Substance Abuse – Chapter 8

1. Substance Abuse – Chapter 8 Health Psychology October 15-17, 2007 Class #23-24

2. Psychoactive Drugs • Any substance that alters: • Mood • Awareness of the external environment • Awareness of the internal environment • Examples: • Marijuana, LSD, cocaine, heroine, alcohol, nicotine, codeine, caffeine, etc.

3. Factors that influence the effects of drugs • Dose-dependent effects • The amount of the drug influences its effect • Its intensity • The kind of effect it has on the person • Tolerance • Refers to the lessened effect the drug will produce with continued usage • Cross-tolerance • Can sometimes occur when one takes a certain drug that then produces a tolerance in another drug of that type • Example: alcohol can produce a tolerance for antianxiety drugs

4. Factors that influence the effects of drugs • Interaction effects • The effects of some drugs can be drastically altered if they are taken in combination with other drugs • The combination is often greater than what one might think the sum of the two drugs would be • Individual differences • Chemical, personality, and experience differences will often cause the same dosage of a drug to produce much different effects depending on the individual who is taking it • Expectations • Psychological factor is often present as individuals sometimes produce the effect that they expect the drug will produce

5. Types of Psychoactive Drugs • Depressants • Reduce physiological arousal and help individuals to relax • Stimulants • Increase arousal • Produce states of arousal • Hallucinogens • Distort sensory experience

6. Alcohol • Alcohol is a depressant yet we often feel lively after a couple of drinks… • It gives this feeling by slowing down the brain centers that control judgments and inhibitions

7. Alcoholism • Refers to one’s dependence on alcohol that seriously interferes with one’s life • Most common and costly form of drug abuse in U.S. • Aproximately 7% of adults 18 and over (10M people) • Traditionally more common (about 2 to 1) among males but recent research suggests that women are closing this gap

8. Transnational alcohol consumption & cirrhosis 30 Austria Italy Portugal Germany Spain 20 Luxembourg France Cirrhosis deaths/100,000 Japan Finland Belgium US Switzerland 10 Canada Sweden Australia UK Norway Netherlands NZ Eire 5 15 10 Per capita alcohol consumption liters/yr

9. Detrimental Effects • Life span of average alcoholic is 12 years shorter than the norm • Alcoholism ranks as the third leading cause of death in U.S. • More than one-third suffer at least one coexisting mental disorder • Organic impairment such as brain shrinkage occurs in a high proportion of alcoholics • About 20% attempt suicide • About 10% are successful

10. Know the Facts About Alcohol! • Alcohol is a contributing factor in at least half of all murders, suicides, and car accidents. • Heavy drinking along with drunk driving increases your chances of serious injury or death. • Heavy drinking along with sex increases your chances of getting a sexually transmitted disease (STD) and HIV or AIDS. • Heavy drinking is also linked with physical fighting, destroyed property, school and job problems, and trouble with law enforcement authorities.

11. Fetal Alcohol Syndrome (FAS) • FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects associated with alcohol consumption during pregnancy • Alcohol enters the mother’s and the fetus’ bloodstream • FAS is the leading known cause of mental retardation and birth defects • Small disproportioned head and lifelong brain abnormalities

12. How does a mother’s drinking affect her unborn child? • Role of the Placenta • The placenta carries nourishment and oxygen from the mother to the fetus and at the same time screens out many potentially harmful substances • Unfortunately some get through…

13. How does a mother’s drinking affect her unborn child? • Facts: • Through the blood vessels in the placenta, the mother’s blood supplies the developing baby with nourishment and oxygen • If the mother drinks alcohol, the alcohol enters her blood stream and then, through the placenta, enters the blood supply of the growing baby • So, when a pregnant woman drinks alcohol, so does her baby • Alcohol is a teratogen, a substance known to be toxic to human development

14. Fetal Alcohol Syndrome (FAS) • Prenatal alcohol exposure does not always result in FAS—although there is no known safe level of alcohol consumption during pregnancy • Most individuals affected by alcohol exposure before birth do not have the characteristic facial abnormalities and growth retardation identified with FAS, yet they have brain and other impairments that are just as significant

15. Sad facts… • In addition to mental retardation, individuals with FAS may have other neurological deficits such as poor motor skills and hand-eye coordination • They may also have a complex pattern of behavioral and learning problems, including difficulties with memory, attention and judgment. • As many as 12,000 infants are born each year with FAS

16. A common question: What if I am pregnant and have been drinking? • If you consumed alcohol before you knew you were pregnant, stop drinking now! • Abstaining from alcohol for the remainder of your pregnancy can have a beneficial effect even on functions that might have been affected by earlier drinking • The sooner you stop drinking, the better the chance of having a healthy baby

