intense pleasure. • Tolerance: Reduced sensitivity to a drug so that increased amounts are needed to achieve the usual effect. • Psychological dependence: A mental attachment to a drug. • Physical dependence: The physical need for a drug. • Physical withdrawal symptoms develop when a person stops using a drug.

12. Substance Dependence • A pattern of substance use leading to impairment or distress, including at least three of the following in a 1-year period: • Development of tolerance. • Experience of withdrawal symptoms. • Use in larger amounts or over a longer period than intended. • Inability to cut down or control use. • Spending an inordinate amount of time thinking about, using, or recovering from using the substance. • Sacrificing relationships and activities due to use. • Continuing use with knowledge that the substance is causing or exacerbating a problem.

13. HOW THE BODY PROCESSES DRUGS

14. Intoxication • Psychoactive drugs intoxicate the brain, causing physical, psychological, and behavioral changes. • Speed and extent of intoxication depend on the characteristics of the user and of the drug. • User’s sex • User’s body size • User’s physiological makeup • User’s history of drug use • The drug’s action • The drug’s dosage • How the drug enters and leaves the body

16. How Drugs Leave the Body • The organs that metabolize drugs are the same organs that break down and eliminate nutritional waste. • The liver metabolizes drug chemicals to be excreted. • Urine • Stool • Some drugs leave the body through other means. • Excreted through the skin • Expelled through the lungs • Eliminated through sweat, saliva, or breast milk

17. Physiological Impact of Drugs • A drug remains active in the body for a certain amount of time, dependent on many factors. • Distribution half-life: The amount of time it takes a drug to move from general circulation to body tissues.

18. Physiological Impact of Drugs • Physiological responses vary by individual. • Body size • Sex • Race • History of drug use • Additive interactions: The effect of one drug combined with the effects of another. • Antagonistic interactions: The effect of one drug is diminished when combined with another drug. • Toxicity can cause temporary or permanent damage.

19. COMMONLY ABUSED DRUGS

20. Prescription Drugs • Prescription medications can be harmful, even fatal, if used improperly. • Taking the incorrect dose • Taking the medicine at the wrong time • Forgetting to take a dose • Failing to take all the medicine

21. A lethal combination of prescription drugs caused the death of actor Heath Ledger.

22. OTC Drugs • Over-the-counter (OTC) drugs are available for purchase without a prescription. • These include aspirin, allergy pills, and cough and cold medicines. • These pose many of the same challenges as prescription drugs. • They are not meant to be taken in higher doses or for longer periods than directed on the label. • Improper use can result in mild to severe harm, including liver damage, rapid heart rate, convulsions, and death.

23. Marijuana • Marijuana is the most commonly used illegal drug in the U.S. • It grows wild and is farmed in many parts of the world. • Intoxication is achieved through smoking or ingestion (eating or drinking products laced with the drug). • The psychoactive ingredient in marijuana, THC, varies widely in strength depending on the plant it comes from.

25. Marijuana: Effects on the Body • Inhaled THC takes minutes to move from lungs, to bloodstream, to brain. • Ingested THC takes longer for the body to process. • Cellular reactions in the brain cause the high, ultimately through the release of the chemical dopamine, boosting the sensation of pleasure. • The heart beats faster; bronchi in the lungs become enlarged; blood vessels in the eyes expand; and dry mouth, hunger, and sleepiness may result. • Mental effects vary by user.

26. Marijuana: Effects on the Body • Chronic users: • May have difficulty processing information. • Can end up with many of the long-term problems tobacco smokers do. • Are at risk for daily cough and phlegm production, respiratory problems, lung damage, impaired immune system, impaired cognitive functioning, and possible increased risk of cancer. • May experience withdrawal systems, similar to those who stop smoking tobacco.

27. Smoking marijuana can cause lung damage and increase the risk of cancer.

28. Stimulants • A class of drugs that stimulate the function of the central nervous system. • Effects on the body include: • Increased heart rate. • Higher blood pressure. • Elevated rate of mental function. • Elevation of mood and increased feelings of happiness (with “uppers”). • There are both legal and illegal stimulants.

29. Stimulants: Caffeine • Caffeine is a stimulate found in coffee, tea, soft drinks, chocolate, and some medications. • It is the most popular mind-altering drug in the world. • Some people enjoy the effects of caffeine. • Users feel more alert and energetic. • Improved mood, concentration, and athletic prowess. • Excessive consumption can cause restlessness, anxiety, dehydration, and irritability. • It can trigger headaches and insomnia and raise blood pressure. • Regular users can suffer withdrawal symptoms.

31. Stimulants: Cocaine • A strong stimulant that triggers the release of dopamine, causing a rush of euphoria. • Effects typically disappear within a few minutes or hours. • Users must continue use to retain the feelings of euphoria. • Cocaine can be snorted, injected, or smoked, depending on the preparation of the drug. • Use gives a feeling of energy and lessens the need for food and sleep. • Side effects include loss of appetite, chest pain, muscle spasms, convulsions, strokes, coma, and death.

