Addictive Behaviors, Licit and Illicit Drugs: Use, Misuse, and Abuse

1. Addictive Behaviors, Licit and Illicit Drugs: Use, Misuse, and Abuse

2. Defining Addiction • Use substance or continue behavior despite negative consequence • Must have the potential to produce positive mood change

3. Defining Addiction • Physiological dependence/psychological dependence • Inextricably tied together • Addiction traditionally based on four criteria: 1) Relief of withdrawal symptoms 2) Continued use despite harm to self and others 3) Unsuccessful efforts to cease using or cut down on use, including relapse 4) Tolerance • Increasingly recognized that these four criteria do not characterize all addictive behavior

4. Signs of Addiction • Addictions characterized by four common symptoms 1) compulsion (can include obsession) 2) loss of control 3) negative consequences 4) denial

5. Compulsive or Pathological Gambling • Facts • Cravings or highs similar to those experienced by drug users • Often seek the excitement more than the money • Men are more likely than women to have gambling problems • Incidence higher in lower-income individuals, those who are divorced, African Americans, older adults, those living within 50 miles of a casino

6. Compulsive or Pathological Gambling • College students • Increasingly involved in gambling due to ease of participation • More casinos • Internet gambling • Often has a detrimental affect on health • 38% have cardiovascular problems • Suicide rate 20 times higher than that of general population

7. Compulsive Shopping and Borrowing • Facts • Money often spent to meet emotional needs not being fulfilled elsewhere • College students often open to spending problems due to targeting by advertisers and credit card companies • On average, compulsive spenders $23,000 in debt • Compulsive spending often leads to compulsive borrowing to help support addiction

8. ABC News: Addictions and Addictive Behavior • Discussion Questions • What are some of the other types of addiction beyond drug, alcohol and nicotine addictions? • Do you think that compulsive shoplifting should be considered a disease? Why or why not? Play Video | Addictions and Addictive Behavior

9. How Addiction Affects Family and Friends • Codependence • Pattern of behavior • Person becomes “addicted to the addict” • Subsume personal needs in order to meet needs or desires of addict • Enabling • Knowingly or unknowingly protects addict from consequences of behavior • Rarely conscious and generally unintentional

10. Drug Abuse in the United States • Facts • Drug and alcohol abuse contributes to more than 120,000 deaths a year • Costs $294 billion in preventable healthcare expenses • Across the U.S. overall use has fallen • Adolescent use has risen in certain drug use

11. Drugs Abuse in the United States • Types of drugs 1) Prescription 2) Over-the-counter 3) Recreational – alcohol, tobacco, coffee 4) Herbal preparations – products of plant origin 5) Illicit (illegal) – all are psychoactive 6) Commercial preparations – household cleaners, pesticides

12. Drug Dynamics • Routes of administration • Oral • Injection 1) Intravenous- into bloodstream 2) Intramuscular- into muscle 3) Subcutaneous- just under the skin • Inhalation • Inunction – through the skin • Suppositories

13. How the Body Metabolizes Drugs Figure 7.1

14. Using, Misusing, and Abusing Drugs • Abuse often associated with illegal drugs, but many people abuse and misuse legal drugs • Drug misuse – use for purpose not intended • Drug abuse – excessive use • Misuse and abuse may lead to addiction • Evaluation of risks and benefits of use of chemical substances is necessary

15. Prescription Drugs • Types of prescription drugs • Antibiotics – fight bacteria • Central nervous system depressants- sedative or hypnotic • Antidepressants • Generic drugs • Less expensive • Many brand name drugs have generic counterparts

16. Over-The-Counter (OTC) • Facts • Nonprescription medicine • More than 1/3 of the time people self-treat • How a prescription drug becomes an OTC drug 1) At least three years of sales 2) Use has been relatively high 3) Adverse drug reactions are not alarming

17. Over-The-Counter (OTC) • Types of OTC drugs • Analgesics – pain relief • GRAS (Generally Recognized as Safe) GRAE (Generally Recognized as Effective) • Cold, cough, allergy, and asthma relievers • Sleeping aids • Dieting Aids

19. Over-The-Counter (OTC) • Rules for proper OTC drug use 1) Know what you are taking 2) Know the effects 3) Reading warnings and cautions 4) Don’t use anything for more than 1 or 2 weeks 5) Be careful if you also take prescriptions 6) Ask your pharmacist if you have questions 7) If you don’t need it, don’t take it!

20. The Over-the-Counter Drug Label Figure 7.2

21. Drug Interactions • Polydrug use • Taking several substances simultaneously • Synergism • Effects are multiplied • Expressed as 2+2=10 • Example: Alcohol and barbiturates • Antagonism • Work at same receptor • One drug blocks the other • Example: Alcohol and antibiotics

22. Drug Interactions • Intolerance • When drugs combine to produce extremely uncomfortable reactions • Example: Antabuse and alcohol • Cross-tolerance • Tolerance for one drug creates a similar reaction to another drug • Example: Alcohol and barbiturates

23. Illicit Drugs • Users of illicit drugs • In 2003, estimated 19.2 million Americans used illicit drugs • College use (tried any illicit drug) was 52% • Why might use in the college population be high? • What do you think would be a successful anti-drug campaign?

