Introduction to Drugs of Abuse

1. Introduction to Drugs of Abuse Cory Campbell, M.D., Ph.D. Neuropsychiatric Institute and Hospitals, UCLA

2. Introduction to Drugs of Abuse • Diagnosis • Terminology • Commonly abused substances • Demographics • Epidemiology

3. Substance Abuse: DSMIV Criteria • Maladaptive pattern of substance use leading to clinically significant impairment or distress, manifested by one (or more) of the following within a 12-month period: • Failure to fulfill major role obligations • Use in situations that is physically hazardous • Legal problems • Social/interpersonal problems due to substance (Has not met criteria for substance dependence)

4. Substance Dependence: DSMIV Criteria • A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following within a 12-month period: • Tolerance • Withdrawal • Larger amounts, longer period than intended

5. Substance Dependence: DSMIV Criteria • Attempts to cut down or control use • Great deal of time to obtain substance or recover from its effects • Social, occupational, recreational activities compromised • Knowledge of problems doesn’t thwart use (specifier: with or without physiological dependence)

6. Defining “addiction” • Physiologic: tolerance and withdrawal • Psychologic: compulsive use, loss of control (i.e., psychological dependence) • Some use “addicted” to mean psychological dependence and “dependent” to mean tolerance and withdrawal (i.e., physiologic dependence) • DSMIV incorporates both

7. Defining “addiction” “…a compulsion to take the drug with a loss of control in limiting intake and a withdrawal syndrome that results in physical as well as motivational signs of discomfort when the drug is removed.” (Koob, 2000)

8. Defining “Reinforcement” • Reinforcer: any event that increases the probability of a response. This definition can also be used to signify a definition for reward, and the two words are often used interchangeably. However, reward often connotes some additional emotional value such as pleasure (Koob, 2000).

9. Commonly Abused Substances • Alcohol • Nicotine • Stimulants (Amphetamines, Cocaine/Crack, MDMA) • Opioids

10. Commonly Abused Substances • Sedative-Hypnotics (Benzodiazepines, Barbiturates) • Hallucinogens (PCP, ketamine, LSD, Cannabis, Mescaline, Psylocybin) • Caffeine • Inhalants (Nitrous Oxide, Nitrites)

11. Commonly Abused Substances • Antihistamines/Anticholinergics • OTC/Dextromethorphan • Anabolic Steroids • Gamma Hydroxybutyrate • Flunitrazepam (Rohypnol)*

12. Routes of administration • PO • IV • Insufflation (“Snort”) • Inhale • Transdermal • SC (“Skin Popping”) • SL

13. Monitoring the Future Study • Broad decline in use • Most significant decline: MDMA by about 50% from 2001 in all grades studied • Increase in inhalants by 8th graders’ annual prevalence from 7.7% to 8.7% • Non-significant increase in Oxycontin, Vicoden all three grades

14. Alcohol • Monitoring the Future Study: 41% of high school seniors binge drank in 1983 vs. 28% in 1992, lowest of any illicit drug use, and rose again to 32% in 1998. No remarkable change since then.

15. Methamphetamine • Monitoring the Future Study (2003): 1.9% annual prevalence for 12th graders, a decline from 3.7% in 1981. • National Household Survey on Drug Abuse: 4.9 million had tried methamphetamine at least once in their lifetimes (2.3 percent of population vs. a non-significant increase from 4.7 million people (2.2 percent) in the 1995.

16. Methamphetamine • Community Epidemiology Work Group: Methamphetamine is the dominant illicit drug problem in San Diego. San Francisco and Honolulu also have substantial methamphetamine-using populations. Patterns of increasing use have been seen in Denver, Los Angeles, Minneapolis, Phoenix, Seattle, and Tucson.

17. Cocaine • In 1997, an estimated 1.5 million were chronic cocaine users vs. an estimate of 5.7 million users in 1985 (NIDA report). • Monitoring the Future Study (2003): 4.8% annual prevalence for 12th graders, a decline from 12.7% in 1986.

18. Cocaine • Community Epidemiology Work Group: Most cocaine users are older, inner-city crack addicts. New users: teenagers smoking crack with marijuana; Hispanic crack users in Texas; and in Atlanta, middle-class suburban users and female crack users in their thirties with no prior drug history.

19. Heroin • Monitoring the Future Survey (2003): heroin use is almost 50% lower than recent peak rates in 8th, 10th and 12th grade students (1.5% lifetime prevalence). • National Household Survey on Drug Abuse: From 1995 to 2002, the rate among those 12 to 17 increased from 0.1 to 0.4 percent; among those age 18 to 25, the rate rose from 0.8 to 1.6 percent.

20. Heroin • Community Epidemiology Work Group: In June 2003, CEWG members reported that heroin indicators were relatively stable, but maintained high levels in Boston, Chicago, Detroit, Newark, Philadelphia, and San Francisco.

21. “Club Drugs” • MDMA • Ketamine • GHB • Flunitrazepam • Methamphetamine

22. Street Names • LSD: cubes, microdot, boomers • PCP: boat, hog, peace pill • Codeine: Captain Cody, schoolboy • Heroin: skag, skunk • Oxycontin: killer

23. Street Names • Cannabis: boom, chronic, blunt • Benzodiazepines: candy, tranks • Flunitrazepam: R2, roofies, rope, forget me pill • GHB: G, Georgia home boy, liquid X, grievous bodily harm

24. Street Names • Methamphetamine: tina, crank, glass, ice • Cocaine: Charlie, flake • MDMA: Adam, Eve • Ritalin: R-ball, Vitamin R, skippy, the smart drug

25. Topics To Follow • Genetics • Treatment (pharmacologic, nonpharmacologic) • Comorbidity/Dual Diagnosis • Animal Models • Epidemiology/Demographics

26. Conclusion • Accurate diagnosis is critical • Knowledge of pharmacology important in understanding drug-specific syndromes and treatment • Although substance dependence is generally declining, still remarkable • Animal models are valuable tool to investigate substance dependence