32. Cocaine use can result in heart damage, stroke, and sudden death.

33. Stimulants: Amphetamines • Chemically similar to the natural stimulants adrenaline and noradrenalin. • They increase a sense of alertness; decrease appetite and the need for sleep; enhance physical performance; and induce feelings of well-being and euphoria. • Off-the-label use of Ritalin and Adderall is an increasing problem on campus. • Adverse reactions can include convulsions, heart attack, and stroke. • Withdrawal symptoms include fatigue, irritability, and depression.

34. Stimulants: Methamphetamine • A highly addictive and dangerous stimulant chemically similar to amphetamine, but more potent and harmful. • It is medically prescribed for some conditions. • Most methamphetamine sold on the street is made in illegal labs from household materials. • It can be smoked, snorted, and injected. • Injection increases the risk of contracting HIV and hepatitis through sharing of needles. • Users feel enhanced mood and body movement.

35. Stimulants: Methamphetamine • Side effects of use • From smaller doses: irregular heartbeat, reduced appetite, irritability, insomnia, confusion, and tremors. • From larger doses: elevated body temperature, convulsions, cardiovascular collapse, and death. • From chronic use: aggressiveness, anorexia, memory loss, hallucinations, paranoia, reduction in motor speed and verbal learning, and cognitive problems. • Physical changes: “meth mouth,” acne, open sores. • Symptoms of withdrawal can be severe.

36. Methamphetamine use can take a dramatic physical toll.

37. Hallucinogens • These alter perception and are capable of causing auditory and visual hallucinations. • LSD (lysergic acid diethylamide): A powerful hallucinogen manufactured from lysergic acid, a substance found in a fungus that grows on rye and other grains. • PCP (phencyclidine): A dangerous synthetic hallucinogen that reduces and distorts sensory input and can unpredictably cause both euphoria and dysphoria. • Psilocybin (magic mushrooms): A hallucinogenic substance obtained from certain types of mushrooms that are indigenous to tropical regions of South America.

38. Psilocybin induces hallucinations and can cause psychosis in some users.

39. Club Drugs • First popularized by young adults at raves. • These include LSD and four other psychoactive substances. • MDMA (ecstasy) • GHB • Rohypnol (roofies) • Ketamine • More than 17,000 emergency room visits each year are a result of using club drugs.

40. Club Drugs • MDMA (methylenedioxymethamphetamine): A synthetic drug, commonly called “ecstasy,” that works as both a stimulant and hallucinogen. • Negative effects are similar to those of amphetamines and cocaine. • GHB (gamma-hydroxybutyric acid): A central nervous system depressant known as a “date rape drug.” • It used to be an OTC drug used by bodybuilders to reduce fat and build muscle, but is now a controlled substance.

41. Ecstasy use can cause anxiety, confusion, and paranoia. Coupled with dehydration, it can also result in fatal organ failure.

42. Club Drugs • Rohypnol (roofies): A powerful sedative known as a “date rape drug” because of its use to impair potential victims of sexual assault. • One side effect can be partial amnesia. • It has never been approved for medical use in the U.S. • Ketamine (special K): A rapid-acting anesthetic most commonly used in animals that can cause a dream-like state and hallucinations in humans. • Used for an “out-of-body” feeling. • High doses can cause delirium, amnesia, high blood pressure, depression, and severe respiratory problems.

43. Inhalants • Household products people sniff in order to get high. • Common inhalants include: • Solvents • Aerosols • Gases • Nitrites • Intoxication results for a brief period of time, requiring multiple sniffs for a continued high. • Side effects can include unconsciousness, heart failure, damage to organs, hearing loss, limb spasms, and bone marrow damage.

44. Depressants • Substances that depress the activity of the central nervous system and slow brain activity. • Alcohol • Barbiturates: Often prescribed to induce sleep. • Sedation can range from mild and short-term to severe and long-term (including coma). • Benzodiazepines: Medications commonly prescribed to treat anxiety and panic attacks. • Commonly known benzodiazepines include Ativan, Xanax, and Valium.

45. Opioids • Drugs derived from opium or synthetic drugs that have similar sleep-inducing, pain-reducing effects. • Also called narcotics. • Heroin is the most widely abused opiate. • It can be injected or smoked. • Typically sold as a white or brown powder or as a sticky black substance known as “black tar heroin.” • Prescription opioids include Percocet, Vicodin, and OxyContin. • Taken properly, they can manage pain. • Large doses can lead to respiratory depression or death.

46. Heroin users can develop collapsed veins, infections, and liver disease.

47. Heroin in Suburbia • Discussion Questions • Are you surprised that a drug like heroin is widely available in many American suburbs? Why do you think many people do not associate a drug like heroin with middle-class America? • Why do you think rehab isn’t always successful for an addict? What do you think is necessary for a person to beat an addiction? • What are some possible signs that someone you know might be experimenting with drugs? Name some steps you might take to help someone you know get help with his or her addiction.