26. Controlled Substances: Stimulants • Cocaine • White crystalline powder • Derived from the leaves of the South American coca shrub • Cocaine rapidly enters bloodstream • Exposed fetus is likely to suffer • Methods of use vary • Freebase cocaine • Crack • Cocaine addiction and society • Annual cost of addiction in USA: $3.8 billion

27. The Ups and Downs of a Typical Dose of Cocaine Figure 7.3

28. Controlled Substances: Amphetamines • Synthetic agents that stimulate the central nervous system • Some are used for medicinal purposes • Ritalin, Adderall for attention deficit hyperactivity disorder • High potential for abuse

29. Controlled Substances: Amphetamines • Methamphetamine • Effects brain and central nervous system • Euphoria lasts 6-8 hours • Methods of use varied: snorted, injected, smoked, ingested • Increasingly more common in rural America • Ice is a potent methamphetamine

30. ABC News: Illicit Drugs • Discussion Questions • Do you think that the young man and woman had a history of using meth? • How did the crystal meth interfere with the young man attempting to get help? Play Video | Illicit Drugs

31. Effects of Amphetamines on the Body and Mind Figure 7.4

32. Controlled Substances: Marijuana and Derivatives • Marijuana • Use goes back 6,000 years • Derived from Cannabis sativa or Cannabis indica (hemp) • Tetrahydrocannabinol, or THC, is the active ingredient • Hashish – derived from the resin of the plant • Long-term studies have not been done in the U.S. • Studies have indicated that the inhalation from smoking is harmful

33. Controlled Substances: Marijuana and Derivatives • Effects of marijuana use • Carbon monoxide to blood-heart works harder • Contains high levels of carcinogens • Suppression of the immune system • Pregnant women at higher risk for stillbirth or miscarriage • Driving ability impaired

34. Controlled Substances: Marijuana and Derivatives • Marijuana and medicine • Helps with severe nausea and vomiting during chemotherapy • Improves appetite of AIDS related wasting syndrome • Aids those with multiple sclerosis by reducing pain and spasticity • Reduces eye pressure of glaucoma

35. Controlled Substances: Marijuana and Derivatives • Marijuana and driving • Reduces reaction time • 6-11% of fatal accident victims had THC in their bloodstream • Why do you think marijuana is the most popular illicit drug on colleges campuses?

36. Controlled Substances: Opiates • Opiates • Cause drowsiness, relieve pain, and induce euphoria • Called narcotics • Derived from opium – from poppy • Include morphine, codeine, heroin, and black tar heroin • Depress CNS • Lower heart rate, respiration, and blood pressure • Decreases sex drive

37. Controlled Substances: Opiates • Black tar heroin • Pure, inexpensive, sticky, dark brown form • Relatively pure and inexpensive • Heroin addiction • Heroin withdrawal is distinct • 3.7 million people have used heroin in their lives

38. Controlled Substances: Opiates • Treatment of opiates • Methadone • Blocks effects of opiates • Potentially addictive; trade one substance for another? • Naltrexone • Opiate antagonist • Lose compulsion to use heroin • Buprenorphine • Blocks cravings for heroin • Non-addictive

39. Controlled Substances: Hallucinogens (Psychedelics) • Hallucinogen facts • Known as psychedelics • Scramble messages coming to reticular formation • Synesthesia – mixing of the message • May “hear colors” and “smell tastes”

40. Controlled Substances: Hallucinogens (Psychedelics) • LSD (lysergic acid diethylamide) • Common hallucinogen used to unlock mind • Used to “turn on” and “tune out” world • 1970’s – placed on controlled substances list • Over 11 million Americans have tried acid • Commonly sold as a “blotter” on paper

41. Reticular Formation Figure 7.5

42. Controlled Substances: Hallucinogens (Psychedelics) • Mescaline • From peyote cactus • Native Americans still use • Typically swallow 10-12 dried peyote buttons • Generally induce immediate vomiting • Psilocybin or “magic mushrooms” • Effects generally wear off in 4-6 hours • Cultivated from spores or harvested wild • Similar to LSD in effect

43. Controlled Substances: Hallucinogens (Psychedelics) • PCP (Phencyclidine) • Originally used as a dissociative anesthetic • Side effects like amnesia led doctors to abandon use Interrupt neurotransmitter glutamate in the brain • May cause euphoria or dysphoria • Known to cause hallucinations, delusions and overall delirium

44. Controlled Substances: Designer Drugs (Club Drugs) • Ecstasy (MDMA) most common club drug • Hallucinations • Paranoia • Amnesia • Death in some cases, especially when combined with alcohol • Chronic use can damage the brain • GHB, Ketamine (Special K), and Rohypnol • Includes “date rape” drug

45. Inhalants • Facts • Inhale chemicals • Legal to purchase • Includes: glue, paint thinner, rubber cement • Amyl nitrate – “poppers” or “rush” • Abused to enhance sexual function • Nitrous oxide • Dental anesthesia • Pain relief • “Silly feeling”

46. Controlled Substances: Steroids • Ergogenic drugs • Used to increase strength, power, bulk, speed, performance • 17-20% of college athletes once estimated to use them • Now estimated at 1.1% • Recent survey shows increased usage in high schools since 1991

47. Controlled Substances: Steroids • Anabolic steroids • Ergogenic drugs • Available as pill or injectable • Adverse effects occur • 1990 Anabolic Steroids Control Act (ASCA) • “Performance-enhancing” steroid alternatives • Gamma-hydroxybutyrate (GHB) • Clenbuterol • Androstenedione (andro) • Who is commonly associated with steroid use and why?

48. Illegal Drug Use in the United States • Facts • Costly habits: estimated $180.9 billion • Half of crime expenditure • Solutions to the problem • Often “scare tactics” unsuccessful • Drug abuse has been around for thousands of years • It is unlikely to change in the near future • Must target at-risk groups • Stricter border control • Need for better educational programs • Do you think employers should do random drug testing?