Psy 526 Human Drug Use and Abuse

Psy 526Human Drug Use and Abuse Outline of Supplemental Readings Ksir, Hart, and Ray Chapters 1, 2, & 3

Chapter 1 Drug Use : An Overview

Who? When and where? “Drug Use On The Rise” How much? What? Why do any of these matter?

Who Is Taking The Drug? • Age • Proximity to us • What they do for a living What Drug Are They Taking? • Obvious question but often over looked • Alcohol vs. heroin • Inhalants vs. alcohol

When And Where Are Drugs Used? • The situation in which the drug is taken makes a big difference. • A 1st grade teacher drinking on Saturday night at home vs. a 1st grade teacher drinking during class. • Even if a subculture accepts the use of an illegal drug, it will distinguish between acceptable and unacceptable situations. • A group might accept marijuana smoking at a party but not when you are taking the kids to the soccer game or right before a multi-million dollar deal meeting.

Why A Person Takes Drugs? • Reasons for drug use often determine whether such use is of concern: • e.g., Vicodin the doctor prescribed for pain vs. Vicodin taken for pleasurable effects. • e.g., Drinking alcohol because you are out with friends vs. drinking alcohol alone in the morning to help get you out of bed.

How A Drug Is Taken? • An amount of cocaine that comes from chewing the coca leaves vs. that much cocaine snorted will lead to very different responses • How the drug is taken can also depend on how fast the user becomes addicted, how fast the response comes and how long it lasts How Much Of A Drug Is Taken? • This is often the difference between normal use and abuse; the difference between life and death

Four Principles Of Psychoactive Drugs • “Drugs” are not good or bad. • Every drug has multiple effects. • Both amount and quality of the drug influence the effect of the drug. • The effects of a drug also depend on the person.

Drug misuse Drug abuse History tells us that as long as humans have been around some have used, misused and abused some plants or substances.

Four Pharmacological Revolutions • Major communicable diseases under control – vaccines • Pharmacological revolution – antibiotics to treat illness of the body • Development of psychopharmacology drugs – treatment of mental illnesses • Development of oral contraception –drugs gave control over the body

Cultural Change in U.S. • After WWII, substance abuse was not a major concern • Soon after, concerns about alcohol came to the forefront • In the mid 1960s, LSD became a household word • Although Nixon declared a “War on Drugs”, there was still tolerance for drug use in the 1960s-70s. • In the 1980s to 1990s, less tolerance of differences including drugs • 2000s, medicinal marijuana and “rave” subculture

Extent Of Drug Use • It is not possible to get accurate information on drug use. • It is not possible to get accurate information on quantity of drugs imported or sold. • Even estimates of beer or prescription drug use based on sales information may not be entirely accurate.

How We Get Information • Survey Based Questionnaires • What are the benefits? • What are some of the limitations?

Trends In Drug Use • Annual High School Senior survey • Prevalence of reported use • Attitude data and risk • Consider who is included and who is not 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 Drug Use And Health • Face-to-face, computer-assisted interviews • 68,000 individuals; carefully sampled households across the US • Broken down into different age groups • Results

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

Correlates Of Drug Use • Age, gender, racial/ethnic grouping, education levels • SES- not a significant factor • Personality problems are poor predictors • Risk factors • Protective factors

Limitations Of Correlation Studies • Does smoking marijuana cause the user to get lower grades? • Are kids who are getting low grades more likely to smoke marijuana?

Motives For Drug Use • We all do things that we know are not right; e.g., eating too much, driving too fast, or drinking too much. • Fads and cultural trends influence what drugs are used.

Influences on drug use.

Chapter 2 Drug Use As A Social Problem

Costs Of Drug Use To Society Cost of maintaining habit Fetal alcohol syndrome Broken home, illness, shorter lives, etc. Emergency room visits Drugs in the workplace Cost of treating patients Cost of criminal behavior Others?

The Big Change • What made the government change from a laissez-faire attitude to one of control? • Toxicity • Dependence • Crime

Potency 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.

Toxicity • What makes a drug toxic? • Amount used • How it is used • What the user did while on the drug

Examples of Drug-Induced Toxicity • Acute • Behavioral toxicity – “intoxication” that impairs the user’s actions and increases the danger to the individual. • Physiological – overdose that causes the user to stop breathing, the heart to stop, or causes other adverse side effects.