17. Alcoholism • loss of control, compulsion, continuation despite known consequences • long lasting or permanent neuroadaptations • 12% of men, 6% of women in the US • 40% develop first symptoms aged • 15 – 19 yrs • greatest increase is in young women

18. The life of an alcoholic can be summarized as… Koob, 2003

19. Symptoms of Alcohol Dependence • Use alcohol to boost self-confidence and to relax around others • Drink to forget their problems or to relieve stress • Often are the ones who want “one more” drink even when their friends have stopped drinking • After friends have left they drink with new friends…often close the bar…stay past last call • Get drunk without planning to • Have blackouts

20. Negative effects… • Drinking alcohol in excess can make you gain weight and give you bad breath as well as… 36 year old, sores caused by diabetes and alcohol abuse. Liver Failure caused by Alcoholism

21. Effects of Alcohol Use… Bleeding Pancreas of an Alcoholic, he’s now dead! How do you think these people turned out?

22. What are the Stats? • In 1998, 35.8% of traffic deaths of 15- to 20-year-olds were alcohol-related • "Binge" drinking means having 5 or more drinks on one occasion. About 15% of teens are binge drinkers in any given month • Approximately 100,000 deaths result each year from the misuse of alcohol

23. Know the Facts! • One drink can make you fail a breath test. • In some states, people under the age of 21 who are found to have any amount of alcohol in their systems can lose their driver's license, be subject to a heavy fine $$$, or have their car permanently taken away! • It is illegal to buy or possess alcohol if you are under 21.

24. Causes: Genes and Environment • Heritability is approximately 50-60% in men and women based on large, population studies • Variability of presentation suggests genetic heterogeneity • Complex multifactorial disease in which polygenic influences and environmental influences interact

25. Early drinking onset is associated with increased risk of alcoholism NIAAA

26. Korsakoff's syndrome • A memory disorder which is caused by a deficiency of vitamin B1, also called thiamine • In the United States, the most common cause of thiamine deficiency is alcoholism…

27. Wernicke-Korsakoff Syndrome • An associated disorder, Wernicke's syndrome, often precedes Korsakoff's syndrome • In fact, they so often occur together that the spectrum of symptoms produced during the course of the two diseases is frequently referred to as Wernicke-Korsakoff syndrome • The main symptoms of Wernicke's syndrome include ataxia (difficulty in walking and maintaining balance), paralysis of some of the muscles responsible for movement of the eyes, and confusion • Untreated Wernicke's will lead to coma and then death

28. Korsakoff’s Syndrome- Causes • One of the main reasons that alcoholism leads to thiamine deficiency has to do with the high-calorie nature of alcohol • A person with a large alcohol intake often, in essence, substitutes alcohol for other, more nutritive calorie sources • Food intake drops off considerably, and multiple vitamin deficiencies develop • Furthermore, it is believed that alcohol increases the body's requirements for B vitamins, at the same time interfering with the absorption of thiamine from the intestine and impairing the body's ability to store and use thiamine • Direct neurotoxic (poisonous damage to the nerves) effects of alcohol may also play some role

29. Symptoms • An individual with Korsakoff's syndrome displays much difficulty with memory • The main area of memory affected is the ability to learn new information

30. Confabulation… • This memory defect is referred to as anterograde amnesia, and leads to a peculiar symptom called "confabulation," in which a person suffering from Korsakoff's fills in the gaps in his or her memory with fabricated or imagined information • One of the hallmarks of Korsakoff's is the person's complete unawareness of the memory defect, and complete lack of worry or concern when it is pointed out

31. Diagnosis • Whenever someone has a possible diagnosis of alcoholism, and then has the sudden onset of memory difficulties, it is important to seriously consider the diagnosis of Korsakoff's syndrome • While there is no specific laboratory test to diagnose Korsakoff's syndrome in a patient, a careful exam of the individual's mental state should be rather revealing • Although the patient's ability to confabulate answers may be convincing, checking the patient's retention of factual information

32. Treatment • Treatment of both Korsakoff's and Wernicke's syndromes involves the immediate administration of thiamine • In fact, any individual who is hospitalized for any reason and who is suspected of being an alcoholic, should receive thiamine

33. Prognosis • Fifteen to twenty percent of all patients hospitalized for Wernicke's syndrome will die of the disorder • Although the degree of ataxia nearly always improves with treatment, half of those who survive will continue to have some permanent difficulty walking • The paralysis of the eye muscles almost always resolves completely with thiamine treatment • Recovery from Wernicke's begins to occur rapidly after thiamine is given

34. Prognosis • Improvement in the symptoms of Korsakoff's syndrome, however, can take months and months of thiamine replacement • Furthermore, patients who develop Korsakoff's syndrome are almost universally memory-impaired for the rest of their lives • Even with thiamine treatment, the memory deficits tend to be irreversible, with less than 20% of patients even approaching recovery

35. Complications • The development of Korsakoff's syndrome often results in an individual requiring in a supervised living situation • Treating the underlying alcohol addiction

36. Treatments • Rehab Centers • Treatment centers where the addict is supervised 24/7 • Supervised detoxification period to eliminate drugs from our bodies system • Alcoholics Anonymous • Self-help group • Little research because of members anonymity but indications are most don’t stick to it • Need to go to regular meetings for it to work • 90 meetings in first 90 days and then at least once per week after that • Antabuse • A type of aversion therapy where usually a pill is taken that will cause the patient to become sick whenever they drink alcohol

37. Alcoholism and Nicotine Addiction Heavy smokers > 20 cigarettes / day • 70% of alcoholics • 10% of the general population

38. Tobacco Prevalence • Usage peaked in US in early 1960’s when about half of men and one-third of women smoked • We’ve seen steady decline in both sexes to about 25% • Some higher numbers though: • Young adults: 28.5% • GED diploma: 42% • Those below poverty level: 33%

39. Smoking cigarettes during pregnancy (US Dept. of Heath and Human Services, 2001) • The good news: • We witnessed a 33 percent drop between 1990 and 1999 • In 1999 just over 12 percent of all women reported smoking during their pregnancies • The greatest success in reducing smoking was for women in their late twenties and early thirties, where there was over a 40 percent drop since 1990

40. Smoking cigarettes during pregnancy (US Dept. of Heath and Human Services, 2001) • The bad news: • Teenagers were more likely than women of any other age to smoke while pregnant • After experiencing a dramatic 20-percent decline in the first part of the decade, smoking rates among pregnant teenagers–unlike women of all other ages--increased by 5 percent from 1994 to 1999 • The highest rate in 1999 (19 percent) was for women 18-19 years of age

41. Smoking during pregnancy is related to violent crimes… • Brennan, Grekin, & Mednick (1999) • Subjects were a birth cohort of 4169 males born between September 1959 and December 1961 in Copenhagen, Denmark • During the third trimester of pregnancy, mothers self-reported the number of cigarettes smoked daily • When the male offspring were 34 years of age, their arrest histories were checked in the Danish National Criminal Register (see next slide)

42. Brennan, Grekin, & Mednick (1999) • Found the following data relating smoking during pregnancy to offsprings’ arrest rate for violent crimes: • Mother did not smoke…8% • Mother smoked 1-2 cigarettes per day…9% • Mother smoked 3-10 cigarettes per day…11%% • Mother smoked 10-20 cigarettes per day…15% • Mother smoked > 20 cigarettes/day…18% • What do you think of these numbers???

43. Second hand Smoke • 9 out of 10 nonsmoking Americans are exposed to this • Lets make some sense of this (see next slide)…

44. Breathing Secondhand Smoke Equals Smoking = Two hours in smoky bar = Two hours in a nonsmoking section of restaurant = 24 hours living with a pack-a-day smoker

45. Where Does Exposure to Secondhand Smoke Happen? • At Home smoking parent or spouse • In Public Places offices bars and restaurants • In Vehicles cars and trucks public transportation

46. Risks to Health • Secondhand smoke contains substances similar to those smokers inhale • No evidence of threshold dose for adverse effects • Components of tobacco smoke (such as cotinine) are found in the bloodstream of non-smokers • Hundreds of studies show adverse health effects in adults and children

47. Effects of Secondhand Smoke on Normal Lungs Just 30 minutes of exposure to smoke compromises the lining of the heart arteries of non-smokers to the same degree as habitual smokers. —Otsuka, Watanabe, Hirata, 2001

48. Lung cancer Respiratory symptoms Cardiovascular disease Exacerbation of asthma Reduced lung function Irritation of eyes, nose and throat Health Effects of Secondhand Smoke on Adults

49. Health Effects of Secondhand Smoke on Adults • Secondhand Smoke causes 65,000 U.S. deaths a year (3,000 from lung cancer and 62,000 from heart disease) —National Cancer Institute, 1999 • For every eight deaths from active smoking, there is one from secondhand smoke. —Glantz and Parmley, 1991 —Taylor, Johnson, and Kazemi, 1991

50. Secondhand Smoke and Strokes Non-smokers exposed to secondhand smoke have 82% higher chance of stroke. —Tobacco Control, British Medical Journal, 1999