Examples of Drug-Induced Toxicity • Chronic • Social problems • Personality changes • Effects on friends and family • Change in lifestyle • Health problems • Heart disease • Lung cancer • Liver danger • Other health effects

Drug Abuse Warning Network • A system for reporting incidences of lethal and non-lethal drug related emergency in some U.S. metropolitan hospitals. • DAWN included improper use of prescription or over-the-counter drugs and the use of any other substance for psychic effect, dependence or suicide. • See table 2.2 on page 32 (data from 2002) • The top three mentions in ER episodes were Alcohol-in- combination, cocaine, and marijuana. • The top three mentions for fatalities were prescription narcotics, cocaine, and heroin/morphine.

Drug Abuse Warning Network • What it tells us about how dangerous a drug is? • What it does NOT tell us about how dangerous a drug is?

Blood Borne Diseases • Specific toxicity for injected drugs • AIDS, HIV and Hepatitis B and C • Why do the blood borne diseases spread so rapidly with these drug users?

Substance Dependence • What does an addict look like? • What do they take? Alcohol, cigarettes, illicit drugs, food, or computer time • How much time do they spend with their vice? • How much do they take? • What makes you decide the rules?

Substance Dependence • Three Basic Processes • Tolerance • Physical dependence • Psychological dependence

Tolerance • Tolerance is a diminished effect after repeated use of the same drug. • When tolerance develops, an increased amount of the drug is required to produce the same effects.

Physical Dependence • Physical dependence refers to the body’s requirement for the drug in order to function normally. • Tolerance may lead to physical dependence (but not always). • When the drug use is stopped promptly, withdrawal effect can happen • From mild (e.g., headaches, nausea) to severe (e.g., seizures, death). • Withdrawal symptoms differ among users and with different drugs.

Psychological Dependence • Psychological dependence is defined by the psychological/behavioral inability to stop using a drug. • Psychological dependence can be observed in person’s behavior, by the amount of time and effort the person spends seeking the drug. • It is not any less REAL than physical dependence. • Like physical dependence, psychological dependence has a physiological basis. • i.e., neurophysiological (body - mind are one)

Changing Views of Dependence • The medical model aims to treat the withdrawal symptoms, often associated with physical dependence. • The positive reinforcement model stresses that the consequences of drug use influence dependence. • Drug use is operant behavior. • Users don’t have to experience withdrawal symptoms to become addicted.

Substance Abuse and Dependence: DSM-IVTR • Substance abuse is considered maladaptive. • It is carefully separated from substance dependence • The essential feature of dependence is continued use despite significant substance-related problems known to user.

Drugs are not evil They can not do anything They can not have power Even our “War on Drugs” shows the perception that drugs are so evil that we have to wage a war on them. Drugs are just objects that have effects on our body.

Dependence is Biological • Biochemical or physiological actions in the brain • We can not scan the brain to determine if a person has developed dependence. • Researchers have searched for genetic, physiological, or biochemical markers. • To date, none have proven reliable predictors.

Personality • It is difficult to determine whether drug use changes personality. • Many other factors play a role in developing someone’s personality.

Dependence as a “Disease” • This is a popular notion. • Alcoholics Anonymous is based on this idea. Its founders and advocates believe that drug dependence should be treated as such. • Others argue that there are no tests that diagnose alcoholism. • There are ways to test and treat the effects but not the disease itself. • What are some potential problems with this label?

Drugs and Crime • Do drugs turn the person into the criminal type? • Do people under the influence of a drug commit crime? • More than half the murders in our nation in 2000 were associated with alcohol, as were two-thirds of all domestic violence. • What are the implications of these statistics? • Some forms of drug use are criminal behavior. • If someone is willing to commit one crime, they might be more willing to do other crimes.

Chapter 3 Drug Products and Their Regulation

Reformism • Race and fear used • Laws came to regulate moral behavior

Issues Leading To Legislation • Fraud in patent medicine • Hostetter’s Bitters 44% pure alcohol • Birney’s Catarrh Cure 4% cocaine • Opium • 1890 federal act allowed only American citizens to import opium • Morphine • “Morphinism” • Cocaine • Mail order cocaine

Two Bureaus, Two Types Of Regulation • The Pure Food and Drug Act • Department of Agriculture • Ensures drugs were pure and honestly labeled • Harrison Act • Treasury Department • Taxing of drug for revenue

Regulation 1906 Pure Food And Drugs Act • Purity • The contents of the product must be correct and labeled correctly • 1912 Sherley Amendment • Safety • Set up FDA as gatekeeper • Directions must be included • Effectiveness • 1962 Kefauver-Harris Amendments

Making Of A New Drug • Preclinical research and development • Clinical research and development • Phase I • Phase II • Phase III • Permission to market

Psy 526 Human Drug Use and Abuse